Pill pd 157
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Pill PD 157: Insights from Recent Research
Pill Questionnaire for Dementia Screening in Parkinson's Disease
Usefulness and Accuracy of the Pill Questionnaire
The Pill Questionnaire has been recommended by the Movement Disorder Society task force as a screening tool to assess the impact of cognitive decline on daily activities in Parkinson's disease (PD) patients. A study involving 529 PD patients evaluated the performance of the Pill Questionnaire in detecting dementia. The results showed that the Pill Questionnaire had an accuracy of 89% for detecting dementia, although its positive predictive value was relatively low at 55%1. This indicates that while the Pill Questionnaire is generally reliable, it may not be as effective in predicting dementia in all cases.
Comparison with Other Functional Scales
The same study also tested the performance of the SCOPA-Motor subscale as a substitute for the Pill Questionnaire. The modified algorithm, which replaced the Pill Questionnaire with the SCOPA-Motor subscale, demonstrated high sensitivity, specificity, and accuracy indexes (over 90%) but had a positive predictive value of 66% for diagnosing probable PD-D (pPD-D)1. This suggests that while the SCOPA-Motor subscale shows promise, it cannot fully replace the Pill Questionnaire for dementia screening in PD patients.
Activities of Daily Living (ADL) Impairments in PD Patients
Comparison of Pill Questionnaire and Neurologist Assessments
A study compared the clinical judgment of experienced neurologists with the Pill Questionnaire in determining ADL impairments in PD patients. The study involved 284 PD patients and found moderate agreement between the two methods (κ=0.521, p<0.001). However, the Pill Questionnaire identified fewer patients with ADL impairments (63 patients) compared to neurologist assessments (108 patients)2. This discrepancy was particularly notable in patients with milder cognitive impairment and lower motor disability, highlighting the importance of comprehensive clinical interviews for accurate ADL impairment assessment.
Pharmacokinetics and Efficacy of Accordion Pill® in PD
Novel Drug Delivery System
The Accordion Pill® (AP-CD/LD) is a novel formulation designed to improve the consistency of levodopa (LD) in the bloodstream, offering more stable symptom management for PD patients. A phase 2 study compared AP-CD/LD with immediate-release carbidopa-levodopa (IR-CD/LD) and found that AP-CD/LD resulted in more stable LD plasma concentrations and significantly decreased peak plasma concentrations (Cmax)3. This led to improved motor symptoms and reduced motor response fluctuations, making AP-CD/LD a promising option for advanced PD patients.
Pill Swallowing Difficulties in PD
Prevalence and Predictors
A prospective study assessed the ability of PD patients to swallow different pill formulations using flexible endoscopic evaluation of swallowing (FEES). The study found that 28% of PD patients had substantial difficulty swallowing pills, with higher disease severity being associated with more swallowing problems4. Capsules were the easiest to swallow, while oval tablets were the most difficult. The study also noted that standardized questionnaires had limited sensitivity but fairly good specificity for detecting pill dysphagia, suggesting the need for FEES assessments in patients reporting swallowing difficulties.
Efficacy and Safety of Xifeng Dingchan Pill in PD
Traditional Chinese Medicine Approach
A multicenter, randomized controlled trial is evaluating the efficacy and safety of Xifeng Dingchan Pill (XFDCP), a traditional Chinese herbal medicine, in treating PD. The trial involves 320 patients with early- and middle-stage PD, comparing XFDCP with standard Western medications like Madopar and Piribedil. The study aims to determine whether XFDCP can improve treatment outcomes and reduce the adverse effects associated with Western medications5. The results are expected to provide evidence for a comprehensive therapy regimen that could delay disease progression and improve the quality of life for PD patients.
Conclusion
Recent research highlights the utility and limitations of the Pill Questionnaire in screening for dementia and ADL impairments in PD patients. Novel drug delivery systems like the Accordion Pill® show promise in providing more stable symptom management. Additionally, addressing pill swallowing difficulties and exploring traditional Chinese medicine approaches like Xifeng Dingchan Pill may offer new avenues for improving PD treatment outcomes.
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Most relevant research papers on this topic
Dementia in Parkinson's disease: Usefulness of the pill questionnaire
The Pill Questionnaire is an acceptable screening tool for dementia in Parkinson's disease patients, but its positive predictive value is low, and the SCOPA-Motor subscale cannot replace it.
Observational Study
Rigorous JournalComparison of activities of daily living impairments in Parkinson's disease patients as defined by the Pill Questionnaire and assessments by neurologists
A comprehensive interview is essential to determine the presence of activities of daily living impairments in Parkinson's disease patients, especially in early cases.
Observational StudyPharmacokinetics and efficacy of a novel formulation of carbidopa-levodopa (Accordion Pill®) in Parkinson's disease.
The Accordion Pill® effectively reduces motor response fluctuations and improves pharmacokinetics in Parkinson's disease patients compared to immediate-release carbidopa-levodopa.
RCTPill swallowing in Parkinson's disease: A prospective study based on flexible endoscopic evaluation of swallowing.
Dysphagia of medication is common in Parkinson's disease patients, with capsules being easier to swallow and FEES assessment recommended for patients reporting swallowing problems.
Observational StudyEvaluation on the efficacy and safety of Chinese herbal medication Xifeng Dingchan Pill in treating Parkinson's disease: study protocol of a multicenter, open-label, randomized active-controlled trial.
XFDCP, combined with Western medicine, may delay disease progression and improve quality of life for Parkinson's disease patients at different stages.
RCT
Large Human TrialSelf‐reported adherence versus pill count in Parkinson's disease: The NET‐PD experience
The Morisky medication adherence questionnaire is an effective alternative to pill counts for monitoring treatment adherence in Parkinson's disease clinical trials.
Observational StudyEffect of Traditional Chinese Formula Dingkun Pill on Primary Dysmenorrhea: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial
The Dingkun pill effectively reduces pain severity in primary dysmenorrhea patients without harmful side effects during 12 weeks of treatment.
RCTUse of the Pill Questionnaire to detect cognitive deficits and assess their impact on daily life in patients with Parkinson's disease
The Pill Questionnaire is a simple and useful test for detecting cognitive impairment and its impact on daily life in Parkinson's disease patients.
Observational StudyReal-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide
Sucroferric oxyhydroxide (SO) improves serum phosphorus control and reduces phosphate binder pill burden in adult peritoneal dialysis patients.
Observational StudyIntravenous Clopidogrel (MDCO-157) Compared with Oral Clopidogrel: The Randomized Cross-Over AMPHORE Study
MDCO-157, an intravenous clopidogrel formulation, showed no significant platelet inhibition at doses up to 300 mg, suggesting higher doses and longer infusions may be needed for sufficient active metabolite generation.
RCT
Very Rigorous Journal