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van der Meer F, Jorgensen J, Hiligsmann M. Burden of non-motor symptoms of Parkinson's disease: cost-of-illness and quality-of-life estimates through a scoping review. Expert Rev Pharmacoecon Outcomes Res 2024:1-11. [PMID: 39138993 DOI: 10.1080/14737167.2024.2390042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 06/25/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Parkinson's Disease (PD) is a progressive, chronic neurodegenerative disease, representing significant economic and social burdens. It is typically defined by motor symptoms (MSs), however, this does not reflect the full patient burden. Non-motor symptoms (NMSs) are increasingly recognized as central characteristics of PD. However, they still lack recognition in research. Therefore, this study aims to identify relevant NMSs, their prevalence, and the effect they have on Quality-of-Life (QoL) and Cost-of-Illness (COI). Secondly, it aims to identify gaps in the current body of knowledge and propose possible ways future research could bridge those gaps. METHODS The study employed a scoping review, identifying 60 records for inclusion, using PubMed and Web of Science. It included studies from Spain or Italy, including data on People with Parkinson's Disease. A comparative analysis was performed using Microsoft Excel. RESULTS It showed that the body of evidence relevant to NMSs, their prevalence, QoL, and COI is limited, or that estimates vary to an extent where interpretation is difficult. CONCLUSION Most studies suffer from generalization, representation, and standardization issues, stemming from their designs and methodological decisions. Although the findings of this study should be interpreted with caution, several recommendations are made for future research.
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Affiliation(s)
- Frank van der Meer
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI, Care & Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Sadek AT, Djerdjour L, Reyes RA, Adams GP, Logan CH, Smith MA, Biddle SG, Wiles TS, Urrea-Mendoza E, McConnell TM, Revilla FJ, Trilk JL. The Feasibility and Efficacy of a Virtual Reality Tandem Cycling Program for Persons with Parkinson's Disease and Their Care Partners. Neurol Ther 2024; 13:1237-1257. [PMID: 38878129 PMCID: PMC11263444 DOI: 10.1007/s40120-024-00636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/30/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Persons with Parkinson's disease (PwPD) suffer from motor and non-motor symptoms which significantly affect their quality of life (QoL), and the QoL of their care partners (CP). Tandem cycling reduces PwPD motor symptoms; however, no studies have examined other benefits or included PwPD CP. We conducted an 8-week community virtual reality (VR) tandem cycling intervention to assess the feasibility and efficacy for PwPD and their CP (i.e., PD dyads). We hypothesized that dyadic tandem cycling would improve (1) PwPD motor and non-motor symptoms and (2) dimensions of PD dyads' QoL and physiologic health. METHODS Ten PD dyads were recruited to complete 8 weeks of progressive intensity, bi-weekly tandem cycling. At pre- and post-testing, PwPD were assessed using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III), functional gait assessment (FGA), and 10-m gait speed test. PD dyads also completed emotional and cognitive status questionnaires [e.g., Geriatric Depression Scale-Short Form (GDS-SF)], and wore BodyGuard 2 heart rate (HR) monitors for 48 h to assess surrogate measures of heart rate variability. Statistical analyses were conducted using Student's t tests with significance set at p ≤ 0.05. RESULTS Eight PD dyads and one PwPD completed the intervention. Retention of PwPD (90%) and CP (80%) was adequate, and PD dyad adherence ranged from 91.67 to 97.91%. PwPD demonstrated significant clinical improvements in MDS-UPDRS-III scores (- 7.38, p < 0.01), FGA scores (+ 3.50, p < 0.01), and 10-m gait speed times (+ 0.27 m/s, p < 0.01), in addition to significant self-reported improvements in mobility (- 13.61, p = 0.02), fatigue (- 5.99, p = 0.02), and social participation (+ 4.69, p < 0.01). CP depressive symptoms significantly decreased (- 0.88, p = 0.02), and PD dyads shared a significant increase in root mean square of the successive differences (RMSSD; p = 0.04). CONCLUSION Our pilot study demonstrated feasibility and multiple areas of efficacy supporting further investigation of community VR tandem cycling as a therapeutic intervention for PD dyads.
