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Lazcano-Ocampo C, van Wamelen D, Samuel M, Silverdale M, Rizos A, Sauerbier A, Koch J, Podlewska A, Leta V, Dafsari HS, Timmermann L, Ashkan K, Ray Chaudhuri K. Evaluation of the effect of bilateral subthalamic nucleus deep brain stimulation on fatigue in Parkinson's Disease as measured by the non-motor symptoms scale. Br J Neurosurg 2024; 38:712-715. [PMID: 34357840 DOI: 10.1080/02688697.2021.1961681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fatigue is a common and disabling non-motor symptom (NMS) in Parkinson's disease (PD) patients. However, the effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on fatigue has not been widely studied. OBJECTIVE To determine the effect of STN DBS on fatigue in PD patients, measured by the Non-motor symptoms scale (NMSS). METHODS Cross-sectional analysis of 50 patients with PD who underwent STN DBS at King's College Hospital and Salford Royal Hospital with fatigue scores (measured by question number 4 from domain 2 (sleep/fatigue) of the NMSS as the primary outcome measure. Secondary outcome measures included the PD Sleep Scale (PDSS), Scales for Outcome in PD (SCOPA)-motor examination, activities of daily living, motor complications, Hoehn and Yahr (HY) stage and changes in Levodopa Equivalent Daily Dose (LEDD). RESULTS 50 patients with a mean follow-up period of 1.98 ± 1.36 years were studied. Significant improvement in median fatigue scores (4.00 (0.75-9.00) to 1.00 (0.00-4.50); p = .001) was observed. In addition, improvements in question 5 (sleep maintenance and fragmentation; 8.00 (4.00-12.00) to 0.00 (0.00-4.00); p < .001) and in domain 2 total score (sleep/fatigue; 20.00 (8.75-27.25) to 6.00 (0.75-16.00); p < .001) were also significant, together with improvements in NMSS total score, SCOPA scores and HY stage (p ≤ .02). Moreover, LEDD but especially dopamine agonists LEDD was significantly reduced after DBS (310.00 (0.00-480.00) to 150.00 (0.00-300.00); p < .020). CONCLUSIONS Even though open label and not using a validated fatigue scale, this observational analysis suggest that fatigue improves significantly after STN DBS with persisting benefits at two years follow-up.
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Affiliation(s)
- Claudia Lazcano-Ocampo
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Daniel van Wamelen
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Michael Samuel
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | - Monty Silverdale
- Salford Royal NHS Foundation Trust, Department of Neurology, Salford, UK
| | - Alexandra Rizos
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Anna Sauerbier
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Julia Koch
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Aleksandra Podlewska
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Valentina Leta
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Keyoumars Ashkan
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Neurosurgery, King's College Hospital, London, UK
| | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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Maetzler W, Correia Guedes L, Emmert KN, Kudelka J, Hildesheim HL, Paulides E, Connolly H, Davies K, Dilda V, Ahmaniemi T, Avedano L, Bouça-Machado R, Chambers M, Chatterjee M, Gallagher P, Graeber J, Maetzler C, Kaduszkiewicz H, Kennedy N, Macrae V, Carrasco Marin L, Moses A, Padovani A, Pilotto A, Ratcliffe N, Reilmann R, Rosario M, Schreiber S, De Sousa D, Van Gassen G, Warring LA, Seppi K, van der Woude CJ, Ferreira JJ, Ng WF. Fatigue-Related Changes of Daily Function: Most Promising Measures for the Digital Age. Digit Biomark 2024; 8:30-39. [PMID: 38510264 PMCID: PMC10954320 DOI: 10.1159/000536568] [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: 11/08/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024] Open
Abstract
Background Fatigue is a prominent symptom in many diseases and is strongly associated with impaired daily function. The measurement of daily function is currently almost always done with questionnaires, which are subjective and imprecise. With the recent advances of digital wearable technologies, novel approaches to evaluate daily function quantitatively and objectively in real-life conditions are increasingly possible. This also creates new possibilities to measure fatigue-related changes of daily function using such technologies. Summary This review examines which digitally assessable parameters in immune-mediated inflammatory and neurodegenerative diseases may have the greatest potential to reflect fatigue-related changes of daily function. Key Messages Results of a standardized analysis of the literature reporting about perception-, capacity-, and performance-evaluating assessment tools indicate that changes of the following parameters: physical activity, independence of daily living, social participation, working life, mental status, cognitive and aerobic capacity, and supervised and unsupervised mobility performance have the highest potential to reflect fatigue-related changes of daily function. These parameters thus hold the greatest potential for quantitatively measuring fatigue in representative diseases in real-life conditions, e.g., with digital wearable technologies. Furthermore, to the best of our knowledge, this is a new approach to analysing evidence for the design of performance-based digital assessment protocols in human research, which may stimulate further systematic research in this area.
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Affiliation(s)
- Walter Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Kirsten Nele Emmert
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Luise Hildesheim
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Emma Paulides
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hayley Connolly
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kristen Davies
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | | | - Luisa Avedano
- European Federation of Crohn’s and Ulcerative Colitis, Brussels, Belgium
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | | | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Johanna Graeber
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Victoria Macrae
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | - Anusha Moses
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
- University of Twente, Department of Medical Cell Biophysics, TechMed Centre, Enschede, The Netherlands
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Ralf Reilmann
- George-Huntington-Institute, R&D-Campus/Technology-Park Münster, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Madalena Rosario
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Dina De Sousa
- European Huntington’s Association, Moerbeke, Belgium
| | | | | | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - C. Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - on behalf of the IDEA-FAST project consortium
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- CHDI Management, CHDI Foundation, Princeton, NJ, USA
- Teknologian tutkimuskeskus VTT Oy, Espoo, Finland
- European Federation of Crohn’s and Ulcerative Colitis, Brussels, Belgium
- MC Healthcare Evaluation, London, UK
- Janssen Research and Development, Cambridge, MA, USA
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
- Asociación Parkinson Madrid, Madrid, Spain
- University of Twente, Department of Medical Cell Biophysics, TechMed Centre, Enschede, The Netherlands
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Parkinson’s UK, London, UK
- George-Huntington-Institute, R&D-Campus/Technology-Park Münster, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
- European Huntington’s Association, Moerbeke, Belgium
- Medical Department, Takeda, Brussels, Belgium
- Janssen LLC, GCSO Immunology, Horsham, PA, USA
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Sanchez-Luengos I, Lucas-Jiménez O, Ojeda N, Peña J, Gómez-Esteban JC, Gómez-Beldarrain MÁ, Vázquez-Picón R, Foncea-Beti N, Ibarretxe-Bilbao N. Predictors of health-related quality of life in Parkinson's disease: the impact of overlap between health-related quality of life and clinical measures. Qual Life Res 2022; 31:3241-3252. [PMID: 35842497 PMCID: PMC9546987 DOI: 10.1007/s11136-022-03187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine predictors of health-related quality of life (HRQoL) in Parkinson's disease (PD) and to explore their predictive value before and after controlling overlapping items between HRQoL and clinical variables. METHODS One hundred and eight PD patients underwent motor, anxiety, depression, apathy, fatigue, and neurocognition assessment. HRQoL was assessed by the Parkinson's Disease Questionnaire-39 (PDQ-39). In order to determine predictors of HRQoL in PD, stepwise multiple regression analyses were performed in two ways: before and after removing the emotional well-being dimension from PDQ-39 to control the overlap between depression and anxiety, and HRQoL. RESULTS HRQoL total index was predicted by anxiety, fatigue, motor symptoms, and depression, explaining 26.9%, 7.2%, 2.8%, and 1.9% of the variance. However, after removing overlapping items, HRQoL total index was predicted by fatigue (16.5%), anxiety (6.1%), motor symptoms (3.9%), and neurocognition (2.5%), but not depression. Regarding HRQoL dimensions, mobility and activities of daily living were predicted by fatigue (19.7% and 5%) and UPDRS-III (4% and 10.2%); emotional well-being by fatigue (7.9%); social support by anxiety (12.2%) and UPDRS-III (8.6%); communication by neurocognition (5.3%) and UPDRS-III (3.4%); cognition by anxiety (10.6%) and bodily discomfort by anxiety (23%) and fatigue (4.1%). CONCLUSION These findings showed the importance of identifying and controlling overlapping items of HRQoL and clinical measures to perform an accurate interpretation. HRQoL dimensions showed different predictors before and after controlling the overlap. Based on these results fatigue, anxiety, motor symptoms, and neurocognition, but not depression are the main predictors of HRQoL in PD patients.
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Affiliation(s)
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | | | | | | | - Nerea Foncea-Beti
- Department of Neurology, Hospital of Galdakao, Galdakao-Usansolo, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
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Xie F, You Y, Guan C, Xu J, Yao F. The Qigong of Prolong Life With Nine Turn Method Relieve Fatigue, Sleep, Anxiety and Depression in Patients With Chronic Fatigue Syndrome: A Randomized Controlled Clinical Study. Front Med (Lausanne) 2022; 9:828414. [PMID: 35847786 PMCID: PMC9280429 DOI: 10.3389/fmed.2022.828414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundChronic fatigue syndrome (CFS) is a complex disease of unknown etiology and mechanism. The purpose of this study was to investigate the effect of Prolong Life with Nine Turn Method (PLWNT) Qigong exercise on CFS focusing on fatigue, sleep quality, depression, and anxiety.MethodsA total of 90 participants diagnosed with CFS were randomly assigned into two parallel groups: PLWNT and cognitive behavioral therapy (CBT). The participants in the PLWNT or CBT group participated in qigong exercise or cognitive behavior education program, respectively, once a week in-person and were supervised online during the remaining 6 days at home, over 12 consecutive weeks. The primary outcome was fatigue (Multi-dimensional Fatigue Inventory 20 [MFI-20]), and secondary outcomes were sleep quality (Pittsburgh Sleep Quality Index [PSQI]), anxiety, depression (Hospital Anxiety and Depression Scale [HADS]), and changes in the Neuropeptide Y (NPY) of peripheral blood.ResultsThe within-group comparisons of the PLWNT and CBT groups revealed significant improvement in both groups in MFI-20, PSQI, and HADS scores (P < 0.05). No significant difference were found between the PLWNT and CBT groups, even though the effective rate of the PLWNT group was 62.22%, which is slightly than 50.00% of the CBT group. The fatigue scores in the PLWNT group were positively correlated with sleep degree (r = 0.315) and anxiety degree (r = 0.333), only anxiety degree (r = 0.332) was found to be positively correlated with fatigue in the CBT group. The analysis of peripheral blood showed that NPY decreased after PLWNT intervention but increased significantly in the CBT.ConclusionThe PLWNT qigong exercise has potential to be an effective rehabilitation method for CFS symptoms including fatigue, sleep disturbance, anxiety, and depression. Future studies should expand study sample size for in-depth investigation to determine the optimal frequency and intensity of PLWNT qigong intervention in CFS patients. The study was registered in the ClinicalTrials.gov database on April 12, 2018, with registration number NCT03496961.
