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Putko BN, Miyasaki JM. Improving Documentation of Impulse Control Disorders at a Movement Disorder Program During the COVID-19 Pandemic. Neurol Clin Pract 2023; 13:e200205. [PMID: 37780813 PMCID: PMC10540937 DOI: 10.1212/cpj.0000000000200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023]
Abstract
Background and Objectives Impulse control disorders (ICD) are a group of behaviors in Parkinson disease (PD), (compulsive buying, gambling, binge eating, craving sweets, and hypersexuality) that occur in up to 20% of individuals with PD, sometimes with devastating results. We sought to determine the rate of ICD screening based on 2020 quality measures for PD care by the American Academy of Neurology. Methods We conducted a quality improvement project to document and improve physician ICD screening in a tertiary movement disorder program. Serial medical records were reviewed for 5 weeks before and 13 weeks after an educational session and documentation tool deployments in 2020. Inclusion criteria included the following: idiopathic PD, PD dementia (PDD), or dementia with Lewy bodies (DLB). Individual encounters for 109 patients preintervention and 276 patients postintervention were reviewed. Results There was no difference between the preintervention and postintervention (pre-IG vs post-IG, respectively) in terms of age, male to female ratio, proportion of patients with PD, PDD, or DLB, duration of diagnosis, or levodopa equivalents. There was a shift to increased ICD queries above the median for the study period (28.8%) for 7 consecutive weeks in post-IG. The frequency of ICD diagnosis was not different from pre-IG to post-IG (95% confidence interval, 0-32.6 vs 2.7-13.4%, p = 0.444). Discussion ICD queries immediately after ICD education and dissemination of documentation tools increased. Both preintervention and postintervention groups were similar in demographic and clinical characteristics. This program was instituted at the height of wave 2 of the COVID-19 pandemic in Alberta during staff redeployment and 100% shift to telemedicine ambulatory care. Our results demonstrate that amid a crisis, quality improvement can still be effective with education and provision of tools for clinicians.
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Affiliation(s)
- Brendan N. Putko
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Janis M. Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Miyasaki JM, Kluger BM. Preface. Handb Clin Neurol 2023; 191:xi. [PMID: 36599519 DOI: 10.1016/b978-0-12-824535-4.09988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Corcoran J, Huang AH, Miyasaki JM, Tarolli CG. Palliative care in Parkinson disease and related disorders. Handb Clin Neurol 2023; 191:107-128. [PMID: 36599503 DOI: 10.1016/b978-0-12-824535-4.00017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although neuropalliative care is a relatively new field, there is increasing evidence for its use among the degenerative parkinsonian syndromes, including idiopathic Parkinson disease, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, and corticobasal syndrome. This chapter outlines the current state of evidence for palliative care among individuals with the degenerative parkinsonian syndromes with discussion surrounding: (1) disease burden and needs across the conditions; (2) utility, timing, and methods for advance care planning; (3) novel care models for the provision of palliative care; and 4) end-of-life care issues. We also discuss currently unmet needs and unanswered questions in the field, proposing priorities for research and the assessment of implemented care models.
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Affiliation(s)
- Jennifer Corcoran
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrew H Huang
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
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Kluger BM, Huang AP, Miyasaki JM. Cannabinoids in movement disorders. Parkinsonism Relat Disord 2022; 102:124-130. [PMID: 36038457 DOI: 10.1016/j.parkreldis.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION On the basis of both scientific progress and popular lore, there is growing optimism in the therapeutic potential of cannabis (marijuana) and cannabinoid-based chemicals for movement disorders. There is also notable skepticism regarding the scientific basis for this therapeutic optimism and significant concerns regarding the safety and regulation of cannabinoid products, particularly those available without prescription. METHODS In recognition of the high interest and controversial nature of this subject, the meeting committee of the International Parkinson and Movement Disorders Society arranged for a talk on cannabis at the 2019 annual meeting's Controversies in Movement Disorders plenary session. This paper summarizes the highlights of this session. RESULTS The endocannabinoid system is strongly tied to motor function and dysfunction, with basic research suggesting several promising therapeutic targets related to cannabinoids for movement disorders. Clinical research on cannabinoids for motor and nonmotor symptoms in Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, and other movement disorders to date are promising at best and inconclusive or negative at worst. Research in other populations suggest efficacy for common symptoms like pain. While social campaigns against recreational cannabinoid use focus on cognitive changes in adolescents, the long-term sequelae of regulated medical use in older adults with movement disorders is unknown. The overall risks of cannabinoids may be similar to other commonly used medications and include falls and apathy. CONCLUSION Further research is greatly needed to better understand the actual clinical benefits and long-term side effects of medical cannabis products for movement disorders indications and populations.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Andrew P Huang
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Bock M, Katz M, Sillau S, Adjepong K, Yaffe K, Ayele R, Macchi ZA, Pantilat S, Miyasaki JM, Kluger B. What's in the Sauce? The Specific Benefits of Palliative Care for Parkinson's Disease. J Pain Symptom Manage 2022; 63:1031-1040. [PMID: 35114353 PMCID: PMC9395211 DOI: 10.1016/j.jpainsymman.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Increasing evidence demonstrates the benefits of palliative care among individuals with Parkinson's disease and related disorders (PDRD), but the critical components that contribute to therapeutic effects are not well understood. OBJECTIVES To determine the specific items most responsive to a palliative care intervention in PDRD and identify key correlates of improvement in patient and care partner outcomes. METHODS The main trial was a pragmatic comparative effectiveness trial of outpatient integrated palliative care compared to standard care among participants with PDRD (NCT02533921), showing significantly higher patient QOL at six months and lower care partner burden at 12 months. We used longitudinal regression models to analyze changes in subdomains of patient QOL and care partner burden and Spearman correlations to evaluate key correlates of change scores in patient and care partner outcomes. We performed a secondary analysis of data from 210 patients and 175 care partners. RESULTS Compared to controls, patients in the intervention reported greater improvement in perceptions of the "self as a whole" at six months (coeff = 0.22, P < 0.05) and care partners reported greater reduction in stress, anger, and loss of control at 12 months (coeff = -.40, -0.25, -0.31, P < 0.05). Positive change in numerous patient non-motor symptoms and grief correlated with improved patient QOL, reduced patient anxiety, and increased care partner spirituality. Alleviation of care partner anxiety and depression correlated with reduced care partner burden. CONCLUSION Specific benefits of an integrated palliative approach in PDRD include improvement in patient holistic self-impressions, care partner self-efficacy, and non-motor symptoms.
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Affiliation(s)
- Meredith Bock
- Department of Neurology, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
| | - Maya Katz
- Department of Neurology, Stanford University, California, USA
| | - Stefan Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Kwame Adjepong
- Department of Neurology, University of California, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Neurology, University of Colorado Anschutz Medical Campus, Colorado, USA; Department of Psychiatry, University of California, San Francisco, California, USA; Department of Epidemiology, University of California, San Francisco, California, USA
| | - Roman Ayele
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Zachary A Macchi
- Department of Neurology, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Steven Pantilat
- Department of Medicine, Division of Palliative Medicine at University of California, San Francisco California, USA
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Benzi Kluger
- Departments of Neurology and Medicine, Division of Palliative Care, University of Rochester, Rochester, New Year, USA
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Kluger BM, Miyasaki JM. Key concepts and opportunities. Handb Clin Neurol 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Miyasaki JM, Kluger BM. Preface. Handb Clin Neurol 2022; 190:xi. [PMID: 36055725 DOI: 10.1016/b978-0-323-85029-2.09987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Pringsheim T, Day GS, Smith DB, Rae-Grant A, Licking N, Armstrong MJ, de Bie RMA, Roze E, Miyasaki JM, Hauser RA, Espay AJ, Martello JP, Gurwell JA, Billinghurst L, Sullivan K, Fitts MS, Cothros N, Hall DA, Rafferty M, Hagerbrant L, Hastings T, O'Brien MD, Silsbee H, Gronseth G, Lang AE. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology 2021; 97:942-957. [PMID: 34782410 PMCID: PMC8672433 DOI: 10.1212/wnl.0000000000012868] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians. METHODS A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.
