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Ruotolo I, Sellitto G, Berardi A, Simeon R, Panuccio F, Amadio E, Ugolini A, Fabbrini G, Galeoto G. Psychometric properties of the Parkinson's disease Questionnaire-39 and its short form Parkinson's disease Questionnaire-8: A systematic review and meta-analysis. J Clin Neurosci 2024; 123:100-117. [PMID: 38564966 DOI: 10.1016/j.jocn.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
Parkinson's disease (PD) affects Quality of Life (QoL), since it is responsible for cognitive impairment, non-motor, and motor symptoms. Outcome measures are fundamental for evaluating treatment's effect on QoL over time. This systematic review aimed to identify the psychometric properties of PDQ-39 and PDQ-8 in the different populations in which they were validated. The electronic databases systematically searched are MEDLINE (via PubMed), CINAHL, SCOPUS, and Web of Science; the research was conducted in July 2023. The psychometric properties considered were those of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Risk of bias was assessed using the COSMIN checklist. The search identified 1306 articles. 398 duplicates were eliminated; 908 articles were analyzed reading title and abstract; 799 were finally excluded because used PDQ-39 and PDQ-8 as outcome measures or were not dealing with psychometric properties; 66 articles were excluded after reading the full text. 43 articles were included in the review; meta-analysis showed all the Cronbach's alpha values were statistically significant for all the subscales of PDQ-39 and PDQ-8. PDQ-39 demonstrated to be a specific HRQoL questionnaire that is correlated with generic HRQoL questionnaires, in fact in many studies included in the review, correlations with SF-36 were found. In the last studies about psychometric properties of PDQ-8 emerged that it is a practical and informative instrument that can be easily used in clinical settings, especially in busy ones, but also in large-scale studies in which a brief instrument would be preferred.
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Affiliation(s)
- Ilaria Ruotolo
- Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - Giovanni Sellitto
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | | | | | | | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy
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Ueno T, Haga R, Arai A, Tomiyama M. Quality of life assessment when considering the introduction of device-assisted therapies in advanced Parkinson's disease: A retrospective observational cross-sectional study. J Neurol Sci 2024; 457:122890. [PMID: 38232467 DOI: 10.1016/j.jns.2024.122890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Device-aided therapy (DAT) is an established treatment for improving the quality of life (QOL) in individuals with advanced Parkinson's disease (APD). Criteria for starting DAT, including motor and non-motor symptoms, have been proposed. However, it remains unclear whether QOL differences among patients with APD influence DAT introduction. Therefore, we aimed to investigate QOL differences between patients with and without DAT introduction. METHODS This retrospective observational cross-sectional study included 245 patients with PD who were followed up between January 1, 2020, and June 30, 2022. We defined cases that underwent DAT introduction after evaluation as "planned-DAT" and those that did not as "not-planned-DAT." We performed between-group comparisons of the PD questionnaire-39 (PDQ-39) summary index (SI) in patients with APD who met the 5-2-1 criteria (≥5 times the oral levodopa dose/day, ≥2 h of "off" symptoms/day, and ≥ 1 h of troublesome dyskinesia/day). RESULTS Seventy-nine patients met the inclusion criteria for APD (median age: 68 [61.0-73.0] years; 62.8% [N = 52] women). The PDQ-39 SI scores were higher in the planned-DAT group (N = 12) than in the not-planned-DAT group (N = 67) (29.2 [22.1-33.6] vs. 19.0 [10.3-49.6] points, P < 0.05). After propensity-score matching according to age and sex, the PDQ-39 SI scores remained higher in the planned-DAT (N = 9) than in the not-planned-DAT group (N = 18) (40.0 [25.4-60.0] vs. 18.5 [7.9-46.8] points, P < 0.05). CONCLUSIONS Our results suggest that QOL assessment using PDQ-39 can be used to identify patients eligible for DAT.
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Affiliation(s)
- Tatsuya Ueno
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan.
| | - Rie Haga
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akira Arai
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Brinke TRT, Jergas H, Sisodia V, Barbe MT, Odekerken VJJ, Verbaan D, Dijk JM, Bot M, Beudel M, van den Munckhof P, Schuurman PR, de Bie RMA. Directional versus ring-mode deep brain stimulation for Parkinson's disease: protocol of a multi-centre double-blind randomised crossover trial. BMC Neurol 2023; 23:372. [PMID: 37853327 PMCID: PMC10583384 DOI: 10.1186/s12883-023-03387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The effectiveness of Deep Brain Stimulation (DBS) therapy for Parkinson's disease can be limited by side-effects caused by electrical current spillover into structures adjacent to the target area. The objective of the STEEred versus RING-mode DBS for Parkinson's disease (STEERING) study is to investigate if directional DBS for Parkinson's disease results in a better clinical outcome when compared to ring-mode DBS. METHODS The STEERING study is a prospective multi-centre double-blind randomised crossover trial. Inclusion criteria are Parkinson's disease, subthalamic nucleus DBS in a 'classic' ring-mode setting for a minimum of six months, and optimal ring-mode settings have been established. Participants are categorised into one of two subgroups according to their clinical response to the ring-mode settings as 'responders' (i.e., patient with a satisfactory effect of ring-mode DBS) or 'non-responder' (i.e., patient with a non-satisfactory effect of ring-mode DBS). A total of 64 responders and 38 non-responders will be included (total 102 patients). After an optimisation period in which an optimal directional setting is found, participants are randomised to first receive ring-mode DBS for 56 days (range 28-66) followed by directional DBS for 56 days (28-66) or vice-versa. The primary outcome is the difference between ring-mode DBS and directional DBS settings on the Movement Disorders Society Unified Parkinson's Disease Rating Scale - Motor Evaluation (MDS-UPDRS-ME) in the off-medication state. Secondary outcome measures consist of MDS-UPDRS-ME in the on-medication state, MDS-UPDRS Activities of Daily Living, MDS-UPDRS Motor Complications-Dyskinesia, disease related quality of life measured with the Parkinson's Disease Questionnaire 39, stimulation-induced side-effects, antiparkinsonian medication use, and DBS-parameters. Participants' therapy preference is measured at the end of the study. Outcomes will be analysed for both responder and non-responder groups, as well as for both groups pooled together. DISCUSSION The STEERING trial will provide insights into whether or not directional DBS should be standardly used in all Parkinson's disease DBS patients or if directional DBS should only be used in a case-based approach. TRIAL REGISTRATION This trial was registered on the Netherlands Trial Register, as trial NL6508 ( NTR6696 ) on June 23, 2017.
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Affiliation(s)
- Timo R Ten Brinke
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Hannah Jergas
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Vibuthi Sisodia
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Vincent J J Odekerken
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Dagmar Verbaan
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Joke M Dijk
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Maarten Bot
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Martijn Beudel
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - P Rick Schuurman
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Rob M A de Bie
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands.
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Soares GM, Bouça‐Machado R, Abreu D, Ferreira JJ. Contributory Factors to Caregiver Burden in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1507-1518. [PMID: 37868922 PMCID: PMC10585976 DOI: 10.1002/mdc3.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/19/2023] [Accepted: 07/16/2023] [Indexed: 10/24/2023] Open
Abstract
Background Although there is growing recognition of the relevancy of informal caregivers there is scarce information on the contributory factors of caregiver burden in Parkinson's Disease (PD). Objective To identify the main associated factors to caregivers' burden in people caring for a person with PD. Methods We analyzed the data set from a multinational online survey the Parkinson's real-world impact assesSMent (PRISM) focusing on medication use, comorbidities, health-related quality of life, relationship changes and the use of healthcare and supportive care resources by people with PD and their carers. Structured questionnaires including the Parkinson's disease quality of life questionnaire (PDQ-39), non-motor symptoms questionnaire (NMSQuest) and the Questionnaire for impulsive-compulsive disorder in Parkinson's disease (QUIP) were applied. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). Results In a cohort of 245 dyads (patient and respective caregiver), caregivers reported a mild to moderate burden. Carers' perception of PD impact in partnership, financial burden, hours of care, patient's age, hypersexuality and health-related quality of life (HRQoL) were found to be significant contributory factors to caregiver burden. Taken together these variables explained 66.8% of the variance in the Interpretation of the ZBI total score. Conclusions Caring for a person with PD entails substantial burden, particularly when the caregiver perceives greater changes in partnership dynamics, dedicates more time to caregiving tasks, has financial burden, and when the patient is older, reports worst HRQoL and has sexual compulsive urges.
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Affiliation(s)
| | - Raquel Bouça‐Machado
- CNS‐Campus NeurológicoTorres VedrasPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Daisy Abreu
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Joauqim J. Ferreira
- Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- CNS‐Campus NeurológicoTorres VedrasPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
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Chang KH, Liu CH, Wang YR, Lo YS, Chang CW, Wu HC, Chen CM. Upregulation of APAF1 and CSF1R in Peripheral Blood Mononuclear Cells of Parkinson's Disease. Int J Mol Sci 2023; 24:ijms24087095. [PMID: 37108258 PMCID: PMC10139006 DOI: 10.3390/ijms24087095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Increased oxidative stress and neuroinflammation play a crucial role in the pathogenesis of Parkinson's disease (PD). In this study, the expression levels of 52 genes related to oxidative stress and inflammation were measured in peripheral blood mononuclear cells of the discovery cohort including 48 PD patients and 25 healthy controls. Four genes, including ALDH1A, APAF1, CR1, and CSF1R, were found to be upregulated in PD patients. The expression patterns of these genes were validated in a second cohort of 101 PD patients and 61 healthy controls. The results confirmed the upregulation of APAF1 (PD: 0.34 ± 0.18, control: 0.26 ± 0.11, p < 0.001) and CSF1R (PD: 0.38 ± 0.12, control: 0.33 ± 0.10, p = 0.005) in PD patients. The expression level of APAF1 was correlated with the scores of the Unified Parkinson's Disease Rating Scale (UPDRS, r = 0.235, p = 0.018) and 39-item PD questionnaire (PDQ-39, r = 0.250, p = 0.012). The expression level of CSF1R was negatively correlated with the scores of the mini-mental status examination (MMSE, r = -0.200, p = 0.047) and Montréal Cognitive Assessment (MoCA, r = -0.226, p = 0.023). These results highly suggest that oxidative stress biomarkers in peripheral blood may be useful in monitoring the progression of motor disabilities and cognitive decline in PD patients.