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Affiliation(s)
- Alia T Sadek
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Leila Djerdjour
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Ryan A Reyes
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Greggory P Adams
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Cara H Logan
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Margaret A Smith
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Sara G Biddle
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | | | - Enrique Urrea-Mendoza
- Department of Clinical Science/TMH Physicians Partners, Medical School, Florida State University, Tallahassee, FL, USA
| | - Tracie M McConnell
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
- Neuroscience Associates, Prisma Health-Upstate, Greenville, SC, USA
| | - Fredy J Revilla
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
- Neuroscience Associates, Prisma Health-Upstate, Greenville, SC, USA
| | - Jennifer L Trilk
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
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Bhidayasiri R, Sringean J, Phumphid S, Anan C, Thanawattano C, Deoisres S, Panyakaew P, Phokaewvarangkul O, Maytharakcheep S, Buranasrikul V, Prasertpan T, Khontong R, Jagota P, Chaisongkram A, Jankate W, Meesri J, Chantadunga A, Rattanajun P, Sutaphan P, Jitpugdee W, Chokpatcharavate M, Avihingsanon Y, Sittipunt C, Sittitrai W, Boonrach G, Phonsrithong A, Suvanprakorn P, Vichitcholchai J, Bunnag T. The rise of Parkinson's disease is a global challenge, but efforts to tackle this must begin at a national level: a protocol for national digital screening and "eat, move, sleep" lifestyle interventions to prevent or slow the rise of non-communicable diseases in Thailand. Front Neurol 2024; 15:1386608. [PMID: 38803644 PMCID: PMC11129688 DOI: 10.3389/fneur.2024.1386608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
The rising prevalence of Parkinson's disease (PD) globally presents a significant public health challenge for national healthcare systems, particularly in low-to-middle income countries, such as Thailand, which may have insufficient resources to meet these escalating healthcare needs. There are also many undiagnosed cases of early-stage PD, a period when therapeutic interventions would have the most value and least cost. The traditional "passive" approach, whereby clinicians wait for patients with symptomatic PD to seek treatment, is inadequate. Proactive, early identification of PD will allow timely therapeutic interventions, and digital health technologies can be scaled up in the identification and early diagnosis of cases. The Parkinson's disease risk survey (TCTR20231025005) aims to evaluate a digital population screening platform to identify undiagnosed PD cases in the Thai population. Recognizing the long prodromal phase of PD, the target demographic for screening is people aged ≥ 40 years, approximately 20 years before the usual emergence of motor symptoms. Thailand has a highly rated healthcare system with an established universal healthcare program for citizens, making it ideal for deploying a national screening program using digital technology. Designed by a multidisciplinary group of PD experts, the digital platform comprises a 20-item questionnaire about PD symptoms along with objective tests of eight digital markers: voice vowel, voice sentences, resting and postural tremor, alternate finger tapping, a "pinch-to-size" test, gait and balance, with performance recorded using a mobile application and smartphone's sensors. Machine learning tools use the collected data to identify subjects at risk of developing, or with early signs of, PD. This article describes the selection and validation of questionnaire items and digital markers, with results showing the chosen parameters and data analysis methods to be robust, reliable, and reproducible. This digital platform could serve as a model for similar screening strategies for other non-communicable diseases in Thailand.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Suwijak Deoisres
- National Electronics and Computer Technology Centre, Pathum Thani, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suppata Maytharakcheep
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Vijittra Buranasrikul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Tittaya Prasertpan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | | | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Araya Chaisongkram
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Worawit Jankate
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jeeranun Meesri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Araya Chantadunga
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Piyaporn Rattanajun
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Phantakarn Sutaphan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Weerachai Jitpugdee
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Marisa Chokpatcharavate
- Chulalongkorn Parkinson's Disease Support Group, Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Society, Bangkok, Thailand
| | - Chanchai Sittipunt
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Society, Bangkok, Thailand
| | | | | | | | | | | | - Tej Bunnag
- Thai Red Cross Society, Bangkok, Thailand
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Li X, Dong ZY, Dong M, Chen L. Early dopaminergic replacement treatment initiation benefits motor symptoms in patients with Parkinson's disease. Front Hum Neurosci 2024; 18:1325324. [PMID: 38807633 PMCID: PMC11131585 DOI: 10.3389/fnhum.2024.1325324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
Background Parkinson's disease (PD) generally progresses slowly, but it is controversial whether delaying treatment accelerates the progression. Objective Determine the correlation between the time of dopaminergic replacement treatment initiation and the severity of clinical symptoms in PD, including motor and non-motor symptoms. Methods PD patients were divided between 155 people who were diagnosed de novo and 165 PD patients receiving dopamine replacement therapy. Basic patient characteristics included gender, age, age at onset, disease duration, and the time of dopaminergic replacement treatment initiation. We used MDS-UPDRS scores to evaluate the severity of motor symptoms and we also used the scale to assess the severity of non-motor symptoms such as cognition, mood, sleep, and quality of life. Results The mean time between symptom onset and the initiation of drug treatment was 31.0 (22.5) months. After adjusting for age, sex, age at onset, and disease duration, we found that the MDS-Unified Parkinson's Disease Rating Scale (UPDRS)-III score increased faster in the de novo group with a similar disease duration (F = 8.7, p = 0.0034) than the treatment group. The cumulative incidence of progression to H-Y score 3 in de novo PD group over disease duration was 39.7% in 50months and 92.2% in 100 months, while in treated group such cumulative incidence was 15.5% in 50 months, 51.4% in 100 months and 81.5% in 150 months. The cumulative incidence of patients in the de novo PD group was higher than that in the treated group (p = 0.001), suggesting that untreated patients were more likely to progress to the advanced stages. Symptoms onset, the time between symptom onset and treatment initiation, age, sex, and disease duration explained 28.95% of the total variation in the MDS-UPDRS-III score for motor symptoms. In drug-naïve patients, the time between symptom onset and treatment initiation explained 20.1% of the total variation in the MDS-UPDRS-III score for motor symptoms (t = 6.15, p < 0.001). Conclusions These data in our study showed that early dopaminergic replacement treatment have played a positive role in PD patients, while dopaminergic replacement delayed treatment might be detrimental to motor symptoms and non-motor state of PD patient. Recognizing early stage symptoms of PD and early diagnosis are of great significance to treatment.
