Self-reported functioning and well-being in patients with Parkinson's disease: comparison of the short-form health survey (SF-36) and the Parkinson's Disease Questionnaire (PDQ-39)

Outcome measurement in neurodegenerative disease: attributes, applications & interpretation

There has been a marked shift from clinically assessed to patient assessed outcomes of treatment in neurodegenerative conditions over recent decades. The use of patient-reported outcome measures (PROMs) provides a method with which researchers and clinicians can gain insightful and meaningful data on health status from the patients' perspective. It is imperative that high-quality PROMs are chosen based upon their measurement properties and their suitability for use in the intended clinical or research context. This review aims to give a brief overview of best practice standards for selecting PROMs, current instruments used in exemplar neurodegenerative conditions and their application in clinical trials and routine measurement.

Quantitative home-based assessment of Parkinson's symptoms: the SENSE-PARK feasibility and usability study

Background

Currently, assessment of symptoms associated with Parkinson’s disease is mainly performed in the clinic. However, these assessments have limitations because they provide only a snapshot of the condition.

Methods

The feasibility and usability of an objective, continuous and relatively unobtrusive system (SENSE-PARK System), which consists of wearable sensors (three worn during the day and one worn at night), a smartphone-based App, a balance board and computer software, was tested 24/7 over 12 weeks in a study including 22 PD patients. During the first four weeks of the study, patients did not get feedback about their performance, during the last eight weeks they did. The study included seven clinical visits with standardized interviews, and regular phone contact. The primary outcome was the number of drop-outs during the study. As secondary outcomes, the Post-Study System Usability Questionnaire (PSSUQ), score and information obtained from the standardized interviews were used to evaluate the usability of the system.

Results

All patients completed the study. The participants rated the usability of the SENSE-PARK System with a mean score of 2.67 (±0.49) on the PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their health condition.

Conclusions

This 12 week controlled study demonstrates that the acceptance level of PD patients using the SENSE-PARK System as a home-based 24/7 assessment is very good. Particular emphasis should be given to a user-friendly design. Motivation to wear such a system can be increased by providing direct feedback about the individual health condition.

Prolactin and sex hormones levels in males with Parkinson's disease

BACKGROUND

The role that oestradiol and testosterone play in Parkinson's disease and their potential to influence the course of the disease has been covered in medical literature. The aim of this work was to compare oestradiol, testosterone, sex hormone-binding protein and prolactin blood levels in males affected with Parkinson's disease and in an age-matched control group, and to show possible dependence between concentrations of plasma hormones and the progression of symptoms of Parkinson's disease.

METHODS

The plasma levels of oestradiol, testosterone, prolactin and sex hormone-binding protein were examined in 36 patients affected with Parkinson's disease and in 69 age-matched control subjects, using chemiluminescent reactions. Patients with Parkinson's disease were examined using scales assessing their clinical state.

RESULTS

The level of prolactin was higher in the affected group. Concentrations of oestradiol and testosterone in the control group exceeded those found in patients. The level of sex hormones was positively correlated with better mood and quality of life in patients affected with Parkinson's disease; prolactin levels correlated negatively with sex steroid concentrations.

CONCLUSIONS

Lower blood levels of sex steroids and higher concentrations of prolactin and its antigonadotrophic activity in males affected with Parkinson's disease may result in a bigger susceptibility to the disease in men. The level of hormones may influence patients' cognition, mood and quality of life.

Diurnal drooling in Chinese patients with Parkinson's disease

OBJECTIVE

The aim of this study is to explore the prevalence and clinical correlates of diurnal drooling in Chinese patients with Parkinson's disease (PD).

METHODS

A cross-sectional analysis of 518 Chinese patients with PD was conducted. Each subject was categorized as a diurnal "drooler" or a "non-drooler" using the Non-Motor Symptoms Scale (NMSS).

RESULTS

One hundred and twenty-one (23.4%) patients exhibited diurnal drooling. Diurnal drooling was reported more frequently in male and late-onset PD patients (p<0.05). The levodopa equivalent daily doses, mean age and disease duration, the percentages of PD family history and levodopa or entacapone use, the incidences of dysarthria, dysphagia and fluctuation, and the Unified PD Rating Scale (UPDRS) part III, NMSS, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and PD Questionnaire 39 (PDQ-39) scores in droolers were significantly greater than in non-droolers (p<0.05). The percentage of benzhexol use in non-droolers was significantly higher than in droolers (p<0.05). The Frontal assessment battery (FAB) and Montreal Cognitive Assessment (MoCA) scores were not different between the droolers and non-droolers. The forward binary logistic regression model indicated that dysarthria, male sex, age, UPDRS part III, sexual dysfunction and a family history of PD were associated with diurnal drooling.

CONCLUSIONS

Diurnal drooling is a relatively common debilitating symptom in Chinese PD patients. It is not only related to male sex, age, dysarthria and PD family history, but also correlates with motor and non-motor severity especially sexual dysfunction of PD. However, it is not related to cognition.

Falls in ambulatory non-demented patients with Parkinson's disease

This study aimed at determining the prevalence of falling in PD patients, to assess generic and disease-specific clinical and pharmacological factors, relationship with health-related quality of life (HR-QoL) and changes in falls from OFF to ON in patients with motor fluctuations. Six-hundred and eighty-three PD patients of the COPARK survey were evaluated (11 had missing data and were excluded from the analysis). Patients with falls were identified as those with a UPDRS Item 13 ≥ 1 in the ON condition. All patients were assessed in a standardized manner [demographics, treatments, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale, Pittsburg questionnaire and HR-QoL scales (SF36, PDQ39)]. Falling was reported by 108/672 (16%) PD patients during the ON state and prevalence increased according to PD severity, from 5% in Hoehn and Yahr stage 1-60% in stage 4. Falling was significantly related to lower HR-QoL. Falling correlated with (1) generic factors such as female gender, age at the end of academic studies and diuretics consumption, (2) motor PD-specific factors including disease severity, frozen gait, difficulties when arising from a chair, dyskinesia and higher levodopa daily equivalent dose and (3) non-motor PD-specific factors such as orthostatic hypotension and hallucinations. Falling was more frequent in OFF than in ON in 48/74 (64%) patients with motor fluctuations and remained unchanged in 27 patients (36%). In summary, falling affected a significant proportion of PD patients, especially in advanced stages. It was associated with a variety of generic and PD-specific factors and was related to reduced HR-QoL.

