Independent validation of SCOPA–psychosocial and metric properties of the PDQ-39 Brazilian version

Is rapid eye movement sleep behavior disorder a marker of Parkinson's disease severity?

BACKGROUND

Parkinson's disease (PD) is characterized by motor and non-motor features. There are several proposed clinical markers to define disease severity. However, if rapid eye movement sleep behavior disorder (RBD) is associated with worse prognosis of both motor and non-motor findings in PD is unknown.

OBJECTIVE

To determine whether RBD is a marker of PD clinical severity.

METHODS

We cross-sectionally compared patients according to the presence of RBD and used Hoehn Yahr, Schwab and England (ADL), MDS-UPDRS, brain magnetic resonance, polysomnography and autonomic reactivity tests to evaluate PD stage and disability. Pairwise comparisons and regression techniques were used to investigate the association of PD clinical markers with RBD.

RESULTS

We enrolled 120 PD patients. RBD was present in 46 % (n = 55; median age 65 years; 67 % male), who were compared to PD patients without RBD (n = 65, median age 62 years, 64 % male). There was also a healthy control group comprising 48 subjects (median age 57 years, 54 % male). Comparing PD patients with and without RBD, RBD was associated with higher MDS-UPDRS Part II scores [15(11-21) x 12(7-16), p = 0.02], higher frequency of abnormal gait (43,6 % x 21,5 %; p = 0.01), greater use of walking aids (21,8 % x 4,6 %; p = 0.005), greater dysautonomia (56,4 % x 47,7 %, p = 0.002) and osteoporosis [PR 1,64(1.37-1.96), p < 0.001) and lower ADL scores [80(80-90) x 90(80-90); p = 0.002], CONCLUSION: The presence of RBD in PD patients was associated with indirect indicators of motor impairment, lower independence in ADL, possibly a higher frequency of dysautonomia and with a higher frequency of osteoporosis.

Psychometric properties of Arabic-translated-related quality of life scales for people with parkinson disease: a scoping review

BACKGROUND

Parkinson's disease (PD) substantially contributes to poor functional outcomes, loss in productivity, and poor health-related quality of life (HRQoL). Despite the existence of various scales, there is a notable gap in existing HRQoL reviews with regard to the availability of Arabic validated scales. As a response to this gap, the aim of our scoping review is to identify validated scales, focusing on their psychometric validation procedures, to contribute valuable insights to the understanding of HRQoL among the Arabic-speaking people with PD.

METHODS

A scoping review was conducted at the end of December 2022, using the Medline and Embase databases. The focus of this review was on examining the psychometric properties and validation procedures of included scales. Articles were included in the full-text screening process if they focused on people with PD of any age, included a scale measuring HRQoL in Arabic, and were written in English, French, or Arabic.

RESULTS

After applying inclusion/exclusion criteria, 10 studies were selected to analyze HRQoL scales validated in people with PD. However, the PDQ-39 is the only HRQol PD specific scales validated in the Arabic language. Five studies validated in people with PD were identified in the context of instrument validation (3 generic, 1 specific validated in 2 studies).

CONCLUSION

There are several HRQoL measurement scales for people with PD. However, only one specific HRQoL instrument has been validated in Arabic for people with PD. For the remaining instruments identified they were just used in people with PD without being validated in this population.

Posterior insula repetitive transcranial magnetic stimulation for chronic pain in patients with Parkinson disease - pain type matters: A double-blinded randomized sham-controlled trial

OBJECTIVES

Altered somatosensory processing in the posterior insula may play a role in chronic pain development and contribute to Parkinson disease (PD)-related pain. Posterior-superior insula (PSI) repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have analgesic effects among patients with some chronic pain conditions. This study aimed at assessing the efficacy of PSI-rTMS for treating PD-related pain.

METHODS

This was a double-blinded, randomized, sham-controlled, parallel-arm trial (NCT03504748). People with PD (PwP)-related chronic pain underwent five daily PSI-rTMS sessions for a week, followed by once weekly maintenance stimulations for seven weeks. rTMS was delivered at 10 Hz and 80% of the resting motor threshold. The primary outcome was a ≥ 30% pain intensity reduction at 8 weeks compared to baseline. Functionality, mood, cognitive, motor status, and somatosensory thresholds were also assessed.

RESULTS

Twenty-five patients were enrolled. Mean age was 55.2 ± 9.5 years-old, and 56% were female. Nociceptive pain accounted for 60%, and neuropathic and nociplastic for 20% each. No significant difference was found for 30% pain reduction response rates between active (42.7%) and sham groups (14.6%, p = 0.26). Secondary clinical outcomes and sensory thresholds also did not differ significantly. In a post hoc analysis, PwP with nociceptive pain sub-type experienced more pain relief after active (85.7%) compared to sham PSI-rTMS (25%, p = 0.032).

CONCLUSION

Our preliminary results suggest that different types of PD-related pain may respond differently to treatment, and therefore people with PD may benefit from having PD-related pain well characterized in research trials and in clinical practice.

Association between Religiousness and Quality of Life among Patients in Brazil diagnosed with Idiopathic Parkinson's Disease

The importance of religiousness in idiopathic Parkinson's disease (IPD) has been the subject of conflicting research. The impact of religiousness on quality of life and depressive symptoms has also been poorly studied in this population. This study investigated the correlation between religiousness and quality of life in patients with IPD. We evaluated 37 patients with IPD (according to the criteria of the Movement Disorders Society) who were from an outpatient clinic specializing in movement disorders in Brazil. We assessed the patients using the Duke University Religion Index and scales for motor impairment, cognition, quality of life, and depression. Spearman's test was used to check for possible correlations between the different dimensions of religiousness and the clinical variables analyzed. Patients with a worse quality of life and more depressive symptoms showed greater intrinsic religiousness.

Is PDQ-39 a reliable measure of quality of life of patients at advanced stages of Parkinson's disease considered for Deep Brain Stimulation

Purpose

Parkinson's disease (PD) significantly impedes, especially at its advanced stages, the health-related quality of life (QoL) of patients. The Parkinson's disease questionnaire (PDQ-39) is a widely-used measure assessing the impact of the disease on the patients' QoL. To date, the reliability of PDQ-39 has not been selectively evaluated for patients at a particular delineated stage of the PD progression. Against this backdrop, the study aimed firstly to evaluate comprehensively the internal consistency reliability of PDQ-39 and the constituent scales specifically for patients at the advanced stages of PD who were candidates for Deep Brain Stimulation (DBS) surgery, and secondly, to compare the Cronbach's alpha coefficients with those reported in other studies conducted with patients across all stages of the PD progression.

