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Kaplan RI, McDowell CP, Wall J, Kinger SB, Salazar RD, Neargarder S, Cronin‐Golomb A. Discordance between Reports of Internalized Symptoms in Persons with Parkinson's Disease and Informants: Results from an Online Survey. Mov Disord Clin Pract 2024; 11:391-397. [PMID: 38269854 PMCID: PMC10982598 DOI: 10.1002/mdc3.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Self-report of motor and non-motor symptoms is integral to understanding daily challenges of persons with Parkinson's disease (PwPD). Care partners are often asked to serve as informants regarding symptom severity, raising the question of concordance with PwPD self-reports, especially regarding internalized (not outwardly visible) symptoms. OBJECTIVES Concordance between PwPD and informant ratings of motor and non-motor symptoms was evaluated across multiple domains. METHODS In 60 PwPD-informant pairs, we compared ratings on 11 online self-report measures comprising 33 total scores, 2/3 of which represented purely internalized symptoms. For discordant scores, multiple regression analyses were used to examine demographic/clinical predictors. RESULTS Though concordant on 85% of measures, PwPD endorsed more non-motor symptoms, bodily discomfort, stigma, and motor symptoms than informants. For PwPD, younger age, greater disease severity, and female gender predicted discordance. CONCLUSIONS Discordance between PwPD and informants on measures assessing symptoms that cannot be outwardly observed may require targeted education.
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Affiliation(s)
- Rini I. Kaplan
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | | | - Juliana Wall
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Shraddha B. Kinger
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Robert D. Salazar
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Sandy Neargarder
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
- Department of PsychologyBridgewater State UniversityBridgewaterMAUSA
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2
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Bouça-Machado R, Fernandes A, Ranzato C, Beneby D, Nzwalo H, Ferreira JJ. Measurement tools to assess activities of daily living in patients with Parkinson's disease: A systematic review. Front Neurosci 2022; 16:945398. [PMID: 35992900 PMCID: PMC9386643 DOI: 10.3389/fnins.2022.945398] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Parkinson's disease (PD) is associated with a progressive inability to accomplish essential activities of daily living (ADL) resulting in a loss of autonomy and quality of life. Accurate measurement of ADL in PD is important to monitor disease progression and optimize care. Despite its relevance, it is still unclear which measurement instruments are the most suitable for evaluating ADL in people with PD. Objective To identify and critically appraise which measurement instruments have been used to assess ADL in PD. Methods A systematic review was conducted using the databases CENTRAL, MEDLINE, and PEDro from their inception to October 2021 to identify all observational and experimental studies conducted in PD or atypical parkinsonism that included an ADL assessment. Titles and abstracts were screened independently by two authors. The clinimetric properties of the measurement instruments were assessed, and the instruments were classified as "recommended," "suggested," or "listed." Results A total of 129 articles were included, with 37 measurement instruments used. The Unified Parkinson's Disease Rating Scale (UPDRS), the Schwab & England ADL scale (S&E scale), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Barthel Index, the Lawton-Brody Instrumental Activities of Daily Living Scale, the Functional Independence Measure (FIM) and the Alzheimer's Disease Cooperative Study - ADL (ADCS-ADL) scale were the seven most frequently cited measurement instruments. Of these, only two included an assessment of basic and instrumental ADL. Conclusion MDS-UPDRS and the S&E scale were the only two scales that could be classified as recommended. For the MDS-UPDRS, either the full version or only Part II, which is focused on ADL, can be used. Future studies should explore the use of wearable devices to assess ADL remotely and more continuously.
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Affiliation(s)
- Raquel Bouça-Machado
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS-Campus Neuroloígico, Torres Vedras, Portugal
| | - Adriana Fernandes
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
| | - Carlo Ranzato
- European School of Physiotherapy, Hogeschool Van Amsterdam, Amsterdam, Netherlands
| | - Duane Beneby
- European School of Physiotherapy, Hogeschool Van Amsterdam, Amsterdam, Netherlands
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal.,Algarve Biomedical Center Research Institute, Algarve, Portugal
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS-Campus Neuroloígico, Torres Vedras, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Becker S, Solbrig S, Michaelis K, Faust B, Brockmann K, Liepelt-Scarfone I. Divergence Between Informant and Self-Ratings of Activities of Daily Living Impairments in Parkinson’s Disease. Front Aging Neurosci 2022; 14:838674. [PMID: 35222002 PMCID: PMC8874137 DOI: 10.3389/fnagi.2022.838674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine the agreement between self- and informant-reported activities of daily living (ADL) deficits in Parkinson’s Disease (PD) patients, and to examine factors influencing ADL ratings.BackgroundIn PD, the loss of functional independence is an important outcome of disease progression. The valid assessment of ADL function in PD is essential, but it is unclear to what extent informants’ and patients’ perceptions of their daily functions concur, and how other factors may influence both ratings.MethodsData of 150 PD patients who underwent cognitive and motor testing, as well as their informants were analyzed. The 10-item Functional Activities Questionnaire (FAQ), completed separately by patients (FAQ-S) and their informants (FAQ-I), assessed ADL function. Weighted κ statistics summarized level of agreement, and a discrepancy score (FAQ-I – FAQ-S) quantified agreement. Correlation analyses between FAQ total scores, patient and informant characteristics, and cognitive scores were conducted, with post hoc regressions to determine the associations between both FAQ scores and cognition, independent of patient characteristics.ResultsThe sample included 87 patients with normal cognition, 50 with mild cognitive impairment, and 13 with dementia. Overall, there was fair to moderate agreement between patients and informants on individual FAQ items (0.27 ≤ κ ≤ 0.61, p < 0.004), with greater discrepancies with increasing cognitive impairment. Patients’ age, motor severity, non-motor burden, and depression also affected both ratings (0.27 ≤ r ≤ 0.50, p < 0.001), with motor severity showing the greatest influence on both ratings. Both the FAQ-I and FAQ-S were correlated with almost all cognitive domains. Post hoc regression analyses controlling for patient characteristics showed that the attention domain was a significant predictor of both the FAQ-S and FAQ-I scores, and memory was also a significant predictor of the FAQ-I score. Only 29.3% of patients agreed perfectly with informants on the FAQ total score, with informants most commonly rating ADL impairments as more severe than patients.ConclusionsPatient and informant ratings of ADL function using FAQ items showed moderate agreement, with only few items reaching substantial agreement. Ratings of both were associated with patient cognitive status, but also other characteristics. In addition to patient and informant reports, objective measures are needed to accurately classify ADL deficits in PD.
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Affiliation(s)
- Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Katja Michaelis
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Bettina Faust
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
- Studienzentrum Stuttgart, IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
- *Correspondence: Inga Liepelt-Scarfone,
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Pennington C, Duncan G, Ritchie C. Altered awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review. Int J Geriatr Psychiatry 2021; 36:15-30. [PMID: 32869379 DOI: 10.1002/gps.5415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Altered awareness of cognitive and neuropsychiatric symptoms is a common feature of neurodegeneration, which can significantly impact on quality of life, medication concordance and personal safety. Elucidating how awareness is affected by common alpha-synucleinopathies therefore has significant clinical relevance. We performed a systematic review of the literature on awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies. METHODS Searches of PubMed and Web of Science were carried out, using keywords and MeSH subheadings, limited to papers in English dealing with humans. The terms "Parkinson's" or "Lewy body" were used to denote the disease of interest, combined with either "agnosia", "anosognosia", "insight", "metacognition", or "neuropsychology" to denote the neuropsychological area of interest. RESULTS 21 publications investigating awareness of cognitive symptoms, and 18 publications on awareness of neuropsychiatric symptoms were identified. The large majority focused on Parkinson's disease rather than Dementia with Lewy Bodies. Cognitively intact people with Parkinson's disease may over-report cognitive symptoms, whilst those with cognitive impairment under-report symptoms. Awareness of neuropsychiatric symptoms is likely to decline over time, particularly in those with progressive cognitive impairment. CONCLUSIONS Altered awareness of cognitive and neuropsychiatric symptoms is common in Parkinson's disease. Symptom awareness varies significantly between individuals, and appears to be influenced by mood and global cognitive functioning, with executive functioning specifically implicated. There are gaps in our understanding of how dopaminergic medications influence symptom awareness, and a need for longitudinal studies of how awareness changes over time in Parkinson's disease and Dementia with Lewy Bodies.
