Persistent Therapeutic Burden after Device‐Aided Therapy in Parkinson's Disease: Insights from Post‐ DAT MANAGE ‐ PD Assessment

BACKGROUND: Device-aided therapies (DAT) improve advanced Parkinson's disease (PD), but residual therapeutic burden may persist. OBJECTIVES: To explore MANAGE-PD as a framework for characterizing residual disease burden after DAT. METHODS: In this multicenter cross-sectional study, 77 DAT-treated patients underwent independent MANAGE-PD assessment. Clinical characteristics, MANAGE-PD domains, clinician recommendations, and factors associated with Category 3 were analyzed. RESULTS: Of 69 evaluable patients, 38 (55.1%) fulfilled Category 3 criteria, but only three (3.9%) were recommended for an additional DAT. Category 3 patients had more advanced disease, greater non-motor burden, poorer quality of life, and higher oral LEDD (907 vs. 450 mg/day). Freezing/gait impairment, painful dystonia, hallucinations, impulse-control disorders, and persistent OFF periods were major contributors. Only Hoehn and Yahr stage and residual oral LEDD remained independently associated with Category 3. CONCLUSIONS: Persistent therapeutic burden remains common despite DAT. MANAGE-PD may provide a framework for structured post-DAT reassessment.