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Affiliation(s)
- Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chia-Hsin Liu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Ru Wang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yen-Shi Lo
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hsiu-Chuan Wu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chiung-Mei Chen
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Hou Y, Han Q, Ou R, Liu K, Lin J, Yang T, Shang H. Essential tremor-Parkinson's disease syndrome: clinical characteristics and subtypes using cluster analysis. Chin Med J (Engl) 2023; 136:446-450. [PMID: 35940881 PMCID: PMC10106194 DOI: 10.1097/cm9.0000000000002229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Essential tremor (ET) and Parkinson's disease (PD) are common movement disorders. ET-PD syndrome is characterized by the occurrence of PD in patients with a previous history of ET, which may be an independent phenotype distinct from PD. This study aims to identify clinical characteristics and subtypes in ET-PD. METHODS A total of 93 newly diagnosed ET-PD patients and 93 newly diagnosed PD patients matched for age, sex, education, and disease duration of PD were selected using propensity score matching analysis. The K-means cluster analysis was performed for 11 variables derived from the ET-PD group, and cluster profiles were established through statistical analysis of demographic and clinical variables. RESULTS The ET-PD group consisted of a high number of patients with a family history of ET exhibiting evident tremor with milder hypokinesia and postural instability symptoms, as compared to the PD group. Through the cluster analysis, two clusters of ET-PD patients were identified. The ET-PD cluster 1 ( n = 34) had a shorter ET duration before PD onset, lower number of patients with a family history of ET, higher unified PD rating scale instability scores, higher non-motor symptoms scores (non-motor symptoms scale D1 scores, Hamilton depression scale scores, Hamilton anxiety scale scores, and PD sleep scale-2 scores), and higher Chinese version of the PD questionnaire-39 scores relative to the ET-PD cluster 2 ( n = 59). CONCLUSION ET-PD patients had significantly different characteristics for motor symptoms as compared to PD patients, and may be distinctly divided into two clinical subtypes, namely, the ET-PD complex type and the ET-PD simple type.
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Affiliation(s)
- Yanbing Hou
- Department of neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Hou Y, Zhang L, Ou R, Wei Q, Gu X, Liu K, Lin J, Yang T, Xiao Y, Gong Q, Shang H. Motor progression marker for newly diagnosed drug-naïve patients with Parkinson's disease: A resting-state functional MRI study. Hum Brain Mapp 2022; 44:901-913. [PMID: 36250699 PMCID: PMC9875914 DOI: 10.1002/hbm.26110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 01/28/2023] Open
Abstract
The effective early prediction of clinical outcomes of Parkinson's disease (PD) is of great significance in the implementation of appropriate interventions. We aimed to propose a method based on the use of baseline resting-state functional characteristics (i.e., fractional amplitude of low-frequency fluctuations, fALFF) to predict motor progression in PD patients. Resting-state functional magnetic resonance imaging was performed on 48 newly-diagnosed drug-naïve PD patients and 27 age- and sex- matched healthy controls (HCs). Two PD subgroups were defined with different annual increase of Unified PD Rating Scale Part III motor scores. Least absolute shrinkage and selection operator regression analysis was performed to explore the baseline region-functional indicators for PD discrimination as well as the predictors for future motor deficits. Two significant models composed of baseline fALFF values from cerebral subregions were proposed. The classification model that distinguished PD patients from HCs (area under the curve [AUC] = 0.897) showed the most significant imaging characteristics in the putamen and precentral gyrus. The other prediction model that evaluated the degree of future deterioration of motor symptoms in PD patients (AUC = 0.916) showed the most significant imaging characteristics in the superior occipital gyrus and caudate nucleus. Furthermore, the increased regional function in bilateral caudate nuclei was correlated with the lower annual increase in motor deficits in all PD patients. The caudate nucleus might be the core region responsible for future motor deficits in newly-diagnosed PD patients, which may aid the development of disease progression preventive strategies in clinical practice.
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Affiliation(s)
- Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Lingyu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xiaojing Gu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Kuncheng Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Junyu Lin
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Tianmi Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Yi Xiao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
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Effects of Subthalamic Nucleus Deep Brain Stimulation on Depression in Patients with Parkinson's Disease. J Clin Med 2022; 11:jcm11195844. [PMID: 36233710 PMCID: PMC9572818 DOI: 10.3390/jcm11195844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: In this study, we aimed to investigate the effects of STN-DBS on PD patients with different levels of depression and to identify predictors of the effects of STN-DBS on PD depression. Methods: We retrospectively collected data for 118 patients with PD depression who underwent STN-DBS at Beijing Tiantan Hospital. Neuropsychological, motor, and quality of life assessments were applied preoperatively and postoperatively. All patients were divided into two groups according to their HAM-D24 total scores (group I: mild depression; group Ⅱ: moderate depression). A mixed repeated-measure analysis of variance (ANOVA) was performed to investigate whether there were differences in depression scores before and after STN-DBS between the two groups. The changes in depression scores were also compared between groups using ANCOVA, adjusting for gender and preoperative HAMA scores. Logistic regression was performed to identify predictors of STN-DBS’s effects on PD depression. Results: Both groups showed significant improvement in depression symptoms after STN-DBS. Compared with patients in group I, patients in group Ⅱ showed greater reductions in their HAM-D24 total scores (p = 0.002) and in HAM-D24 subitems including cognitive disturbances (p = 0.026) and hopelessness symptoms (p = 0.018). Logistic regression indicated that gender (female) (p = 0.014) and preoperative moderate depression (p < 0.001) patients had greater improvements in depression after STN-DBS. Conclusions: Patients with moderate depression showed better improvement than patients with mild depression. Gender (female) and preoperative HAMA scores are predictors of STN-DBS’s effects on PD depression.
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Chang KH, French IT, Liang WK, Lo YS, Wang YR, Cheng ML, Huang NE, Wu HC, Lim SN, Chen CM, Juan CH. Evaluating the Different Stages of Parkinson's Disease Using Electroencephalography With Holo-Hilbert Spectral Analysis. Front Aging Neurosci 2022; 14:832637. [PMID: 35619940 PMCID: PMC9127298 DOI: 10.3389/fnagi.2022.832637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/08/2022] [Indexed: 01/04/2023] Open
Abstract
Electroencephalography (EEG) can reveal the abnormalities of dopaminergic subcortico-cortical circuits in patients with Parkinson's disease (PD). However, conventional time-frequency analysis of EEG signals cannot fully reveal the non-linear processes of neural activities and interactions. A novel Holo-Hilbert Spectral Analysis (HHSA) was applied to reveal non-linear features of resting state EEG in 99 PD patients and 59 healthy controls (HCs). PD patients demonstrated a reduction of β bands in frontal and central regions, and reduction of γ bands in central, parietal, and temporal regions. Compared with early-stage PD patients, late-stage PD patients demonstrated reduction of β bands in the posterior central region, and increased θ and δ2 bands in the left parietal region. θ and β bands in all brain regions were positively correlated with Hamilton depression rating scale scores. Machine learning algorithms using three prioritized HHSA features demonstrated "Bag" with the best accuracy of 0.90, followed by "LogitBoost" with an accuracy of 0.89. Our findings strengthen the application of HHSA to reveal high-dimensional frequency features in EEG signals of PD patients. The EEG characteristics extracted by HHSA are important markers for the identification of depression severity and diagnosis of PD.
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Affiliation(s)
- Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Isobel Timothea French
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Central University and Academia Sinica, Taipei, Taiwan
| | - Wei-Kuang Liang
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Cognitive Intelligence and Precision Healthcare Research Center, National Central University, Taoyuan, Taiwan
| | - Yen-Shi Lo
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Ru Wang
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Ling Cheng
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
- Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Clinical Phenome Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Norden E. Huang
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Cognitive Intelligence and Precision Healthcare Research Center, National Central University, Taoyuan, Taiwan
- Data Analysis and Application Laboratory, The First Institute of Oceanography, Qingdao, China
| | - Hsiu-Chuan Wu
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chiung-Mei Chen
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Cognitive Intelligence and Precision Healthcare Research Center, National Central University, Taoyuan, Taiwan
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An Activity Recognition Framework for Continuous Monitoring of Non-Steady-State Locomotion of Individuals with Parkinson’s Disease. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fundamental knowledge in activity recognition of individuals with motor disorders such as Parkinson’s disease (PD) has been primarily limited to detection of steady-state/static tasks (e.g., sitting, standing, walking). To date, identification of non-steady-state locomotion on uneven terrains (stairs, ramps) has not received much attention. Furthermore, previous research has mainly relied on data from a large number of body locations which could adversely affect user convenience and system performance. Here, individuals with mild stages of PD and healthy subjects performed non-steady-state circuit trials comprising stairs, ramp, and changes of direction. An offline analysis using a linear discriminant analysis (LDA) classifier and a Long-Short Term Memory (LSTM) neural network was performed for task recognition. The performance of accelerographic and gyroscopic information from varied lower/upper-body segments were tested across a set of user-independent and user-dependent training paradigms. Comparing the F1 score of a given signal across classifiers showed improved performance using LSTM compared to LDA. Using LSTM, even a subset of information (e.g., feet data) in subject-independent training appeared to provide F1 score > 0.8. However, employing LDA was shown to be at the expense of being limited to using a subject-dependent training and/or biomechanical data from multiple body locations. The findings could inform a number of applications in the field of healthcare monitoring and developing advanced lower-limb assistive devices by providing insights into classification schemes capable of handling non-steady-state and unstructured locomotion in individuals with mild Parkinson’s disease.
