Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation

The Prevalence of Depression Among Parkinson's Disease Patients in Saudi Arabia: A Cross-Sectional Study

Background and Aim

Depression is thought to affect up to half of Parkinson's patients at some point during their illness, while anxiety is reported by about 40% of PD patients. The study aimed to assess the prevalence of depression and anxiety among patients with Parkinson's disease (PD) in Saudi Arabia.

Methods

The study involved Saudi Arabian citizens and residents aged 40 or older with PD, who completed internet-survey (including online and email-based data collection) or telephone-survey by trained interviewers. We used the Parkinson's Disease Questionnaire for quality-of-Life assessment questionnaire (PDQ-39), Patient Health Questionnaire-9 for depression (PHQ-9), and General Anxiety Disorder-7 anxiety questionnaire (GAD-7).

Results

The study included 46 participants, of whom 37% were aged 60-69 years, 67% were male, 46% had completed a university education, and 87% were married. Depression symptoms were present in 84.8% of participants, while 73.9% experienced anxiety. PD patients lacking social support were 8 times more likely to develop major depression [OR = 8.27, 95% CI (1.47-46.31), p = 0.016] and 5 times more likely to experience anxiety symptoms [OR = 5.36, 95% CI (1.14-25.26), p = 0.034]. Those unable to perform daily living activities or who faced stigma had a 16.5 times higher likelihood of anxiety symptoms [OR = 16.5, 95% CI (1.62-168.48), p = 0.018]. Furthermore, cognitive impairment increased the likelihood of anxiety by 11 times [OR = 11.43, 95% CI (1.83-71.42), p = 0.009].

Conclusion

The study reveals a high prevalence of depression and anxiety among Parkinson's disease patients, linked to physical impairments and social isolation. Many patients report no mental health improvement despite treatment, highlighting the need for routine mental health assessments, social support, and tailored interventions to enhance their quality of life. The small sample size may limit the statistical power, precision, and generalizability of the study's findings.

Exploring the stigma experienced by people affected by Parkinson's disease: a systematic review

BACKGROUND

Stigma significantly impacts individuals with Parkinson's disease (PD) and their caregivers, exacerbating social isolation, psychological distress, and reducing quality of life (QoL). Although considerable research has been conducted on PD's clinical aspects, the social and emotional challenges, like stigma, remain underexplored. Addressing stigma is crucial for enhancing well-being, fostering inclusivity and improving access to care and support. The review aims to fill this knowledge gap by synthesising existing literature on PD stigma, examining its effects on individuals and families affected, and identifying areas where interventions could reduce stigma's impact.

METHODS

This systematic review was conducted following Joanna Briggs Institute guidance. Studies were identified through searches in six databases, relevant websites, and reference lists. Covidence was used for duplicate removal, screening, and data extraction. Thematic analysis identified key themes from qualitative data, while narrative synthesis integrated findings from qualitative and quantitative studies. The review protocol was registered on PROSPERO (CRD42023399343).

RESULTS

This review included 22 studies published between 2002 and 2024, using both qualitative and quantitative methodologies. Five key themes emerged. The first highlighted stereotypes in PD, such as misconceptions about symptoms, age stereotyping, and supernatural beliefs. The second explored drivers and facilitators of stigma, identifying factors like duration since diagnosis, disease severity, lack of public education, and media representation. The third theme revealed stigma's impact on mental health and well-being, exacerbating feelings of shame, embarrassment, and social isolation. The fourth, responses and consequences of stigma, detailed strategies employed by individuals with PD to manage stigma, including seeking social support and adopting coping mechanisms. The fifth theme, beyond stigma, explored positive aspects of living with PD, highlighting resilience, positive interactions, and advocacy efforts.

CONCLUSION

This systematic review underscores the significant impact of stigma on individuals with PD and their caregivers, manifesting as social isolation, diminished QoL, and psychological distress. Key drivers include public misconceptions, cultural biases, and limited awareness and addressing these challenges requires targeted interventions. Recommendations include education to dispel myths, public awareness campaigns and advocacy efforts to reduce stigma, enhance support, and improve QoL.

