Relationship between the MDS-UPDRS and Quality of Life: A large multicenter study of 3206 patients

BACKGROUND

The relationship between Health-Related Quality of Life (HRQoL) and MDS-UPDRS has not been fully studied so far. The aim of this study was to evaluate the relationship between all MDS-UPDRS components and HRQoL in a representative international cohort of PD patients.

METHODS

We collected demographic and disease-related data as well as MDS-UPDRS and PDQ8 scales. Data were analyzed using correlations between PDQ8 and all MDS-UPDRS items, subsequently two hierarchical multiple regressions were performed, first between the scores of the MDS-UPDRS Parts and PDQ8 and second between individual items from those Parts demonstrating significant relationship to PDQ8 scores in the first regression. LASSO regression analyses were performed to evaluate the relationship between PDQ8 and all individual MDS-UPDRS items.

RESULTS

A total of 3206 PD patients were included in the study. In the first regression analysis, PDQ8 was significantly related to MDS-UPDRS parts I and II, but not to III and IV. In the second regression model, significant contributions to PDQ8 were found for Part I items Fatigue, Pain, Depressed mood, Apathy; and Part II items Dressing, Doing hobbies, Freezing, Speech and Tremor. In the LASSO analysis, six Part I, seven Part II, three Part III and one Part IV items contributed to PDQ8 scores. The five items most significantly related to the model were Depressed mood, Dressing, Apathy, Pain and Fatigue.

CONCLUSIONS

This is so far the largest study related to HRQoL issues in PD. Restrictions in activities of daily living and non-motor symptoms significantly contribute to HRQoL in PD.

Differences in MDS-UPDRS Scores Based on Hoehn and Yahr Stage and Disease Duration

Background

The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a newly developed tool to assess Parkinson's disease (PD). Changes in scores on the scale over the course of PD, including increasing disease duration and Hoehn and Yahr (HY) stages, have not been described. The objectives of this study were to analyze MDS-UPDRS scores on Parts I through IV and their differences based on HY stage and disease duration in a large cohort of patients with PD.

Methods

For this cross-sectional study, demographic data and MDS-UPDRS scores were collected, including HY stage. Subscores on MDS-UPDRS Parts I through IV were analyzed using 1-way analyses of variance for each HY stage and in 5-year increments of disease duration. Part III (motor assessment) scores were analyzed separately for on and off states.

Results

The mean age of the 3206 patients was 65.8 ± 10.6 years, 53.3% were men, the mean disease duration was 11.5 ± 4.6 years, and the median HY stage was 2 (range, 0-5); 2156 patients were examined in an on state and 987 were examined in an off state. Scores for all MDS-UPDRS parts increased significantly through HY stages 1 through 5, with an average increase of 3.8, 7.7, 14.6, and 2.0 points consecutively for parts I through IV, respectively. For the 5-year increments of disease duration, MDS-UPDRS subscores increased by an average of 1.6, 3.3, 4.2, and 1.4 points consecutively for parts I through IV, respectively. This increase was significant only during the first 15 years of disease for all 4 parts, including part III scores evaluated in both on and off states.

Conclusions

MDS-UPDRS scores for all 4 parts increase significantly with every HY stage and also with 5-year increments of disease duration in the first 15 years of the disease.

Sniffing the diagnosis: Olfactory testing in neurodegenerative parkinsonism

OBJECTIVE

To determine the diagnostic utility of olfactory testing in patients with neurodegenerative parkinsonism.

METHODS

The Sniffin' Sticks test battery for assessment of odor identification, discrimination, and threshold was applied to patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) as well as healthy controls (HC). Two different cohorts were analyzed: A PD/healthy control that included PD patients and HC as well as a PD/diseased control cohort for which patients PD, MSA and PSP were recruited. The former cohort was exploited to calculate cut-off values that discriminate PD patients from HC with a sensitivity (sensitivity-weighted cut-off) or specificity (specificity-weighted cut-off) exceeding 95%, respectively. The PD/diseased controls cohort was used to determine the diagnostic accuracy using these cut-off values in discriminating patients with neurodegenerative parkinsonism.