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Affiliation(s)
- Catherine Pennington
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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5
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Palleis C, Gehmeyr M, Mehrkens JH, Bötzel K, Koeglsperger T. Establishment of a Visual Analog Scale for DBS Programming (VISUAL-STIM Trial). Front Neurol 2020; 11:561323. [PMID: 33192994 PMCID: PMC7661931 DOI: 10.3389/fneur.2020.561323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Deep brain stimulation (DBS) has become a standard treatment for advanced stages of Parkinson's disease, essential tremor, and dystonia. In addition to the correct surgical device implantation, effective programming is regarded to be the most important factor for clinical outcome. Despite established strategies for adjusting neurostimulation, DBS programming remains time- and resource-consuming. Although kinematic and neuronal biosignals have recently been examined as potential feedback for closed-loop DBS (CL-DBS), there is an ongoing need for programming strategies to adapt the stimulation parameters and electrode configurations accurately and effectively. Methods: Here, we tested the usefulness of a patient-rated visual analog scale (VAS) for real-time adjustment of DBS parameters. The stimulation parameters (contact and amplitude) in Parkinson's patients with STN-DBS (n = 17) were optimized based on the patient's subjective VAS rating. A Minkowski distance (Md) was calculated to compare the individual combination of contact selection and amplitude to the stimulation parameters that resulted from classical programming based on clinical signs and symptoms. Results: We found no statistically significant difference between VAS-based and classical programming in regard to the specific contact or amplitude used or in regard to the clinical disease severity (UPDRS). Conclusions: Our data suggest that VAS-based and classical programming strategies both lead to similar short-term results. Although further research will be required to assess the validity of VAS-based DBS programming, our results support the investigation of the patient's subjective rating as an additional and valid feedback signal for individualized DBS adjustment.
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Affiliation(s)
- Carla Palleis
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Mona Gehmeyr
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,Department of Translational Brain Research, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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6
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Müller-Oehring EM, Fama R, Levine TF, Hardcastle C, Goodcase R, Martin T, Prabhakar V, Brontë-Stewart HM, Poston KL, Sullivan EV, Schulte T. Cognitive and motor deficits in older adults with HIV infection: Comparison with normal ageing and Parkinson's disease. J Neuropsychol 2020; 15:253-273. [PMID: 33029951 DOI: 10.1111/jnp.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/10/2020] [Indexed: 12/24/2022]
Abstract
Despite the life-extending success of antiretroviral pharmacotherapy in HIV infection (HIV), the prevalence of mild cognitive impairment in HIV remains high. Near-normal life expectancy invokes an emerging role for age-infection interaction and a potential synergy between immunosenescence and HIV-related health factors, increasing risk of cognitive and motor impairment associated with degradation in corticostriatal circuits. These neural systems are also compromised in Parkinson's disease (PD), which could help model the cognitive deficit pattern in HIV. This cross-sectional study examined three groups, age 45-79 years: 42 HIV, 41 PD, and 37 control (CTRL) participants, tested at Stanford University Medical School and SRI International. Neuropsychological tests assessed executive function (EF), information processing speed (IPS), episodic memory (MEM), visuospatial processing (VSP), and upper motor (MOT) speed and dexterity. The HIV and PD deficit profiles were similar for EF, MEM, and VSP. Although only the PD group was impaired on MOT compared with CTRL, MOT scores were related to cognitive scores in HIV but not PD. Performance was not related to depressive symptoms, socioeconomic status, or CD4+ T-cell counts. The overlap of HIV-PD cognitive deficits implicates frontostriatal disruption in both conditions. The motor-cognitive score relation in HIV provides further support for the hypothesis that these processes share similar underlying mechanisms in HIV infection possibly expressed with or exacerbated by ageing.
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Affiliation(s)
- Eva M Müller-Oehring
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA.,Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Rosemary Fama
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA.,Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Taylor F Levine
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA
| | - Cheshire Hardcastle
- Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Ryan Goodcase
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA
| | - Talora Martin
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA
| | - Varsha Prabhakar
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA
| | - Helen M Brontë-Stewart
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA.,Neurosurgery, Stanford University School of Medicine, California, USA
| | - Kathleen L Poston
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA.,Neurosurgery, Stanford University School of Medicine, California, USA
| | - Edith V Sullivan
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA
| | - Tilman Schulte
- Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA.,Clinical Psychology, Palo Alto University, California, USA
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7
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Pennington C, Duncan G, Ritchie C. Altered awareness of motor symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review. Int J Geriatr Psychiatry 2020; 35:972-981. [PMID: 32525228 DOI: 10.1002/gps.5362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Altered awareness of motor symptoms is reported in people with Parkinson's disease and Dementia with Lewy Bodies, and may adversely affect quality of life and medication concordance. How symptom awareness is influenced by motor and cognitive disease severity, age and medication use is not fully understood. We carried out a systematic review of the literature on motor symptom awareness in Parkinson's disease and Dementia with Lewy Bodies. METHODS Pubmed and Wed of Science were searched for relevant articles published in or prior to March 2019. Data regarding participant demographics, diagnosis, cognitive status, method of assessing awareness and study findings were extracted from relevant publications. RESULTS Sixteen relevant publications were identified. Motor symptom awareness appears to decline over the course of Parkinson's disease. Imaging studies implicate the prefrontal cortex, with different mechanisms involved in hypokinesia and dyskinesia awareness. The hypothesis that people with right hemisphere based disease would have more severely reduced awareness is only weakly supported. Most studies focused on cognitively intact individuals, and on awareness of dyskinesia rather than hypokinesia. CONCLUSIONS Whilst reduced awareness of dyskinesia and to a lesser extent hypokinesia is common, there is a lack of longitudinal data on how awareness changes over time, and how it interacts with global cognitive changes. Motor symptom awareness in Dementia with Lewy Bodies is understudied. Future studies of symptom awareness should include robust assessment of overall cognitive functioning, and use a longitudinal design to elucidate how awareness changes over time. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Catherine Pennington
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Telemedicine in the Era of Coronavirus Disease 2019 (COVID-19): A Neurosurgical Perspective. World Neurosurg 2020; 139:549-557. [PMID: 32426065 PMCID: PMC7229725 DOI: 10.1016/j.wneu.2020.05.066] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022]
Abstract
Despite the substantial growth of telemedicine and the evidence of its advantages, the use of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the coronavirus disease 2019 (COVID-19) pandemic has limited typical evaluation of patients with neurologic issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuroexamination. However, we argue that an accurate and comprehensive neurologic examination can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. In addition, certain neurosurgical visits such as postoperative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.
