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Jaramillo-Jimenez A, Bocanegra Y, Buriticá O, Pineda Salazar DA, Moreno Gómez L, Tobón Quintero CA, Aguirre-Acevedo DC, Sierra Castrillon M, Vasquez D, Velez-Hernandez JE, Borda MG, García-Cifuentes E, Aguillón DF, Madrigal-Zapata L, Aarsland D, Lopera F. Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:305-313. [PMID: 38065663 DOI: 10.1016/j.rcpeng.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/05/2021] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored. OBJECTIVE We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints. METHODS We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted. RESULTS PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores. CONCLUSIONS HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.
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Affiliation(s)
- Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Semillero de Investigación SINAPSIS, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Yamile Bocanegra
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Omar Buriticá
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - David Antonio Pineda Salazar
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | | | - Carlos Andrés Tobón Quintero
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Área de investigación e Innovación, Institución Prestadora de Servicios de Salud (IPS Universitaria), Medellín, Colombia
| | - Daniel Camilo Aguirre-Acevedo
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Melissa Sierra Castrillon
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Daniel Vasquez
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | | | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Elkin García-Cifuentes
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - David Fernando Aguillón
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Lucía Madrigal-Zapata
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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Long-term results of carbidopa/levodopa enteral suspension across the day in advanced Parkinson's disease: Post-hoc analyses from a large 54-week trial. Clin Park Relat Disord 2022; 8:100181. [PMID: 36594071 PMCID: PMC9803946 DOI: 10.1016/j.prdoa.2022.100181] [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: 07/18/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Carbidopa/levodopa enteral suspension (CLES) previously demonstrated reduction in total daily OFF from baseline by over 4 hours in advanced Parkinson's disease patients across 54 weeks. Evidence on CLES's long-term effectiveness on patterns of motor-symptom control throughout the day remains limited. Methods We present post-hoc analyses of a large, open-label study of CLES monotherapy (N = 289). Diary data recorded patients' motor states at 30-minute intervals over 3 days at baseline and weeks 4, 12, 24, 36, and 54. Adjusted generalized linear mixed models assessed changes from baseline at each timepoint for four outcome measures: time to ON without troublesome dyskinesia (ON-woTD) after waking, motor-symptom control as measured by motor states' durations throughout the day, number of motor-state transitions, and presence of extreme fluctuations (OFF to ON with TD). Results Patients demonstrated short-term (wk4) and sustained (wk54) improvement in all outcomes compared to baseline. At weeks 4 and 54, patients were more likely to reach ON-woTD over the course of their day (HR: 1.86 and 2.51, both P < 0.0001). Across 4-hour intervals throughout the day, patients also experienced increases in ON-woTD (wk4: 58-65 min; wk54: 60-78 min; all P < 0.0001) and reductions in OFF (wk4: 50-61 min; wk54: 56-68 min; all P < 0.0001). At weeks 4 and 54, patients' motor-state transitions were reduced by about half (IRR: 0.53 and 0.49, both P < 0.0001), and fewer patients experienced extreme fluctuations (OR: 0.22 and 0.15, both P < 0.0001). Conclusion CLES monotherapy was associated with significant long-term reductions in motor-state fluctuations, faster time to ON-woTD upon awakening, and increased symptom control throughout the day.
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Key Words
- ADL, Activities of daily living
- APD, Advanced Parkinson's disease
- CGI-S, Clinical Global Impression of disease severity
- CLES, Carbidopa/levodopa enteral suspension
- Carbidopa/levodopa enteral suspension
- Carbidopa/levodopa intestinal gel
- Duodopa
- Duopa
- Dyskinesia
- HR, Hazard ratio
- IRR, Incidence rate ratio
- Long-term effectiveness
- OFF, “Off” time
- ON, “On” time
- ON-wTD, “On” time with troublesome dyskinesia
- ON-woTD, “On” time without troublesome dyskinesia
- OR, Odds ratio
- PD, Parkinson’s disease
- PEG-J, Percutaneous endoscopic gastrojejunostomy
- Parkinson’s disease
- QoL, Quality of life
- RCT, Randomized controlled trial
- SD, Standard deviation
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Pahwa R, Aldred J, Gupta N, Terasawa E, Garcia-Horton V, Steffen DR, Kandukuri PL, Chaudhari VS, Jalundhwala YJ, Bao Y, Kukreja P, Isaacson SH. Patterns of Daily Motor-Symptom Control with Carbidopa/Levodopa Enteral Suspension Versus Oral Carbidopa/Levodopa Therapy in Advanced Parkinson's Disease: Clinical Trial Post Hoc Analyses. Neurol Ther 2022; 11:711-723. [PMID: 35192177 PMCID: PMC9095782 DOI: 10.1007/s40120-022-00332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction A clinical trial in advanced Parkinson’s disease (APD) has established the superiority of carbidopa/levodopa enteral suspension (CLES) in reducing total patient “off” time (OFF) and increasing total “on” time without troublesome dyskinesia (ON-woTD) over orally administered immediate-release carbidopa/levodopa tablets (IR–CL). However, temporal patterns of these improvements throughout the waking day have not been examined. In this analysis, time to ON-woTD after waking and patterns of motor-symptom control throughout the waking day were compared between CLES and IR–CL. Methods Post hoc analyses of APD patient-diary data from the phase 3 randomized controlled trial were used to compare changes in time to ON-woTD after waking, motor-symptom control throughout the waking day, occurrence of extreme fluctuations between OFF and “on” with troublesome dyskinesia, and motor-state transitions with CLES versus IR–CL from baseline to week 12. Results The sample included 33 CLES-treated and 30 IR–CL-treated patients. Among the CLES group, the percentage of patient days achieving ON-woTD within 30 min of waking was three times higher at week 12 versus baseline (33% vs. 11%, p = 0.0043); no significant change occurred with IR–CL. When the waking day was divided into four 4-h periods, CLES versus IR–CL treatment produced significantly greater reductions in OFF during three periods, and two periods had increased ON-woTD. Fewer CLES-treated patients had extreme fluctuations at week 12 (3% vs. 23%, p = 0.0224) compared to IR–CL-treated patients. From baseline to week 12, CLES-treated patients had greater reductions in the average number of motor-state transitions compared to IR–CL-treated patients (− 1.6, p = 0.0295). Conclusion CLES-treated patients experienced a more rapid onset of ON-woTD after waking and greater consistency of ON-woTD throughout their waking day than IR–CL-treated patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00332-0. In advanced Parkinson’s disease, patients’ motor-symptom states (such as “on” time without troublesome dyskinesia [good “on” time] and “off” time), and the timing at which they occur, can impact patients’ quality of life and ability to complete activities of daily living. Carbidopa/levodopa enteral suspension is administered continuously into the jejunum, potentially reducing some of the motor-state variation that is common with orally administered carbidopa/levodopa, including delayed “on” time after waking and transitions between “off” and “on” throughout the day. In post hoc analyses of clinical trial data, patterns of motor-states across the waking day were compared between carbidopa/levodopa enteral suspension and orally administered immediate-release carbidopa/levodopa at week 12. Outcomes included time to good “on” after waking; occurrence of extreme fluctuations between “off” time and “on” time with troublesome dyskinesia; time in each motor-state during 4-h intervals across the day; and frequency of motor-state transitions. Three times as many carbidopa/levodopa enteral suspension-treated patients achieved good “on” within 30 min of waking after 12 weeks versus baseline, whereas no significant change was observed for the orally administered immediate-release carbidopa/levodopa group. Compared to orally administered immediate-release carbidopa/levodopa-treated patients, fewer carbidopa/levodopa enteral suspension-treated patients experienced extreme fluctuations, had greater reductions in motor-state transitions, and greater reductions in duration of “off” during three of the four intervals in the day. These findings provide a first look at the impact of carbidopa/levodopa enteral suspension on motor-state patterns throughout the day, and suggest that carbidopa/levodopa enteral suspension provides more consistent motor-symptom control and predictable benefit throughout the day than orally administered carbidopa/levodopa.
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Affiliation(s)
- Rajesh Pahwa
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | | | | | | | | | | | | | | | | | | | | | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center, Boca Raton, FL, USA
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Hattori N, Takeda A, Hanya Y, Kitagawa T, Arai M, Furusawa Y, Mochizuki H, Nagai M, Takahashi R. Effects of rasagiline on Parkinson’s Disease Questionnaire (PDQ-39) emotional well-being domain in patients with Parkinson’s disease: A post-hoc analysis of clinical trials in Japan. PLoS One 2022; 17:e0262796. [PMID: 35077474 PMCID: PMC8789184 DOI: 10.1371/journal.pone.0262796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background
Identifying the factors that influence health-related quality of life (HRQoL) is of great scientific interest, but a potential causal relationship between treatment and HRQoL has yet to be fully elucidated. Japanese patients reported better HRQoL outcomes on the Parkinson’s Disease Questionnaire (PDQ-39) emotional well-being domain, a 6-question subset of the PDQ-39 which is considered to reflect the emotional aspects of the disease-specific HRQoL, when treated with rasagiline, than placebo, in both a monotherapy clinical trial (NCT02337725) and an adjunctive therapy clinical trial in patients with wearing-off phenomena (NCT02337738).