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Affiliation(s)
- Tamara Pringsheim
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Gregory S Day
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Don B Smith
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Alex Rae-Grant
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Nicole Licking
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Melissa J Armstrong
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Rob M A de Bie
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Emmanuel Roze
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Janis M Miyasaki
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Robert A Hauser
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Alberto J Espay
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Justin P Martello
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Julie A Gurwell
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Lori Billinghurst
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Kelly Sullivan
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Michael S Fitts
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Nicholas Cothros
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Deborah A Hall
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Miriam Rafferty
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Lynn Hagerbrant
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Tara Hastings
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Mary Dolan O'Brien
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Heather Silsbee
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Gary Gronseth
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Anthony E Lang
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
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9
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de Rus Jacquet A, Bogard S, Normandeau CP, Degroot C, Postuma RB, Dupré N, Miyasaki JM, Monchi O, Martino D, Fon EA, Cicchetti F. Clinical perception and management of Parkinson's disease during the COVID-19 pandemic: A Canadian experience. Parkinsonism Relat Disord 2021; 91:66-76. [PMID: 34536727 PMCID: PMC8407944 DOI: 10.1016/j.parkreldis.2021.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
Background The COVID-19 pandemic has necessitated the social isolation of the population and the rapid implementation of remote care for patients with neurodegenerative diseases. The objective of this study was to explore the perceived impact of confinement in patients with Parkinson's disease and document the effects of gender and living environment. Methods We recruited two cohorts from the Canadian provinces of Québec and Alberta, which differed in the dynamics of COVID-19 spreading at the time of the study, and administered a questionnaire on the perceived effects of confinement on daily living and disease management. Results The data reveals that approximately half of the patients experienced a change in one or more clinical symptoms, with differences observed between gender (e.g. day-to-day changes in slowness in men, aggravated headaches in women) and geographic location (e.g. increased depression in Alberta but reduced sleep quality in Québec). Furthermore, participants identifying as women or living in Alberta implemented more frequently home or online exercise. Lastly, high levels of satisfaction with phone or video consultations did not translate into a sustained interest to pursue this mode of healthcare. Conclusions This study suggests that COVID-19-related confinement affected Parkinson's disease manifestation and management. Patients also reported varying levels of interest to continue remote care. A number of differences reported in our study were seemingly related to gender and living environment.
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Affiliation(s)
- Aurelie de Rus Jacquet
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC, Canada; Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada.
| | - Sarah Bogard
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine P Normandeau
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Clotilde Degroot
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ronald B Postuma
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Nicolas Dupré
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC, Canada; Département de Médecine, Faculté de Médicine, Université Laval, Québec, QC, Canada
| | | | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Edward A Fon
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC, Canada; Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada.
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10
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Yen K, Miyasaki JM, Waldron M, Yu L, Sankar T, Ba F. DBS-Edmonton App, a Tool to Manage Patient Expectations of DBS in Parkinson Disease. Neurol Clin Pract 2021; 11:e308-e316. [PMID: 34484906 DOI: 10.1212/cpj.0000000000000962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Objective After deep brain stimulation (DBS) for Parkinson disease (PD), patients often do not report the level of satisfaction anticipated. This misalignment can relate to patients' expectations for an invasive treatment and insufficient knowledge of DBS's effectiveness in relieving motor and nonmotor symptoms (NMS). Patient satisfaction depends on expectations and goals for treatment. We hypothesized that improving patient education with a patient-centered shared decision-making tool emphasizing autonomy would improve patient satisfaction and clinical outcome. Methods We developed a computer application (DBS-Edmonton app), allowing patients with PD to input their symptoms and to learn how effective DBS addresses their prioritized symptoms. Sixty-two volunteers referred for DBS used the DBS-Edmonton app. DBS-related knowledge and patient perceptions of the DBS-Edmonton app were assessed with pre- and post-use questionnaires. Fourteen of 24 patients who proceeded to DBS achieved optimization at 6 months. Perceived functional improvement was assessed and compared with 12 control patients with DBS who did not use the DBS-Edmonton app. Results All 62 volunteers considered the DBS-Edmonton app helpful and would recommend it to others. There was improved knowledge about how NMS and axial symptoms respond to DBS. Postoperatively, there was no significant difference in symptoms improvement assessed by standard scales between the groups. Volunteers who used the DBS-Edmonton app had greater satisfaction (p = 0.014). Conclusion This interventional study showed that the DBS-Edmonton app improved DBS-related knowledge and patient satisfaction, independent of the objective motor outcome. It may assist patients in deciding to proceed to DBS and can be easily incorporated into practice to improve patient satisfaction post-DBS.
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Affiliation(s)
- Kevin Yen
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Janis M Miyasaki
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle Waldron
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lin Yu
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Tejas Sankar
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Fang Ba
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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11
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Miyasaki JM, Lim SY, Chaudhuri KR, Antonini A, Piemonte M, Richfield E, Alburquerque Gonzalez D, Lorenzl S, Walker R, Bhidayasiri R, Bouca R, McConvey V. Access and Attitudes Toward Palliative Care Among Movement Disorders Clinicians. Mov Disord 2021; 37:182-189. [PMID: 34431560 DOI: 10.1002/mds.28773] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neuropalliative care is an emerging field for those with neurodegenerative illnesses, but access to neuropalliative care remains limited. OBJECTIVE We sought to determine Movement Disorder Society (MDS) members' attitudes and access to palliative care. METHODS A quantitative and qualitative survey instrument was developed by the MDS Palliative Care Task Force and e-mailed to all members for completion. Descriptive statistics and qualitative analysis were triangulated. RESULTS Of 6442 members contacted, 652 completed the survey. Completed surveys indicating country of the respondent overwhelmingly represented middle- and high-income countries. Government-funded homecare was available to 54% of respondents based on patient need, 25% limited access, and 21% during hospitalization or an acute defined event. Eighty-nine percent worked in multidisciplinary teams. The majority endorsed trigger-based referrals to palliative care (75.5%), while 24.5% indicated any time after diagnosis was appropriate. Although 66% referred patients to palliative care, 34% did not refer patients. Barriers were identified by 68% of respondents, the most significant being available workforce, financial support for palliative care, and perceived knowledge of palliative care physicians specific to movement disorders. Of 499 respondents indicating their training in palliative care or desire to learn these skills, 55% indicated a desire to gain more skills. CONCLUSIONS The majority of MDS member respondents endorsed a role for palliative care in movement disorders. Many members have palliative training or collaborate with palliative care physicians. Although significant barriers exist to access palliative care, the desire to gain more skills and education on palliative care is an opportunity for professional development within the MDS. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Janis M Miyasaki
- Parkinson and Movement Disorders Program, Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College, Denmark Hill Campus, London, United Kingdom
| | - Angelo Antonini
- Movement Disorders Unit-Center for Rare Neurological Diseases, Department of Neuroscience, University of Padua, Padua, Italy
| | - Maria Piemonte
- Physical Therapy, Speech Therapy, and Occupational Therapy Department, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Daniela Alburquerque Gonzalez
- Centro de Trastornos del Movimiento, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Ludwig-Maximillians-University, Munich, Germany.,Department of Neurology, Kliniku Agatharied, Hausham, Germany
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Raquel Bouca
- Instituto de Medicina Molecular Joao Lobo Antunes, Lisbon, Portugal
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12
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Gross RA, Yuan Y, Keran C, Miyasaki JM. Author Response: Leadership, Recognition Awards, and Publication by Men and Women in the American Academy of Neurology. Neurology 2021; 97:203. [PMID: 34312314 DOI: 10.1212/wnl.0000000000012336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Keran C, Gross RA, Yuan Y, Miyasaki JM. Author Response: Leadership, Recognition Awards, and Publication by Men and Women in the American Academy of Neurology. Neurology 2021; 97:201. [PMID: 34312312 DOI: 10.1212/wnl.0000000000012334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Butt A, Kamtchum-Tatuene J, Khan K, Shuaib A, Jickling GC, Miyasaki JM, Smith EE, Camicioli R. White matter hyperintensities in patients with Parkinson's disease: A systematic review and meta-analysis. J Neurol Sci 2021; 426:117481. [PMID: 33975191 DOI: 10.1016/j.jns.2021.117481] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/25/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mechanisms driving neurodegeneration in Parkinson's disease (PD) are unclear and neurovascular dysfunction may be a contributing factor. White matter hyperintensities (WMH) are commonly found on brain MRI in patients with PD. It is controversial if they are more prevalent or more severe in PD compared with controls. This systematic review aims to answer this question. METHODS A systematic search of electronic databases was conducted for studies of WMH in patients with PD. A qualitative synthesis was done for studies reporting WMH prevalence or WMH scores on a visual rating scale (VRS). In studies reporting total WMH volume, the difference between patients with PD and controls was pooled using random effects meta-analysis. RESULTS Among 3860 subjects from 24 studies, 2360 were cases and 1500 controls. Fifteen studies reported WMH scores and four studies reported the prevalence of WMH. On VRS, five studies reported no difference in WMH scores, three found higher WMH scores in PD compared to controls, three reported increased WMH scores either in periventricular or deep white matter, and four reported higher scores only in PD with dementia. In studies reporting WMH volume, there was no difference between patients with PD and controls (pooled standardized mean difference = 0.1, 95%CI: -0.1-0.4, I2 = 81%). CONCLUSION WMH are not more prevalent or severe in patients with PD than in age-matched controls. PD dementia may have more severe WMH compared to controls and PD with normal cognition. Prospective studies using standardized methods of WMH assessment are needed.
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Affiliation(s)
- Asif Butt
- Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada.
