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.
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: 31 Jul '17
Abstract: To assess the impact of mild cognitive impairment (MCI) or cognitive decline on health-related quality of life (HR-QOL) in Parkinson's disease (PD).HR-QOL measured by the Parkinson Disease Quality of Life Questionnaire (PDQ-39), MCI according to Movement Disorder Society Task Force criteria and cognitive decline from premorbid baseline were assessed in non-demented PD patients at 6 movement disorder clinics.Among 137 patients, after adjusting for education, gender, disease duration, and Movement Disorder Society Unified Parkinson's Disease Rating Scale total score, MCI was associated with worse scores within the PDQ-39 dimension of communication (p = 0.008). Subjects were divided into tertiles of cognitive decline from premorbid level. Scores in the dimension of stigma were worst in the second tertile of cognitive decline (p = 0.03). MCI was associated with worse social support scores in the second tertile of cognitive decline (p = 0.008).MCI and cognitive decline from premorbid baseline are associated with reduced HR-QOL in communication, stigma, and social support domains. The cognitive decline from premorbid baseline modifies the association between MCI and HR-QOL in PD and knowing both will allow a better appreciation of difficulties patients face in daily life.
Pub.: 19 Jun '13, Pinned: 31 Jul '17
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: 31 Jul '17
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
Abstract: Health-related Quality of Life (HrQoL) is probably the most important outcome parameter for the evaluation and management of chronic diseases. As this parameter is subjective and prone to bias, there is an urgent need to identify objective surrogate markers. Gait velocity has been shown to be associated with HrQoL in numerous chronic diseases, such as Parkinson's disease (PD). With the development and wide availability of simple-to-use wearable sensors and sophisticated gait algorithms, kinematic gait parameters may soon be implemented in clinical routine management. However, the association of such kinematic gait parameters with HrQoL in PD has not been assessed to date.Kinematic gait parameters from a 20-meter walk from 43 PD patients were extracted using a validated wearable sensor system. They were compared with the Visual Analogue Scale of the Euro-Qol-5D (EQ-5D VAS) by performing a multiple regression analysis, with the International Classification of Functioning, Disability and Health (ICF) model as a framework.Use of assistive gait equipment, but no kinematic gait parameter, was significantly associated with HrQoL.The widely accepted concept of a positive association between gait velocity and HrQoL may, at least in PD, be driven by relatively independent parameters, such as assistive gait equipment.
Pub.: 23 May '17, Pinned: 30 Jul '17
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
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
Abstract: The authors examined associations of various sleep-disturbance symptoms with health-related quality of life (HRQOL) in 153 adults with Parkinson's disease (PD). PD patients reported more snoring, sleep inadequacy, daytime somnolence, and sleep-maintenance problems than the general population. Symptoms having the broadest and strongest unique associations with generic HRQOL (eight scales; two composites of SF-36) were daytime somnolence (five scales; one composite), sleep initiation (eight scales; two composites), and awakening short of breath or with headache (six scales; two composites). Associations of selected sleep-disturbance symptoms--some unanticipated--suggest that assessing specific symptoms is worthwhile in clinical care.
Pub.: 20 Nov '13, Pinned: 30 Jul '17