Abstract
INTRODUCTION: Intermittent subcutaneous (SC) apomorphine is a fast-acting dopamine agonist used in the management of motor fluctuations in advanced Parkinson's disease (PD). While its motor benefits are well established the effects on non-motor domains and the modifying role of chronological age remain less certain. This prospective observational study aimed to evaluate the effectiveness of intermittent SC apomorphine on motor and non-motor outcomes in idiopathic PD patients with persistent motor fluctuations despite optimized oral therapy, and to examine whether age influenced therapeutic response. METHODS: Thirty-five idiopathic PD patients treated with intermittent SC apomorphine were followed for twelve weeks and assessed at baseline and week 12. Motor outcomes included Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and diary-based daily "off" and "on" time without dyskinesia. Non-motor outcomes comprised the Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), Parkinson's Disease Questionnaire (PDQ-8), and Parkinson's Disease Sleep Scale (PDSS). Subgroup analyses compared outcomes between patients aged <45 and ≥45 years and interaction effects were explored. RESULTS: MDS-UPDRS Part III scores improved from 45.71 (SD 11.93) to 29.86 (SD 12.24) (p <0.001). Mean daily "off" time decreased from 5.60 (1.65) to 2.26 (0.95) hours, while "on" time without dyskinesia raise from 10.34 (1.76) to 13.89 (0.93) hours (both p <0.001). Non-motor outcomes also improved: BDI declined from 23.03 (5.70) to 18.09 (4.87), MoCA increased from 15.74 (5.51) to 18.03 (6.05), and PDQ-8 from 22.80 (5.60) to 17.54 (5.84) (all p <0.001). Parkinson's disease sleep scale showed no significant change. No significant age-by-treatment interaction effects were detected. CONCLUSION: Intermittent subcutaneous apomorphine was associated with significant improvements in multidimensional aspects, including motor and various non-motor domains, which are closely related to cognition, mood, and quality of life in PD. Benefits were consistent across age groups, indicating chronological age does not influence efficacy.