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Solano B, Cámara A, Compta Y. Parkinsonism outcomes in different settings: How the type of care matters. Parkinsonism Relat Disord 2024:106972. [PMID: 38637206 DOI: 10.1016/j.parkreldis.2024.106972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Berta Solano
- Neurology Department of the Universitary Hospital Josep Trueta. Avinguda de França, S/N, 17007, Girona, Catalonia, Spain
| | - Ana Cámara
- Parkinson's Disease & Movement Disorders Unit, Neurology Service, Hospital Clínic I Universitari de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN- RND, InstitutClínic de Neurociències UBNeuro (Maria de Maeztu Excellence Centre), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Neurology Service, Hospital Clínic I Universitari de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN- RND, InstitutClínic de Neurociències UBNeuro (Maria de Maeztu Excellence Centre), Universitat de Barcelona, Barcelona, Catalonia, Spain.
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Kruse C, Lipinski A, Verheyen M, Balzer-Geldsetzer M, Wittenberg M, Lorenzl S, Richinger C, Schmotz C, Tönges L, Woitalla D, Klebe S, Bloem BR, Hommel A, Meissner WG, Laurens B, Boraud T, Foubert-Samier A, Vergnet S, Tison F, Costa N, Odin P, Rosqvist K, Norlin JM, Hjalte F, Schrag A, Dodel R. Care of Late-Stage Parkinsonism: Resource Utilization of the Disease in Five European Countries. Mov Disord 2024; 39:571-584. [PMID: 38425158 DOI: 10.1002/mds.29718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease that leads to progressive disability. Cost studies have mainly explored the early stages of the disease, whereas late-stage patients are underrepresented. OBJECTIVE The aim is to evaluate the resource utilization and costs of PD management in people with late-stage disease. METHODS The Care of Late-Stage Parkinsonism (CLaSP) study collected economic data from patients with late-stage PD and their caregivers in five European countries (France, Germany, the Netherlands, UK, Sweden) in a range of different settings. Patients were eligible to be included if they were in Hoehn and Yahr stage >3 in the on state or Schwab and England stage at 50% or less. In total, 592 patients met the inclusion criteria and provided information on their resource utilization. Costs were calculated from a societal perspective for a 3-month period. A least absolute shrinkage and selection operator approach was utilized to identify the most influential independent variables for explaining and predicting costs. RESULTS During the 3-month period, the costs were €20,573 (France), €19,959 (Germany), €18,319 (the Netherlands), €25,649 (Sweden), and €12,156 (UK). The main contributors across sites were formal care, hospitalization, and informal care. Gender, age, duration of the disease, Unified Parkinson's Disease Rating Scale 2, the EQ-5D-3L, and the Schwab and England Scale were identified as predictors of costs. CONCLUSION Costs in this cohort of individuals with late-stage PD were substantially higher compared to previously published data on individuals living in earlier stages of the disease. Resource utilization in the individual sites differed in part considerably among these three parameters mentioned. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Anna Lipinski
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Malte Verheyen
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Monika Balzer-Geldsetzer
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Michael Wittenberg
- Coordination Center for Clinical Trials of the Philipps-University Marburg, Marburg, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Christian Schmotz
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Krankenhaus Kupferdreh, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, Essen, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Adrianus Hommel
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Wassilios G Meissner
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Brice Laurens
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Thomas Boraud
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Alexandra Foubert-Samier
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Sylvain Vergnet
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - François Tison
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Nadège Costa
- Health Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Frida Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - Richard Dodel
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Grotewold N, Albin RL. Update: Descriptive epidemiology of Parkinson disease. Parkinsonism Relat Disord 2024; 120:106000. [PMID: 38233324 PMCID: PMC10922566 DOI: 10.1016/j.parkreldis.2024.106000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
We review the descriptive epidemiology of Parkinson disease (PD). PD is a prevalent neurologic disorder in high Socio-Demographic Index (SDI) nations with rising prevalence in low and middle SDI nations. PD became a prevalent disorder in high SDI nations during the 20th century. Population growth, population aging, and increased disease duration are major drivers of rising PD prevalence. Exposure to industrial toxicants may also be a contributor to rising PD prevalence. PD is an age-related disorder with incidence likely peaking in the 8th decade of life and prevalence in the 9th decade of life. PD is notable for significant sex difference in PD risk with greater risk in men. There may be ancestral differences in PD prevalence and risk. PD is associated with moderately increased mortality though this may be underestimated. Despite significant research, there is considerable uncertainty about basic features of PD epidemiology.
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Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
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Goerz CJ, Kanungo A, Lix LM, Leslie WD, Burchill C, Hobson DE. Determining the impact of specialized care on health outcomes and health care utilization in Parkinsonism. Parkinsonism Relat Disord 2024:106026. [PMID: 38369425 DOI: 10.1016/j.parkreldis.2024.106026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Although care of Parkinsonism (PKM) is assumed to be optimally provided by movement disorder neurologists within an interdisciplinary clinic model, there is a paucity of published data to support this. OBJECTIVES To investigate the impact of movement disorder neurologist care of individuals with Parkinsonism (PKM). METHODS A retrospective exposure design was adopted using administrative data. Incident PKM individuals were identified in billing claims. A nine-year exposure period to movement disorder neurologist, general neurologist and non-neurologist care was calculated based on the billing codes. Regression models were used to test the association of provider exposure on time to death and long-term care (LTC) admission. Linear models were used to test varying provider exposure and hospital admissions, hospital days and emergency department visits. RESULTS 1914 incident individuals were identified. There was no difference in PKM mortality, emergency visits, hospital admissions, or hospital days between providers, however exposure to general neurology and non-neurology care was associated with a significantly higher risk of admission to LTC compared to movement disorder neurologist care (HR 1.43; 95% CI 1.09-1.87 for general neurology (p-value = 0.0089); HR 1.61; 95% CI 1.25-2.05 for non-neurology (p-value = 0.0002), respectively. CONCLUSION Movement disorder neurologist care is associated with a lower risk of admission to LTC over general neurologist care in individuals with PKM.
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Affiliation(s)
- Conrad J Goerz
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Canada
| | - Anish Kanungo
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Charles Burchill
- Manitoba Centre for Health Policy, University of Manitoba, Canada
| | - Douglas E Hobson
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Canada.
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Dham B, Richard I, Schneider EB, George BP. Association of Postoperative Delirium and Parkinson Disease After Common United States Surgical Procedures. J Surg Res 2023; 291:711-719. [PMID: 37566934 DOI: 10.1016/j.jss.2023.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION To determine the association of Parkinson disease (PD) and postoperative delirium following common surgical procedures. METHODS We performed a retrospective database analysis of the National Inpatient Sample. We used a matched sample of patients with and without PD who underwent any of ten common surgical procedures in the US, 2005-2014. Primary outcome measure was postoperative delirium for patients with and without PD. Secondary measures included disposition, length of stay, and hospital costs. RESULTS There were 3,235,866 patients receiving any of the ten most common operative procedures, 2005-2014. There were 35,743 patients with and without PD matched based on age, sex, elective admission status, Charlson Comorbidity index, and presence of dementia. Median age was 77 y (interquartile range 72-82), median Charlson Comorbidity index was 1 (standard deviation 0-2), 46.6% were female, and 46.8% were admitted electively. The three most common operative procedures were hip arthroplasty (28.5%), knee arthroplasty (16.1%), and percutaneous coronary angioplasty (14.9%). Postoperative delirium was present in 1519 patients with PD compared to 828 matched patients without PD (4.2% versus 2.3%; P < 0.001). The adjusted odds ratio of postoperative delirium for PD compared to the matched cohort without PD was 1.88 (95% confidence interval 1.73-2.05). Those undergoing spinal fusion (adjusted odds ratio 2.99, 95% confidence interval 2.06-4.38) had the greatest odds of delirium. For patients with PD, adjusted length of stay, adjusted hospital costs, and adjusted odds of postacute care facility discharge were greater compared to the matched cohort without PD. CONCLUSIONS Patients with PD are more likely to develop postoperative delirium and have a more complicated postoperative course with longer length of stay and greater hospitalization costs.
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Affiliation(s)
- Bhavpreet Dham
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Irene Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Eric B Schneider
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin P George
- Department of Neurology, University of Rochester Medical Center, Rochester, New York.
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Santos García D, de Deus Fonticoba T, Cores C, Suárez Castro E, Hernández Vara J, Jesús S, Mir P, Cosgaya M, José Martí M, Pastor P, Cabo I, Seijo M, Legarda I, Vives B, Caballol N, Rúiz Martínez J, Croitoru I, Cubo E, Miranda J, Alonso Losada MG, Labandeira C, López Ariztegui N, Morales-Casado M, González Aramburu I, Infante J, Escalante S, Bernardo N, Blázquez Estrada M, Menéndez González M, García Caldentey J, Borrué C, Vela L, Catalán MJ, Gómez Mayordomo V, Kurtis M, Prieto C, Ordás C, Nogueira V, López Manzanares L, Ávila Rivera MA, Puente V, García Moreno JM, Solano Vila B, Álvarez Sauco M, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Gastón I, Kulisevsky J, Valero C, de Fábregues O, González Ardura J, López Díaz LM, Martinez-Martin P. Falls Predict Acute Hospitalization in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:105-124. [PMID: 33843696 PMCID: PMC9912731 DOI: 10.3233/jpd-212539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a need for identifying risk factors for hospitalization in Parkinson's disease (PD) and also interventions to reduce acute hospital admission. OBJECTIVE To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort. METHODS PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit. RESULTS Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065-5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319-6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757-8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124-4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080-8.322; p = 0.035) was an independent predictor of AH. CONCLUSION Falls is an independent predictor of AH in PD patients.