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Taghizadeh G, Martinez-Martin P, Meimandi M, Habibi SAH, Jamali S, Dehmiyani A, Rostami S, Mahmuodi A, Mehdizadeh M, Fereshtehnejad SM. Barthel Index and modified Rankin Scale: Psychometric properties during medication phases in idiopathic Parkinson disease. Ann Phys Rehabil Med 2019; 63:500-504. [PMID: 31816448 DOI: 10.1016/j.rehab.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/04/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Independence in activities of daily living (ADL) is one of the most important aspects in planning treatment for people with Parkinson disease (PD). The Barthel Index (BI) and modified Rankin Scale (mRS) are commonly used in neurological diseases. OBJECTIVE This study was conducted to confirm the validity and reliability of the BI and mRS in PD during ON and OFF medication phases. METHODS We included 260 individuals with a diagnosis of idiopathic PD. The disability in ADL was measured by the BI, mRS, Parkinson's Disease Questionnaire-39 (PDQ-39), Unified Parkinson Disease Rating Scale-Activities of Daily Living (UPDRS-ADL), and Schwab and England ADL scale (SE). Test-retest, inter-rater reliability, and internal consistency were assessed by the intra-class correlation (ICC) and Cronbach α coefficients. Dimensionality was evaluated by factor analysis. Convergent validity was assessed by the SE, Berg Balance Scale (BBS), PDQ-39 and UPDRS-ADL. RESULTS For the 260 participants (187 [71.9%] males; mean [SD] age 60.3 [12.3] years), both the BI and mRS achieved an acceptable level of test-retest and inter-rater reliability (ICC=0.77 to 0.91) in ON and OFF medication phases. The Cronbach α for BI was 0.85 and 0.88, respectively. We found 1 and 2 factors for BI in ON and OFF phases, respectively. Investigation of convergent validity showed moderate to high correlation for the BI with the UPDRS-ADL, SE, PDQ-39 (ADL), BBS and mRS scores in ON and OFF phases (ρ=0.51-0.74) and mRS with SE, UPDRS-ADL, PDQ-39 (ADL) and BBS scores (ρ=0.48-0.82). CONCLUSION The BI and mRS showed acceptable validity and reliability to measure the degree of disability in patients with PD in daily activities in both ON and OFF medication phases.
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Affiliation(s)
- Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Mahsa Meimandi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Sayed Amir Hasan Habibi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Shamsi Jamali
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Arian Dehmiyani
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Siavash Rostami
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Alieh Mahmuodi
- Department of Aging, University of Social Welfare Rehabilitation Sciences, Tehran, Iran
| | - Maryam Mehdizadeh
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Division of Neurology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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10
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Balestrino R, Hurtado-Gonzalez CA, Stocchi F, Radicati FG, Chaudhuri KR, Rodriguez-Blazquez C, Martinez-Martin P. Applications of the European Parkinson's Disease Association sponsored Parkinson's Disease Composite Scale (PDCS). NPJ PARKINSONS DISEASE 2019; 5:26. [PMID: 31798050 PMCID: PMC6881347 DOI: 10.1038/s41531-019-0097-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/18/2019] [Indexed: 12/31/2022]
Abstract
This study was addressed to determine the presence of Parkinson disease (PD) manifestations, their distribution according to motor subtypes, and the relationships with health-related quality of life (QoL) using the recently validated European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). Frequency of symptoms was determined by the scores of items (present if >0). Using ROC analysis and Youden method, MDS-UPDRS motor subtypes were projected on the PDCS to achieve a comparable classification based on the PDCS scores. The same method was used to estimate severity levels from other measures in the study. The association between the PDCS and QoL (PDQ-39) was analyzed by correlation and multiple linear regression. The sample consisted of 776 PD patients. We found that the frequency of PD manifestations with PDCS and MDS-UPDRS were overlapping, the average difference between scales being 5.5% only. Using the MDS-UPDRS subtyping, 215 patients (27.7%) were assigned as Tremor Dominant (TD), 60 (7.7%) Indeterminate, and 501 (64.6%) Postural Instability and Gait Difficulty (PIGD) in this cohort. With this classification as criterion, the analogous PDCS-based ratio provided these cut-off values: TD subtype, ≥1.06; Indeterminate, <1.06 but >0.65; and PIGD, <0.65. The agreement between the two scales on this classification was substantial (87.6%; kappa = 0.69). PDCS total score cut-offs for PD severity were: 23/24 for mild/moderate and 41/42 for moderate/severe. Moderate to high correlations (r = 0.35–0.80) between PDCS and PDQ-39 were obtained, and the four PDCS domains showed a significant independent influence on QoL. The conclusions are: (1) the PDCS assessed the frequency of PD symptoms analogous to the MDS-UPDRS; (2) motor subtypes and severity levels can be determined with the PDCS; (3) a significant association between PDCS and QoL scores exists.
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Affiliation(s)
| | - Carlos Alberto Hurtado-Gonzalez
- 2Facultad de Psicología, Universidad Cooperativa de Colombia, Seccional Cali, and Facultad de Medicina, Universidad Libre, Cali, Colombia
| | - Fabrizio Stocchi
- 3Institute for Research and Medical Care, IRCCS, San Raffaele, Rome, Italy
| | | | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,5Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK
| | | | - Pablo Martinez-Martin
- 6National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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Psychometric properties of the Berg balance scale in idiopathic Parkinson’ disease in the drug off-phase. Neurol Sci 2018; 39:2175-2181. [DOI: 10.1007/s10072-018-3570-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Prashanth R, Dutta Roy S. Early detection of Parkinson's disease through patient questionnaire and predictive modelling. Int J Med Inform 2018; 119:75-87. [PMID: 30342689 DOI: 10.1016/j.ijmedinf.2018.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/01/2018] [Accepted: 09/06/2018] [Indexed: 01/10/2023]
Abstract
Early detection of Parkinson's disease (PD) is important which can enable early initiation of therapeutic interventions and management strategies. However, methods for early detection still remain an unmet clinical need in PD. In this study, we use the Patient Questionnaire (PQ) portion from the widely used Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) to develop prediction models that can classify early PD from healthy normal using machine learning techniques that are becoming popular in biomedicine: logistic regression, random forests, boosted trees and support vector machine (SVM). We carried out both subject-wise and record-wise validation for evaluating the machine learning techniques. We observe that these techniques perform with high accuracy and high area under the ROC curve (both >95%) in classifying early PD from healthy normal. The logistic model demonstrated statistically significant fit to the data indicating its usefulness as a predictive model. It is inferred that these prediction models have the potential to aid clinicians in the diagnostic process by joining the items of a questionnaire through machine learning.
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Affiliation(s)
- R Prashanth
- Department of Electrical Engineering, Indian Institute of Technology Delhi, India.
| | - Sumantra Dutta Roy
- Department of Electrical Engineering, Indian Institute of Technology Delhi, India
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Rodríguez-Blázquez C, Alvarez M, Arakaki T, Campos Arillo V, Chaná P, Fernández W, Garretto N, Martínez-Castrillo JC, Rodríguez-Violante M, Serrano-Dueñas M, Ballesteros D, Rojo-Abuin JM, Ray Chaudhuri K, Merello M, Martínez-Martín P. Self-Assessment of Disability in Parkinson's Disease: The MDS-UPDRS Part II Versus Clinician-Based Ratings. Mov Disord Clin Pract 2017; 4:529-535. [PMID: 30363416 DOI: 10.1002/mdc3.12462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/11/2022] Open
Abstract
Background Parkinson's disease (PD) is characterized by motor and nonmotor symptoms that progress with time, causing disability. The performance of a disease-specific, self-applied tool for assessing disability, the MDS-UPDRS Part II, is tested against generic and rater-based rating scales. Methods An international, cross-sectional, observational study was performed. Patients were assessed with the Hoehn and Yahr (HY) and five disability measures: MDS-UPDRS Part II, Schwab and England Scale (S&E), Clinical Impression of Severity Index-PD (CISI-PD) Disability item, Barthel Index (BI), and Rapid Assessment of Disability Scale (RADS). Data analysis included correlation coefficients, Mann-Whitney and Kruskal-Wallis tests, and intraclass-correlation coefficient for concordance. Results The sample was composed of 451 patients, 55.2% men, with a mean age of 65.06 years (SD = 10.71). Disability rating scales correlated from |0.75| (CISI-PD Disability with BI) to 0.87 (MDS-UPDRS Part II with RADS). In general, MDS-UPDRS Part II showed high correlation coefficients with clinical variables and satisfactory concordance with the rest of disability measures, with ICC ranging from 0.83 (with BI) to 0.93 (with RADS). All disability rating scales showed statistical significant differences in the sample grouped by sex, age, disease duration, and severity level. Conclusions The MDS-UPDRS Part II showed an appropriate performance to assess disability in PD, even better than some rater-based, generic or specific, scales applied in this study.