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Affiliation(s)
- Fangfang Xie
- Department of Acupuncture and Massage Rehabilitation Center, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanli You
- Department of Traditional Chinese Medicine, ChangHai Hospital, Naval Medical University, Shanghai, China
| | - Chong Guan
- Department of School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiatuo Xu
- Department of School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jiatuo Xu
| | - Fei Yao
- Department of Acupuncture and Massage Rehabilitation Center, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Fei Yao
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Associations Between Fatigue and Disability, Depression, Health-Related Hardiness and Quality of Life in People with Stroke. J Stroke Cerebrovasc Dis 2022; 31:106543. [PMID: 35525062 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106543] [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: 11/24/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stroke is a common cause of mortality and morbidity which affects approximately 17 million people globally each year. Common symptoms associated with stroke are physical disabilities, impaired cognitive functions, depression, and fatigue, all of which can significantly impact health-related quality of life (HRQoL). To date, no research has explored the inter-relationship among fatigue, disability, depression, health-related hardiness, and quality of life in stroke survivors. METHODS Data was obtained from a sub-study of the 45 and Up Study; including 576 Australian adults who had been diagnosed with a stroke. The cross-sectional questionnaire obtained demographic and health status information, as well as clinical measures and stroke-related measures. Associations among fatigue and disability, depression, health-related hardiness and quality of life were analysed using a linear regression model. RESULTS In comparison to those participants with no stroke-related disability, those with slight (β = 1.141; p = 0.008), moderate (β = 3.250; p < 0.001) or severe (β = 3.526; p < 0.001) disability had significantly higher fatigue scores. For every one unit increase in the depression score, the fatigue score increased by 1.502 points (p < 0.001). For every one unit increase in the health-related hardiness score, the fatigue score decreased by 0.054 points (p = 0.044). For every one unit increase in the quality of life score, the fatigue score decreased by 0.068 points (p < 0.001). CONCLUSION This study found significant associations among fatigue and disability, depression, health-related hardiness, and quality of life in stroke survivors. Accurate detection and management of fatigue may help improve the rehabilitation of stroke survivors.
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Gu SC, Ye Q, Wang CD, Zhao SR, Zhou J, Gao C, Zhang Y, Liu ZG, Yuan CX. Pingchan Granule for Motor Symptoms and Non-Motor Symptoms of Parkinson’s Disease: A Randomized, Double-Blind, Placebo-Controlled Study. Front Pharmacol 2022; 13:739194. [PMID: 35281890 PMCID: PMC8914044 DOI: 10.3389/fphar.2022.739194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/17/2022] [Indexed: 12/20/2022] Open
Abstract
Background: Pingchan granule (PCG) is a traditional Chinese medicine for treating Parkinson’s disease (PD). Objective: This study aimed at evaluating the efficacy and safety of PCG for motor and non-motor symptoms of PD. Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 292 participants with mild-to-moderate PD were included and followed for 36 weeks (24 week treatment, 12-week follow-up after intervention), randomly assigned at a 1:1 ratio to receive PCG or placebo. The primary outcomes included the severity of motor symptoms assessed by the Unified Parkinson’s disease Rating Scale (UPDRS) part 3 (UPDRS-III) score and the rate of disease progression assessed by the total UPDRS score. Secondary outcomes included non-motor symptoms assessed using the Scale for Outcomes in Parkinson’s Disease-Autonomic (SCOPA-AUT), Parkinson’s disease Sleep Scale (PDSS), 24-item Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), UPDRS part 2 (UPDRS-II), and 39-item Parkinson’s Disease Questionnaire (PDQ-39) scores. Assessments were done at baseline (T0), 12 weeks (T1), 24 weeks (T2), and 36 weeks (T3). Results: Generalized estimating equation analyses revealed that the PCG group had significantly better improvement in UPDRS-III score at T1, T2, and T3 [time-by-group interaction, T1: β, −0.92 (95% CI, −1.59–−0.25; p = 0.01); T2: β, −2.08 (95% CI, −2.90–−1.27; p < 0.001); T3: β, −4.54 (95% CI, −5.37–−3.71; p < 0.001))]. The PCG group showed a greater decrease (rate of disease change) in the total UPDRS score between T0 and T2 [−2.23 (95% CI, −2.72–−1.73; p < 0.001) points per week vs. −0.21 (95% CI, −0.80–0.39; p = 0.50) points per week in the placebo group, p < 0.001]. Ameliorations of SCOPA-AUT, PDSS, HAM-D, HAM-A, UPDRS-II, and PDQ-39 scores were also observed. Conclusion: PCG had a long-lasting and extensive symptomatic efficacy for both motor and non-motor symptoms of PD with good tolerance. Trial registration: Chinese Clinical Trial Register, ChiCTR-INR-17011949.
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Affiliation(s)
- Si-Chun Gu
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Ye
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chang-De Wang
- Department of Neurology, Shanghai TCM-integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shao-Rong Zhao
- Department of Neurology, Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Zhou
- Department of Neurology, Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Gao
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shangha, China
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shangha, China
| | - Zhen-Guo Liu
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shangha, China
- *Correspondence: Zhen-Guo Liu, ; Can-Xing Yuan,
| | - Can-Xing Yuan
- Department of Neurology, Shanghai TCM-integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Zhen-Guo Liu, ; Can-Xing Yuan,
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Terra MB, Caramaschi IKF, Araújo HAGDO, Souza RJD, Silva TCOD, Nascimento TS, Probst VS, Smaili SM. Is fatigue associated with balance in Parkinson's disease? MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220013921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Patient and caregiver outcomes with levodopa-carbidopa intestinal gel in advanced Parkinson’s disease. NPJ Parkinsons Dis 2021; 7:108. [PMID: 34848716 PMCID: PMC8633325 DOI: 10.1038/s41531-021-00246-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/07/2021] [Indexed: 01/02/2023] Open
Abstract
Levodopa-carbidopa intestinal gel (LCIG) has shown to be efficacious in motor and non-motor symptoms (NMS). Nevertheless, studies with patient Quality of Life (QoL) as a primary endpoint are scarce. To assess the effect of LCIG on Advanced Parkinson’s Disease (APD) patients QoL. Secondarily, the impact on motor symptoms and NMS, emotional well-being, treatment satisfaction, and caregiver QoL, stress, disease burden, anxiety, depression, and work impairment were also investigated. In this prospective, 6-month multicenter postmarketing observational study, LCIG was administered to 59 patients with APD. Endpoints were assessed using validated scales and questionnaires. LCIG significantly improved patient QoL (PDQ-39 mean change ± standard deviation from baseline, −12.8 ± 14.6; P < 0.0001), motor symptoms (UPDRS-III in “On,” −6.5 ± 11.8; P = 0.0002), NMS (NMSS, −35.7 ± 31.1; P < 0.0001), mood (Norris/Bond-Lader VAS, −6.6 ± 21.1; P = 0.0297), fatigue (PFS-16, −0.6 ± 1.0; P = 0.0003), depression (BDI-II, −5.1 ± 9.4; P = 0.0002), anxiety (BAI, −6.2 ± 9.6; P < 0.0001), and patient treatment satisfaction (SATMED-Q, 16.1 ± 16.8; P < 0.0001). There were significant correlations between the change from baseline to 6 months between PDQ-39 and UPDRS-IV, NMSS, BAI, BDI-II, AS, and PFS-16 scores, and Norris/Bond-Lader alertness/sedation factor. Caregiver anxiety also improved (Goldberg anxiety scale, −1.1 ± 1.0; P = 0.0234), but the clinical relevance of this finding is questionable. The serious adverse events reported were similar to those previously described for LCIG. In patients with APD, LCIG improves QoL, motor symptoms and NMS, emotional well-being, and satisfaction with the treatment. Improvement in patient QoL is associated with improvements in motor complications, NMS, anxiety, depression, apathy and fatigue. Improvements in patients’ QoL does not correspond with improvements in caregivers’ QoL or burden.
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Ou R, Hou Y, Liu K, Lin J, Jiang Z, Wei Q, Zhang L, Cao B, Zhao B, Song W, Shang H. Progression of Fatigue in Early Parkinson's Disease: A 3-Year Prospective Cohort Study. Front Aging Neurosci 2021; 13:701906. [PMID: 34744684 PMCID: PMC8568310 DOI: 10.3389/fnagi.2021.701906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/28/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: To explore the frequency, evolution, associated factors, and risk factors of fatigue over 3-year of prospective follow-up in a cohort of patients with early Parkinson’s disease (PD). Methods: A total of 174 PD patients in the early stage were enrolled and quantitively assessed motor and non-motor symptoms using comprehensive scales including the Fatigue Severity Scale (FSS) annually. Each subject was categorized as PD with and without fatigue based on a cut-off mean value of 4 using FSS. The generalized estimating equation (GEE) was utilized to investigate the associated factors, and the stepwise binary logistic regression model was performed to explore the predictors. Results: The frequency of fatigue was slightly changed (ranging from 35.1 to 40.4%) during the 3-year follow-up. The changed pattern of the frequency of fatigue was similar to that of anxiety. Fatigue was significantly associated with nocturnal sleep disorders (B 2.446, P < 0.001), high Hamilton Anxiety Rating Scale (HAMA) score (B 1.072, P = 0.011), and high Unified PD Rating Scale (UPDRS) III score (B 1.029, P = 0.003) over time. High UPDRS III score [odds ratio (OR) 1.051, P = 0.015] at baseline increased the risk of developing fatigue after 1-year; high LEDD (OR 1.002, P = 0.037) increased the risk of developing fatigue after 2-year; and high LEDD (OR 1.003, P = 0.049) and high HAMA score (OR 1.077, P = 0.042) increased the risk of developing fatigue after 3-year. Conclusion: Our present study provided evidence of the longitudinal evolution of fatigue in patients with early PD and help clinical management of fatigue.