Depressive symptoms in Brazilian Parkinson's disease patients treated with subthalamic nucleus deep brain stimulation: A Cross-Sectional study

Parkinson's disease (PD) is a neurological disorder that primarily affects movement and is often accompanied by depressive symptoms. Subthalamic nucleus (STN) deep brain stimulation (DBS) has emerged as a therapeutic intervention for PD, although its impact on depressive symptoms remains complex. This study investigates the relationship between PD, DBS, and depressive symptoms, focusing on how DBS influences cognitive function and mood among PD patients in Brazil. The study involved two cohorts: one in 2019 with 46 participants and another in 2022 with 31 patients. Distinct assessment instruments, including the Geriatric Depression Scale-15 and Beck Depression Inventory-II, were employed to evaluate depressive symptoms. The results revealed no significant correlation between participants' gender and the presence of DBS, but substantial differences were observed in age, disease duration, and Activities of Daily Living scores. Patients undergoing DBS showed notably poorer cognitive performance compared to those treated solely with medication. Furthermore, the use of DBS was associated with higher scores on depressive symptoms scales within one of the cohorts. These findings underscore the intricate interplay among PD, DBS treatment, and depressive symptoms, highlighting the necessity for tailored approaches to patient care.

Self-perceived stigma in Parkinson's Disease in an online sample: Comparison with in-person sample, role of anxiety, and relative utility of four measures of stigma perception

OBJECTIVE

Persons with Parkinson's disease (PwPD) experience motor and non-motor symptoms that may elicit stigmatization. We investigated whether online assessment would replicate in-person findings of younger age and depression as predictors of stigma perception. We further assessed the predictive value of anxiety, and compared predictors across four stigma measures.

METHODS

The online study (n = 347), like the earlier in-person study (n = 362), used the Parkinson's Disease Questionnaire stigma subscale (PDQ-39stigma). It also assessed anxiety and added the Stigma Scale for Chronic Illness (SSCI), Stigmatization Scale, and Mental Health Consumers' Experience of Stigma Scale. We correlated stigma perception scores with demographic/clinical characteristics and conducted hierarchical regression and mediation analyses.

RESULTS

Online and in-person predictors of stigma perception with the PDQ-39stigma included younger age (men) and depression (men, women). Depression mediated the relation between stigma perception and motor experiences of daily living (EDLs). In the online sample, when anxiety was added, it predicted stigma perception (PDQ-39stigma, SSCI) and mediated the relation between stigma and both motor and non-motor EDLs (PDQ-39stigma). For all four stigma-perception scales, younger age predicted scores. Multiple additional predictors of PDQ-39stigma and SSCI scores suggest their utility relative to the other two scales. Conclusions: Younger age and depression predicted self-perceived stigma in online and in-person samples, indicating the cross-modal utility of the measure, PDQ-39stigma. In the online sample, anxiety also predicted stigma perception per the PDQ-39stigma and SSCI. We recommend both measures and note that treating depression and anxiety may be important especially in younger PwPD to reduce self-perceived stigma.

Validation Study of the Parkinson's Disease Stigma Questionnaire (PDStigmaQuest)

Background

Stigma is a relevant aspect of Parkinson's disease (PD). Specific stigma tools are needed to address the complex construct of stigma in PD comprehensively.

Objective

To test the dimensionality and psychometric properties of the newly developed Parkinson's Disease Stigma Questionnaire (PDStigmaQuest).

Methods

In this multi-center, cross-sectional study including PD patients and healthy controls, the dimensionality of the PDStigmaQuest was examined through exploratory factor analysis. Acceptability and psychometric properties were investigated. PDStigmaQuest scores of patients and healthy controls were compared.

Results

In total, 201 PD patients and 101 healthy controls were included in the final analysis. Results suggested high data quality of the PDStigmaQuest (0.0001% missing data for patients). The exploratory factor analysis produced four factors: felt stigma, hiding, enacted stigma: rejection, and enacted stigma: patronization, explaining 47.9% of variance. An optional work domain for employed patients was included. Moderate floor effects and skewness, but no ceiling effects were found. Cronbach's alpha of 0.85 indicated high internal consistency. Calculated item-total correlations met standard criteria. Test-retest reliability was high (rs = 0.83). PDStigmaQuest scores correlated significantly with other stigma measures (rs = 0.56-0.69) and were significantly higher in patients than in healthy controls and higher in patients with depressive symptoms than in those without.