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Alterations of Sphingolipid and Phospholipid Pathways and Ornithine Level in the Plasma as Biomarkers of Parkinson's Disease. Cells 2022; 11:cells11030395. [PMID: 35159203 PMCID: PMC8834036 DOI: 10.3390/cells11030395] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 02/01/2023] Open
Abstract
The biomarkers of Parkinson’s disease (PD) remain to be investigated. This work aimed to identify blood biomarkers for PD using targeted metabolomics analysis. We quantified the plasma levels of 255 metabolites in 92 PD patients and 60 healthy controls (HC). PD patients were sub-grouped into early (Hoehn–Yahr stage ≤ 2, n = 72) and advanced (Hoehn–Yahr stage > 2, n = 20) stages. Fifty-nine phospholipids, 3 fatty acids, 3 amino acids, and 7 biogenic amines, demonstrated significant alterations in PD patients. Six of them, dihydro sphingomyelin (SM) 24:0, 22:0, 20:0, phosphatidylethanolamine-plasmalogen (PEp) 38:6, and phosphatidylcholine 38:5 and 36:6, demonstrated lowest levels in PD patients in the advanced stage, followed by those in the early stage and HC. By contrast, the level of ornithine was highest in PD patients at the advanced stage, followed by those at the early stage and HC. These biomarker candidates demonstrated significant correlations with scores of motor disability, cognitive dysfunction, depression, and quality of daily life. The support vector machine algorithm using α-synuclein, dihydro SM 24:0, and PEp 38:6 demonstrated good ability to separate PD from HC (AUC: 0.820). This metabolomic analysis demonstrates new plasma biomarker candidates for PD and supports their role in participating PD pathogenesis and monitoring disease progression.
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Prell T, Liebermann JD, Mendorf S, Lehmann T, Zipprich HM. Pain coping strategies and their association with quality of life in people with Parkinson's disease: A cross-sectional study. PLoS One 2021; 16:e0257966. [PMID: 34723975 PMCID: PMC8559924 DOI: 10.1371/journal.pone.0257966] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To develop multidimensional approaches for pain management, this study aimed to understand how PD patients cope with pain. DESIGN Cross-sectional, cohort study. SETTING Monocentric, inpatient, university hospital. PARTICIPANTS 52 patients with Parkinson's disease (without dementia) analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Motor function, nonmotor symptoms, health-related quality of life (QoL), and the Coping Strategies Questionnaire were assessed. Elastic net regularization and multivariate analysis of variance (MANOVA) were used to study the association among coping, clinical parameters, and QoL. RESULTS Most patients cope with pain through active cognitive (coping self-statements) and active behavioral strategies (increasing pain behaviors and increasing activity level). Active coping was associated with lower pain rating. Regarding QoL domains, active coping was associated with better physical functioning and better energy, whereas passive coping was associated with poorer emotional well-being. However, as demonstrated by MANOVA, the impact of coping factors (active and passive) on the Short Form 36 domains was negligible after correction for age, motor function, and depression. CONCLUSION Passive coping strategies are the most likely coping response of those with depressive symptoms, whereas active coping strategies are the most likely coping response to influence physical function. Although coping is associated with pain rating, the extent that pain coping responses can impact on QoL seems to be low.
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Affiliation(s)
- Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Healthy Aging, Jena University Hospital, Jena, Germany
| | | | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
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Tolosa E, Ebersbach G, Ferreira JJ, Rascol O, Antonini A, Foltynie T, Gibson R, Magalhaes D, Rocha JF, Lees A. The Parkinson's Real-World Impact Assessment (PRISM) Study: A European Survey of the Burden of Parkinson's Disease in Patients and their Carers. JOURNAL OF PARKINSONS DISEASE 2021; 11:1309-1323. [PMID: 34024784 PMCID: PMC8461669 DOI: 10.3233/jpd-212611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: A greater understanding of the everyday experiences of people with Parkinson’s disease (PD) and their carers may help improve clinical practice. Objective: The Parkinson’s Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD and their carers. Methods: PRISM is an observational cross-sectional study, in which people with PD and their carers completed an online survey using structured questionnaires, including the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQuest) and Zarit Burden Interview (ZBI). Results: Data were collected from 861 people with PD (mean age, 65.0 years; mean disease duration, 7.7 years) and 256 carers from six European countries. People with PD reported a large number of different co-morbidities, non-motor symptoms (mean NMSQuest score, 12.8), and impaired HRQoL (median PDQ-39 summary score, 29.1). Forty-five percent of people with PD reported at least one impulse control behaviour. Treatment patterns varied considerably between different European countries. Levodopa was taken in the last 12 months by 85.9% of participants, and as monotherapy by 21.8%. Carers, who were mostly female (64.8%) and the partner/spouse of the person with PD (82.1%), reported mild to moderate burden (mean ZBI total score, 26.6). Conclusions: The PRISM study sheds light on the lives of people with PD and those who care for them, re-emphasising the many challenges they face in everyday life. The study also provides insights into the current treatment of PD in Europe.
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Affiliation(s)
- Eduardo Tolosa
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Olivier Rascol
- Toulouse Parkinson Expert Center, Departments of Neurosciences and Clinical Pharmacology, Centre d'Investigation Clinique de Toulouse CIC1436, NS-Park/FCRIN Network, and NeuroToul COEN Center, University Hospital of Toulouse, INSERM, University of Toulouse, Toulouse, France
| | - Angelo Antonini
- Parkinson Disease and Movement Disorder Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | | | | | - Andrew Lees
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Toldo JMP, Arjona M, Campos Neto GC, Vitor T, Nogueira SA, Amaro E, Saba RA, Silva SMCA, Ferraz HB, Felício AC. Virtual Rehabilitation in Parkinson Disease: A Dopamine Transporter Imaging Study. Am J Phys Med Rehabil 2021; 100:359-366. [PMID: 33727518 DOI: 10.1097/phm.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life. DESIGN Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance. RESULTS Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015). CONCLUSIONS In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved.
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Affiliation(s)
- Juliana M P Toldo
- From the Hospital Israelita Albert Einstein, São Paulo, Brazil (JMPT, MA, GCCN, TV, SAN, EAJ, ACF); Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (RAS, SMCAS); and Universidade Federal de São Paulo, São Paulo, Brazil (RAS, SMCAS, HBF)
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Zhao N, Yang Y, Zhang L, Zhang Q, Balbuena L, Ungvari GS, Zang Y, Xiang Y. Quality of life in Parkinson's disease: A systematic review and meta-analysis of comparative studies. CNS Neurosci Ther 2021; 27:270-279. [PMID: 33372386 PMCID: PMC7871788 DOI: 10.1111/cns.13549] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Studies regarding the impact of Parkinson's disease (PD) on quality of life (QOL) have reported conflicting results, and the underlying QOL domains require further study. In order to understand the association between PD and QOL, we conducted this meta-analysis to systematically compare QOL between PD patients and healthy controls. METHOD The PubMed, PsycINFO, EMBASE, and Web of Science databases were systematically searched. Data were analyzed using the random-effects model. RESULTS Twenty studies covering 2707 PD patients and 150,661 healthy controls were included in the study. Compared with healthy controls, PD patients had significantly poorer QOL overall and in most domains with moderate to large effects sizes. Different QOL measures varied in their association with quality of life, with the Parkinson's Disease Questionnaire-39 (PDQ-39) having the largest effect size (standard mean difference, SMD = -1.384, 95% CI: -1.607, -1.162, Z = 12.189, P < 0.001), followed by the Europe Quality of Life Questionnaire-visual analogue scale (EQ-VAS) (SMD = -1.081, 95% CI: -1.578, -0.584, Z = -4.265, P < 0.001), Europe Quality of Life Questionnaire-5D (EQ-5D) (SMD = -0.889, 95% CI: -1.181, -0.596, Z = -5.962, P < 0.001), and the Short-form Health Survey (SF) scales (physical dimension: SMD = -0.826, 95% CI: -1.529, -0.123, Z = -2.303, P = 0.021; mental dimension: SMD = -0.376, 95% CI: -0.732, -0.019, Z = -2.064, P = 0.039). CONCLUSION PD patients had lower QOL compared with healthy controls in most domains, especially in physical function and mental health. Considering the negative impact of poor QOL on daily life and functional outcomes, effective measures should be developed to improve QOL in this population.
