A pinboard by
Nader Abu Farha

MD ( Medical Doctor ) Student, An Najah National University & An Najah National University Teaching Hospital


To identify factors that are associated with poor health-related quality of life in PD patients

Introduction : Parkinson’s disease (PD) is the most common chronic neurodegenerative disorder, it’s a complex disease affecting both motor and non-motor systems in the brain. PD is characterized by motor symptoms including resting tremor, rigidity, bradykinesia and postural instability. However, less is known about non-motor symptoms (NMS), which are very common and often go under recognized and unreported by both patients and clinicians. NMS are comprised of a large range of symptoms : bad sleep quality, fatigue, depression, neuropsychiatric, autonomic, GI and other symptoms. As the disease progresses, the effectiveness of the medication regimen often decreases, daily functioning and social participation become increasingly compromised. NMS are increasingly prevalent over the course of the disease and have become important determinants of patients’ quality of life with PD progression, thus PD has a great impact on the quality of life of the patients.

Objectives : To identify the clinical and demographic factors that are associated with poor health-related quality of life (HRQOL) in patients with PD and how to deal with these factors to improve HRQOL in PD patients.

Methods : A detailed search for researches and studies reporting HRQOL in Parkinson’s disease patients was performed using “PubMed”, and included all the available and updated literature. Manual search for books, documents and manuscripts was also conducted on references of papers reporting reviews.

Results : Non-motor symptoms (NMS) are important features of PD and have become the leading cause of poor HRQOL with disease progression. Depressive symptoms, sleep disorders and increased physical disability were significantly related to lower HRQOL among PD patients.

Conclusion : This study identifies a number of significant associated factors that should be considered when dealing with Parkinson’s disease patients. PD patients with depression, sleep disorders and physical disability reported poor HRQOL.


Pharmacotherapy and generic health‐related quality of life in Parkinson's disease

Abstract: Improvement of health‐related quality of life (HRQoL) is one of the primary objectives of symptomatic therapies in Parkinson's disease (PD). The aim of this observational study was to investigate possible changes in generic HRQoL in relation to changed PD pharmacotherapy in the clinical setting.A total of 219 outpatients with mild to moderate PD (median H&Y score = 2.0), treated with oral antiparkinsonian medications, were investigated twice with a 6‐month interval. At baseline, PD medication dose was increased for 82 patients for clinical reasons (median increase of 100 mg levodopa equivalent daily dose or 31.9%), whereas medication remained unchanged for 137 patients. Two generic HRQoL questionnaires, EQ‐5D and 15D, were used at baseline and at 6 months, and the baseline and delta HRQoL values were compared between the treatment groups.In the entire sample, the EQ‐VAS score decreased during the study period, indicating a general decline in HRQoL (P = 0.04). There were no differences in the baseline HRQoL values or delta values between the treatment groups as measured with EQ‐5D or 15D (levodopa dose elevated vs dopamine agonist/MAO‐B inhibitor dose elevated vs no change in medication).An approximately 1/3 increase in antiparkinsonian medication dose did not have an impact on generic HRQoL. Disease‐specific QoL may be more sensitive to pharmacotherapy‐related changes in PD.

Pub.: 10 Nov '15, Pinned: 31 Jul '17

Clinical phenotype of drug-naïve Parkinson's disease based on nonmotor symptoms.

Abstract: Nonmotor symptoms in Parkinson's disease (PD) are heterogeneous and can result in a variety of symptoms at various disease stages. The objective of the present study was to identify clinically meaningful nonmotor symptoms and to assess the relationship between changes in nonmotor symptoms and cognition and motor symptoms.A total of 159 patients who had drug-naïve PD participated in this study. Nonmotor symptoms (Nonmotor Symptoms Scale), PD status (Unified Parkinson's Disease Rating Scale), depression (Geriatric Depression Scale or Montgomery-Asberg Depression Scale) and health-related quality of life (39-item Parkinson's Disease Questionnaire) were assessed. An exploratory factor analysis was performed to establish a nonmotor symptom factor, which was analyzed to evaluate whether the results were associated with the clinical severity measures.Exploratory factor analysis revealed one factor comprised of sleep/fatigue, attention/memory and mood/cognition. The modified Hoehn and Yahr Stage, Unified Parkinson's Disease Rating Scale Part III, Montgomery-Asberg Depression Scale and the 39-item Parkinson's Disease Questionnaire Summary Index were independently associated with the sleep/fatigue, attention/memory and mood/cognition domains. The presence of these domains was associated with advanced Parkinson's disease or depressed mood.This study shows that motor impairment and depressed mood in PD are related to sleep/fatigue, attention/memory and mood/cognition. Sleep/fatigue, attention/memory and mood/cognition also had a major impact on health-related quality of life. It is appropriate to identify patients with severe motor symptoms and depressed mood in order to signify the need to consider more detailed care and further assessment.