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Affiliation(s)
- Diego Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain,Correspondence to: Dr. Diego Santos García, Department of Neurology, Hospital Universitario de A Coruña (HUAC), Complejo Hospitalario Universitario de A Coruña (CHUAC), C/ As Xubias 84, 15006, A Coruña, Spain. Tel.: +34 646173341; E-mail:
| | | | - Carlos Cores
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Jorge Hernández Vara
- Neurology Department and Neurodegenerative Diseases Research. Vall D’Hebron Universitary Campus, Barcelona, Spain
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain,CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain,CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | | | | | - Pau Pastor
- Movement disorders Unit, University Hospital Mutua de Terrassa, Barcelona, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - Inés Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Bárbara Vives
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Javier Miranda
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | - Carmen Labandeira
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | | | - Jon Infante
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Noemí Bernardo
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | | | | | | | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS) - Institut Català de la Salut. Girona, Spain
| | | | | | | | | | | | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain,Hospital de Sant Pau, Barcelona, Spain
| | | | - Oriol de Fábregues
- Neurology Department and Neurodegenerative Diseases Research. Vall D’Hebron Universitary Campus, Barcelona, Spain
| | | | | | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
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Trends and Sex Differences in Hospitalizations and Mortality in Parkinson's Disease in Spain (2010-2019): A Nationwide Population-Based Study. J Clin Med 2023; 12:jcm12030902. [PMID: 36769549 PMCID: PMC9918014 DOI: 10.3390/jcm12030902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
The incidence of hospitalizations of Parkinson´s disease (PD) in Spain suffered a steady rise from 1997 to 2012. However, data on the trends during the following decade (2010-2019) are lacking. Hospital admissions with a primary and secondary diagnosis of PD were selected using the Spanish National Hospital Discharge Database (SNHDD) for the period 2010-2019. The primary endpoint was the incidence of hospitalizations and in-hospital mortality, stratified in biannual periods. The incidence of PD hospitalizations increased progressively over time from 81.25 cases in 2010-2011 to 94.82 cases in 2018-2019 per 100,000 inhabitants. Male sex, age and comorbidity also increased progressively in PD inpatients. PD as a comorbid condition presented a higher increment (annual percentage of change, APC +1.71%, p < 0.05) than PD as the main reason of hospitalization (APC +1.26%, p < 0.05). In the multivariate regression model, factors associated with mortality were male sex (OR = 1.15, 95% CI 1.01-1.35), age (>80 years, OR = 12.76, 95% CI 3.96-29.64) and comorbidity (Charlson index ≥ 2, OR 1.77, 95% CI 1.69-1.85). Adjusted mortality by age, sex, comorbidity and diagnostic position remained stable. In conclusion, PD hospitalizations in Spain have increased, with a parallel increment in mean age, male sex and higher comorbidities. However, adjusted mortality remains unchanged. The burden of this disease may increase the complexity and costs of hospital care in the future.
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Kannarkat GT, Rafferty MR, Luo S, Liu H, Mills KA. Effect of Exercise and Rehabilitation Therapy on Risk of Hospitalization in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:494-500. [PMID: 35586527 PMCID: PMC9092731 DOI: 10.1002/mdc3.13456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/23/2022] [Accepted: 03/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background Exercise and physical therapy (PT) can improve motor function and quality of life in individuals with Parkinson's disease (PD), but their role in hospitalization avoidance is not well-studied. Objectives To determine the longitudinal and temporal association of exercise and PT use with hospital encounter. Methods Longitudinal regression and χ2 analyses were performed on Parkinson's Foundation Parkinson's Outcome Project exercise and PT use data from 4674 and 9259 persons with PD, respectively. Results Greater exercise duration and intensity were associated with reduced odds of hospital encounter, whereas both PT and occupational therapy use were associated with increased odds. In the 2 years before a hospital encounter, there was an increased frequency of PT use, but not reductions in exercise. Conclusions Consistent exercise may reduce hospitalization risk whereas PT referral may identify at-risk individuals without preventing this outcome. Further work to incentivize consistent exercise in PD may reduce healthcare use.
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Affiliation(s)
| | - Miriam R. Rafferty
- Shirley Ryan AbilityLabChicagoIllinoisUSA
- Department of Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sheng Luo
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Hongliang Liu
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Kelly A. Mills
- Department of NeurologyThe Johns Hopkins HospitalBaltimoreMarylandUSA
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Soh EML, Neo S, Saffari SE, Wong ASY, Ganesan G, Li W, Ng HL, Xu Z, Tay KY, Au WL, Tan KB, Tan LCS. Longitudinal Healthcare Utilization and Costs in Parkinson's Disease: Pre-Diagnosis to 9 Years After. JOURNAL OF PARKINSON'S DISEASE 2022; 12:957-966. [PMID: 34974439 DOI: 10.3233/jpd-212982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is currently insufficient long-term data on costs of treatment in patients with Parkinson's disease (PD), which is chronic and progressive, and associated with substantial healthcare costs. Identifying patterns in healthcare utilization and cost may illuminate further discussion on early intervention. OBJECTIVE To characterize long-term healthcare utilization and costs of PD in newly diagnosed patients managed by movement disorder specialists. METHODS Using a longitudinal matched-cohort study of linked data from the National Neuroscience Institute Parkinson's disease and Movement Disorder and healthcare administrative databases in Singapore from 2008-2017, we compared healthcare utilization and costs between patients and controls matched on age, sex, race, and Charlson Comorbidity Index score. RESULTS 1,162 patients met study inclusion criteria and 1,157 matched controls were identified. The total mean annual healthcare cost (at 2017 costs) was significantly increased in patients compared to controls from years 1-9 post-diagnosis. The increased cost was observed 2 years before diagnosis (USD2322 vs. 2052; p < 0.001). Mean annual cost attributable to PD increased from USD1854 at 1-year post-diagnosis to USD2652 at 9 years. Over 9 years, average costs were significantly higher across all domains of healthcare utilization except primary care-cost of intermediate and long-term care was increased by a factor of 2.5, specialist care by 2.3, emergency department visits by 1.6, and hospital admissions by 1.3. CONCLUSION PD results in higher healthcare utilization and costs. Pre-diagnosis increase in healthcare utilization observed in patients supports the presence of prodromal PD symptoms and may present an opportunity for early diagnosis.
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Affiliation(s)
| | - Shermyn Neo
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Seyed Ehsan Saffari
- Duke-NUS Medical School, Singapore
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Aidan Sheng Yong Wong
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Ganga Ganesan
- Policy Research and Evaluation Division, Ministry of Health, Singapore
| | - Wei Li
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Hwee Lan Ng
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Zheyu Xu
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Kay Yaw Tay
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Wing Lok Au
- Duke-NUS Medical School, Singapore
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Louis Chew Seng Tan
- Duke-NUS Medical School, Singapore
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
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Ypinga JHL, Van Halteren AD, Henderson EJ, Bloem BR, Smink AJ, Tenison E, Munneke M, Ben-Shlomo Y, Darweesh SKL. Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL). BMC Neurol 2021; 21:286. [PMID: 34294077 PMCID: PMC8298196 DOI: 10.1186/s12883-021-02308-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson's Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. METHODS This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). DISCUSSION This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
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Affiliation(s)
- Jan H L Ypinga
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Agnes J Smink
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Morissette MP, Prior HJ, Tate RB, Wade J, Leiter JRS. Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study. Fam Med Community Health 2021; 8:fmch-2020-000390. [PMID: 32719017 PMCID: PMC7388873 DOI: 10.1136/fmch-2020-000390] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease. Design A retrospective population-based cohort study. Setting Administrative health data for the Province of Manitoba between 1990–1991 and 2014–2015. Participants A total of 47 483 individuals were diagnosed with a concussion using International Classification of Diseases (ICD) codes (ICD-9-CM: 850; ICD-10-CA: S06.0). All concussed subjects were matched with healthy controls at a 3:1 ratio based on age, sex and geographical location. Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model, with adjustments for socioeconomic status and pre-existing medical conditions. Results 28 021 men (mean age ±SD, 25±18 years) and 19 462 women (30±21 years) were included in the concussion group, while 81 871 men (25±18 years) and 57 159 women (30±21 years) were included in the matched control group. Concussion was associated with adjusted hazard ratios of 1.39 (95% CI 1.32 to 1.46, p<0.001) for ADHD, 1.72 (95% CI 1.69 to 1.76; p<0.001) for MADs, 1.72 (95% CI 1.61 to 1.84; p<0.001) for dementia and 1.57 (95% CI 1.41 to 1.75; p<0.001) for Parkinson’s disease. Conclusion Concussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.