Influence of the nonergot dopamine agonist piribedil on vigilance in patients With Parkinson Disease and excessive daytime sleepiness (PiViCog-PD): an 11-week randomized comparison trial against pramipexole and ropinirole

OBJECTIVES

The aim of this study was to investigate the effects of piribedil on vigilance and cognitive performance in patients with Parkinson disease experiencing excessive daytime sleepiness on pramipexole or ropinirole.

METHODS

In this 11-week randomized, active-controlled, rater-blinded phase III study, eligible patients were randomly assigned to either receive piribedil or to continue on pramipexole or ropinirole. The primary outcome was the median reaction times during the second 15 minutes of the subtest "vigilance" of the Test battery for Attention Performances (TAP). Secondary outcomes included the Epworth Sleepiness Scale, Unified Parkinson's Disease Rating Scale, neuropsychological testing, and items of the Clinical Global Impression.

RESULTS

Forty-four patients received piribedil; 36 continued on either pramipexole or ropinirole. There was no difference in the primary end point reaction time of the TAP subtest vigilance between piribedil and the comparator (996 vs 954 milliseconds, P = 0.68). Piribedil reduced daytime sleepiness with lower Epworth Sleepiness Scale scores at the end of treatment compared with the comparator (-4 vs -2 points; P = 0.01). The median Unified Parkinson's Disease Rating Scale III score at the end of treatment was comparable between the 2 groups. Neuropsychological tests revealed no significant between-treatment differences. A higher therapeutic effect and global improvement were shown by the Clinical Global Impression of piribedil-treated patients.

CONCLUSIONS

This study shows that switching from pramipexole or ropinirole to piribedil has no effect on the reaction time of the TAP subtest vigilance but upholds the same therapeutic motor effect and reduces daytime sleepiness to a clinically relevant degree in patients with excessive daytime sleepiness.

A Randomized Controlled Trial to Reduce Falls in People With Parkinson’s Disease

Background. Falls are common and disabling in people with Parkinson’s disease (PD). There is a need to quantify the effects of movement rehabilitation on falls in PD. Objective. To evaluate 2 physical therapy interventions in reducing falls in PD. Methods. We randomized 210 people with PD to 3 groups: progressive resistance strength training coupled with falls prevention education, movement strategy training combined with falls prevention education, and life-skills information (control). All received 8 weeks of out-patient therapy once per week and a structured home program. The primary end point was the falls rate, recorded prospectively over a 12 month period, starting from the completion of the intervention. Secondary outcomes were walking speed, disability, and quality of life. Results. A total of 1547 falls were reported for the trial. The falls rate was higher in the control group compared with the groups that received strength training or strategy training. There were 193 falls for the progressive resistance strength training group, 441 for the movement strategy group and 913 for the control group. The strength training group had 84.9% fewer falls than controls (incidence rate ratio [IRR] = 0.151, 95% CI 0.071-0.322, P < .001). The movement strategy training group had 61.5% fewer falls than controls (IRR = 0.385, 95% CI 0.184-0.808, P = .012). Disability scores improved in the intervention groups following therapy while deteriorating in the control group. Conclusions. Rehabilitation combining falls prevention education with strength training or movement strategy training reduces the rate of falls in people with mild to moderately severe PD and is feasible.

Prevalence and clinical correlates of drooling in Parkinson disease: a study on 518 Chinese patients

BACKGROUND

The prevalence and clinical correlates of drooling in Chinese patients with Parkinson disease (PD) are unknown.

METHODS

A cross-sectional analysis of 518 Chinese patients with PD was conducted. Assessments included Unified PD Rating Scale (UPDRS), Non-Motor Symptoms Scale (NMSS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), PD Questionnaire-39 (PDQ-39), Frontal assessment battery (FAB) and Montreal Cognitive Assessment (MoCA).

RESULTS

Two hundred and seventy-three PD patients (52.7%) reported drooling (droolers). Drooling occurred more frequently in the late-onset PD patients than the early-onset PD patients (p < 0.05). Droolers had higher levodopa equivalent daily doses, higher incidences of dysarthria, dysphagia and fluctuation, higher scores for the UPDRS part III, NMSS, HAMD and HAMA, and higher scores for the mobility, activities of daily life, stigma and communication subdomains of the PDQ-39 than the non-droolers (p < 0.05). The percentage of benzhexol use in the non-droolers was significantly higher than the droolers (p < 0.05). The FAB and MoCA scores between the droolers and non-droolers were not different. The binary logistic regression analysis indicated that dysarthria, dysphagia, benzhexol use, and a lower score for the naming domain of the MoCA were associated with drooling.

CONCLUSIONS

Drooling is a relatively common disabling symptom in Chinese PD patients. Patients with dysarthria, dysphagia and naming disorder are likely to experience drooling. Drooling is not correlated with disease duration and motor severity of PD.

Effects of cannabidiol in the treatment of patients with Parkinson's disease: an exploratory double-blind trial

INTRODUCTION

Parkinson's disease (PD) has a progressive course and is characterized by the degeneration of dopaminergic neurons. Although no neuroprotective treatments for PD have been found to date, the endocannabinoid system has emerged as a promising target.

METHODS

From a sample of 119 patients consecutively evaluated in a specialized movement disorders outpatient clinic, we selected 21 PD patients without dementia or comorbid psychiatric conditions. Participants were assigned to three groups of seven subjects each who were treated with placebo, cannabidiol (CBD) 75 mg/day or CBD 300 mg/day. One week before the trial and in the last week of treatment participants were assessed in respect to (i) motor and general symptoms score (UPDRS); (ii) well-being and quality of life (PDQ-39); and (iii) possible neuroprotective effects (BDNF and H(1)-MRS).

RESULTS

We found no statistically significant differences in UPDRS scores, plasma BDNF levels or H(1)-MRS measures. However, the groups treated with placebo and CBD 300 mg/day had significantly different mean total scores in the PDQ-39 (p = 0.05).

CONCLUSIONS

Our findings point to a possible effect of CBD in improving quality of life measures in PD patients with no psychiatric comorbidities; however, studies with larger samples and specific objectives are required before definitive conclusions can be drawn.

The cognition and emotional well-being indices of the Parkinson's disease questionnaire-39: what do they really measure?

