Biochemical and nutritional changes during continuous subcutaneous apomorphine infusion in advanced Parkinson's disease: findings from an observational cohort.

内容摘要

Patients with Parkinson's disease (PD) receiving device-aided therapies (DATs) frequently experience vitamin B depletion and nutritional challenges. However, the effects of continuous subcutaneous apomorphine infusion (CSAI) on vitamin B status and nutritional outcomes in advanced PD remain unclear. To evaluate the clinical effectiveness of CSAI and associated changes in vitamin B status, homocysteine (Hcy) levels and nutritional outcomes in patients with advanced PD. A prospective observational cohort study in a single centre. Thirty patients with advanced PD were enrolled between January 2023 and March 2025. Clinical, biochemical and nutritional assessments were performed at baseline and after 3&#x2009;months. Motor outcomes included daily OFF hours, dyskinesia hours, Hoehn and Yahr stage and the Unified PD Rating Scale (UPDRS). Biochemical measures comprised serum vitamins B1, B6, B12, folate and plasma Hcy levels. Nutritional status was assessed using body weight, body mass index (BMI) and the Mini Nutritional Assessment-Short Form (MNA-SF). Thirty participants (mean age 68.5&#x2009;&#xb1;&#x2009;9.2&#x2009;years; disease duration 12.0&#x2009;&#xb1;&#x2009;3.9&#x2009;years; Hoehn & Yahr 3.7&#x2009;&#xb1;&#x2009;0.7) completed follow-up. After 3&#x2009;months of CSAI, daily OFF hours, dyskinesia hours and UPDRS Part 4 scores decreased significantly (p&#x2009;<&#x2009;0.05 for all). The oral levodopa daily dose was significantly reduced (p&#x2009;<&#x2009;0.001). Serum vitamin B1 and B12 levels increased significantly, while Hcy levels showed a modest but significant reduction (p&#x2009;<&#x2009;0.05). Body weight, BMI and total MNA-SF score remained unchanged (p&#x2009;>&#x2009;0.05). However, MNA-SF categories shifted toward improved nutritional classification (p&#x2009;=&#x2009;0.008). Adjunctive antiparkinsonian medications were significantly reduced, while levodopa remained universally prescribed. CSAI significantly reduced motor complications and oral levodopa exposure. Secondary analyses showed selective biochemical improvements with stable overall nutritional status. Findings should be interpreted considering the observational design, lack of control group and short follow-up. CSAI demonstrates significant improvements in motor performance and vitamin B status, along with stabilised nutritional and cognitive profiles among Advanced PD patients Patients with Advanced Parkinson&#x2019;s disease (PD) are at risk of vitamin B deficiencies and other nutritional challenges, especially when receiving device-aided therapy (DAT). These risks are particularly noted in patients treated with levodopa-carbidopa intestinal gel infusion (LCIG). Continuous subcutaneous apomorphine infusion (CSAI) is an alternative treatment option, but its effects on vitamin B status and overall nutrition are not well understood. This study evaluated changes in clinical measures, rating scales, vitamin B levels, and nutritional outcomes in 30 patients over 3&#x2009;months of CSAI treatment. After 3&#x2009;months, patients showed significant improvements in motor symptoms. Daily levodopa doses were reduced, and both daily OFF hours and dyskinesia hours decreased significantly. Serum vitamin B1 and B12 levels increased significantly, while Hcy levels decreased slightly but significantly, suggesting an overall improvement in vitamin B status. Cognitive assessment and general nutritional measures, including body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF) scores, showed no significant changes. However, the distribution of nutritional categories shifted modestly, with a small reduction in the proportion of patients classified as malnourished and a slight increase in those with normal nutritional status. Overall, CSAI therapy was associated with substantial improvements in motor complications and a significant reduction in oral levodopa exposure. There was a significant reduction in the use of most adjunctive antiparkinsonian medications, while levodopa therapy remained universally prescribed. At the same time, metabolic and nutritional parameters showed generally small-to-moderate changes over the short-term follow-up period. In summary, 3&#x2009;months of CSAI treatment was associated with improved motor function and better vitamin B status in patients with advanced PD, whereas cognitive and general nutritional outcomes remained stable. These findings indicate that CSAI may offer metabolic benefits and warrant further investigation regarding its potential role in preventing nutritional deficiencies.