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Affiliation(s)
- Marc P Morissette
- Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada .,Applied Health Sciences, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert B Tate
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Wade
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff R S Leiter
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Zhou Y, Ibrahim A, Hardy KG, Jenkins ME, Naish MD, Trejos AL. Design and Preliminary Performance Assessment of a Wearable Tremor Suppression Glove. IEEE Trans Biomed Eng 2021; 68:2846-2857. [PMID: 33999812 DOI: 10.1109/tbme.2021.3080622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Approximately 25% of individualsliving with parkinsonian tremor do not respond to traditional treatments. Wearable tremor suppression devices (WTSD) provide an alternative approach, however, tremor in the fingers has not been given as much attention as tremor in the elbow and the wrist. Therefore, the objective of this study is to design a wearable tremor suppression glove that can suppress tremor simultaneously, but independently, in multiple hand joints without restricting the user's voluntary motion. METHODS A WTSD was designed for managing tremor in the index finger metacarpophalangeal (MCP) joint, thumb MCP joint, and the wrist. The prototype was tested and assessed on a participant living with parkinsonian tremor. RESULTS The experimental evaluation showed an overall suppression of 73.1%, 80.7%, and 85.5% in resting tremor, 70.2%, 79.5%, and 81% in postural tremor, and 60.0%, 58.7%, and 65.0% in kinetic tremor in the index finger MCP joint, the thumb MCP joint, and the wrist, respectively. CONCLUSION This first assessment of a WTSD for people living with Parkinson's disease provides confirmation of the feasibility of the approach. The next step requires a comprehensive validation on a broader population in order to evaluate the performance of the WTSD. SIGNIFICANCE This study demonstrates the feasibility of using a WTSD to manage hand and finger tremor. The device enriches the field of upper-limb tremor management, as the first WTSD for multiple joints of the hand.
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13
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Espiritu AI, Anna C Brillantes MM, G Layog AV, G Jamora RD. Reasons for hospitalization and factors of mortality in patients with Parkinson's disease in the Philippines. Neurodegener Dis Manag 2021; 11:229-238. [PMID: 33966488 DOI: 10.2217/nmt-2020-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We aimed to determine the reasons for hospitalizations and factors of mortality of Filipino Parkinson's disease (PD) patients in a tertiary hospital. Methods: We conducted a retrospective review of medical records of PD patients admitted to our institution between 2016 and 2018. Demographic and clinical data were analyzed. Results: We included 166 PD patients. The most common cause of admission was infectious (pneumonia, urinary tract, and skin-soft tissue infections) (n = 65, 39.2%). The most common cause of mortality was sepsis (n = 9, 5.4%). Renal comorbidity was a significant factor of mortality (OR: 3.67, 95% CI: 1.11-12.12; p = 0.033). Conclusion: Interventions designed to reduce the risk of complications in PD patients should be prioritized to potentially decrease the probability of eventual hospitalization.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine & Philippine General Hospital, University of The Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of The Philippines Manila, Manila, Philippines
| | | | - Allister Vincent G Layog
- Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, Philippines.,Department of Clinical Neurosciences, University of The East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine & Philippine General Hospital, University of The Philippines Manila, Manila, Philippines.,Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, Philippines.,Movement Disorders Service & Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City & Global City, Philippines
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14
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Akbar U, McQueen RB, Bemski J, Carter J, Goy ER, Kutner J, Johnson MJ, Miyasaki JM, Kluger B. Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323939. [PMID: 33789923 PMCID: PMC8142437 DOI: 10.1136/jnnp-2020-323939] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
Parkinson's disease and related disorders (PDRD) are the second most common neurodegenerative disease and a leading cause of death. However, patients with PDRD receive less end-of-life palliative care (hospice) than other illnesses, including other neurologic illnesses. Identification of predictors of PDRD mortality may aid in increasing appropriate and timely referrals. To systematically review the literature for causes of death and predictors of mortality in PDRD to provide guidance regarding hospice/end-of-life palliative care referrals. We searched MEDLINE, PubMed, EMBASE and CINAHL databases (1970-2020) of original quantitative research using patient-level, provider-level or caregiver-level data from medical records, administrative data or survey responses associated with mortality, prognosis or cause of death in PDRD. Findings were reviewed by an International Working Group on PD and Palliative Care supported by the Parkinson's Foundation. Of 1183 research articles, 42 studies met our inclusion criteria. We found four main domains of factors associated with mortality in PDRD: (1) demographic and clinical markers (age, sex, body mass index and comorbid illnesses), (2) motor dysfunction and global disability, (3) falls and infections and (4) non-motor symptoms. We provide suggestions for consideration of timing of hospice/end-of-life palliative care referrals. Several clinical features of advancing disease may be useful in triggering end-of-life palliative/hospice referral. Prognostic studies focused on identifying when people with PDRD are nearing their final months of life are limited. There is further need for research in this area as well as policies that support need-based palliative care for the duration of PDRD.
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Affiliation(s)
- Umer Akbar
- Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | | | - Julienne Bemski
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Julie Carter
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Elizabeth R Goy
- Department of Neurology, Portland VA Medical Center, Portland, Oregon, USA
| | - Jean Kutner
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Miriam J Johnson
- Department of Palliative Medicine, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Janis M Miyasaki
- Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Benzi Kluger
- Department of Neurology, University of Rochester, Rochester, New York, USA
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Abstract
OBJECTIVE We assessed long-term incidence and prevalence trends of dementia and parkinsonism across major ethnic and immigrant groups in Ontario. METHODS Linking administrative databases, we established two cohorts (dementia 2001-2014 and parkinsonism 2001-2015) of all residents aged 20 to 100 years with incident diagnosis of dementia (N = 387,937) or parkinsonism (N = 59,617). We calculated age- and sex-standardized incidence and prevalence of dementia and parkinsonism by immigrant status and ethnic groups (Chinese, South Asian, and the General Population). We assessed incidence and prevalence trends using Poisson regression and Cochran-Armitage trend tests. RESULTS Across selected ethnic groups, dementia incidence and prevalence were higher in long-term residents than recent or longer-term immigrants from 2001 to 2014. During this period, age- and sex-standardized incidence of dementia in Chinese, South Asian, and the General Population increased, respectively, among longer-term immigrants (by 41%, 58%, and 42%) and long-term residents (28%, 7%, and 4%), and to a lesser degree among recent immigrants. The small number of cases precluded us from assessing parkinsonism incidence trends. For Chinese, South Asian, and the General Population, respectively, prevalence of dementia and parkinsonism modestly increased over time among recent immigrants but significantly increased among longer-term immigrants (dementia: 134%, 217%, and 117%; parkinsonism: 55%, 54%, and 43%) and long-term residents (dementia: 97%, 132%, and 71%; parkinsonism: 18%, 30%, and 29%). Adjustment for pre-existing conditions did not appear to explain incidence trends, except for stroke and coronary artery disease as potential drivers of dementia incidence. CONCLUSION Recent immigrants across major ethnic groups in Ontario had considerably lower rates of dementia and parkinsonism than long-term residents, but this difference diminished with longer-term immigrants.
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16
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Emergency Room Visit Prevention for Older Patients with Parkinsonism in a Geriatric Clinic. Can J Neurol Sci 2020; 48:666-675. [PMID: 33183363 DOI: 10.1017/cjn.2020.253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Older persons with parkinsonism (PWP) are at high risk for hospitalization and adverse outcomes. Few effective strategies exist to prevent Emergency Department (ED) visits and hospitalization. The interdisciplinary Geriatrics Clinic for Parkinson's ("our clinic") was founded to address the complexity of parkinsonism in older patients, supported by a pharmacist-led telephone intervention (TI) service. Our primary objective was to study whether TI could avert ED visits in older PWP. METHODS Using a prospective, observational cohort, we collected data from all calls in 2016, including who initiated and reasons for the calls, patient demographics, number of comorbidities and medications, diagnoses, duration of disease, and intervention provided. Calls with intention to visit ED were classified as "crisis calls". Outcome of whether patients visited ED was collected within 1 week, and user satisfaction by anonymous survey within 3 weeks. RESULTS We received 337 calls concerning 114 patients, of which 82 (24%) were "crisis calls". Eighty-one percent of calls were initiated by caregivers. Ninety-three percent of "crisis calls" resolved without ED visit after TI. The main reasons for "crisis calls" were non-motor symptoms (NMS) (39%), adverse drug effects (ADE) (29%), and motor symptoms (18%). Ninety-seven percent of callers were satisfied with the TI. CONCLUSION Pharmacist-led TI in a Geriatrics Clinic for Parkinson's was effective in preventing ED visits in a population of older PWP, with high user satisfaction. Most calls were initiated by caregivers. Main reasons for crisis calls were NMS and ADE. These factors should be considered in care planning for older PWP.
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17
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Hepgul N, Wilson R, Yi D, Evans C, Bajwah S, Crosby V, Wilcock A, Lindsay F, Byrne A, Young C, Groves K, Smith C, Burman R, Chaudhuri KR, Silber E, Higginson IJ, Gao W. Immediate versus delayed short-term integrated palliative care for advanced long-term neurological conditions: the OPTCARE Neuro RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Palliative care is recommended to help meet the needs of patients with progressive non-cancer conditions, such as long-term neurological conditions. However, few trials have tested palliative care in this population.
Objectives
To determine the effectiveness and cost-effectiveness of short-term integrated palliative care in improving symptoms, improving patient- and caregiver-reported outcomes and reducing hospital use for people severely affected by long-term neurological conditions.
Design
Pragmatic, randomised controlled, multicentre, fast-track trial, with an embedded qualitative component and surveys.
Setting
Seven UK centres (South London, Nottingham, Liverpool, Cardiff, Brighton, Ashford and Sheffield) with multiprofessional palliative care teams and neurology services.