Objective
To investigate how rasagiline exerts its effect on the PDQ-39 emotional well-being domain in Japanese patients with Parkinson’s disease.
Methods
A path analysis was performed to assess the direct treatment effects of rasagiline on the PDQ-39 emotional well-being domain and the effects mediated indirectly through the influence on items related to motor symptoms by a post-hoc analysis of two clinical trials in Japan.
Results
In the monotherapy trial, the PDQ-39 emotional well-being domain was mainly affected indirectly through items related to motor symptoms (80.7%) composed of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part II (67.2%) and Part III (13.5%). In the adjunctive therapy trial, the PDQ-39 emotional well-being domain was also mainly influenced indirectly through effects on items related to motor symptoms (1 mg/day: 54.7%, 0.5 mg/day: 57.6%) composed of MDS-UPDRS Part II (1 mg/day: 35.6%, 0.5 mg/day: 40.9%), Part III (1 mg/day: 8.0%, 0.5 mg/day: 8.3%) and mean daily OFF-time (1 mg/day: 11.1%, 0.5 mg/day: 8.4%).
Conclusions
The effects of rasagiline on the PDQ-39 emotional well-being domain were mediated primarily by influence on the subjective aspects of motor experiences of daily living.
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Affiliation(s)
- Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
- * E-mail:
| | - Atsushi Takeda
- Department of Neurology, National Hospital Organization Sendai Nishitaga Hospital, Miyagi, Japan
- Department of Cognitive & Motor Aging, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yuki Hanya
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Tadayuki Kitagawa
- Japan Development Center, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Masaki Arai
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Yoshihiko Furusawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Nagai
- Clinical Research Support Center, Ehime University Hospital, Ehime, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Altwal F, Padovan-Neto FE, Ritger A, Steiner H, West AR. Role of 5-HT1A Receptor in Vilazodone-Mediated Suppression of L-DOPA-Induced Dyskinesia and Increased Responsiveness to Cortical Input in Striatal Medium Spiny Neurons in an Animal Model of Parkinson's Disease. Molecules 2021; 26:molecules26195790. [PMID: 34641332 PMCID: PMC8510243 DOI: 10.3390/molecules26195790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 01/06/2023] Open
Abstract
L-DOPA therapy in Parkinson’s disease (PD) is limited due to emerging L-DOPA-induced dyskinesia. Research has identified abnormal dopamine release from serotonergic (5-HT) terminals contributing to this dyskinesia. Selective serotonin reuptake inhibitors (SSRIs) or 5-HT receptor (5-HTr) agonists can regulate 5-HT activity and attenuate dyskinesia, but they often also produce a loss of the antiparkinsonian efficacy of L-DOPA. We investigated vilazodone, a novel multimodal 5-HT agent with SSRI and 5-HTr1A partial agonist properties, for its potential to reduce dyskinesia without interfering with the prokinetic effects of L-DOPA, and underlying mechanisms. We assessed vilazodone effects on L-DOPA-induced dyskinesia (abnormal involuntary movements, AIMs) and aberrant responsiveness to corticostriatal drive in striatal medium spiny neurons (MSNs) measured with in vivo single-unit extracellular recordings, in the 6-OHDA rat model of PD. Vilazodone (10 mg/kg) suppressed all subtypes (axial, limb, orolingual) of AIMs induced by L-DOPA (5 mg/kg) and the increase in MSN responsiveness to cortical stimulation (shorter spike onset latency). Both the antidyskinetic effects and reversal in MSN excitability by vilazodone were inhibited by the 5-HTr1A antagonist WAY-100635, demonstrating a critical role for 5-HTr1A in these vilazodone actions. Our results indicate that vilazodone may serve as an adjunct therapeutic for reducing dyskinesia in patients with PD.
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Affiliation(s)
- Feras Altwal
- Center for Neurodegenerative Disease & Therapeutics, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (F.A.); (A.R.W.)
- School of Graduate and Postdoctoral Studies, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
- Discipline of Neuroscience, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - Fernando E. Padovan-Neto
- Discipline of Neuroscience, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - Alexandra Ritger
- School of Graduate and Postdoctoral Studies, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
- Discipline of Neuroscience, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - Heinz Steiner
- Stanson Toshok Center for Brain Function and Repair, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
- Discipline of Cellular and Molecular Pharmacology, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
- Correspondence:
| | - Anthony R. West
- Center for Neurodegenerative Disease & Therapeutics, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (F.A.); (A.R.W.)
- Discipline of Neuroscience, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
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Jaramillo-Jimenez A, Bocanegra Y, Buriticá O, Pineda Salazar DA, Moreno Gómez L, Tobón Quintero CA, Aguirre-Acevedo DC, Sierra Castrillon M, Vasquez D, Velez-Hernandez JE, Borda MG, García-Cifuentes E, Aguillón DF, Madrigal-Zapata L, Aarsland D, Lopera F. Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00134-7. [PMID: 34489098 DOI: 10.1016/j.rcp.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored. OBJECTIVE We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints. METHODS We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted. RESULTS PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores. CONCLUSIONS HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.
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Affiliation(s)
- Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Semillero de Investigación SINAPSIS, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Yamile Bocanegra
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Omar Buriticá
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - David Antonio Pineda Salazar
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | | | - Carlos Andrés Tobón Quintero
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Área de investigación e Innovación, Institución Prestadora de Servicios de Salud (IPS Universitaria), Medellín, Colombia
| | - Daniel Camilo Aguirre-Acevedo
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Melissa Sierra Castrillon
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Daniel Vasquez
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | | | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Elkin García-Cifuentes
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - David Fernando Aguillón
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Lucía Madrigal-Zapata
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
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Hauser RA, Walsh RR, Pahwa R, Chernick D, Formella AE. Amantadine ER (Gocovri ®) Significantly Increases ON Time Without Any Dyskinesia: Pooled Analyses From Pivotal Trials in Parkinson's Disease. Front Neurol 2021; 12:645706. [PMID: 33841311 PMCID: PMC8032973 DOI: 10.3389/fneur.2021.645706] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Clinical trials for antiparkinsonian drugs aimed at managing motor complications typically use patient diaries to divide levodopa-induced dyskinesias (LID) into "troublesome" and "non-troublesome" categories. Yet, given the choice, most patients would prefer to live without experiencing any dyskinesia. However, the concept of evaluating time spent ON without any dyskinesia as an outcome has never been tested. We conducted analyses of pooled Gocovri pivotal trial data in order to evaluate the extent to which Gocovri increased the time PD patients spent ON without dyskinesia (troublesome or non-troublesome), beyond its already identified improvement in reducing troublesome dyskinesia. Methods: Patients enrolled in phase 3 trials (EASE LID [NCT02136914] or EASE LID 3 [NCT02274766]) recorded time spent in the following PD diary states at baseline and Week 12 (endpoint): asleep, OFF, ON with troublesome dyskinesia, ON with non-troublesome dyskinesia, and ON without dyskinesia. Mixed model repeated measures analyses with estimated Cohen D effect sizes were performed on the modified intent to treat population to evaluate changes in time spent in these states. Results: Patients randomized to receive Gocovri showed an increase in ON time without dyskinesia and corresponding decreases in ON time with dyskinesia and OFF time vs. placebo. Treatment effects were statistically significant for Gocovri vs. placebo starting at Week 2 and were sustained until Week 12. On MMRM analysis at Week 12, patients in the Gocovri group showed an adjusted mean ± SE increase over placebo of 2.9 ± 0.6 h in ON time without dyskinesia (Cohen D effect size 0.79) and an adjusted mean ± SE decrease of -1.9 ± 0.6 h in ON time with dyskinesia (troublesome + non-troublesome) (Cohen D effect size 0.49), that included a -1.5 ± 0.4 h placebo-adjusted reduction in ON time with troublesome dyskinesia and a -0.6 ± 0.4 h reduction in ON time with non-troublesome dyskinesia. OFF time was reduced by -1.0 ± 0.3 h compared to placebo. Conclusions: Gocovri treatment more than doubled the daily time patients spent ON without dyskinesia. These results suggest that the Gocovri treatment effect was driven by a reduction in overall motor complications including ON time with both troublesome and non-troublesome dyskinesia as well as time spent OFF.
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Affiliation(s)
- Robert A Hauser
- Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Ryan R Walsh
- Muhammad Ali Parkinson Center at Barrow Neurological Institute, Phoenix, AZ, United States
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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9
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Nakajima T, Suzuki Y, Miyaue N. Successful Management of Parkinson's Disease Dyskinesia During Local Anesthesia With Dexmedetomidine. Cureus 2021; 13:e13739. [PMID: 33842117 PMCID: PMC8020600 DOI: 10.7759/cureus.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dyskinesia is among the most problematic issues for local anaesthesia management in Parkinson's disease (PD) patients. We present a case of a patient with PD who underwent spinal anaesthesia while utilizing dexmedetomidine (DEX) to reduce dyskinesia during urological surgery. DEX stimulates α₂-adrenergic receptors, which works to reduce the dyskinesia in PD patients.