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Affiliation(s)
- Na Zhao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health SciencesUniversity of MacauMacao SARChina
- Center for Cognition and Brain SciencesUniversity of MacauMacao SARChina
- Center for Cognition and Brain DisordersInstitutes of Psychological SciencesHangzhou Normal UniversityHangzhouChina
| | - Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health SciencesUniversity of MacauMacao SARChina
- Center for Cognition and Brain SciencesUniversity of MacauMacao SARChina
- Institute of Advanced Studies in Humanities and Social SciencesUniversity of MacauMacao SARChina
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & The Advanced Innovation Center for Human Brain ProtectionSchool of Mental HealthCapital Medical UniversityBeijingChina
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & The Advanced Innovation Center for Human Brain ProtectionSchool of Mental HealthCapital Medical UniversityBeijingChina
| | - Lloyd Balbuena
- Department of PsychiatryUniversity of SaskatchewanSaskatoonSKCanada
| | - Gabor S. Ungvari
- Division of PsychiatrySchool of MedicineUniversity of Western Australia/Graylands HospitalPerthWAAustralia
- The University of Notre Dame AustraliaFremantleWAAustralia
| | - Yu‐Feng Zang
- Center for Cognition and Brain DisordersInstitutes of Psychological SciencesHangzhou Normal UniversityHangzhouChina
| | - Yu‐Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health SciencesUniversity of MacauMacao SARChina
- Center for Cognition and Brain SciencesUniversity of MacauMacao SARChina
- Institute of Advanced Studies in Humanities and Social SciencesUniversity of MacauMacao SARChina
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Hadley R, Eastwood-Gray O, Kiddier M, Rose D, Ponzo S. "Dance Like Nobody's Watching": Exploring the Role of Dance-Based Interventions in Perceived Well-Being and Bodily Awareness in People With Parkinson's. Front Psychol 2020; 11:531567. [PMID: 33224044 PMCID: PMC7674205 DOI: 10.3389/fpsyg.2020.531567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Evidence indicates that bodily perception is negatively related to Parkinson's disease (PD); in particular, people with Parkinson's (PwP) feel dissatisfaction in their physical abilities and appearance. While established treatments exist to ameliorate motor symptoms in PD, research has yet to explore the effects of well-being-focused interventions in relation to the subjective experience of bodily concerns of PwP. This mixed methods exploratory study investigated the constructs of body appreciation in relation to well-being in PwP and the impact of participation in a dance class on body appreciation and well-being, comparing PwP with age-matched controls. Participants (n = 27 PwP, n = 14 controls) completed the Warwick Edinburgh Mental Well-Being Scale and the Body Appreciation Scale before and after taking part in a dance class. Well-being was positively associated with body appreciation in PwP (r s = 0.64, p < 0.001) but not in controls. Following participation in a dance class, all participants' well-being scores increased; a greater increase in well-being scores was observed for controls. A pilot qualitative study explored bodily awareness with PwP who attended dance classes (n = 4) and other movement-based activities (n = 4). Analysis of the interview data indicated that PwP who danced showed heightened bodily awareness, including bodily limitations, in comparison with PwP who did not dance. These preliminary findings provide initial insight explaining the lack of improvements in body appreciation in PwP following a dance class. The current study highlights the need for dance interventions for PwP to consider incorporating elements that encourage a body positive attitude alongside fostering perceived well-being.
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Affiliation(s)
- Rebecca Hadley
- Department of Psychology and Sports Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Olivia Eastwood-Gray
- Department of Psychology and Sports Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | | | - Dawn Rose
- School of Music, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Sonia Ponzo
- Department of Psychology and Sports Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Suicidal and death ideation in patients with progressive supranuclear palsy and corticobasal syndrome. J Affect Disord 2020; 276:1061-1068. [PMID: 32768878 DOI: 10.1016/j.jad.2020.07.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/17/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A large proportion of patients with atypical parkinsonian syndromes suffer from depression, an antecedent of suicide. This study aimed to explore the prevalence and clinical correlates of suicidal and death ideation (SDI) in patients with Progressive Supranuclear Palsy (PSP) and Corticobasal Syndrome (CBS), as well as compare the differences with patients with Parkinson's disease (PD). METHODS This was a case-control, cross-sectional study. SDI was diagnosed based on the assessment of the Hamilton Depression Rating Scale (HRDS). The prevalence of SDI among patients with PD, PSP, and CBS (n = 3400, 268, and 65 respectively) were compared before and after propensity score matching (PSM). A forward binary logistic regression model was used to explore the associated factors of SDI. RESULTS None of the patients reported suicide attempts. The prevalence of SDI in patients with PSP and CBS were 27.2% and 29.2%, respectively, which was significantly higher than that in patients with PD before and after PSM (P < 0.05). The prevalence of SDI was not significantly different among patients with PSP with different subtypes (Richardson syndrome, Parkinsonism, and other), both before and after PSM (P > 0.05). Multivariate analysis indicated that higher gait and midline score and depression were independently associated with an increased risk of SDI in patients with PSP (P < 0.05), while higher non-motor symptoms score and depression were independently associated with the occurrence of SDI in patients with CBS (P < 0.05). CONCLUSIONS Our study highlights the importance of screening SDI in patients with PSP and CBS.
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Hermann W, Schmitz-Peiffer H, Kasper E, Fauser M, Franke C, Wienecke M, Otto K, Löhle M, Brandt MD, Reichmann H, Storch A. Sleep Disturbances and Sleep Disordered Breathing Impair Cognitive Performance in Parkinson's Disease. Front Neurosci 2020; 14:689. [PMID: 32903712 PMCID: PMC7438827 DOI: 10.3389/fnins.2020.00689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 06/05/2020] [Indexed: 01/30/2023] Open
Abstract
Background Sleep disturbances and impairment of cognitive function are among the most frequent non-motor symptoms in Parkinson’s disease (PD) with negative implications on quality of life of patients and caregivers. Despite the fact that sleep disturbances are a major issue in PD patients, only limited data are available regarding interactions of sleep disturbances and cognitive performance. Objective This post hoc analysis of the RaSPar trial was therefore designed to further elucidate sleep disturbances and their impact on cognition in PD. Methods Twenty-six PD patients with sleep disturbances were evaluated thoroughly including assessments of patients’ subjective and objective sleep quality by interview, questionnaires, and polysomnography (PSG). Cognitive performance was assessed by Parkinson Neuropsychometric Dementia Assessment (PANDA) and Test of Attentional Performance (TAP), and associations of sleep and cognitive function were evaluated. Results We did not detect differences in cognitive performance between patients with and without rapid eye movement (REM) sleep behavior disorder (RBD). Instead, cognitive impairment, particularly affecting cognitive domains attention, executive function/working memory, and semantic memory, was associated with impaired PSG-measured sleep quality (e.g., sleep efficiency) and sleep disordered breathing (SDB) (Apnea-Hypopnea Index > 5/h). Global cognitive performance was decreased in patients with SDB (PANDA score 23.2 ± 3.5 vs. 26.9 ± 2.2, P = 0.020, unpaired two-sided t-test). Conclusion Sleep apnea and other sleep disturbances impair cognitive performance in PD and should be evaluated in routine care, and treatment options such as continuous airway pressure therapy should be considered.
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Affiliation(s)
- Wiebke Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Sleep Centre, Department of Neurology and Department of Internal Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Rostock, Rostock, Germany
| | | | - Elisabeth Kasper
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Mareike Fauser
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Christiana Franke
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Miriam Wienecke
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Sleep Centre, Department of Neurology and Department of Internal Medicine, Technische Universität Dresden, Dresden, Germany
| | - Karolin Otto
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Matthias Löhle
- Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Rostock, Rostock, Germany
| | - Moritz D Brandt
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Sleep Centre, Department of Neurology and Department of Internal Medicine, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Rostock, Rostock, Germany
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Zhu J, Lu L, Zhong M, Jiang X, Wu Z, Dong J, Pan Y, Zhang L. Increased rapid eye movement density in Chinese patients with Parkinson's disease and RBD. Neurol Sci 2020; 42:961-968. [PMID: 32676757 DOI: 10.1007/s10072-020-04597-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Impaired rapid eye movement sleep is common among patients with Parkinson's disease (PD). However, information on rapid eye movement density (REM) among PD patients is currently lacking. The current study sought to characterize REM density in PD patients and to examine the associations between REM density sleep parameters and clinical manifestations. PARTICIPANTS AND METHODS We retrospectively recruited 172 PD patients. All participants were assessed with a two-night polysomnography, and REM density was calculated. Clinical assessments were completed in PD patients before polysomnography. RESULTS Rapid eye movement sleep behavior disorder (RBD) was observed in 93 patients (54.1%). The disease duration, UPDRS part III score, Hoehn and Yahr (H-Y) stage, and HAMA, HAMD, PDQ-39 scores, and REM density in the Parkinson's disease patients with rapid eye movement sleep behavior disorder (RBD) were significantly higher than in the patients without RBD (P < 0.05). However, NREM sleep stage 3 time (N3 time) and percentage of N3 time of total sleep time (N3%) were significantly lower in the RBD patients than in the patients without RBD (P < 0.05). The forward binary logistic regression model showed that REM density, UPDRS-III score, and N3 sleep time were associated with RBD in the PD patients. CONCLUSIONS Our results confirm the high prevalence of RBD in patients with PD. Increased REM density was the main risk factor of RBD.
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Affiliation(s)
- Jun Zhu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Liyu Lu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Min Zhong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Xu Jiang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Zhuang Wu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Jingde Dong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China.