Participants
People living with multiple sclerosis, idiopathic Parkinson’s disease, motor neurone disease, multiple system atrophy or progressive supranuclear palsy, with unresolved symptoms and/or complex psychosocial needs. The qualitative study involved patients, caregivers and health-care staff.
Interventions
Participants were randomised to receive short-term integrated palliative care, delivered by multiprofessional teams, immediately or after a 12-week wait (standard care group).
Main outcome measures
The primary outcome was a combined score of eight symptoms measured by the Integrated Palliative care Outcome Scale for Neurological conditions 8 symptom subscale (IPOS Neuro-S8) at 12 weeks. Secondary outcomes included patients’ other physical and psychological symptoms, quality of life (EuroQol-5 Dimensions, five-level version), care satisfaction, caregiver burden, service use and cost, and harms. Data were analysed using multiple imputation, generalised linear mixed models, incremental cost-effectiveness ratios (threshold was the National Institute for Health and Care Excellence £20,000 per quality-adjusted life-year) and cost-effectiveness planes. Qualitative data were analysed thematically.
Results
We recruited 350 patients and 229 caregivers. There were no significant between-group differences for primary or secondary outcomes. Patients receiving short-term integrated palliative care had a significant improvement, from baseline to 12 weeks, on the primary outcome IPOS Neuro-S8 (–0.78, 95% confidence interval –1.29 to –0.26) and the secondary outcome of 24 physical symptoms (–1.95, 99.55% confidence interval –3.60 to –0.30). This was not seen in the control group, in which conversely, care satisfaction significantly reduced from baseline to 12 weeks (–2.89, 99.55% confidence interval –5.19 to –0.59). Incremental cost-effectiveness ratios were smaller than the set threshold (EuroQol-5 Dimensions index score –£23,545; IPOS Neuro-S8 –£1519), indicating that the intervention provided cost savings plus better outcomes. Deaths, survival and hospitalisations were similar between the two groups. Qualitative data suggested that the impact of the intervention encompassed three themes: (1) adapting to losses and building resilience, (2) attending to function, deficits and maintaining stability, and (3) enabling caregivers to care.
Conclusions
Our results indicate that short-term integrated palliative care provides improvements in patient-reported physical symptoms at a lower cost and without harmful effects when compared with standard care.
Limitations
Outcome measures may not have been sensitive enough to capture the multidimensional changes from the intervention. Our surveys found that the control/standard and intervention services were heterogeneous.
Future work
Refining short-term integrated palliative care and similar approaches for long-term neurological conditions, focusing on better integration of existing services, criteria for referral and research to improve symptom management.
Trial registration
Current Controlled Trials ISRCTN18337380.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 36. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Sussex Community NHS Foundation Trust, Brighton, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Vincent Crosby
- Department of Palliative Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Wilcock
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Carolyn Young
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Clare Smith
- Department of Palliative Care, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Surrey, UK
| | - Rachel Burman
- Department of Palliative Care, King’s College Hospital, London, UK
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, King’s College Hospital and King’s College London, London, UK
| | - Eli Silber
- Department of Neurology, King’s College Hospital, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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18
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Life expectancy of parkinsonism patients in the general population. Parkinsonism Relat Disord 2020; 77:94-99. [DOI: 10.1016/j.parkreldis.2020.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
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Yang S, Wang F, Yang L, Xu F, Luo M, Chen X, Feng X, Zou X. The physical significance of acoustic parameters and its clinical significance of dysarthria in Parkinson's disease. Sci Rep 2020; 10:11776. [PMID: 32678256 PMCID: PMC7366911 DOI: 10.1038/s41598-020-68754-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Abstract
Dysarthria is universal in Parkinson’s disease (PD) during disease progression; however, the quality of vocalization changes is often ignored. Furthermore, the role of changes in the acoustic parameters of phonation in PD patients remains unclear. We recruited 35 PD patients and 26 healthy controls to perform single, double, and multiple syllable tests. A logistic regression was performed to differentiate between protective and risk factors among the acoustic parameters. The results indicated that the mean f0, max f0, min f0, jitter, duration of speech and median intensity of speaking for the PD patients were significantly different from those of the healthy controls. These results reveal some promising indicators of dysarthric symptoms consisting of acoustic parameters, and they strengthen our understanding about the significance of changes in phonation by PD patients, which may accelerate the discovery of novel PD biomarkers.
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Affiliation(s)
- Shu Yang
- College of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China.,Department of Public Health, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Fengbo Wang
- Department of Rehabilitation, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Liqiong Yang
- Department of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Man Luo
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Xiaqing Chen
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Xixi Feng
- Department of Public Health, Chengdu Medical College, Chengdu, 610500, Sichuan, China.
| | - Xianwei Zou
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China.
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20
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Parkinson's disease and patient related outcomes in stroke: A matched cohort study. J Stroke Cerebrovasc Dis 2020; 29:104826. [PMID: 32402719 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate post-stroke outcomes in patients with Parkinson's disease (PD). METHODS A matched cohort study was performed. Stroke patients with PD and non-PD controls were extracted from the Thailand Universal Insurance Database. Logistic regressions were used to evaluate the association between PD and in-hospital outcomes (mortality and complications). The PD-associated long-term mortality was evaluated using Royston-Parmar models. RESULTS A total of 1967 patients with PD were identified between 2003 and 2015 and matched to controls (1:4) by age, sex, admission year, and stroke type. PD patients had decreased odds of in-hospital death: OR (95% CI) 0.66 (0.52 - 0.84) and 0.61 (0.43 - 0.85) after ischaemic and haemorrhagic strokes, respectively. PD was associated with a length-of-stay greater than median (4 days) after both stroke types: 1.37 (1.21 - 1.56) and 1.45 (1.05 - 2.00), respectively. Ischaemic stroke patients with PD also had increased odds of developing pneumonia, sepsis and AKI: 1.52 (1.2 - 1.83), 1.54 (1.16 - 2.05), and 1.33 (1.02 - 1.73). In haemorrhagic stroke patients, PD was associated with pneumonia: 1.89 (1.31 - 2.72). Survival analyses showed that PD was protective against death in the short term (HR=0.66; 95% CI 0.53-0.83 ischaemic, and HR=0.50; 95% CI 0.37 - 0.68 haemorrhagic stroke), but leads to an increased mortality risk approximately 1 and 3 months after ischaemic and haemorrhagic stroke, respectively. CONCLUSION PD is associated with a reduced mortality risk during the first 2-4 weeks post-admission but an increased risk thereafter, in addition to increased odds of in-hospital complications and prolonged hospitalisation.
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21
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Challenges in ICU Care. Crit Care Nurs Q 2020; 43:205-215. [DOI: 10.1097/cnq.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lebel K, Duval C, Goubault E, Bogard S, Blanchet PJ. Can We Predict the Motor Performance of Patients With Parkinson's Disease Based on Their Symptomatology? Front Bioeng Biotechnol 2020; 8:189. [PMID: 32266228 PMCID: PMC7105871 DOI: 10.3389/fbioe.2020.00189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/27/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: Parkinson's disease hinders the ability of a person to perform daily activities. However, the varying impact of specific symptoms and their interactions on a person's motor repertoire is not understood. The current study investigates the possibility to predict global motor disabilities based on the patient symptomatology and medication. Methods: A cohort of 115 patients diagnosed with Parkinson's disease (mean age = 67.0 ± 8.7 years old) participated in the study. Participants performed different tasks, including the Timed-Up & Go, eating soup and the Purdue Pegboard test. Performance on these tasks was judged using timing, number of errors committed, and count achieved. K-means method was used to cluster the overall performance and create different motor performance groups. Symptomatology was objectively assessed for each participant from a combination of wearable inertial sensors (bradykinesia, tremor, dyskinesia) and clinical assessment (rigidity, postural instability). A multinomial regression model was derived to predict the performance cluster membership based on the patients' symptomatology, socio-demographics information and medication. Results: Clustering exposed four distinct performance groups: normal behavior, slightly affected in fine motor tasks, affected only in TUG, and affected in all areas. The statistical model revealed that low to moderate level of dyskinesia increased the likelihood of being in the normal group. A rise in postural instability and rest tremor increase the chance to be affected in TUG. Finally, LEDD did not help distinguishing between groups, but the presence of Amantadine as part of the medication regimen appears to decrease the likelihood of being part of the groups affected in TUG. Conclusion: The approach allowed to demonstrate the potential of using clinical symptoms to predict the impact of Parkinson's disease on a person's mobility performance.
