Daytime Alertness in Parkinson's Disease: Potentially Dose-Dependent, Divergent Effects by Drug Class

• Type of Material: Article
• Authors: Donald Bliwise, Emory University; Lynn Marie Trotti, Emory University; Anthony G. Wilson, Emory University; Sophia A. Greer, Emory University; Cathy Wood-Siverio, Emory University; Jorge Juncos, Emory University; Stewart Factor, Emory University; Alan Freeman, Emory University; David Rye, Emory University
• Language: English
• Date: 2012-08
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Movement Disorder Society
• Final Published Version (URL): http://onlinelibrary.wiley.com/doi/10.1002/mds.25082/abstract
• Title of Journal or Parent Work: Movement Disorders
• ISSN: 0885-3185
• Volume: 27
• Issue: 9
• Start Page: 1118
• End Page: 1124
• Grant/Funding Information: This work was supported by R01 NS-050595 (DLB); UL1 RR-025008/KL2 RR-025009 (Atlanta Clinical and Translational Science Institute); U01 NS-050324 (CoQ10 trial) and a grant from the Michael J. Fox Foundation
• Keywords: Parkinson’s Disease; Sleep; Dopaminergic Treatment; Daytime Alertness; Maintenance of Wakefulness Test
• Research Categories: Biology, Neuroscience

Abstract

Background Many patients with idiopathic Parkinson’s disease experience difficulties maintaining daytime alertness. Controversy exists regarding whether this reflects effects of anti-Parkinsonian medications, the disease itself or other factors such as nocturnal sleep disturbances. In this study we examined the phenomenon by evaluating medicated and unmedicated Parkinson’s patients with objective polysomnographic measurements of nocturnal sleep and daytime alertness. Methods Patients (n = 63) underwent a 48-hour laboratory-based study incorporating 2 consecutive nights of overnight polysomnography and 2 days of Maintenance of Wakefulness Testing. We examined correlates of individual differences in alertness, including demographics, clinical features, nocturnal sleep variables and class and dosage of anti-Parkinson’s medications. Results Results indicated that: 1) relative to unmediated patients, all classes of dopaminergic medications were associated with reduced daytime alertness and this effect was not mediated by disease duration or disease severity; 2) increasing dosages of dopamine agonists were associated with less daytime alertness, whereas higher levels of levodopa were associated with higher levels of alertness. Variables unrelated to Maintenance of Wakefulness Test defined daytime alertness included age, sex, years with diagnosis, motor impairment score and most nocturnal sleep variables. Conclusions Deficits in objectively assessed daytime alertness in Parkinson’s disease appear to be a function of both the disease and the medications and their doses utilized. The apparent divergent dose-dependent effects of drug class in Parkinson’s disease are anticipated by basic science studies of the sleep/wake cycle under different pharmacological agents.