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Ueno T, Kon T, Haga R, Nishijima H, Arai A, Tomiyama M. Assessing the relationship between non-motor symptoms and health-related quality of life in Parkinson’s disease: a retrospective observational cohort study. Neurol Sci 2020; 41:2867-2873. [DOI: 10.1007/s10072-020-04406-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
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Validation of an Individualized Measure of Quality of Life, Patient Generated Index, for Use with People with Parkinson's Disease. Neurol Res Int 2020; 2020:6916135. [PMID: 32292601 PMCID: PMC7149443 DOI: 10.1155/2020/6916135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022] Open
Abstract
Methods Patients with PD completed the PGI and various standard patient-reported outcome (PRO) measures. The PGI and standard PRO measures were compared at the total score, domain, and item levels. Pearson's correlations and independent t-tests were used, as well as positive and negative predictive values. Results The sample (n = 76) had a mean age of 69 (standard deviation 9) and were predominantly men (59%). The PGI was moderately correlated (r = -0.35) with the standardized disease-specific QOL measure Parkinson's Disease Questionnaire (PDQ-8). Within one severity rating, agreement between the PGI and different standard outcome measures ranged from 85 to 100% for walking, 69 to 100% for fatigue, 38 to 75% for depression, and 20 to 80% for memory/concentration. Conclusion This study demonstrates that nominated areas of QOL on the PGI provide comparable results to standard PRO measures, and provides evidence in support of the validity of this individualized measure in PD.
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Sebastian R, Gray WK, Foley A, Trendall L, Oh D, Hand A, Dodds S, McClenaghan E, Santos VD, Oates LL, Fisher J, Walker RW. What Predicts Hospital Admissions in Community-Dwelling People With Parkinsonism? J Geriatr Psychiatry Neurol 2020; 33:103-108. [PMID: 31409182 DOI: 10.1177/0891988719868309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Previous studies have looked at the reasons for hospital admission in people with parkinsonism (PwP), yet few have looked at factors that precipitate admission. METHODS People with parkinsonism with a diagnosis of idiopathic Parkinson disease of Hoehn and Yahr stage III-V and those with Parkinson plus syndromes were assessed for motor and nonmotor symptoms, quality of life, and functional performance. Logistic regression was used to investigate predictors of hospital admission over the subsequent 2 years. RESULTS Overall, 162 patients consented to be part of the study. Seventy-one PwP (43.8%) had at least 1 hospital admission, and 17 (10.5%) patients had 3 or more admissions to hospital. Poorer cognition, more nonmotor symptoms, poorer quality of life, slower timed-up-and-go test scores, and abnormal swallow predicted a subsequent hospital admission. DISCUSSION Our study emphasizes the importance of nonmotor symptoms in predicting admission. A cost-benefit analysis of early intervention to prevent admission should be considered.
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Affiliation(s)
- Roshan Sebastian
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom
| | - Aishling Foley
- The Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Lydia Trendall
- The Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Doori Oh
- The Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Annette Hand
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom.,Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Steve Dodds
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom
| | - Elliot McClenaghan
- The Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | - Lloyd L Oates
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom
| | - James Fisher
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, United Kingdom.,Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Haunton VJ. Movement disorders: a themed collection. Age Ageing 2019; 49:12-15. [PMID: 31830237 DOI: 10.1093/ageing/afz147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 08/23/2019] [Accepted: 10/10/2019] [Indexed: 11/14/2022] Open
Abstract
Movement disorders are a diverse and challenging group of neurological conditions. Geriatricians and allied health professionals play a key role in the care of patients living with these disorders. Age and Ageing is making freely available online a collection of 15 papers that highlight the breadth and depth of this field. Perhaps unsurprisingly papers on Parkinson's disease predominate, but rarer movement disorders, including those seen following stroke and Huntington's disease, are also represented. Difficulties in diagnosis are explored, together with innovative approaches to management of both motor and non-motor symptoms. The collection includes qualitative work, longitudinal studies and clinical trials, and both the individual patient perspective and the international perspective are considered. There are papers for generalists, papers for specialists, papers for clinical commissioners and papers for researchers. Comprehensive review articles provide clarity, guidance and pragmatism. Finally, a New Horizons article encourages us to look to the future of movement disorders, which lies not only in developing novel therapies and trials but also in recognising the enormous value of palliative care and the multidisciplinary approach.
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Affiliation(s)
- Victoria J Haunton
- Geriatric Medicine, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
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24
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Balash Y, Korczyn AD, Migirov AA, Gurevich T. Quality of life in Parkinson's disease: A gender-specific perspective. Acta Neurol Scand 2019; 140:17-22. [PMID: 30953570 DOI: 10.1111/ane.13095] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The epidemiology, manifestations, and course of Parkinson's disease (PD) may differ in men and women. Assessments of severity of the illness and quality of life (QoL), and the burden on their caregivers (CG) may change as the disease advances. We determined gender differences in assessment by patients with PD themselves and by their CGs. METHODS Married couples in whom one of the partners was a PD patient and his/her spouse served as CG were separately evaluated. The patient completed the PD QoL Questionnaire (PDQ-39), and the spouse completed the Multidimensional Caregiver Strain Index (MCSI). Comparisons were performed using statistical tests. RESULTS We studied 122 patient-CG pairs consisting of 86 (70.5%) male patients. Female patients reported reduced QoL due to depression and pain. Worsening of QoL in advanced PD was reported only by male patients. Female CGs felt exhaustion and damage to their health resulting from care twice as often as male CG. Social constraint and time limitations were more frequent in female CGs, whereas in male CGs it remained the same. With increasing disease severity female CGs reported that manipulations and excessive demands from their male spouses increased, while male CGs reported the same level in female patients. Male CGs, unexpectedly considered themselves more free as PD advanced in their spouses. CONCLUSIONS Male and female PD patients and CGs assess differently the severity and burden of the disease. Clinicians and social workers should be aware of these factors in attempting to improve QoL of PD patients and CGs.
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Affiliation(s)
- Yacov Balash
- Movement Disorders Unit Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler School of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Amos D. Korczyn
- Movement Disorders Unit Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler School of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Angel A. Migirov
- Movement Disorders Unit Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Tanya Gurevich
- Movement Disorders Unit Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler School of Medicine Tel‐Aviv University Tel‐Aviv Israel
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25
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Hitchcott PK, Fastame MC, Corona F, Pilloni G, Porta M, Pau M, Conti R, Penna MP. Self-reported physical and mental health and motor functioning in elders with and without Parkinson's disease. PSYCHOL HEALTH MED 2019; 24:788-798. [PMID: 30729806 DOI: 10.1080/13548506.2019.1574355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Parkinson's Disease (PD) is a neurological disorder characterized by motor symptoms and other clinical conditions, such as cognitive impairment, negative mood, anxiety. The present study explored the impact of PD on self-reported physical and mental health, objective cognition and postural control. The relationship among these variables was examined in order to understand the impact on quality of life. Fifty-four participants, 27 with and 27 without PD, were recruited in Sardinia - an area with an atypical prevalence of PD and psychological characteristics that might mitigate the impact of PD on life quality. Participants completed objective tests of cognitive ability and postural control and self-report measures of physical and mental health. The detrimental effect of PD was evident across all outcomes. Self-reported physical and mental health were both related to postural control. Variance in perceived physical health was explained, not only by PD itself and postural control but also by participation in leisure activities. Self-report outcomes related to life quality are related not only by motor disturbances associated with PD but also with lifestyle activities. In conclusion, social contexts promoting socially-oriented activities, such as that found in Sardinia, may, therefore, mitigate some of the detrimental consequences of PD.
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Affiliation(s)
- Paul Kenneth Hitchcott
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
| | - Maria Chiara Fastame
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
| | - Federica Corona
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Giuseppina Pilloni
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Micaela Porta
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Massimiliano Pau
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Rachele Conti
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
| | - Maria Pietronilla Penna
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
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A High-Intensity Exercise Boot Camp for Persons With Parkinson Disease: A Phase II, Pragmatic, Randomized Clinical Trial of Feasibility, Safety, Signal of Efficacy, and Disease Mechanisms. J Neurol Phys Ther 2019; 43:12-25. [DOI: 10.1097/npt.0000000000000249] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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27
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Liu H, Ou R, Wei Q, Hou Y, Cao B, Zhao B, Shang H. Rapid eye movement behavior disorder in drug-naïve patients with Parkinson’s disease. J Clin Neurosci 2019; 59:254-258. [DOI: 10.1016/j.jocn.2018.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/10/2018] [Accepted: 07/08/2018] [Indexed: 01/24/2023]
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28
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Gender and onset age related-differences of non-motor symptoms and quality of life in drug-naïve Parkinson's disease. Clin Neurol Neurosurg 2018; 175:124-129. [PMID: 30408646 DOI: 10.1016/j.clineuro.2018.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 09/08/2018] [Accepted: 11/01/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aims to explore the gender and onset age-related differences of non-motor symptoms (NMS) and the determinants of quality of life (QoL) in a large cohort of Chinese drug-naïve Parkinson's disease (PD) patients. PATIENTS AND METHODS A cross-sectional analysis of 569 drug-naïve PD patients was conducted. The frequency and severity of each NMS was evaluated by Non-Motor Symptom Scale (NMSS), which consists of 9 subdomains. PD Questionnaire-39 (PDQ-39) was used to assess the QoL of PD patients. A stepwise multiple regression model was used to explore the determinants of QoL. RESULTS A total of 552 patients (97.0%) exhibited at least one NMS. The three most common NMS were sleep/fatigue (74%), attention/memory (62.7%) and miscellaneous (62%). The frequencies of sleep/fatigue and mood/apathy were more prevalent in women and the frequencies of urinary and sexual dysfunction were more prevalent in men (P < 0.05). Patients with late-onset PD showed higher frequencies of perceptual problems/hallucinations, attention/memory, gastrointestinal, urinary, sexual dysfunction, and miscellaneous compared to patients with early-onset PD (P < 0.05). The multiple regression analysis model indicated that female, disease duration, UPDRS III score, depression, and NMSS subcores including sleep/fatigue, mood/apathy, attention/memory, and gastrointestinal were the determinants of QoL in patients with drug-naïve PD. CONCLUSIONS NMS was common in untreated PD patients. They are heterogeneous in patients with drug-naïve PD, which are dramatic determinants on decreased QoL in PD. Our results are beneficial for clinical management of NMS in drug-naïve PD.