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Affiliation(s)
- Takamichi Nakajima
- Center for Medical Education and Training, Saiseikai Matsuyama Hospital, Matsuyama, JPN
| | - Yasuyuki Suzuki
- Anesthesiology, Saiseikai Matsuyama Hospital, Matsuyama, JPN
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10
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Hauser RA, Kremens DE, Elmer LW, Kreitzman DL, Walsh RR, Johnson R, Howard R, Nguyen JT, Patni R. Prevalence of Dyskinesia and OFF by 30-Minute Intervals Through the Day and Assessment of Daily Episodes of Dyskinesia and OFF: Novel Analyses of Diary Data from Gocovri Pivotal Trials. JOURNAL OF PARKINSONS DISEASE 2020; 9:591-600. [PMID: 31081793 PMCID: PMC6700613 DOI: 10.3233/jpd-181565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Parkinson’s disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life. Objective: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes. Methods: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials—analyzed for 17 hours following wake-up—at baseline and week 12. Results: Diaries were evaluable for 162 patients. At baseline, 67% of patients woke up OFF, with prevalence decreasing to 13% at 2 hours and then remaining relatively steady at ∼12% (range, 6–17%) across half-hour intervals thereafter. Troublesome dyskinesia prevalence rose steadily from 5% to 24% over the first 2 hours, then fluctuated between 20% and 44% through the rest of the waking day. At baseline, patients experienced a mean of 3.0 daily episodes of troublesome dyskinesia (average duration 2.0 hours each), and 2.2 daily episodes of OFF (average duration 1.1 hour each). At week 12, Gocovri-treated patients showed greater reductions than placebo in troublesome dyskinesia and OFF episodes per day (treatment difference: –1.0 episodes and –0.4 episodes, respectively) and average episode duration (treatment difference: –0.6 hours and –0.3 hours, respectively). Mean duration of individual episodes of ON without troublesome dyskinesia (Good ON) increased by 5.0 hours for Gocovri, compared with 2.0 hours for placebo. Patients taking Gocovri experienced 2.2 fewer transitions between states than patients taking placebo. Conclusions: Troublesome dyskinesia and OFF occurred in the morning and throughout the waking day. Gocovri-treated patients experienced fewer, shorter episodes of both troublesome dyskinesia and OFF, thereby increasing the duration of continuous Good ON episodes and reducing the frequency of transitions between motor states.
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Affiliation(s)
| | | | | | - David L Kreitzman
- Parkinson's Disease and Movement Disorders Center of Long Island, Commack, NY, USA
| | - Ryan R Walsh
- Muhammad Ali Parkinson Center at Barrow Neurological Institute, Phoenix, AZ, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | | | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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11
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Cenci MA, Riggare S, Pahwa R, Eidelberg D, Hauser RA. Dyskinesia matters. Mov Disord 2019; 35:392-396. [PMID: 31872501 DOI: 10.1002/mds.27959] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Abstract
Levodopa-induced dyskinesia (LID) represents a significant source of discomfort for people with Parkinson's disease (PD). It negatively affects quality of life, it is associated with both motor and nonmotor fluctuations, and it brings an increased risk of disability, balance problems, and falls. Although the prevalence of severe LID appears to be lower than in previous eras (likely owing to a more conservative use of oral levodopa), we have not yet found a way to prevent the development of this complication. Advanced surgical therapies, such as deep brain stimulation, ameliorate LID, but only a minority of PD patients qualify for these interventions. Although some have argued that PD patients would rather be ON with dyskinesia than OFF, the deeper truth is that patients would very much prefer to be ON without dyskinesia. As researchers and clinicians, we should aspire to make that goal a reality. To this end, translational research on LID is to be encouraged and persistently pursued. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- M Angela Cenci
- Basal Ganglia Pathophysiology Unit, Dept. of Experimental Medical Science, Lund University, Lund, Sweden
| | - Sara Riggare
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Rajesh Pahwa
- University of Kansas Medical Center, Movement Disorders Division, Kansas City, Kansas, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Robert A Hauser
- University of South Florida, Department of Neurology, Tampa, Florida, USA
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12
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Balestrino R, Hurtado-Gonzalez CA, Stocchi F, Radicati FG, Chaudhuri KR, Rodriguez-Blazquez C, Martinez-Martin P. Applications of the European Parkinson's Disease Association sponsored Parkinson's Disease Composite Scale (PDCS). NPJ PARKINSONS DISEASE 2019; 5:26. [PMID: 31798050 PMCID: PMC6881347 DOI: 10.1038/s41531-019-0097-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/18/2019] [Indexed: 12/31/2022]
Abstract
This study was addressed to determine the presence of Parkinson disease (PD) manifestations, their distribution according to motor subtypes, and the relationships with health-related quality of life (QoL) using the recently validated European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). Frequency of symptoms was determined by the scores of items (present if >0). Using ROC analysis and Youden method, MDS-UPDRS motor subtypes were projected on the PDCS to achieve a comparable classification based on the PDCS scores. The same method was used to estimate severity levels from other measures in the study. The association between the PDCS and QoL (PDQ-39) was analyzed by correlation and multiple linear regression. The sample consisted of 776 PD patients. We found that the frequency of PD manifestations with PDCS and MDS-UPDRS were overlapping, the average difference between scales being 5.5% only. Using the MDS-UPDRS subtyping, 215 patients (27.7%) were assigned as Tremor Dominant (TD), 60 (7.7%) Indeterminate, and 501 (64.6%) Postural Instability and Gait Difficulty (PIGD) in this cohort. With this classification as criterion, the analogous PDCS-based ratio provided these cut-off values: TD subtype, ≥1.06; Indeterminate, <1.06 but >0.65; and PIGD, <0.65. The agreement between the two scales on this classification was substantial (87.6%; kappa = 0.69). PDCS total score cut-offs for PD severity were: 23/24 for mild/moderate and 41/42 for moderate/severe. Moderate to high correlations (r = 0.35–0.80) between PDCS and PDQ-39 were obtained, and the four PDCS domains showed a significant independent influence on QoL. The conclusions are: (1) the PDCS assessed the frequency of PD symptoms analogous to the MDS-UPDRS; (2) motor subtypes and severity levels can be determined with the PDCS; (3) a significant association between PDCS and QoL scores exists.
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Affiliation(s)
| | - Carlos Alberto Hurtado-Gonzalez
- 2Facultad de Psicología, Universidad Cooperativa de Colombia, Seccional Cali, and Facultad de Medicina, Universidad Libre, Cali, Colombia
| | - Fabrizio Stocchi
- 3Institute for Research and Medical Care, IRCCS, San Raffaele, Rome, Italy
| | | | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,5Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK
| | | | - Pablo Martinez-Martin
- 6National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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13
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Chu SY, Tan CL. Perception on the Quality of Life, Communication and Life Satisfaction among Individuals with Parkison's and Their Caregivers. Ethiop J Health Sci 2019; 29:551-558. [PMID: 31666775 PMCID: PMC6813271 DOI: 10.4314/ejhs.v29i5.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/07/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Speech impairment, which reduces Quality of Life (QOL), frequently occurs in individuals with Parkinson's disease (PD). As speaking is required for social interaction, speech impairment can reduce one's life satisfaction. Although QOL has been well-studied in individuals with PD, the QOL of their caregivers has seldom been investigated. This study compared the QOL of individuals with PD and their caregivers. The relationships between QOL, self-rated speech scale, and life satisfaction level were examined. METHOD A total of 20 individuals with PD and their caregivers completed the Parkinson's disease Questionnaire-39 (PDQ-39) scale and the Life Satisfaction Scale (LSS). In addition, PD participants were asked to complete the Self-Rated Speech Scale (SRSS) to rate their speech intelligibility. RESULT PD participants reported significantly lower QOL scores than their caregivers. However, there was no difference between the two groups on the social support and stigma dimensions, indicating that both groups reported similar levels of social support and stigma in their daily lives. A moderate significant correlation was observed between the LSS and PDQ-39 scores in the PD group, suggesting that life satisfaction could affect their QOL. Moreover, moderate correlation was found between the LSS and SRSS, showing that participants self-reported speech intelligibility has an impact on their life satisfaction. CONCLUSION In general, individuals with PD showed lower QOL than their caregivers. Given that the SRSS, LSS and QOL are moderately correlated, identifying patients' perception on their speech intelligibility and life satisfaction could help clinicians to better understand their patients' needs when delivering speech therapy services.
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Affiliation(s)
- Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme, KUALA LUMPUR, Malaysia
| | - Chai Li Tan
- Faculty of Health Sciences, Speech Sciences Programme, KUALA LUMPUR, Malaysia
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14
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Chu SY, Tan CL. Subjective Self-Rated Speech Intelligibility and Quality of Life in Patients with Parkinson’s Disease in a Malaysian Sample. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/1874944501811010485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives:
This study compared the Quality of Life (QOL) of individuals with Parkinson’s disease (PD) with a healthy control from a sample in Malaysia. The relationship between the QOL, age, gender, duration of disease, self-rated speech scale, and life satisfaction level was examined.
Methods:
Fifty-four individuals with PD and 55 non-PD control adults completed the Parkinson’s Disease Questionnaire-39 (PDQ-39) and rated their speech intelligibility [Self-Rated Speech Scale (SRSS)] and life satisfaction level [Life Satisfaction Scale (LSS)] on a 10-point scale.
