Health-Related Quality of Life in Relation to the 5-2-1 Criteria in Parkinson’s Disease in Sweden

Hjalte F, Gustafsson A, Samuelsson J, Bergquist F, Johansson A, Odin P

Device-aided therapies (DAT) offer alternatives to oral or transdermal dopaminergic treatments in advanced Parkinson’s disease (PD). They can reduce motor fluctuations and dyskinesia and improve health-related quality of life (HRQoL). The 5-2-1 criteria can be seen as a rough indicator when DAT might be considered, that is, when a patient has daily ≥2 hours off and/or ≥1 hour troublesome dyskinesia despite ≥5 daily oral levodopa intakes.

The objective of this study was to analyse differences in HRQoL and clinical outcomes in patients fulfilling and not fulfilling the 5-2-1 criteria.

Patients from three different regions in Sweden, registered in the National Parkinson’s Disease Patient Registry (PARKreg), with registrations in off hours, dyskinesia hours, and Parkinson’s Disease Questionnaire-8 (PDQ-8) score were included. The generic QoL questionnaire EQ-5D was also evaluated. Data from PARKreg was complemented with data from a medical record review.

In total, 365 (36%) of 1085 patients with sufficient information met the 5-2-1 criteria. Patients meeting the criteria had a significantly lower HRQoL, as measured by PDQ-8 and EQ-5D, compared to those not meeting the criteria. Each additional hour spent in off or with dyskinesia was associated with lower HRQoL, where time in off state had the strongest impact.
The 5-2-1 criteria identified patients with high disease burden and poor QoL, in combination with motor fluctuations and/or dyskinesia. This delineates a group of patients for whom further investigation for DAT candidacy or other optimizations of treatments may be indicated.

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Movement Disorders Clinical Practice, 2025
DOI: 10.1002/mdc3.70120