INTRODUCTION

The Parkinson's disease questionnaire-39 (PDQ-39) is a common measure of health related quality of life (HRQoL) that is widely used with Parkinson disease (PD) patients. Previous evidence suggests that the PDQ-39 reflects at least 8 dimensions (i.e., Emotion, Cognitions, Mobility, etc). To date, little research has examined the external/convergent validity of the Cognitions and Emotional Well-being domains of the PDQ-39.

METHODS

A convenience sample of 303 PD patients underwent a comprehensive multi-domain neuropsychological evaluation, including tests of execution function, episodic verbal memory, processing speed, language and working memory, as well as completing measures of depression, apathy, state and trait anxiety and HRQoL (PDQ-39). Hierarchical regressions were conducted in order to examine the relationship between scores on neuropsychological tests and the Cognitions index, as well as mood measures and the Emotional Well-being index of the PDQ-39.

RESULTS

Neuropsychological test performance did not account for a significant amount of variance in the PDQ-39 Cognitions index scores. Instead, it was depression that significantly contributed to the Cognitions index, above and beyond neuropsychological performance. The PDQ-39 Emotional Well-being index was also related to mood measures, primarily depression and trait anxiety.

CONCLUSIONS

The PDQ-39 Cognition index may be more related to mood functioning, as opposed to cognitive functioning, and should not be considered a "proxy" for cognitive functioning. Future studies are needed to better explain the construct of this index.

Reproductive life characteristics in females affected with Parkinson's disease and in healthy control subjects - a comparative study on Polish population

BACKGROUND

Sex and blood level of sex hormones play a key role not only in the susceptibility to develop Parkinson's disease (PD) but also influence the natural course of the disease. The aim of this study was to compare reproductive lifespan events in females affected with PD and in "non-parkinsonian" age matched subjects and to evaluate whether the whole life endogenous oestrogen level is associated with variables describing the course of the disease.

MATERIALS AND METHODS

Reproductive lifespan, age at menarche, age at menopause, gynaecological interventions and parity were compared in 76 women with idiopathic PD and in the age-adjusted control group of 74 subjects. Affected women underwent neurological and psychological assessment. Data were analysed using Mann-Whitney U Test and Spearman Rank Correlation Test.

RESULTS

Women affected with PD had a shorter reproductive lifespan and experienced final menstruation earlier than the control group. Early menopause was reported by 24% of the patients and only by 16% of the control subjects. Parkinsonian women reported more commonly the history of surgical menopause. Duration of reproductive lifespan, age at menopause and the type of menopause influenced both motor and cognitive functioning of patients.

CONCLUSIONS

There may be a relationship between the lifetime average endogenous oestrogen level and the susceptibility to develop PD. Longer reproductive lifespan resulting in higher "whole life" female sex steroids concentrations may exert a protective effect on central nervous system, resulting in milder course of the disease.

Effects of combined MAO-B inhibitors and levodopa vs. monotherapy in Parkinson's disease

Background: Prior studies report that monoamine oxidases inhibitors (MAO-I) when used as an adjunct to levodopa ameliorate motor symptoms in Parkinson’s disease (PD), but this was not tested in relation to cognitive or psychiatric measures.

Objective: Here, we tested the effects of MAO-I as an adjunct to levodopa, in comparison to levodopa or dopamine (DA) agonists alone, on various cognitive, affective and quality of life measures.

Methods: We studied three groups of subjects: healthy controls, PD patients on combined levodopa and MAO-I, and PD patients on levodopa or DA agonists only.

Results: We found that compared to monotherapy, combined MAO-I and levodopa seemed to improve cognition, including probabilistic learning, working memory and executive functions. There were no differences between the different medication regimes on deterministic learning, attention or memory recall. It was also found that MAO-I as an adjunct to levodopa improves affective measures such as depression, apathy, anxiety and quality of life. Interestingly, this enhancing effect of combined levodopa and MAO-I was more pronounced in PD patients with severe akinesia, compared to patients with severe tremor.

Conclusion: Our data are in agreement with (a) the Continuous Dopaminergic Stimulation (CDS) theory which states that continuous stimulation of the basal ganglia enhances motor, psychiatric and cognitive functions in PD patients; and/or (b) findings that MAO-I increase the bioavailability of monoamines that have beneficial effects on motor and behavioral dysfunction in PD.

Freezing of gait in Chinese patients with Parkinson disease

A total of 474 Chinese Parkinson disease (PD) patients were evaluated to explore the prevalence and clinical correlates of freezing of gait (FOG) in this cross-sectional study. Two hundred and twenty-one PD patients (46.62%) reported FOG (freezers). FOG occurred more frequently in older patients and patients with low limbs as the site of onset, longer disease duration and higher Hoehn and Yahr (H&Y) stage (P<0.05). After adjusting for confounding factors, the freezers had higher scores for the Unified PD Rating Scale (UPDRS) part III, Non-Motor Symptoms Scale (NMSS), PD Questionnaire 39 (PDQ-39), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), and lower scores for the Mini-Mental status examination (MMSE), frontal assessment battery (FAB) and Montreal Cognitive Assessment (MoCA) compared with the non-freezers (P<0.05). The binary logistic regression analysis indicated that festination, falls, a high daily dose of levodopa, the use of a dopamine receptor agonist, a high H&Y stage, the severity of urinary symptoms and a high HAMD score were associated with FOG. FOG is a relatively common disabling symptom in Chinese PD patients. Patients that were older, or reported a longer disease duration, low limbs as the site of onset and a more severe disability were more likely to experience FOG. Non-motor symptoms, especially urinary symptoms and depression, may also be related to FOG.

Nonmotor symptoms in a malaysian Parkinson's disease population

Background. The nonmotor symptoms are important determinants of health and quality of life in Parkinson's disease but are not well recognized and addressed in clinical practice. This study was conducted to determine the prevalence of nonmotor symptoms and their impact on quality of life in patients with Parkinson's disease. Methods. This was a cross-sectional study among patients with idiopathic Parkinson's disease. Exclusion criteria were a Mini Mental State Examination score of <21/30. Prevalence of nonmotor symptoms was determined using the NMSQuest. The severity of nonmotor symptoms and the quality of life were assessed using validated disease-specific questionnaires (PDQ-39 and NMSS). Results. A total of 113 patients consisting of 60 males and 53 females were recruited. The median duration of illness was 5.0 (2.0-8.0) years. The prevalence rate of nonmotor symptoms in our cohort was 97.3%. The most common reported nonmotor symptom in our cohort was gastrointestinal (76.1%). We found that the severity of the nonmotor symptoms was associated with poorer quality of life scores (r s : 0.727, P < 0.001). Conclusions. Nonmotor symptoms were highly prevalent in our patients with Parkinson's disease and adversely affected the quality of life of our patients. In contrast to western studies, the most common nonmotor symptom is gastrointestinal. The possibility of an Asian diet playing a role in this observation requires further study.

Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson's disease: results from a randomised, controlled trial

BACKGROUND

The risk of suicide behaviours post-deep brain stimulation (DBS) surgery in Parkinson's disease (PD) remains controversial. We assessed if suicide ideation and behaviours are more common in PD patients (1) randomised to DBS surgery versus best medical therapy (BMT); and (2) randomised to subthalamic nucleus (STN) versus globus pallidus interna (GPi) DBS surgery.

METHODS

In Phase 1 of the Veterans Affairs CSP 468 study, 255 PD patients were randomised to DBS surgery (n=121) or 6 months of BMT (n=134). For Phase 2, a total of 299 patients were randomised to STN (n=147) or GPi (n=152) DBS surgery. Patients were assessed serially with the Unified Parkinson's Disease Rating Scale Part I depression item, which queries for suicide ideation; additionally, both suicide behaviour adverse event data and proxy symptoms of increased suicide risk from the Parkinson's Disease Questionnaire (PDQ-39) and the Short Form Health Survey (SF-36) were collected.

RESULTS

In Phase 1, no suicide behaviours were reported, and new-onset suicide ideation was rare (1.9% for DBS vs 0.9% for BMT; Fisher's exact p=0.61). Proxy symptoms of relevance to suicide ideation were similar in the two groups. Rates of suicide ideation at 6 months were similar for patients randomised to STN versus GPi DBS (1.5% vs 0.7%; Fisher's exact p=0.61), but several proxy symptoms were worse in the STN group.

CONCLUSIONS

Results from the randomised, controlled phase of a DBS surgery study in PD patients do not support a direct association between DBS surgery and an increased risk for suicide ideation and behaviours.

Screening for early detection of parkinsonism using a self-administered questionnaire: a cross-sectional epidemiologic study

BACKGROUND

Manganese (Mn) is a common component of welding fume. Exposure to Mn fume has been associated with parkinsonism. A simple and reliable screening tool to evaluate Mn exposed workers for neurotoxic injury would have broad occupational health application.

METHODS

This study investigated 490 occupational welders recruited from a trade union list. Subjects were examined by a movement disorders specialist using the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3). Parkinsonism, intermediate, and normal groups were defined as UPDRS3 score ≥ 15, 6-15, and <6, respectively. Workers completed a health status questionnaire (PDQ39) and a Parkinson disease (PD) Symptoms Questionnaire. Areas under receiver operator curve (AUC) were analyzed based on these scores, adjusted for age, smoking, race, gender, and neurologist, using normal as the reference.

RESULTS

The AUC was 0.79 (95% confidence interval [CI]=0.73-0.84) for PDQ39 and 0.78 (95% CI=0.72-0.85) for PD Symptoms Questionnaire score. At 70% sensitivity, the specificity for PDQ39 score and PD Symptoms Questionnaire score for the prediction of parkinsonism was 73.1% and 80.1%, respectively.

CONCLUSIONS

These results suggest the questionnaires have reasonably good sensitivity and specificity to predict parkinsonism in Mn exposed workers. These questionnaires could be a valuable first step in a tiered screening approach for Mn exposed workers.

A fixed-dose randomized controlled trial of olanzapine for psychosis in Parkinson disease

Background: Psychosis is a common and debilitating side effect of long-term dopaminergic treatment of Parkinson disease (PD). While clozapine is an effective treatment, the need for blood monitoring has limited its first-line use. 

Objective: Since olanzapine shows similar receptor affinity to clozapine, we hypothesized that it might be an effective alternative to clozapine for treatment of drug-induced psychosis (DIP) in PD, and that lower doses than usual might make it tolerable.

Methods: In 1998-2003 we conducted a four-week, double-blind, placebo-controlled, parallel group, fixed-dose trial of olanzapine (0, 2.5mg, or 5mg) in 23 PD patients with DIP while allowing for clinically realistic dose adjustments of dopaminomimetic mid-study. The primary outcome measures were Brief Psychiatric Rating Scale (BPRS) ratings scored from videotaped interviews after study termination by an observer blinded to dose assignment and to interview timing, and CGI (Clinical Global Impression). The Unified Parkinson’s Disease Rating Scale motor subscale (UPDRS) was the primary measure of tolerability.

Results: Intention-to-treat analysis found no significant differences among treatment groups in study completion or serious adverse events. However, a disproportionate number of olanzapine vs. placebo subjects reported mild side effects (p<0.04), many citing motor worsening. Fourteen patients completed the study (seven on placebo, two on 2.5mg olanzapine, five on 5mg olanzapine). In study completers, analysis by repeated measures ANOVA revealed no significant difference between olanzapine and placebo groups in BPRS psychosis reduction (p=0.536), parkinsonism (p=0.608), or any other measured parameters (CGI, MMSE, Beck Depression Inventory, Hamilton Depression score, PDQ‑39, Schwab-England ADL assessment, and sleep scores).

Conclusion: This study adds to other evidence that olanzapine is ineffective in treating medication-induced psychosis in Parkinson disease.

Parkinson's disease and forced exercise: a preliminary study

Objective. The concept of forced exercise has drawn attention for the treatment of Parkinson's disease symptoms with anecdotal reports of success. This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson's disease symptoms in a blinded, randomized, and controlled setting. Setting. Parkinson's disease outpatient clinic, Veterans Administration Medical Center. Method. We assessed 23 patients (13 experimental and 10 controls) on a number of standard Parkinson's measures at baseline, after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care, and then after a three-month period had elapsed. Dependent measures were UPDRS-III, Berg Balance Scale, finger taping test, and the PDQ-39. Results. Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time. A within subjects effect was demonstrated for the forced exercise group on overall UPDRS-III scores at the three-month end point. No other within group effects were noted. Results suggest that early enthusiasm for forced exercise may need tempering. Limitations of the study are discussed as well as numerous logistical challenges to this type of study.