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Khurshid Khan
- Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Ashfaq Shuaib
- Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Glen C Jickling
- Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
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15
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Akbar U, McQueen RB, Bemski J, Carter J, Goy ER, Kutner J, Johnson MJ, Miyasaki JM, Kluger B. Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323939. [PMID: 33789923 PMCID: PMC8142437 DOI: 10.1136/jnnp-2020-323939] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
Parkinson's disease and related disorders (PDRD) are the second most common neurodegenerative disease and a leading cause of death. However, patients with PDRD receive less end-of-life palliative care (hospice) than other illnesses, including other neurologic illnesses. Identification of predictors of PDRD mortality may aid in increasing appropriate and timely referrals. To systematically review the literature for causes of death and predictors of mortality in PDRD to provide guidance regarding hospice/end-of-life palliative care referrals. We searched MEDLINE, PubMed, EMBASE and CINAHL databases (1970-2020) of original quantitative research using patient-level, provider-level or caregiver-level data from medical records, administrative data or survey responses associated with mortality, prognosis or cause of death in PDRD. Findings were reviewed by an International Working Group on PD and Palliative Care supported by the Parkinson's Foundation. Of 1183 research articles, 42 studies met our inclusion criteria. We found four main domains of factors associated with mortality in PDRD: (1) demographic and clinical markers (age, sex, body mass index and comorbid illnesses), (2) motor dysfunction and global disability, (3) falls and infections and (4) non-motor symptoms. We provide suggestions for consideration of timing of hospice/end-of-life palliative care referrals. Several clinical features of advancing disease may be useful in triggering end-of-life palliative/hospice referral. Prognostic studies focused on identifying when people with PDRD are nearing their final months of life are limited. There is further need for research in this area as well as policies that support need-based palliative care for the duration of PDRD.
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Affiliation(s)
- Umer Akbar
- Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | | | - Julienne Bemski
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Julie Carter
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Elizabeth R Goy
- Department of Neurology, Portland VA Medical Center, Portland, Oregon, USA
| | - Jean Kutner
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Miriam J Johnson
- Department of Palliative Medicine, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Janis M Miyasaki
- Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Benzi Kluger
- Department of Neurology, University of Rochester, Rochester, New York, USA
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Miyasaki JM, Lim TT, Bhidayasiri R. Editorial: Inclusion, equity, diversity and social justice in movement disorders research. Parkinsonism Relat Disord 2021; 85:114-116. [PMID: 33840573 DOI: 10.1016/j.parkreldis.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Janis M Miyasaki
- Department of Medicine, Division Neurology, University of Alberta, Edmonton, Canada.
| | | | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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17
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Marsili L, Bologna M, Miyasaki JM, Colosimo C. Device-aided therapies for advanced Parkinson disease: insights from an international survey. Neurol Sci 2021; 42:2961-2964. [PMID: 33550525 DOI: 10.1007/s10072-021-05106-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In the advanced stage of Parkinson disease (PD), therapeutic interventions include device-aided therapies such as continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG) infusion, and deep brain stimulation (DBS). Recent evidence has underlined the general lack of randomized, blinded, head-to-head studies on device-aided therapies for advanced PD. METHODS To better clarify the real-world attitude of clinicians on this matter, we conducted an international survey of forty-four experienced movement disorder specialists regarding the management of device-aided therapies in advanced PD. RESULTS Our international survey showed a general agreement that nowadays, motor complications are less common compared to the past (59% agreement), that guidelines to identify candidates for device-aided therapies are currently lacking (57% agreement), and that device-aided therapies will have increased demand in the future (75% agreement). CONCLUSIONS We conclude that guidelines to assist clinicians and patients to choose device-aided therapies are required.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA.
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, Parkinson and Movement Disorders Program and the Complex Neurologic Symptoms Clinic, Kaye Edmonton Clinic, University of Alberta, Edmonton, AL, Canada
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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Miyasaki JM, Robinson MT. Editorial: Neuropalliative care for movement disorders in the time of COVID-19. Parkinsonism Relat Disord 2020; 80:201-202. [PMID: 33272807 DOI: 10.1016/j.parkreldis.2020.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Janis M Miyasaki
- Affiliation: JMM University of Alberta, Edmonton, Alberta, Canada.
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Marsili L, Bologna M, Miyasaki JM, Colosimo C. Parkinson's disease advanced therapies - A systematic review: More unanswered questions than guidance. Parkinsonism Relat Disord 2020; 83:132-139. [PMID: 33158747 DOI: 10.1016/j.parkreldis.2020.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022]
Abstract
In advanced Parkinson's disease (PD), therapeutic interventions include device-aided therapies such as continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG) infusion, and deep brain stimulation (DBS). We reappraised the evidence guiding the decision of appropriate device-aided therapies in advanced PD, and systematically reviewed the literature (including ongoing clinical trials) comparing CSAI, LCIG, DBS in terms of efficacy and cost-effectiveness, with particular consideration to possible conflicts of interests. Of 14,980 documents screened, sixteen were included (4 and 13 studies examining efficacy and cost-effectiveness, respectively). LCIG and DBS showed higher efficacy compared to best medical therapy (BMT). DBS was more expensive than BMT and LCIG. Lifetime costs of CSAI were lower of those of DBS, and DBS lifetime costs were lower than those of LCIG. The majority of studies (11 out of 16) showed direct or indirect sponsorship from pharmaceutical or device companies. Only one ongoing clinical trial comparing LCIG with DBS was found. Device-aided therapies address unmet needs in advanced PD. LCIG and DBS are superior to BMT in head-to-head studies; however, initial and lifetime costs should be considered when choosing those therapies. Guidelines to assist clinicians and patients to choose device-aided therapies, free from conflict of interests, are required.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, Parkinson and Movement Disorders Program and the Complex Neurologic Symptoms Clinic, Kaye Edmonton Clinic, University of Alberta, Edmonton, AL, Canada
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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Miyasaki JM, Maplethorpe E, Yuan Y, Keran C, Gross RA. Leadership, recognition awards, and publication by men and women in the American Academy of Neurology. Neurology 2020; 95:e3313-e3320. [DOI: 10.1212/wnl.0000000000010810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo study sex differences with respect to publications, leadership, and recognition awards in the American Academy of Neurology (AAN) in light of recent research highlighting inequities in these domains.MethodsWe examined medical school graduation, neurology residency (using American Medical Association and American Council for Graduate Medical Education data), membership in the AAN, first and last authorship in Neurology®, membership on AAN committees, and AAN recognition awards by sex for 1997, 2007, and 2017.ResultsFemale medical students were less likely to enter neurology residency in 1997 only. In 2007 and 2017, there was no proportionate difference between men and women as last author, a surrogate for senior member of the author panel. In 2017, women were proportionately more likely to be first authors than men, a surrogate for principal investigator of the study. Committee membership was less for women in 1997 and 2007 (p < 0.001) but was not proportionately different in 2017 (p = 0.534). Women were proportionately more likely to receive recognition awards in all years studied (1997 p = 0.008, 2007 p < 0.001, 2017 p < 0.001), although absolute numbers of women were lower.ConclusionsFemale membership, leadership (through committee membership), and publications as last author were lower in 1997 in the AAN. These same metrics demonstrated substantial proportionate changes, with no differences in last authorship in 2007 and 2017, greater likelihood for women to be first author in 2017, no differences in committee membership in 2017, and greater likelihood of receiving awards determined by merit in all 3 years.
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Prizer LP, Kluger BM, Sillau S, Katz M, Galifianakis NB, Miyasaki JM. The presence of a caregiver is associated with patient outcomes in patients with Parkinson's disease and atypical parkinsonisms. Parkinsonism Relat Disord 2020; 78:61-65. [DOI: 10.1016/j.parkreldis.2020.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
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Miyasaki JM, Kluger BM, Sillau S, Katz M, Galifianakis N, Prizer LP. Associations between spiritual well-being and quality of life in Parkinson disease. Ann Palliat Med 2020; 9:1288-1289. [PMID: 32312061 DOI: 10.21037/apm.2020.03.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/22/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Janis M Miyasaki
- Parkinson and Movement Disorders Program, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maya Katz
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Lindsay P Prizer
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Prizer LP, Kluger BM, Sillau S, Katz M, Galifianakis N, Miyasaki JM. Correlates of spiritual wellbeing in persons living with Parkinson disease. Ann Palliat Med 2020; 9:S16-S23. [DOI: 10.21037/apm.2019.09.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/19/2019] [Indexed: 11/06/2022]
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Jordan SR, Kluger B, Ayele R, Brungardt A, Hall A, Jones J, Katz M, Miyasaki JM, Lum HD. Optimizing future planning in Parkinson disease: suggestions for a comprehensive roadmap from patients and care partners. Ann Palliat Med 2020; 9:S63-S74. [PMID: 32036671 PMCID: PMC7408313 DOI: 10.21037/apm.2019.09.10] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Living with Parkinson disease (PD) is complicated by an unpredictable disease course which can delay planning for future needs. This study explores patient and care partner needs related to future planning using a palliative care framework with physical, psychological, social, cultural, end-of-life, and ethical aspects of care in PD to guide analysis. METHODS Secondary analysis of patient and care partner interviews from a randomized clinical trial comparing interdisciplinary outpatient palliative care versus standard care for individuals with PD and care partners in an academic setting. Sixty participants were interviewed (30 patients and 30 care partners) about needs related to future planning. Team-based thematic analysis was used to identify key themes. RESULTS Many care partners and patients living with PD described a desire for information about what to expect and how to plan for the future. Participants posed multiple questions about PD progression and devised the metaphor of a "roadmap" as a guide for decision making and planning. When exploring the concept of a PD roadmap, five themes emerged: (I) desire for a comprehensive tool for future planning, such as a roadmap, (II) care partner preferences for specific future planning, (III) PD-related life changes as opportunity for future planning and decision-making, (IV) cues from family, peers, and medical professionals about "location" on the roadmap, and (V) opportunities and challenges to integrating a PD roadmap into patient-centered care. CONCLUSIONS Patients and care partners described key needs related to future planning that can inform a comprehensive roadmap to assist with education, communication, and decision making. A roadmap tool can promote individualized anticipatory guidance and multidimensional shared decision-making discussions between patients, care partners, and the healthcare team related to PD progression.
