How neurologists interpret figurative descriptions of OFF periods in Parkinson’s disease

The figurative speech patients with Parkinson’s Disease (PD) used to describe OFF periods are inconsistently interpreted and understood by neurologists according to study results published in Neurology: Clinical Practice.

To aid communication between patients and clinicians, the study researchers wanted to understand how patients describe OFF periods or the recurrence of motor and non-motor symptoms when the effects of dopaminergic therapy wear off.

They invited U.S. patients taking at least 1 PD drug and participating in the Fox Insight study to describe their experiences with AUS periods. They identified which of the 2,110 responses used imagery, medical terminology, and verbatim descriptions, and then generated topics.

Three neurologists who specialize in movement disorders compiled a list of common PD symptoms that can occur during OFF periods, and then classified the figurative phrases used by patients as a symptom from that list. You could add additional symptoms. Finally, they had to specify the symptom that most closely matched the patient’s formulation.

Of the participants, 86 (55 women, P = 0.002) responded with 109 cases of visual language, while 168 participants used medical terminology (including 4 who also used visual language); the rest used literal language. Those who did not use imagery had a shorter duration of illness than those who did (mean 6.07 years and 7.69 years, respectively; P = 0.004).

The most common topics included references to materials with specific properties such as mud or gelatin (18.35% of the phrases) and the effects of chemicals such as: B. Feeling drunk or high (17.43%).

The neurologists most frequently selected motor symptoms (51 cases) as what they thought the figurative language phrases most likely represented: slowness was assessed by at least 1 neurologist for 29 (26.6%) phrases, stiffness for 29 (26.6%) ) Phrases and tremors selected for 15 (13.8%) sentences. Among the selected non-motor symptoms, akathisia / restlessness (12, 11.0%) and concentration problems (12, 11.0%) were the most common.

The proportion of phrases with complete agreement between neurologists with regard to the specific symptom presented was significantly lower in cases in which all neurologists selected a non-motor versus a motor symptom (10, 9.2% versus 32, 29.4%; P = 0 , 0002).

All 3 neurologists chose the same symptoms in 42 cases (38.5%). Their most common common responses were stiffness (11), imbalance (7), and slowness (7). 2 of the 3 chose the same symptom for 44 sentences. For 19 sentences at least 1 neurologist declared “I really don’t know” and in 3 cases they all said “I really don’t know”.

Limitations of the study included the inability to ask participants what they meant by the figurative language phrase used, as well as the relatively high level of education and poor sample diversity.

The study researchers concluded that the imagery used by patients with Parkinson’s disease is not consistently understood by professionals and that “[given] Subjectively interpreting imagery and examining what patients are trying to convey when using such language is important and could improve patient-doctor communication. “

Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.


Chahine LM, Edison B., Daeschler M. et al. Use of imagery by people with Parkinson’s disease to describe “off” periods: clear as mud. Neurol: Clin Pract. Published online March 9, 2021. doi: 10.1212 / CPJ.0000000000001059

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