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Affiliation(s)
- Ruwei Ou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Kuncheng Liu
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Junyu Lin
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Jiang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyu Zhang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Zhi Y, Gao C. Acupuncture in the treatment of fatigue in Parkinson's disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23389. [PMID: 33235114 PMCID: PMC7710230 DOI: 10.1097/md.0000000000023389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fatigue is a commonly occurring nonmotor symptom among individuals of Parkinson's disease (PD). Little is known about how to measure fatigue in PD. This study is aiming to investigate the safety and efficacy of acupuncture for PD-related fatigue. METHODS RCTs of acupuncture for PD-related fatigue will be retrieved from inception to July 2020 in 9 different databases such as Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and so on. Search words will be used for the BC and acupuncture. The analysis would include randomised, controlled, clinical trials of PD patients with fatigue that were published in either Chinese or English. The primary outcome is the fatigue condition. Two or three reviewers should be in charge of study selection, data extraction and evaluating the risk of bias. RevMan software (V.5.3) will be used to perform the assessment of the risk of bias and data synthesis. RESULTS To provide evidence for the efficacy and safety of acupuncture treating PD-related fatigue. CONCLUSION This study will be helpful for understanding the effect and safety of acupuncture for PD-related fatigue. TRIAL REGISTRATION NUMBER CRD42020160823.
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11
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Cognitive fatigue and cortical-striatal network in old age. Aging (Albany NY) 2020; 11:2312-2326. [PMID: 30995207 PMCID: PMC6519999 DOI: 10.18632/aging.101915] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/10/2019] [Indexed: 11/25/2022]
Abstract
Cognitive fatigue (CF) is among the most common and disturbing aging symptoms, and substantially interferes with activities demanding sustained mental effort. Here we examined the relationship between the cortical-striatal network and CF (assessed by the 18-item visual analogue scale) when a group of cognitively and physically healthy older adults participated in a 30-minute cognitively fatiguing task-related fMRI experiment. We also explored whether CF would interfere with the “Posterior-Anterior Shifting in Aging” (PASA) phenomenon, an aging-associated neural reliance on frontal regions to support cognitive capacity. We revealed that decreased connectivity strength of the cortical-striatal network over the course of the task was related to higher CF. Correlation between CF and the cortical-striatal network was more robust in anterior relative to posterior components. Moreover, a positive relationship between reliance on the anterior part of the cortical-striatal network and cognitive performance only existed among older adults experiencing low CF. These findings suggest a crucial role of the cortical-striatal network, especially the anterior component, in linking to CF. The PASA phenomenon may only be applicable to older adults without vulnerability to CF.
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12
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Lazcano-Ocampo C, Wan YM, van Wamelen DJ, Batzu L, Boura I, Titova N, Leta V, Qamar M, Martinez-Martin P, Ray Chaudhuri K. Identifying and responding to fatigue and apathy in Parkinson’s disease: a review of current practice. Expert Rev Neurother 2020; 20:477-495. [DOI: 10.1080/14737175.2020.1752669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Claudia Lazcano-Ocampo
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Department of Neurology, Hospital Sotero Del Rio, Santiago, Chile
| | - Yi Min Wan
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Department of Psychiatry, Ng Teng Fong General Hospital, Singapore
| | - Daniel J van Wamelen
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Cognition and Behaviour; Department of Neurology; Nijmegen, Radboud University Medical Centre; Donders Institute for Brain, The Netherlands
| | - Lucia Batzu
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Iro Boura
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Budgetary Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Valentina Leta
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Mubasher Qamar
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health. Madrid, Spain
| | - K Ray Chaudhuri
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
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Moon S, Sarmento CVM, Steinbacher M, Smirnova IV, Colgrove Y, Lai SM, Lyons KE, Liu W. Can Qigong improve non-motor symptoms in people with Parkinson's disease - A pilot randomized controlled trial? Complement Ther Clin Pract 2020; 39:101169. [PMID: 32379638 PMCID: PMC7607921 DOI: 10.1016/j.ctcp.2020.101169] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/14/2020] [Accepted: 03/31/2020] [Indexed: 01/27/2023]
Abstract
Non-motor symptoms (NMS) including sleep disorders, anxiety, depression, fatigue, and cognitive decline can significantly impact quality of life in people with PD. Qigong exercise is a mind-body exercise that shows a wide range of benefits in various medical conditions. The purpose of this study was to investigate the effect of Qigong exercise on NMS with a focus on sleep quality. Seventeen participants completed a 12-week intervention of Qigong (n = 8) or sham Qigong (n = 9). Disease severity, anxiety and depression levels, fatigue, cognition, quality of life, and other NMS of the participants were evaluated prior to the intervention and at the end of the 12-week intervention. After the intervention, both Qigong and sham-Qigong group showed significant improvement in sleep quality (p < 0.05) and overall NMS (p < 0.05). No significant difference was found between groups. Qigong exercise has the potential as a rehabilitation method for people with PD, specifically alleviating NMS in PD. However, this finding needs to be carefully considered due to the small sample size and potentially low intervention fidelity of this study.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Caio V M Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA; Department of Physical Therapy, Department of Physical Therapy, California State University, Fresno, CA, USA.
| | - Michael Steinbacher
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Irina V Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Yvonne Colgrove
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Sue-Min Lai
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
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Ahn JH, Kim M, Mun JK, Cho Y, Kim JS, Youn J, Kim JS, Cho JW. The Dysfunctional Autonomic Function and “Dysfunctional” Fatigue in Drug Naïve Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:605-612. [DOI: 10.3233/jpd-201919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Jun Kyu Mun
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Yoonsu Cho
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
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15
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Mental health in Parkinson's disease after receiving aquatic therapy: a clinical trial. Acta Neurol Belg 2019; 119:193-200. [PMID: 30413971 DOI: 10.1007/s13760-018-1034-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
Depression is a major determinant of quality of life in individuals with Parkinson's disease. The aim of this study was to evaluate the effects of a program of Ai Chi aquatic therapy on pain, depression and quality of life in people with Parkinson's disease. Participants were randomized to receive dry land physiotherapy treatment (control group) or aquatic Ai Chi sessions in the pool (experimental group). The outcome measures used included the VAS pain scale, the Geriatric Depression Scale and the SF-36 quality of life scale. In the experimental group treated with aquatic therapy, significant differences were found in the pain, depression and quality of life variables post-treatment (p < 0.001). In the control group, improvements were only observed in the VAS pain scale, and these were less significant than the changes found in the experimental group (p = 0.006). The significant changes registered in the experimental group at the post-treatment assessment were maintained 1 month after completing the experimental intervention program. In conclusion, these findings indicate that physical exercise performed in water has positive effects on some of the factors that influence mood and quality of life in people with Parkinson's disease.
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16
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Kaminska M, Mery VP, Lafontaine AL, Robinson A, Benedetti A, Gros P, Kimoff RJ. Change in Cognition and Other Non-Motor Symptoms With Obstructive Sleep Apnea Treatment in Parkinson Disease. J Clin Sleep Med 2018; 14:819-828. [PMID: 29734988 DOI: 10.5664/jcsm.7114] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/09/2018] [Indexed: 01/11/2023]
Abstract
STUDY OBJECTIVES Parkinson disease (PD) non-motor symptoms are associated with sleep disorders and impair quality of life. Our objective was to assess the effect of obstructive sleep apnea (OSA) treatment using continuous positive airway pressure (CPAP) on PD non-motor symptoms. METHODS In this prospective observational study, 67 patients with idiopathic PD underwent polysomnography. Those with moderate-severe OSA were offered CPAP therapy. Subjects were divided into those without OSA (OSA-), and those with OSA (OSA+). Analyses were conducted for 6 and 12 months' follow-up data. At 6 months, those who had used CPAP at home for at least 1 month were considered CPAP users (OSA+CPAP+), whereas those who did not try it, or declined further treatment following a short trial were considered non-users (OSA+CPAP-). For the 12-month analysis, only those still actively using CPAP at 12 months were included in the OSA+CPAP+ group. Non-motor symptom measurements were: Epworth Sleepiness Scale, Montreal Cognitive Assessment (MoCA), Unified Parkinson's Disease Rating Scale part 1 (UPDRS1), Parkinson's Disease Sleep Scale (PDSS), Fatigue Severity Scale, Apathy Scale, Beck Depression Inventory, and Hospital Anxiety and Depression Scale (HADS). RESULTS Sixty-five participants were re-assessed at least once. At 6 months, 30 participants were categorized as OSA+CPAP+, 11 OSA+CPAP-, and 18 OSA-. At 12 months, 21 were categorized as OSA+CPAP+, 21 OSA+CPAP-, and 17 OSA-. The UPDRS1 and PDSS improved from baseline in OSA+CPAP+ at 6 months (-2.7, standard deviation [SD] 4.0, P = .001, and 7.9, SD 19.0, P = .03, respectively) and 12 months (-4.1, SD 5.4, P = .002, and 11.4, SD 24.4, P = .04, respectively), but not in other groups. The MoCA and HADS-A improved in OSA+CPAP+ at 12 months (1.7, SD 3.5, P = .04, and -2.1, SD 3.8, P = .02, respectively). The MoCA improved in those with low baseline MoCA and those with REM sleep behavior disorder. Mean CPAP use in users at 12 months was 3 hours 36 minutes per night. CONCLUSIONS CPAP treatment of OSA in PD is associated with improved overall non-motor symptoms, sleep quality, anxiety, and global cognitive function over a 12-month period.