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Affiliation(s)
- Karina Lebel
- Département de Génie électrique et de Génie Informatique, Faculté de Génie, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada
| | - Christian Duval
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l'activité physique, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Etienne Goubault
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l'activité physique, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Sarah Bogard
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l'activité physique, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Pierre J Blanchet
- Faculté de Médecine Dentaire, Université de Montréal, Montreal, QC, Canada.,Centre Hospitalier de l'Université de Montréal (C.H.U. Montreal), Montreal, QC, Canada
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Okunoye O, Kojima G, Marston L, Walters K, Schrag A. Factors associated with hospitalisation among people with Parkinson's disease - A systematic review and meta-analysis. Parkinsonism Relat Disord 2020; 71:66-72. [PMID: 32156461 DOI: 10.1016/j.parkreldis.2020.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is associated with an increased risk of admission to hospital; however data on the main reasons for admission are lacking. Our objective was to determine the pooled prevalence of the most common factors leading to admission among people with Parkinson's disease. METHODOLOGY A systematic literature search was conducted in 11 electronic databases. We included all studies providing reasons for admissions among PD patients without restrictions to diagnostic criteria of PD, language or year of study. In the included studies, methodological quality, publication bias and heterogeneity were assessed. Meta-analysis was performed using random-effects models to calculate the pooled estimates of the identified top factors that lead to admission among people with PD. RESULTS A total of 7283 studies were identified of which nine studies including 7162 people with PD were included in this review. There was a high degree of heterogeneity between studies regarding reasons for hospitalisation. The pooled prevalence of the topmost reasons for hospitalisation among people with PD was 22% (95%CI 16.0%–30.0%) for infections (mainly urinary tract infections and pneumonia); 19% (95%CI 13.0%–27.0%) for worsening motor manifestations of PD; 18% (95%CI 14.0%–21.0%) for falls/fractures; 13% (95%CI 9.0%–18%) for cardiovascular co-morbidities; 8% (95%CI 4.0%–13.0%) for neuropsychiatric and 7% (95%CI 4.0%–11.0%) for gastrointestinal complications. CONCLUSION The main reasons for hospitalisation among people with PD are infections, worsening motor features, falls/fractures, cardiovascular co-morbidities, neuropsychiatric and gastrointestinal complications. Further research is needed on targeting and implementing preventative strategies.
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Affiliation(s)
- Olaitan Okunoye
- Department of Clinical and Movement Neurosciences, University College London, UK.
| | - Gotaro Kojima
- Department of Primary Care and Population Health, University College London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, UK
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, UK
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24
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Winser SJ, Paul LF, Magnus LKL, Yan S, Shenug TP, Sing YM, Cheing G. Economic Evaluation of Exercise-Based Fall Prevention Programs for People with Parkinson's Disease: A Systematic Review. J Altern Complement Med 2019; 25:1225-1237. [PMID: 31556689 DOI: 10.1089/acm.2019.0148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Falls are common in Parkinson's disease (PD). Exercise interventions can prevent falls. This review aims to (1) explore the existing evidence regarding the cost-effectiveness of exercise-based fall prevention programs for people with PD and (2) discuss the implications of the review findings for future research and clinical practice. Design: Databases AMED Allied and Complementary Medicine, CINAHL, CRD, EBSCO, EMBASE, MEDLINE, PubMed, Scopus, and Web of Science were searched from their inception until June 2019. Randomized and nonrandomized trials that included an economic evaluation of fall prevention programs for people with PD were considered. Quality of the economic evaluation was assessed using the Consensus on Health Economic Criteria list (CHEC-list), and the methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk of bias tool. Results: Nine hundred and sixty-five studies were screened to include three studies involving 556 participants. Quality of economic evaluation assessed using CHEC-list was high. The methodological quality was high for two studies and low for one study. Tested interventions included Tai Ji Quan, physiotherapist-led, supervised, weekly and monthly balance, and strengthening exercises. The duration of the interventions ranged from 10 weeks to 6 months, while the intervention frequency ranged from two sessions per week to one session per month. Treatment sessions lasted for 60 min in all three studies. One high economic and methodological quality study comparing Tai Ji Quan with resistance and stretching exercises reported least cost resource use among Tai Ji Quan group (USD 80,441) and greater incremental number of falls prevented. All three tested interventions had an 80% probability of being cost-effective with the corresponding country-specific threshold incremental cost-effectiveness ratio values. Conclusions: The findings provide some evidence for exercise-based intervention as a cost-effective treatment option for preventing falls in PD; however, due to the limited number of available studies, heterogeneity of the interventions, and diversity of assessment settings, a firm conclusion cannot be established. Additional studies evaluating the cost-effectiveness of fall prevention programs involving larger samples and using different treatment parameters in various settings are warranted.
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Affiliation(s)
- Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Li Francis Paul
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Leung Ka Long Magnus
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Szeto Yan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Tsui Pui Shenug
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yuen Man Sing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Gladys Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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25
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Aslam S, Simpson E, Baugh M, Shill H. Interventions to minimize complications in hospitalized patients with Parkinson disease. Neurol Clin Pract 2019; 10:23-28. [PMID: 32190417 DOI: 10.1212/cpj.0000000000000709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/30/2019] [Indexed: 11/15/2022]
Abstract
Background In this study, we sought to evaluate the efficacy of inpatient interventions on hospitalization-related complications in patients with Parkinson disease (PD). Hospitalized patients with PD have an increased risk of complications. Although several interventions have been suggested in the literature, data-driven recommendations are limited. Methods This study was designed as a prospective cohort study. A hospital-wide alert system was incorporated into the electronic medical record (EMR) system. The alert was triggered when a patient with PD or on dopaminergic therapy was admitted prompting the inpatient pharmacy to confirm medication details. A warning was also triggered if antidopaminergic medications were ordered. In-services were performed for nursing staff and physicians regarding these measures. Charts of patients with PD admitted 6 months before and after the intervention were reviewed to serve as the 2 comparison groups. Results There were 73 patients (mean 73.2 years) preintervention group and 103 patients (mean 72.3 years) postintervention group. There were no significant differences in reasons for admission, admission to neurologic vs non-neurologic floor, or admitting service between the groups. The percentage of patients for whom contraindicated medications were ordered decreased from 42.5% to 17.5% (p < 0.001). Medication administration with doses given over 30 minutes late decreased from 46% to 39% (p = 0.068). Medications ordered correctly were 42.9% vs 54.7% (p = 0.131) before and after the intervention. Length of stay was 5.3 vs 5.2 days (p = 0.896), and mean complications were 0.38 vs 0.37 (p = 0.864). Conclusion An intervention involving EMR alerts and in-service didactics for nurses and physicians decreased the frequency of contraindicated medications ordered in hospitalized patients with PD, but it did not change other hospital outcomes or complications.
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Affiliation(s)
- Sana Aslam
- Barrow Neurological Institute, Phoenix, AZ
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26
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Szatmári S, Ajtay A, Bálint M, Takáts A, Oberfrank F, Bereczki D. Linking Individual Patient Data to Estimate Incidence and Prevalence of Parkinson's Disease by Comparing Reports of Neurological Services and Pharmacy Prescription Refills at a Nationwide Level. Front Neurol 2019; 10:640. [PMID: 31275231 PMCID: PMC6591465 DOI: 10.3389/fneur.2019.00640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives: We set forth to estimate the number of those with Parkinson's disease (PD) in Hungary, a country with a single-payer health insurance system covering 10 million inhabitants. Methods: We analyzed all hospital and outpatient reports from neurological services and pharmacy reports of prescription refills. We cross-checked clinically administered diagnosis of PD with prescription refills of antiparkinsonian medications using record linkage. We used the ICD-10 code of G20 in any diagnostic category to find all cases with possible PD. For case certification those patients were considered to have PD who were recorded with G20 code in at least 2 calendar years. For a more conservative estimation we determined the number of those who also refilled antiparkinsonian medication. Results: Between 2010 and 2012 there were 46,383 subjects with certified PD by clinical criteria. Crude and age-standardized incidence were 49/100,000/year (95% CI: 45–53), and 56/100,000/year (95% CI: 51–60). Crude and age standardized prevalence rates were 404/100,000 (95% CI: 392–416) and 471/100,000 (95% CI: 456–485). Of all clinically certified PD patients 72% refilled antiparkinsonian medications. Discussion: The incidence and prevalence of PD in Hungary is higher than earlier estimates, which should be considered in organizing healthcare services for this patient group.
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Affiliation(s)
- Szabolcs Szatmári
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary.,Department of Neurology, Semmelweis University, Budapest, Hungary.,MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
| | - András Ajtay
- Department of Neurology, Semmelweis University, Budapest, Hungary.,MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
| | - Mónika Bálint
- Hungarian Academy of Sciences Centre for Economic and Regional Studies, Budapest, Hungary
| | - Annamária Takáts
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Ferenc Oberfrank
- Institute of Experimental Medicine of the Hungarian Academy of Sciences, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary.,MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
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Abstract
ABSTRACT:Objectives:We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism.Methods:We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model.Results:From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism.Conclusion:Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.
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28
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Marras C, Beck JC, Bower JH, Roberts E, Ritz B, Ross GW, Abbott RD, Savica R, Van Den Eeden SK, Willis AW, Tanner CM. Prevalence of Parkinson's disease across North America. NPJ PARKINSONS DISEASE 2018; 4:21. [PMID: 30003140 PMCID: PMC6039505 DOI: 10.1038/s41531-018-0058-0] [Citation(s) in RCA: 485] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 01/19/2023]
Abstract
Estimates of the prevalence of Parkinson's disease in North America have varied widely and many estimates are based on small numbers of cases and from small regional subpopulations. We sought to estimate the prevalence of Parkinson's disease in North America by combining data from a multi-study sampling strategy in diverse geographic regions and/or data sources. Five separate cohort studies in California (2), Minnesota (1), Hawaii USA (1), and Ontario, Canada (1) estimated the prevalence of PD from health-care records (3), active ascertainment through facilities, large group, and neurology practices (1), and longitudinal follow-up of a population cohort (1). US Medicare program data provided complementary estimates for the corresponding regions. Using our age- and sex-specific meta-estimates from California, Minnesota, and Ontario and the US population structure from 2010, we estimate the overall prevalence of PD among those aged ≥45 years to be 572 per 100,000 (95% confidence interval 537-614) that there were 680,000 individuals in the US aged ≥45 years with PD in 2010 and that that number will rise to approximately 930,000 in 2020 and 1,238,000 in 2030 based on the US Census Bureau population projections. Regional variations in prevalence were also observed in both the project results and the Medicare-based calculations with which they were compared. The estimates generated by the Hawaiian study were lower across age categories. These estimates can guide health-care planning but should be considered minimum estimates. Some heterogeneity exists that remains to be understood.