Conclusions

The patient-reported 18-item PDStigmaQuest showed strong psychometric properties of validity and reliability. Our results suggest that the PDStigmaQuest can be used to assess and evaluate stigma comprehensively in PD, which will improve our understanding of the construct of PD stigma.

Rapid eye movement sleep behavior disorder is associated with decreased quality of life and stigma in people with Parkinson's disease

BACKGROUND

Individuals with Parkinson's disease (PD) may present with rapid eye movement sleep behavior disorder (RBD). We therefore investigated the association between RBD and quality of life (QOL) in people with PD.

METHODS

Individuals with PD and a Mini-Mental State Examination score ≥ 24 were divided into two groups using the RBD screening questionnaire (RBDSQ): those with an RBDSQ score ≥ 5 were assigned to the "probable RBD" (pRBD) group, and those with a score < 5 to the "non-pRBD" group. Participants were then evaluated for motor symptoms (Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III and modified Hoehn and Yahr Scale), cognitive functions (Montreal Cognitive Assessment and Frontal Assessment Battery [FAB]), anhedonia (Snaith-Hamilton Pleasure Scale), and QOL (Parkinson's Disease Questionnaire [PDQ]-39 total and subscores for mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort). Each measure was compared between the two groups (Mann-Whitney U test/χ² test). Multiple regression analyses were performed to identify factors contributing to the total score and the subscore of the stigma domain of the PDQ-39.

RESULTS

Ninety-three individuals with PD were recruited (mean ± standard deviation age, 67.0 ± 10.6 years). The pRBD group exhibited a longer disease duration (P = 0.006), worse FAB (P = 0.015) and PDQ-39 total (P = 0.032) scores. RBDSQ scores correlated with higher scores in the PDQ-39 stigma domain (B = 2.44, P = 0.033).

CONCLUSION

RBD is associated with worse QOL and stigma in people with PD. The RBDSQ is a useful tool for the prediction of such disturbances in QOL.

Parkinson's Disease Stigma Questionnaire (PDStigmaQuest): Development and Pilot Study of a Questionnaire for Stigma in Patients with Idiopathic Parkinson's Disease

BACKGROUND

Stigma is significant in Parkinson's disease (PD). However, no specific tool is available to assess stigma in PD comprehensively.

OBJECTIVE

This pilot study aimed to develop and test a stigma questionnaire specific to PD patients (PDStigmaQuest).

METHODS

Based on a literature review, clinical experience, expert consensus, and patients' feedback, we developed the preliminary, patient-completed PDStigmaQuest in German language. It included 28 items covering five stigma domains: uncomfortableness, anticipated stigma, hiding, experienced stigma, and internalized stigma. In this pilot study, 81 participants (PD patients, healthy controls, caregivers, and health professionals) were included to investigate the acceptability, feasibility, comprehensibility, and psychometric properties of the PDStigmaQuest.

RESULTS

The PDStigmaQuest showed 0.3% missing data points for PD patients and 0.4% for controls, suggesting high data quality. Moderate floor effects, but no ceiling effects were found. In the item analysis, most items met the standard criteria of item difficulty, item variance, and item-total correlation. Cronbach's alpha was > 0.7 for four of five domains. PD patients' domain scores were significantly higher than healthy controls' for uncomfortableness, anticipated stigma, and internalized stigma. Feedback to the questionnaire was predominantly positive.

CONCLUSION

Our results indicate that the PDStigmaQuest is a feasible, comprehensive, and relevant tool to assess stigma in PD and helps to understand the construct of stigma in PD further. Based on our results, the preliminary version of the PDStigmaQuest was modified and is currently validated in a larger population of PD patients for use in clinical and research settings.

Cross-Cultural Differences in Stigma Associated with Parkinson's Disease: A Systematic Review

BACKGROUND

Stigma is an important social attitude affecting the quality of life (QoL) of people with Parkinson's disease (PwP, PD) as individuals within society.

OBJECTIVE

This systematic review aimed to 1) identify the factors associated with stigma in PD and 2) demonstrate culture-based diversity in the stigmatization of PwP. We also reported data from the Turkish PwP, which is an underrepresented population.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a literature search of the PubMed/Medline electronic database was performed covering the last 26 years. Articles on self-perceived stigma in PD with a sample size >  20 and quantitative results were included. Data were extracted by independent reviewers.