Methods

The sample included 36 Bulgarian patients (29 men and 7 women) at advanced stages of PD (Hoehn and Yahr stage 4), PD duration, M = 11.06, SD = 3.50). The internal consistency reliability of the questionnaire and the constituent scales was assessed using three criteria: Cronbach's alpha coefficients, inter-item and item-total correlations.

Results

The internal consistency reliability indicators were satisfactory for the entire instrument and for most of the scales and similar to those reported in previous studies. None of the scales had low internal consistency reliability results across the three criteria. Except for the Communication scale, seven of the eight scales had Cronbach's alpha values that were satisfactory or marginally below the cut off score. All scales had acceptable inter-item correlations. Three of the scales (Emotional Well-Being, Cognition and Communication) contained more than one item with non-satisfactory item-total correlations. With minor exceptions, the removal of the items with low item-total correlations either did not improve or improved marginally or even decreased the Cronbach's alpha coefficients of the respective scale. The Communication scale was the only scale with a Cronbach's alpha coefficient that was both low and comparatively different to other studies and had as well low item-total correlations for all constituent items, thus showing non-satisfactory results on two of the three internal consistency reliability estimates. In contrast, the Mobility scale met all three internal consistency reliability criteria.

Conclusion

PDQ-39 is a reliable tool for assessing the QoL of patients at advanced stages of PD across multiple health-related domains. The questionnaire can be recommended for inclusion in the best practice guidelines for evaluating DBS candidacy and the efficacy of DBS treatment for patients' QoL.

Psychometric properties of the Parkinson's disease Questionnaire-39 and its short form Parkinson's disease Questionnaire-8: A systematic review and meta-analysis

Parkinson's disease (PD) affects Quality of Life (QoL), since it is responsible for cognitive impairment, non-motor, and motor symptoms. Outcome measures are fundamental for evaluating treatment's effect on QoL over time. This systematic review aimed to identify the psychometric properties of PDQ-39 and PDQ-8 in the different populations in which they were validated. The electronic databases systematically searched are MEDLINE (via PubMed), CINAHL, SCOPUS, and Web of Science; the research was conducted in July 2023. The psychometric properties considered were those of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Risk of bias was assessed using the COSMIN checklist. The search identified 1306 articles. 398 duplicates were eliminated; 908 articles were analyzed reading title and abstract; 799 were finally excluded because used PDQ-39 and PDQ-8 as outcome measures or were not dealing with psychometric properties; 66 articles were excluded after reading the full text. 43 articles were included in the review; meta-analysis showed all the Cronbach's alpha values were statistically significant for all the subscales of PDQ-39 and PDQ-8. PDQ-39 demonstrated to be a specific HRQoL questionnaire that is correlated with generic HRQoL questionnaires, in fact in many studies included in the review, correlations with SF-36 were found. In the last studies about psychometric properties of PDQ-8 emerged that it is a practical and informative instrument that can be easily used in clinical settings, especially in busy ones, but also in large-scale studies in which a brief instrument would be preferred.

Telephone-based application of the Activities of Daily Living Questionnaire in patients with Parkinson's disease

BACKGROUND

 The Activities of Daily Living Questionnaire (ADLQ) focuses on assessing the ability to perform activities of daily living (ADLs) based on the self-perception of individuals with Parkinson's disease (PD). A Brazilian Portuguese version of the questionnaire is available (ADLQ-Brazil), and further investigation is needed to fully assess its measurement properties.

OBJECTIVE

 To investigate construct and concurrent validity of the telephone-based administration of the ADLQ-Brazil with community individuals with PD.

METHODS

 There were 50 adults with PD (mean age: 68 ± 9.5 years) invited to answer the ADLQ-Brazil on two randomized occasions, face-to-face and by telephone, 7 to 10 days apart. Clinical-based measures including the Movement Disorder Society-Sponsored Revision of the Unified Parkinson Disease Rating Scale, Timed Up and Go Test, Nine Hole Peg Test, Mini-Balance Evaluation Systems Test, Apathy Scale, Beck Depression Inventory, Modified Fatigue Impact Scale, and Parkinson Disease Quality of Life Questionnaire were applied during the first session, to establish construct validity.

RESULTS

 The total scores on the ADLQ-Brazil were significantly associated with the clinical-based measures, thus providing evidence of construct validity. No significant differences were observed between the mean scores obtained with the face-to-face and telephone-based administration of the questionnaire (95%CI = 0.997). A high level of agreement was found in the total scores obtained between both applications of the ADLQ-Brazil (95%CI = 0.994-0.998), and most of the individual items had, on average, moderate agreement.

CONCLUSION

 The findings provide psychometric support for the ADLQ-Brazil as a telephone interview to assess the performance of ADLs in individuals with PD.

Sarcopenia and dynapenia is correlated to worse quality of life perception in middle-aged and older adults with Parkinson's disease

BACKGROUND

There are few studies that assess the relationship between nutritional status and quality of life in individuals with Parkinson's disease, despite the well-established negative impact of sarcopenia and dynapenia on functional capacity and quality of life. These conditions impair protein-muscular status and are prevalent in individuals with Parkinson's disease. This study aimed to examine the relationship between nutritional status, including body composition, functional capacity, and diagnosis of sarcopenia and dynapenia, and quality-of-life perception in individuals with Parkinson's disease.

METHODS

This is a cross-sectional study conducted in two Parkinson's disease centers in the northeast of Brazil. The researchers assessed muscle strength, muscle mass, and physical performance to diagnose dynapenia, sarcopenia and functional capacity. Quality of life was estimated using the Parkinson's disease Quality of Life Questionnaire.

RESULTS

We found positive correlations between quality of life and variables such as severity and duration of the disease, as well as positive screening for sarcopenia (p<0.001). Negative correlations were observed between quality of life and muscle strength and functional capacity. The study also found that individuals with sarcopenia and dynapenia had significantly worse quality-of-life scores compared to those who did not have these nutritional outcomes (p <0.05; p <0.001).

CONCLUSIONS

The presence of sarcopenia, dynapenia, low gait speed, disease duration, and severity had an impact on higher scores in the Parkinson's Disease Quality of Life Questionnaire, indicating a worsening perception of quality of life.