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Affiliation(s)
- Sarah R Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Benzi Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Roman Ayele
- Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA; College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adreanne Brungardt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anne Hall
- Research Stakeholder, University of California, San Francisco, CA, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maya Katz
- Movement Disorders and Neuromodulation Center, University of California, San Francisco, CA, USA
| | - Janis M Miyasaki
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA.
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Abstract
Movement disorders in women during pregnancy are uncommon. Therefore, high quality studies are limited, and guidelines are lacking for the treatment of movement disorders in pregnancy, thus posing a significant therapeutic challenge for the treating physicians. In this chapter, we discuss movement disorders that arise during pregnancy and the preexisting movement disorders during pregnancy. Common conditions encountered in pregnancy include but are not limited to restless legs syndrome, chorea gravidarum, Parkinson disease, essential tremor, and Huntington disease as well as more rare movement disorders (Wilson's disease, dystonia, etc.). This chapter summarizes the published literature on movement disorders and pharmacologic and surgical considerations for neurologists and physicians in other specialties caring for patients who are pregnant or considering pregnancy.
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Affiliation(s)
- Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Macchi ZA, Koljack CE, Miyasaki JM, Katz M, Galifianakis N, Prizer LP, Sillau SH, Kluger BM. Patient and caregiver characteristics associated with caregiver burden in Parkinson's disease: a palliative care approach. Ann Palliat Med 2019; 9:S24-S33. [PMID: 31735048 DOI: 10.21037/apm.2019.10.01] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/02/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder associated with caregiver burden. Higher rates of burden are associated with adverse outcomes for caregivers and patients. Our aim was to understand patient and caregiver predictors of caregiver burden in PD from a palliative care approach. METHODS We conducted a cross-sectional analysis of baseline data from PD patients and caregivers in a randomized trial of outpatient palliative care at three study sites: University of Colorado, University of Alberta, and University of California San Francisco. The primary outcome measure of caregiver burden, the Zarit Burden Interview (ZBI), was compared against the following patient and caregiver variables: site of care, age, disease/caretaking duration, presence of atypical parkinsonism, race, income, education level, deep brain stimulation status, the Unified Parkinson's Disease Rating Scale (UPDRS) and Edmonton Symptom Assessment System Revised: Parkinson Disease (ESAS) for symptom severity and burden, the Montreal Cognitive Assessment (MoCA) for cognitive function, Quality of Life in Alzheimer's Disease (QOL-AD) scale for patient and caregiver perspectives on patient general quality of life, Parkinson's Disease Questionnaire 39 (PDQ-39) scale for health-related quality of life, Hospital Anxiety and Depression Scale (HADS) for patient and caregiver mood, Prolonged Grief Questionnaire, Functional Assessment of Chronic Illness Therapy- Spiritual Well-Being (FACIT-SP) of patient and caregiver, and Palliative Performance Scale for functional status. A stepwise multivariate linear regression model was used to determine associations with ZBI. RESULTS A total of 175 patients (70.9% male; average age 70.7±8.1 years; average disease duration 117.2±82.6 months), and 175 caregivers (73.1% female; average age 66.1±11.1 years) were included. Patient spiritual well-being (FACIT-SP Faith subscale, r2=0.024, P=0.0380), patient health-related quality of life (PDQ-39, r2=0.161, P<0.0001), caregiver depression (HADS Depression, r2=0.062, P=0.0014), caregiver anxiety (HADS Anxiety, r2=0.077, P=0.0002), and caregiver perspective on patient quality of life (QOL-AD Caregiver Perspective, r2=0.088, P<0.0001) were significant contributors to ZBI scores. CONCLUSIONS Patient and caregiver factors contribute to caregiver burden in persons living with PD. These results suggest targets for future interventions to improve caregiver support.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA
| | - Claire E Koljack
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Maya Katz
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA 94122, USA
| | - Nick Galifianakis
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA 94122, USA
| | - Lindsay P Prizer
- Department of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA.
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LaFaver K, Miyasaki JM, Keran CM, Rheaume C, Gulya L, Levin KH, Jones EC, Schwarz HB, Molano JR, Hessler A, Singhal D, Shanafelt TD, Sloan JA, Novotny PJ, Cascino TL, Busis NA. Author response: Age and sex differences in burnout, career satisfaction, and well-being in US neurologists. Neurology 2019; 93:863. [DOI: 10.1212/wnl.0000000000008451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Friedman JH, Violante MR, Miyasaki JM. Editorial to "Increases in institutionalization, healthcare resource utilization, and mortality risk associated with Parkinson disease psychosis: retrospective cohort study" by Friedman et al. Parkinsonism Relat Disord 2019; 68:93-94. [DOI: 10.1016/j.parkreldis.2019.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022]
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Holden SK, Koljack CE, Prizer LP, Sillau SH, Miyasaki JM, Kluger BM. Measuring quality of life in palliative care for Parkinson's disease: A clinimetric comparison. Parkinsonism Relat Disord 2019; 65:172-177. [PMID: 31253494 PMCID: PMC6774894 DOI: 10.1016/j.parkreldis.2019.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Quality of life (QOL) assessments allow for more complete evaluation of patients' lived experiences in relation to chronic conditions, such as Parkinson's disease (PD). In palliative care, such instruments are vital to ensure QOL issues are catalogued and addressed for patients. However, little is known regarding the psychometric properties of quality of life scales for use in palliative care for PD, specifically. METHODS 210 participants with parkinsonian disorders, who participated in a larger palliative intervention clinical trial, completed four quality of life scales (PDQ-39, PROMIS-29, QOL-AD, and McGill QOL) at baseline and post-intervention. Psychometric properties, including internal consistency and concurrent validity, were examined. Factor analyses were performed to evaluate relationships between scale items. Minimal clinically important differences (MCID) and responsiveness were calculated for each scale. RESULTS All scales demonstrated good internal consistency and concurrent validity. Factor analyses revealed few deviations from the defined subdomains of the scales. Mean absolute MCID values were estimated at 12.7, 10.9, 3.9, and 18.9 for PDQ-39, PROMIS-29, QOL-AD, and McGill QOL, respectively. The PDQ-39 and PROMIS-29 demonstrated higher responsiveness to palliative intervention, while the QOL-AD was more responsive in the control group. CONCLUSIONS The PDQ-39, PROMIS-29, QOL-AD, and McGill QOL are all valid for use in PD palliative care, though subdomains of the scales in this population may differ slightly from those initially defined. We recommend the use of PDQ-39 and PROMIS-29 as outcome measures in clinical trials for palliative care in PD, though the QOL-AD may be superior for tracking disease progression.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Claire E Koljack
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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Lum HD, Jordan SR, Brungardt A, Ayele R, Katz M, Miyasaki JM, Hall A, Jones J, Kluger B. Framing advance care planning in Parkinson disease: Patient and care partner perspectives. Neurology 2019; 92:e2571-e2579. [PMID: 31028124 DOI: 10.1212/wnl.0000000000007552] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/25/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Advance care planning (ACP) is a core quality measure in caring for individuals with Parkinson disease (PD) and there are no best practice standards for how to incorporate ACP into PD care. This study describes patient and care partner perspectives on ACP to inform a patient- and care partner-centered framework for clinical care. METHODS This is a qualitative descriptive study of 30 patients with PD and 30 care partners within a multisite, randomized clinical trial of neuropalliative care compared to standard care. Participants were individually interviewed about perspectives on ACP, including prior and current experiences, barriers to ACP, and suggestions for integration into care. Interviews were analyzed using theme analysis to identify key themes. RESULTS Four themes illustrate how patients and care partners perceive ACP as part of clinical care: (1) personal definitions of ACP vary in the context of PD; (2) patient, relationship, and health care system barriers exist to engaging in ACP; (3) care partners play an active role in ACP; (4) a palliative care approach positively influences ACP. Taken together, the themes support clinician initiation of ACP discussions and interdisciplinary approaches to help patients and care partners overcome barriers to ACP. CONCLUSIONS ACP in PD may be influenced by patient and care partner perceptions and misperceptions, symptoms of PD (e.g., apathy, cognitive dysfunction, disease severity), and models of clinical care. Optimal engagement of patients with PD and care partners in ACP should proactively address misperceptions of ACP and utilize clinic teams and workflow routines to incorporate ACP into regular care.