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Affiliation(s)
- Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada.,Respiratory Division and Sleep Laboratory, McGill University Health Centre - Montreal, Quebec, Canada
| | - Victoria P Mery
- Clinica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Anne-Louise Lafontaine
- Montreal Neurological Hospital, McGill University Health Centre - Montreal, Quebec, Canada
| | - Ann Robinson
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada.,Deptartment of Medicine and Deptartment of Epidemiology, Biostatistics and Occupational Health, McGill University - Montreal, Quebec, Canada
| | | | - R John Kimoff
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada.,Respiratory Division and Sleep Laboratory, McGill University Health Centre - Montreal, Quebec, Canada
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Serrano-Dueñas M, Bravo R, Merchán T, Serrano M. Fatigue in Parkinson's disease: Metric properties of the fatigue impact scale for daily use (D-FIS), and its impact on quality of life. Clin Neurol Neurosurg 2018; 169:12-15. [PMID: 29597014 DOI: 10.1016/j.clineuro.2018.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In Parkinson's disease patients, fatigue is a disabling non-motor symptom whose prevalence ranges from 28% to 58%. The Fatigue Impact Scale for Daily Use (D-FIS), one of the various scales for quantifying fatigue. The aim of our study was to analyze the metric properties of the D-FIS in PD subjects and assess the impact of fatigue on their quality of life. PATIENTS AND METHODS The cohort in this study was comprised of 211 consecutive patients with a PD diagnosis regularly followed up at the Movement Disorders Unit of the Neurology Department at Carlos Andrade Marín Hospital (HCAM) in Quito, Ecuador, according to the United Kingdom PD Society Brain Bank criteria. Data Quality, Acceptability, Reliability, Stability (test-retest), Validity and Multiple linear regression analysis were determined. RESULTS The final sample consisted of 138 men (65.4%) and 73 women. Forty-six percent of these (98 patients) were in stage II of H&Y. We obtained a Cronbach's α value of 0.912 and an ICC value of 0.79. D-FIS was strongly correlated with depression (Spearman rho [Srho] 0.60), anxiety (Srho 0.59), quality of life (Srho 0.67), and non-motor symptoms (Srho 0.66). The scale's discriminant validity, assessed among the different stages of H&Y by the Kruskal-Wallis test, showed major significance (X2 = 23.183, p ≤ 0.001). In the Multiple linear regression study, the resulting model proves that fatigue has a determining effect on quality of life. CONCLUSIONS The D-FIS has good metric properties and demonstrates that fatigue significantly affects PD patients' quality of life and that its impact is independent from that of anxiety, depression, and sleep disorders.
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Affiliation(s)
- Marcos Serrano-Dueñas
- Medicine Faculty, Pontifical Catholic University of Ecuador, Neurological Service, Carlos Andrade Marin Hospital, Quito-Ecuador, Ecuador.
| | - Rosaura Bravo
- Medicine Faculty, Pontifical Catholic University of Ecuador, Neurological Service, Carlos Andrade Marin Hospital, Quito-Ecuador, Ecuador.
| | - Tamara Merchán
- Medicine Faculty, Pontifical Catholic University of Ecuador, Neurological Service, Carlos Andrade Marin Hospital, Quito-Ecuador, Ecuador.
| | - Maite Serrano
- Medicine Faculty, Pontifical Catholic University of Ecuador, Neurological Service, Carlos Andrade Marin Hospital, Quito-Ecuador, Ecuador.
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Kong KH, Ng HL, Li W, Ng DW, Tan SI, Tay KY, Au WL, Tan LCS. Acupuncture in the treatment of fatigue in Parkinson's disease: A pilot, randomized, controlled, study. Brain Behav 2018; 8:e00897. [PMID: 29568693 PMCID: PMC5853635 DOI: 10.1002/brb3.897] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/11/2017] [Accepted: 11/19/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Fatigue is a common and disabling problem in patients with Parkinson's disease (PD), and there is currently no satisfactory treatment. As acupuncture has been reported to be effective in fatigue related to other conditions, we sought to evaluate its efficacy in PD. METHODS This was a single center, randomized, sham-controlled study. Forty PD patients with moderately severe fatigue were randomized to receive 5 weeks of biweekly real or sham acupuncture. The primary outcome was change on the General Fatigue score of the Multidimensional Fatigue Inventory (MFI-GF) at 5 weeks. Secondary outcomes included MFI-Total score, Unified Parkinson's Disease Rating Scale Motor score (UPDRS Motor), Parkinson's Disease Questionnaire-39 (PDQ 39), Geriatrics Depression Scale (GDS), and Epworth Sleepiness Scale ESS). All outcome measures were evaluated at baseline, 5 and 9 weeks. RESULTS Both groups showed significant improvements in MFI-GF and MFI-Total scores at 5 and 9 weeks, but there were no significant between-group differences. There were no improvements from baseline for PDQ 39, GDS, and ESS. Although improvements were noted for the UPDRS Motor score in the real acupuncture group, no between-group difference could be demonstrated. CONCLUSIONS Both real and sham acupuncture are equally effective in improving PD-related fatigue, and it is likely that this is due to nonspecific or placebo effects.
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Affiliation(s)
- Keng H Kong
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Hwee L Ng
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Wei Li
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Dora W Ng
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Siang I Tan
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Kay Y Tay
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Wing L Au
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Louis C S Tan
- Neurology, National Neuroscience Institute Singapore City Singapore
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20
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Yoon JE, Kim JS, Jang W, Park J, Oh E, Youn J, Park S, Cho JW. Gender Differences of Nonmotor Symptoms Affecting Quality of Life in Parkinson Disease. NEURODEGENER DIS 2017; 17:276-280. [PMID: 28848156 DOI: 10.1159/000479111] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Gender differences of health-related quality of life (HRQoL) in patients with various disorders have been reported. Various nonmotor symptoms (NMSs) also affect the patients' lives and HRQoL, even in the early stages of Parkinson disease (PD). Our study aimed to identify whether there are gender differences of HRQoL in PD patients in the early stages, and which NMSs are associated with HRQoL depending on gender. METHOD Eighty-nine PD patients (47 males, 42 females) and 36 healthy controls were enrolled. We evaluated HRQoL, NMSs, and their associations in each gender. RESULT The total Parkinson Disease Quality of Life Questionnaire and Beck Anxiety Inventory scores were higher in female patients than in male patients. The correlation analysis revealed no association between NMSs and HRQoL in male patients. In female patients, HRQoL was highly correlated with depression, and moderately associated with fatigue. CONCLUSIONS Gender differences of an association between HRQoL and NMSs exist in PD. We found that fatigue and depression were the main determinants of poor HRQoL in female patients even in the early stages. We suggest that a gender-specific therapeutic approach is important, and it is necessary to pay special attention to the predictors associated with causing poor HRQoL.
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Affiliation(s)
- Jee-Eun Yoon
- Departments of Neurology, Seoul National University School of Medicine, Seoul National University Bundang Hospital, Bundang, Republic of Korea
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Barone P, Erro R, Picillo M. Quality of Life and Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:499-516. [PMID: 28802930 DOI: 10.1016/bs.irn.2017.05.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Health-related quality of life (HRQoL) is defined as "the perception and evaluation by patients themselves of the impact caused on their lives by the disease and its consequences." HRQoL is conceptualized as a combination of physical, psychological, and social well-being in the context of a particular disease. Following earlier studies revolving on the impact of the classic motor symptoms of Parkinson's disease on HRQoL, mounting evidence have been produced that nonmotor symptoms (NMS) significantly and independently contribute to worse HRQoL. This holds particularly true for such NMS such as neuropsychiatric disturbances, cognitive impairment, and fatigue, the burden of which might well exceed the effects of the motor symptoms. Nonetheless, there is very sparse evidence on how to manage these NMS and whether targeting NMS would in fact lead to an improvement of HRQoL, which calls for the need of future trials with NMS as primary outcomes.
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Affiliation(s)
- Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy.
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy; University College London, Institute of Neurology, London, United Kingdom
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy
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Rostaminia S, Mayberry A, Ganesan D, Marlin B, Gummeson J. iLid: Low-power Sensing of Fatigue and Drowsiness Measures on a Computational Eyeglass. ACTA ACUST UNITED AC 2017; 1. [PMID: 29417956 DOI: 10.1145/3090088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The ability to monitor eye closures and blink patterns has long been known to enable accurate assessment of fatigue and drowsiness in individuals. Many measures of the eye are known to be correlated with fatigue including coarse-grained measures like the rate of blinks as well as fine-grained measures like the duration of blinks and the extent of eye closures. Despite a plethora of research validating these measures, we lack wearable devices that can continually and reliably monitor them in the natural environment. In this work, we present a low-power system, iLid, that can continually sense fine-grained measures such as blink duration and Percentage of Eye Closures (PERCLOS) at high frame rates of 100fps. We present a complete solution including design of the sensing, signal processing, and machine learning pipeline; implementation on a prototype computational eyeglass platform; and extensive evaluation under many conditions including illumination changes, eyeglass shifts, and mobility. Our results are very encouraging, showing that we can detect blinks, blink duration, eyelid location, and fatigue-related metrics such as PERCLOS with less than a few percent error.
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Abstract
BACKGROUND AND PURPOSE Objective ambulatory activity during daily living has not been characterized for people with Parkinson disease prior to initiation of dopaminergic medication. Our goal was to characterize ambulatory activity based on average daily step count and examine determinants of step count in nonexercising people with de novo Parkinson disease. METHODS We analyzed baseline data from a randomized controlled trial, which excluded people performing regular endurance exercise. Of 128 eligible participants (mean ± SD = 64.3 ± 8.6 years), 113 had complete accelerometer data, which were used to determine daily step count. Multiple linear regression was used to identify factors associated with average daily step count over 10 days. Candidate explanatory variable categories were (1) demographics/anthropometrics, (2) Parkinson disease characteristics, (3) motor symptom severity, (4) nonmotor and behavioral characteristics, (5) comorbidities, and (6) cardiorespiratory fitness. RESULTS Average daily step count was 5362 ± 2890 steps per day. Five factors explained 24% of daily step count variability, with higher step count associated with higher cardiorespiratory fitness (10%), no fear/worry of falling (5%), lower motor severity examination score (4%), more recent time since Parkinson disease diagnosis (3%), and the presence of a cardiovascular condition (2%). DISCUSSION AND CONCLUSIONS Daily step count in nonexercising people recruited for this intervention trial with de novo Parkinson disease approached sedentary lifestyle levels. Further study is warranted for elucidating factors explaining ambulatory activity, particularly cardiorespiratory fitness, and fear/worry of falling. Clinicians should consider the costs and benefits of exercise and activity behavior interventions immediately after diagnosis of Parkinson disease to attenuate the health consequences of low daily step count.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A170).