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Affiliation(s)
| | - Mario Alvarez
- Department of Movement Disorders and Neurodegeneration CIREN La Habana Cuba
| | - Tomoko Arakaki
- Department of Neurology Hospital Ramos Mejía Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA) Buenos Aires Argentina
| | - Víctor Campos Arillo
- Movement Disorders Unit Department of Neuroscience Hospital Vithas-Xanit International Benalmadena Malaga Spain
| | - Pedro Chaná
- CETRAM Facultad de Ciencias Médicas Universidad de Santiago de Chile Santiago Chile
| | - William Fernández
- Movement Disorders Unit Department of Neurology Universidad Nacional de Colombia Bogotá Colombia
| | - Nélida Garretto
- Department of Neurology Hospital Ramos Mejía Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA) Buenos Aires Argentina
| | | | | | - Marcos Serrano-Dueñas
- Movement Disorder and Biostatistics Units Neurological Service Carlos Andrade Marín Hospital and Medicine Faculty (Ecuadorian Institute of Social Security) Pontifical Catholic University of Ecuador Quito Ecuador
| | - Diego Ballesteros
- Movement Disorders Section Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina
| | - Jose Manuel Rojo-Abuin
- Department of Statistics Centre of Human and Social Sciences Spanish Council for Scientific Research Madrid Spain
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence King's College Hospital King's College London
| | - Marcelo Merello
- Movement Disorders Section Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina
| | - Pablo Martínez-Martín
- National Center of Epidemiology and CIBERNED Carlos III Institute of Health Madrid Spain
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Martínez-Martín P, Rojo-Abuin JM, Rodríguez-Violante M, Serrano-Dueñas M, Garretto N, Martínez-Castrillo JC, Arillo VC, Fernández W, Chaná-Cuevas P, Arakaki T, Alvarez M, Ibañez IP, Rodríguez-Blázquez C, Chaudhuri KR, Merello M. Analysis of four scales for global severity evaluation in Parkinson's disease. NPJ PARKINSONS DISEASE 2016; 2:16007. [PMID: 28725695 PMCID: PMC5516587 DOI: 10.1038/npjparkd.2016.7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/10/2016] [Accepted: 03/18/2016] [Indexed: 01/01/2023]
Abstract
Global evaluations of Parkinson’s disease (PD) severity are available, but their concordance and accuracy have not been previously tested. The present international, cross-sectional study was aimed at determining the agreement level among four global scales for PD (Hoehn and Yahr, HY; Clinical Global Impression of Severity, CGIS; Clinical Impression of Severity Index, CISI-PD; and Patient Global Impression of Severity, PGIS) and identifying which of them better correlates with itemized PD assessments. Assessments included additional scales for evaluation of the movement impairment, disability, affective disorders, and quality of life. Spearman correlation coefficients, weighted and generalized kappa, and Kendall’s concordance coefficient were used. Four hundred thirty three PD patients, 66% in HY stages 2 or 3, mean disease duration 8.8 years, were analyzed. Correlation between the global scales ranged from 0.60 (HY with PGIS) to 0.91 (CGIS with CISI-PD). Kendall’s coefficient of concordance resulted 0.76 (P<0.0001). HY and CISI-PD showed the highest association with age, disease duration, and levodopa-equivalent daily dose, and CISI-PD with measures of PD manifestations, disability, and quality of life. PGIS and CISI-PD correlated similarly with anxiety and depression scores. The lowest agreement in classifying patients as mild, moderate, or severe was observed between PGIS and HY or CISI-PD (58%) and the highest between CGIS and CISI-PD (84.3%). The four PD global severity scales agree moderately to strongly among them; clinician-based ratings estimate PD severity, as established by other measures, better than PGIS; and the CISI-PD showed the highest association with measures of impairment, disability, and quality of life.
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Affiliation(s)
- Pablo Martínez-Martín
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Jose Manuel Rojo-Abuin
- Department of Statistics, Centre of Human and Social Sciences, Spanish Council for Scientific Research, Madrid, Spain
| | | | - Marcos Serrano-Dueñas
- Movement Disorder and Biostatistics Units, Neurological Service, Carlos Andrade Marín Hospital and Medicine Faculty, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Nélida Garretto
- Department of Neurology, Hospital Ramos Mejia, Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | | | - Víctor Campos Arillo
- Movement Disorders Unit, Department of Neuroscience, Hospital Xanit International, Benalmádena (Málaga), Spain
| | - William Fernández
- Movement Disorders Unit, Department of Neurology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Pedro Chaná-Cuevas
- CETRAM, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Tomoko Arakaki
- Department of Neurology, Hospital Ramos Mejia, Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Mario Alvarez
- Department of Movement Disorders and Neurodegeneration, CIREN, La Habana, Havana, Cuba
| | - Ivonne Pedroso Ibañez
- Department of Movement Disorders and Neurodegeneration, CIREN, La Habana, Havana, Cuba
| | | | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, King's College, London, UK
| | - Marcelo Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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15
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Holden SK, Jones WE, Baker KA, Boersma IM, Kluger BM. Outcome measures for Parkinson's disease dementia: a systematic review. Mov Disord Clin Pract 2015; 3:9-18. [PMID: 26998505 DOI: 10.1002/mdc3.12225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parkinson's disease dementia (PDD) is a major cause of morbidity and mortality in Parkinson's disease (PD), which severely affects patient functioning and quality of life and increases the risk for nursing home admission. Unfortunately, current treatment options for PDD are limited and have only marginal therapeutic effects. As novel treatments are developed, there will be a need to assess their efficacy in well-designed randomized controlled trials. However, there is no consensus on the optimal outcome measures for use in PDD clinical trials. METHODS A systematic review of PDD clinical trials and empiric studies of outcome measures used in PDD was performed. Outcome measures were divided into five categories: 1) cognitive; 2) behavioral and mood; 3) activities of daily living and quality of life; 4) global; and 5) caregiver burden. FINDINGS A total of 20 PDD pharmacologic clinical trials were identified. These trials incorporated a broad array of outcome measures, which were used inconsistently across trials. We summarize the psychometric properties and other relevant data on outcome measures used, including their diagnostic utility, inter-rater reliability, test-retest reliability, responsiveness, clinically meaningful change, and availability of alternate forms. CONCLUSIONS We have identified the best-evidenced PDD outcome measures in each domain. Further research is needed to assess the validity, reliability, and clinically meaningful change of these measures in PDD to inform the design of future clinical trials and enhance the ability of clinicians, researchers and policy-makers to interpret study results. In addition, the development of outcome measures specific to PDD may be warranted.
