Journal of Neural Transmission

, Volume 117, Issue 7, pp 837–846 | Cite as

The wearing-off phenomenon and the use of questionnaires to facilitate its recognition in Parkinson’s disease

  • Mark StacyEmail author
Movement Disorders-Review Article


Long-term treatment of Parkinson’s disease (PD) with dopaminergic therapy is associated with a re-emergence of PD symptoms, referred to as wearing-off. Signs of wearing-off encompass motor symptoms, such as slowness of movement and stiffness, and non-motor symptoms, including anxiety and fatigue. Both motor and non-motor symptoms impact significantly on the function and quality of life of PD patients. Early detection and management of wearing-off has been shown to improve patient symptoms; however, identification of wearing-off, particularly the non-motor symptoms, is hampered by a lack of patient education, awareness, patient–physician communication, and limited time for evaluation. Several questionnaires have been developed to aid the detection of wearing-off. This review investigates the development and use of the Wearing-Off Questionnaires (WOQ-32, WOQ-19, and WOQ-9), as well as their sensitivity and specificity in identifying wearing-off. The manuscript also provides an overview of the motor and non-motor signs of wearing-off and highlights the available treatment strategies for managing this potentially debilitating phenomenon.


Parkinson’s disease Levodopa Wearing-off Questionnaire 



The author would like to thank Diya Lahiri, PhD for her editorial assistance.

Conflict of interest statement

No compensation was provided to Dr Stacy for his work on this manuscript. Dr Stacy has received honoraria and consultancy fees from Novartis and Orion Pharma.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Division of NeurologyDuke University Medical SchoolDurhamUSA

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