Parkinson's Disease-related Pains are Not Equal: Clinical, Somatosensory and Cortical Excitability Findings in Individuals With Nociceptive Pain

Chronic pain is a frequent and burdensome nonmotor symptom of Parkinson's disease (PD). PD-related chronic pain can be classified as nociceptive, neuropathic, or nociplastic, the former being the most frequent subtype. However, differences in neurophysiologic profiles between these pain subtypes, and their potential prognostic and therapeutic implications have not been explored yet. This is a cross-sectional study on patients with PD (PwP)-related chronic pain (ie, started with or was aggravated by PD). Subjects were assessed for clinical and pain characteristics through questionnaires and underwent quantitative sensory tests and motor corticospinal excitability (CE) evaluations. Data were then compared between individuals with nociceptive and non-nociceptive (ie, neuropathic or nociplastic) pains. Thirty-five patients were included (51.4% male, 55.7 ± 11.0 years old), 20 of which had nociceptive pain. Patients with nociceptive PD-related pain had lower warm detection threshold (WDT, 33.34 ± 1.39 vs 34.34 ± 1.72, P = .019) and mechanical detection threshold (MDT, 2.55 ± 1.54 vs 3.86 ± .97, P = .007) compared to those with non-nociceptive pains. They also presented a higher proportion of low rest motor threshold values than the non-nociceptive pain ones (64.7% vs 26.6%, P = .048). In non-nociceptive pain patients, there was a negative correlation between WDT and non-motor symptoms scores (r = -.612, P = .045) and a positive correlation between MDT and average pain intensity (r = .629, P = .038), along with neuropathic pain symptom scores (r = .604, P = .049). It is possible to conclude that PD-related chronic pain subtypes have distinctive somatosensory and CE profiles. These preliminary data may help better frame previous contradictory findings in PwP and may have implications for future trial designs aiming at developing individually-tailored therapies. PERSPECTIVE: This work showed that PwP-related nociceptive chronic pain may have distinctive somatosensory and CE profiles than those with non-nociceptive pain subtypes. These data may help shed light on previous contradictory findings in PwP and guide future trials aiming at developing individually-tailored management strategies.

Influence of motor impairment on exercise capacity and quality of life in patients with Parkinson disease

This study evaluated the impact of motor impairment (MI) on exercise capacity and quality of life in patients with Parkinson disease (PD). One hundred ninety-two patients (≥50 years old) were divided according to the Hoehn and Yahr stages in: mild (stage I), mild to moderate (stage II), moderate (stage III), and advanced MI (stage IV). Exercise capacity (6-min walk test [6MWT]) and quality of life (Parkinson's Disease Questionnaire [PDQ-39]) were obtained. In this context, 6MWT was progressively worse with increasing the severity of MI (P<0.01). Patients with advanced MI achieved 39% of predicted 6MWT of healthy subject, while subjects with mild MI achieved 83% of healthy subject (P<0.01). In addition, patients with advanced MI presented higher (i.e., worse) PDQ-39 scores in summary index, cognition, mobility and activities of daily live domains compared to other groups (P<0.01). Patients with moderate MI also presented worse scores in PDQ-39 summary index, mobility and activities of daily live domains in comparison with mild MI patients (P<0.01). Higher MI was correlated with worse exercise capacity (6MWT: r=-0.46, P<0.01), with worse PDQ-39 summary index and the mobility and activities of daily live domains scores (r=0.38, r=0.46, and r=0.43, P<0.01). In conclusion, MI is related to lower exercise capacity and quality of life (i.e., PDQ-39 summary index and mobility and activities of daily live domains) in patients with PD.

Longitudinal, Interdisciplinary Home Visits vs. Usual Care for Homebound People with Advanced Parkinson's Disease (IN-HOME-PD): Study protocol for a controlled trial

Background

The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization.

Objective

The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care.

Methods

In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination.

Results

The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway.

Conclusions

To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs.

Trial Registration

ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459.

International Registered Report Identifier (IRRID)

PRR1-10.2196/31690

Virtual Rehabilitation in Parkinson Disease: A Dopamine Transporter Imaging Study

OBJECTIVE

The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life.

DESIGN

Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance.

RESULTS

Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015).

CONCLUSIONS

In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved.

Tools to assess the quality of life in patients with Parkinson's disease: a systematic review

INTRODUCTION

The clinical, social, and economic implications of Parkinson's disease (PD) are significant; disability occurs leading to a low quality of life (QoL). Information on the QoL of patients with PD and studies on the relationship between QoL and motor and cognitive function are necessary for both research and clinical use to make informed decisions in healthcare and rehabilitation. The aim of this study was to determine which scales are most used to assess QoL in patients with PD.

AREA COVERED

A literature search was conducted in MEDLINE, Scopus, CINAHL, PsycINFO, and Web of Science. Two authors independently identified eligible studies based on predefined inclusion criteria and extracted the data. Study quality and the risk of bias were assessed using the COSMIN checklist.

EXPERT OPINION

116 suitable studies were included, and 42 different instruments were identified. The most frequently used scales were the 39-items and 8-items Parkinson's Disease Questionnaire (PDQ-39) (PDQ-8). These findings suggest further investigation of existing PD outcome measures would benefit patients, researchers, and clinicians. Validated, universal outcome measures are required to allow comparisons across practice; therefore, we recommend that future researchers use a common set of outcome assessments based on the results of this review.

Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study)

INTRODUCTION

Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands.

METHODS AND ANALYSIS

This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group.

ETHICS AND DISSEMINATION

The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants.

TRIAL REGISTRATION NUMBER

Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.

Progressive muscle-strength protocol for the functionality of upper limbs and quality of life in individuals with Parkinson's disease: Pilot study

The effects of physical-therapy intervention on the motor function of upper limbs and the quality of life in patients with Parkinson's disease (PD) are not fully understood. We evaluated the effects of a progressive muscle-strengthening protocol for upper limbs on the functionality and quality of life. Patients were divided into two groups: Intervention (n = 6) and Control (n = 7). Assessment tools used were: Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire, Nine-Hole Peg Test (9HPT), Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA), 10-Repetition Maximum (10-RM) and handgrip dynamometer, which were applied pre- and post-intervention, with follow-up for one month after the last training session. Only, the Intervention group (post-intervention) showed significant statistical differences, with the following outcomes: UPDRS III (p = 0.042); 9HPT, right (p = 0.028) and left side (p = 0.028); TEMPA for total right side (p = 0.028), left side (p = 0.028) and total bilateral tasks (p = 0.028); TEMPA task 2 - open a jar and take a spoonful of coffee (p = 0.028), task 3 - pick up a pitcher and pour water into a glass for right (p = 0.046) and left side (p = 0.028), task 5 - write on an envelope and stick on a stamp (p = 0.028), and task 6 - shuffle and deal playing cards (p = 0.028). We observed significant statistical differences between groups (post-intervention) for TEMPA task 6 (p = 0.032), total right side (p = 0.032), and total bilateral tasks (p = 0.032). An increase in the maximum load in the post-intervention stage, based on the 10-RM test, was observed on the right (p = 0.003) and left (p = 0.007) sides. Our results showed an improvement in upper-limb functionality in PD patients submitted to progressive muscle-strength training, although not in quality of life.