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Affiliation(s)
- Hillary D Lum
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada.
| | - Sarah R Jordan
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Adreanne Brungardt
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Roman Ayele
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Maya Katz
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Janis M Miyasaki
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Anne Hall
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Jacqueline Jones
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
| | - Benzi Kluger
- From the Division of Geriatric Medicine, Department of Medicine (H.D.L., S.R.J., A.B.), College of Nursing (R.A., J.J.), and Department of Neurology (B.K.), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center (H.D.L.); Denver-Seattle Center of Innovation (R.A.), Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Movement Disorders and Neuromodulation Center (M.K.) and Research Stakeholder (A.H.), University of California, San Francisco; and Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada
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LaFaver K, Miyasaki JM, Keran CM, Rheaume C, Gulya L, Levin KH, Jones EC, Schwarz HB, Molano JR, Hessler A, Singhal D, Shanafelt TD, Sloan JA, Novotny PJ, Cascino TL, Busis NA. Age and sex differences in burnout, career satisfaction, and well-being in US neurologists. Neurology 2018; 91:e1928-e1941. [PMID: 30305448 DOI: 10.1212/wnl.0000000000006497] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 08/05/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine age and sex differences in burnout, career satisfaction, and well-being in US neurologists. METHODS Quantitative and qualitative analyses of men's (n = 1,091) and women's (n = 580) responses to a 2016 survey of US neurologists. RESULTS Emotional exhaustion in neurologists initially increased with age, then started to decrease as neurologists got older. Depersonalization decreased as neurologists got older. Fatigue and overall quality of life in neurologists initially worsened with age, then started to improve as neurologists got older. More women (64.6%) than men (57.8%) met burnout criteria on univariate analysis. Women respondents were younger and more likely to work in academic and employed positions. Sex was not an independent predictive factor of burnout, fatigue, or overall quality of life after controlling for age. In both men and women, greater autonomy, meaning in work, reasonable amount of clerical tasks, and having effective support staff were associated with lower burnout risk. More hours worked, more nights on call, higher outpatient volume, and higher percent of time in clinical practice were associated with higher burnout risk. For women, greater number of weekends doing hospital rounds was associated with higher burnout risk. Women neurologists made proportionately more negative comments than men regarding workload, work-life balance, leadership and deterioration of professionalism, and demands of productivity eroding the academic mission. CONCLUSIONS We identified differences in burnout, career satisfaction, and well-being in neurologists by age and sex. This may aid in developing strategies to prevent and mitigate burnout and promote professional fulfillment for different demographic subgroups of neurologists.
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Affiliation(s)
- Kathrin LaFaver
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Janis M Miyasaki
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Christopher M Keran
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Carol Rheaume
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Lisa Gulya
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Kerry H Levin
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Elaine C Jones
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Heidi B Schwarz
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Jennifer R Molano
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Amy Hessler
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Divya Singhal
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Tait D Shanafelt
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Jeff A Sloan
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Paul J Novotny
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Terrence L Cascino
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Neil A Busis
- From the Department of Neurology (K.L.), University of Louisville, KY; Department of Medicine (J.M.M.), University of Alberta, Canada; Member Insights Department (C.M.K., C.R., L.G.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Consulting Neurologist (E.C.J.), Specialists on Call, Bristol, RI; Department of Neurology (H.B.S.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Rehabilitation Medicine (J.R.M.), University of Cincinnati College of Medicine, OH; Department of Neurology (A.H.), University of Kentucky College of Medicine, Lexington; Department of Neurology (D.S.), University of Oklahoma College of Medicine, Oklahoma City; WellMD Center (T.D.S.), Stanford Medicine, CA; Division of Biomedical Statistics and Informatics (J.A.S., P.J.N.) and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA.
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Katz M, Goto Y, Kluger BM, Galifianakis NB, Miyasaki JM, Kutner JS, Jones CA, Pantilat SZ. Top Ten Tips Palliative Care Clinicians Should Know About Parkinson's Disease and Related Disorders. J Palliat Med 2018; 21:1507-1517. [PMID: 30204543 DOI: 10.1089/jpm.2018.0390] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Parkinson's disease (PD) affects 1%-2% of individuals older than 60 years and is the 14th leading cause of death in the United States. People with PD, across all stages of the disease, suffer from a significant symptom burden that includes many nonmotor symptoms (such as depression, fatigue, pain, and dementia), and most will ultimately die from complications of this degenerative and incurable illness. Even at diagnosis, a palliative care (PC) approach can help the patient adjust to his or her diagnosis and maintain an optimal quality of life. We brought together a team of PD and PC experts to assemble practical tips for the care of people with PD. The "Top 10" format emphasizes the most relevant issues to enable PC clinicians to provide optimal care for those suffering with this complex neurodegenerative disease.
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Affiliation(s)
- Maya Katz
- 1 Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Yuika Goto
- 2 Division of Palliative Medicine, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Benzi M Kluger
- 3 Departments of Neurology and Medicine, University of Colorado School of Medicine , Aurora, Colorado
| | - Nicholas B Galifianakis
- 1 Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Janis M Miyasaki
- 4 Department of Neurology, University of Alberta , Edmonton, Alberta, Canada
| | - Jean S Kutner
- 5 Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado
| | - Christopher A Jones
- 6 Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania , Philadelphia
| | - Steve Z Pantilat
- 2 Division of Palliative Medicine, Department of Medicine, University of California , San Francisco, San Francisco, California
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Prizer LP, Gay JL, Wilson MG, Emerson KG, Glass AP, Miyasaki JM, Perkins MM. A Mixed-Methods Approach to Understanding the Palliative Needs of Parkinson’s Patients. J Appl Gerontol 2018; 39:834-845. [DOI: 10.1177/0733464818776794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parkinson’s disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.
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Miyasaki JM, Rheaume C, Gulya L, Ellenstein A, Schwarz H, Vidic T, Shanafelt T, Cascino T, Keran C, Busis N. Author response: Qualitative study of burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2018; 90:903. [DOI: 10.1212/wnl.0000000000005487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
PURPOSE OF REVIEW Parkinson disease often spans decades of a patient's lifetime. Over time, nonmotor symptoms predominate and may limit dopaminergic therapy. Neurologists continue to play a vital role in treatment. In addition to balancing neurobehavioral complications of Parkinson disease with motor benefit, addressing nonmotor symptoms common in the advanced stage may improve quality of life and reduce symptom burden. Symptoms such as dysphagia, constipation, urinary dysfunction, orthostatic hypotension, and pain respond to nonpharmacologic and pharmacologic therapies. RECENT FINDINGS Evidence for treatment of many nonmotor symptoms is weak or lacking. The evidence for treatment of the atypical parkinsonian syndromes (progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration) in advanced stages is even more scant. SUMMARY Engaging palliative care physicians in the joint care of patients can provide patients with access to expertise in end-of-life issues. Neurologic illnesses have specific hospice criteria to guide clinicians for referrals. Evidence supports that assisting patients with advance directives can result in improved satisfaction with care and improved quality of life in the last weeks of life. Neurologists can remain engaged in their patients' care throughout the course of illness.
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Busis NA, Shanafelt TD, Keran CM, Levin KH, Schwarz HB, Molano JR, Vidic TR, Kass JS, Miyasaki JM, Sloan JA, Cascino TL. Author response: Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2017; 89:1650-1651. [DOI: 10.1212/wnl.0000000000004484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Prizer LP, Gay JL, Perkins MM, Wilson MG, Emerson KG, Glass AP, Miyasaki JM. Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients. Palliat Med 2017; 31:861-867. [PMID: 28659011 DOI: 10.1177/0269216317701383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients. AIM To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson's disease patients and their reported referral practices. DESIGN A cross-sectional survey study of neurologists. SETTING/PARTICIPANTS A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology's clinician database. RESULTS Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = -16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral. CONCLUSION Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.
