Objective: Explore the relationship between multi-domain cognitive testing and patient-reported psychiatric symptoms in PwPD to self-medication management capabilities.

Background: Parkinson’s disease (PD) is a complex neurodegenerative disorder characterized by varied degrees and combinations of cognitive, psychiatric and motor dysfunctions. Pharmacotherapy management of symptoms is the most common approach to treatment but medication regimens can be complicated, burdensome, and change as recognized disease impact evolves. “Psychiatric” symptoms may affect up to 50% of people with PD (PwPD) and may adversely impact the capacity for independent self-medication management. Accurate identification of the degree of such symptoms may enhance the provider’s ability to assess appropriate medication adherence and consider alternate solutions or regimens. Clinicians’ accurate recognition, appreciation and willingness to address these symptoms in PwPD might be problematic.

Method: Retrospective review of data collected through routine care of PwPD that were evaluated by multi-domain computerized cognitive testing and completed patient reported outcomes (PROs): Self-Efficacy for Managing Medications and Treatments Short Form 4a (MM) and Scale for the Assessment of Positive Symptoms (SAPS-PD). Cognitive domains assessed were: Memory, Executive Function, Visual Spatial, Information Processing, Verbal Function, Attention and a Global Cognitive Summary Score (GCS).

Results: 161 PwPD, 60% male, average age 73+/- 13 years. Significant relationships were identified by regression analysis (p<0.01) for the following: MM and SAPS-PD (r² = 0.22), MM vs GCS (r² = 0.39). 27% of PwPD reported low confidence in self-managing medications (37% of males and 21% of females).

Conclusion: Low confidence in medication self-management in PwPD is more common than appreciated. Self-management of medications decline with increased SAPS-PD symptom impairment and MM is also impacted by cognitive impairment (CI) measured by objective multi-domain cognitive assessment. SAPS-PD PRO and objective multidomain cognitive testing can enhance recognition for addressing issues related to impaired self-management of medication and cognitive impairment in PwPD. Increased adherence to prescribed medication schedules and addressing such unmet needs as insufficient medication management can aide in optimizing care plans.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-cognition-positive-symptoms-and-medication-management/