Clinical correlates of sarcopenia and falls in Parkinson's disease

BACKGROUND

Sarcopenia is a complex and multifactorial geriatric condition seen in several chronic degenerative diseases. This study aimed to screen for sarcopenia and fall risk in a sample of Parkinson's disease (PD) patients and to investigate demographic and clinical factors associated.

METHODS

This is a cross-sectional study. We evaluated 218 PD patients at the Movement Disorders Clinic in Fortaleza, Brazil, and collected clinical data including experiencing falls in the six months prior to their medical visit. Probable sarcopenia diagnosis was confirmed by using a sarcopenia screening tool (SARC-F questionnaire) and the presence of low muscle strength.

RESULTS

One hundred and twenty-one patients (55.5%) were screened positive for sarcopenia using the SARC-F and 103 (47.4%) met the criteria for probable sarcopenia. Disease duration, modified Hoehn and Yahr stage, Schwab and England Activities of Daily Living Scale score, levodopa equivalent dose, probable sarcopenia and positive SARC-F screening were all associated with experiencing falls. Disease duration, lower quality of life and female gender were independently associated with sarcopenia. Experiencing falls was significantly more frequent among patients screened positive in the SARC-F compared to those screened negative.

CONCLUSIONS

Sarcopenia and PD share common pathways and may affect each other's prognosis and patients' quality of life. Since sarcopenia is associated with lower quality of life and increased risk of falls, active case finding, diagnosis and proper management of sarcopenia in PD patients is essential.

Efficacy of the Nintendo Wii combination with Conventional Exercises in the rehabilitation of individuals with Parkinson's disease: A randomized clinical trial

BACKGROUND

Studies have demonstrated that the combination of Nintendo Wii (NW) with Conventional Exercises (CE) was effective in the rehabilitation of patients with Parkinson's Disease (PD), but there are no studies comparing the effects of this combination on both techniques isolated.

OBJECTIVE

To investigate if the effects of the combination of NW to CE are superior to isolated techniques in the rehabilitation of balance, gait, functional mobility and improvement of the quality of life of individuals with PD.

METHODS

45 patients with PD were divided into three groups, NW alone, CE alone and NW plus EC. The sessions occurred for 50 minutes, twice a week and evaluations administered before and after the 2-month intervention.

RESULTS

Significant differences were found in the pre and post intervention analyzes of all the outcomes in the three groups, but there was no difference between the groups. The effect size was evaluated, in which the NW plus CE group had a greater magnitude of the therapeutic effect.

CONCLUSION

The NW plus CE was statistically as effective as each intervention alone in the rehabilitation of patients with PD, however, the use of this combination provided a magnitude of the therapeutic effect superior to the other groups.

Neocortical Lewy bodies are associated with impaired odor identification in community-dwelling elders without clinical PD

BACKGROUND

The association of Lewy bodies (LBs) with olfactory dysfunction was investigated in community-dwelling elders without clinical Parkinson's disease (PD) using the 12-item Brief Smell Identification Test (BSIT), a standard measure of odor identification.

METHODS

280 participants in the Rush Memory and Aging Project completed the BSIT annually. Lewy bodies were detected in 13 brain regions by immunohistochemistry and were assigned to the Braak PD stages 1-6.

RESULTS

Of the 280 participants, 101 (36.1%) had LBs which were maximal in the olfactory bulb and tract (85.1%) and least in Heschl's cortex (21.8%). Due to the small number of cases in Braak PD stages 2, 3 and 5, the distribution of LBs in the 6 Braak PD stages was contracted into 3 main LB stages: (1) LBs in olfactory bulbs and dorsal motor nucleus of vagus, (2) further extension of LBs to limbic and other brainstem regions and (3) additional extension of LBs to neocortical areas. MMSE, global cognition and odor test scores were lower and frequency of dementia was higher at the time of the last valid BSIT, in cases with LBs as compared to those without LBs. Linear regression analyses showed that LBs were associated with impaired olfaction. However, on stratification of LBs into 3 stages, only the stage 3 cases were independently associated with impaired olfaction.

CONCLUSION

Although LB pathology was detected in olfactory bulbs in the early stage of LB progression (stage 1), the strongest association of LBs with olfactory dysfunction was observed in the late pathological stage (stage 3) when LBs extended to neocortical areas.

Resistance training reduces depressive symptoms in elderly people with Parkinson disease: A controlled randomized study

BACKGROUND

Depression affects up to 40% of individuals with Parkinson's disease (PD).

PURPOSE

To assess resistance training effects on the depressive symptoms of elderly PD patients.

STUDY DESIGN

A randomized control study.

METHODS

Thirty-three patients (aged ≥ 60 years) were randomly divided into two groups: (a) control group: n = 16 and (b) resistance training group (RTG): n = 17. All patients with Parkinson's disease (stage 1-3 on the Hoehn and Yahr scale). The RTG, in addition to maintaining their pharmacological treatments, performed 20 weeks of resistance training. The control group maintained their pharmacological treatments. Depressive symptoms, quality of life, unified Parkinson's Disease scale, and functional capacity were evaluated in both groups.

RESULTS

The RTG presented a significant reduction (P < .05) of depressive symptoms (pre = 17.9 ± 8 score; post = 10.3 ± 6 score; effect size: -0.48), improved quality of life (pre = 40.3 ± 21.1 score; post = 30.2 ± 16.8 score; effect size: -0.26), and improved UPDRS (pre = 64 ± 34.6 score; post = 49.1 ± 24.1 score; effect size: -0.24). No significant changes in the control group regarding depressive symptoms (pre = 18.7 ± 5.4 score; post = 19.4 ± 5.2 score; effect size: 0.07), quality of life (pre = 39 ± 16.1 score; post = 40.6 ± 15.6 score; effect size: 0.05), and UPDRS (pre = 61.1 ± 24.3 score; post = 64.9 ± 23.4 score; effect size: 0.08) after 20 weeks.