The dysarthria impact profile: a preliminary French experience with Parkinson's disease

This preliminary study aimed to adapt the Dysarthria Impact Profile (DIP) in French and to confirm its relevance for the assessment of the psychosocial impact of dysarthria in Parkinson's disease (PD). The DIP scale was administered to 10 people with PD and 10 age-matched control subjects. The DIP psychometric properties were calculated (discriminant validity, internal consistency, and concurrent validity), notably by using the Voice Handicap Index (VHI) for interscale comparisons. The French version of the DIP discriminated people with PD from control subjects (χ² test, P < 0.05). Good internal consistency was observed in both populations (Cronbach's α = 0.93 for PD people and α = 0.76 for control subjects). The DIP was highly correlated with the VHI (Spearman's ρ = −0.70, P < 0.01), confirming the external validity of the scale. There was no direct relationship between PD speech and quality of life as assessed by the Parkinson's Disease Questionnaire-39 (PDQ-39). Our preliminary data suggest that the French version of the DIP has the potential to make a useful contribution for the assessment and outcome management in acquired dysarthria for both clinicians and researchers.

Incorporating yoga into an intense physical therapy program in someone with Parkinson's disease: a case report

PURPOSE

The purpose of this case report was to document outcomes following an intense exercise program integrating yoga with physical therapy exercise in a male with Parkinson's disease.

METHOD

The participant performed an intense 1½-hour program (Phase A) incorporating strengthening, balance, agility and yoga exercises twice weekly for 12 weeks. He then completed a new home exercise program developed by the researchers (Phase B) for 12 weeks.

RESULTS

His score on the Parkinson's Disease Questionnaire improved 16 points while his score on the High Level Mobility Assessment tool improved 11 points. There were also improvements in muscle length of several lower extremity muscles, in upper and lower extremity muscle strength, in dynamic balance and he continues to work full time 29 months later. There were no improvements in thoracic posture or aerobic power.

DISCUSSION

This intense program was an effective dose of exercise for someone with Parkinson's disease and allowed him to continue to participate in work, leisure, and community activities.

Outcome measures in stroke rehabilitation

Owing to the complex nature of neurological disease and trauma, comprehensive and standardized assessments are needed to evaluate individuals effectively. No one standardized assessment is applicable for every situation as each test serves a different purpose. Assessments are either generic or disease specific. However, in neurological rehabilitation, most assessments are disease specific as the generic measures may not be precise for outcomes. This chapter outlines some of the challenges and considerations that the test administrator needs to consider when selecting the most appropriate and corresponding assessment. Four key factors are suggested for determining which assessment to use:

Efficacy of a multimodal cognitive rehabilitation including psychomotor and endurance training in Parkinson's disease

Mild cognitive impairment, especially executive dysfunction might occur early in the course of Parkinson's disease. Cognitive training is thought to improve cognitive performance. However, transfer of improvements achieved in paper and pencil tests into daily life has been difficult. The aim of the current study was to investigate whether a multimodal cognitive rehabilitation programme including physical exercises might be more successful than cognitive training programmes without motor training. 240 PD-patients were included in the study and randomly allocated to three treatment arms, group A cognitive training, group B cognitive training and transfer training and group C cognitive training, transfer training and psychomotor and endurance training. The primary outcome measure was the ADAS-Cog. The secondary outcome measure was the SCOPA-Cog. Training was conducted for 4 weeks on a rehabilitation unit, followed by 6 months training at home. Caregivers received an education programme. The combination of cognitive training using paper and pencil and the computer, transfer training and physical training seems to have the greatest effect on cognitive function. Thus, patients of group C showed the greatest improvement on the ADAS-Cog and SCOPA-COG and were more likely to continue with the training programme after the study.

Pseudobulbar affect: burden of illness in the USA

INTRODUCTION

Pseudobulbar affect (PBA) is characterized by involuntary and uncontrollable laughing and/or crying episodes, occurring secondary to neurological disease or injury. The impact of PBA on social and occupational function, health status, quality of life (QOL), and quality of relationships (QOR) is not well studied.

METHODS

This US survey conducted by Harris Interactive compared health status and daily function of patients with and without PBA. Eligible respondents were Harris Panel Online registrants previously diagnosed with stroke, multiple sclerosis, Parkinson's disease, Alzheimer's disease, traumatic brain injury, or amyotrophic lateral sclerosis, or primary, nonpaid caregivers for such patients who were too debilitated to participate. PBA was identified by a Center for Neurologic Study lability scale score of 13 or greater. Measures included the 36-item short form health survey (SF-36), the work productivity and impairment (WPAI) questionnaire, visual analog scales (VAS) for impact of PBA symptoms on QOL and QOR, and customized questions related to burden and impact of involuntary laughing/crying episodes on patients' lives. Survey responses were weighted to adjust for the relative proportion of the primary neurological conditions in the overall population and between group differences in patient age and gender. PBA and non-PBA group responses were compared using two-tailed t tests adjusted for severity of the primary neurological conditions.

RESULTS

The 1,052 respondents included 399 PBA group participants and 653 controls. The PBA group showed significantly worse scores versus non-PBA controls on component and summary SF-36 scores (P<0.05 for all), VAS scores (P<0.05 for both), and WPAI scores (P<0.05). Among PBA group respondents, PBA contributed a great deal to or was the main cause of patients becoming housebound for 24% and being moved to supervised living placement for 9% of respondents.

CONCLUSION

PBA is associated with considerable burden incremental to that of the underlying neurological conditions, affecting QOL, QOR, health status, and social and occupational functioning.

Health-related quality of life and strain in caregivers of Australians with Parkinson's disease: an observational study

Background

The relationship between health-related quality of life (HRQoL) in people with Parkinson’s disease and their caregivers is little understood and any effects on caregiver strain remain unclear. This paper examines these relationships in an Australian sample.

Methods

Using the generic EuroQol (EQ-5D) and disease-specific Parkinson’s Disease Questionnaire-39 Item (PDQ-39), HRQoL was evaluated in a sample of 97 people with PD and their caregivers. Caregiver strain was assessed using the Modified Caregiver Strain Index. Associations were evaluated between: (i) caregiver and care-recipient HRQoL; (ii) caregiver HRQoL and caregiver strain, and; (iii) between caregiver strain and care-recipient HRQoL.

Results

No statistically significant relationships were found between caregiver and care-recipient HRQoL, or between caregiver HRQoL and caregiver strain. Although this Australian sample of caregivers experienced relatively good HRQoL and moderately low strain, a significant correlation was found between HRQoL of people with PD and caregiver strain (rho 0.43, p < .001).

