Schröder et al The mean number of Parkinson’s disease patients seen per week was 20.2 (range 14–25). The neurologists had a wide range of length of experience: 23% had been qualified for 9–14 years, 37% for 15–24 years, and 30% for 25–34 years. All reported that they were aware of the content of the national treatment guidelines on Parkinson’s disease. The demographic characteristics of the 320 patients in grade II (n = 82; 56% male; mean age 63.4 years) and III (n = 238; 55% male; mean age 68.6 years) who were included in the analysis are shown in Table 2. The proportion of patients receiving dopamine agonists and L-dopa by age group (,70 years or $70 years) and grade (II or III) is shown in Table 3. Whilst in younger patients (espe- cially in grade II) dopamine agonists were more frequently used than L-dopa, the opposite was true in older patients. Therefore, the data indicate a general trend for neurologists to adhere to the guideline. Figure 1 illustrates the level of adher- ence to the four parameters; three of these parameters were only followed in about half of the patients. The recommen- dation to use dopamine agonists without L-dopa in patients ,70 years old with lower grades of functional impairment (parameter 1, L-dopa-sparing approach) was observed in only 53% of cases (n = 34). Moreover, more than a third of these younger patients (n = 23; 36%) were already receiving L-dopa and 19% (n = 12) were receiving L-dopa without a dopamine agonist. In patients $70 years old in grade II (parameter 3) or III (parameter 4), recommendations to use L-dopa without dopamine agonists were also only partially Table 2 Patient demographics (n = 320) Age (years)* Time since diagnosis (years)* hoehn and Yahr stage # i ii iii iV V home circumstances (multiple responses possible) Lives with partner Lives alone Nursing home Lives with family/friends employment status Full time employment Part time employment Unemployed retired homemaker caregiver required – professional or informal hospitalized due to Parkinson’s disease ## Notes: *mean (SD); #n = 304; ##n = 307. 106 submit your manuscript | www.dovepress.com Dovepress 67.2 (9.6) 4.1 (3.9) 82 (27.0%) 144 (47.4%) 65 (21.4%) 12 (3.9%) 1 (0.3%) 228 (71.2%) 51 (15.9%) 4 (1.3%) 27 (8.4%) 39 (12.2%) 14 (4.4%) 8 (2.5%) 239 (74.7%) 19 (5.9%) 182 (56.9%) 74 (24.1%) Dovepress adhered to (n = 9 [50%] and n = 58 [52%], respectively). In contrast, the recommended use of dopamine agonists (mono or combination) in more functionally impaired patients aged ,70 years (parameter 2) was observed in the majority of cases (n = 107; 84%). A total of 137 of the 320 patients (43%) were treated in accordance with the guidelines as stated by the neurologists. There were no statistically significant differences (Fisher’s exact test) between the guideline and nonguideline groups of patients (Figure 1). However, more neurologists who claimed that their patients were in the “guideline group” adhered to parameter 1 (n = 16 [66.7%] versus n = 18 [45.0%]). There was almost no difference between the two groups regarding adherence to parameter 2 (n = 48 [85.7%] and n = 59 [83.1%]). The small sample size for parameter 3 (n = 18) precluded further statistical interpretation. For parameter 4, adherence was actually slightly higher in the nonguideline group (n = 36; 55.4%) than in the guideline group (n = 22; 47.8%). Treatment in the patient subgroups is summarized in Table 4. Symptom severity appeared to have an impact on the choice of therapy in less functionally impaired patients (grade II) in both age groups: in patients aged ,70 years, L-dopa was less likely to be given to those with mild symp- toms than those with more severe symptoms. Mild symptoms were also a predictor for the use of amantadine and mono- amine oxidase (MAO)-B inhibitors in this age group. In patients aged $70 years, mild symptoms were a predictor for dopamine agonist and amantadine use. In more functionally Table 3 Treatment received by patients (n = 320) divided into those aged ,70 years or $70 years, and grade ii or grade iii of functional impairment Grade II Patients aged ,70 years (n = 64) DA monotherapy 27 (42.2%) DA, no L-dopa 34 (53.1%) DA (overall) 45 (70.3%) L-dopa (overall) 23 (35.9%) L-dopa + DA 11 (17.2%) L-dopa, no DA 12 (18.8%) Patients aged $70 years (n = 18) L-dopa monotherapy 4 (22.2%) L-dopa, no DA 9 (50.0%) DA (overall) 7 (38.9%) L-dopa (overall) 14 (77.8%) DA, no L-dopa 2 (11.1%) Abbreviation: DA, dopamine agonist. Grade III Patients aged ,70 years (n = 127) 24 (18.9%) 41 (32.3%) 107 (84.3%) 81 (63.8%) 66 (52.0%) 15 (11.8%) Patients aged $70 years (n = 111) 28 (25.2%) 58 (52.3%) 49 (44.1%) 102 (91.9%) 5 (4.5%) Neuropsychiatric Disease and Treatment 2011:7