CONCLUSION

Resistance training reduces depressive symptoms and improves the quality of life and functionality of elderly with PD.

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation

Objective:

Parkinson’s disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS).

Methods:

We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society‐sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson’s Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable.

Results:

After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03).

Conclusions:

Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Strength training improves the respiratory muscle strength and quality of life of elderly with Parkinson disease

BACKGROUND

The progression of Parkinson disease can lead to respiratory muscle weakness, reduced peak expiratory flow and quality of life (QoL). The aim was to evaluate the effects of strength training on levels of respiratory muscle strength, peak expiratory flow and QoL of elderly with Parkinson disease.

METHODS

A total of 28 patients were randomized into one of two groups: the control group (CG) comprised 16 participants, and the strength training group (STG) comprised 12 participants. All subjects maintained the standard pharmacological treatment for Parkinson disease, and the intervention group participated in a 16-week strength training program. The primary outcome was the measurement of respiratory muscle strength.

RESULTS

The STG showed improved values of maximum inspiratory pressures (36.11±11.82 to 52.94±24.17; P=0.01), maximum expiratory pressures (56.67±22.08 to 71.04±33.71; P=0.03) and QoL (41.75±20.33 to 34±20.92; P=0.0054); there was no significant difference in the peak expiratory flow (336.11±198.04 to 380±229.57; P=0.09). The CG showed significantly decreased values of peak expiratory flow (336.88±183.40 to 279.37±125.12, P=0.02) and non-significant changes in the other variables.

CONCLUSIONS

Sixteen weeks of strength training improves the inspiratory and expiratory muscle strength and QoL of elderly with Parkinson disease. These findings suggest that strength training could be considered an adjunct therapeutic intervention for elderly with Parkinson disease.

The effect of resistance training on the anxiety symptoms and quality of life in elderly people with Parkinson's disease: a randomized controlled trial

OBJECTIVES

To assess the effects of resistance training on the anxiety symptoms and quality of life in patients with Parkinson's disease.

METHODS

Thirty-five elderly patients were randomly divided into two groups: 17 patients in the control group and 18 in the intervention group. All patients maintained standard pharmacological treatment for Parkinson's disease, but the intervention group participated in a 24-week resistance training program. The anxiety symptoms were assessed through the Beck's Anxiety Inventory, and quality of life by the Parkinson's Disease Questionnaire-39.

RESULTS

There was a significant reduction in anxiety level and increase in quality of life after 24 weeks of resistance training.

CONCLUSION

The results of the present study indicate that resistance training is an effective intervention in the reduction of anxiety symptoms and improves the quality of life in elderly people with Parkinson's disease.

Quality of life in Parkinson's disease: Italian validation of the Parkinson's Disease Questionnaire (PDQ-39-IT)

Translation and cross-cultural adaptation of the 39-item Parkinson's Disease Questionnaire (PDQ-39) to the Italian culture was performed by Oxford University Innovation in 2008, but this version has never been validated. Therefore, we performed the process of validation of the Italian version of the PDQ-39 (PDQ-39-IT) following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. The translated PDQ-39-IT was tested with 104 patients diagnosed with Parkinson's disease (PD) who were recruited between June and October 2017. The mean age of the participants was 65.7 ± 10.2 years, and the mean duration of symptoms was 7.4 ± 5.3 years. The internal consistency of the PDQ-39-IT was assessed by Cronbach's alpha and ranged from 0.69 to 0.92. In an assessment of test-retest reliability in 35 of the 104 patients, the infraclass correlation coefficient (ICC) ranged from 0.85 to 0.96 for the various subitems of the PDQ-39-IT (all p < 0.01). Spearman's rank correlation coefficient for the validity of the PDQ-39-IT and the Italian version of the 36-Item Short Form (SF-36) was - 0.50 (p < 0.01). The results show that the PDQ-39-IT is a reliable and valid tool to assess the impact of PD on functioning and well-being. Thus, the PDQ-39-IT can be used in clinical and research practice to assess this construct and to evaluate the overall effect of different treatments in Italian PD patients.

Effects of physical exercise programs on cognitive function in Parkinson's disease patients: A systematic review of randomized controlled trials of the last 10 years

Background

Given the relative importance of cognitive impairment, there was considerable interest in identifying the cognitive profile of PD patients, in order to ensure specific and appropriate therapeutic interventions.

Purpose

To determine the effects of physical exercise programs on cognitive function in PD patients, compared with the control group.

Data sources

Medline, Cochrane, Scopus, PEDro and Web of Science (last searched in September 2016).

Study selection

Randomized clinical trials examining the effects of physical exercise programs and cognitive function in PD patients. Nine studies fulfilled the selection criteria and were included in this review.

Data extraction

Characteristics of the publication, characteristics of the participants, test used for cognitive screening, cognitive domain assessed, tools used to assess cognitive function, characteristics of the experimental intervention, characteristics of the control group, mean results and standard deviation of function cognitive. The PEDro score was used to evaluate methodological quality.

Data synthesis

Most eligible studies showed good methodological quality based on the PEDro scale. Studies have shown that adapted tango for PD patients, cognitive training combined with motor training, and treadmill training promote the preservation or improvement of cognitive function in PD patients.

Limitations

The diversity of cognitive tests used to assess cognitive function and the high heterogeneity identified between the physical exercise programs.

Conclusions

Physical exercise programs promote positive and significant effects on global cognitive function, processing speed, sustained attention and mental flexibility in PD patients, at a mild to moderate stage for patients with a 6-year clinical diagnosis of PD. However, treadmill training performed 3 times a week for about 60 minutes and for a period of 24 weeks produced larger improvements in cognition.