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Giguère-Rancourt A, Plourde M, Doiron M, Langlois M, Dupré N, Simard M. Goal management training ® home-based approach for mild cognitive impairment in Parkinson's disease: a multiple baseline case report. Neurocase 2018; 24:276-286. [PMID: 30821637 DOI: 10.1080/13554794.2019.1583345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Approximately 30% of patients with Parkinson's disease experience mild cognitive impairment (PD-MCI), often affecting executive functions. Our objective was to assess tolerability, safety and preliminarily efficacy of Goal Management Training® (GMT) for PD-MCI. GMT was administered at home, for five weeks. Dysexecutive Questionnaire (DEX), Parkinson Disease Questionnaire (PDQ-39), Zoo Map Test and Dementia Rating Scale-II were administered before, one and four weeks after Adapted-GMT. Reliable Change Index (RCI) was calculated. One participant completed GMT with caregiver. Executive complaints decreased (DEX RCIs between -2.10 and -1.68), PDQ-39 was maintained (RCI = -0.18). Adapted-GMT seems safe for PD-MCI, but efficacy remains doubtful.
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Affiliation(s)
- Ariane Giguère-Rancourt
- a School of Psychology , Laval University , Quebec City , Canada.,b Centre de Recherche CERVO , Institut de Recherche en Santé Mentale de Québec , Quebec City , Canada
| | - Marika Plourde
- a School of Psychology , Laval University , Quebec City , Canada.,b Centre de Recherche CERVO , Institut de Recherche en Santé Mentale de Québec , Quebec City , Canada
| | - Maxime Doiron
- a School of Psychology , Laval University , Quebec City , Canada.,b Centre de Recherche CERVO , Institut de Recherche en Santé Mentale de Québec , Quebec City , Canada.,c Department of Medicine, Faculty of Medicine , Laval University , Québec , Canada.,d Axe Neurosciences du CHU de Québec , Université Laval , Québec , QC , Canada
| | - Mélanie Langlois
- c Department of Medicine, Faculty of Medicine , Laval University , Québec , Canada.,d Axe Neurosciences du CHU de Québec , Université Laval , Québec , QC , Canada
| | - Nicolas Dupré
- c Department of Medicine, Faculty of Medicine , Laval University , Québec , Canada.,d Axe Neurosciences du CHU de Québec , Université Laval , Québec , QC , Canada
| | - Martine Simard
- a School of Psychology , Laval University , Quebec City , Canada.,b Centre de Recherche CERVO , Institut de Recherche en Santé Mentale de Québec , Quebec City , Canada
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30
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Gul A, Yousaf J. L-Dopa response to Cortical Dysfunctions, health related quality of life and Fatigue Severity in Idiopathic Parkinson's disease. Pak J Med Sci 2018; 34:1014-1018. [PMID: 30190772 PMCID: PMC6115581 DOI: 10.12669/pjms.344.14753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine (i) levodopa (L-Dopa) responsiveness on cortical functions, health related quality of life and fatigue severity (ii) relationship between cortical functions, health related quality of life and fatigue severity post L-Dopa treatment of patients with idiopathic Parkinson’s Disease (I-PD). Methods: Participants included 50 patients diagnosed with I-PD who were attending Civil and Bahawal Victoria Hospital, Bahawalpur, Pakistan during May 2016 to July 2017 and 50 healthy individuals (HI) took part in the study. Participants completed Cortical Function Assessment, Parkinson’s Disease Questionnaire and Fatigue Severity Scale. Patients were tested twice on these measures: pre and post- L-Dopa treatment. Results: Patients with I-PD showed cortical functioning deficits, deteriorated health related quality of life and experience of severe fatigue, in contrast with HI. There was significant improvement in cortical functioning and quality of life while reduction in fatigue severity was observed after three months of L-Dopa medication in I- PD patients. Higher cortical functioning deficits correlated with deteriorated health related quality of life and severe fatigue. Cortical functioning was a significant predictor of health related quality of life and fatigue severity. Conclusion: L-Dopa is an effective treatment for cortical dysfunctions, health related quality of life and fatigue in I-PD. Cortical functioning is a significant marker of quality of life and fatigue in patients with I-PD.
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Affiliation(s)
- Amara Gul
- Dr. Amara Gul, PhD. Department of Applied Psychology, The Islamia University of Bahawalpur, Bahawalpur. Pakistan
| | - Javed Yousaf
- Javed Yousaf, M.Phil. Department of Applied Psychology, The Islamia University of Bahawalpur, Bahawalpur. Pakistan
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31
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Camps J, Samà A, Martín M, Rodríguez-Martín D, Pérez-López C, Moreno Arostegui JM, Cabestany J, Català A, Alcaine S, Mestre B, Prats A, Crespo-Maraver MC, Counihan TJ, Browne P, Quinlan LR, Laighin GÓ, Sweeney D, Lewy H, Vainstein G, Costa A, Annicchiarico R, Bayés À, Rodríguez-Molinero A. Deep learning for freezing of gait detection in Parkinson’s disease patients in their homes using a waist-worn inertial measurement unit. Knowl Based Syst 2018. [DOI: 10.1016/j.knosys.2017.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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32
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A mixed methods evaluation of a Mindfulness-Based Stress Reduction course for people with Parkinson's disease. Complement Ther Clin Pract 2017; 29:220-228. [DOI: 10.1016/j.ctcp.2017.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022]
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33
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Ou R, Liu H, Hou Y, Wei Q, Cao B, Zhao B, Shang H. Executive dysfunction, behavioral changes and quality of life in Chinese patients with progressive supranuclear palsy. J Neurol Sci 2017; 380:182-186. [DOI: 10.1016/j.jns.2017.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
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34
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Balash Y, Korczyn AD, Knaani J, Migirov AA, Gurevich T. Quality-of-life perception by Parkinson's disease patients and caregivers. Acta Neurol Scand 2017; 136:151-154. [PMID: 28083960 DOI: 10.1111/ane.12726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND The quality-of-life (QoL) perception by Parkinson's disease (PD) patients and their caregivers (CG) has not been studied in depth. OBJECTIVE To examine patient/proxy agreements on the PD QoL Questionnaire (PDQ-39), the Scale of Quality of Life of Care-Givers (SQLC) and the Multidimensional Caregiver Strain Index (MCSI). METHODS Patients with PD and their CG completed the above-mentioned questionnaires about themselves and each other. The intraclass correlations between their scores (paired t test) were compared. RESULTS Twelve patient-CG pairs were studied. Agreements for QoL items were strong and comparable for the total scores of the PDQ-39, SQLC and MCSI questionnaires (75.4% ± 14%; 78.1% ± 14.1% and 78.2% ± 14.3%, respectively). Agreements ranged from moderate to strong (0.57-0.88, P≤.05) for the patients' physical condition (PDQ-39 items 3, 5, 6, 8, 12-15, 23, 24, 35), mental concentration (item 31) and depression (item 17). Disagreements were apparent in 20%-25% of the pairs and were particularly significant for PDQ-39 items #33 and #25 (embarrassment of patients in public and distressing dreams or hallucinations), in which the CG gave higher scores than the patients. CONCLUSIONS Agreements between patients with PD and CG were generally good for most, but not all, of the PDQ-39, SQLC and MCSI domains.
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Affiliation(s)
- Y. Balash
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - A. D. Korczyn
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - J. Knaani
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
| | - A. A. Migirov
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
| | - T. Gurevich
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
- Sagol School of Neuroscience; Tel-Aviv University; Tel Aviv Israel
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Shahgholi L, De Jesus S, Wu SS, Pei Q, Hassan A, Armstrong MJ, Martinez-Ramirez D, Schmidt P, Okun MS. Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence. PLoS One 2017; 12:e0180425. [PMID: 28683150 PMCID: PMC5500337 DOI: 10.1371/journal.pone.0180425] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background Patients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors. Methods We queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit. Results Of the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities. Conclusion Hospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates.