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Affiliation(s)
- Lindsay P Prizer
- 1 Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer L Gay
- 2 Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Molly M Perkins
- 1 Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark G Wilson
- 2 Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Kerstin G Emerson
- 3 The Institute of Gerontology, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Anne P Glass
- 4 School of Health and Applied Human Sciences, The University of North Carolina Wilmington, Wilmington, NC, USA
| | - Janis M Miyasaki
- 5 Movement Disorders Program, University of Alberta, Edmonton, AB, Canada
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Miyasaki JM, Rheaume C, Gulya L, Ellenstein A, Schwarz HB, Vidic TR, Shanafelt TD, Cascino TL, Keran CM, Busis NA. Qualitative study of burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2017; 89:1730-1738. [PMID: 28931640 DOI: 10.1212/wnl.0000000000004526] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To understand the experience and identify drivers and mitigating factors of burnout and well-being among US neurologists. METHODS Inductive data analysis was applied to free text comments (n = 676) from the 2016 American Academy of Neurology survey of burnout, career satisfaction, and well-being. RESULTS Respondents providing comments were significantly more likely to be older, owners/partners of their practice, solo practitioners, and compensated by production than those not commenting. The 4 identified themes were (1) policies and people affecting neurologists (government and insurance mandates, remuneration, recertification, leadership); (2) workload and work-life balance (workload, electronic health record [EHR], work-life balance); (3) engagement, professionalism, work domains specific to neurology; and (4) solutions (systemic and individual), advocacy, other. Neurologists mentioned workload > professional identity > time spent on insurance and government mandates when describing burnout. Neurologists' patient and clerical workload increased work hours or work brought home, resulting in poor work-life balance. EHR and expectations of high patient volumes by administrators impeded quality of patient care. As a result, many neurologists reduced work hours and call provision and considered early retirement. CONCLUSIONS Our results further characterize burnout among US neurologists through respondents' own voices. They clarify the meaning respondents attributed to ambiguous survey questions and highlight the barriers neurologists must overcome to practice their chosen specialty, including multiple regulatory hassles and increased work hours. Erosion of professionalism by external factors was a common issue. Our findings can provide strategic direction for advocacy and programs to prevent and mitigate neurologist burnout and promote well-being and engagement.
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Affiliation(s)
- Janis M Miyasaki
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA.
| | - Carol Rheaume
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Lisa Gulya
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Aviva Ellenstein
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Heidi B Schwarz
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Thomas R Vidic
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Tait D Shanafelt
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Terrence L Cascino
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Chris M Keran
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
| | - Neil A Busis
- From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Departments of Medicine, Hematology and Oncology (T.D.S.) and Neurology (T.L.C.), Mayo Clinic, Rochester, NY; and Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
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Jinnah HA, Albanese A, Bhatia KP, Cardoso F, Da Prat G, de Koning TJ, Espay AJ, Fung V, Garcia-Ruiz PJ, Gershanik O, Jankovic J, Kaji R, Kotschet K, Marras C, Miyasaki JM, Morgante F, Munchau A, Pal PK, Rodriguez Oroz MC, Rodríguez-Violante M, Schöls L, Stamelou M, Tijssen M, Uribe Roca C, de la Cerda A, Gatto EM. Treatable inherited rare movement disorders. Mov Disord 2017; 33:21-35. [PMID: 28861905 DOI: 10.1002/mds.27140] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/19/2022] Open
Abstract
There are many rare movement disorders, and new ones are described every year. Because they are not well recognized, they often go undiagnosed for long periods of time. However, early diagnosis is becoming increasingly important. Rapid advances in our understanding of the biological mechanisms responsible for many rare disorders have enabled the development of specific treatments for some of them. Well-known historical examples include Wilson disease and dopa-responsive dystonia, for which specific and highly effective treatments have life-altering effects. In recent years, similarly specific and effective treatments have been developed for more than 30 rare inherited movement disorders. These treatments include specific medications, dietary changes, avoidance or management of certain triggers, enzyme replacement therapy, and others. This list of treatable rare movement disorders is likely to grow during the next few years because a number of additional promising treatments are actively being developed or evaluated in clinical trials. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Alberto Albanese
- Department of Neurology, Humanitas Research Hospital, Rozzano, Italy.,Catholic University, Milan, Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Francisco Cardoso
- Department of Internal Medicine, Movement Disorders Clinic, Neurology Service, UFMG, Belo Horizonte, MG, Brazil
| | - Gustavo Da Prat
- Department of Neurology, Affiliated University of Buenos Aires, Buenos Aires, Argentina.,University DelSalvadore, Buenos Aires, Argentina
| | - Tom J de Koning
- Department of Genetics, Pediatrics and Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement Disorders, University of Cincinnati, Ohio, USA
| | - Victor Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Oscar Gershanik
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Ryuji Kaji
- Department of Neurology, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Katya Kotschet
- Clinical Neurosciences, St. Vincent's Health, Melbourne, Australia
| | - Connie Marras
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | | | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alexander Munchau
- Department of Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuroscience, Bangalore, India
| | - Maria C Rodriguez Oroz
- University Hospital Donostia, Madrid, Spain.,BioDonostia Research Institute, Basque Center on Cognition, Brain and Language, San Sebastian, Madrid, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | | | - Ludger Schöls
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tubingen, Tubingen, Germany.,German Center for Neurodegenerative Diseases, Tubingen, Germany
| | - Maria Stamelou
- Neurology Clinic, Philipps University Marburg, Marburg, Germany.,Parkinson's Disease and Other Movement Disorders Department, HYGEIA Hospital, Athens, Greece
| | - Marina Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Claudia Uribe Roca
- Department of Neurology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | - Emilia M Gatto
- Department of Neurology, Affiliated University of Buenos Aires and University DelSalvadore, Buenos Aires, Argentina
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Abstract
Neurological services and resources are scarce in low-income and developing countries, such as the Philippines. We looked into the treatment gaps in Parkinson’s disease (PD) care in the Philippines in the following areas: epidemiology, healthcare, financial coverage, pharmacotherapy, surgical treatment and manpower. We collected relevant data on the above-mentioned areas. There is no available Philippine data on PD prevalence. Philippine healthcare is paid through user fees at the point of service. The average consultation fee in Manila ranges from US$10.57–31.74. The average minimum daily wage is US$9.39–10.17. Philippine healthcare is devolved to the local government units. Deep brain stimulation surgery is only available in Manila. Most PD medications are available in the Philippines. There are only nine movement disorder specialists for a population of 100.98 million. Gaps and challenges in PD care in the Philippines still exist.
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Affiliation(s)
- Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine – Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Movement Disorder Service & Section of Neurology, Institute for Neurosciences, St Luke’s Medical Center – Quezon City & Global City, Philippines
| | - Janis M Miyasaki
- Movement Disorders Program, University of Alberta, Edmonton, Alberta, Canada
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Abu Snineh M, Camicioli R, Miyasaki JM. Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns. Parkinsonism Relat Disord 2017; 39:77-79. [DOI: 10.1016/j.parkreldis.2017.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/23/2017] [Accepted: 03/07/2017] [Indexed: 01/15/2023]
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Busis NA, Shanafelt TD, Keran CM, Levin KH, Schwarz HB, Molano JR, Vidic TR, Kass JS, Miyasaki JM, Sloan JA, Cascino TL. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2017; 88:797-808. [PMID: 28122905 DOI: 10.1212/wnl.0000000000003640] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists. METHODS A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March 21, 2016. RESULTS Response rate was 40.5% (1,671 of 4,127). Average age of participants was 51 years, with 65.3% male and nearly equal representation across US geographic regions. Approximately 60% of respondents had at least one symptom of burnout. Hours worked/week, nights on call/week, number of outpatients seen/week, and amount of clerical work were associated with greater burnout risk. Effective support staff, job autonomy, meaningful work, age, and subspecializing in epilepsy were associated with lower risk. Academic practice (AP) neurologists had a lower burnout rate and higher rates of career satisfaction and quality of life than clinical practice (CP) neurologists. Some factors contributing to burnout were shared between AP and CP, but some risks were unique to practice setting. Factors independently associated with profession satisfaction included meaningfulness of work, job autonomy, effectiveness of support staff, age, practicing sleep medicine (inverse relationship), and percent time in clinical practice (inverse relationship). Burnout was strongly associated with decreased career satisfaction. CONCLUSIONS Burnout is common in all neurology practice settings and subspecialties. The largest driver of career satisfaction is the meaning neurologists find in their work. The results from this survey will inform approaches needed to reduce burnout and promote career satisfaction and well-being in US neurologists.