RESULTS

After screening 163 articles, 57 were eligible for review, most of which were from Europe or Asia. Only two studies have been conducted in South America. No study from Africa was found. Among the 61 factors associated with stigma, disease duration, sex, and age were most frequently studied. A comparison of the investigated factors across the world showed that, while the effect of motor impairment or treatment on stigma seems to be culture-free, the impact of sex, education, marriage, employment, cognitive impairment, and anxiety on stigma may depend on culture.

CONCLUSION

The majority of the world's PD population is underrepresented or unrepresented, and culture may influence the perception of stigma in PwP. More diverse data are urgently needed to understand and relieve the challenges of PwP within their society.

Age Cutoff for Early-Onset Parkinson's Disease: Recommendations from the International Parkinson and Movement Disorder Society Task Force on Early Onset Parkinson's Disease

Background

Early-onset Parkinson's disease (EOPD)/young-onset Parkinson's disease (YOPD) is defined as Parkinson's disease (PD) with an age at onset (AAO) after age 21 years but before the usual AAO for PD. Consensus is lacking, and the reported maximal age for EOPD/YOPD has varied from 40 to 60 years, leading to a lack of uniformity in published studies and difficulty in harmonization of data. EOPD and YOPD have both been used in the literature, somewhat interchangeably.

Objective

To define the nomenclature and AAO cutoff for EOPD/YOPD.

Methods

An extensive review of the literature and task force meetings were conducted. Conclusions were reached by consensus.

Results

First, the literature has seen a shift from the use of YOPD toward EOPD. This seems motivated by an attempt to avoid age-related stigmatization of patients. Second, in defining EOPD, 56% of the countries use 50 or 51 years as the cutoff age. Third, the majority of international genetic studies in PD use an age cutoff of younger than 50 years to define EOPD. Fourth, many studies suggest that changes in the estrogen level can affect the predisposition to develop PD, making the average age at menopause of 50 years an important factor to consider when defining EOPD. Fifth, considering the differential impact of the AAO of PD on professional and social life, using 50 years as the upper cutoff for the definition of EOPD seems reasonable.

Conclusions

This task force recommends the use of EOPD rather than YOPD. It defines EOPD as PD with AAO after 21 years but before 50 years.

Effects of Cannabis in Parkinson's Disease: A Systematic Review and Meta-Analysis

The legalization of cannabis in many countries has allowed many Parkinson's disease (PD) patients to turn to cannabis as a treatment. As such there is a growing interest from the PD community to be properly guided by evidence regarding potential treatment benefits of cannabis. This systematic review and meta-analysis aims to compile the best available evidence to help guide patients and their family, clinicians and researchers make informed decisions. A systematic search of the literature was conducted in June 2021. Five randomized controlled studies and eighteen non-randomized studies investigated cannabis treatment in PD patients. No compelling evidence was found to recommend the use of cannabis in PD patients. However, a potential benefit was identified with respect to alleviation of PD related tremor, anxiety, pain, improvement of sleep quality and quality of life. Given the relative paucity of well-designed randomized studies, there is an identified need for further investigation, particularly in these areas.

Self-Stigma in Parkinson's Disease: A 3-Year Prospective Cohort Study

Purpose

Self-stigma is common in patients with Parkinson's disease (PD) and may lead to social isolation and delayed search for medical help. We conducted a 3-year prospective longitudinal study to investigate the development and evolution of self-stigma in patients with early stage PD and to explore the associated and predictive factors of self-stigma in PD.

Method

A total of 224 patients with early stage PD (disease duration <3 years) were enrolled at baseline and followed up annually for 3 consecutive years. Self-stigma was assessed by the stigma subscale of the Parkinson's Disease Questionnaire (items 23–26). The generalized estimating equation model was used to investigate the associated factors of self-stigma over 3 years, and the binary logistic model was used to explore the predictors of self-stigma in patients with PD without self-stigma at baseline.