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24
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Reliability and validity study of a Turkish version of the fatigue severity scale in Parkinson’s disease patients. Int J Rehabil Res 2017; 40:185-190. [DOI: 10.1097/mrr.0000000000000224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Nguyen H, Lebel K, Boissy P, Bogard S, Goubault E, Duval C. Auto detection and segmentation of daily living activities during a Timed Up and Go task in people with Parkinson's disease using multiple inertial sensors. J Neuroeng Rehabil 2017; 14:26. [PMID: 28388939 PMCID: PMC5384139 DOI: 10.1186/s12984-017-0241-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 04/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Wearable sensors have the potential to provide clinicians with access to motor performance of people with movement disorder as they undergo intervention. However, sensor data often have to be manually classified and segmented before they can be processed into clinical metrics. This process can be time consuming. We recently proposed detection and segmentation algorithms based on peak detection using Inertial Measurement Units (IMUs) to automatically identify and isolate common activities during daily living such as standing up, walking, turning, and sitting down. These algorithms were developed using a homogenous population of healthy older adults. The aim of this study was to investigate the transferability of these algorithms in people with Parkinson’s disease (PD). Methods A modified Timed Up And Go task was used since it is comprised of these activities, all performed in a continuous fashion. Twelve older adults diagnosed with early PD (Hoehn & Yahr ≤ 2) were recruited for the study and performed three trials of a 10 and 5-m TUG during OFF state. They were outfitted with 17 IMUs covering each body segment. Raw data from IMUs were detrended, normalized and filtered to reveal kinematics peaks that corresponded to different activities. Segmentation was accomplished by identifying the first minimum or maximum to the right and the left of these peaks. Segmentation times were compared to results from two examiners who visually segmented the activities. Specificity and sensitivity were used to evaluate the accuracy of the detection algorithms. Results Using the same IMUs and algorithms developed in the previous study, we were able to detect these activities with 97.6% sensitivity and 92.7% specificity (n = 432) in PD population. However, with modifications to the IMUs selection, we were able to detect these activities with 100% accuracy. Similarly, applying the same segmentation to PD population, we were able to isolate these activities within ~500 ms of the visual segmentation. Re-optimizing the filtering frequencies, we were able to reduce this difference to ~400 ms. Conclusions This study demonstrates the agility and transferability of using a system of IMUs to accurately detect and segment activities in daily living in people with movement disorders.
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Affiliation(s)
- Hung Nguyen
- Département des Sciences de l'activité Physique, Université du Québec àMontréal, 141 Avenue du Président -Kennedy, Montréal, Québec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Karina Lebel
- Faculty of Medicine and Health Sciences, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Research Center on Aging, Sherbrooke, Québec, Canada.,Interdisciplinary Institute for Technological Innovation (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Research Center on Aging, Sherbrooke, Québec, Canada.,Interdisciplinary Institute for Technological Innovation (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sarah Bogard
- Département des Sciences de l'activité Physique, Université du Québec àMontréal, 141 Avenue du Président -Kennedy, Montréal, Québec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Etienne Goubault
- Département des Sciences de l'activité Physique, Université du Québec àMontréal, 141 Avenue du Président -Kennedy, Montréal, Québec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Christian Duval
- Département des Sciences de l'activité Physique, Université du Québec àMontréal, 141 Avenue du Président -Kennedy, Montréal, Québec, Canada. .,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
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Ribas CG, Alves da Silva L, Corrêa MR, Teive HG, Valderramas S. Effectiveness of exergaming in improving functional balance, fatigue and quality of life in Parkinson's disease: A pilot randomized controlled trial. Parkinsonism Relat Disord 2017; 38:13-18. [PMID: 28190675 DOI: 10.1016/j.parkreldis.2017.02.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 12/27/2022]
Abstract
Although motor symptoms in Parkinson's disease (PD) are well established, few studies have described the effects of exergaming on the clinical and functional outcomes of PD. OBJECTIVES To analyze the effectiveness of exergaming in improving functional balance, fatigue, functional exercise capacity and quality of life in PD. METHODS The study population consisted of 20 patients (12 males and 8 females) aged 61 ± 9.11 years allocated into two groups: an exergaming group (EGG) (n = 10) and a conventional exercise, or control, group (CG) (n = 10). The following variables were evaluated: functional balance (Berg Scale), fatigue (Fatigue Severity Scale), functional exercise capacity (Six-Minute Walk Test) and quality of life (PDQ-39 Quality of Life Questionnaire). RESULTS RM-ANOVA showed that balance and fatigue differed significantly between time points: balance [F(1.29, 23.33) = 4.16, p = 0.043] and fatigue [F(2,36) = 5.96, p = 0.006]. In both cases post hoc Bonferroni testing revealed an improvement after 12 weeks of exergaming (p = 0.033 and p = 0.000, respectively). However, this benefit was not sustained after 60 days of follow-up for either outcome. There were no differences in functional exercise capacity or quality of life between the two groups after 12 weeks of treatment. CONCLUSION Exergaming was effective in enhancing balance and reducing fatigue in PD patients after 12 weeks of treatment, but this benefit was not sustained in the long-term.
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Affiliation(s)
- Camila Gemin Ribas
- Department of Physical Therapy, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Letícia Alves da Silva
- Department of Physical Therapy, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Marina Ribas Corrêa
- Department of Physical Therapy, Universidade Federal Do Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Hélio Ghizone Teive
- Department of Neurology, Universidade Federal Do Paraná (UFPR), Curitiba, PR, Brazil
| | - Silvia Valderramas
- Department of Neurology, Universidade Federal Do Paraná (UFPR), Curitiba, PR, Brazil.
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27
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Rieu I, Houeto JL, Pereira B, De Chazeron I, Bichon A, Chéreau I, Ulla M, Brefel-Courbon C, Ory-Magne F, Dujardin K, Tison F, Krack P, Durif F. Impact of Mood and Behavioral Disorders on Quality of Life in Parkinson's disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:267-77. [PMID: 27003781 DOI: 10.3233/jpd-150747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mood symptoms negatively affect quality of life of Parkinson's disease (PD); however little is known about the impact of behavioral disorders such as impulse control disorders, and non-motor fluctuations on quality of life. OBJECTIVE To assess the impact of mood and behavioral disorders on quality of life in PD. METHODS 136 (84% male) PD were included (mean age: 61 ± 8y; mean duration of disease: 8.8 ± 5.4y). Mood symptoms, behavioral disorders and non-motor fluctuations were detected and quantified using the recently validated "Ardouin Scale of Behavior in Parkinson's Disease". Motor symptoms were assessed using UPDRS and quality of life with the "39-item Parkinson's Disease Questionnaire". RESULTS Both motor and non-motor factors significantly affected the quality of life of PD patients. Multivariate regression of the relationship between items of the quality of life questionnaire and the Ardouin Scale showed that alteration of patients' quality of life was strongly correlated with the presence of mood symptoms (such as depression, anxiety ...) and with non-motor fluctuations (especially in the OFF period). A significant correlation was also found between the number of symptoms and their severity, and the quality of life deterioration. Some behavioral disorders (compulsive buying / eating behavior) also negatively affected patient's quality of life to a lesser extent. Alternatively, excess in motivation and hobbyism behaviors had a positive impact on mobility and emotional well-being dimensions respectively of quality of life. CONCLUSIONS This study shows the main impact of mood symptoms and non-motor fluctuations on worsening quality of life in PD.
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Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | - Jean Luc Houeto
- Department Neurology, CIC INSERM-0802, CHU de Poitiers 86021 Poitiers cedex; INSERM U 1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Université de Poitiers, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Biostatistics Unit, Clermont-Ferrand, France
| | - Ingrid De Chazeron
- Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Department of Psychiatry B, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Amélie Bichon
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Unité 836, Grenoble Institut des Neurosciences, 38043 Grenoble, France
| | - Isabelle Chéreau
- CHU Clermont-Ferrand, Department of Psychiatry B, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Miguel Ulla
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | | | - Fabienne Ory-Magne
- University, Hospital Toulouse, Neurology department, CHU Purpan, Toulouse, France
| | - Kathy Dujardin
- Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - François Tison
- University of Bordeaux, Institut des Maladies Neurodégénératives, CNRS UMR 5293 et CHU de Bordeaux, France
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Unité 836, Grenoble Institut des Neurosciences, 38043 Grenoble, France
| | - Franck Durif
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
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28
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Schrag A, Taddei RN. Depression and Anxiety in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:623-655. [DOI: 10.1016/bs.irn.2017.05.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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29
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Zhang TM, Yu SY, Guo P, Du Y, Hu Y, Piao YS, Zuo LJ, Lian TH, Wang RD, Yu QJ, Jin Z, Zhang W. Nonmotor symptoms in patients with Parkinson disease: A cross-sectional observational study. Medicine (Baltimore) 2016; 95:e5400. [PMID: 27977578 PMCID: PMC5268024 DOI: 10.1097/md.0000000000005400] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Parkinson disease (PD) is usually accompanied by numerous nonmotor symptoms (NMS), such as neuropsychiatric symptoms, sleep disorders, autonomic dysfunctions, and sensory disturbances. However, it is not clear that the factors influencing the occurrence of NMS and its sequence with motor symptoms (MS).We conducted comprehensive assessments of NMS by using 13 scales in 1119 PD patients.A total of 70.8% PD patients present NMS. Olfactory dysfunction tends to occur in PD patients with older age, more severe depression, sleep problems, and autonomic dysfunctions. Older patients are more likely to have olfactory dysfunction before MS than younger patients. Rapid eye movement behavior disorder is more prone to happen in patients with older age, older onset age, more severe depression, sleep problems, and autonomic dysfunctions. Patients with rapid eye movement behavior disorder before MS are older in onset age than after group.Olfactory dysfunction, constipation, rapid eye movement behavior disorder, and depression, as early warning NMSs of PD, connected to each other. There is a clinical heterogeneity that older patients are more likely to have NMS before MS, while younger patients are opposite.