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Affiliation(s)
- C Marras
- 1The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, ON Canada
| | - J C Beck
- The Parkinson's Foundation, New York, NY USA.,3New York University, New York, NY USA
| | - J H Bower
- 4Department of Neurology, School of Medicine, Mayo Clinic, Rochester, MN USA
| | - E Roberts
- 5Public Health Institute, Oakland, CA USA
| | - B Ritz
- 6Department of Epidemiology, UCLA Fielding School of Public Health and UCLA Geffen School of Medicine, Los Angeles, CA USA.,7Department of Environmental Health, UCLA Fielding School of Public Health and UCLA Geffen School of Medicine, Los Angeles, CA USA.,8Department of Neurology, UCLA Fielding School of Public Health and UCLA Geffen School of Medicine, Los Angeles, CA USA
| | - G W Ross
- 9Veterans Affairs Pacific Islands Health Care System, Honolulu, HI USA
| | - R D Abbott
- 10Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - R Savica
- 4Department of Neurology, School of Medicine, Mayo Clinic, Rochester, MN USA
| | - S K Van Den Eeden
- 11Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - A W Willis
- 12Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,13Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - C M Tanner
- 14Department of Neurology, University of California - San Francisco & PD Research Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, CA USA
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29
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Koay L, Rose J, Abdelhafiz AH. Factors that lead to hospitalisation in patients with Parkinson disease-A systematic review. Int J Clin Pract 2018; 72. [PMID: 29119656 DOI: 10.1111/ijcp.13039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Parkinson disease (PD) frequently leads to acute hospitalisation resulting in increased cost to health care systems and reduced quality of life for patients. The objective of this review was to identify causes that lead to acute hospitalisation of patients with PD. METHODS A systematic review of English language literature from 1997 to present. FINDINGS The incidences of acute general medical or surgical problems that trigger acute hospitalisation in patients with PD are similar to those in the general population. However, falls, acute decompensation of PD symptoms and infections are far more common in PD patients and are responsible for more than 50% of the causes of hospitalisation in this patients' group. IMPLICATIONS Preventive strategies to avoid decompensation of PD symptoms and early detection and treatment of infections are needed to reduce hospitalisation in patients with PD.
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Affiliation(s)
- Luan Koay
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Joanne Rose
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
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30
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Heckman GA, Crizzle AM, Chen J, Pringsheim T, Jette N, Kergoat MJ, Eckel L, Hirdes JP. Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 7:103-115. [PMID: 27689617 DOI: 10.3233/jpd-160931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes. OBJECTIVES The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population. METHODS Population-based cross-sectional cohort study. Residents with PD and/or Parkinsonism living in long-term care (LTC) facilities in 6 Canadian provinces and 1 Northern Territory and Complex Continuing Care (CCC) facilities in Manitoba and Ontario, Canada. The RAI MDS 2.0 instrument was used to assess all LTC residents and CCC residents. Clinical characteristics and the prevalence of major comorbidities were examined. Multivariate modeling was used to identify the characteristics of PD residents most associated with the prescription of antipsychotics and the use of restraints in LTC and CCC facilities. RESULTS Residents with PD in LTC and CCC exhibit a high prevalence of dementia, major psychiatric disorders, stroke, heart failure, chronic obstructive pulmonary disease and diabetes mellitus. More than 90% of LTC and CCC residents with PD had cognitive impairment; with more than half having moderate to severe impairment. Residents with PD were more likely to receive antipsychotics than those without PD. Antipsychotic use was associated with psychosis and aggressive behaviours, but also with unsteady gait and higher comorbidity and medication count. Similarly, although more common in CCC than LTC facilities, both psychosis and aggressive behaviours were associated with restraint use, as was greater cognitive and functional impairment, and urinary incontinence. Younger age, male gender, and lower physician access were all associated with greater antipsychotic and restraint use. CONCLUSIONS LTC and CCC residents with PD are very complex medically. Use of antipsychotics and restraints is common, and their use is often associated with factors other than psychosis or aggression.
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Affiliation(s)
- George A Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Alexander M Crizzle
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jonathen Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences and Hotchkiss Brain Institute and Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences and Hotchkiss Brain Institute and Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | | | - Leslie Eckel
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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31
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Camacho-Soto A, Warden MN, Searles Nielsen S, Salter A, Brody DL, Prather H, Racette BA. Traumatic brain injury in the prodromal period of Parkinson's disease: A large epidemiological study using medicare data. Ann Neurol 2017; 82:744-754. [PMID: 29024046 DOI: 10.1002/ana.25074] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 08/31/2017] [Accepted: 09/29/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Studies suggest a greater risk of Parkinson's disease (PD) after traumatic brain injury (TBI), but it is possible that the risk of TBI is greater in the prodromal period of PD. We aimed to examine the time-to-TBI in PD patients in their prodromal period compared to population-based controls. METHODS We identified 89,790 incident PD cases and 118,095 comparable controls aged > 65 years in 2009 using Medicare claims data. Using data from the preceding 5 years, we compared time-to-TBI in PD patients in their prodromal period to controls. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for TBI in a Cox regression, while adjusting for age, sex, race/ethnicity, modified Charlson comorbidity index, smoking, and alcohol use. RESULTS Risk of TBI was greater in PD patients in their prodromal period across all age and sex groups, with HRs consistently increasing with proximity to PD diagnosis. HRs ranged from 1.64 (95% CI, 1.52, 1.77) 5 years preceding diagnosis to 3.93 (95% CI, 3.74, 4.13) in the year before. The interaction between PD, TBI, and time was primarily observed for TBI attributed to falls. Motor dysfunction and cognitive impairment, suggested by corresponding International Classification of Diseases, Ninth Revision codes, partially mediated the PD-TBI association. INTERPRETATION There is a strong association between PD and a recent TBI in the prodromal period of PD. This association strengthens as PD diagnosis approaches and may be a result of undetected nonmotor and motor symptoms, but confirmation will be required. Ann Neurol 2017;82:744-754.
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Affiliation(s)
| | - Mark N Warden
- Washington University School of Medicine, Department of Neurology, St. Louis, MO
| | | | - Amber Salter
- Washington University in St. Louis, Division of Biostatistics, St. Louis, MO
| | - David L Brody
- Washington University School of Medicine, Department of Neurology, St. Louis, MO
| | - Heidi Prather
- Washington University School of Medicine, Department of Neurology, St. Louis, MO.,Washington University School of Medicine, Department of Orthopedic Surgery, St. Louis, MO
| | - Brad A Racette
- Washington University School of Medicine, Department of Neurology, St. Louis, MO.,University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
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32
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Shahgholi L, De Jesus S, Wu SS, Pei Q, Hassan A, Armstrong MJ, Martinez-Ramirez D, Schmidt P, Okun MS. Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence. PLoS One 2017; 12:e0180425. [PMID: 28683150 PMCID: PMC5500337 DOI: 10.1371/journal.pone.0180425] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background Patients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors. Methods We queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit. Results Of the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities. Conclusion Hospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates.
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Affiliation(s)
- Leili Shahgholi
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Sol De Jesus
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Daniel Martinez-Ramirez
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Peter Schmidt
- National Parkinson’s Foundation, Miami, Florida, United States of America
| | - Michael S. Okun
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
- * E-mail:
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Muzerengi S, Rick C, Begaj I, Ives N, Evison F, Woolley R, Clarke C. Coding accuracy for Parkinson's disease hospital admissions: implications for healthcare planning in the UK. Public Health 2017; 146:4-9. [DOI: 10.1016/j.puhe.2016.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022]
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Kelly B, Blake C, Lennon O. Acute Hospital Admissions of Individuals with a Known Parkinson’s Disease Diagnosis in Ireland 2009–2012: A Short Report. JOURNAL OF PARKINSONS DISEASE 2016; 6:709-716. [DOI: 10.3233/jpd-160839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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García-Ramos R, López Valdés E, Ballesteros L, Jesús S, Mir P. The social impact of Parkinson's disease in Spain: Report by the Spanish Foundation for the Brain. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2013.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hassan A, Wu SS, Schmidt P, Simuni T, Giladi N, Miyasaki JM, Bloem BR, Malaty IA, Okun MS. The Profile of Long-term Parkinson's Disease Survivors with 20 Years of Disease Duration and Beyond. JOURNAL OF PARKINSONS DISEASE 2016; 5:313-9. [PMID: 25720446 DOI: 10.3233/jpd-140515] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinson's disease (PD) patients with 20 years or more survival (PD-20) are not well characterized. OBJECTIVE To evaluate PD-20 patient characteristics and identify areas for improvement of their health care. METHODS The international, multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII) study database was queried to identify PD-20 subjects. Demographic and clinical data were analyzed. RESULTS We identified 187 PD-20 subjects (55% men) representing 4% (187/4,619) of all NPF-QII participants. Subjects were mean age 69.5 years; mean age at PD onset was 44.0 years. The majority (75% ) had 20-25 years of PD duration, the longest duration being 49 years. They were median Hoehn and Yahr stage 3, and 75% had motor fluctuations. Half (54% ) reported exercising. The majority (89% ) were living at home and required a caregiver (88% ). They were mildly cognitively impaired for age (Montreal Cognitive Assessment estimate 22.6±3.7), with most deficits in verbal fluency and delayed recall. Quality of life (Parkinson's Disease Quality of Life Questionnaire index 36±15% ) was mild to moderately impaired, with most impairment in mobility and activities of daily living. Caregiver strain measured by the Multidimensional Caregiver Strain Index (27±16% ), recorded highest subscores in social constraint. PD-20 subjects aged <70 years versus ≥70 only differed significantly by worse cognition (P < 0.0001). CONCLUSIONS PD-20 subjects reflect an elite group of PD survivors with early-onset disease and relatively mild cognitive disability despite long disease duration. Interventions for caregivers, mobility, and activities of daily living are areas that could improve caregiver burden and patient quality of life.