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Affiliation(s)
- Leili Shahgholi
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Sol De Jesus
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Daniel Martinez-Ramirez
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Peter Schmidt
- National Parkinson’s Foundation, Miami, Florida, United States of America
| | - Michael S. Okun
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
- * E-mail:
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A Cross-sectional Analysis of the Characteristics of Individuals With Parkinson Disease Who Avoid Activities and Participation Due to Fear of Falling. J Neurol Phys Ther 2017; 41:31-42. [PMID: 27977519 DOI: 10.1097/npt.0000000000000162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Avoidance behavior can have deleterious consequences on health and quality of life for persons with Parkinson disease (PD); for this reason, it is important to identify potentially mitigable characteristics. We compared the characteristics of individuals with PD who exhibit fear of falling (FOF) avoidance behavior with those who do not. METHODS Fifty-nine participants with PD were classified as avoiders (n = 27) or nonavoiders (n = 32) by using the Fear of Falling Avoidance Behavior Questionnaire and compared across 5 domains: demographic characteristics; PD-specific symptoms (subtype, Movement Disorder Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-39 [PDQ-39]); balance and falls (fall history, Berg Balance Scale [BBS], Activities-Specific Balance Confidence [ABC] Scale, Impact of Events Scale, Consequences of Falling Questionnaire [CoFQ]); physical performance (30 Second Sit-to-Stand Test, Timed Up and Go Test, physical activity monitoring); and psychological factors (Zung Anxiety Scale, Beck Depression Inventory [BDI]). RESULTS There were no differences between avoiders and nonavoiders for demographic characteristics and fall history (Ps > 0.272). Avoiders had worse MDS-UPDRS (Ps < 0.014) and PDQ-39 scores (Ps < 0.028). Avoiders had poorer balance performance (BBS, P = 0.003), lower balance confidence (ABC, P < 0.001), and more fall catastrophization (CoFQ, P < 0.001). Avoiders reported more depression (P = 0.015) and anxiety (P = 0.028). DISCUSSION AND CONCLUSIONS PD FOF avoiders had more involved symptoms and scored lower on balance and physical performance measures. In addition, they reported greater psychological stress. Several potentially mitigable characteristics of those with FOF avoidance behavior were identified.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A153).
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Morris ME, Taylor NF, Watts JJ, Evans A, Horne M, Kempster P, Danoudis M, McGinley J, Martin C, Menz HB. A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. J Physiother 2017; 63:94-100. [PMID: 28342682 DOI: 10.1016/j.jphys.2017.02.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022] Open
Abstract
QUESTIONS For people with idiopathic Parkinson's disease, does a 6-week, comprehensive, home exercise program reduce falls and disability and improve health-related quality of life? Is the program cost-effective? DESIGN Randomised, controlled trial with concealed allocation and assessor blinding. PARTICIPANTS One hundred and thirty-three community-dwelling adults with Parkinson's disease. INTERVENTION The experimental group completed a 6-week home program comprising progressive resistance strength training, movement strategy training and falls education. The control group completed 6 weeks of non-specific life skills training. Participants in both groups received weekly therapist-guided sessions for 6 consecutive weeks and a weekly self-directed home program. OUTCOME MEASURES The primary outcome was the rate of falls, documented for the 12-month period immediately after therapy. Secondary outcomes were disability and health-related quality of life, assessed before and after intervention and at a 12-month follow-up. RESULTS A total of 2255 falls were reported by the 12-month follow-up. The proportion of fallers in the experimental and control groups was 61 and 72%, respectively, which was not statistically significantly different (RR=0.85, 95% CI 0.66 to 1.09). There was no significant between-group difference in the rate of falls (incidence rate ratio=1.58, 95% CI 0.73 to 3.43). A survival analysis of participant time to first fall did not show a significant between-group difference (log-rank test χ2=0.79, p=0.37). No significant between-group differences occurred for mobility, disability or quality of life. The mean cost of delivering the experimental intervention was AUD1596. CONCLUSION A home program of strength and movement strategy training and falls education does not prevent falls when applied at the dose used in this study. Arguably, the dosage of therapy was insufficient. Future trials need to explore further therapy content, repetitions and duration, in order to optimise outcomes and cost-effectiveness. [Morris ME, Taylor NF, Watts JJ, Evans A, Horne M, Kempster P, Danoudis M, McGinley J, Martin C, Menz HB (2017) A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. Journal of Physiotherapy 63: 94-100].
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Affiliation(s)
- Meg E Morris
- La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University; Northpark Private Hospital (Healthscope)
| | - Nicholas F Taylor
- La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health
| | - Jennifer J Watts
- Centre for Population Health Research, Faculty of Health, Deakin University
| | | | - Malcolm Horne
- Florey Institute for Neurosciences and Mental Health; Department of Medicine, University of Melbourne
| | - Peter Kempster
- Neurosciences Department, Monash Health; Department of Medicine, Monash University
| | - Mary Danoudis
- La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University
| | | | - Clarissa Martin
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Hylton B Menz
- La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University
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Pinto S, Cardoso R, Sadat J, Guimarães I, Mercier C, Santos H, Atkinson-Clement C, Carvalho J, Welby P, Oliveira P, D'Imperio M, Frota S, Letanneux A, Vigario M, Cruz M, Martins IP, Viallet F, Ferreira JJ. Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark). BMJ Open 2016; 6:e012885. [PMID: 27856480 PMCID: PMC5128890 DOI: 10.1136/bmjopen-2016-012885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). METHODS AND ANALYSIS Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. ETHICS AND DISSEMINATION The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. TRIAL REGISTRATION NUMBER NCT02753192, Pre-results.
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Affiliation(s)
- Serge Pinto
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Rita Cardoso
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
| | - Jasmin Sadat
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Isabel Guimarães
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Speech Therapy Department, Escola Superior de Saude do Alcoitão, Alcabideche, Portugal
| | - Céline Mercier
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Helena Santos
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Cyril Atkinson-Clement
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Joana Carvalho
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Pauline Welby
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Pedro Oliveira
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Mariapaola D'Imperio
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Sónia Frota
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Alban Letanneux
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
| | - Marina Vigario
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Marisa Cruz
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Isabel Pavão Martins
- Neurology Department, Faculty of Medicine, Language Research Laboratory, University of Lisbon, Lisbon, Portugal
| | - François Viallet
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Joaquim J Ferreira
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
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Abstract
Occupational therapists need to be able to evaluate the profession's interventions critically: to stop the ineffective, to reduce the hazardous and to promote the effective. Randomised controlled trials are a research tool for testing the efficacy of interventions with small to moderate effects. This review aims to cover the issues to be considered when designing a randomised controlled trial of complex interventions, such as occupational therapy.
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Chandler MJ, Parks AC, Marsiske M, Rotblatt LJ, Smith GE. Everyday Impact of Cognitive Interventions in Mild Cognitive Impairment: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2016; 26:225-251. [PMID: 27632385 PMCID: PMC5048589 DOI: 10.1007/s11065-016-9330-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/22/2016] [Indexed: 01/13/2023]
Abstract
Cognitive interventions in Mild Cognitive Impairment (MCI) seek to ameliorate cognitive symptoms in the condition. Cognitive interventions may or may not generalize beyond cognitive outcomes to everyday life. This systematic review and meta-analysis sought to assess the effect of cognitive interventions compared to a control group in MCI on generalizability outcome measures [activities of daily living (ADLs), mood, quality of life (QOL), and metacognition] rather than cognitive outcomes alone. PRISMA guidelines were followed. MEDLINE and PsychInfo were utilized as data sources to locate references related to cognitive interventions in individuals with MCI. The cognitive intervention study was required to have a control or alternative treatment comparison group to be included. Thirty articles met criteria, including six computerized cognitive interventions, 14 therapist-based interventions, and 10 multimodal (i.e., cognitive intervention plus an additional intervention) studies. Small, but significant overall median effects were seen for ADLs (d = 0.23), mood (d = 0.16), and metacognitive outcomes (d = 0.30), but not for QOL (d = 0.10). Computerized studies appeared to benefit mood (depression, anxiety, and apathy) compared to controls, while therapist-based interventions and multimodal interventions had more impact on ADLs and metacognitive outcomes than control conditions. The results are encouraging that cognitive interventions in MCI may impact everyday life, but considerably more research is needed. The current review and meta-analysis is limited by our use of only PsychInfo and MEDLINE databases, our inability to read full text non-English articles, and our reliance on only published data to complete effect sizes.
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Affiliation(s)
- M J Chandler
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - A C Parks
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - M Marsiske
- University of Florida, Gainesville, FL, USA
| | | | - G E Smith
- University of Florida, Gainesville, FL, USA
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41
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Rouillard M, Audiffren M, Albinet C, Ali Bahri M, Garraux G, Collette F. Contribution of four lifelong factors of cognitive reserve on late cognition in normal aging and Parkinson’s disease. J Clin Exp Neuropsychol 2016; 39:142-162. [DOI: 10.1080/13803395.2016.1207755] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Sleeman I, Che ZC, Counsell C. Risk of fracture amongst patients with Parkinson’s disease and other forms of parkinsonism. Parkinsonism Relat Disord 2016; 29:60-5. [DOI: 10.1016/j.parkreldis.2016.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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43
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McDonald T. Supporting the pillars of life quality in long-term care. JOURNAL OF RELIGION, SPIRITUALITY & AGING 2016. [DOI: 10.1080/15528030.2016.1143906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Asakawa T, Fang H, Sugiyama K, Nozaki T, Kobayashi S, Hong Z, Suzuki K, Mori N, Yang Y, Hua F, Ding G, Wen G, Namba H, Xia Y. Human behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev 2016; 68:741-772. [PMID: 27375277 DOI: 10.1016/j.neubiorev.2016.06.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan; Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan.
| | - Huan Fang
- Department of Pharmacy, Jinshan Hospital of Fudan University, Shanghai, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Katsuaki Suzuki
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Norio Mori
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Yilin Yang
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Fei Hua
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Guanghong Ding
- Shanghai Key laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
| | - Guoqiang Wen
- Department of Neurology, Hainan General Hospital, Haikou, Hainan, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Ying Xia
- Department of Neurosurgery, The University of Texas McGovern Medical School, Houston, TX 77030, USA.