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Affiliation(s)
- Xin Li
- Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhao-ying Dong
- Department of Neurology, Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Meng Dong
- Tianjin Medical University, Tianjin, China
| | - Lei Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Diseases and Neurodegenerative Disease, Tianjin, China
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Sharma P, Baruah U, Yadav A, Kushwaha S, Dhamija RK. Understanding Psychosocial Functioning, Caregiver Burden, and Neuropalliative Care in Parkinson's Disease - A Mixed-Methods Study. Ann Indian Acad Neurol 2024; 27:289-296. [PMID: 38902870 PMCID: PMC11232814 DOI: 10.4103/aian.aian_83_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Despite advancements in treatment, patients with Parkinson's disease (PD) experience a range of symptoms that affect their quality of life. There is a need to integrate neuropalliative care into standard care. The aim of the study is to understand the psychosocial functioning in persons with PD and explore their caregivers' burden. METHODS The study utilizes a mixed-methods design where 50 patient-caregiver dyads attending the outpatient services of the movement disorder clinic at a tertiary care hospital were measured on psychosocial functioning and caregiver burden and palliative care outcomes for a period of 6 months. Focus group discussions were conducted with 18 patient-caregiver dyads to understand the needs of palliative care. RESULTS It was found that caregiver burden was positively correlated with palliative care outcomes scores of patients ( r = 0.586) and caregivers ( r = 0.675) and psychosocial functioning was positively correlated with palliative care outcomes of patients ( r = 0.708). The psychosocial functioning score was higher among female patients (indicating worse functioning) than males, and female caregivers experienced significantly higher caregiver burden. The qualitative findings reveal that there is a substantial gap in awareness about palliative care, lack of information, presence of stigmatizing beliefs, and lack of adequate accessibility to palliative facilities. CONCLUSION The study lays the foundation for future PD neuropalliative care research, guiding interventions, and exploration of regional variations in PD experiences in India. There is a need to address caregiver burden in PD in India.
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Affiliation(s)
- Prerna Sharma
- Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Upasana Baruah
- Department of Psychiatric Social Work, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Akanksha Yadav
- Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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Evidente VGH, DeKarske D, Coate B, Abler V. The effects of treatment with pimavanserin on activities of daily living in patients with Parkinson's disease psychosis: a 16-week, single-arm, open-label study. Ther Adv Neurol Disord 2024; 17:17562864241228350. [PMID: 38476466 PMCID: PMC10929044 DOI: 10.1177/17562864241228350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/14/2023] [Indexed: 03/14/2024] Open
Abstract
Background More than half of patients with Parkinson's disease will experience psychosis symptoms in the form of hallucinations or delusions at some point over the course of their disease. These symptoms can significantly impact patients' health-related quality of life, cognitive abilities, and activities of daily living (ADLs) and function. Clinical assessment of how psychosis impacts these measures is crucial; however, few studies have assessed this sufficiently, in part due to a lack of appropriate scales for comprehensively assessing function. Objective The objective was to assess how symptoms of Parkinson's disease psychosis (PDP) impact ADLs and function, cognitive function, and health-related quality of life. Design To address this unmet need, we utilized a modified version of the Functional Status Questionnaire (mFSQ) to measure the impact of psychosis on ADLs and function in patients with PDP treated with pimavanserin, a US Food and Drug Administration-approved medication to treat hallucinations and delusions associated with PDP. Methods Eligible patients entered a 16-week, single-arm, open-label study of oral pimavanserin (34 mg) taken once daily. The primary endpoint was change from baseline to Week 16 on the mFSQ. Secondary endpoints included the Movement Disorders Society-modified Unified Parkinson's Disease Rating Scale (MDS-UPDRS) I and II; Schwab and England ADL; Clinical Global Impression-Severity of Illness (CGI-S), Clinical Global Impression-Improvement (CGI-I), and Patient Global Impression-Improvement (PGI-I), and were also measured as change from baseline to Week 16 using mixed-effects model for repeated measures (MMRM) and least-squares mean (LSM). Results Our results in a proof-of-concept, 16-week, open-label clinical study in 29 patients demonstrated that an improvement in psychosis symptoms following treatment with pimavanserin was associated with improvements in multiple measures of ADLs and function. Notably, a significant improvement was found on the primary endpoint, change from baseline to Week 16 in mFSQ score [LSM [SE] 14.0 [2.50], n = 17; 95% CI (8.8, 19.3); p < 0.0001]. Conclusion These findings highlight the potential for improvement in function with improvement of psychosis symptoms in patients with PDP and suggest that the mFSQ may be a measurement tool to evaluate the level of improvement in function. Trial registration ClinicalTrials.gov Identifier: NCT04292223.