Results

The prevalence of self-stigma decreased from 58.0% at baseline to 49.2% after 3 years. The Hamilton Depression Rating Scale (HDRS) score was the only associated factor [B: 0.160 (1.106–0.214), P < 0.001] of self-stigma over 3 years and the only predictor [OR: 1.252 (1.044–1.502), P = 0.015] of the onset of self-stigma.

Conclusion

Self-stigma is very common in PD, but its prevalence tends to decrease as the disease progresses. Depression was the only associated and predictive factor of self-stigma in PD and could be an effective target of alleviating self-stigma.

Determinants of Self-Stigma in People with Parkinson's Disease: A Mixed Methods Scoping Review

BACKGROUND

Self-stigma in people with Parkinson's disease (PD) can substantially impact quality of life and possibilities for social participation. An integrative analysis of determinants of self-stigma has been lacking.

OBJECTIVE

We sought to explore which complementary insights from qualitative and quantitative studies, as well as from expert consultation, could be gained.

METHODS

An established mixed methods study design was employed to first conduct a mixed methods scoping review of published qualitative and quantitative literature, and then consult with experts to arrive at an exhaustive list of determinants of self-stigma after a thematic synthesis.

RESULTS

A total of 87 unique determinants of self-stigma were identified. Quantitative studies and expert consultations mainly identified personal determinants of people with self-stigma (e.g., age, anxiety, or apathy). In contrast, qualitative studies identified social situations associated with self-stigma (e.g., joint meals of people with typical PD with others). Notably, self-stigma of people with PD was found to be particularly salient in unfamiliar places, at the working place or in contact with people without PD. Across methods, cognitive impairment, tremor, and abnormal walk and unsteady gait, respectively, were associated with self-stigma.

CONCLUSION

The mixed method study design yielded complementary insights, but also factors commonly associated with self-stigma across methods. Future prioritization exercises may gain further insights into self-stigma of people with PD. Facilitating social encounters by both addressing needs of affected people and raising knowledge and public awareness may improve quality of life in people with PD.

Exploring the perceptions and stigmatizing experiences of Israeli family caregivers of people with Parkinson's disease

Providing care to people with Parkinson's disease (PD) poses challenges for family carers, including experiencing stigmatic beliefs -i.e., family stigma. However, to the best of our knowledge, there is no empirical study examining the stigmatic experiences of family members of people with PD. This was the aim of the present study. Three focus groups with 22 Israeli spouses of people with PD were conducted. Data were analyzed using theory-led thematic analysis. Overall, the spouses in our study shared mainly experiences of the stigma attached to the illness and/or to their loved ones, and not to themselves as carers. Three major themes emerged: the stereotypes that typify PD, stigmatizing behaviors towards the person with the disease, and structural stigma. Our findings highlight the profound stigma confronting carers of persons with PD, particularly when it comes to structural stigma.

Stigma and Associated Correlates of Elderly Patients With Parkinson's Disease

Background: Stigmatizing experiences is common in Parkinson's disease (PD) and appears to provide a negative contribution to the quality of life. Our aim of this study was to investigate the extent of stigma and its predictive factors in patients with PD from our hospital in Shanghai, China. Methods: In 276 individuals with PD (135 women and 141 men), stigma was measured by the 24-item Stigma Scale for Chronic Illness (SSCI). Multivariate linear regression model was used to assess predictors of stigma including demographics (age and gender), disease duration, stage (Hoehn and Yahr Scale), motor function (Unified Parkinson's Disease Rating Scale Part 3, UPDRS-III), non-motor symptoms (Non-Motor Symptoms Scale, NMSS), cognitive level (Mini-Mental State Examination, MMSE), as well as anxiety (Hamilton Anxiety Rating Scale, HAM-A) and depressive disorders (Hamilton Depression Rating Scale, HAM-D-24). Results: The total score of SSCI was 49.9 ± 14.3, and 48.5% of the patients checked "rarely" to "sometimes." For the total sample, the full model accounted for 47.8% of the variance in stigma (P < 0.05). Higher UPDRS-III scores, longer course of disease, younger age, tremor-dominant subtype, and higher depression scores were significantly associated with stigma among individuals with PD. Conclusion: Our finding suggested a mild-to-moderate level of stigma in patients with PD. Tremor-dominant subtype, longer course of disease, younger age, severe motor symptoms, and depression are the predictors of stigma in PD.