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Affiliation(s)
- Anhar Hassan
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel S Wu
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Peter Schmidt
- National Parkinson's Foundation, Miami, Florida, USA
| | - Tanya Simuni
- Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Janis M Miyasaki
- The Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bastiaan R Bloem
- Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands
| | - Irene A Malaty
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA
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Gaskin J, Gomes J, Darshan S, Krewski D. Burden of neurological conditions in Canada. Neurotoxicology 2016; 61:2-10. [PMID: 27153747 DOI: 10.1016/j.neuro.2016.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/19/2022]
Abstract
Neurological conditions are among the leading causes of disability in the Canadian population and are associated with a large public health burden. An increase in life expectancy and a declining birth rate has resulted in an aging Canadian population, and the proportion of age-adjusted mortality due to non-communicable diseases has been steadily increasing. These conditions are frequently associated with chronic disability and an increasing burden of care for patients, their families and caregivers. The National Population Health Study of Neurological Conditions (NPHSNC) aims to improve knowledge about neurological conditions and their impacts on individuals, their families, caregivers and health care system. The Systematic Review of Determinants of Neurological Conditions, a specific objective within the NPHSNC, is a compendium of systematic reviews on risk factors affecting onset and progression of the following 14 priority neurological conditions: Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), brain tumours (BT), cerebral palsy (CP), dystonia, epilepsy, Huntington's disease (HD), hydrocephalus, multiple sclerosis (MS), muscular dystrophies (MD), neurotrauma, Parkinson's disease (PD), spina bifida (SB), and Tourette's syndrome (TS). The burden of neurological disease is expected to increase as the population ages, and this trend is presented in greater detail for Alzheimer's and Parkinson's disease because the incidence of these two common neurological diseases increases significantly with age over 65 years. This article provides an overview of burden of neurological diseases in Canada to set the stage for the in-depth systematic reviews of the 14 priority neurological conditions presented in subsequent articles in this issue.
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Affiliation(s)
- J Gaskin
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.
| | - J Gomes
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada; Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada; Environmental Health Research Unit, University of Ottawa, ON, Canada
| | - S Darshan
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada
| | - D Krewski
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, ON, Canada; Risk Sciences International, Ottawa, ON, Canada
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Measuring the Burden of Hospitalization in Patients with Parkinson´s Disease in Spain. PLoS One 2016; 11:e0151563. [PMID: 26977930 PMCID: PMC4792469 DOI: 10.1371/journal.pone.0151563] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 03/01/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This epidemiological survey estimates the hospitalization burden related to Parkinson´s Disease in Spain. METHODS This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalizations of patients with Parkinson´s disease that were reported from 1997-2012 were analyzed. Codes were selected using the 9th International Classification of Diseases: ICD-9-CM: 332.0. RESULTS A total of 438,513 hospital discharges of patients with Parkinson´s Disease were reported during the study period. The annual hospitalization rate was 64.2 cases per 100,000. The average length of hospital stay was 10 days. The trend for the annual hospitalization rate differed significantly depending on whether Parkinson´s disease was the main cause of hospitalization (n = 23,086, 1.14% annual increase) or was not the main cause of hospitalization (n = 415,427, 15.37% annual increase). The overall case-fatality rate among hospitalized patients was 10%. The case fatality rate among patient´s hospitalized with Parkinson´s disease as the main cause of hospitalization was 2.5%. The hospitalization rate and case-fatality rate significantly increased with age. The primary causes of hospitalization when Parkinson´s disease was not coded as the main cause of hospitalization were as follows: respiratory system diseases (24%), circulatory system diseases (19%), injuries and poisoning, including fractures (12%), diseases of the digestive system (10%) and neoplasms (5%). The annual average cost for National Health Care System was € 120 M, with a mean hospitalization cost of €4,378. CONCLUSIONS Parkinson´s disease poses a significant health threat in Spain, particularly in the elderly. While hospitalizations due to Parkinson´s Disease are relatively stable over time, the number of patients presenting with Parkinson´s disease as an important comorbidity has increased dramatically. Medical staff must be specifically trained to treat the particular needs of hospitalized patients suffering from Parkinson´s disease as an important comorbidity.
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A systematic review of interventions to reduce hospitalisation in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:3-7. [DOI: 10.1016/j.parkreldis.2016.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 11/22/2022]
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Measuring the burden and mortality of hospitalisation in Parkinson's disease: A cross-sectional analysis of the English Hospital Episodes Statistics database 2009–2013. Parkinsonism Relat Disord 2015; 21:449-54. [DOI: 10.1016/j.parkreldis.2015.01.017] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/12/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
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Butt DA, Tu K, Young J, Green D, Wang M, Ivers N, Jaakkimainen L, Lam R, Guttman M. A Validation Study of Administrative Data Algorithms to Identify Patients with Parkinsonism with Prevalence and Incidence Trends. Neuroepidemiology 2014; 43:28-37. [DOI: 10.1159/000365590] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022] Open
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Lakshminarayana R, Wang D, Burn D, Chaudhuri KR, Cummins G, Galtrey C, Hellman B, Pal S, Stamford J, Steiger M, Williams A. Smartphone- and internet-assisted self-management and adherence tools to manage Parkinson's disease (SMART-PD): study protocol for a randomised controlled trial (v7; 15 August 2014). Trials 2014; 15:374. [PMID: 25257518 PMCID: PMC4283131 DOI: 10.1186/1745-6215-15-374] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/18/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nonadherence to treatment leads to suboptimal treatment outcomes and enormous costs to the economy. This is especially important in Parkinson's disease (PD). The progressive nature of the degenerative process, the complex treatment regimens and the high rates of comorbid conditions make treatment adherence in PD a challenge. Clinicians have limited face-to-face consultation time with PD patients, making it difficult to comprehensively address non-adherence. The rapid growth of digital technologies provides an opportunity to improve adherence and the quality of decision-making during consultation. The aim of this randomised controlled trial (RCT) is to evaluate the impact of using a smartphone and web applications to promote patient self-management as a tool to increase treatment adherence and working with the data collected to enhance the quality of clinical consultation. METHODS/DESIGN A 4-month multicentre RCT with 222 patients will be conducted to compare use of a smartphone- and internet-enabled Parkinson's tracker smartphone app with treatment as usual for patients with PD and/or their carers. The study investigators will compare the two groups immediately after intervention. Seven centres across England (6) and Scotland (1) will be involved. The primary objective of this trial is to assess whether patients with PD who use the app show improved medication adherence compared to those receiving treatment as usual alone. The secondary objectives are to investigate whether patients who receive the app and those who receive treatment as usual differ in terms of quality of life, quality of clinical consultation, overall disease state and activities of daily living. We also aim to investigate the experience of those receiving the intervention by conducting qualitative interviews with a sample of participants and clinicians, which will be administered by independent researchers. TRIAL REGISTRATION ISRCTN45824264 (registered 5 November 2013).
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Affiliation(s)
| | - Duolao Wang
- />Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Burn
- />Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - K Ray Chaudhuri
- />Neurology/Movement Disorders, National Parkinson Foundation Centre of Excellence, King’s College Hospital, University Hospital Lewisham, Kings College and Institute of Psychiatry, London, UK
| | - Gemma Cummins
- />John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Clare Galtrey
- />St George’s Healthcare NHS Foundation Trust, London, UK
| | | | - Suvankar Pal
- />NHS Forth Valley, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | | | - Malcolm Steiger
- />University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Adrian Williams
- />University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - The SMART-PD Investigators
- />uMotif Ltd, London, UK
- />Liverpool School of Tropical Medicine, Liverpool, UK
- />Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
- />Neurology/Movement Disorders, National Parkinson Foundation Centre of Excellence, King’s College Hospital, University Hospital Lewisham, Kings College and Institute of Psychiatry, London, UK
- />John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- />St George’s Healthcare NHS Foundation Trust, London, UK
- />NHS Forth Valley, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- />The Cure Parkinson’s Trust, London, UK
- />University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
- />University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Affiliation(s)
- Tejal Patel
- University of Waterloo School of Pharmacy, Waterloo, Ontario
| | - Feng Chang
- University of Waterloo School of Pharmacy, Waterloo, Ontario
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Zeng J, Wei M, Li T, Chen W, Feng Y, Shi R, Song Y, Zheng W, Ma W. Risk of obstructive sleep apnea in Parkinson's disease: a meta-analysis. PLoS One 2013; 8:e82091. [PMID: 24349191 PMCID: PMC3857239 DOI: 10.1371/journal.pone.0082091] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022] Open
Abstract
STUDY OBJECTIVES Sleep disorders are a common symptom of Parkinson's disease (PD) and they significantly impair the sleep quality of the PD patients. However, there is no conclusive evidence to support the relation between PD and the prevalence of obstructive sleep apnea (OSA). The purpose of this meta-analysis review is to evaluate the association between PD and the prevalence of OSA. METHODS A comprehensive literature search was conducted on PubMed and Embase through July 2013. Only studies that referred to PD and the prevalence of OSA and that met the selection criteria were included in the analysis. The odds ratios (ORs) were used to evaluate the relationship of PD and the prevalence of OSA by the fixed-effect model. RESULTS Five eligible studies were analyzed in this study including 322 cases and 6,361 controls. The pooled-analysis showed the OR to be 0.60 (95% confidence interval (CI): 0.44 to 0.81, P = 0.001) and I(2) = 0.0% (χ(2) = 3.90, P = 0.420) in the fixed-effect model. CONCLUSIONS Although we only included five small sample studies that indicated high homogeneity in the heterogeneity test, the results suggest that there is a significant negative association between PD and the prevalence of OSA; PD patients generally have a reduced prevalence of OSA. According to our analysis, these results are primarily due to the lower BMI of PD patients when compared with the general population controls.