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Affiliation(s)
- Virgilio G. H. Evidente
- Movement Disorders Center of Arizona, 9500 E. Ironwood Square Drive, Suite 118, Scottsdale, AZ 85258, USA
| | | | - Bruce Coate
- Acadia Pharmaceuticals Inc., San Diego, CA, USA
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Zhang A, Song Z, Di A, Zhou Z, Zheng L, Zhuang L. Acupuncture for the Treatment of Neuropsychiatric Symptoms in Parkinson's Disease: A Systematic Review and Meta-Analysis. Complement Ther Med 2024; 80:103020. [PMID: 38185400 DOI: 10.1016/j.ctim.2024.103020] [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: 07/24/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) of Parkinson's disease (PD) have received increasing attention, but effective treatment options remain limited. Acupuncture may have clinical benefits for NPSs in PD patients, but high-quality evidence supporting this possibility still needs to be discovered. Therefore, we conducted a meta-analysis to evaluate the effect of acupuncture treatment on NPSs in PD patients. METHODS Randomized controlled trials (RCTs) of acupuncture treatment for PD retrieved from the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and Scopus, were used to evaluate NPSs of PD patients. The Cochrane Intervention System Evaluation Manual assessed the methodological quality. RESULTS A total of 13 RCTs involving 719 patients were included. The results showed that compared with medication alone or sham acupuncture, acupuncture improved sleep quality in PD patients, with Parkinson's Disease Sleep Scale (PDSS) [standardized mean difference (SMD)= 0.48, 95% confidence interval (CI)= 0.242 to 0.793, P = 0.001]. The I scores and total scores on Unified Parkinson's Disease Rating Scale (UPDRS) indicated acupuncture treatment was effective (SMD=-0.66, 95%CI=-0.66 to -0.18, P = 0.042; SMD=-0.77, 95%CI=-1.31 to -0.23, P = 0.005). Results of the Epworth Sleepiness Scale (ESS) and Parkinson's Disease Questionnaire-39 (PDQ-39) showed no statistically significant differences (SMD=-0.27, 95%CI=-0.08 to 0.62, P = 0.128; SMD=-0.20, 95%CI=-0.42 to 0.01, P = 0.554). Anxiety and depression research had no significant differences due to the excessive inter-study bias. CONCLUSION Acupuncture treatment can improve sleep quality, psychological and behavioral alterations, and the overall condition of PD patients. However, the study revealed no significant positive intervention effects on anxiety, depression, and quality of life, underscoring the necessity for continued research to elucidate these domains' intricacies and develop productive therapeutic approaches.
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Affiliation(s)
- Anxin Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zefeng Song
- Medical Department, Dalian University of Technology, Dalian 116024, China
| | - Anqi Di
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zelin Zhou
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Liang Zheng
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Lixing Zhuang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
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8
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Seshadri S, Contento A, Sugiura K, Abendroth M, Macchi Z, Kluger BM. Parkinson's Disease Carepartners' Perceptions of the Challenges and Rewards of Caregiving. Am J Hosp Palliat Care 2024:10499091231223739. [PMID: 38264847 DOI: 10.1177/10499091231223739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Multiple debilitating symptoms and the progressive nature of Parkinson's disease (PD) affect carepartners' quality of life. Although, there is abundant knowledge on caregiver burden there is limited knowledge on PD carepartners' perceptions of caregiving. AIM To understand family members' perception of their role, and of the challenges and rewards of PD caregiving. METHOD Using a qualitative descriptive research design, we conducted semi-structured interviews with current and former PD carepartners (n = 16). Interviews were audio-recorded, de-identified, and transcribed verbatim. Data were coded and analyzed to identify themes. RESULTS We identified 5 themes: (a) Unpredictability is the hardest part of caregiving. It was hard to cope with the unpredictable daily and longer-term fluctuations in PD symptoms; (b) Disease progression and multiple symptoms contribute to carepartners' emotional distress. Carepartners felt unprepared and were saddened by the patient's and their own losses; (c) Caring for a family member is not a "burden." Though stressful, carepartners resisted associating caregiving with the term "burden"; (d) Caregiving is a partnership. Carepartners saw their role as being less of "givers" and more of partners in disease management; and (e) Caregiving is an opportunity for personal satisfaction, joy, and growth. Caregiving was seen as a "gift" that enabled carepartners to express love and experience personal growth. CONCLUSIONS Despite challenges PD carepartners view their role as "partners" in the management of the disease and find meaning and strength in caregiving. A palliative care approach emphasizing the positives and challenges of caregiving may provide carepartners with better support.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | | | - Kei Sugiura
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | | | | | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
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9
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Steendam-Oldekamp E, van Laar T. The Effectiveness of Inpatient Rehabilitation in Parkinson's Disease: A Systematic Review of Recent Studies. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S93-S112. [PMID: 38788087 DOI: 10.3233/jpd-230271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Parkinson's disease (PD) is a progressive disease, which is associated with the loss of activities of daily living independency. Several rehabilitation options have been studied during the last years, to improve mobility and independency. Objective This systematic review will focus on inpatient multidisciplinary rehabilitation (MR) in people with Parkinson's disease (PwPD), based on recent studies from 2020 onwards. Methods Search strategy in three databases included: multidisciplinary rehabilitation, Parkinson's Disease, inpatient rehabilitation, motor-, functional- and cognitive performance, cost-effectiveness, Quality of Life, and medication changes/Levodopa equivalent daily doses. Results Twenty-two studies were included, consisting of 13 studies dealing with inpatient MR and 9 studies on inpatient non-MR interventions. Inpatient PD multidisciplinary rehabilitation proved to be effective, as well as non-MR rehabilitation. Conclusions This review confirms the efficacy of inpatient MR and non-MR in PD, but is skeptical about the past and current study designs. New study designs, including new physical training methods, more attention to medication and costs, new biomarkers, artificial intelligence, and the use of wearables, will hopefully change rehabilitation trials in PwPD in the future.
