@phdthesis{b410fb53-4835-43e7-b0e8-0d46ba5a2f16,
  abstract     = {{Background: Non-motor symptoms (NMS) substantially impair quality of life in Parkinson's disease (PD) patients, yet treatment gaps persist. Guideline adherence for NMS management remains poorly characterised. Also, reliable symptom monitoring tools are needed: the Parkinson’s KinetiGraph (PKG) for sleep assessment and the Home Diary (HD) for motor fluctuations both require further validation.<br/><br/>Aims: The overarching aim of this thesis is to improve understanding of NMS<br/>management in PD and to strengthen the evidence base for tools used to measure and monitor PD symptoms and fluctuations.<br/><br/>Methods: A descriptive, cross-sectional study assessed adherence to national and international pharmacological NMS treatment guidelines. An open-label, observational study evaluated rotigotine’s effects on sleep and daytime sleepiness, along with correlations between PKG parameters and subjective questionnaires. The HD was validated in one investigational and one observational clinical study.<br/><br/>Results: On average, 32% of NMS were treated according to guidelines. Rotigotine improved sleep only in dopamine agonist-naïve patients and those with severe baseline sleep disturbances. Daytime sleepiness did not worsen with rotigotine, PKG scores even indicated improvement. However, PKG-derived nocturnal sleep and daytime sleepiness metrics showed no significant correlations with corresponding questionnaires. Structured patient training on motor complications did not significantly improve overall clinical observer-patient HD agreement, although dyskinesia detection showed non-significant improvement. Temporal HD<br/>agreement was fair between relative-observer and relative-patient groups.<br/>Distributions of daily time spent in “off” and “on without dyskinesia” states differed significantly between both relative-observer and patient-observer groups, but not between relatives and patients.<br/><br/>Conclusions: Low adherence to NMS guidelines suggests under-recognition,<br/>underscoring the need for systematic detection and management strategies.<br/>Rotigotine may improve sleep in patients with severe baseline disturbances and warrants further study for daytime sleepiness. PKG sleep metrics require further validation against polysomnography and established questionnaires. The HD reflects subjective motor state experience and is not interchangeable with observer ratings; validated monitoring alternatives are needed.}},
  author       = {{Janz, Carin}},
  isbn         = {{978-91-8021-866-5}},
  issn         = {{1652-8220}},
  language     = {{eng}},
  number       = {{2026:68}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Parkinson's Disease: Measurement, Monitoring, and Management - Focus on non-motor symptom treatment guidelines, sleep disturbances, and motor complications}},
  url          = {{https://lup.lub.lu.se/search/files/247655497/e-spik_ex_Carin.pdf}},
  year         = {{2026}},
}