Opinion|Videos|April 23, 2025

Off Fluctuations in Parkinson Disease

Panelists discuss how off fluctuations in Parkinson disease become increasingly prevalent as the disease progresses, significantly impacting patient quality of life through reduced mobility, independence, and overall well-being.

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Prevalence of Off Fluctuations and Quality-of-Life Impact

Off Fluctuations Prevalence:

  • Approximately 40% of patients experience motor fluctuations after 4 to 6 years of levodopa therapy
  • By 10 years of treatment, up to 90% of patients develop off episodes (Aradi 2020)
  • Off periods increase in frequency and duration as disease progresses
  • Early fluctuations may be end-of-dose wearing off, progressing to unpredictable on-off phenomena

Quality-of-Life Impact:

  • Progressive deterioration in activities of daily living and independence
  • Increased caregiver burden and health care utilization
  • Significant psychological impact: anxiety, depression, social isolation
  • Mobility limitations affecting employment, social interactions, and self-care
  • Sleep disturbances and fatigue compound functional limitations

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