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Affiliation(s)
- Elien Steendam-Oldekamp
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
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10
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Dams J, Zapp JJ, König HH. Modelling the Cost Effectiveness of Treatments for Parkinson's Disease: An Updated Methodological Review. PHARMACOECONOMICS 2023; 41:1205-1228. [PMID: 37344724 PMCID: PMC10492764 DOI: 10.1007/s40273-023-01289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This article systematically reviewed the methodological quality of modelling approaches for economic evaluations of the treatment of motor symptoms in Parkinson's disease in studies published after 2010. METHODS A systematic literature search was undertaken using PubMed, EconLit, the Cochrane Database of Systematic Reviews, National Health Service Economic Evaluation Database and Health Technology Assessment databases of the UK National Health Service Centre for Review and Dissemination (March 2010 to July 2022). Quality was assessed using a checklist from the German Scientific Working Group. RESULTS A total of 20 studies were evaluated, with the majority based on Markov models (n = 18). Studies assessed the cost effectiveness of medical (n = 12) or surgical (n = 8) treatment, and included costs from a payer or healthcare provider's perspective (n = 17). Furthermore, all studies included quality-adjusted life-years as an effect measure. In the quality assessment of the literature, a mean score of 42.1 points (out of 56 points) on the checklist of the German Scientific Working Group was achieved. Seventeen studies concluded the intervention under study was (likely) cost effective. No intervention was classified as cost ineffective. CONCLUSIONS The quality of economic evaluation models in Parkinson's disease has improved in terms of calculating cost and transition parameters, as well as carrying out probabilistic sensitivity analyses, compared with the published literature of previous systematic reviews up to 2010. However, there is still potential for further development in terms of the integration of non-motor complications and treatment changes, the transparent presentation of parameter estimates, as well as conducting sensitivity analyses and validations to support the interpretation of results.
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany.
| | - Johann-Jacob Zapp
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
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11
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Park YS, Kim H, Yun I, Park EC, Jang SY. Association between caregiver type and catastrophic health expenditure among households using inpatient medical services: using Korean health panel. BMC Health Serv Res 2023; 23:721. [PMID: 37400782 DOI: 10.1186/s12913-023-09703-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Caregiving services often place a financial burden on individuals and households that use inpatient medical services. Consequently, this study aimed to examine the association between the type of caregiver and catastrophic health expenditure among households utilizing inpatient medical services. METHODS Data were extracted from the Korea Health Panel Survey conducted in 2019. This study included 1126 households that used inpatient medical and caregiver services. These households were classified into three groups: formal caregivers, comprehensive nursing services, and informal caregivers. Multiple logistic regression was used to analyze the association between caregiver type and catastrophic health expenditure (CHE). RESULTS Households receiving formal caregiving had an increased likelihood of CHE at threshold levels of 40% compared to those who received care from family (formal caregiver: OR 3.11; CI 1.63-5.92). Compared to those who received formal caregiving, households using comprehensive nursing services (CNS) had a decreased likelihood of CHE (CNS: OR, 0.35; CI 0.15-0.82). In addition, considering the economic value associated with informal care, there was no significant relationship between households received formal caregiving and informal caregiving. CONCLUSION This study found that the association with CHE differed based on the type of caregiving used by each household. Households using formal care had a risk of developing CHE. Households using CNSs were likely to have a decreased association with CHE, compared to households using informal and formal caregivers. These findings highlight the need to expand policies to mitigate the burden on caregivers for households forced to use formal caregivers.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyunkyu Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
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12
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Alegre-Ayala J, Vela-Desojo L, Fernández-Vázquez D, Navarro-López V, Macías-Macías Y, Cano-de-la-Cuerda R. Occupational performance skills in Parkinson's disease: relationship with health-related quality of life and caregiver burden. Rev Neurol 2023; 77:3-11. [PMID: 37365719 PMCID: PMC10663802 DOI: 10.33588/rn.7701.2023097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION The progression of Parkinson's disease (PD) results in a loss of ability to performance activities of daily living and health-related quality of life. The objectives of this study were to establish the relations between occupational performance skills and health-related quality of life, and the degree of caregiver burden in PD patients. PATIENTS AND METHODS Forty-nine patients at different stages of PD according to the Hoehn and Yahr scale participated in the study. Patients were assessed using the Parkinson's Disease Questionnaire (PDQ-39), the EuroQoL (EQ-5D), the Assessment of Motor and Process Skills (AMPS), and the Zarit Caregiver Burden Interview (ZCBI). RESULTS Strong correlations were found between the motor skills section of the AMPS scale and the PDQ-39 (r = -0.76; p = 0.001), and the EQ-5D questionnaires (r = 0.72; p = 0.001), while moderate correlations were found with the process skills. AMPS process skills were moderately correlated with mobility and activities of daily living. The ZCBI was only weakly correlated with the AMPS motor skills (r = -0.34; p = 0.02). CONCLUSION Declining scores on the AMPS scale are closely related to the loss of health-related quality of life in PD patients, and, to a lesser extent, with the degree of caregiver burden.
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Affiliation(s)
| | - L Vela-Desojo
- Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, España
| | | | | | - Y Macías-Macías
- Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, España
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13
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Soilemezi D, Palmar‐Santos A, Navarta‐Sánchez MV, Roberts HC, Pedraz‐Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study. Health Expect 2023; 26:670-682. [PMID: 36573594 PMCID: PMC10010098 DOI: 10.1111/hex.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. OBJECTIVE This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. METHODS A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. RESULTS A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. CONCLUSIONS Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.