Results:
PD participants reported significantly lower QOL scores than the control group (Mann-Whitney U). Although there was no significant relationship between the QOL, age, gender, and duration of disease for PD participants, moderately significant correlations were observed between QOL, LSS and SRSS ratings (Spearman correlation). Individuals with PD showed lower QOL and higher concern in their communication than the control group.
Conclusion:
Identifying patients’ perception of their speech performance could help clinicians to better understand patients’ needs when delivering speech therapy services.
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15
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Galeoto G, Colalelli F, Massai P, Berardi A, Tofani M, Pierantozzi M, Servadio A, Fabbrini A, Fabbrini G. Quality of life in Parkinson's disease: Italian validation of the Parkinson's Disease Questionnaire (PDQ-39-IT). Neurol Sci 2018; 39:1903-1909. [PMID: 30088166 DOI: 10.1007/s10072-018-3524-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/03/2018] [Indexed: 12/24/2022]
Abstract
Translation and cross-cultural adaptation of the 39-item Parkinson's Disease Questionnaire (PDQ-39) to the Italian culture was performed by Oxford University Innovation in 2008, but this version has never been validated. Therefore, we performed the process of validation of the Italian version of the PDQ-39 (PDQ-39-IT) following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. The translated PDQ-39-IT was tested with 104 patients diagnosed with Parkinson's disease (PD) who were recruited between June and October 2017. The mean age of the participants was 65.7 ± 10.2 years, and the mean duration of symptoms was 7.4 ± 5.3 years. The internal consistency of the PDQ-39-IT was assessed by Cronbach's alpha and ranged from 0.69 to 0.92. In an assessment of test-retest reliability in 35 of the 104 patients, the infraclass correlation coefficient (ICC) ranged from 0.85 to 0.96 for the various subitems of the PDQ-39-IT (all p < 0.01). Spearman's rank correlation coefficient for the validity of the PDQ-39-IT and the Italian version of the 36-Item Short Form (SF-36) was - 0.50 (p < 0.01). The results show that the PDQ-39-IT is a reliable and valid tool to assess the impact of PD on functioning and well-being. Thus, the PDQ-39-IT can be used in clinical and research practice to assess this construct and to evaluate the overall effect of different treatments in Italian PD patients.
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Affiliation(s)
- Giovanni Galeoto
- Department of Public Health, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Marco Tofani
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Annamaria Servadio
- Department of Health Professions, "Tor Vergata" University of Rome, Rome, Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy. .,IRCCS Neuromed, Pozzilli, IS, Italy.
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16
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Ferrazzoli D, Ortelli P, Madeo G, Giladi N, Petzinger GM, Frazzitta G. Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson's disease rehabilitation. Neurosci Biobehav Rev 2018; 90:294-308. [PMID: 29733882 DOI: 10.1016/j.neubiorev.2018.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions, affecting the motor behaviour. We summarize evidence that the interplay between motor and cognitive approaches is crucial in PD rehabilitation. Rehabilitation is complementary to pharmacological therapy and effective in reducing the PD disturbances, probably acting by inducing neuroplastic effects. The motor behaviour results from a complex integration between cortical and subcortical areas, underlying the motor, cognitive and motivational aspects of movement. The close interplay amongst these areas makes possible to learn, control and express habitual-automatic actions, which are dysfunctional in PD. The physiopathology of PD could be considered the base for the development of effective rehabilitation treatments. As the volitional action control is spared in early-medium stages of disease, rehabilitative approaches engaging cognition permit to achieve motor benefits and appear to be the most effective for PD. We will point out data supporting the relevance of targeting both motor and cognitive aspects in PD rehabilitation. Finally, we will discuss the role of cognitive engagement in motor rehabilitation for PD.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Graziella Madeo
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Centre, Sieratzki Chair in Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, CA, 90033, United States; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, United States.
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
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17
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Perez-Lloret S, Rascol O. Efficacy and safety of amantadine for the treatment of L-DOPA-induced dyskinesia. J Neural Transm (Vienna) 2018; 125:1237-1250. [PMID: 29511826 DOI: 10.1007/s00702-018-1869-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/27/2018] [Indexed: 12/19/2022]
Abstract
L-DOPA induced dyskinesias (LIDs) may affect up to 40% of Parkinson's disease (PD) and impact negatively health-related quality of life. Amantadine has demonstrated significant antidyskinetic effects in animal PD models and in randomized double-blind placebo-controlled trials (RCTs) in patients with PD. These effects are thought to be related to the blockade of NMDA receptors modulating cortico-striatal glutamatergic-dopaminergic interactions involved in the genesis of LIDs. There are three pharmaceutical forms of amantadine currently available in the market: an oral immediate-release (IR) formulation, which is widely available; an extended-release (ER) formulation (ADS-5102) which has been recently developed and approved by the FDA; and an intravenous infusion (IV) solution, which is not commonly used in clinical practice. RCTs with amantadine IR or ER, involving more than 650 patients have shown consistent and long-lasting reductions in LIDs. Interestingly, ADS-5102 not only reduced LIDs, but also reduced significantly at the same time the duration of daily OFF-time, a unique finding compared with other antiparkinsonian medications that usually reduce time spent OFF at the cost of worsening of LIDs. Amantadine IR might also have possible effects on other PD symptoms such as apathy or fatigue. The most common adverse reactions with amantadine are constipation, cardiovascular dysfunction including QT prolongation, orthostatic hypotension and edema, neuropsychiatric symptoms such as hallucinations, confusion and delirium, nausea and livedo reticularis. Corneal degeneration is rare but critical. In summary, amantadine immediate and extended-release are effective and safe for the treatment of LIDs.
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Affiliation(s)
- Santiago Perez-Lloret
- Institute of Cardiology Research, University of Buenos Aires, National Research Council (CONICET-ININCA), Buenos Aires, Argentina
| | - Olivier Rascol
- University of Toulouse 3, CHU of Toulouse, Toulouse, France. .,INSERM, Department of Clinical Pharmacology and Neurosciences, Faculty of Medicine, Centre d'Investigation Clinique CIC1436, Centre Expert Parkinson de Toulouse, 37 Allées Jules Guesde, 31000, Toulouse, France. .,NeuroToul Center of Excellence in Neurodegeneration (COEN), Toulouse, France.
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18
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Perez-Lloret S, Negre-Pages L, Damier P, Delval A, Derkinderen P, Destée A, Meissner WG, Tison F, Rascol O. L-DOPA-induced dyskinesias, motor fluctuations and health-related quality of life: the COPARK survey. Eur J Neurol 2017; 24:1532-1538. [PMID: 28940893 DOI: 10.1111/ene.13466] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Studies assessing the correlations between L-DOPA-induced dyskinesias (LIDs) and motor fluctuations with health-related quality of life (HRQoL) in Parkinson's disease (PD) have yielded conflicting results. This study aimed to assess the relationship between LIDs and motor fluctuations with HRQoL in patients with PD, and to assess the relative contribution of their severity and duration in a large sample of patients with PD. METHODS A total of 683 patients with PD from the COPARK survey were evaluated. HRQoL was assessed using the 39-Item Parkinson's Disease Questionnaire (PDQ-39) (primary outcome) and 36-Item Short Form Survey (SF-36). The daily duration and severity of LIDs were obtained from Unified Parkinson's Disease Rating Scale (UPDRS) IV items 32 and 33, respectively. The daily duration of motor fluctuations was obtained from UPDRS IV item 36 and severity was estimated as the difference between the UPDRS 2 (Activities of Daily Living) score in 'OFF' versus 'ON' condition. RESULTS A total of 235 patients with PD (35%) experienced motor fluctuations and 182 (27%) experienced LIDs. The PDQ-39 total and SF-36 physical scores were significantly worse in patients with LIDs, after adjusting for the presence of motor fluctuations. The PDQ-39 total score and SF-36 physical and mental score were significantly worse in patients with motor fluctuations, after adjusting for the presence of LIDs. The severity of LIDs and the duration of motor fluctuations significantly and independently affected PDQ-39 scores. The SF-36 physical score was affected only by the severity of motor fluctuations, whereas the mental score was not affected by any of the aforementioned variables. CONCLUSION Our findings suggest that LIDs (mainly their severity) and motor fluctuations (mainly their duration) correlate independently with HRQoL in patients with PD.