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Affiliation(s)
| | | | | | - Yang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | | | | | - Li-jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Teng-hong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Rui-dan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Qiu-jin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Zhao Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Wei Zhang
- Department of Geriatrics
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases; Center of Parkinson's Disease, Beijing Institute for Brain Disorders; Beijing Key Laboratory on Parkinson Disease, Beijing, China
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30
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Pauletti C, Mannarelli D, Locuratolo N, Pollini L, Currà A, Marinelli L, Rinalduzzi S, Fattapposta F. Attention in Parkinson's disease with fatigue: evidence from the attention network test. J Neural Transm (Vienna) 2016; 124:335-345. [PMID: 27783210 DOI: 10.1007/s00702-016-1637-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Abstract
Fatigue is a non-specific symptom that is common in chronic diseases and represents one of the most disabling symptoms in Parkinson's disease. PD patients often experience cognitive deficits related above all to executive functions. The relationship between cognitive changes and fatigue in PD patients has not been explored in depth. The Attention Network Test (ANT) is a rapid, widely used test to measure the efficiency of three attentional networks, i.e., alerting, orienting, and executive, by evaluating reaction times (RTs) in response to visual stimuli. To assess the association between fatigue and the efficiency of the attentional networks, according to the Posnerian view, ANT was administered to 15 parkinsonian patients with fatigue (PFS-16 > 2.95), 17 parkinsonian patients without fatigue, and 37 age- and sex-matched healthy controls. Anxiety, depression, quality of sleep, and quality of life were also assessed. Parkinsonian patients displayed significantly longer RTs and lower executive network efficiency than controls. Patients with fatigue displayed significantly lower executive network efficiency than patients without fatigue. Moreover, patients with fatigue exhibited a lower accuracy than either patients without fatigue or controls. Finally, patients without fatigue displayed a more efficient alerting network than either patients with fatigue or controls. Although the pathogenesis of fatigue is multifactorial, our results indicate that fatigue may be closely related to an alteration of the striato-thalamo-cortical loop connecting the neostriatum to the prefrontal cortex, which is also responsible for the executive dysfunction that is typical of Parkinson's disease.
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Affiliation(s)
- Caterina Pauletti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy. .,Vaclav Vojta Rehabilitation Center, Via Pincherle 186, 00146, Rome, Italy.
| | - Daniela Mannarelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Nicoletta Locuratolo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Luca Pollini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Antonio Currà
- Academic Neurologic Unit, A. Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Lucio Marinelli
- Department of Neurosciences Rehabilitation Ophthalmology Genetics Maternal and Child Health (DiNOGMI), Institute of Neurology, University of Genova, Largo Daneo 3, 16132, Genova, Italy
| | - Steno Rinalduzzi
- Neurology and Neurophysiopathology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Francesco Fattapposta
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
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31
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IL-6 serum levels are elevated in Parkinson's disease patients with fatigue compared to patients without fatigue. J Neurol Sci 2016; 370:153-156. [PMID: 27772747 DOI: 10.1016/j.jns.2016.09.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/15/2016] [Accepted: 09/19/2016] [Indexed: 11/20/2022]
Abstract
To investigate the influence of interleukin-6 (IL-6) and soluble tumor necrosis factor receptors (sTNFR) in fatigued Parkinson's disease (PD) patients. Forty-four PD patients were evaluated, and fatigue was assessed with the Parkinson Fatigue Scale. Logistic regression analysis was used to evaluate the contribution of disease severity scores and cytokine levels on fatigue scores. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of IL-6 in fatigue. Fatigued PD patients had worse cognitive function and depressive symptoms. These patients had worse PD signs and symptoms, displayed more advanced stages of PD, and had greater functional dependence. There was a significant difference in IL-6 serum levels (p=0.026), but there was no difference in sTNFR levels. Total scores on the Unified Parkinson Disease Rating Scale (β=1.108; p=0.004) and IL-6 levels (β=12.843; p=0.020) were found to be significant predictors of fatigue scores. A ROC curve revealed that IL-6 concentrations of 1.18pg/ml represented the best cut-off value for detecting fatigue (sensitivity of 0.941 and specificity of 0.704). Fatigued PD patients have poor clinical outcomes and elevated IL-6 serum levels when compared with non-fatigued patients. These results suggest that IL-6 may play a role in the pathophysiology of fatigue in PD.
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Paul BS, Singh A, Jain D, Singh G, Kaushal S, Paul G, Kaura K. Assessment of fatigue in Parkinson's disease: Indian perspective. Ann Indian Acad Neurol 2016; 19:451-455. [PMID: 27994352 PMCID: PMC5144464 DOI: 10.4103/0972-2327.194419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Fatigue is one of the most frequent nonmotor manifestations in Parkinson's disease (PD), having a major effect on quality of life but is not reported in Indian patients. Aims: To evaluate the frequency of fatigue in a cohort of PD population and its correlation with disease. Settings and Design: Fatigue Severity Scale (FSS) was translated and validated in local vernacular language. All patients of PD visiting neurology outpatient department of a tertiary care hospital. Subjects and Methods: A total of 150 patients were screened, and 104 were included in this study. They were divided into – Group I with fatigue (score of >4 in each item) and Group II without fatigue. Statistical Analysis: Data were analyzed by SPSS software version 20.0. Spearman correlation was used to evaluate the convergent validity of the FSS-Ind score with PD-related variables. The principal components analysis was applied to detect the domain structure of the FSS. Results: Of the total 104 patients, 68 (65.3%) patients experienced fatigue. The duration of disease was significantly more (P = 0.021) in Group I (4.39 ± 3.8 years) than in the Group II (3.13 ± 1.6 years). The severity of disease also showed a positive correlation with fatigue with 50.9% patients in H and Y stage >3 experiencing fatigue. 69.1% patients of tremor phenotype experienced fatigue as compared to 32.3% of rigid phenotype. There was no relation of fatigue with age, gender, H and Y stage, levodopa equivalent dose and mean Unified PD Rating Scale motor III score. Conclusions: Translated version of the FSS, FSS-Ind has high internal consistency and validity which supports its application as an effective tool in detecting fatigue in patients with PD. Fatigue in PD was related to duration and phenotype of the disease.
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Affiliation(s)
- Birinder Singh Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Amandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dinesh Jain
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gunchan Paul
- Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Karan Kaura
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Elbers RG, Verhoef J, van Wegen EEH, Berendse HW, Kwakkel G. Interventions for fatigue in Parkinson's disease. Cochrane Database Syst Rev 2015; 2015:CD010925. [PMID: 26447539 PMCID: PMC9240814 DOI: 10.1002/14651858.cd010925.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Factors contributing to subjective fatigue in people with idiopathic Parkinson's disease (PD) are not well known. This makes it difficult to manage fatigue effectively in PD. OBJECTIVES To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE (via PubMed); Ovid EMBASE; EBSCO CINAHL; Ovid PsycINFO; PEDro; and the WHO International Clinical Trials Registry Platform Search Portal up to April 2015. References of included studies and identified review articles were screened for additional studies. There were no restrictions based on language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) that report on subjective fatigue in people with PD. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data collection and risk of bias assessments. MAIN RESULTS Eleven studies were eligible for this systematic review, with a total of 1817 people. Three studies included only people who experienced clinically relevant fatigue (Fatigue Severity Scale score ≥ 4 out of 7 or Multidimensional Fatigue Inventory total score > 48 out of 100), whereas all other studies did not select participants on the basis of experienced fatigue. Nine studies investigated the effects of medication (i.e. levodopa-carbidopa, memantine, rasagiline, caffeine, methylphenidate, modafinil or doxepin) on subjective fatigue. All studies were placebo controlled. There was insufficient evidence to determine the effect of doxepin on the impact of fatigue on activities in daily life (ADL) or fatigue severity (one study, N = 12, standardised mean difference (SMD) = -1.50, 95% confidence interval (CI) -2.84 to -0.15; low quality evidence). We found high quality evidence that rasagiline reduced or slowed down the progression of physical aspects of fatigue (one study, N = 1176, SMD = -0.27, 95% CI -0.39 to -0.16, I(2) = 0%). None of the other pharmacological interventions affected subjective fatigue in PD. With regard to adverse effects, only levodopa-carbidopa showed an increase for the risk of nausea (one study, N = 361, risk ratio (RR) = 1.85, 95% CI 1.05 to 3.27; high quality evidence). Two studies investigated the effect of exercise on fatigue compared with usual care. We found low quality evidence for the effect of exercise on reducing the impact of fatigue on ADL or fatigue severity (two studies, N = 57, SMD = -0.45, 95% CI -1.21 to 0.32, I(2) = 44%). AUTHORS' CONCLUSIONS Based on the current evidence, no clear recommendations for the treatment of subjective fatigue in PD can be provided. Doxepin may reduce the impact of fatigue on ADL and fatigue severity; however, this finding has to be confirmed in high quality studies. Rasagiline may be effective in reducing levels of physical fatigue in PD. No evidence was found for the effectiveness of levodopa-carbidopa, memantine, caffeine, methylphenidate, modafinil or exercise. Studies are needed to investigate the effect of exercise intensity on exercise capacity and subjective fatigue. Future studies should focus on interventions that address the maladaptive behavioural or cognitive aspects of fatigue in people with PD. Characteristics, such as severity and nature of perceived fatigue and underlying mood disorders should be considered to identify responders and non-responders when studying interventions for fatigue. The development of a core-set of self-report fatigue questionnaires with established responsiveness and known minimal important difference values will facilitate the interpretation of change in fatigue scores.