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Affiliation(s)
- Neil A Busis
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada.
| | - Tait D Shanafelt
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Christopher M Keran
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Kerry H Levin
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Heidi B Schwarz
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Jennifer R Molano
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Thomas R Vidic
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Joseph S Kass
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Janis M Miyasaki
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Jeff A Sloan
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
| | - Terrence L Cascino
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; Division of Hematology (T.D.S.), Division of Biomedical Statistics and Informatics (J.A.S.), and Department of Neurology (T.L.C.), Mayo Clinic, Rochester, MN; Member Insights Department (C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (K.H.L.), Cleveland Clinic, OH; Department of Neurology (H.B.S.), University of Rochester Medical Center, NY; Department of Neurology and Rehabilitation (J.R.M.), University of Cincinnati, OH; Department of Neurology (T.R.V.), Elkhart Clinic, IN; Department of Neurology (J.S.K.), Baylor College of Medicine, Houston, TX; and Alberta Health Services Medicine (J.M.M.), University of Alberta, Canada
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Planetta PJ, Miyasaki JM. New insights into the neural basis of functional movement disorders. Neurology 2016; 87:554-5. [DOI: 10.1212/wnl.0000000000002957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hassan A, Wu SS, Schmidt P, Simuni T, Giladi N, Miyasaki JM, Bloem BR, Malaty IA, Okun MS. The Profile of Long-term Parkinson's Disease Survivors with 20 Years of Disease Duration and Beyond. J Parkinsons Dis 2016; 5:313-9. [PMID: 25720446 DOI: 10.3233/jpd-140515] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinson's disease (PD) patients with 20 years or more survival (PD-20) are not well characterized. OBJECTIVE To evaluate PD-20 patient characteristics and identify areas for improvement of their health care. METHODS The international, multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII) study database was queried to identify PD-20 subjects. Demographic and clinical data were analyzed. RESULTS We identified 187 PD-20 subjects (55% men) representing 4% (187/4,619) of all NPF-QII participants. Subjects were mean age 69.5 years; mean age at PD onset was 44.0 years. The majority (75% ) had 20-25 years of PD duration, the longest duration being 49 years. They were median Hoehn and Yahr stage 3, and 75% had motor fluctuations. Half (54% ) reported exercising. The majority (89% ) were living at home and required a caregiver (88% ). They were mildly cognitively impaired for age (Montreal Cognitive Assessment estimate 22.6±3.7), with most deficits in verbal fluency and delayed recall. Quality of life (Parkinson's Disease Quality of Life Questionnaire index 36±15% ) was mild to moderately impaired, with most impairment in mobility and activities of daily living. Caregiver strain measured by the Multidimensional Caregiver Strain Index (27±16% ), recorded highest subscores in social constraint. PD-20 subjects aged <70 years versus ≥70 only differed significantly by worse cognition (P < 0.0001). CONCLUSIONS PD-20 subjects reflect an elite group of PD survivors with early-onset disease and relatively mild cognitive disability despite long disease duration. Interventions for caregivers, mobility, and activities of daily living are areas that could improve caregiver burden and patient quality of life.
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Affiliation(s)
- Anhar Hassan
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel S Wu
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Peter Schmidt
- National Parkinson's Foundation, Miami, Florida, USA
| | - Tanya Simuni
- Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Janis M Miyasaki
- The Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bastiaan R Bloem
- Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands
| | - Irene A Malaty
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA
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Factor SA, Bennett A, Hohler AD, Wang D, Miyasaki JM. Quality improvement in neurology: Parkinson disease update quality measurement set: Executive summary. Neurology 2016; 86:2278-83. [PMID: 27170564 DOI: 10.1212/wnl.0000000000002670] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/14/2016] [Indexed: 01/29/2023] Open
Affiliation(s)
- Stewart A Factor
- From the Department of Neurology (S.A.F.), Emory University School of Medicine, Atlanta, GA; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neurology (A.D.H.), Boston University School of Medicine, MA; OSF/Illinois Neurological Institute and University of Illinois College of Medicine at Peoria (D.W.), IL; and University of Alberta (J.M.M.), Edmonton, Canada
| | - Amy Bennett
- From the Department of Neurology (S.A.F.), Emory University School of Medicine, Atlanta, GA; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neurology (A.D.H.), Boston University School of Medicine, MA; OSF/Illinois Neurological Institute and University of Illinois College of Medicine at Peoria (D.W.), IL; and University of Alberta (J.M.M.), Edmonton, Canada
| | - Anna D Hohler
- From the Department of Neurology (S.A.F.), Emory University School of Medicine, Atlanta, GA; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neurology (A.D.H.), Boston University School of Medicine, MA; OSF/Illinois Neurological Institute and University of Illinois College of Medicine at Peoria (D.W.), IL; and University of Alberta (J.M.M.), Edmonton, Canada
| | - David Wang
- From the Department of Neurology (S.A.F.), Emory University School of Medicine, Atlanta, GA; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neurology (A.D.H.), Boston University School of Medicine, MA; OSF/Illinois Neurological Institute and University of Illinois College of Medicine at Peoria (D.W.), IL; and University of Alberta (J.M.M.), Edmonton, Canada
| | - Janis M Miyasaki
- From the Department of Neurology (S.A.F.), Emory University School of Medicine, Atlanta, GA; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neurology (A.D.H.), Boston University School of Medicine, MA; OSF/Illinois Neurological Institute and University of Illinois College of Medicine at Peoria (D.W.), IL; and University of Alberta (J.M.M.), Edmonton, Canada
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Beal MF, Oakes D, Shoulson I, Henchcliffe C, Galpern WR, Haas R, Juncos JL, Nutt JG, Voss TS, Ravina B, Shults CM, Helles K, Snively V, Lew MF, Griebner B, Watts A, Gao S, Pourcher E, Bond L, Kompoliti K, Agarwal P, Sia C, Jog M, Cole L, Sultana M, Kurlan R, Richard I, Deeley C, Waters CH, Figueroa A, Arkun A, Brodsky M, Ondo WG, Hunter CB, Jimenez-Shahed J, Palao A, Miyasaki JM, So J, Tetrud J, Reys L, Smith K, Singer C, Blenke A, Russell DS, Cotto C, Friedman JH, Lannon M, Zhang L, Drasby E, Kumar R, Subramanian T, Ford DS, Grimes DA, Cote D, Conway J, Siderowf AD, Evatt ML, Sommerfeld B, Lieberman AN, Okun MS, Rodriguez RL, Merritt S, Swartz CL, Martin WRW, King P, Stover N, Guthrie S, Watts RL, Ahmed A, Fernandez HH, Winters A, Mari Z, Dawson TM, Dunlop B, Feigin AS, Shannon B, Nirenberg MJ, Ogg M, Ellias SA, Thomas CA, Frei K, Bodis-Wollner I, Glazman S, Mayer T, Hauser RA, Pahwa R, Langhammer A, Ranawaya R, Derwent L, Sethi KD, Farrow B, Prakash R, Litvan I, Robinson A, Sahay A, Gartner M, Hinson VK, Markind S, Pelikan M, Perlmutter JS, Hartlein J, Molho E, Evans S, Adler CH, Duffy A, Lind M, Elmer L, Davis K, Spears J, Wilson S, Leehey MA, Hermanowicz N, Niswonger S, Shill HA, Obradov S, Rajput A, Cowper M, Lessig S, Song D, Fontaine D, Zadikoff C, Williams K, Blindauer KA, Bergholte J, Propsom CS, Stacy MA, Field J, Mihaila D, Chilton M, Uc EY, Sieren J, Simon DK, Kraics L, Silver A, Boyd JT, Hamill RW, Ingvoldstad C, Young J, Thomas K, Kostyk SK, Wojcieszek J, Pfeiffer RF, Panisset M, Beland M, Reich SG, Cines M, Zappala N, Rivest J, Zweig R, Lumina LP, Hilliard CL, Grill S, Kellermann M, Tuite P, Rolandelli S, Kang UJ, Young J, Rao J, Cook MM, Severt L, Boyar K. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol 2014; 71:543-52. [PMID: 24664227 DOI: 10.1001/jamaneurol.2014.131] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit. OBJECTIVE To examine whether CoQ10 could slow disease progression in early PD. DESIGN, SETTING, AND PARTICIPANTS A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation. INTERVENTIONS The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E. MAIN OUTCOMES AND MEASURES Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo. RESULTS The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo). CONCLUSIONS AND RELEVANCE Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00740714.