Conclusion

Poor HRQoL in people with PD is associated with higher strain in caregivers. Therapy interventions may target problems reported as most troublesome by people with PD, with potential to reduce strain on the caregiver.

Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson's disease

Background

The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated.

Methods/design

180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined.

Discussion

This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD.

Trial registration

The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).

Reliability and validity study of a Brazilian-Portuguese version of the fatigue severity scale in Parkinson's disease patients

The Fatigue Severity Scale (FSS) is one of the most frequently used self-rating scales for fatigue in Parkinson's disease (PD) and it lacks a validated Brazilian-Portuguese version. OBJECTIVE: To determine the construct validity and reproducibility of a Brazilian-Portuguese version of the FSS in patients with PD. METHODS: In a cross-sectional study, a Portuguese-language version of the FSS was applied to 30 patients with PD (62±11 years-old). The Parkinson's disease questionnaire (PDQ-39) was used as the validation criterion, while the Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS), and the Beck Depression Inventory were employed to analyze the correlations with the FSS score. RESULTS: The test-retest intraclass correlation coefficient was 0.91 (p<0.01) for the Brazilian-Portuguese version of the FSS score, which was highly correlated with the PDQ-39 overall score (r=0.93; p<0.01) and the Beck Depression Inventory (r=0.75; p<0.01). It showed a correlation with the Hoehn and Yahr scale (r=0.40; p=0.02), and with the UPDRS as well (r=0.45, p=0.01). CONCLUSIONS: The Brazilian-Portuguese version of the FSS is valid and reproducible for using in Brazilian patients with PD.

Effects of parkinsonism on health status in welding exposed workers

BACKGROUND

Previous studies suggest that welders frequently display parkinsonian signs, such as bradykinesia and tremor. Demonstrating that these parkinsonian findings are associated with reductions in quality of life (QoL) or health status could have important repercussions for worker safety and performance.

METHODS

Subjects included 394 active workers exposed to welding fumes and evaluated for parkinsonism by movement disorders experts in a worksite-based epidemiology study. Subjects were diagnosed with parkinsonism if the Unified Parkinson Disease Rating Scale motor subsection part 3 (UPDRS3) score was ≥15. All subjects completed a Parkinson's disease (PD) symptom questionnaire and the PDQ39, a widely used QoL and health status measure for PD.

RESULTS

Total PDQ39 score and all subscores were greater in welders with parkinsonism than welders without parkinsonism, with the most significant differences observed for mobility, emotional well-being, and activities of daily living (ADL's). The PDQ39 scores for welding exposed workers with parkinsonism were similar to scores seen in a group of early PD patients.

CONCLUSION

Parkinsonism in active, welding exposed workers is associated with reductions in health status and QoL affecting a broad range of categories and within the range seen in early PD.

Quality of life among testicular cancer survivors: a case-control study in the United States

INTRODUCTION

Evidence from previous studies has suggested there may be physical and mental changes in health among testicular cancer survivors. No studies have been conducted in the United States, however.

METHODS

Study participants were initially enrolled in the US Servicemen's Testicular Tumor Environmental and Endocrine Determinants (STEED) study between 2002 and 2005. A total of 246 TGCT (testicular germ cell tumor) cases and 236 non-testicular cancer controls participated in the current study, and completed a self-administered questionnaire. Mean time since diagnosis for cases was 14 years, and no less than five for all cases. Component scores determined from responses to questions about physical and mental health on SF36 were tabulated to yield two summary measures, physical component scores (PCS), and mental component scores (MCS). Component and summary scores were normalized to a score of 50 with a standard deviation of 10 by a linear T-score transformation.

RESULTS

Overall, cases may not suffer greatly in different quality of life than controls. When all cases and controls are compared, TGCT cases had lower PCS (mean: 51.9 95% CI: 50.6-53.2, P value: 0.037) than controls (mean: 53.6 95% CI: 52.7-54.6). MCS were not significantly different (P value: 0.091). In multivariate analyses, several physical health components were worse for TGCT cases such as role-physical (OR 1.19, 95% CI: 1.01-1.39) and general health (OR 1.26, 95% CI: 1.07-1.49) compared to controls. However, TGCT cases treated with chemotherapy had lower PCS (cases: 50.2, 95% CI: 47.6-52.8; controls: 53.6, 95% CI: 52.7-54.6, P value: 0.0032) and MCS (cases: 49.3, 95% CI: 46.5-52.1; controls: 52.0, 95% CI: 50.9-53.2, P value: 0.039). TGCT cases who received treatments other than chemotherapy did not differ from controls in either PCS or MCS.

DISCUSSION

Physical and general health limitations may affect testicular cancer survivors. Men treated with chemotherapy, however, may be most likely to suffer adverse health outcomes due to a combination of body-wide effects on physical and mental factors which affect various aspects of physical health, mental health, and overall quality of life. And in particular, physical functioning, role-physical, and general health are strongly affected.

Health-related quality of life among community-dwelling patients with intractable neurological diseases and their caregivers in Japan

AIMS

The aims of this study were: (i) to clarify the general quality of life (QOL) of patients with intractable neurological disease; (ii) to clarify the general QOL of the caregivers of these patients; and (iii) to explore the association of QOL in patient-caregiver pairs.

METHODS

A cross-sectional survey was conducted between November 2003 and May 2004 among community-dwelling patients diagnosed with Parkinson's disease (PD), spinocerebellar degeneration (SCD), multiple system atrophy (MSA), and amyotrophic lateral sclerosis (ALS) and their caregivers using a mailed, self-administered questionnaire. To measure QOL, we used the Medical Outcome Study 36-Item Short Form (SF-36) for patients and the short form of the health-related QOL scale SF-36 (SF-8) for caregivers.

RESULTS

A total of 418 questionnaires were analyzed. For the patients, all of the general QOL domains of the SF-36 were significantly lower than the national standard value for all of the diagnoses. Physical function, role physical, and role emotional domains were also low. For caregivers, all of the QOL summary scores of the SF-8 for all diagnoses were significantly lower than the national standard value. Although there were several significant correlations of QOL between patients and caregivers, overall the correlations were low.

CONCLUSIONS

Support for patients with neurological diseases and their caregivers is needed in order to maintain physical and mental QOL.

