Chair of the IAPRD 2018 Scientific Program Executive Committee Hubert Fernandez (Cleveland Clinic, Cleveland, OH, US) discusses identification of patients with Parkinson’s disease (PD) at risk of cognitive decline, and the advantages of levodopa-carbidopa intestinal gel in advanced PD.
You so you know that is an an easy and a difficult question to answer cognitive decline in parkinson’s is incredibly important it is probably the one of the most rate limiting factors in our optimization and parkinson treatment once a patient has significant cognitive decline then it really sorry so once the patient has cognitive decline it really limits our
Ability to to optimally control their motor symptoms so the problem with cognitive decline is that unless it’s really pretty advanced it’s very subtle you know unlike motor symptoms in parkinson’s disease they always start from mildly and then progress so in parkinson’s disease motor symptoms you have a little bit of a shake here that’s smiled and then this has
Become smart and this becomes severe in cognitive decline mild would be you initially forget someone’s name or someone’s face and then moderate you know you forgot one you what you wanted to do and then severe you don’t know how to dress yourself so the the progression is a bit more deceiving and subtle in cognitive decline compared to parkinson’s and we don’t know
How to measure it other than just clinical measurement which is as i just mentioned very it’s not at best it’s it’s it’s very crude so the biggest risk factor for cognitive decline in parkinson’s is age as a person ages gets older then they develop more cognitive decline so we just have to be hyper vigilant in that patient population the second is the severity of
Parkinson’s the more severe the motor symptoms are the likely the bigger hit from the cognitive standpoint is as well and so you just have to be more careful this is from the practical standpoint when you have someone who’s a setup more severe disease and then also a little bit of an older age population they’re at higher risk and then from the practical standpoint
I look at the caregiver because the patient usually won’t have as much insight as the spouse or as a caregiver they would know if if the patient has is declining cognitively motor wise you can sense because you can see it it’s very visible to you cognition wise it’s a bit more subtle so you have to be creative and you have to use resources outside the patient okay
So the levodopa carbidopa intestinal gel or lc ig it’s an interesting product and has been out in the market in in the european market for four decades and it just came about to be utilized in america and other parts of the world it is the liquid form of levodopa which is our most efficacious drug for parkinson’s disease and the liquid form allows it to be delivered
Directly to the small intestines and for continuous delivery the problem with levodopa is it’s very efficacious but it’s half-life or duration of effect is very short but if you do it in liquid form and deliver it every second of the waking day then you maximize the benefit of the drug so it’s really great it changed our the way we treat parkinson’s disease because
We are now able to deliver the best drug there is to date but in a longer and a more sustained fashion the problem is it’s still an external pump it’s still a little bit larger than we’d like it to be so the operation can be a little clunky for some patients and hopefully technology will catch us up on this and the pump becomes smaller and the liquid becomes more
Concentrated so that it could give also freedom in doing activities of daily living in addition to delivering it in a more constant flow and so so that actually what excites me the most is the practical aspect of lc ig at the same time it has kind of what we call it up the ante in delivering and being creative in the administration of medications to make it more
Nimble more user friendly less expensive for patients so i think if anything that is the contribution of el cid is like to challenge all other industry developers like think of better ways of delivering this we started it you have you need to make it better
Transcribed from video
Hubert Fernandez, IAPRD 2018 – Cognitive decline in Parkinson's disease By Touch Medical Media Services