Pub.: 18 Jul '15, Pinned: 30 Jul '17

Relationship between the MDS-UPDRS domains and the health-related quality of life of Parkinson's disease patients.

Abstract: The Movement Disorder Society sponsored version of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a comprehensive instrument for assessing Parkinson's disease (PD). The present study was aimed at determining the relationships between MDS-UPDRS components and health-related quality of life (HRQoL) evaluations in PD patients.An international, multicenter, cross-sectional study was carried out of 435 PD patients assessed with the MDS-UPDRS, Hoehn and Yahr (HY), Clinical Impression Severity for PD, EQ-5D and PD Questionnaire - eight items (PDQ-8). Spearman's rank correlation coefficients, exploratory factor analysis and multiple linear regression models (dependent variables EQ-5D and PDQ-8) were performed.The participants' age was 66.71 ± 10.32 years (51.5% men). PD duration was 8.52 ± 6.14, and median HY was 2 (range 1-5). The correlation between the EQ-5D index and the MDS-UPDRS ranged from -0.46 (Part IV) to -0.72 (Part II) and for the PDQ-8 index from 0.47 (Part III) to 0.74 (Part II). In multiple regression models with the MDS-UPDRS domains as independent variables, the main determinant for both the EQ-5D index and the PDQ-8 was Part II followed by Part I. After factorial grouping of the cardinal PD manifestations embedded in the MDS-UPDRS Parts III and IV for inclusion into multiple regression models, a factor formed by M-EDL, nM-EDL and fluctuations was the main determinant for both the EQ-5D and PDQ-8 indexes.The MDS-UPDRS component most tightly related with the HRQoL measures was a combination of motor and non-motor experiences of daily living.

Pub.: 23 Jan '14, Pinned: 30 Jul '17

The impact of non-motor symptoms on the Health-Related Quality of Life of Parkinson's disease patients from Southwest China.

Abstract: The impact of non-motor symptoms (NMS) on the Health-Related Quality of Life (HRQoL) of patients with Parkinson's disease (PD) in the Chinese population are largely unknown.To study the impact of NMS on the HRQoL in Chinese PD patients.A total of 693 PD patients from Southwest China were included in the study. NMS of patients were evaluated by non-motor symptoms scale (NMSS) and Parkinson's disease questionnaire-39 item version (PDQ-39) was used to evaluate the HRQoL of PD.The mean total score of NMSS was 37.2 ± 33.0 and the most prevalent NMS domain was sleep/fatigue (79.8%). There was a significant strong positive correlation between total NMSS score (rs = 0.71, P < 0.01), sleep/fatigue domain (rs = 0.60, P < 0.01) and PDQ-39 SI. Mood/apathy (rs = 0.55, P < 0.01), attention/memory (rs = 0.42, P < 0.01), gastrointestinal (rs = 0.44, P < 0.01) and Miscellany domains (rs = 0.46, P < 0.01) moderately correlated with PDQ-39 SI. A strong correlation was found between PDQ-39 SI (rs = 0.71, P < 0.01), emotional well-being (rs = 0.62, P < 0.01), cognitions (rs = 0.62, P < 0.01), and the total score of NMSS. Moderate correlation was found between mobility (rs = 0.45, P < 0.01), activities of daily living (rs = 0.43, P < 0.01), stigma (rs = 0.42, P < 0.01), communication (rs = 0.47, P < 0.01), bodily discomfort (rs = 0.46, P < 0.01) and the total score of NMSS. Female, H-Y stage, UPDRS-III and NMSS total score were the potential determinants of worse HRQoL of PD patients.NMS have close association with various aspects of the HRQoL. Severe NMS may be related to dramatic decline of the HRQoL of PD patients.