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Affiliation(s)
- Roy G Elbers
- University of Applied Sciences LeidenDepartment of PhysiotherapyZernikedreef 11PO Box 382LeidenNetherlands2300 AJ
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - John Verhoef
- Faculty of Health, University of Applied Sciences LeidenP.O.Box 382LeidenNetherlands2300 AJ
| | - Erwin EH van Wegen
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Henk W Berendse
- Neuroscience Campus Amsterdam, VU University Medical CenterDepartment of NeurologyAmsterdamNetherlands
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
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Skorvanek M, Rosenberger J, Minar M, Grofik M, Han V, Groothoff JW, Valkovic P, Gdovinova Z, van Dijk JP. Relationship between the non-motor items of the MDS-UPDRS and Quality of Life in patients with Parkinson's disease. J Neurol Sci 2015; 353:87-91. [PMID: 25918077 DOI: 10.1016/j.jns.2015.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/11/2015] [Accepted: 04/10/2015] [Indexed: 11/17/2022]
Abstract
The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a newly developed comprehensive tool to assess Parkinson's disease (PD), which covers a wider range of non-motor PD manifestations than the original UPDRS scale. The aim of this study was to assess the relationship between the MDS-UPDRS and Quality of Life (QoL) and to analyze the relationship between individual MDS-UPDRS non-motor items and QoL. A total of 291 PD patients were examined in a multicenter Slovak study. Patients were assessed by the MDS-UPDRS, HY scale and PDQ39. Data were analyzed using the multiple regression analyses. The mean participant age was 68.0 ± 9.0 years, 53.5% were men, mean disease duration was 8.3 ± 5.3 years and mean HY was 2.7 ± 1.0. In a multiple regression analysis model the PDQ39 summary index was related to MDS-UPDRS parts II, I and IV respectively, but not to part III. Individual MDS-UPDRS non-motor items related to the PDQ39 summary index in the summary group and in the non-fluctuating patients subgroup were pain, fatigue and features of dopamine dysregulation syndrome (DDS). In the fluctuating PD patient subgroup, PDQ39 was related to pain and Depressed mood items. Other MDS-UPDRS non-motor items e.g. Anxious mood, Apathy, Cognitive impairment, Hallucinations and psychosis, Sleep problems, Daytime sleepiness and Urinary problems were related to some PDQ39 domains. The overall burden of NMS in PD is more important in terms of QoL than motor symptoms. Individual MDS-UPDRS non-motor items related to worse QoL are especially pain and other sensations, fatigue and features of DDS.
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Affiliation(s)
- Matej Skorvanek
- Dept. of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic; Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.
| | - Jaroslav Rosenberger
- Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic
| | - Michal Minar
- 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Milan Grofik
- Dept. of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Vladimir Han
- Dept. of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Johan W Groothoff
- Dept. of Community and Occupational Health, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Valkovic
- 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic; Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Zuzana Gdovinova
- Dept. of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic; Dept. of Community and Occupational Health, University Medical Center Groningen, Groningen, The Netherlands
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Elbers RG, Verhoef J, van Wegen EEH, Berendse HW, Kwakkel G. Interventions for fatigue in Parkinson's disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Elbers RG, van Wegen EEH, Verhoef J, Kwakkel G. Impact of fatigue on health-related quality of life in patients with Parkinson’s disease: a prospective study. Clin Rehabil 2013; 28:300-11. [DOI: 10.1177/0269215513503355] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the longitudinal association between the impact of fatigue and health-related quality of life and to determine if potential confounders distorted this association. Design: Baseline, 3-, 6- and 12-week assessments of a randomized clinical trial were used. Setting: Outpatient rehabilitation centre. Subjects: Patients with idiopathic Parkinson’s disease. Methods: Quality of life was assessed with the Parkinson’s Disease Questionnaire-39 and the Multidimensional Fatigue Inventory was used to assess fatigue. Time-independent and time-dependent factors were investigated for their bivariate association with quality of life by applying random coefficient analysis. Candidate confounders were successively added to the longitudinal association model to determine if the relationship between quality of life and fatigue was distorted. A change beyond 15% of found regression coefficient of the Multidimensional Fatigue Inventory was considered significant. Results: One hundred and fifty-three patients were included. Impact of fatigue was significantly associated with poorer quality of life (β = 0.24, 95% confidence interval = 0.18 to 0.30). This association was significantly distorted by depression (30.0%) and anxiety (24.1%). No distortion was found for other factors. After controlling for confounders, fatigue remained significantly associated with quality of life (β = 0.12, 95% confidence interval = 0.06 to 0.18, r2 = 2.3%). Conclusions: Our results suggest that patients who experience fatigue tend to report lower levels of quality of life. However, this longitudinal relationship is confounded by depression and anxiety and suggests that the unique contribution of fatigue to overall quality of life is rather small.
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Affiliation(s)
- Roy G Elbers
- University of Applied Sciences Leiden, Leiden, The Netherlands
- VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Erwin EH van Wegen
- VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - John Verhoef
- University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Gert Kwakkel
- VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
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Graff LA, Clara I, Walker JR, Lix L, Carr R, Miller N, Rogala L, Bernstein CN. Changes in fatigue over 2 years are associated with activity of inflammatory bowel disease and psychological factors. Clin Gastroenterol Hepatol 2013; 11:1140-6. [PMID: 23602816 DOI: 10.1016/j.cgh.2013.03.031] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/24/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cross-sectional studies have identified high levels of fatigue in patients with active or quiescent inflammatory bowel disease (IBD), but there has been little attention to the long-term effects of fatigue in these patients. We performed a longitudinal study of fatigue in patients with IBD to determine its course and contributing factors. METHODS Data were obtained from participants in the Manitoba IBD Cohort Study (N = 312; 51% with Crohn's disease), a longitudinal population-based study. Symptomatic disease activity was measured every 6 months for 2 years to characterize long-term disease patterns as active, fluctuating, or inactive, based on the validated Manitoba IBD Index. We collected data concurrently on fatigue (Multidimensional Fatigue Inventory), psychological function, and laboratory biomarkers at the point of study entry and 1 and 2 years later. RESULTS Of the study participants, 26% had consistently inactive, 29% had fluctuating, and 45% had consistently active disease over the 2-year time period. Mean levels of fatigue were strongly associated with disease activity; participants with consistently inactive disease had the lowest level of fatigue at each time point. Multivariate analyses indicated fatigue levels increased over time regardless of disease pattern (P < .001). Adjusting for disease activity, disease type and age, sex (female; P < .001), and psychological variables of distress (P < .001), reduced psychological well-being (P = .002) and poor sleep quality (P < .001) were associated independently with increases in fatigue over time. CONCLUSIONS Fatigue can increase over time in patients with IBD, even when their disease is in remission. Psychological factors are useful targets for intervention to reduce fatigue.
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Affiliation(s)
- Lesley A Graff
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
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van Dijk JP, Havlikova E, Rosenberger J, Nagyova I, Skorvanek M, Gdovinova Z, Lok W, Groothoff JW, Middel B. Influence of disease severity on fatigue in patients with Parkinson's disease is mainly mediated by symptoms of depression. Eur Neurol 2013; 70:201-9. [PMID: 23969578 DOI: 10.1159/000351779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Fatigue is a frequent non-motor complaint of patients with Parkinson's disease (PD). Despite increasing knowledge on fatigue, the factors leading to its development are still not recognised. The aim of this investigation was to test, using structural equation modelling, the hypothesis that the influence of disease severity on fatigue is mediated by symptoms of depression in patients with PD. METHOD The sample consisted of 190 PD patients (93 men, 48.9%, mean age 68.2±9.3 years, mean disease duration 6.4±4.7 years) recruited from hospitals and outpatient clinics in the East Slovakia region. The Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. LISREL was used to analyse the data. RESULTS Disease severity was directly associated with symptoms of depression (β=0.26) and directly affected fatigue in terms of increased levels of general fatigue (β=0.35), physical fatigue (β=0.22), reduced activity (β=0.31) and mental fatigue (β=0.29), but did not directly influence reduced motivation. Symptoms of depression mediated the impact of disease severity on general fatigue (β=0.25), on reduced activity (β=0.31) and on mental fatigue (β=0.28), but not on physical fatigue. Reduced motivation was not mediated, but directly influenced by more symptoms of depression (β=0.82). DISCUSSION Since increased symptoms of depression mediate the impact of disease severity on three domains of fatigue in PD patients, disease management should focus on the treatment of PD and symptoms of depression.
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Affiliation(s)
- Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
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Stocchi F. Benefits of treatment with rasagiline for fatigue symptoms in patients with early Parkinson's disease. Eur J Neurol 2013; 21:357-60. [DOI: 10.1111/ene.12205] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- F. Stocchi
- Institute of Neurology; IRCCS San Raffaele Pisana; Rome Italy
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Kang SY, Ma HI, Lim YM, Hwang SH, Kim YJ. Fatigue in drug-naïve Parkinson's disease. Eur Neurol 2013; 70:59-64. [PMID: 23796615 DOI: 10.1159/000350289] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fatigue is common in Parkinson's disease (PD), causing serious negative effects on quality of life. Despite its clinical importance, the nature of fatigue in PD is poorly understood because its underlying neurobiology is unknown. Fatigue can be more complicated in advanced PD because of its chronicity. In order to find features that are innate to fatigue in PD, it would be useful to conduct a study looking at de novo PD. Assessing fatigue in de novo patients allows excluding at least one confounding factor. METHODS We prospectively investigated 87 drug-naïve PD patients. Thirty-nine patients (44.8%) were found to have fatigue around the time of diagnosis of PD. RESULTS We found that depression and difficulties with activities of daily living were independent risk factors for fatigue; however, motor dysfunction was not related. Clinically meaningful responses to dopaminergic medication were observed. DISCUSSION Our study determined that fatigue occurs in the early stages of PD. It can inform clinical decision-making to significantly benefit PD patients with fatigue.