The impact of levodopa on quality of life in patients with Parkinson disease

BACKGROUND

Parkinson disease (PD) is associated with a progressive decline in patient quality of life (QoL), because of motor and nonmotor manifestations of PD and treatment-related side effects.

REVIEW SUMMARY

Treatment with carbidopa/levodopa-the current gold standard therapy-improves QoL in the short term, but gains are not maintained over a long term. Long-term treatment is associated with symptom re-emergence (end-of-dose "wearing off") and development of dyskinesia, which may have an adverse impact on QoL.

CONCLUSIONS

Levodopa (LD; combined with carbidopa) remains the gold standard for symptomatic treatment of PD, but long-term treatment is associated with complications that may adversely affect QoL. Recent studies have suggested that the addition of a catechol-O-methyltransferase inhibitor may improve QoL through the reduction of some of the motor complications of LD therapy. Further studies are required to determine the full effects of this as well as other treatments that are used to manage LD-associated complications on QoL.

The Short Form 36 health survey in spine disease--validation against condition-specific measures

Health-Related Quality of Life (HRQoL) assessments in spinal disease offer the potential of outcome measures that better represent patients' disability and response to treatment. The Short Form 36 Health Survey (SF-36) is a generic HRQoL questionnaire that has been extensively used in primary and secondary care, but before it can be routinely applied in patients with spinal disease must be validated against traditional specific measures of physical and mental morbidity. Patients with lumbar disc prolapse, lumbar canal stenosis, and cervical spondylotic radiculomyelopathy were identified from a prospectively maintained database. Visual Analogue Scales (VAS) and condition-specific questionnaires including the Roland Morris Disability Score (RMDS), Myelopathy Disability Index (MDI), and Hospital Anxiety and Depression Scales (HADS), were completed alongside the SF-36 survey at baseline and following surgery. Convergent, discriminant, and predictive validity were assessed by computing correlations between the specific and generic scores. In addition, responsiveness (Standardised Response Mean, SRM) and floor and ceiling effects were examined. Data from 1623 assessments of 620 patients were available. Convergent validity was shown by strong correlations between condition-specific physical scores (MDI or RMDS) and the Physical Function and Bodily Pain domains of SF-36 (rho = -0.52 to -0.76, all p < 0.01). VAS for leg or arm pain were also strongly correlated with Bodily Pain domain scores (rho = -0.54 to -0.77, all p < 0.01). Discriminant validity was confirmed by non-significant partial correlations between Physical Function and Mental Health SF-36 domains when controlled for HADS scores (r = -0.01 to 0.02, p > 0.05). Predictive validity was demonstrated by similar correlations between pre- and post-operative scores for specific and generic instruments. Physical Function, Bodily Pain, and Mental Health domains were all free of significant floor or ceiling effects and showed moderate to good responsiveness (SRM 0.54-1.72). SF-36 domain scores are valid for measuring morbidity and surgical outcomes in common spinal disorders.

Health related quality of life in early Parkinson's disease: impact of motor and non-motor symptoms, results from Chinese levodopa exposed cohort

OBJECTIVE

To identify the motor and non-motor factors that are associated with health related quality of life (HR-QOL) in a subgroup of Parkinson's disease (PD) patients with Levodopa therapy in early clinical stages.

METHODS

391 Levodopa exposed patients were evaluated during the baseline assessment of a clinical trial in China. HR-QOL was measured by the Short Form 36 (SF-36). Motor and non-motor variables were determined during a structured interview and by clinical examination by movement disorder specialists. Multiple regression analyses were used to determine which variables were associated with low levels of HR-QOL.

RESULTS

Even if excluding non-motor variables from the regression model, motor factors, particularly motor deficits (measured by motor score of UPDRS), rigidity (measured by item 22 of UPDRS), and disease severity (measured by Hoehn&Yahr scale), explained only 18.9% of the variance of total SF-36 score. Whereas, when non-motor variables were included in the model, especially depression (measured by CES-D), sleep disturbances (measured by PSQ-I), and fatigue (measured by FSS), 61.7% of the variance of SF-36 score could be explained. Two motor variables, UPDRS motor score and Hoehn&Yahr score, were also contributed to the model, however, the 95% confidence intervals (CIs) of these two motor factors were wide and included the null value (CIs -0.282, 0.019 for UPDRS motor score, and CIs -4.043, 0.856 for Hoehn&Yahr score). Neither, did higher daily levodopa dose contribute significantly to both models predicting SF-36 score.

CONCLUSIONS

In our sample patients with levodopa therapy, motor disability and severity of parkinsonism contributed to a lesser extent to patients' self-report distress, within the first 5 years of disease onset. The clinical factors that showed the highest predictive value for worsen HR-QOL were non-motor symptoms, such as depression, sleep disorders, and fatigue. Great effort should be made to recognize and treat those conditions, thus improving all aspects of PD and giving these patients as a good HR-QOL as possible.

Quality of life in relation to mood, coping strategies, and dyskinesia in Parkinson's disease

Given the variability of the results found in the literature, the current study is a step toward better clarifying the influence of motor and nonmotor factors on quality of life in Parkinson's disease. A total of 135 participants with Parkinson's disease were selected. Semistructured interviews were carried out, after which their mental and cognitive states were assessed using different scales (MINI, MADRS, EHD, HAMA). Finally, all participants completed 3 self-report questionnaires: 2 assessing coping strategies (WCC, CHIP) and 1, quality of life (Parkinson's disease questionnaire-39). It appears that the presence of dyskinesia, depression, and anxiety were linked to a poor quality of life. Interestingly, some different coping strategies, namely diversion as well as emotional strategies, were associated with a poor quality of life. These results encourage us to develop interventions focused on coping strategies and tailored to the emotional and clinical characteristics of each patient.

Validation of an Estonian version of the Parkinson's Disease Questionnaire (PDQ-39)

Introduction

Diagnosis and management of Parkinson's disease (PD) rely heavily on evaluation of clinical symptoms and patients' subjective perception of their condition. The purpose of this study was to evaluate the validity, acceptability, and reliability of the Estonian version of the 39-question Parkinson 's disease Questionnaire (PDQ-39).

Methods

Study subjects were approached during their regular clinic follow-up visits. 104 patients consented to the study and 81 completed questionnaires were used for subsequent testing of psychometric characteristics, validity and reliability.