Pub.: 29 Oct '13, Pinned: 30 Jul '17

Personality affects aspects of health-related quality of life in Parkinson's disease via psychological coping strategies.

Abstract: Personality traits influence health-related quality of life (HRQoL) in Parkinson's disease (PD). Further, an individual's personality traits can influence the strategies they use to cope with a particular stressful situation. However, in PD, the interplay between personality traits, choice of coping strategy, and their subsequent effect on HRQoL remains unclear.The objective of this study was to examine whether personality (neuroticism and extraversion) indirectly affects HRQoL through the use of specific psychological coping strategies.One hundred and forty-six patients with PD completed questionnaires on personality (Big Five Aspects Scale; BFAS), coping (Ways of Coping Questionnaire; WCQ), and mood-specific (Depression, Anxiety and Stress Scale; DASS-21) and disease-specific HRQoL (Parkinson's Disease Questionnaire; PDQ-39).After controlling for gender, age at diagnosis, and age at testing, the emotion-focused coping strategy of escape-avoidance was significantly correlated with neuroticism and certain aspects of HRQoL (cognitive impairment and social support). This suggests that neurotic personality traits may negatively impact on some aspects of HRQoL due to an increased use of escape-avoidance coping strategies. By contrast, planned problem-solving and escape-avoidance coping strategies were both significantly linked to extraversion and interpersonal and mood-related domains of HRQoL. This suggests that extraversion may positively impact on some aspects of HRQoL due to patients adopting greater planned, problem-solving coping strategies, and using fewer escape-avoidance coping mechanisms.Psychological interventions aimed at targeting maladaptive coping strategies, such as the use of escape-avoidance coping, may be effective in minimising the negative impact of neuroticism on HRQoL in PD.

Pub.: 14 Aug '13, Pinned: 30 Jul '17

Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson's disease.

Abstract: The relative impact of motor- and non-motor symptoms on health-related quality of life in early Parkinson's disease is poorly documented.188 patients with incident Parkinson's disease from a population-based study were examined at the time of diagnosis, before initiation of dopaminergic treatment, with follow-up of 166 patients three years later. Health-related quality of life was assessed by the 36-item Short-form Health Survey (SF-36). Motor and non-motor variables were derived from the Unified Parkinson's disease rating scale and other established scales.Multiple regression analyses showed that the non-motor symptoms strongest associated with reduced SF-36 scores at diagnosis and three years later were depression, fatigue and sensory complaints. The motor symptoms most related to impaired SF-36 scores were problems with gait and activities of daily living that cover personal needs. The variance of SF-36 mental summary scores was much better explained by non-motor vs. motor symptoms, both at baseline (R(2) = 0.384 vs. 0.095) and 3 years later (R(2) = 0.441 vs. 0.195). Also SF-36 physical summary scores were better explained by non-motor vs. motor symptoms with R(2) = 0.372 vs. 0.322 at baseline and R(2) = 0.468 vs. 0.315 after 3 years.In early PD, including the phase before dopaminergic treatment is initiated, non-motor symptoms are more important for reduced health-related quality of life than motor symptoms. Fatigue, depression, sensory complaints and gait disturbances emerge as the most relevant symptoms and should be given corresponding attention in the management of patients with early PD.

Pub.: 07 Aug '13, Pinned: 30 Jul '17

Self-rated health mediates the association between functional status and health-related quality of life in Parkinson's disease.

Abstract: To explore whether self-rated health acts as a potential mediator in the association between functional status and health-related quality of life in Parkinson's disease.Older persons (as most patients with Parkinson's disease are) who reported poor self-rated health compared with those with excellent self-rated health were two-and-a-half times more likely to have experienced a decline in functional ability.Cross-sectional.Socio-demographic and clinical data of the patients (n = 176) were obtained during a structured interview and from medical records. Functional status was measured with the Unified Parkinson's Disease Rating Scale (total score), self-rated health with the first item of the Short-Form 36-item Health Survey Questionnaire and health-related quality of life with the disease-specific questionnaire called the Parkinson's Disease Quality of Life Questionnaire-39. Multiple linear regression analyses and the Sobel test were employed to assess mediation.Self-rated health seems to have a mediating effect on the association between functional status and health-related quality of life. The Sobel test confirmed an indirect effect of functional status via self-rated health on health-related quality of life and showed a statistically significant indirect effect of functional status on health-related quality of life via self-rated health against the direct route without the mediator.Self-rated health partially mediates the deteriorating effect of functional status on health-related quality of life.Supportive and adaptation psychosocial intervention programmes leading to restored self-rated health may enhance the quality of life regardless of disability in Parkinson's disease.