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Affiliation(s)
- Suk Yun Kang
- Department of Neurology, Hallym University College of Medicine Seoul, Seoul, Republic of Korea. sukyunkang @ hanmail.net
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Falup-Pecurariu C. Fatigue assessment of Parkinson’s disease patient in clinic: specific versus holistic. J Neural Transm (Vienna) 2013; 120:577-81. [DOI: 10.1007/s00702-013-0969-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
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Skorvanek M, Nagyova I, Rosenberger J, Krokavcova M, Ghorbani Saeedian R, Groothoff JW, Gdovinova Z, van Dijk JP. Clinical determinants of primary and secondary fatigue in patients with Parkinson’s disease. J Neurol 2013; 260:1554-61. [DOI: 10.1007/s00415-012-6828-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 12/20/2012] [Accepted: 12/27/2012] [Indexed: 01/18/2023]
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Dubayova T, Krokavcova M, Nagyova I, Rosenberger J, Gdovinova Z, Middel B, Groothoff JW, van Dijk JP. Type D, anxiety and depression in association with quality of life in patients with Parkinson’s disease and patients with multiple sclerosis. Qual Life Res 2012; 22:1353-60. [DOI: 10.1007/s11136-012-0257-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
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Valderramas S, Feres AC, Melo A. Reliability and validity study of a Brazilian-Portuguese version of the fatigue severity scale in Parkinson's disease patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:497-500. [DOI: 10.1590/s0004-282x2012000700005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 03/13/2012] [Indexed: 11/22/2022]
Abstract
The Fatigue Severity Scale (FSS) is one of the most frequently used self-rating scales for fatigue in Parkinson's disease (PD) and it lacks a validated Brazilian-Portuguese version. OBJECTIVE: To determine the construct validity and reproducibility of a Brazilian-Portuguese version of the FSS in patients with PD. METHODS: In a cross-sectional study, a Portuguese-language version of the FSS was applied to 30 patients with PD (62±11 years-old). The Parkinson's disease questionnaire (PDQ-39) was used as the validation criterion, while the Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS), and the Beck Depression Inventory were employed to analyze the correlations with the FSS score. RESULTS: The test-retest intraclass correlation coefficient was 0.91 (p<0.01) for the Brazilian-Portuguese version of the FSS score, which was highly correlated with the PDQ-39 overall score (r=0.93; p<0.01) and the Beck Depression Inventory (r=0.75; p<0.01). It showed a correlation with the Hoehn and Yahr scale (r=0.40; p=0.02), and with the UPDRS as well (r=0.45, p=0.01). CONCLUSIONS: The Brazilian-Portuguese version of the FSS is valid and reproducible for using in Brazilian patients with PD.
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Chou KL, Persad CC, Patil PG. Change in fatigue after bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord 2012; 18:510-3. [DOI: 10.1016/j.parkreldis.2012.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 01/19/2012] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Although the diagnosis of Parkinson disease (PD) still relies mainly on the appearance of its classical motor features of resting tremor, rigidity, bradykinesia, and postural instability, nonmotor manifestations in PD are now recognized as an integral component of this multisystem disorder. REVIEW SUMMARY Nonmotor complications in PD occur commonly. The current understanding of cognitive dysfunction; neuropsychiatric manifestations including psychosis, impulsive control, and compulsive disorders, depression, anxiety and apathy; autonomic complications such as hypotension, erectile dysfunction, and urinary complications; sleep disorders and other nonmotor manifestations are summarized in this review. CONCLUSION Nonmotor complications often carry a greater impact than motor features in PD. Therefore, heightened awareness and proper recognition of these features are critical in improving a Parkinson patient's quality of life.
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Elbers RG, van Wegen EEH, Verhoef J, Kwakkel G. Reliability and structural validity of the Multidimensional Fatigue Inventory (MFI) in patients with idiopathic Parkinson's disease. Parkinsonism Relat Disord 2012; 18:532-6. [PMID: 22361576 DOI: 10.1016/j.parkreldis.2012.01.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/28/2011] [Accepted: 01/30/2012] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The Multidimensional Fatigue Inventory (MFI) is commonly used in patients with Parkinson's disease (PD). However, most measurement properties have not been investigated in this population. The aim of this study was to investigate internal consistency, test-retest reliability, measurement error, structural validity, and floor and ceiling effects of the MFI in PD. METHODS Patients with PD (N = 153) completed the MFI at baseline and week 3 in a randomized clinical trial. Cronbach's α, intraclass correlation coefficient (ICC), and the smallest detectable change (SDC) were calculated. Bland and Altman analysis was performed. Principal Component Analysis (PCA) was used to explore structural validity. Floor and ceiling effects were investigated. RESULTS Cronbach's α for the MFI-total and subscales ranged from 0.74 (reduced motivation (RM)) to 0.92 (MFI-total). ICC's ranged from 0.65 (mental fatigue (MF) to 0.81 (physical fatigue (PF)), SDC ranged from 4 points (PF and RM) to 15 points (MFI-total). Bland and Altman analysis showed no systematic differences between assessments. A floor effect was found for MF and ceiling effects for PF and reduced activity (RA). A four-factor model was extracted, combining general fatigue (GF) and PF as one factor. CONCLUSIONS The MFI is reliable and valid to assess fatigue in patients with PD. Clinicians and researchers interested in assessing specific aspects of fatigue should consider interpreting GF and PF as one subscale measuring physical aspects of fatigue. To establish whether the MFI can detect meaningful changes, studies on anchor-based responsiveness and the minimal important change are needed in PD.
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Affiliation(s)
- Roy G Elbers
- University of Applied Sciences Leiden, Department of Physiotherapy, Zernikedreef 11, PO Box 382, 2300 AJ Leiden, The Netherlands.
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Metta V, Logishetty K, Martinez-Martin P, Gage HM, Schartau PES, Kaluarachchi TK, Martin A, Odin P, Barone P, Stocchi F, Antonini A, Chaudhuri KR. The possible clinical predictors of fatigue in Parkinson's disease: a study of 135 patients as part of international nonmotor scale validation project. PARKINSONS DISEASE 2011; 2011:125271. [PMID: 22191065 PMCID: PMC3236421 DOI: 10.4061/2011/125271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 09/14/2011] [Accepted: 09/14/2011] [Indexed: 11/20/2022]
Abstract
Fatigue is a common yet poorly understood and underresearched nonmotor symptom in Parkinson's disease. Although fatigue is recognized to significantly affect health-related quality of life, it remains underrecognised and empirically treated. In this paper, the prevalence of fatigue as measured by a validated visual analogue scale and the Parkinson's disease nonmotor symptoms scale (PDNMSS) was correlated with other motor and nonmotor comorbidities. In a cohort of patients from a range of disease stages, occurrence of fatigue correlated closely with more advanced Parkinson's disease, as well as with depression, anxiety, and sleep disorders, hinting at a common underlying basis.
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Affiliation(s)
- Vinod Metta
- National Parkinson Foundation Centre of Excellence, King's College Hospital, King's College London, Denmark Hill Campus, 9th Floor, Ruskin Wing, > London SE5 9RS, UK
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The importance of non-motor disturbances to quality of life in Parkinson's disease. J Neurol Sci 2011; 310:12-6. [DOI: 10.1016/j.jns.2011.05.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/07/2011] [Indexed: 11/20/2022]
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Rascol O, Fitzer-Attas CJ, Hauser R, Jankovic J, Lang A, Langston JW, Melamed E, Poewe W, Stocchi F, Tolosa E, Eyal E, Weiss YM, Olanow CW. A double-blind, delayed-start trial of rasagiline in Parkinson's disease (the ADAGIO study): prespecified and post-hoc analyses of the need for additional therapies, changes in UPDRS scores, and non-motor outcomes. Lancet Neurol 2011; 10:415-23. [PMID: 21482191 DOI: 10.1016/s1474-4422(11)70073-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The ADAGIO study investigated whether rasagiline has disease-modifying effects in Parkinson's disease. Rasagiline 1 mg per day, but not 2 mg per day, was shown to be efficacious in the primary analysis. Here, we report additional secondary and post-hoc analyses of the ADAGIO study. METHODS ADAGIO was a placebo-controlled, double-blind, multicentre, delayed-start study, in which 1176 patients with untreated early Parkinson's disease were randomly assigned to receive rasagiline 1 mg or 2 mg per day for 72 weeks (early-start groups) or placebo for 36 weeks followed by rasagiline 1 mg or 2 mg per day for 36 weeks (delayed-start groups). We assessed the need for additional antiparkinsonian therapy and changes in non-motor experiences of daily living and fatigue scales (prespecified outcomes) and changes in unified Parkinson's disease rating scale (UPDRS) scores and subscores in placebo and active groups (post-hoc outcomes). The ADAGIO study is registered with ClinicalTrials.gov, number NCT00256204. FINDINGS The need for additional antiparkinsonian therapy was reduced with rasagiline 1 mg (25 of 288 [9%] patients) and 2 mg (26 of 293 [9%]) versus placebo (108 of 593 [18%]; odds ratio for 1 mg rasagiline vs placebo 0·41, 95% CI 0·25-0·65, p=0·0002; 2 mg rasagiline vs placebo 0·41, 0·26-0·64, p=0·0001). At week 36, both doses significantly improved UPDRS motor subscores compared with placebo (1 mg rasagiline mean difference -1·88 [SE 0·35]; 2 mg rasagiline -2·18 [0·35]; both p<0·0001) and activities of daily living subscores (ADL; 1 mg rasagiline -0·86 [0·18]; 2 mg rasagiline -0·88 [0·18]; both p<0·0001), and 1 mg rasagiline significantly improved UPDRS mentation subscore (-0·22 [0·08]; p=0·004). At week 72, the only significant difference between early-start and delayed-start groups was for ADL subscore with the 1 mg dose (-0·62 [0·29]; p=0·035). When assessed for the effect on non-motor symptoms at week 36, both doses showed benefits on the Parkinson fatigue scale versus placebo (1 mg rasagiline mean difference -0·14 [SE 0·05], p=0·0032; 2 mg rasagiline -0·19 [0·05], p<0·0001), and the 1 mg dose showed benefits on the scale for non-motor experiences of daily living compared with placebo (mean difference -0·33 [0·17]; p=0·049). The rate of progression of total UPDRS score for patients in the placebo group was 4·3 points [SE 0·3] over 36 weeks, with extrapolation to about 6 units per year. In the placebo group, patients with the lowest quartile of baseline UPDRS scores (≤14; n=160) progressed more slowly than did those with highest scores (>25·5; n=145; mean difference -3·46 [SE 0·77]; p<0·0001). INTERPRETATION These findings show that rasagiline delayed the need for symptomatic antiparkinsonian drugs and emphasise the contribution of the UPDRS ADL in the response of the rasagiline 1 mg per day early-start versus delayed-start group. The rate of UPDRS deterioration was less than was anticipated from previous studies and correlated with baseline severity. Understanding of the pattern of UPDRS deterioration is essential to assess disease modification. FUNDING Teva Pharmaceutical Industries and H Lundbeck A/S.
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Affiliation(s)
- Olivier Rascol
- Department of Clinical Pharmacology, Faculty of Medicine, Toulouse, France.
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