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Affiliation(s)
- S Perez-Lloret
- INSERM, Services de Pharmacologie Clinique et Neurosciences, Centre d'Investigation Clinique CIC 1436, NS-Park/FCRIN Network, NeuroToul COEN Center, Université de Toulouse UPS, CHU de Toulouse, Toulouse, France.,Institute of Cardiology Research, University of Buenos Aires, National Research Council (CONICET-ININCA), Buenos Aires, Argentina
| | - L Negre-Pages
- LN Pharma, Toulouse.,Département d'Information Médicale, Unité de Recherche Clinique et Epidémiologie, Hôpital la Colombière, Montpellier
| | - P Damier
- Department of Neurology, INSERM, NS-Park/FCRIN Network, Université de Nantes, CHU de Nantes, Nantes
| | - A Delval
- Department of Neurology, INSERM, NS-Park/FCRIN Network, Université de Lille, CHU de Lille, U 837 Eq6, Lille
| | - P Derkinderen
- Department of Neurology, INSERM, NS-Park/FCRIN Network, Université de Nantes, CHU de Nantes, Nantes
| | - A Destée
- Department of Neurology, INSERM, NS-Park/FCRIN Network, Université de Lille, CHU de Lille, U 837 Eq6, Lille
| | - W G Meissner
- CNRS, CHU de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Service de Neurologie, NS-Park/FCRIN Network, Université de Bordeaux, Bordeaux, France
| | - F Tison
- CNRS, CHU de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Service de Neurologie, NS-Park/FCRIN Network, Université de Bordeaux, Bordeaux, France
| | - O Rascol
- INSERM, Services de Pharmacologie Clinique et Neurosciences, Centre d'Investigation Clinique CIC 1436, NS-Park/FCRIN Network, NeuroToul COEN Center, Université de Toulouse UPS, CHU de Toulouse, Toulouse, France
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19
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Fox SH, Metman LV, Nutt JG, Brodsky M, Factor SA, Lang AE, Pope LE, Knowles N, Siffert J. Trial of dextromethorphan/quinidine to treat levodopa-induced dyskinesia in Parkinson's disease. Mov Disord 2017; 32:893-903. [PMID: 28370447 DOI: 10.1002/mds.26976] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/18/2017] [Accepted: 02/02/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nondopaminergic pathways represent potential targets to treat levodopa-induced dyskinesia in Parkinson's disease (PD). This pilot-study (NCT01767129) examined the safety/efficacy of the sigma-1 receptor-agonist and glutamatergic/monoaminergic modulator, dextromethorphan plus quinidine (to inhibit rapid dextromethorphan metabolism), for treating levodopa-induced dyskinesia. METHODS PD patients were randomized to dextromethorphan/quinidine (45 mg/10 mg twice daily)/placebo in two 2-week double-blind, crossover treatment periods, with intervening 2-week washout. After 14 days, a 2-hour intravenous levodopa-infusion was administered. Patient examinations were videotaped before infusion ("off" state) and every 30 minutes during and afterwards until patients returned to "off." The primary endpoint was dyskinesia-severity during infusion measured by Unified Dyskinesia Rating Scale part 3 area-under-curve scores (blinded expert rated). Additional endpoints included other dyskinesia/motor assessments, global measures of clinical-change, and adverse-events. RESULTS A total of 13 patients were randomized and completed the study (efficacy-evaluable population). Dyskinesia-severity was nonsignificantly lower with dextromethorphan/quinidine than placebo during infusion (area-under-curve 966.5 vs 1048.8; P = .191 [efficacy-evaluable patients]), and significantly lower in a post-hoc sensitivity analysis of the per-protocol-population (efficacy-evaluable patients with ≥ 80% study-drug-compliance, n = 12) when measured from infusion start to 4-hours post-infusion completion (area-under-curve 1585.0 vs 1911.3; P = .024). Mean peak dyskinesia decreased significantly from infusion-start to return to "off" (13.3 vs 14.9; P = .018 [efficacy-evaluable patients]). A total of 9 patients rated dyskinesia "much/very much improved" on dextromethorphan/quinidine versus 1-patient on placebo. Dextromethorphan/quinidine did not worsen PD-motor scores, was generally well tolerated, and was associated with more frequent adverse events. CONCLUSION This study provides preliminary evidence of clinical benefit with dextromethorphan/quinidine for treating levodopa-induced dyskinesia in PD. Larger studies with a longer treatment duration need to corroborate these early findings. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Susan H Fox
- The Edmond J Safra Program in Parkinson's Disease, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - John G Nutt
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | - Anthony E Lang
- The Edmond J Safra Program in Parkinson's Disease, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Laura E Pope
- Avanir Pharmaceuticals, Inc, Aliso Viejo, California, USA
| | - Nadine Knowles
- Avanir Pharmaceuticals, Inc, Aliso Viejo, California, USA
| | - João Siffert
- Avanir Pharmaceuticals, Inc, Aliso Viejo, California, USA
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Alberico SL, Kim YC, Lence T, Narayanan NS. Axial levodopa-induced dyskinesias and neuronal activity in the dorsal striatum. Neuroscience 2016; 343:240-249. [PMID: 27956068 DOI: 10.1016/j.neuroscience.2016.11.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 12/17/2022]
Abstract
Levodopa-induced dyskinesias are abnormal involuntary movements that limit the effectiveness of treatments for Parkinson's disease. Although dyskinesias involve the striatum, it is unclear how striatal neurons are involved in dyskinetic movements. Here we record from striatal neurons in mice during levodopa-induced axial dyskinesias. We developed an automated 3-dimensional motion tracking system to capture the development of axial dyskinesias at ∼10ms resolution, and correlated these movements with neuronal activity of striatal medium spiny neurons and fast-spiking interneurons. The average firing rate of medium spiny neurons increased as axial dyskinesias developed, and both medium spiny neurons and fast-spiking interneurons were modulated around axial dyskinesias. We also found that delta field potential power increased in the striatum with dyskinesia, and that this increased delta power coupled with striatal neurons. Our findings provide insight into how striatal networks change as levodopa-induced dyskinesias develop, and suggest that increased medium spiny neuron firing, increased delta field potential power, and abnormal delta-coupling may be neurophysiological signatures of dyskinesias. These data could be helpful in understanding the role of the striatum in the pathogenesis of dyskinesias in Parkinson's disease.
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Affiliation(s)
- Stephanie L Alberico
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Young-Cho Kim
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Tomas Lence
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Nandakumar S Narayanan
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States.
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Quality of life in patients with PD and their caregiving spouses: A view from both sides. Clin Neurol Neurosurg 2015; 139:24-8. [DOI: 10.1016/j.clineuro.2015.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 04/01/2015] [Accepted: 08/22/2015] [Indexed: 11/19/2022]
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Moldovan AS, Groiss SJ, Elben S, Südmeyer M, Schnitzler A, Wojtecki L. The treatment of Parkinson's disease with deep brain stimulation: current issues. Neural Regen Res 2015; 10:1018-22. [PMID: 26330809 PMCID: PMC4541217 DOI: 10.4103/1673-5374.160094] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 11/04/2022] Open
Abstract
Deep brain stimulation has become a well-established symptomatic treatment for Parkinson's disease during the last 25 years. Besides improving motor symptoms and long-term motor complications, positive effects on patients' mobility, activities of daily living, emotional well-being and health-related quality of life have been recognized. Apart from that, numerous clinical trials analyzed effects on non-motor symptoms and side effects of deep brain stimulation. Several technical issues and stimulation paradigms have been and are still being developed to optimize the therapeutic effects, minimize the side effects and facilitate handling. This review summarizes current therapeutic issues, i.e., patient and target selection, surgical procedure and programming paradigms. In addition it focuses on neuropsychological effects and side effects of deep brain stimulation.
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Affiliation(s)
- Alexia-Sabine Moldovan
- Center for Movement Disorders and Neuromodulation, Department of Neurology, University Hospital Düsseldorf, Germany & Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Stefan Jun Groiss
- Center for Movement Disorders and Neuromodulation, Department of Neurology, University Hospital Düsseldorf, Germany & Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Saskia Elben
- Center for Movement Disorders and Neuromodulation, Department of Neurology, University Hospital Düsseldorf, Germany & Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Martin Südmeyer
- Center for Movement Disorders and Neuromodulation, Department of Neurology, University Hospital Düsseldorf, Germany & Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Alfons Schnitzler
- Center for Movement Disorders and Neuromodulation, Department of Neurology, University Hospital Düsseldorf, Germany & Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Lars Wojtecki
- Center for Movement Disorders and Neuromodulation, Department of Neurology, University Hospital Düsseldorf, Germany & Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
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Mordin M, Masaquel C, Abbott C, Copley-Merriman C. Factors affecting the health-related quality of life of patients with cervical dystonia and impact of treatment with abobotulinumtoxinA (Dysport): results from a randomised, double-blind, placebo-controlled study. BMJ Open 2014; 4:e005150. [PMID: 25324317 PMCID: PMC4201999 DOI: 10.1136/bmjopen-2014-005150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To describe the health-related quality of life (HRQOL) burden of cervical dystonia (CD) and report on the HRQOL and patient perception of treatment benefits of abobotulinumtoxinA (Dysport). DESIGN The safety and efficacy of a single injection of abobotulinumtoxinA for CD treatment were evaluated in a previously reported international, multicenter, double-blind, randomised trial. HRQOL measures were assessed in the trial and have not been previously reported. SETTING Movement disorder clinics in the USA and Russia. PARTICIPANTS Patients had to have a diagnosis of CD with symptoms for at least 18 months, as well as a total Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score of at least 30; a Severity domain score of at least 15; and a Disability domain score of at least 3. Key exclusion criteria included treatment with botulinum toxin type A (BoNT-A) or botulinum toxin type B (BoNT-B) within 16 weeks of enrolment. INTERVENTIONS Patients were randomised to receive either 500 U abobotulinumtoxinA (n=55) or placebo (n=61). PRIMARY AND SECONDARY OUTCOME MEASURES Efficacy assessments included TWSTRS total (primary end point) and subscale scores at weeks 0, 4, 8, 12; a pain visual analogue scale at weeks 0 and 4; and HRQOL assessed by the SF-36 Health Survey (SF-36; secondary end point) at weeks 0 and 8. RESULTS Patients with CD reported significantly greater impairment for all SF-36 domains relative to US norms. Patients treated with abobotulinumtoxinA reported significantly greater improvements in Physical Functioning, Role Physical, Bodily Pain, General Health and Role Emotional domains than placebo patients (p≤0.03 for all). The TWSTRS was significantly correlated with Physical Functioning, Role Physical and Bodily Pain scores, for those on active treatment. CONCLUSIONS CD has a marked impact on HRQOL. Treatment with a single abobotulinumtoxinA injection results in significant improvement in patients' HRQOL. TRIAL REGISTRATION NUMBER The trial is registered at ClinicalTrials.gov, numbers NCT00257660 and NCT00288509.