RESULTS

PD patients (n = 67) performed significantly worse in olfactory testing than HC (n = 41) and patients with MSA (n = 23) or PSP (n = 23). There was no significant difference in olfactory function between MSA and PSP patients. Diagnostic performance of the identification subscore was similar to the sum score of the Sniffin' Sticks test (AUC identification test 0.94, AUC sum score 0.96), while threshold and discrimination subscores were inferior. In patients with parkinsonism, the specificity-weighted cut-off predicted a diagnosis of PD with a sensitivity and specificity of 76.6 and 87.0%, respectively. The discriminative value of this cut-off in separating PD from MSA was 76.7% (sensitivity) and 95.7% (specificity). The corresponding, prevalence-adjusted positive predictive value of olfactory testing exceeded 95%.

CONCLUSIONS

Our data suggest that assessment of olfactory function, particularly odor identification, can be useful to discriminate PD from atypical parkinsonian disorders, particularly MSA patients.

Revealing the thermodynamic driving force for ligand-based reductions in quinoids; conceptual rules for designing redox active and non-innocent ligands

Metal and ligand-based reductions have been modeled in octahedral ruthenium complexes revealing metal-ligand interactions as the profound driving force for the redox-active behaviour of orthoquinoid-type ligands. Through an extensive investigation of redox-active ligands we revealed the most critical factors that facilitate or suppress redox-activity of ligands in metal complexes, from which basic rules for designing non-innocent/redox-active ligands can be put forward. These rules also allow rational redox-leveling, i.e. the moderation of redox potentials of ligand-centred electron transfer processes, potentially leading to catalysts with low overpotential in multielectron activation processes.

Dorsolateral nigral hyperintensity on 3.0T susceptibility-weighted imaging in neurodegenerative Parkinsonism

BACKGROUND

Absence of a hyperintense, ovoid area within the dorsolateral border of the otherwise hypointense pars compacta of the substantia nigra (referred to as dorsolateral nigral hyperintensity) on iron-sensitive high-field magnetic resonance imaging sequences seems to be a typical finding for patients with Parkinson's disease (PD).

OBJECTIVE

This study was undertaken to evaluate the diagnostic value of the dorsolateral nigral hyperintensity in a cohort of patients with neurodegenerative parkinsonism including PD, multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) as well as healthy controls using high-field susceptibility-weighted imaging (SWI) at 3.0 Tesla (T).

METHODS

Absence of dorsolateral nigral hyperintensity was assessed on visual inspection of anonymized 3.0T SWI scans in a case-control study including 148 patients with neurodegenerative parkinsonism (PD: n = 104; MSA: n = 22; PSP: n = 22) and 42 healthy controls.

RESULTS

Dorsolateral nigral hyperintensity was absent unilaterally in all patients with MSA or PSP, in 83 of 90 patients with PD, but only in one of the healthy controls resulting in an overall correct classification of 95.2% in discriminating neurodegenerative parkinsonism from controls in the per-protocol analysis. Overall correct classification was 93.2% in the intent-to-diagnose analysis, including also SWI scans with poor quality (12.1% of all scans) for nigral evaluation.

CONCLUSION

Visual assessment of dorsolateral nigral hyperintensity on high-field SWI scans may serve as a new simple diagnostic imaging marker for neurodegenerative parkinsonian disorders.

Mortality in Parkinson's disease: a 38-year follow-up study

BACKGROUND

In this study we report on the outcome including overall and cause-specific mortality of Parkinson's disease (PD) patients subsequent to 38 years of surveillance. This is an extension study of our previous report on mortality.

METHODS

Two hundred thirty-seven patients with a symptom onset between 1974 and 1984 were followed until the date of December 31, 2012 or death, representing a follow-up period of up to 38 years. Overall and cause-specific standardized mortality ratios (SMRs) were calculated, and predictors for survival at disease onset were estimated.

RESULTS AND CONCLUSION

Two hundred thirty patients had died by December 31, 2012; a total of 3,489 person-years were available for observation. The SMR at 38 years of follow-up was 2.02 (1.76-2.29). Employing Cox's proportional hazard modeling, male sex, gait disorder, absence of classical rest tremor, and absence of asymmetry predicted poor survival in this cohort. Increased cause-specific SMRs were found for pneumonia and cerebrovascular and cardiovascular diseases.

Accessibility and availability of abortion in six European countries

OBJECTIVES

The accessibility and availability of abortion are a reflection of abortion law and the accessibility and availability of abortion services. Experiences from six European countries with different political, cultural, social and religious backgrounds (the Netherlands, France, Great Britain, Slovenia, Hungary and Turkey) are presented.