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Affiliation(s)
- Samantha K Holden
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
| | - Wallace E Jones
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
| | - Keith A Baker
- St. Luke's University Health Network, Department of Emergency Medicine, Bethlehem, PA
| | - Isabel M Boersma
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
| | - Benzi M Kluger
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
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Urwyler P, Nef T, Müri RM, Killen A, Collerton D, Burn D, McKeith I, Mosimann UP. Patient and Informant Views on Visual Hallucinations in Parkinson Disease. Am J Geriatr Psychiatry 2015; 23:970-6. [PMID: 25623941 DOI: 10.1016/j.jagp.2014.12.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/18/2014] [Accepted: 12/25/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Visual hallucinations (VHs) are a very personal experience, and it is not clear whether information about them is best provided by informants or patients. Some patients may not share their hallucinatory experiences with caregivers to avoid distress or for fear of being labeled insane, and others do not have informants at all, which limits the use of informant-based questionnaires. The aim of this study was to compare patient and caregiver views about VHs in Parkinson disease (PD), using the North-East Visual Hallucinations Interview (NEVHI). METHODS Fifty-nine PD patient-informant pairs were included. PD patients and informants were interviewed separately about VHs using the NEVHI. Informants were additionally interviewed using the four-item version of the Neuropsychiatric Inventory. Inter-reliability and concurrent validity of the different measures were compared. RESULTS VHs were more commonly reported by patients than informants. The inter-rater agreement between NEVHI-patient and NEVHI-informant was moderate for complex VHs (Cohen's kappa = 0.44; 95% confidence interval [CI]: 0.13-0.75; t = 3.43, df = 58, p = 0.001) and feeling of presence (Cohen's kappa = 0.35; 95% CI: 0.00-0.70; t = 2.75, df = 58, p = 0.006), but agreement was poor for illusions (Cohen's kappa = 0.25; 95% CI: -0.07-0.57; t = 2.36, df = 58, p = 0.018) and passage hallucinations (Cohen's kappa = 0.16; 95% CI: -0.04-0.36; t = 2.26, df = 58, p = 0.024). CONCLUSION When assessing VHs in PD patients, it is best to rely on patient information, because not all patients share the details of their hallucinations with their caregivers.
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Affiliation(s)
- Prabitha Urwyler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René M Müri
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Alison Killen
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel Collerton
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom; Northumberland, Tyne & Wear NHS Foundation Trust, Bensham Hospital, Gateshead, United Kingdom
| | - David Burn
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ian McKeith
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Urs Peter Mosimann
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland.
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Lawrence BJ, Gasson N, Kane R, Bucks RS, Loftus AM. Activities of daily living, depression, and quality of life in Parkinson's disease. PLoS One 2014; 9:e102294. [PMID: 25025280 PMCID: PMC4099301 DOI: 10.1371/journal.pone.0102294] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/17/2014] [Indexed: 12/13/2022] Open
Abstract
This study examined whether activities of daily living (ADL) mediate the relationship between depression and health-related quality of life (HR-QOL) in people with Parkinson's disease (PD). A cross-sectional, correlational research design examined data from 174 participants who completed the Geriatric Depression Scale (GDS-15), Parkinson's Disease Questionnaire-39 (PDQ-39), and Unified Parkinson's Disease Rating Scale-section 2 (UPDRS-section 2 [ADL]). Multiple Regression Analysis (MRA) was used to examine the mediator model. Depression and ADL significantly (p<.001) predicted HR-QOL, and depression significantly (p<.001) predicted ADL. Whilst ADL did not impact on the relationship between depression and HR-QOL, there was a significant (p<.001) indirect effect of depression on HR-QOL via ADL, suggesting both direct and indirect (via ADL) effects of depression on HR-QOL. The magnitude of this effect was moderate (R2 = .13). People with PD who report depression also experience greater difficulty completing ADL, which impacts upon their HR-QOL. It is recommended that clinicians adopt a multidisciplinary approach to care by combining pharmacological treatments with psycho/occupational therapy, thereby alleviating the heterogeneous impact of motor and non-motor symptoms on HR-QOL in people with PD.
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Affiliation(s)
- Blake J. Lawrence
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Natalie Gasson
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- Parkinson's Centre (ParkC), Curtin University, Perth, Western Australia, Australia
| | - Robert Kane
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Romola S. Bucks
- Parkinson's Centre (ParkC), Curtin University, Perth, Western Australia, Australia
- School of Psychology, University of Western Australia, Perth, Western Australia, Australia
| | - Andrea M. Loftus
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- Parkinson's Centre (ParkC), Curtin University, Perth, Western Australia, Australia
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18
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Murray LL, Rutledge S. Reading comprehension in Parkinson's disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:S246-S258. [PMID: 24686432 DOI: 10.1044/2014_ajslp-13-0087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Although individuals with Parkinson's disease (PD) self-report reading problems and experience difficulties in cognitive-linguistic functions that support discourse-level reading, prior research has primarily focused on sentence-level processing and auditory comprehension. Accordingly, the authors investigated the presence and nature of reading comprehension in PD, hypothesizing that (a) individuals with PD would display impaired accuracy and/or speed on reading comprehension tests and (b) reading performances would be correlated with cognitive test results. METHOD Eleven adults with PD and 9 age- and education-matched control participants completed tests that evaluated reading comprehension; general language and cognitive abilities; and aspects of attention, memory, and executive functioning. RESULT The PD group obtained significantly lower scores on several, but not all, reading comprehension, language, and cognitive measures. Memory, language, and disease severity were significantly correlated with reading comprehension for the PD group. CONCLUSION Individuals in the early stages of PD without dementia or broad cognitive deficits can display reading comprehension difficulties, particularly for high- versus basic-level reading tasks. These reading difficulties are most closely related to memory, high-level language, and PD symptom severity status. The findings warrant additional research to delineate further the types and nature of reading comprehension impairments experienced by individuals with PD.
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Martinez-Martin P, Rodriguez-Blazquez C, Frades-Payo B. Specific patient-reported outcome measures for Parkinson’s disease: analysis and applications. Expert Rev Pharmacoecon Outcomes Res 2014; 8:401-18. [DOI: 10.1586/14737167.8.4.401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Rodriguez-Blazquez C, Rojo-Abuin JM, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A, Garretto N, Gershanik O, Kurtis MM, Martinez-Castrillo JC, Mendoza-Rodriguez A, Moore HP, Rodriguez-Violante M, Singer C, Tilley BC, Huang J, Stebbins GT, Goetz CG, Martinez-Martin P. The MDS-UPDRS Part II (motor experiences of daily living) resulted useful for assessment of disability in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:889-93. [PMID: 23791519 DOI: 10.1016/j.parkreldis.2013.05.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/24/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the motor experiences of daily living section of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS M-EDL) for assessing disability in PD patients; to determine the association between disability and quality of life; and to identify cut-off score ranges for no, mild, moderate and severe disability with this measure. METHODS International, observational, cross-sectional study of 435 PD patients, assessed with: MDS-UPDRS, Hoehn and Yahr staging, Rapid Assessment of Disability Scale, Clinical Impression of Severity Index for PD, Parkinson's Disease Questionnaire-8 and EQ-5D. Descriptive statistics, Spearman's rank correlation coefficients, Kruskal-Wallis test for group comparisons, ordinal logistic regression analysis for setting cut-off values and a step-wise multiple linear regression model were calculated. RESULTS MDS-UPDRS M-EDL correlated 0.70-0.80 with other disability measures, and -0.46 to 0.74 with quality of life scales. Scores significantly increased with higher disease duration and severity (p < 0.001). Cut-off values for the M-EDL were: 0-2 points, no disability; 3-16, mild; 17-31, moderate; and 32 points or more, severe. Linear regression analysis identified the MDS-UPDRS nM-EDL section as the main determinant of M-EDL, followed by the rest of MDS-UPDRS sections (explained variance: 59%). CONCLUSIONS MDS-UPDRS M-EDL proved to be useful for assessing disability in PD.
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21
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Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ. Quality of life and burden in caregivers for patients with Parkinson's disease: concepts, assessment and related factors. Expert Rev Pharmacoecon Outcomes Res 2012; 12:221-30. [PMID: 22458623 DOI: 10.1586/erp.11.106] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Caregivers of Parkinson's disease patients face responsibilities stemming from providing assistance to a person, usually a family member, who suffers a progressively disabling disease characterized by both motor and nonmotor symptoms. These circumstances impact on the physical, emotional and psychosocial aspects of the caregivers' lives and, therefore, on their quality of life (QoL). Studies have identified factors related to caregivers' global QoL and health-related QoL, causing caregivers distress and affecting their QoL. These factors are related to patients' and caregivers' characteristics and may be classified as sociodemographic, psychological and disease related. Caregiver's burden refers to the multiplicity of difficulties ensuing as a consequence of caring, including, for example, health problems, modification of habits, economic loss and QoL deterioration. Therefore, burden-related factors are also briefly reviewed. The implementation of effective interventions to preserve the caregiver's wellbeing and allow the patients to remain at home and be properly assisted is a pragmatic consequence of this knowledge.