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Affiliation(s)
- Dia Soilemezi
- Department of Psychology, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
| | - Ana Palmar‐Santos
- Nursing Department, Faculty of MedicineUniversidad Autónoma de MadridMadridSpain
| | | | - Helen C. Roberts
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Azucena Pedraz‐Marcos
- Unidad de Investigación en Cuidados y Sistemas de SaludThe Carlos III Health Institute (ISCIII)MadridSpain
- Grupo de investigación ISCiiiResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
- Nursing and Healthcare, Department of Public HealthAarhus UniversityAarhusDenmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
| | - Line K. Bragstad
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | - Ellen G. Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | | | - Mari Carmen Portillo
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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14
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Martinez-Martin P, Skorvanek M, Henriksen T, Lindvall S, Domingos J, Alobaidi A, Kandukuri PL, Chaudhari VS, Patel AB, Parra JC, Pike J, Antonini A. Impact of advanced Parkinson's disease on caregivers: an international real-world study. J Neurol 2023; 270:2162-2173. [PMID: 36633671 PMCID: PMC9835744 DOI: 10.1007/s00415-022-11546-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/25/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Caring for a partner or family member with Parkinson's disease (PD) negatively affects the caregiver's own physical and emotional well-being, especially those caring for people with advanced PD (APD). This study was designed to examine the impact of APD on caregiver perceived burden, quality of life (QoL), and health status. METHODS Dyads of people with PD and their primary caregivers were identified from the Adelphi Parkinson's Disease Specific Program (DSP™) using real-world data from the United States, Japan and five European countries. Questionnaires were used to capture measures of clinical burden (people with PD) and caregiver burden (caregivers). RESULTS Data from 721 patient-caregiver dyads in seven countries were captured. Caregivers had a mean age 62.6 years, 71.6% were female, and 70.4% were a spouse. Caregivers for people with APD had a greater perceived burden, were more likely to take medication and had lower caregiver treatment satisfaction than those caring for people with early or intermediate PD; similar findings were observed for caregivers of people with intermediate versus early PD. Caregivers for people with intermediate PD were also less likely to be employed than those with early PD (25.3% vs 42.4%) and spent more time caring (6.6 vs 3.2 h/day). CONCLUSIONS This real-world study demonstrates that caregivers of people with APD experience a greater burden than those caring for people with early PD. This highlights the importance of including caregiver-centric measures in future studies, and emphasizes the need for implementing treatments that reduce caregiver burden in APD. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Pablo Martinez-Martin
- grid.413448.e0000 0000 9314 1427Center for Networked Biomedical Research, Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Matej Skorvanek
- grid.11175.330000 0004 0576 0391Department of Neurology, P. J. Šafárik University, Košice, Slovakia
- grid.412894.20000 0004 0619 0183Department of Neurology, University Hospital L. Pasteur, Košice, Slovakia
| | - Tove Henriksen
- grid.475435.4Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | | | - Josefa Domingos
- European Parkinson’s Disease Association (EPDA), Sevenoaks, UK
| | - Ali Alobaidi
- grid.431072.30000 0004 0572 4227AbbVie Inc., North Chicago, IL USA
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Chicago, IL USA
| | | | | | - Apeksha B. Patel
- grid.431072.30000 0004 0572 4227AbbVie Inc., North Chicago, IL USA
| | | | - James Pike
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - Angelo Antonini
- grid.5608.b0000 0004 1757 3470Movement Disorders Unit, Department of Neuroscience, University of Padova, Padua, Italy
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15
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Contaldi E, Magistrelli L, Comi C. Disease mechanisms as subtypes: Immune dysfunction in Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:67-93. [PMID: 36803824 DOI: 10.1016/b978-0-323-85555-6.00008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In recent years, the contraposition between inflammatory and neurodegenerative processes has been increasingly challenged. Inflammation has been emphasized as a key player in the onset and progression of Parkinson disease (PD) and other neurodegenerative disorders. The strongest indicators of the involvement of the immune system derived from evidence of microglial activation, profound imbalance in phenotype and composition of peripheral immune cells, and impaired humoral immune responses. Moreover, peripheral inflammatory mechanisms (e.g., involving the gut-brain axis) and immunogenetic factors are likely to be implicated. Even though several lines of preclinical and clinical studies are supporting and defining the complex relationship between the immune system and PD, the exact mechanisms are currently unknown. Similarly, the temporal and causal connections between innate and adaptive immune responses and neurodegeneration are unsettled, challenging our ambition to define an integrated and holistic model of the disease. Despite these difficulties, current evidence is providing the unique opportunity to develop immune-targeted approaches for PD, thus enriching our therapeutic armamentarium. This chapter aims to provide an extensive overview of past and present studies that explored the implication of the immune system in neurodegeneration, thus paving the road for the concept of disease modification in PD.
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Affiliation(s)
- Elena Contaldi
- Movement Disorders Centre, "Maggiore della Carità" University Hospital, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, "Maggiore della Carità" University Hospital, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Cristoforo Comi
- Neurology Unit, S.Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Vercelli, Italy.
