Openly discussing specific OFF symptoms and frequently asking direct, proactive questions may help identify patients who are experiencing OFF episodes.3-5 Patients should be routinely asked about OFF episodes in the outpatient, inpatient, and skilled nursing settings.6
- Are common in patients experiencing OFF episodes
- May be more problematic than motor symptoms
Non-motor symptoms can include a wide range of autonomic, sensory, and cognitive symptoms; however, recognition of non-motor complications can be difficult.3-5 Questioning patients directly about non-motor symptoms can help identify OFF episodes.3-5
Here are some examples of open-ended, probing questions you might ask to help elicit a more complete clinical picture of your patients’ OFF episodes.
- What does your best “ON” feel like?
- During which periods of the day do you feel your best “ON?”
- Do you typically plan your activities around the times you feel "ON"?
- Before your next dose is due, do your symptoms come back?
- First thing in the morning, are you stiff and slow?
- Is your response to your PD medication the same throughout the day?
- Are you taking your medication because the clock says it is time? Or do your symptoms prompt you to take your medication?
Ask questions about cognitive and behavioral non-motor symptoms, such as:
- Do you feel tired, anxious or depressed?
- Do you experience mood swings or sudden/intermittent confusion?
- Stocchi F, Antonini A, Barone P, et al; DEEP study group. Early DEtection of wEaring off in Parkinson disease: the DEEP study. Parkinsonism Relat Disord. 2014;20:204-211.
- Stacy M, Bowron A, Guttman M, et al. Identification of motor and nonmotor wearing-off in Parkinson’s disease: comparison of a patient questionnaire versus a clinician assessment. Mov Disord. 2005;20:726-733.
- Hillen ME, Sage JI. Nonmotor fluctuations in patients with Parkinson's disease. Neurology. 1996;47:1180-1183.
- Raudino F. Non motor off in Parkinson’s disease. Acta Neurol Scand. 2001;104:312-315.
- Witjas T, Kaphan E, Azulay JP, et al. Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Neurology. 2002;59:408-413.
- Parkinson’s Disease Quality Measurement Set Update. American Academy of Neurology Web site. November 2015. https://www.aan.com/siteassets/home-page/policy-and-guidelines/quality/quality-measures/16pdmeasureset_pg.pdf. Accessed February 20, 2018.
- Jankovic J. Motor fluctuations and dyskinesias in Parkinson’s disease: clinical manifestations. Mov Disord. 2005:20(suppl 11):S11–S16.
- Obering CD, Chen JJ, Swope DM. Update on apomorphine for the rapid treatment of hypomobility (“off”) episodes in Parkinson's disease. Pharmacotherapy. 2006;26:840-852.