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Affiliation(s)
- Pablo Martinez-Martin
- Alzheimer Disease Research Unit, CIEN Foundation-Reina Sofia Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Cl. Valderrebollo, 5, 28031 Madrid, Spain.
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22
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The importance of non-motor disturbances to quality of life in Parkinson's disease. J Neurol Sci 2011; 310:12-6. [DOI: 10.1016/j.jns.2011.05.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/07/2011] [Indexed: 11/20/2022]
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23
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Seidel SE, Tilley BC, Huang P, Palesch YY, Bergmann KJ, Goetz CG, Swearingen CJ. Subject-investigator reproducibility of the Unified Parkinson's Disease Rating Scale. Parkinsonism Relat Disord 2011; 18:230-3. [PMID: 22018910 DOI: 10.1016/j.parkreldis.2011.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the subject-investigator agreement on the Unified Parkinson's Disease Rating Scale (UPDRS) subsections I and II. METHODS Subject-investigator agreement was estimated at baseline and endpoint by Kappa statistics for individual items and concordance correlations for subscale totals using data from two NIH Exploratory Trials in Parkinson's Disease studies. RESULTS All but two questions had moderate subject-investigator agreement at baseline and endpoint. Participants consistently rated their disease activity worse that investigators. CONCLUSION UPDRS self-administration produces similar results to investigator-administration. Although slightly elevated, UPDRS self-administration can be accommodated in a clinical trial setting.
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Affiliation(s)
- Sydney E Seidel
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA
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24
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Self-awareness of motor dysfunction in patients with Huntington's disease in comparison to Parkinson's disease and cervical dystonia. J Int Neuropsychol Soc 2011; 17:788-95. [PMID: 21729402 DOI: 10.1017/s1355617711000725] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Individuals suffering from Huntington's disease (HD) have been shown to present with poor self-awareness of a variety of symptoms. The aim of this study was to better assess the self-awareness of motor symptoms and activities of daily living (ADL) impairment in HD, in comparison to Parkinson's disease (PD) and cervical dystonia (CD). In particular, the anosognosia/anosodiaphoria of involuntary movements has been investigated. Self-awareness was tested in 23 patients with HD by comparing patient and caregiver ratings in reference to clinical control groups (25 PD with dyskinesias, PDdys; 21 PD without dyskinesias, PDndys; and 20 with CD). Patients were assessed neurologically by relevant rating scales. Self-awareness was tested using a scale based on 15 films demonstrating 3 types of motor symptoms (chorea/dyskinesias, parkinsonism, torticollis) as well as the Self-Assessment Parkinson's Disease Disability Scale. General cognitive status, verbal learning, cognitive control, and mood were also analyzed. Our results indicate that self-awareness of choreic movements was affected more severely in HD than in PDdys, despite comparable cognitive status. Patient-proxy agreement on ADL impairment was roughly similar in all clinical groups. The results are discussed in the context of orbitofrontal-limbic pathology as a potential trigger of anosognosia/anosodiaphoria in individuals with HD.
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25
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Dahodwala N, Karlawish J, Siderowf A, Duda JE, Mandell DS. Delayed Parkinson's disease diagnosis among African-Americans: the role of reporting of disability. Neuroepidemiology 2011; 36:150-4. [PMID: 21508648 DOI: 10.1159/000324935] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 01/29/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Racial differences in the observed prevalence of Parkinson's disease (PD) may be due to delayed diagnosis among African-Americans. We sought to compare the stage at which African-American and white PD patients present for healthcare, and determine whether perception of disability accounts for racial differences. METHODS Using records of veterans with newly diagnosed PD at the Philadelphia Veterans Affairs Medical Center, we calculated differences in reporting of symptoms as the difference in z-scores on the Unified Parkinson Disease Rating Scale part 2 (disability) and part 3 (motor impairment). Ordinal logistic regression was used to determine predictors of stage at diagnosis. RESULTS African-American (n = 16) and white (n = 58) veterans with a mean age of 70.1 years were identified. African-Americans presented at a later PD stage than whites (median Hoehn + Yahr stage 2.5 vs. 2.0, p = 0.02) and were more likely to under-report disability relative to motor impairment (81 vs. 40%, p < 0.01). Multivariate analysis showed that under-reporting of disability accounted for much of the effect of race on stage of diagnosis. CONCLUSIONS Under-reporting of disability among African-Americans may account for later stages of PD diagnosis than whites. This study begins to explain the mechanisms underlying observed racial disparities in PD.
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Affiliation(s)
- Nabila Dahodwala
- Parkinson's Disease Research, Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA, USA.
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Nisenzon AN, Robinson ME, Bowers D, Banou E, Malaty I, Okun MS. Measurement of patient-centered outcomes in Parkinson's disease: what do patients really want from their treatment? Parkinsonism Relat Disord 2010; 17:89-94. [PMID: 20952243 DOI: 10.1016/j.parkreldis.2010.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 09/06/2010] [Accepted: 09/16/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parkinson's disease (PD) impacts several domains of functioning, some of which may be neglected when designing treatment or evaluating outcome using current clinical standards. We therefore argue that taking the patients' perspectives of their condition may allow for a more in-depth assessment of patient goals and subsequent tailoring of care. METHODS One hundred and forty-eight patients with idiopathic PD completed a modified version of the Patient-Centered Outcomes Questionnaire (PCOQ-PD), to evaluate treatment success and expectations from the patient's perspective across 10 motor and non-motor functional domains. We also examined patient subgroups based on importance of improvement in various domains. RESULTS Patients' ratings suggested there was substantial variation in functional interference that was generally unrelated to demographic variables. On average, across all domains, patients indicated a 50.32% reduction in symptoms would be successful (range = 40.63-58.23%), regardless of treatment experience. Change scores between patients' usual levels of symptom interference and their treatment success levels suggested a greater degree of change was desired in motor versus non-motor domains (p < 0.05). Finally, cluster analyses revealed two patient subgroups based on overall importance of improvement (High vs. Low Importance Endorsement). Notably, the two groups differed in self-reported usual symptom levels despite having similar clinical severity. CONCLUSIONS We empirically examined treatment success from the PD patient's view as opposed to clinician judgment alone, thereby broadening the set of criteria by which to evaluate outcome. Findings from this exploratory study may guide future treatment emphases and guide patient-provider communication via clarification of patient-defined success.
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Affiliation(s)
- Anne N Nisenzon
- Department of Clinical and Health Psychology, University of Florida, Health Science Center, P.O. Box 100165, Gainesville, FL 32610-0165, USA.
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Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil GE, Thomaes T, Giladi N. Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson's disease and their carers. Gait Posture 2009; 30:459-63. [PMID: 19660949 DOI: 10.1016/j.gaitpost.2009.07.108] [Citation(s) in RCA: 425] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 06/19/2009] [Accepted: 07/02/2009] [Indexed: 02/02/2023]
Abstract
Freezing of gait (FOG) is difficult to measure due to its unpredictable occurrence. This study investigated: (1) whether the new freezing of gait questionnaire (NFOG-Q) is a reliable measure of freezing by comparing patients' ratings with those of carers' and (2) whether adding a video improved its reliability. Non-demented people with Parkinson's disease (PD) (N=102) and their carers of similar age and cognitive status were recruited from movement disorders clinics in three countries. The NFOG-Q was administered to carers and patients independently before and after watching a video showing several examples of FOG. Patients had very high agreement between their pre- and post-video detection of FOG (Kappa=0.91). However, this was less than in carers (Kappa=0.79). The video had a significant influence (p=0.01) on the rating of FOG severity (duration) but not on the estimation of its functional impact. Post-video freezing severity scores in the 69 freezers showed high agreement with carers' scores (ICC=0.78 [0.65;0.87]). We conclude that the NFOG-Q is a reliable tool to detect and evaluate the impact and severity of FOG. Adding a video does not add to the sensitivity and specificity of FOG detection but influences the estimation of FOG severity.