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Jenkinson C, Clarke C, Gray R, Hewitson P, Ives N, Morley D, Rick C, Wheatley K, Williams A. Comparing results from long and short form versions of the Parkinson's disease questionnaire in a longitudinal study. Parkinsonism Relat Disord 2015; 21:1312-6. [DOI: 10.1016/j.parkreldis.2015.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 08/20/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
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Ou R, Guo X, Wei Q, Cao B, Yang J, Song W, Shao N, Zhao B, Chen X, Shang H. Festination in Chinese patients with Parkinson's disease. Clin Neurol Neurosurg 2015; 139:172-6. [PMID: 26496878 DOI: 10.1016/j.clineuro.2015.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the occurrence and clinical associations of festination in Chinese patients with Parkinson's disease (PD). METHODS A total of 480 PD patients were recruited in this cross-sectional study. Assessments scales included the Unified PD Rating Scale (UPDRS) part III, PD Questionnaire-39 (PDQ-39), Non-Motor Symptoms Scale (NMSS), Mini-Mental State Examination (MMSE), frontal assessment battery (FAB), Montreal Cognitive Assessment (MoCA), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). RESULTS One hundred and forty PD patients (29.2%) reported festination. Festination occurred more frequently in patients with lower limbs as the site of onset and patients with longer disease duration or higher Hoehn and Yahr (H&Y) stage (P<0.05). The mean age, levodopa and entacapone use, incidences of motor complications, falls and freezing of gait, and the scores for the UPDRS part III, NMSS, HAMD and HAMA were higher in patients with festination than those without festination (P<0.05). There were no differences in the scores for the PDQ-39, MMSE, FAB and MoCA between the patients with and without festination. The binary logistic regression model indicated that UPDRS part III, lower limbs as the site of onset, freezing of gait and falls were associated with festination. CONCLUSIONS Festination is a relatively common disabling symptom in Chinese PD patients. Patients with lower limbs as the site of onset and more severe disability were more likely to experience festination. Festination in PD is not related to non-motor symptoms and cognitive dysfunction.
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Affiliation(s)
- Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Xiaoyan Guo
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Na Shao
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
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Cummings J, Friedman JH, Garibaldi G, Jones M, Macfadden W, Marsh L, Robert PH. Apathy in Neurodegenerative Diseases: Recommendations on the Design of Clinical Trials. J Geriatr Psychiatry Neurol 2015; 28:159-73. [PMID: 25809634 DOI: 10.1177/0891988715573534] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/08/2014] [Indexed: 12/18/2022]
Abstract
Apathy is a common feature of neurodegenerative disorders but is difficult to study in a clinical trial setting due to practical and conceptual barriers. Principal challenges include a paucity of data regarding apathy in these disorders, an absence of established diagnostic criteria, the presence of confounding factors (eg, coexisting depression), use of concomitant medications, and an absence of a gold-standard apathy assessment scale. Based on a literature search and ongoing collaboration among the authors, we present recommendations for the design of future clinical trials of apathy, suggesting Alzheimer disease and Parkinson disease as models with relevance across a wider array of neuropsychiatric disorders. Recommendations address clarification of the targeted study population (apathy diagnosis and severity at baseline), confounding factors (mood/cognition, behavior, and treatment), outcome measures, study duration, use of comparators and considerations around environment, and the role of the caregiver and patient assent. This review contributes to the search for an optimal approach to study treatment of apathy in neuropsychiatric disorders.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Joseph H Friedman
- Department of Neurology, Movement Disorders Program, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - George Garibaldi
- Clinical Development, Neurosciences, F. Hoffman-La Roche AG, Basel, Switzerland
| | - Martin Jones
- Bridge Medical Consulting Ltd, London, United Kingdom
| | - Wayne Macfadden
- Clinical Development, Neurosciences, F. Hoffman-La Roche AG, Basel, Switzerland
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippe H Robert
- CoBTeK, Research Memory Center CMRR CHU, University of Sophia Antipolis, Nice, France
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Kelly L, Jenkinson C, Morley D. Outcome measurement in neurodegenerative disease: attributes, applications & interpretation. Neurodegener Dis Manag 2015; 5:305-16. [PMID: 26295721 DOI: 10.2217/nmt.15.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There has been a marked shift from clinically assessed to patient assessed outcomes of treatment in neurodegenerative conditions over recent decades. The use of patient-reported outcome measures (PROMs) provides a method with which researchers and clinicians can gain insightful and meaningful data on health status from the patients' perspective. It is imperative that high-quality PROMs are chosen based upon their measurement properties and their suitability for use in the intended clinical or research context. This review aims to give a brief overview of best practice standards for selecting PROMs, current instruments used in exemplar neurodegenerative conditions and their application in clinical trials and routine measurement.
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Affiliation(s)
- Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - David Morley
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
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49
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Ferreira JJ, Godinho C, Santos AT, Domingos J, Abreu D, Lobo R, Gonçalves N, Barra M, Larsen F, Fagerbakke Ø, Akeren I, Wangen H, Serrano JA, Weber P, Thoms A, Meckler S, Sollinger S, van Uem J, Hobert MA, Maier KS, Matthew H, Isaacs T, Duffen J, Graessner H, Maetzler W. Quantitative home-based assessment of Parkinson's symptoms: the SENSE-PARK feasibility and usability study. BMC Neurol 2015; 15:89. [PMID: 26059091 PMCID: PMC4460963 DOI: 10.1186/s12883-015-0343-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 05/20/2015] [Indexed: 11/13/2022] Open
Abstract
Background Currently, assessment of symptoms associated with Parkinson’s disease is mainly performed in the clinic. However, these assessments have limitations because they provide only a snapshot of the condition. Methods The feasibility and usability of an objective, continuous and relatively unobtrusive system (SENSE-PARK System), which consists of wearable sensors (three worn during the day and one worn at night), a smartphone-based App, a balance board and computer software, was tested 24/7 over 12 weeks in a study including 22 PD patients. During the first four weeks of the study, patients did not get feedback about their performance, during the last eight weeks they did. The study included seven clinical visits with standardized interviews, and regular phone contact. The primary outcome was the number of drop-outs during the study. As secondary outcomes, the Post-Study System Usability Questionnaire (PSSUQ), score and information obtained from the standardized interviews were used to evaluate the usability of the system. Results All patients completed the study. The participants rated the usability of the SENSE-PARK System with a mean score of 2.67 (±0.49) on the PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their health condition. Conclusions This 12 week controlled study demonstrates that the acceptance level of PD patients using the SENSE-PARK System as a home-based 24/7 assessment is very good. Particular emphasis should be given to a user-friendly design. Motivation to wear such a system can be increased by providing direct feedback about the individual health condition.
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Affiliation(s)
- Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal. .,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal. .,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.
| | - Catarina Godinho
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal. .,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal. .,Center for Interdisciplinary Research Egas Moniz (CiiEM), Cooperativa de Ensino Superior Egas Moniz, Monte de Caparica, Caparica, Portugal.
| | - Ana T Santos
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Josefa Domingos
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Daisy Abreu
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Raquel Lobo
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Nilza Gonçalves
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Marcio Barra
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Frank Larsen
- NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway.
| | - Øyvind Fagerbakke
- NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway.
| | - Ingvild Akeren
- NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway.
| | - Hilde Wangen
- NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway.
| | - J Artur Serrano
- NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
| | | | | | | | | | - Janet van Uem
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany. .,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany.
| | - Markus A Hobert
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany. .,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany.
| | - Katrin S Maier
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany. .,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany.
| | | | | | | | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tuebingen, Germany.
| | - Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany. .,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany.
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Nitkowska M, Tomasiuk R, Czyżyk M, Friedman A. Prolactin and sex hormones levels in males with Parkinson's disease. Acta Neurol Scand 2015; 131:411-6. [PMID: 25399742 DOI: 10.1111/ane.12334] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role that oestradiol and testosterone play in Parkinson's disease and their potential to influence the course of the disease has been covered in medical literature. The aim of this work was to compare oestradiol, testosterone, sex hormone-binding protein and prolactin blood levels in males affected with Parkinson's disease and in an age-matched control group, and to show possible dependence between concentrations of plasma hormones and the progression of symptoms of Parkinson's disease. METHODS The plasma levels of oestradiol, testosterone, prolactin and sex hormone-binding protein were examined in 36 patients affected with Parkinson's disease and in 69 age-matched control subjects, using chemiluminescent reactions. Patients with Parkinson's disease were examined using scales assessing their clinical state. RESULTS The level of prolactin was higher in the affected group. Concentrations of oestradiol and testosterone in the control group exceeded those found in patients. The level of sex hormones was positively correlated with better mood and quality of life in patients affected with Parkinson's disease; prolactin levels correlated negatively with sex steroid concentrations. CONCLUSIONS Lower blood levels of sex steroids and higher concentrations of prolactin and its antigonadotrophic activity in males affected with Parkinson's disease may result in a bigger susceptibility to the disease in men. The level of hormones may influence patients' cognition, mood and quality of life.
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Affiliation(s)
- M. Nitkowska
- Department of Neurology; Medical University of Warsaw; Mazowiecki Szpital Bródnowski; Warsaw Poland
| | - R. Tomasiuk
- Biochemistry Laboratory; Mazowiecki Szpital Bródnowski; Warsaw Poland
| | - M. Czyżyk
- Department of Physiotherapy; Mazowiecki Szpital Bródnowski; Warsaw Poland
| | - A. Friedman
- Department of Neurology; Medical University of Warsaw; Mazowiecki Szpital Bródnowski; Warsaw Poland
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