Persistent Therapeutic Burden after Device-Aided Therapy in Parkinson's Disease: Insights from Post-DAT MANAGE-PD...

Device-aided therapies (DAT) improve advanced Parkinson's disease (PD), but residual therapeutic burden may persist.

To explore MANAGE-PD as a framework for characterizing residual disease burden after DAT.

In this multicenter cross-sectional study, 77 DAT-treated patients underwent independent MANAGE-PD assessment. Clinical characteristics, MANAGE-PD domains, clinician recommendations, and factors associated with Category 3 were analyzed.

Of 69 evaluable patients, 38 (55.1%) fulfilled Category 3 criteria, but only three (3.9%) were recommended for an additional DAT. Category 3 patients had more advanced disease, greater non-motor burden, poorer quality of life, and higher oral LEDD (907 vs. 450 mg/day). Freezing/gait impairment, painful dystonia, hallucinations, impulse-control disorders, and persistent OFF periods were major contributors. Only Hoehn and Yahr stage and residual oral LEDD remained independently associated with Category 3.

Persistent therapeutic burden remains common despite DAT. MANAGE-PD may provide a framework for structured post-DAT reassessment.