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16
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Pugh M, Perrin PB, Watson JD, Kuzu D, Tyler C, Villaseñor T, Lageman SK, Moreno OA. Psychometric investigation of the affiliate stigma scale in Mexican Parkinson's disease caregivers: Development of a short form. NeuroRehabilitation 2023; 52:71-81. [PMID: 34397425 DOI: 10.3233/nre-210105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Parkinson's disease (PD) caregivers, particularly in Latin America, may experience high levels of affiliate stigma due to their association with a person having a disability. The most common measure used of this construct in the literature, the Affiliate Stigma Scale, was validated using non-standard and questionable methods. OBJECTIVE The purpose of this study was to investigate the factor structure and psychometric properties of the Spanish version of the Affiliate Stigma Scale with PD caregivers in Mexico using more widely accepted psychometric approaches including confirmatory and exploratory factor analyses (CFAs, EFAs). METHODS A sample of 148 PD caregivers from Mexico completed this measure, as well as indices of caregiver burden and anxiety. RESULTS Initial CFAs revealed that the data did not fit either the originally proposed one-factor or three-factor structures. An EFA was then conducted which was unable to discern any factor structure. Upon instituting a stepwise removal alpha-if-item-deleted process, a 5-item Affiliate Stigma Scale Spanish Short Form was retained with an adequate Cronbach's alpha, good convergent validity, and a Short Form CFA generally indicating adequate fit. CONCLUSIONS The new Spanish Affiliate Stigma Scale Short Form holds promise for more appropriately measuring affiliate stigma likely in general but particularly in Spanish and among PD caregivers. The Short Form can assist not only in assessing levels of caregiver affiliate stigma, but in creating novel interventions to help support caregivers and decrease stigma.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Jack D Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Duygu Kuzu
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Carmen Tyler
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Guadalajara, Mexico
| | - Sarah K Lageman
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Oswaldo A Moreno
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Gu SC, Shi R, Gaoag C, Yuan XL, Wu Y, Zhang Y, De Wang C, Fan RD, Chen X, Yuan CX, Ye Q. Traditional Chinese medicine Pingchan granule for motor symptoms and functions in Parkinson's disease: A multicenter, randomized, double-blind, placebo-controlled study. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 108:154497. [PMID: 36283254 DOI: 10.1016/j.phymed.2022.154497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/14/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pingchan granule (PCG) is a traditional Chinese medicine for Parkinson's disease (PD). HYPOTHESIS/PURPOSE This was the first study aiming to evaluate the efficacy and safety of PCG for motor symptoms, gait impairments and quality of life in PD. STUDY DESIGN AND METHODS In this multicenter, randomized, double-blind, placebo-controlled trial, 292 participants were included and followed for 9 months, randomly assigned at a 1:1 ratio to receive PCG or placebo. The primary outcome was the severity of motor symptoms assessed by Movement Disorder Society Unified Parkinson's Rating Scale III (MDS-UPDRS-III) motor score. Secondary outcomes included timed up and go test (TUG), functional gait assessment (FGA), freezing of gait (FOG), and quality of life assessed by Parkinson's disease questionnaire (PDQ-39). Assessments were done at baseline (T0), 3 months (T1), 6 months (T2) and 9 months (T3). TRIAL REGISTRATION Chinese Clinical Trial Register, ChiCTR-INR-1,701,194. RESULTS Generalized estimating equation analyses revealed that PCG group had significantly better improvement in MDS-UPDRS-III motor score than placebo group, as well as its domain scores of axial symptoms, bradykinesia, rigidity, and tremor. Improvements of TUG time, FGA, FOG questionnaire (FOGQ), and PDQ39 scores were also observed. CONCLUSION PCG had a long-lasting efficacy for motor symptoms and function in PD with good tolerance, supporting that PCG might be a viable alternative in the management of PD.
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Affiliation(s)
- Si-Chun Gu
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - Rong Shi
- Department of Emergency, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, 201203, China
| | - Chen Gaoag
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiao-Lei Yuan
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - You Wu
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Chang De Wang
- Department of Neurology, Shanghai TCM-integrated Hospital, Shanghai University of Traditional Chinese Medicine, 230 Baoding Road, Shanghai, 200082, China
| | - Rui-Dong Fan
- Department of integrated traditional Chinese and Western medicine, Shigatse people's Hospital, Jilin South Road, Sangzhuzi District, Shigatse, Tibet, China
| | - Xiqun Chen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, United States
| | - Can-Xing Yuan
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.
| | - Qing Ye
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.
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Fleisher JE, Suresh M, Klostermann EC, Lee J, Hess SP, Myrick E, Mitchem D, Woo K, Sennott BJ, Witek NP, Chen SM, Beck JC, Ouyang B, Wilkinson JR, Hall DA, Chodosh J. IN-HOME-PDCaregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease. Parkinsonism Relat Disord 2023; 106:105222. [PMID: 36446676 PMCID: PMC9825655 DOI: 10.1016/j.parkreldis.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Family caregivers of people with advanced Parkinson's Disease (PD) are at high risk of caregiver strain, which independently predicts adverse patient outcomes. We tested the effects of one year of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) with 16 weeks of peer mentoring on caregiver strain compared with usual care. METHODS We enrolled homebound people with advanced PD (PWPD) and their primary caregiver as IN-HOME-PD dyads. We trained experienced PD family caregivers as peer mentors. Dyads received four structured home visits focused on advanced symptom management, home safety, medications, and psychosocial needs. Starting at approximately four months, caregivers spoke weekly with a peer mentor for 16 weeks. We compared one-year change in caregiver strain (MCSI, range 0-72) with historical controls, analyzed intervention acceptability, and measured change in anxiety, depression, and self-efficacy. RESULTS Longitudinally, IN-HOME-PD caregiver strain was unchanged (n = 51, 23.34 (SD 9.43) vs. 24.32 (9.72), p = 0.51) while that of controls worsened slightly (n = 154, 16.45 (10.33) vs. 17.97 (10.88), p = 0.01). Retention in peer mentoring was 88.2%. Both mentors and mentees rated 100% of mentoring calls useful, with mean satisfaction of 91/100 and 90/100, respectively. There were no clinically significant improvements in anxiety, depression, or self-efficacy. CONCLUSIONS Interdisciplinary telehealth-enhanced home visits combined with peer mentoring mitigated the worsening strain observed in caregivers of less advanced individuals. Mentoring was met with high satisfaction. Future caregiver-led peer mentoring interventions are warranted given the growing, unmet needs of PD family caregivers. TRIAL REGISTRATION NCT03189459.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Madhuvanthi Suresh
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Ellen C Klostermann
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Serena P Hess
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Brianna J Sennott
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie P Witek
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Sarah Mitchell Chen
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - James C Beck
- Parkinson's Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA.