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Affiliation(s)
- Margaret Mordin
- Market Access and Outcomes Strategy, RTI Health Solutions, Ann Arbor, Michigan, USA
| | - Catherine Masaquel
- Market Access and Outcomes Strategy, RTI Health Solutions, Ann Arbor, Michigan, USA
| | - Chandra Abbott
- Neurology Medical Affairs, Ipsen Biopharmaceuticals Inc, Basking Ridge, New Jersey, USA
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Validation of the Korean version of the 39-Item Parkinson's Disease Questionnaire (PDQ-39). Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:67-74. [DOI: 10.1016/j.anr.2014.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/06/2013] [Accepted: 11/18/2013] [Indexed: 11/21/2022] Open
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Martínez-Martín P. Health-related quality of life in Parkinson’s disease: outcomes of the therapeutic interventions. Expert Rev Pharmacoecon Outcomes Res 2014; 1:99-108. [DOI: 10.1586/14737167.1.1.99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Pablo Martínez-Martín
- Section of Neuroepidemiology,Área de Epidemiología Aplicada,Centro Nacional de Epidemiología,Instituto de Salud Carlos III,C/Sinesio Delgado, 4,28029 – Madrid, Spain.
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McKee KE, Hackney ME. The effects of adapted tango on spatial cognition and disease severity in Parkinson's disease. J Mot Behav 2013; 45:519-29. [PMID: 24116748 DOI: 10.1080/00222895.2013.834288] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors determined effects of community-based adapted tango on spatial cognition and disease severity in Parkinson's disease (PD) while controlling for the effects of social interaction. Thirty-three individuals with mild-to-moderate PD (stage I-III) were assigned to twenty 90-min tango (n = 24) or education (n = 9) lessons over 12 weeks. Disease severity, spatial cognition, balance, and fall incidence were evaluated pre-, post-, and 10-12 weeks postintervention. The authors evaluated differences using t tests and analyses of variance. Twenty-three tango and 8 education participants finished. Tango participants improved on disease severity (p = .008), and spatial cognition (p = .021) compared with education participants. Tango participants also improved in balance (p = .038), and executive function (p = .012). Gains were maintained 10-12 weeks postintervention. Multimodal exercise with structured syllabi may improve disease severity and spatial cognition in PD.
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Affiliation(s)
- Kathleen E McKee
- a Department of Neurology , Massachusetts General Hospital , Cambridge
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Daneault JF, Carignan B, Sadikot AF, Panisset M, Duval C. Drug-induced dyskinesia in Parkinson's disease. Should success in clinical management be a function of improvement of motor repertoire rather than amplitude of dyskinesia? BMC Med 2013; 11:76. [PMID: 23514355 PMCID: PMC3751666 DOI: 10.1186/1741-7015-11-76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 03/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dyskinesia, a major complication in the treatment of Parkinson's disease (PD), can require prolonged monitoring and complex medical management. DISCUSSION The current paper proposes a new way to view the management of dyskinesia in an integrated fashion. We suggest that dyskinesia be considered as a factor in a signal-to-noise ratio (SNR) equation where the signal is the voluntary movement and the noise is PD symptomatology, including dyskinesia. The goal of clinicians should be to ensure a high SNR in order to maintain or enhance the motor repertoire of patients. To understand why such an approach would be beneficial, we first review mechanisms of dyskinesia, as well as their impact on the quality of life of patients and on the health-care system. Theoretical and practical bases for the SNR approach are then discussed. SUMMARY Clinicians should not only consider the level of motor symptomatology when assessing the efficacy of their treatment strategy, but also breadth of the motor repertoire available to patients.
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Affiliation(s)
- Jean-François Daneault
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
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Chaudhuri KR, Rizos A, Sethi KD. Motor and nonmotor complications in Parkinson's disease: an argument for continuous drug delivery? J Neural Transm (Vienna) 2013; 120:1305-20. [PMID: 23456290 PMCID: PMC3751411 DOI: 10.1007/s00702-013-0981-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/13/2013] [Indexed: 01/19/2023]
Abstract
The complications of long-term levodopa therapy for Parkinson’s disease (PD) include motor fluctuations, dyskinesias, and also nonmotor fluctuations—at least equally common, but less well appreciated—in autonomic, cognitive/psychiatric, and sensory symptoms. In seeking the pathophysiologic mechanisms, the leading hypothesis is that in the parkinsonian brain, intermittent, nonphysiological stimulation of striatal dopamine receptors destabilizes an already unstable system. Accordingly, a major goal of PD treatment in recent years has been the attainment of continuous dopaminergic stimulation (CDS)—or, less theoretically (and more clinically verifiable), continuous drug delivery (CDD). Improvements in the steadiness of the plasma profiles of various dopaminergic therapies may be a signal of progress. However, improvements in plasma profile do not necessarily translate into CDS, or even into CDD to the brain. Still, it is reassuring that clinical studies of approaches to CDD have generally been positive. Head-to-head comparative trials have often failed to uncover evidence favoring such approaches over an intermittent therapy. Nevertheless, the findings among recipients of subcutaneous apomorphine infusion or intrajejunal levodopa/carbidopa intestinal gel suggest that nonmotor PD symptoms or complications may improve in tandem with motor improvement. In vivo receptor binding studies may help to determine the degree of CDS that a dopaminergic therapy can confer. This may be a necessary first step toward establishing whether CDS is, in fact, an important determinant of clinical efficacy. Certainly, the complexities of optimal PD management, and the rationale for an underlying strategy such as CDS or CDD, have not yet been thoroughly elucidated.
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Affiliation(s)
- K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence and National RLS, King's College Hospital, 9th Floor Ruskin Wing, Denmark Hill, London, SE5 9RS, UK.
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Murphy R, Tubridy N, Kevelighan H, O'Riordan S. Parkinson's disease: how is employment affected? Ir J Med Sci 2013; 182:415-9. [PMID: 23325501 DOI: 10.1007/s11845-013-0902-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/06/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rates of unemployment and early retirement are increased in Parkinson's disease (PD) and contribute to disease burden. AIMS To investigate time to loss of employment from PD onset and predictors of continued employment; to identify common issues and possible interventions in the workplace. METHODS Eighty-eight patients with PD diagnosed at age≤65 years took part in a retrospective cohort study. Veterans RAND Short Form-36 and an employment survey were administered. RESULTS Unemployment rates for males were increased compared to the general Irish population (standardized ratio of 1.6, 95% CI 1.2-2.2, P<0.05). There was no significant difference for females. Median retirement age was 58 years for males and 61 years for females compared to 63.5 and 65 years, respectively, in the general population. In survival analysis, median time to loss of employment was 7 years (95% CI 4.8-9.2). After 5 years, 40% remained working and 14% after 10 years. Early age of PD onset (P<0.001), early diagnosis (P<0.002) and high scores in vitality (P<0.005) were associated with prolonged employment. There was no association with sex, education, type or hours of work. Slowness, fatigue and tremor were the most challenging symptoms at work. Changes in work schedule and type of work were suggested helpful adjustments. CONCLUSION Loss of employment places a significant socioeconomic burden on young PD patients. More detailed examination of specific issues and reasonable adjustments is needed, along with patient and employer education.
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Affiliation(s)
- R Murphy
- UCD School of Medicine and Medical Sciences, Belfield, Dublin 4, Ireland.
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Huot P, Johnston TH, Koprich JB, Fox SH, Brotchie JM. The Pharmacology of l-DOPA-Induced Dyskinesia in Parkinson’s Disease. Pharmacol Rev 2013; 65:171-222. [DOI: 10.1124/pr.111.005678] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Evans AH, Farrell MJ, Gibson SJ, Helme RD, Lim SY. Dyskinetic patients show rebound worsening of affect after an acute L-dopa challenge. Parkinsonism Relat Disord 2012; 18:514-9. [DOI: 10.1016/j.parkreldis.2012.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 01/05/2012] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
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Homayoun H, Goetz CG. Facing the unique challenges of dyskinesias in Parkinson’s disease. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dyskinesia is among the most challenging complications of levodopa and dopaminergic drug therapy in advanced Parkinson’s disease. This symptom has a negative impact on the quality of life of patients with Parkinson’s disease and is hard to manage. Current advances in our understanding of the diverse phenomenology and complicated pathophysiology of dyskinesia have led to a number of novel strategies aimed at better control of this complication. Further insight has been gained from focusing on the characteristics of the rating scale used for assessment of dyskinesia and from the inherent susceptibility of dyskinesia to placebo effect. Here, we will briefly review the phenomenology, pathophysiology and the treatment of dyskinesia in Parkinson’s disease.