Pub.: 21 Dec '13, Pinned: 30 Jul '17

The Key Determinants to Quality of Life in Parkinson's Disease Patients: Results from the Parkinson's Disease Biomarker Program (PDBP).

Abstract: The impact of motor- and non-motor symptoms on health-related quality of life (HRQOL) in Parkinson's disease (PD) has received increasing attention.To address this, the study explored a large cohort of patients enrolled in the PD Biomarker Program.The PD Questionnaire-39 (PDQ-39) measured HRQOL, whereas the Unified PD Rating Scale (UPDRS) assessed motor and non-motor symptoms. Determinants of HRQOL in PD patients were identified by stepwise linear regression analysis. The relationship between the PDQ-39 and UPDRS subscale scores then was explored through structural equation modeling.The mean disease duration was 6.8 years and the mean PDQ-39 summary index (PDQ-39SI) was 18.4. UPDRS-I (non-motor function) and UPDRS-II (motor questionnaire) scores demonstrated the strongest correlations with PDQ-39SI (r Ϡ 0.4, P < 0.05), whereas UPDRS-III (motor exam) and UPDRS-IV (motor complications) scores were correlated moderately with PDQ-39SI (0.3 < r < 0.4, P < 0.05). Multiple linear stepwise regression analyses showed that age (β= -0.13, P < 0.001), education (β= -0.07, P = 0.008), UPDRS-I (β= 0.32, P = 0.000), and UPDRS-II (β= 0.44, P < 0.001) significantly contributed to HRQOL, and cumulatively accounted for 69.1% of the PDQ-39SI variance. UPDRS-II score was the primary predictor of PDQ-39SI, accounting for 57.3% of the variance, whereas UPDRS-I score accounted for 7.5%. UPDRS-III and -IV and other factors measured did not survive step regression. Structural equation modeling confirmed the association of UPDRS-II (β= 0.67, P < 0.001) and UPDRS-I (β= 0.35, P < 0.001) with the PDQ-39SI.Both motor and non-motor function scores impacted significantly HRQOL in PD. UPDRS-III, however, has limited contributions to HRQOL although it is used as a main outcome in many clinical trials.

Pub.: 04 Jun '16, Pinned: 30 Jul '17

Sleeping difficulties and health‐related quality of life in Parkinson's disease

Abstract: Various sleep‐related symptoms occur in Parkinson's disease (PD). Their occurrence with health‐related quality of life (HRQL), comorbid sleep disorders, and other comorbidities was studied.Altogether, 1447 randomly selected patients with Parkinson's disease, aged 43–89 years, participated in a questionnaire study. A structured questionnaire with 207 items was based on the Basic Nordic Sleep Questionnaire. Questions on demographics, PD, sleep disorders, and comorbidities were included.The response rate was 59.0%, and of these, 80% had answered to all questions that were used in the analyses (N=684). Occurrence of long sleep was found in 26.2% of the subjects, short sleep in 32.5%, poor sleep in 21.2%, sleep deprivation in 33.8%, disrupted sleep in 47.4%, and difficulties to fall asleep in 12.2%, respectively. Poor self‐rated health and poor quality of life occurred in 44.4% and in 43.3% of all participants. In the logistic regression, age and gender differentially predicted long sleep and sleep deprivation, such that older age and being male were positively associated with long sleep but negatively associated with the report of sleep deprivation. Depression, subjective negative stress, and fatigue occurred with long sleep. On the other hand, poor sleep and excessive daytime sleepiness occurred with short sleep and sleep deprivation.The sleep difficulties in PD are frequent. The long sleeping patients have depression, stress, and fatigue.

Pub.: 10 Jun '16, Pinned: 30 Jul '17