Effects of virtual rehabilitation versus conventional physical therapy on postural control, gait, and cognition of patients with Parkinson's disease: study protocol for a randomized controlled feasibility trial

Background

There is an association among postural instability, gait dysfunction, and cognitive impairment in subjects with Parkinson’s disease (PD). Difficulty in dividing attention, response inhibition, and visuospatial attention deficiencies may contribute to the impairment of motor performance during daily activities. There are strong evidences that physical therapy can prevent physical and cognitive decline in individuals with PD. Recently, the European Physiotherapy Guideline (EPG) was developed based on randomized clinical trials about the effectiveness of the physical therapy to improve the functional deficiencies of individuals with PD. The EPG did not include the use of promising new intervention as virtual reality in PD due the lack of studies about its safety, feasibility and effectiveness. Therefore, this study protocol had as objective to evaluate the feasibility, safety and effectiveness of a physical therapy program-based on the European Physiotherapy Guideline (EPG) compared to Kinect-based training on postural control, gait, cognition, and quality of life (QoL) of Individuals with PD.

Methods/design

A single-blind, parallel, randomized, controlled feasibility trial will be conducted with a sample of 32 individuals diagnosed with idiopathic PD. Participants will be allocated into control group (CG) and experimental group (EG). The intervention of the CG will be conventional physical therapy, and the intervention of the EG will be a supervised practice of five Kinect games. Both groups will perform 14 sessions of 1 h each one, twice a week over 7 weeks. Process outcomes will be safety, feasibility, adherence, and acceptability. Safety will be assessed by the proportion of participants who experienced intervention-related adverse events or any serious adverse event during the study period. Feasibility will be assessed through the scores of the games recorded in all training sessions. Adherence will be assessed through the participant’s attendance. Acceptability will be the motivation of the participants regarding the interventions. Clinical outcomes will be (1) postural control, (2) cognitive function, (3) balance, (4) gait, and (5) QoL. Individuals will be assessed pre- and post-interventions and after 30 days by a blinded evaluator.

Discussion

This protocol will clarify if an intervention based on Kinect games will be feasible, safe, and acceptable for individuals with PD compared to conventional physical therapy. We will verify whether the proposed interventions can improve clinical outcomes as postural control, gait, cognition, and QoL of individuals with PD. Our hypothesis is that both Kinect games and conventional physical therapy will be feasible, safe, and acceptable for individuals with PD and will promote positive clinical effects. The results of this feasibility study will be used to design a future definitive clinical trial.

Trial registration

Unique identification number in WHO Trial Registration: U1111-1171-0371. Brazilian Clinical Trial Registration Number RBR-27kqv5, registration date: February, 2016.

Electronic supplementary material

The online version of this article (10.1186/s40814-017-0210-3) contains supplementary material, which is available to authorized users.

The impact of cognitive performance on quality of life in individuals with Parkinson's disease

Background

Evidence points to the occurrence of cognitive impairment in all stages of PD, constituting a frequent and debilitating symptom, due to high impact on quality of life and mortality of patients.

Objective

To correlate cognitive performance with quality of life in PD.

Methods

The sample was drawn from a Movement Disorders Clinic of a reference hospital in Porto Alegre. Inclusion criteria were: PD diagnosis, according to the United Kingdom Parkinson's Disease Society Brain Bank criteria for idiopathic PD (Hughes et al. 1992) and patient consent to participate. Patients with other neurological pathologies and those submitted to deep brain stimulation were excluded. The evaluation consisted of a cognitive testing battery (composed of eight tests for assessing cognitive performance), and a questionnaire on quality of life (PDQ-39) and depression (BDI).

Results

The sample comprised 85 individuals with PD, with a mean age of 62.9 years (±10.7), mean disease duration of 10.4 years (±5.7), and mean educational level of four years (±4.3). There was a significant relationship between total score on the PDQ and all cognitive tests, showing that poor cognitive performance was correlated with poor quality of life. Moreover, a significant correlation was observed between cognitive tests and depression, H&Y, education level, and age.

Conclusion

It may be concluded that the individuals with PD in this sample showed a correlation between poorer quality of life and worse cognitive performance. Poor performance was also correlated with more advanced stage, older age, low level of education and depression.

Assessing health-related quality of life with the SCOPA-PS in French individuals with Parkinson's disease having undergone DBS-STN: A validation study

INTRODUCTION

The aims of this study were to validate the French version of the SCales for Outcomes in Parkinson's Disease-PsychoSocial (SCOPA-PS) in individuals with Parkinson's disease (PD) who underwent deep brain stimulation of the subthalamic nucleus (DBS-STN), to confirm the unifactorial structure of this questionnaire, and to establish its psychometric properties.

METHODS

Routinely used psychological questionnaires (BDI-II, STAI-Y, PDQ-39, UPDRS III) and the SCOPA-PS were used for a cross-sectional observational study of 154 PD patients. SCOPA-PS acceptability, scaling assumption, reliability, ordinal confirmatory factor analysis and validity were assessed.

RESULTS

The ICC for two-week test-retest reliability was 0.88. SEM was 8.42. In confirmatory factor analysis, the one-factor model showed an acceptable fit to the data (Chi(2)/df=2.130; CFI=0.976; RMSEA=0.086). No floor or ceiling effects were observed. Skewness was 0.33. Item-total correlation coefficients ranged from 0.47 to 0.71. Cronbach's alpha was 0.86. SCOPA-PS SI correlated with PDQ-39 SI (rs=0.83) and with state-anxiety and depression (rs=0.56 and 0.69 respectively). The SCOPA-PS SI was higher in more depressed patients and in those with the most severe PD motor symptoms.

CONCLUSION AND DISCUSSION

SCOPA-PS French version is a one-factor scale with satisfactory psychometric properties consistent with other language versions. This short scale can be used to evaluate the psychosocial component of QoL in PD patients treated with DBS-STN.

Efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com Parkinson

O objetivo desta pesquisa foi verificar os efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com doença de Parkinson, antes e após o tratamento com aplicação do questionário da doença de Parkinson PDQ-39. Corresponde a um estudo experimental, do tipo ensaio clínico não controlado, de natureza quantitativa. O estudo envolveu 14 indivíduos, que passaram por 20 sessões individuais de tratamento distribuídas em duas sessões semanais, com duração entre 30 e 40 minutos cada. Na análise dos dados, foi utilizado o teste de Wilcoxon, para encontrar o valor da significância estatística p≤0,05. Os escores do Questionário da Doença de Parkinson-39 total e seus domínios diminuíram quando comparados aos do período da avaliação e da reavaliação dos pacientes. No entanto, os valores de p expressam que essa diminuição foi significativa especificamente para os domínios mobilidade, bem-estar emocional, estigma e cognição, e o escore do Questionário da Doença de Parkinson-39 total. Assim, os resultados demonstraram que a realidade virtual não imersiva contribuiu positivamente sobre a qualidade de vida desses indivíduos.