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Affiliation(s)
- Houman Homayoun
- Rush University Medical Center, Chicago, IL 60612, USA; Suite 755, 1725 W. Harrison Street, Chicago, IL 60612, USA
| | - Christopher G Goetz
- Rush University Medical Center, Chicago, IL 60612, USA; Suite 755, 1725 W. Harrison Street, Chicago, IL 60612, USA
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Schouten HJ, Knol W, Egberts TC, Schobben AF, Jansen PA, van Marum RJ. Quality of Life of Elderly Patients With Antipsychotic-Induced Parkinsonism: A Cross-Sectional Study. J Am Med Dir Assoc 2012; 13:82.e1-5. [DOI: 10.1016/j.jamda.2010.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
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Buetow S, Henshaw J, Cha R, O'Sullivan D. Distinguishing objective from subjective assessments of the severity of medication-related safety events among people with Parkinson's disease: a qualitative study. J Clin Pharm Ther 2011; 37:436-40. [PMID: 22129248 DOI: 10.1111/j.1365-2710.2011.01316.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Safety events indicating medication-related errors in Parkinson's disease (PD) are common but seldom studied, particularly from lay perspectives. Our objective was to study the meaning and significance to people living with PD of their experience of safety events. METHODS Twenty qualitative interviews were conducted by telephone with purposively sampled individuals with PD, a proxy, or both, throughout New Zealand. Themes identified from the data included joint assessments of the objective and subjective severity of the individual safety events. RESULTS AND DISCUSSION Most of the events indicated minor objective errors, whose severity was sometimes perceived as major, especially in the face of callous communication. WHAT IS NEW AND CONCLUSION Variation between objective and subjective assessments of the severity of possible errors indicated by safety events highlight the importance of distinguishing between, and using, both forms of assessment.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
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Abstract
After more than 40 years of clinical use, levodopa (LD) still remains the gold standard for symptomatic efficacy in Parkinson's disease (PD). However, long-term treatment with LD is often complicated by the development of various types of motor response oscillations as well as drug-induced dyskinesias. These treatment-related motor complications evolve in approximately one-third of patients after only 2 years of LD exposure and, once established, they are difficult to treat and significantly contribute to overall disability and disease burden. Although first described soon after the introduction of LD, the pathophysiology of motor complications is still not completely understood. In fact, it is most likely that non-physiological pulsatile stimulation of dopamine receptors, which is followed by various downstream alterations, plays a key role in the development of LD-induced motor response oscillations and dyskinesias. This review outlines the various types of motor complications and will also address underlying mechanisms, treatment options, as well as impact on clinical disability and quality of life (QoL).
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Affiliation(s)
- E Hametner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Schröder S, Kuessner D, Arnold G, Zöllner Y, Jones E, Schaefer M. Do neurologists in Germany adhere to the national Parkinson's disease guideline? Neuropsychiatr Dis Treat 2011; 7:103-10. [PMID: 21552312 PMCID: PMC3083983 DOI: 10.2147/ndt.s8895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Indexed: 11/23/2022] Open
Abstract
Implementation of guidelines can improve clinical practice. The aim in this study was to investigate whether neurologists in Germany adhered to the national Parkinson's disease guideline. Data were obtained from a cross-sectional survey of 60 neurologists. Analyses were performed on 320 patients with idiopathic Parkinson's disease with either low grades of functional impairment (Hoehn and Yahr stage I) or higher grades of functional impairment (stage II-V) but without motor complications. The sample was divided into four groups depending on age and grade of functional impairment. For each group, a biometric parameter on the use of dopamine agonists and L-dopa was defined based on the guideline. In patients aged <70 years, the recommendation to use dopamine agonists without L-dopa (parameter 1) was observed in 53% of patients with lower grades of functional impairment, whilst recommended use of dopamine agonists in more functionally impaired patients (parameter 2) was followed to a greater extent (84%). In patients aged ≥70 years, recommendations to use L-dopa without dopamine agonists were adhered to in only 50% of less functionally impaired (parameter 3) and 52% of more functionally impaired (parameter 4) patients. In conclusion, our results indicated there was moderate but not full adherence to the guideline.
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Affiliation(s)
- Sabrina Schröder
- Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany
| | | | - Guy Arnold
- Department of Neurology, Sindelfingen-Böblingen Hospital, Sindelfingen, Germany
| | | | | | - Marion Schaefer
- Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany
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Social and clinical determinants of quality of life in Parkinson's disease in a Russian cohort study. Parkinsonism Relat Disord 2010; 16:243-8. [DOI: 10.1016/j.parkreldis.2009.11.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 11/05/2009] [Accepted: 11/26/2009] [Indexed: 11/19/2022]
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Herzog J, Deuschl G. Tiefe Hirnstimulation bei der Parkinson-Krankheit. DER NERVENARZT 2010; 81:669-79. [DOI: 10.1007/s00115-010-2938-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pavon JM, Whitson HE, Okun MS. Parkinson's disease in women: a call for improved clinical studies and for comparative effectiveness research. Maturitas 2010; 65:352-8. [PMID: 20117891 PMCID: PMC2875870 DOI: 10.1016/j.maturitas.2010.01.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 12/24/2009] [Accepted: 01/04/2010] [Indexed: 11/25/2022]
Abstract
The incidence and prevalence of Parkinson's disease (PD) is expected to rise precipitously over the next several decades, as will the associated healthcare related costs. The epidemiology and disease manifestations of PD may differ when comparing women to men. Women are for example less likely to acquire PD, and in several studies have demonstrated a delayed onset of motor symptoms. Women, however, are more likely to experience PD-related complications that may lead to disability (e.g. depression and medication-associated dyskinesia). Further, there are purported differences in the treatment and treatment outcomes in PD men compared to women. Whether estrogen, other hormonal activity, or whether multiple factors underpin these findings remains unknown. Also unknown is whether estrogen itself may represent a therapeutic option for symptomatic PD treatment. This review summarizes what is known about gender differences in epidemiology, clinical features, treatment outcomes (medical and surgical/deep brain stimulation), and social impact among all available PD studies. We offer expert opinion regarding the shortcomings of the current evidence, and we propose a detailed list of studies that will help to clarify important gender related PD questions. Our hope is that this review will spark comparative effectiveness research into improving care and outcomes in women with PD.
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Affiliation(s)
- J M Pavon
- Department of Medicine, Duke University, Durham, NC, USA.
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Mann RK, Edwards R, Zhou J, Jog M, Duval C. Intra- and inter-limb coherency during stance in non-dyskinetic and dyskinetic patients with Parkinson's disease. Clin Neurol Neurosurg 2010; 112:392-9. [PMID: 20206438 DOI: 10.1016/j.clineuro.2010.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 01/26/2010] [Accepted: 02/08/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Examine the level of intra- and inter-limb coherency in non-dyskinetic and dyskinetic patients with Parkinson's disease (PD). PATIENTS & METHODS Using a magnetic tracking system, whole-body 3D movements were assessed in 10 dyskinetic patients with clear monophasic peak-dose levodopa-induced dyskinesia (LID), in 10 non-dyskinetic patients and in 10 control subjects, standing with their arms out. Patients were tested during their best ON period. Coherency in the kinematics of pairs of body segments was assessed by spectral analysis. For each pair examined, we calculated the highest coherency between 0.5 and 3.0Hz and the frequency at which this maximum coherency occurred. RESULTS Analysis of variance showed that for 34 out of the 44 (77.3%) comparisons we studied, there were significant differences between the means of coherencies of the groups. Typically, the control group had the highest coherency and the patients with LID had the lowest. Patients with LID also tended to have their maximum coherency at higher frequencies than the control and non-dyskinetic patient groups (30 out of 44 comparisons were significant). These trends appeared in all types of inter-segment comparisons, including bilaterally symmetric segments, biomechanically linked segments (in which coherencies were higher overall in all groups, but still different between groups) and in other comparisons, but the trends were not so clear for comparisons involving the feet. CONCLUSION LID is indeed incoherent in the frequency domain, suggesting that body segments may be driven by different neural outputs. The challenges of dealing with these incoherent involuntary movements when planning and executing voluntary movements must certainly play a role in motor difficulties observed in patients with LID. The fact that both dyskinetic and non-dyskinetic patients showed less coherency than controls suggests that levodopa may alter postural control by decreasing stiffness and increasing limb independence.