RESULTS

Abortion laws in Europe range from complete prohibition to complete liberalization of abortion. Some countries demand a waiting period for the procedure, pre-abortion counseling, parental approval for minors, and in the others there are no mandatory requirements. Abortions are generally performed in authorized facilities by gynecologists or general practitioners. Abortion services are easily accessible, in terms of the law, availability of facilities and health insurance coverage of the procedure in the Netherlands, France and Slovenia. Abortion service is less accessible in United Kingdom, Hungary and Turkey, as a result of limited accessibility to abortion services or a relatively high abortion fee. In some Eastern European countries there has been a tendency in the last decade to limit the availability and access to abortion.

CONCLUSIONS

In Europe abortion is generally well accessible in terms of abortion laws. There are differences in accessibility to abortion services between the countries, and in some countries, also between different areas of the country.

Continuation and compliance of contraceptive use

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented. The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants, intrauterine devices (IUD), the pill and Depo-Provera. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation rates are highest for methods not affected by compliance. Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptive use (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectiveness can largely be attributed to compliance with the prescribed contraceptive regimens. Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition, the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.

Medico-legal aspects of abortion in Europe

OBJECTIVE

The practice of abortion in a particular country reflects culture, economic status, religion and the law. Various aspects of abortion in Europe - laws, rates and practices - are presented.

RESULTS

Abortion is completely prohibited in Ireland and Malta. In Poland it is permitted only to save the woman's life or protect her physical health. On the grounds of protecting the woman's mental health it is also permitted in Northern Ireland, Portugal, Spain and Switzerland. On socioeconomic grounds abortion is permitted in Finland, Great Britain and Hungary. In the other European countries it is permitted on demand. Eastern Europe has the highest abortion rate (Romania 78/1000 women aged 15-44), and Western Europe has the lowest (The Netherlands 6.5/1000); the disparity may be attributable to differences in availability and use of effective contraceptives. Within the first 12 weeks of gestation, vacuum aspiration has replaced dilatation and curettage, as the most commonly used method to perform abortion. More recently, medical abortion (mifepristone with prostaglandins) in early pregnancy has been used in several European countries.

CONCLUSIONS

Reduction of the need for induced abortion and prevention of unsafe abortion through the provision of appropriate legislation and good family planning services should be an integral part of health care in every country.

Interindividual-intergroup discontinuity reduction through the anticipation of future interaction

Consistent with the role of a long-term perspective in reducing the tendency of intergroup relations to be more competitive than interindividual relations in the context of noncorrespondent outcomes, an experiment demonstrated that anticipated future interaction reduced intergroup but not interindividual competitiveness. Further results indicated that the effect was present only for groups composed of members high in abstractness (Openness-Intellect on the Big 5 Inventory and Intuition on the Myers-Briggs Type Inventory) who trusted their opponents.

Interindividual-intergroup discontinuity reduction through the anticipation of future interaction

Consistent with the role of a long-term perspective in reducing the tendency of intergroup relations to be more competitive than interindividual relations in the context of noncorrespondent outcomes, an experiment demonstrated that anticipated future interaction reduced intergroup but not interindividual competitiveness. Further results indicated that the effect was present only for groups composed of members high in abstractness (Openness-Intellect on the Big 5 Inventory and Intuition on the Myers-Briggs Type Inventory) who trusted their opponents.

Sexual behavior of secondary-school students in Slovenia

OBJECTIVES

The aim of this study was to analyze the sexual behavior of secondary-school students in Slovenia.

METHODS

The research was carried out on a representative sample of 4706 secondary-school students aged 15-19 years in Slovenia. The data were obtained by a self-administered questionnaire in April 1996.

RESULTS

The average age of the students was 17.5 years. Most students had experiences in kissing (70%) and caressing (59%); a lower number had experiences in petting (43%). Sexual intercourse had been experienced by 38% of the students. The median age at the first sexual intercourse was 18.5 years. The main motives for the first sexual intercourse were love (45%), accident (22%) and curiosity (15%). Contraceptive methods currently used were condoms (60%), the pill (14%), coitus interruptus (4%), other methods (3%) and no method (19%). According to the students, the most appropriate sources of information on sexuality were friends (26%), parents (19%), different sources (19%) and professionals (15%).

CONCLUSION

By the age of 18.5 years, approximately one-half of secondary-school students in Slovenia experience sexual intercourse. Most students currently use effective contraception, condoms being the most popular method. The students expect to receive information about sexuality from friends, parents and professionals, but not from the school environment.