Cross-cultural validity, reliability, and psychometric properties of the persian version of the scales for outcomes in Parkinson's disease-psychosocial questionnaire

Objectives. Considering the influence of different motor and nonmotor features of Parkinson's disease (PD), it is important to evaluate the psychosocial functioning of the patients. For this purpose, the scales for outcomes in Parkinson's disease-psychosocial questionnaire (SCOPA-PS) has been previously designed. The aim of our study was to assess the cross-cultural validation and psychometric properties of the Persian version of the SCOPA-PS. Methods. One hundred and ten nondemented idiopathic Parkinson's disease (IPD) patients were consecutively recruited from an outpatient referral movement disorder clinic. Eligible patients filled up a number of questionnaires including the Persian version of SCOPA-PS during the face-to-face interview session and clinical examination to measure disease severity, nonmotor psychiatric symptoms, and health-related quality of life (HRQoL). Results. The highest and lowest correlation coefficients of internal consistency were reported for item 7 on "asking for help" (r = 0.765) and item 5 on "sexual problems" (r = 0.553). Cronbach's alpha reliability coefficient of the entire scale was 0.87 (95% CI: 0.83-0.90). The Hoehn and Yahr stage (r = 0.34, P < 0.001), Schwab and England ADL scale (r = -0.55, P < 0.001), anxiety (r = 0.64, P < 0.001), depression (r = 0.71, P < 0.001), and fatigue (r = 0.35, P < 0.001) were significantly correlated with the total score of the SCOPA-PS questionnaire. Conclusions. The Persian version of SCOPA-PS is a highly reliable and valid scale to measure psychosocial functioning in IPD patients with different sex, age-group, and educational level, which could be applied in future researches. Disease severity scales, depression, anxiety, fatigue, and different domains of HRQoL were all associated with psychosocial functioning in PD patients.

Feasibility, safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study

OBJECTIVES

To assess the feasibility, safety and outcomes of playing Microsoft Kinect Adventures™ for people with Parkinson's disease in order to guide the design of a randomised clinical trial.

DESIGN

Single-group, blinded trial.

SETTING

Rehabilitation Center of São Camilo University, Brazil.

PARTICIPANTS

Seven patients (six males, one female) with Parkinson's disease (Hoehn and Yahr Stages 2 and 3).

INTERVENTIONS

Fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures!

MAIN OUTCOME MEASURES

The feasibility and safety outcomes were patients' game performance and adverse events, respectively. The clinical outcomes were the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and Parkinson's Disease Questionnaire (PDQ-39).

RESULTS

Patients' scores for the four games showed improvement. The mean [standard deviation (SD)] scores in the first and last sessions of the Space Pop game were 151 (36) and 198 (29), respectively [mean (SD) difference 47 (7), 95% confidence interval 15 to 79]. There were no adverse events. Improvements were also seen in the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and PDQ-39 following training.

CONCLUSION

Kinect-based training was safe and feasible for people with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Patients improved their scores for all four games. No serious adverse events occurred during training with Kinect Adventures!, which promoted improvement in activities (balance and gait), body functions (cardiopulmonary aptitude) and participation (quality of life).

Health-related quality of life of australians with Parkinson disease: a comparison with international studies

PURPOSE

This study describes the health-related quality of life (HRQOL) of Australians living with Parkinson disease (PD) and compares the findings to international reports.

METHODS

The Parkinson's Disease Questionnaire-39 (PDQ-39) was used to measure HRQOL in 210 individuals with PD living in Australia. In parallel, a tailored literature search identified previous studies on HROQL in people with PD. A quantitative meta-analysis with a random-effects model was used to compare the HRQOL of individuals with PD living in Australia and other countries.

RESULTS

The mean PDQ-39 summary index (SI) score for this sample of Australians with PD was 20.9 (SD 12.7). Ratings for the dimension of social support and stigma were significantly lower than ratings for bodily discomfort, mobility, activities of daily living, cognition, and emotional well-being. Comparing the Australian and international PD samples revealed a significant heterogeneity in overall HRQOL (I(2)=97%). The mean PDQ-39 SI scores for Australians were lower, indicating better HRQOL relative to samples from other countries.

CONCLUSIONS

This Australian sample with PD perceived their HRQOL as poor, although it was less severely compromised than that of international samples. While further research is required, these findings can inform the clinical decision-making processes of physiotherapists.

Translation and validation of the korean version of the 39-item Parkinson's disease questionnaire

Background and Purpose

The importance of health-related quality of life (HrQoL) has been increasingly emphasized when assessing and providing treatment to patients with chronic, progressive, degenerative disorders. The 39-item Parkinson's disease questionnaire (PDQ-39) is the most widely used patient-reporting scale to assess HrQoL in Parkinson's disease (PD). This study evaluated the validity and reliability of the translated Korean version of the PDQ-39 (K-PDQ-39).

Methods

One hundred and two participants with PD from 10 movement disorder clinics at university-affiliated hospitals in South Korea completed the K-PDQ-39. All of the participants were also tested using the Unified Parkinson's Disease Rating Scale (UPDRS), Korean version of the Mini-Mental State Examination (K-MMSE), Korean version of the Montgomery-Asberg Depression Scale (K-MADS), Epworth Sleepiness Scale (ESS) and non-motor symptoms scale (NMSS). Retests of the K-PDQ-39 were performed over time intervals from 10 to 14 days in order to assess test-retest reliability.

Results

Each K-PDQ-39 domain showed correlations with the summary index scores (rS=0.559-0.793, p<0.001). Six out of eight domains met the acceptable standard of reliability (Cronbach's α coefficient ≥0.70). The Guttman split-half coefficient value of the K-PDQ-39 summary index, which is an indicator of test-retest reliability, was 0.919 (p<0.001). All of the clinical variables examined except for age, comprising disease duration, levodopa equivalent dose, modified Hoehn and Yahr stage (H&Y stage), UPDRS part I, II and III, mood status (K-MADS), cognition (K-MMSE), daytime sleepiness (ESS) and (NMSS) showed strong correlations with the K-PDQ-39 summary index (p<0.01).

Conclusions

The K-PDQ-39 has been validated for use in the Korean-speaking PD population. The questionnaire is a valid and reliable assessment tool for assessing the HrQoL of Korean PD patients.

Neuropsychological and quality of life assessment in patients with Parkinson's disease submitted to bilateral deep brain stimulation in the subthalamic nucleus

Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms.