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Affiliation(s)
- Rena K Mann
- Dept. of Mathematics & Statistics, University of Victoria, Victoria, British Columbia, Canada
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Buetow S, Henshaw J, Bryant L, O'Sullivan D. Medication timing errors for Parkinson's disease: perspectives held by caregivers and people with Parkinson's in new zealand. PARKINSONS DISEASE 2009; 2010:432983. [PMID: 20975777 PMCID: PMC2957227 DOI: 10.4061/2010/432983] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 08/27/2009] [Indexed: 11/20/2022]
Abstract
Background. Common but seldom published are Parkinson's disease (PD) medication errors involving late, extra, or missed doses. These errors can reduce medication effectiveness and the quality of life of people with PD and their caregivers. Objective. To explore lay perspectives of factors contributing to medication timing errors for PD in hospital and community settings. Design and Methods. This qualitative research purposively sampled individuals with PD, or a proxy of their choice, throughout New Zealand during 2008-2009. Data collection involved 20 semistructured, personal interviews by telephone. A general inductive analysis of the data identified core insights consistent with the study objective. Results. Five themes help to account for possible timing adherence errors by people with PD, their caregivers or professionals. The themes are the abrupt withdrawal of PD medication; wrong, vague or misread instructions; devaluation of the lay role in managing PD medications; deficits in professional knowledge and in caring behavior around PD in formal health care settings; and lay forgetfulness. Conclusions. The results add to the limited published research on medication errors in PD and help to confirm anecdotal experience internationally. They indicate opportunities for professionals and lay people to work together to reduce errors in the timing of medication for PD in hospital and community settings.
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Affiliation(s)
- Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland 1142, New Zealand
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Dubayova T, Nagyova I, Havlikova E, Rosenberger J, Gdovinova Z, Middel B, van Dijk JP, Groothoff JW. The association of type D personality with quality of life in patients with Parkinson's disease. Aging Ment Health 2009; 13:905-12. [PMID: 19888711 DOI: 10.1080/13607860903046529] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. Type D personality is characterized by ineffective coping strategies that reduce QoL in patients with coronary heart disease. The aim of this study was to evaluate whether Type D personality also predicts QoL in patients with Parkinson's disease (PD). In addition, gender differences in Type D personalities are explored. METHODS The sample consisted of 153 PD patients (51.4% males; mean age 67.9 +/- 9.3 years). DS-14 was used to measure Type D personality, negative affectivity (NA) and social inhibition (SI). The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL, and the Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess functional status. The regression model consisted of disease severity, disease duration, age and DS-14 and its two scales (NA and SI). RESULTS Type D is negatively associated with overall QoL in PD patients and most subscales of the PDQ-39. Type D explained emotional well-being in both genders but was significant in the models for stigma, cognition, and communication only in men. NA and SI played a less important role in women in comparison with men. CONCLUSION Type D personality is an important part of the QoL model in PD patients of both genders, especially in the NA scale. The gender differences suggest that male and female PD patients require different coping strategies.
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Affiliation(s)
- Tatiana Dubayova
- Department of Neurology, Medical Faculty, University of PJ Safarik, Kosice, Slovakia.
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Haycox A, Armand C, Murteira S, Cochran J, François C. Cost effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson's disease in the UK setting: an economic Markov model evaluation. Drugs Aging 2009; 26:791-801. [PMID: 19728752 DOI: 10.2165/11316770-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Levodopa is the most effective treatment for the symptoms of Parkinson's disease (PD). However, after an initial period of benefit, several limitations become apparent, including motor complications such as dyskinesia. Dyskinesia can severely affect patients' quality of life and increases healthcare resource use. Thus, delaying the need for levodopa, and therefore the onset of levodopa-induced dyskinesia, is important. OBJECTIVE The aim of this study was to compare the cost effectiveness, from a UK healthcare payer perspective, of two antiparkinsonian treatment strategies in early PD: first-line monotherapy with rasagiline, a novel monoamine oxidase B inhibitor; and the non-ergoline dopamine receptor agonist pramipexole. METHODS An economic Markov model was developed as a pragmatic tool to derive comparative information on the effectiveness, utility and costs of these two strategies over a 5-year period. Model input data were obtained from the TEMPO study for rasagiline and from a study by the Parkinson Study Group for pramipexole. Effectiveness outcomes were time to levodopa and time to levodopa-induced dyskinesia. Cost and quality-adjusted life-year (QALY) data were derived from published sources. RESULTS Rasagiline was the dominant strategy. Compared with pramipexole, use of the rasagiline strategy was estimated to reduce costs by 18% per patient over 5 years and was associated with an additional 10% delay in dyskinesia onset (0.41 years; 95% CI 0.27, 0.55). This strategy was also found to prolong the time to levodopa initiation by 25% through a gain of 0.83 levodopa-free years (95% CI 0.56, 1.1). In addition, use of the rasagiline strategy was found to generate a 5% gain in QALYs over 5 years compared with the pramipexole strategy (3.7 +/- 0.02 vs 3.51 +/- 0.03). Sensitivity analyses confirmed that the model was robust. CONCLUSIONS Rasagiline represents a cost-effective alternative to pramipexole in the treatment of early PD in the UK.
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Affiliation(s)
- Alan Haycox
- University of Liverpool Management School, Liverpool, UK
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Schapira AHV, Olanow CW. Drug selection and timing of initiation of treatment in early Parkinson's disease. Ann Neurol 2009; 64 Suppl 2:S47-55. [DOI: 10.1002/ana.21460] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Psychological Issues and Evaluation for Patients Undergoing Implantable Technology. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Schneider MG, Swearingen CJ, Shulman LM, Ye J, Baumgarten M, Tilley BC. Minority enrollment in Parkinson's disease clinical trials. Parkinsonism Relat Disord 2008; 15:258-62. [PMID: 18693062 DOI: 10.1016/j.parkreldis.2008.06.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 05/24/2008] [Accepted: 06/24/2008] [Indexed: 11/18/2022]
Abstract
Under-representation of minorities in clinical trials limits access to information relevant to all segments of the population. We assessed the enrollment of minority subjects with Parkinson's disease (PD) into clinical trials. We searched PubMed for published studies of PD trials conducted in the US over the past 20 years and found that only 41 reported racial/ethnic participation (17%). In those trials reporting race/ethnicity, 8% of subjects were non-white, compared to 20% of the non-white US population over age 60. Results of this study identified the need for better reporting of racial composition in clinical trials and for the enrollment of more minority participants in research studies.
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Affiliation(s)
- Myra G Schneider
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Chen JJ, Trombetta DP, Fernandez HH. Palliative Management of Parkinson Disease: Focus on Nonmotor, Distressing Symptoms. J Pharm Pract 2008. [DOI: 10.1177/0897190008318370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parkinson disease is a progressive neurodegenerative disease that commonly affects elderly persons. In the absence of neuroprotective or curative therapies, currently available therapies only provide symptomatic benefit. Progression to advanced Parkinson disease is often accompanied by functional dependence with increased risk of admission to a long-term care facility. The prevalence of Parkinson disease in long-term care facilities, within the United States, has been estimated to be between 5.2% and 10%. Patients with advanced Parkinson disease also experience other distressing motor and nonmotor conditions, such as motor complications, dementia, depression, gastrointestinal distress, orthostatic hypotension, pain, and psychosis, which can be a challenge for clinicians to manage. The presence of distressing symptoms along with the fact that Parkinson disease remains incurable necessitate discussion on a palliative care approach to this disorder. This article discusses the symptomatic management of distressing symptoms encountered in the long-term care resident with Parkinson disease, including motor complications and nonmotor features.
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Affiliation(s)
- Jack J. Chen
- Schools of Medicine and Pharmacy, Movement Disorders Center, Loma Linda University, California,
| | - Dominick P. Trombetta
- Geriatrics/Internal Medicine, College of Pharmacy and Nursing, Wilkes University, Wilkes-Barre, Pennsylvania
| | - Hubert H. Fernandez
- Department of Neurology, McKnight Brain Institute/University of Florida, Gainesville, Florida, Movement Disorders Center
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Klepac N, Trkulja V, Relja M, Babić T. Is quality of life in non-demented Parkinson's disease patients related to cognitive performance? A clinic-based cross-sectional study. Eur J Neurol 2008; 15:128-33. [PMID: 18217883 DOI: 10.1111/j.1468-1331.2007.02011.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Whilst the association between dementia and poorer health-related quality of life (Hr-QoL) in Parkinson's disease (PD) has been well established, we aimed to explore the relationship between cognitive performance and Hr-QoL in PD without dementia. Consecutive PD patients (n = 124, 54% men, age 60.4 +/- 10.3 years) judged as non-demented based on DSM-IV criteria and Mini Mental State Examination, free of other neurodegenerative diseases or psychotic difficulties and antipsychotic/antidepressive/anxyolitic treatment were assessed in a battery of neuropsychological tests. We used Parkinson's disease questionnaire (PDQ-39) to asses Hr-QoL and Beck's Depression Inventory (BDI) to quantify depression. In the univariate analysis, better performance in each of the tests evaluating visual attention/memory or visuospatial and executive functions was associated with better Hr-QoL. In multivariate analysis [adjustment for BDI score, PD severity and duration, l-dopa dose, age, sex, education, employment status and early PD onset (<50 years of age)] in which these tests were either represented by a common variable identified in a principal components analysis or were considered individually, better cognitive performance was independently associated with better Hr-QoL. The association was conditional on the level of depression, i.e., apparent only in patients with low(er) BDI scores. Cognitive performance appears associated with Hr-QoL even in non-demented PD patients.
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Affiliation(s)
- N Klepac
- Department of Neurology, University Clinical Hospital Center Zagreb, Zagreb University School of Medicine, Zagreb, Croatia.
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