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OFF periods; Parkinson’s disease; risk factors; demographics; associations



OFF periods are episodes when Parkinson’s disease (PD) medications work suboptimally, with symptoms returning and impacting quality of life. We aimed to characterize OFF periods using patient-reported frequency, severity, and duration, as well as determine these characteristics’ associations with demographics.


A retrospective cohort study using Fox Insight Data Exploration Network (Fox DEN) database was conducted. Eligible patients had PD and were > 18 years. The experience of OFF periods was characterized by frequency (number of episodes/day), duration (duration/episode), and severity (impact on activities). Significance level was Bonferroni-corrected for multivariate analyses.


From a population of 6,757 persons with PD, 88% were non-Hispanic Whites (mean age: 66 ± 8.8 years); 52.7% were males versus 47.3% females; mean PD duration was 5.7 ± 5.2; and 51% experienced OFF periods. Subsequent analyses were limited to non-Hispanic Whites, as they constituted a large majority of the participants and were the subgroup that had the sample size to derive reliable inferences. The analyses showed that 67% experienced 1–2 episodes/day, 90% experienced > 15-minute episodes, and 55% reported slight–mild severity/episode. Lower age was associated with a higher frequency (incidence rate ratio [IRR]: 0.992; P < 0.001) and severity (odds ratio [OR]: 0.985; P = 0.001) of OFF episodes. Income of < $35,000 was associated with 15.1% more episodes/day (IRR: 1.15, p < 0.001) and 66.5% higher odds of a severe episode (OR: 1.66; P < 0.001). Females experienced 7.5% more episodes compared to males (IRR: 1.075; P = 0.003). Longer PD duration was associated with 1.3% more episodes/day (IRR: 1.013; P < 0.001) and 10% higher odds of a severe episode (OR: 1.10; P < 0.001).


Lower age, income < $35,000, longer PD duration, female gender, and being unemployed are associated with a higher frequency and severity of OFF periods with no associations for duration/episode among non-Hispanic Whites with PD. In time-constrained clinic environments, clinicians should tailor OFF periods management counseling to vulnerable demographic groups to enhance care delivery.(J Patient Cent Res Rev. 2024;11:8-17.)

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May 3rd, 2023


August 30th, 2023


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