OBJECTIVE

To evaluate the influence of DBS in the STN on cognition, mood and quality of life.

METHODS

We studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test.

RESULTS

A total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale.

CONCLUSION

DBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood.

Parkinson's disease: Impact of clinical and cognitive aspects on quality of life

Parkinson's disease (PD) is a chronic disease manifested principally by motor signs and symptoms, but with frequent neuropsychological alterations.

OBJECTIVES

To study the relationship between clinical and cognitive aspects and the perception of quality of life (QOL) in PD patients.

METHODS

Twenty consecutive patients (13 men) with idiopathic PD (mean age: 64.5y), mean disease time of 7.8 years and at stages 1-3 according to the modified Hoehn and Yahr staging scale (HYS), all outpatients from the Neurology Department of the Celso Pierro General and Maternity Hospital (PUC-Campinas), were analyzed. The following were applied: a clinical-neurological assessment, the Mini-Mental State Examination (MMSE), standard neuropsychological battery of the CERAD (Consortium to Establish a Registry for Alzheimer's Disease), Hamilton Depression Rating Scale (HAM-D) and a QOL questionnaire (Parkinson's Disease Questionnaire - PDQ-39). Statistical analysis was carried out at a significance level of p<0.05.

RESULTS

On the PDQ-39 under the sections total, mobility and activities of daily living, and the items motor compromise (HYS) and language of the MMSE were predictors of worse QOL. Verbal fluency was a factor for emotional well-being on the PDQ-39, whereas higher scores for HAM-D and worse performance on the item attention and calculation of the MMSE were associated with worse QOL in the social support section. Total score on the MMSE and educational level were QOL factors in cognition.

CONCLUSIONS

The findings of the present study suggest that clinical, cognitive, motor or other depression-related factors contribute differently to the domains of QOL.

Cross-cultural validation of the Scales for Outcomes in Parkinson's Disease-Psychosocial questionnaire (SCOPA-PS) in four Latin American countries

OBJECTIVE

To conduct a cross-national validation of the Scales for Outcomes in Parkinson's Disease-PsychoSocial questionnaire (SCOPA-PS) in four Latin American Countries.

METHODS

Data quality (missing items), scale assumptions (item-test correlation), internal consistency (Cronbach's alpha, item homogeneity), factor structure, content validity, and precision (standard error of measurement, SEM) of the scale were explored, as was convergent validity with motor symptoms (Clinical Impression of Severity Index [CISI-PD], Scales for Outcomes in Parkinson's Disease-Motor Scale), emotional status (Hospital Anxiety and Depression Scale) and health-related quality of life (Parkinson Disease Questionnaire-39). Known-groups validity was studied by category of severity, based on Hoehn and Yahr staging (HY), CISI-PD, and disease duration.

RESULTS

Three hundred thirty-one Parkinson's disease (PD) patients with usable data participated (mean age 64.7 years; 42.3% female; mean PD duration 8.5 years; HY, 1 to 5). Data quality (missing items <10%), scale assumptions (item-total correlation = 0.43 - 0.71) and internal consistency of SCOPA-PS (Cronbach's alpha = 0.87; item homogeneity = 0.38) were satisfactory. Factor analysis suggested a unifactorial structure. High convergent validity was found for depression (r(S) = 0.61), anxiety (r(S) = 0.62), and health-related quality of life (r(S) = 0.82). Known-groups validity analyses indicated a gradual influence of severity category and disease duration on SCOPA-PS scores (P < 0.0001). SEM value was 8.24 (7 to 12 in previous studies). These magnitudes may be indicative of the threshold for a real change and a minimum important difference.

CONCLUSIONS

The Latin American versions of the SCOPA-PS displayed appropriate psychometric attributes.

Determinants of quality of life in Brazilian patients with Parkinson's disease

Our objective was to identify determinants of health-related quality of life (HRQoL) in a cohort of Brazilian patients with Parkinson's disease (PD). Patients were evaluated by means of the Hoehn and Yahr staging (H&Y), Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England scale (S&E), Mini-Mental State Exam, Geriatric Depression Scale, and Hospital Anxiety and Depression Scale (HADS). HRQol was assessed using the MOS-Short-Form 36 (SF-36), the Parkinson's disease Questionnaire (PDQ-39), and the Scales for Outcomes in Parkinson's Disease-Psychosocial Questionnaire (SCOPA-PS). 144 patients were evaluated (mean age 62 years; 53.5% men; mean duration of illness 6.6 years; median H&Y, 2 (range: 1-4). Mean SCOPA-PS and PDQ-39 Summary Index (SI) were 39.2 and 40.7, respectively. Both, PDQ-39 and SCOPA-PS SIs correlated at a moderate level (r = 0.30-0.50) with H&Y, S&E, total UPDRS, HADS subscales, and SF-36 Physical and Mental Components. PDQ-39 and SCOPA-PS were closely associated (r = 0.73). HRQoL significantly deteriorated as H&Y progressed, as a whole. Mood disturbances, disability, motor complications, and education were independent predictors of HRQoL in the multivariate analysis model. In PD Brazilian patients, HRQoL correlated significantly with diverse measures of severity. Depression showed to be the most consistent determinant of HRQoL, followed by disability, motor complications, and education years. There was a close association between the PDQ-39 and SCOPA-PS summary scores.

Anxiety and depression: main determinants of health-related quality of life in Brazilian patients with Parkinson's disease

Determinants of health-related quality of life (HRQoL) were assessed in 115 Brazilian patients (56.5% males; mean age 62.5 years) with Parkinson's disease (PD). Hoehn and Yahr (H&Y) staging, Scales for Outcomes in Parkinson's Disease-Motor Scale (SCOPA-MS), Cumulative Illness Rating Scale-Geriatrics, Hospital Anxiety and Depression Scale (HADS), Parkinson's Disease Questionnaire (PDQ-39), and SCOPA-Psychosocial Questionnaire (SCOPA-PS) were applied. Median H&Y was 3 and the SCOPA-MS score was 25.6+/-13.1. The proportion of patients who scored > or =11 points in the HADS-Depression and HADS-Anxiety subscales were 47% and 30.4%, respectively. In the multivariate model, HADS-Anxiety or HADS-Depression (p<0.0001), disability (SCOPA-MS II) (p=0.0001) and comorbidity (p=0.0005) were independently associated to PDQ-39 and SCOPA-PS. Mood disturbances were the main determinants of HRQoL.