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Affiliation(s)
- Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium.
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Alessandro S, Ceravolo R, Brusa L, Pierantozzi M, Costa A, Galati S, Placidi F, Romigi A, Iani C, Marzetti F, Peppe A. Non-motor functions in parkinsonian patients implanted in the pedunculopontine nucleus: focus on sleep and cognitive domains. J Neurol Sci 2009; 289:44-8. [PMID: 19765737 DOI: 10.1016/j.jns.2009.08.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Between 2005 and 2007, six patients affected by idiopathic Parkinson's disease (IPD) were submitted to the bilateral implantation (and subsequent deep brain stimulation - DBS) of the pedunculopontine nucleus (PPN) plus the subthalamic nucleus (STN). This review synthesizes the effects of PPN low-frequency stimulation on non-motor functions, focusing on patient sleep quality and cognitive performance. If not associated to STN-DBS, PPN-DBS promoted a modest amelioration of patient motor performance. However, during PPN-DBS, they experienced on the one hand a significant improvement in executive functions and working memory, on the other hand a beneficial change in sleep architecture. Overall, the limited sample hampers definite conclusions. Yet, although the PPN-DBS induced motor effects are quite disappointing (discouraging extended trials based upon the sole PPN implantation), the neuropsychological profile supports the contention by which in selected PD patients, with subtle cognitive deficits or vanished efficacy of previous implanted STN, PPN-DBS might still represent a reliable and compassionate option.
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Cotter EM, Burgio LD, Roth DL, Gerstle J, Richardson P. Comparison of Caregiver and Occupational Therapist Ratings of Dementia Patients' Performance of Activities of Daily Living. J Appl Gerontol 2008. [DOI: 10.1177/0733464807310681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although proxy reports of activities of daily living (ADLs) are commonly used, especially when the care recipient has dementia, how well these caregiver reports correspond to professionals' ratings is not always clear. In this study, dementia caregivers completed an orally administered version of the Self-Care subscale of the Functional Independence Measure (FIM). ADL interactions were videotaped in the home, and independent raters assigned a FIM score to these interactions. An occupational therapist later viewed the videotaped ADLs and assigned FIM scores to those interactions. These three sets of scores were then compared. All possible correlations were significant (n = 21; p ≤ .005; r s = .620 to .933; Mdn = .862), and there were no significant differences among ratings obtained from the different sources. These results support earlier conclusions regarding the validity and clinical utility of caregiver proxy ratings of functional ability in elders with dementia.
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Haffenden A, Khan U, Kiss ZHT, Suchowersky O. Surgery for Parkinson's disease improves disability but not impairment components of the UPDRS-II. Parkinsonism Relat Disord 2007; 13:399-405. [PMID: 17368072 DOI: 10.1016/j.parkreldis.2007.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/02/2007] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
The Unified Parkinson's Disease Rating Scale (UPDRS) activities of daily living (ADL) items have been described as reflecting both disability (true ADL items) and impairment (rather than ADLs). As a result of combining these scores, UPDRS part II scores may not accurately reflect the impact of surgery on ADLs [Hariz G.M., Lindberg M., Hariz M.I., Bergenheim A.T. Does the ADL part of the unified Parkinson's disease rating scale measure ADL? An evaluation in patients after pallidotomy and thalamic deep brain stimulation. Mov Disord 2003;18:373-81.]. The goal of the present study was to assess the metric properties of the ADL section of the UPDRS in terms of its ability to measure surgical change. We tested the effects of unilateral pallidotomy (N=14) and bilateral subthalamic nucleus (STN) DBS (N=11) on both disability and impairment components of the UPDRS-II at uniform follow-up assessment periods of 6 months and 1 year, with a subset of pallidotomy patients (N=9) re-assessed at 2 years. Across the follow-up periods in both patient groups, items identified as best reflecting disability showed significant improvement from pre-surgical levels, whereas items representing impairment showed no overall change. Consistent with this, change in total ADL scores was tempered by the inclusion of the impairment items. Because the measurement of a patient's functional status is important in determining the effectiveness of an intervention, analysis of appropriate items from the UPDRS ADL section is imperative.
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Affiliation(s)
- A Haffenden
- Movement Disorders and Therapeutic Brain Stimulation Program, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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Martínez‐Martín P, Cubo E. Scales to measure parkinsonism. HANDBOOK OF CLINICAL NEUROLOGY 2007; 83:289-327. [DOI: 10.1016/s0072-9752(07)83012-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Martinez-Martin P, Prieto L, Forjaz MJ. Longitudinal metric properties of disability rating scales for Parkinson's disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2006; 9:386-93. [PMID: 17076869 DOI: 10.1111/j.1524-4733.2006.00131.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES This study analyzes the longitudinal metric attributes of three Parkinson's disease (PD) disability scales, taking Hoehn and Yahr (HY) staging as the reference measure of PD progression. METHODS A sample of 87 PD patients was assessed during regular medical visits, using the HY, the Unified Parkinson's Disease Rating Scale--Activities of Daily Living Section (UPDRS-ADL), the Schwab and England Scale (SES), and the Intermediate Scale for Assessment of PD (ISAPD), across a follow-up period of 2.6 +/- 1.0 years. RESULTS The following cross-sectional attributes were analyzed, at baseline and again on conclusion of the study: floor and ceiling effects, convergent validity, reliability, and standard error of measurement, all of which were found to be adequate. Longitudinal reproducibility values (intraclass correlation coefficient) were 0.81 (ISAPD) to 0.84 (UPDRS-ADL). Insofar as longitudinal validity was concerned, the change scores of the three disability scales correlated significantly with the HY change score, absolute value r = 0.33 to 0.45, P < 0.003. Slightly lower values were found when taking the annual rate of change, absolute value r = 0.20 to 0.36. The three scales were acceptable, even though there were small differences among them. The "minimal clinically important difference" proposed for these scales is: SES, -6; UPDRS-ADL, +2; ISAPD, +1.5 points. CONCLUSIONS The three scales proved adequate for longitudinal assessment of PD disability. UPDRS-ADL was more precise and ISAPD more consistent. Magnitude of change and correlation with change in HY were slightly higher with the ISAPD. Effect size and standardized response mean for the minimal change in HY were higher for the UPDRS-ADL.
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Affiliation(s)
- Pablo Martinez-Martin
- Unit of Neuroepidemiology, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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Forjaz MJ, Martinez-Martin P. Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: Part II, construct and content validity. Mov Disord 2006; 21:1892-8. [PMID: 16958134 DOI: 10.1002/mds.21071] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article is the second of a two-part series concerning the metric properties of the following three Parkinson's disease (PD) scales: modified Hoehn and Yahr staging (H&Y), Schwab and England (S&E), and Unified Parkinson's Disease Rating Scale (UPDRS) 3.0. Part II focuses on construct and content validity. To assess construct validity, a sample of 1,136 PD patients completed the above-mentioned PD scales. Correlation coefficients between measures of disability and dysfunction [S&E, UPDRS Activities of Daily Living (ADL), and UPDRS Motor Examination] were |r| = 0.69-0.77, indicating good convergent validity. Results showed that the S&E (F(5,945) = 193.47; P < 0.0001) and UPDRS subscales discriminated between modified H&Y stages (F(20,2784) = 25.28; P < 0.001). A panel of 12 to 13 international experts rated the relevance of the scales and items. This enabled the scales' content validity index to be calculated, which ranged from 41.7% (UPDRS Mentation) to 83.3% (UPDRS Motor Examination). In conclusion, while the modified H&Y, S&E, and UPDRS displayed satisfactory construct validity, the content validity of all scales except UPDRS Motor Examination failed to attain adequate standards.