Results

The content validity was assessed through qualitative content analysis during the pilot study. The patients indicated that the questions were relevant to measure the quality of life of people with PD.

The analysis of means showed that the ceiling and floor effects of domain results were within the limits of 15% of Summary Index and of all domains except Stigma, Social Support and Communication where the ceiling effect was 16% to 24% of the responses. Convergent validity was interpreted through correlation between disease severity and PDQ-39 domains. There was a statistically significant difference between the domain scores in patients with mild versus moderate PD in domains of Mobility, ADL, and Communication but not for Stigma, Social Support and Cognition. The reliability was good, Cronbach alpha for all domains and summary index was over 0.8 and item-test correlations between domains and summary index ranged from 0.56 to 0.83.

Conclusion

The psychometric characteristics of an Estonian version of the PDQ-39 were satisfactory. The results of this study were comparable to the results of previous validation studies in other cultural settings in UK, USA, Canada, Spain and Italy.

The Estonian version of the PDQ-39 is an acceptable, valid and reliable instrument for quality of life measurement in PD patients.

The suitability of patient‐based measures in the field of Parkinson's disease: A systematic review

The aim of this study is to appraise the suitability of current quality of life (QOL) questionnaires for use in the field of Parkinson's disease (PD). Computerized bibliographic databases were screened for publications from 1960 to December 2006. Predefined selection criteria were used to identify QOL questionnaires in PD studies. Two investigators independently assessed and, subsequently, agreed on a set of multidimensional generic and PD-specific QOL questionnaires. Data were extracted concerning the internal structure, reliability, validity, and responsiveness of the included questionnaires. Sixteen-questionnaires were found, of which 14 questionnaires were included (six generic measures and eight PD-specific). In general, the psychometrics of all the questionnaires were adequately described. Sensitivity to change, however, has been reported for only a limited number of instruments. Almost all included questionnaires used QOL as a keyword, but only two questionnaires fitted the broad QOL definition used in this review. Considering the few "real " QOL questionnaires, we conclude that there is a strong need for such instruments.

A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis

BACKGROUND

The issue of when to start treatment in Parkinson's disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a "wait and watch" policy. The effect of the latter policy on the self reported health status of people with PD is unknown.

AIMS

To record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up.

METHODS

A multicentre, prospective, "real life" observational audit based study addressing patient reported outcomes in relation to self reported health status and other sociodemographic details.

RESULTS

198 untreated PD were assessed over a mean period of 18 months. During two follow-up assessments, the self reported health status scores in all eight domains of the PDQ-39 and the overall PDQ-39 summary index worsened significantly (p<0.01) in patients left untreated. In a comparative group in whom treatment was initiated at or soon after diagnosis, there was a trend towards improvement in self reported health status scores after treatment was started.

CONCLUSIONS

This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.

TCH346 as a neuroprotective drug in Parkinson's disease: a double-blind, randomised, controlled trial

BACKGROUND

There is an important unmet medical need in Parkinson's disease for a neuroprotective treatment that slows or stops disease progression. TCH346 is a potent anti-apoptotic drug that protects against loss of dopaminergic neurons in laboratory models. Our aim was to assess TCH346 as a neuroprotective drug in patients with Parkinson's disease.

METHODS

Patients presenting at 45 international movement disorder clinics with early untreated Parkinson's disease were assessed as part of this parallel-group, double-blind, randomised controlled trial. 301 eligible patients were randomly assigned 12-18 months' treatment with TCH346 at a daily dose of 0.5 mg (n=78), 2.5 mg (n=79), or 10 mg (n=73), or placebo (n=71), followed by a 4 week washout period. The primary outcome measure was time to development of a disability requiring dopaminergic treatment. Secondary outcome measures were the annual rate of change in the unified Parkinson's disease rating scale (UPDRS) and the PDQ-39, a measure of quality of life. Analyses were by intention-to-treat. This study is pending registration with .

FINDINGS

255 patients completed the study. TCH346 did not differ from placebo for any of the study outcomes. Treatment was needed in 26 (34%) patients in the TCH346 0.5 mg group, 30 (38%) in the TCH346 2.5 mg group, 24 (33%) in the TCH346 10 mg group, and 23 (32%) in the placebo group. There were no significant differences between groups. There were no differences between groups in the annual change in the UPDRS or PDQ-39 either. Few patients withdrew because of adverse events and none was judged to be related to the study intervention.

INTERPRETATION

TCH346 did not show evidence of a neuroprotective effect. The discrepancy between the preclinical promise of TCH346 and the clinical outcome could have arisen because of the use of laboratory models that do not accurately reflect the pathogenesis of Parkinson's disease, the doses of study drug used, insensitive clinical endpoints, and the patient population selected for study.

Efficacy and tolerability of entacapone versus cabergoline in parkinsonian patients suffering from wearing-off

In this 12-wk, multi-center, randomized, open-label, rater-blinded study, efficacy and tolerability of Entacapone (ENT) or Cabergoline (CBG) in conjunction with levodopa were compared in 161 older Parkinson's disease patients with wearing-off. Patients received either ENT, 3 to 5 times daily, or CBG, titrated according to requirements to a maximum of 6 mg/d. A significant decrease of nearly 2 hours in the daily OFF-time (primary efficacy variable) was recorded in both treatment groups. The non-inferiority test failed despite a trend in favor of ENT. Reduction in OFF-time occurred faster in the ENT compared to the CBG treated patients. A decrease of approximately 20% was detected in parts II and III of the UPDRS, with no differences between the groups. Forty-three percent of the patients in the ENT group reported dyskinesias at baseline, and 35% at the final visit. The corresponding figures in the CBG group were 46% and 43%. Quality of life, measured by PDQ-39, increased substantially with both ENT and CBG. The mean daily dosage at the final visit was 698 mg for ENT (plus 447 mg levodopa) and 3.45 mg for CBG (plus 475 mg levodopa). Adverse events (AE), leading to discontinuation, were reported in 8.5% of the ENT and 13.9% of the CBG treated patients. Nausea was the most common AE in each group, corresponding figures being 7.3% with ENT and 25.3% with CBG (P=0.0024). A probable or possible causal relationship with ENT was reported in 41% and with CBG in 64% of the AE. Among these, only one serious AE (dehydration) was recorded with each treatment group. ENT and CBG reduced the patient's motor complications effectively and to a similar degree. The clinical benefit was more quickly apparent with ENT, which also showed a more favorable AE profile than CBG.