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Affiliation(s)
- Jun Zeng
- Institute of Genetic Engineering, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Min Wei
- Institute of Genetic Engineering, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Taoping Li
- Sleep Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wei Chen
- Department of Urology, Nanfang hospital, Southern Medical University, Guangzhou, Guangdong. P. R. China
| | - Yuan Feng
- Sleep Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Rong Shi
- Institute of Genetic Engineering, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Yanbin Song
- Institute of Genetic Engineering, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wenling Zheng
- Institute of Genetic Engineering, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wenli Ma
- Institute of Genetic Engineering, Southern Medical University, Guangzhou, Guangdong, P. R. China
- * E-mail:
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Eriksson AK, Löfving S, Callaghan RC, Allebeck P. Alcohol use disorders and risk of Parkinson's disease: findings from a Swedish national cohort study 1972-2008. BMC Neurol 2013; 13:190. [PMID: 24314068 PMCID: PMC4029307 DOI: 10.1186/1471-2377-13-190] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol has been suggested to be either protective of, or not associated with Parkinson's disease (PD). However, experimental animal studies indicate that chronic heavy alcohol consumption may have dopamine neurotoxic effects relevant for PD. We studied the association between diagnosed alcohol use disorders and PD. METHODS All individuals in Sweden admitted with a diagnosis of an alcohol use disorder or appendicitis (reference group) between January 1, 1972 and December 31, 2008 were identified through the Swedish National Inpatient Register, and followed for up to 37 years for a diagnosis of PD. We estimated hazard ratios (HR) with 95% confidence intervals (CI) and adjusted for age and sex. RESULTS We found 1,741 (0.3%) cases of PD in the cohort of 602,930 individuals, 1,083 (0.4%) among those admitted with an alcohol use disorder and 658 (0.2%) of the individuals admitted with appendicitis. The mean follow-up time was 13.6 and 17.1 years, respectively. The HR for PD associated with an alcohol use disorder was 1.38 (CI 1.25-1.53) adjusted for age and sex. When the risk was estimated in age groups for first hospital admission with PD the highest risk was observed in the lowest age group, ≤44, HR 2.39 (0.96-5.93), adjusted for age at exposure and sex. CONCLUSIONS A history of an alcohol use disorder conferred an increased risk of admission with a diagnosis of Parkinson's disease in both women and men. In particular, the risk seemed higher at lower ages of first admission with Parkinson's disease.
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Affiliation(s)
- Anna-Karin Eriksson
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
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Hassan A, Wu SS, Schmidt P, Dai Y, Simuni T, Giladi N, Bloem BR, Malaty IA, Okun MS. High rates and the risk factors for emergency room visits and hospitalization in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:949-54. [DOI: 10.1016/j.parkreldis.2013.06.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 06/02/2013] [Accepted: 06/13/2013] [Indexed: 11/28/2022]
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Dodel R, Jönsson B, Reese JP, Winter Y, Martinez-Martin P, Holloway R, Sampaio C, Růžička E, Hawthorne G, Oertel W, Poewe W, Stebbins G, Rascol O, Goetz CG, Schrag A. Measurement of costs and scales for outcome evaluation in health economic studies of Parkinson's disease. Mov Disord 2013; 29:169-76. [DOI: 10.1002/mds.25571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 01/09/2013] [Accepted: 02/01/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Richard Dodel
- Department of Neurology; Philipps-University Marburg; Marburg Germany
| | - Bengt Jönsson
- Department of Economics; Stockholm School of Economics; Stockholm Sweden
| | - Jens Peter Reese
- Department of Neurology; Philipps-University Marburg; Marburg Germany
| | - Yaroslav Winter
- Department of Neurology; Philipps-University Marburg; Marburg Germany
| | - Pablo Martinez-Martin
- Alzheimer Disease Research Unit and Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Research Center for Neurological Diseases (CIEN) Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation; Madrid Spain
| | - Robert Holloway
- Department of Neurology; University of Rochester Medical Center; Rochester New York USA
| | - Cristina Sampaio
- Clinical Pharmacology and Therapeutics, Faculdade de Medicina de Lisboa; Lisbon Portugal
| | - Evžen Růžička
- Department of Neurology; First Medical Faculty, Charles University in Prague; Prague Czech Republic
| | - Graeme Hawthorne
- Department of Psychiatry; The University of Melbourne; Melbourne Australia
| | - Wolfgang Oertel
- Department of Neurology; Philipps-University Marburg; Marburg Germany
| | - Werner Poewe
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University Medical Center; Chicago Illinois USA
| | - Oliver Rascol
- Laboratoire de Pharmacologie Medicale et Clinique; Toulouse France
| | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center; Chicago Illinois USA
| | - Anette Schrag
- Institute of Neurology, University College London; London United Kingdom
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Abstract
Increased α-synuclein levels and mutations in mitochondria-associated proteins both cause familial Parkinson's disease (PD), and synuclein and mitochondria also play central, but poorly understood, roles in the pathogenesis of idiopathic PD. A fraction of synuclein interacts with mitochondria, and synuclein can produce mitochondrial fragmentation and impair mitochondrial complex I activity. However, the consequences of these mitochondrial changes for bioenergetic and other mitochondrial functions remain poorly defined, as does the role of synuclein-mitochondria interactions in the normal and pathologic effects of synuclein. Understanding the functional consequences of synuclein's interactions with mitochondria is likely to provide important insights into disease pathophysiology, and may also reveal therapeutic strategies.
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Affiliation(s)
- Ken Nakamura
- Gladstone Institute of Neurological Disease, 1650 Owens Street, San Francisco, CA 94158, USA.
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49
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García-Ramos R, López Valdés E, Ballesteros L, Jesús S, Mir P. The social impact of Parkinson's disease in Spain: Report by the Spanish Foundation for the Brain. Neurologia 2013; 31:401-13. [PMID: 23816428 DOI: 10.1016/j.nrl.2013.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Understanding the social and economic impact of Parkinson's disease is essential for resource planning and raising social awareness. DEVELOPMENT Researchers reviewed the data published to date on epidemiology, morbidity and mortality, dependency, and economic impact of Parkinson's disease in Spain. In addition, a study has been carried out in order to define the public and private health care resources of Spanish patients affected by Parkinson's disease by means of an e-mail survey of all neurologists specialising in this disease and belonging to the Spanish Society of Neurology's study group for movement disorders. CONCLUSIONS The incidence and prevalence rates of Parkinson's disease in Spain are similar to those in the rest of Europe. According to current population estimates, there are at least 300.000 patients with Parkinson's disease and one new case per 10.000 habitants per year in Spain. This has a major impact on the patient's quality of life and nearly doubles patient mortality. In addition, the disease generates sizeable costs for the country that may exceed 17.000€ per year per patient; costs will rise due to the ageing of the population and the new therapies employed. Healthcare professionals and administrators dedicate their efforts to providing quality care to patients. Despite the above, we still have a long way to go in order to provide quality, efficient, multidisciplinary, and universal healthcare.
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Affiliation(s)
- R García-Ramos
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España.
| | - E López Valdés
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España
| | - L Ballesteros
- Servicio de Neurología, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - S Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), España
| | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), España
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Itoh K, Nakamura K, Iijima M, Sesaki H. Mitochondrial dynamics in neurodegeneration. Trends Cell Biol 2012; 23:64-71. [PMID: 23159640 DOI: 10.1016/j.tcb.2012.10.006] [Citation(s) in RCA: 358] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 09/18/2012] [Accepted: 10/03/2012] [Indexed: 12/21/2022]
Abstract
It has been only 15 years since studies began on the molecular mechanisms underlying mitochondrial fission and fusion using simple model organisms such as Drosophila, yeast, and Caenorhabditis elegans. Beyond the primary functions of mitochondrial fission and fusion in controlling organelle shape, size, and number, it became clear that these dynamic processes are also critical to regulating cell death, mitophagy, and organelle distribution. Now, studies suggest that prominent changes occur in mitochondrial dynamics in a broad array of neurodegenerative diseases, and there is substantial evidence suggesting a key role in disease pathogenesis because neurons are among the most energy-consuming cell types and have a highly developed cell shape. Here, we review the recent findings on mitochondrial dynamics in neurodegeneration.
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Affiliation(s)
- Kie Itoh
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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