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Affiliation(s)
- Maria João Forjaz
- Neuroepidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
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Mackin RS, Areán P, Elite-Marcandonatou A. Problem solving therapy for the treatment of depression for a patient with Parkinson's disease and mild cognitive impairment: a case study. Neuropsychiatr Dis Treat 2006; 2:375-9. [PMID: 19412485 PMCID: PMC2671813 DOI: 10.2147/nedt.2006.2.3.375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The present investigation reports on the use of problem solving therapy (PST) to treat depression in an 83-year-old woman with Parkinson's disease (PD) and concurrent mild cognitive impairment (MCI). A neuropsychological evaluation was conducted prior to the intervention and the patient demonstrated mild deficits of executive functioning and memory. The PST treatment consisted of 12 one-hour sessions that occurred weekly. Depressive symptoms were evaluated using the Hamilton Depression Rating scale and the Montgomery-Asberg Depression rating scale. At a post-treatment assessment (week 12), clinician assessment indicated that the client no longer met criteria for MDD. Weekly depression severity ratings showed significant reduction in severity of depressive symptoms over 12 weeks. Results at 1-month and 6-month follow-up demonstrated that the therapeutic gains were not only maintained, but that the client continued to improve. These results suggest that PST may be an effective treatment for the treatment of depression for individuals with a PD and concurrent MCI.
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Affiliation(s)
- R Scott Mackin
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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Visser M, Marinus J, Stiggelbout AM, van Hilten JJ. Responsiveness of impairments and disabilities in Parkinson's disease. Parkinsonism Relat Disord 2006; 12:314-8. [PMID: 16621658 DOI: 10.1016/j.parkreldis.2006.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 01/19/2006] [Indexed: 10/24/2022]
Abstract
The objective of this study is to evaluate the responsiveness of items of the Activities of Daily Living (ADL) and Motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) in patients with Parkinson's Disease (PD). A standardized Response Mean (SRM) per item was calculated using data of four trials (n=376) that randomised patients with early PD to dopamine agonist (DA) monotherapy or placebo. In the ADL section, the SRMs ranged from -0.04 (no effect) to -0.50 (moderate effect). Hand functions were the most responsive ADL items with 'handwriting' showing the largest response. Self-assessed symptoms were the least responsive. In the Motor section, SRMs ranged from -0.09 to -0.60 with bradykinesia items showing the largest response, especially the item 'finger taps'. The tremor items showed the smallest response, however, rest tremor arms was much more responsive than rest tremor of the head and legs or postural tremor. SRMs in the placebo group ranged from 0.08 to -0.21 in the ADL section and from 0.03 to -0.35 in the Motor section. ADL and motor items have comparable and mostly small effect sizes. The most responsive items are in the ADL section hand functions and in the Motor section bradykinesia items. A more responsive ADL section would omit the self-assessed symptoms and the Motor section would retain only rest tremor arms of the tremor items.
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Affiliation(s)
- M Visser
- Department of Neurology, K5 Q 92, Leiden University Medical Centre, P.O. Box 9600, NL-2300 RC Leiden, The Netherlands.
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Martinez-Martin P, Forjaz MJ. Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: Part I, feasibility, scaling assumptions, reliability, and precision. Mov Disord 2006; 21:1182-8. [PMID: 16673397 DOI: 10.1002/mds.20916] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article sought to assess the feasibility, scaling assumptions, reliability, precision, and factor analysis of the three most widely used rating scales in Parkinson's disease (PD): modified Hoehn and Yahr (HY), Schwab and England (SE), and Unified Parkinson's Disease Rating Scale (UPDRS). A multicenter sample of 1,136 PD patients was assessed. The percentage of missing data was 8% for SE, HY, and UPDRS mentation, and almost negligible (<2%) for the other UPDRS subscales. A high floor effect was found for UPDRS mentation (23%) and complications scales (36%). Item content validity, measured by multitrait scaling analysis, was adequate for all UPDRS subscales (scaling successes > 90%). Internal consistency coefficients for the UPDRS scales ranged from 0.79 (mentation) to 0.92 (activities of daily living and motor). Factor structure of the UPDRS mentation, activities of daily living, and complications subscales was replicated. As a whole, the HY, SE, and UPDRS are acceptable, consistent, and potentially sensitive rating scales.
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Affiliation(s)
- Pablo Martinez-Martin
- Neuroepidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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Capecci M, Ricciuti RA, Burini D, Bombace VG, Provinciali L, Iacoangeli M, Scerrati M, Ceravolo MG. Functional improvement after subthalamic stimulation in Parkinson's disease: a non-equivalent controlled study with 12-24 month follow up. J Neurol Neurosurg Psychiatry 2005; 76:769-74. [PMID: 15897496 PMCID: PMC1739649 DOI: 10.1136/jnnp.2004.047001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of chronic bilateral STN-S in improving the functional status of PD patients compared with patients treated with drugs alone. METHODS Controlled study of disability index changes over 12 and 24 month chronic STN stimulation. Of 39 patients with advanced PD meeting CAPSIT criteria for STN-S, 23 underwent surgery; 16 patients decided against surgery and continued on drug schedule adjustments. Functional status was measured using the Activities of Daily Living section of the Unified Parkinson's Disease Rating Scale (UPDRS-ADL), Brown's Disability Scale, and Functional Independence Measure. UPDRS motor score and subscores for selected items, levodopa equivalent daily dose, and Beck Depression Inventory scores were also monitored. RESULTS T12 follow up data were available for all 39 patients and T24 data for 13 STN-S and 8 control subjects. Compared with controls, STN-S patients experienced significant or highly significant improvements in all independence measures at both 12 and 24 months (time x treatment effect T12: F = 19.5, p = 0.00008; T24: F = 6.2, p = 0.005). Forward stepwise regression for independent predictors of the yearly rate of UPDRS-ADL score modification in the entire sample showed that treatment was the only factor significantly associated with functional status change (beta coefficient -0.54, t value -2.5, p = 0.02), whereas other variables-UPDRS motor score, BDI, and age at disease onset and enrolment-were not in the equation. CONCLUSION STN-S is an effective therapeutic option in advanced PD. It induced a consistent improvement of functional abilities over two years to an extent that was not achieved with drug therapy alone.
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Affiliation(s)
- M Capecci
- Neurorehabilitation Clinic, Department of Neurosciences, Polytechnic University of Marche, Italy
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Leritz E, Loftis C, Crucian G, Friedman W, Bowers D. Self-Awareness of Deficits in Parkinson Disease. Clin Neuropsychol 2004; 18:352-61. [PMID: 15739807 DOI: 10.1080/1385404049052412] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Anosognosia is an unawareness or denial of deficits. While it has mainly been associated with damage to cortical brain regions, anosognosia has also been reported in patients with subcortical brain disease. The present study investigated whether anosognosia is a feature of Parkinson disease. Forty-eight Parkinson disease patients with predominantly left- (N = 16) or right-sided (N = 32) motor symptoms who eventually underwent right or left pallidotomies, and 48 individuals identified as caregivers completed questionnaires rating severity of PD. There was no discrepancy in report between patients and caregivers as a function of pallidotomy side. However, as a group, patients rated themselves as significantly less impaired on 2 measures of activities of daily living, indicating that basal ganglia dysfunction may alter insight into severity of illness. Patients and caregivers in the left-symptom PD group differed significantly on selected measures of functional independence. This suggests the potential interaction of laterality and handedness. The importance of future investigations in PD patients with more severe cognitive impairment is stressed.
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Affiliation(s)
- Elizabeth Leritz
- Department of Clinical and Health Psychology, University of Florida Brain Institute, Gainesville, FL, USA.
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