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Affiliation(s)
| | - M Flint Beal
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | - David Oakes
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Ira Shoulson
- Department of Neurology, Georgetown University, Washington, DC
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | | | - Richard Haas
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Jorge L Juncos
- Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland
| | | | | | - Clifford M Shults
- Department of Neurosciences, University of California, San Diego, La Jolla10VA Medical Center, San Diego, California
| | - Karen Helles
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Victoria Snively
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Mark F Lew
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Brian Griebner
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Arthur Watts
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York12Department of Neurology, University of Rochester, Rochester, New York
| | - Shan Gao
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Emmanuelle Pourcher
- Québec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Canada
| | - Louisette Bond
- Québec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Canada
| | | | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington
| | - Cherissa Sia
- Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington
| | - Mandar Jog
- London Health Sciences Centre, London, Ontario, Canada
| | - Linda Cole
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Roger Kurlan
- Overlook Medical Center, Atlantic Neuroscience Institute, Summit, New Jersey
| | - Irene Richard
- Department of Neurology, University of Rochester, Rochester, New York
| | - Cheryl Deeley
- Department of Neurology, University of Rochester, Rochester, New York
| | - Cheryl H Waters
- Columbia University Medical Center, Neurological Institute, New York, New York
| | - Angel Figueroa
- Columbia University Medical Center, Neurological Institute, New York, New York
| | - Ani Arkun
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | - Matthew Brodsky
- Department of Neurology, Oregon Health and Science University, Portland
| | - William G Ondo
- Department of Neurology, University of Texas Health Science Center at Houston
| | | | | | - Alicia Palao
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Janis M Miyasaki
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Julie So
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James Tetrud
- The Parkinson's Institute and Clinical Center, Sunnyvale, California
| | - Liza Reys
- The Parkinson's Institute and Clinical Center, Sunnyvale, California
| | - Katharine Smith
- The Parkinson's Institute and Clinical Center, Sunnyvale, California
| | - Carlos Singer
- Department of Neurology, University of Miami School of Medicine, Miami, Florida
| | - Anita Blenke
- Department of Neurology, University of Miami School of Medicine, Miami, Florida
| | - David S Russell
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Candace Cotto
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Joseph H Friedman
- Department of Neurology, Butler Hospital, Providence, Rhode Island26Alpert Medical School, Brown University, Providence, Rhode Island
| | - Margaret Lannon
- Department of Neurology, Butler Hospital, Providence, Rhode Island27Port City Neurology, Inc, Scarborough, Maine
| | - Lin Zhang
- Department of Neurology, University of California, Davis, School of Medicine and Sacramento VA Medical Center, Sacramento
| | | | | | - Thyagarajan Subramanian
- Milton S. Hershey Medical Center, Department of Neurology, Pennsylvania State Hershey College of Medicine, Hershey
| | - Donna Stuppy Ford
- Milton S. Hershey Medical Center, Department of Neurology, Pennsylvania State Hershey College of Medicine, Hershey
| | | | - Diane Cote
- Ottawa Hospital Civic Site, Ottawa, Ontario, Canada
| | | | | | - Marian Leslie Evatt
- Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia33Atlanta VA Medical Center, Atlanta, Georgia
| | - Barbara Sommerfeld
- Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia
| | - Abraham N Lieberman
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael S Okun
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - Ramon L Rodriguez
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - Stacy Merritt
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - Camille Louise Swartz
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - W R Wayne Martin
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela King
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Ray L Watts
- Department of Neurology, University of Alabama at Birmingham
| | - Anwar Ahmed
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - Hubert H Fernandez
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - Adrienna Winters
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Ted M Dawson
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Becky Dunlop
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Andrew S Feigin
- Feinstein Institute for Medical Research, Center for Neurosciences, Manhasset, New York
| | - Barbara Shannon
- Feinstein Institute for Medical Research, Center for Neurosciences, Manhasset, New York
| | | | - Mattson Ogg
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | - Samuel A Ellias
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Cathi-Ann Thomas
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Karen Frei
- The Parkinson's and Movement Disorder Institute, Fountain Valley, California
| | - Ivan Bodis-Wollner
- State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Sofya Glazman
- State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Thomas Mayer
- State University of New York, Downstate Medical Center, Brooklyn, New York
| | | | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - April Langhammer
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Ranjit Ranawaya
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorelei Derwent
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Kapil D Sethi
- Department of Neurology, Georgia Health Science University, Augusta
| | - Buff Farrow
- Department of Neurology, Georgia Health Science University, Augusta
| | - Rajan Prakash
- Department of Neurology, Georgia Health Science University, Augusta
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla
| | | | - Alok Sahay
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maureen Gartner
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vanessa K Hinson
- Department of Neurology, Medical University of South Carolina, Charleston
| | | | | | - Joel S Perlmutter
- Department of Neurology, Washington University in St Louis, Missouri
| | - Johanna Hartlein
- Department of Neurology, Washington University in St Louis, Missouri
| | - Eric Molho
- Movement Disorders Center, Albany Medical Center, Albany, New York
| | - Sharon Evans
- Movement Disorders Center, Albany Medical Center, Albany, New York
| | - Charles H Adler
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Amy Duffy
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Marlene Lind
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Lawrence Elmer
- Center for Neurological Health, University of Toledo, Toledo, Ohio
| | - Kathy Davis
- Department of Neurology, Medical University of Ohio at Toledo
| | - Julia Spears
- Department of Neurology, Medical University of Ohio at Toledo
| | | | - Maureen A Leehey
- Department of Neurology, University of Colorado Health Science Center, Denver
| | - Neal Hermanowicz
- Department of Neurology, University of California, Irvine Medical Center, Irvine
| | - Shari Niswonger
- Department of Neurology, University of California, Irvine Medical Center, Irvine
| | - Holly A Shill
- Banner Sun Health Research Institute, Sun City, Arizona
| | - Sanja Obradov
- Banner Sun Health Research Institute, Sun City, Arizona
| | - Alex Rajput
- Department of Neurology, University of Saskatchewan, Royal University Hospital, Saskatchewan, Canada
| | - Marilyn Cowper
- Department of Neurology, University of Saskatchewan, Royal University Hospital, Saskatchewan, Canada
| | - Stephanie Lessig
- Department of Neurology, University of California, San Diego, La Jolla
| | - David Song
- Department of Neurology, University of California, San Diego, La Jolla
| | - Deborah Fontaine
- Department of Neurology, University of California, San Diego, La Jolla
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen Williams
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jo Bergholte
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | | | - Mark A Stacy
- Department of Neurology, Duke University, Durham, North Carolina
| | - Joanne Field
- Department of Neurology, Duke University, Durham, North Carolina
| | - Dragos Mihaila
- State University of New York Upstate Medical Center and Syracuse VA Medical Center, Syracuse
| | - Mark Chilton
- State University of New York Upstate Medical Center and Syracuse VA Medical Center, Syracuse
| | - Ergun Y Uc
- Department of Neurology, University of Iowa, Iowa City
| | - Jeri Sieren
- Department of Neurology, University of Iowa, Iowa City
| | - David K Simon
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Lauren Kraics
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Althea Silver
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James T Boyd
- Department of Neurology, University of Vermont College of Medicine, Burlington
| | - Robert W Hamill
- Department of Neurology, University of Vermont College of Medicine, Burlington
| | | | - Jennifer Young
- Department of Neurology, University of Vermont College of Medicine, Burlington
| | - Karen Thomas
- Department of Neurology, Ohio State University, Columbus
| | | | - Joanne Wojcieszek
- Department of Neurology, Indiana University School of Medicine, Indianapolis
| | - Ronald F Pfeiffer
- Department of Neurology, University of Tennessee Health Science Center, Memphis
| | - Michel Panisset
- Department of Neurology, CHUM-Hôpital Notre-Dame, Montréal, Québec, Canada
| | - Monica Beland
- Department of Neurology, CHUM-Hôpital Notre-Dame, Montréal, Québec, Canada
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Science, Baltimore
| | - Michelle Cines
- Department of Neurology, University of Maryland School of Science, Baltimore
| | - Nancy Zappala
- Department of Neurology, University of Maryland School of Science, Baltimore
| | - Jean Rivest
- Department of Neurology, University of Sherbrooke, Québec, Canada
| | - Richard Zweig
- Department of Neurology, Louisiana State University Health Science Center, Shreveport
| | - L Pepper Lumina
- Department of Neurology, Louisiana State University Health Science Center, Shreveport
| | | | - Stephen Grill
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | | | - Paul Tuite
- Department of Neurology, University of Minnesota, Minneapolis
| | | | - Un Jung Kang
- Department of Neurology, University of Chicago, Chicago, Illinois
| | - Joan Young
- Department of Neurology, University of Chicago, Chicago, Illinois
| | - Jayaraman Rao
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Maureen M Cook
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Lawrence Severt
- Department of Neurology, Beth Israel Medical Center, New York, New York
| | - Karyn Boyar
- Department of Neurology, Beth Israel Medical Center, New York, New York
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Abstract
PURPOSE OF REVIEW This review discusses movement disorders that occur during pregnancy, the treatment of preexisting movement disorders, and the influence the pregnant state has on movement disorders symptoms, in order to guide clinicians in providing better counseling for female patients who are pregnant or considering pregnancy. RECENT FINDINGS Unique considerations for movement disorders during pregnancy include investigations and their safety during pregnancy and the impact of treatment on both the pregnant patient and her fetus. SUMMARY The most common movement disorders arising in pregnancy are restless leg syndrome and chorea gravidarum. Preexisting movement disorders in women who become pregnant may also be seen.
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Miyasaki JM, Long J, Mancini D, Moro E, Fox S, Lang A, Marras C, Chen R, Strafella A, Arshinoff R, Ghoche R, Hui J. Palliative care for advanced Parkinson disease: An interdisciplinary clinic and new scale, the ESAS-PD. Parkinsonism Relat Disord 2012; 18 Suppl 3:S6-9. [DOI: 10.1016/j.parkreldis.2012.06.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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