Discordance in Motor and Non‐Motor Wearing‐Off Classifications Between Routine Clinical Assessment and the 9‐Item Wearing‐Off Questionnaire in Parkinson's Disease: An Exploratory Paired Study

ABSTRACT Background Wearing‐off (WO), particularly non‐motor WO, is difficult to recognize during routine clinical assessments in Parkinson's disease (PD). The 9‐item Wearing‐off Questionnaire (WOQ‐9) is a brief, structured, patient‐completed screening tool. Aim To compare paired motor and non‐motor WO classifications between physician judgment during routine assessments and the WOQ‐9 and to describe WOQ‐9 positivity within 24 months of symptom onset. Methods We retrospectively analyzed data from prospectively recorded routine‐care assessments of 57 levodopa‐treated patients with PD. Patients completed the WOQ‐9 before clinical consultation. Before reviewing responses, physicians recorded motor and non‐motor WO classifications based on unstructured interviews and neurological examinations. WOQ‐9 items were considered positive when the symptom was present and improved after medication. Paired classifications were compared using McNemar's exact test. Results Motor WO was positive in 36 of 57 patients (63.2%) using each approach, although 10 individual classifications were discordant ( p = 1.000). Non‐motor WO was positive in eight patients (14.0%) during routine assessment and in 18 (31.6%) using the WOQ‐9 ( p = 0.021); 13 were positive only on the WOQ‐9 and three only during routine assessment. In an exploratory analysis, four of eight patients within 24 months of symptom onset were WOQ‐9 positive. Conclusion Physician and WOQ‐9 classifications showed different patterns for motor and non‐motor WO. WOQ‐9 positivity was observed among patients within 24 months of symptom onset, although this subgroup was small. The brief WOQ‐9 may complement, rather than replace, routine assessments, particularly for non‐motor fluctuations.