| | - Bichun Ouyang
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jayne R Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Deborah A Hall
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
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19
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Jerry M, Arcona S, McMorrow D, Schwartz H, Princic N, Sasane R. Work Loss and Direct and Indirect Costs Associated with Parkinson's Disease. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:309-319. [PMID: 37138588 PMCID: PMC10150754 DOI: 10.2147/ceor.s398509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose To examine work loss and indirect costs during the three-year periods prior to and following initial diagnosis of Parkinson's disease (PD) in patients and in spouses of PD patients, as well as direct costs of healthcare. Patients and Methods This is a retrospective, observational cohort study using the MarketScan Commercial and Health and Productivity Management databases. Results A total of 286 employed PD patients and 153 employed spouses met all diagnostic and enrollment criteria for short-term disability (STD) analysis (PD Patient cohort and Caregiving Spouse cohort). The proportion of PD patients having a STD claim increased from roughly 5% and plateaued at around 12-14% starting in the year prior to first diagnosis of PD. The mean number of days lost from work due to STD per year increased from 1.4 days in the 3rd year prior to diagnosis to 8.6 days in the 3rd year after diagnosis (corresponding to an increase in indirect costs from $174 to $1104). STD use for spouses of patients with PD was lowest in the year after their spouses were diagnosed and then rose dramatically in the 2nd and 3rd years after the spouse's diagnosis. Total all-cause direct health-care costs increased during the years leading up to PD diagnosis and were highest in the years following diagnosis, with PD-related costs contributing ~20-30% of the total. Conclusion PD has both a significant direct and indirect financial burden on patients and their spouses when analyzed for 3 years before and after diagnosis.
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Affiliation(s)
- Michelle Jerry
- Merative, Ann Arbor, MI, USA
- Correspondence: Michelle Jerry, Merative, 100 Phoenix Dr Ste 200, Ann Arbor, MI, 48108, USA, Email
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20
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Fleisher JE, Moshkovich A, Levin M, Akram F, Hess SP, Suresh M, Bentley CD, Manak T, Mattke M, Miller A, Pennsyl CE, Pierce CM, Voss M, Taylor A, Schroeder K, Chodosh J. Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders. Alzheimer Dis Assoc Disord 2023; 37:42-49. [PMID: 36346930 PMCID: PMC10204123 DOI: 10.1097/wad.0000000000000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Family caregivers of people living with dementia have high caregiver strain and poor health consequences. Limited research exists on Lewy body dementia (LBD) caregivers and their specific comorbidities. This study aimed to (1) identify the prevalence of self-reported comorbidities among LBD caregivers and (2) contextualize these findings with historical data on caregivers of persons living with Alzheimer disease and associated disorders (ADADs). METHODS In a national, online survey, LBD family caregivers completed the Self-Administered Comorbidity Questionnaire and we compared these findings with extant literature on ADAD caregiver comorbidities. RESULTS Among 217 LBD caregivers, 84.3% were female, 39.1% were 64 years old or younger, and 66.8% had >2 years of caregiving experience. Caregivers self-identified as current (83.9%) or former (16.1%) caregivers. The most frequent comorbidities were hypertension (38.2%), depression (35.0%), back pain (34.1%), and arthritis (27.7%). LBD caregivers, particularly younger caregivers, had a higher prevalence of depression compared with ADAD caregivers and older adult populations, and back pain prevalence nearly equivalent to spinal cord injury caregivers. CONCLUSIONS Our study is the first to illustrate and contextualize specific comorbidities among LBD caregivers. Understanding the causality and impact of these conditions will be critical in designing effective interventions to improve the lives of families affected by LBD.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center
| | | | - Melissa Levin
- Department of Neurological Sciences, Rush University Medical Center
- Chicago Medical School - Rosalind Franklin University, North Chicago, IL
| | - Faizan Akram
- Department of Neurological Sciences, Rush University Medical Center
| | - Serena P Hess
- Department of Neurological Sciences, Rush University Medical Center
| | | | - Cintra D Bentley
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Thomas Manak
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Maraline Mattke
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Allegra Miller
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Claire E Pennsyl
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Carmen M Pierce
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Margaret Voss
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | | | | | - Joshua Chodosh
- Department of Medicine, Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine
- VA New York Harbor Healthcare System, Medicine Service, New York, NY
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21
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Lamotte G, Cheshire WP. Do not forget about caregivers in autonomic medicine! Clin Auton Res 2022; 32:403-404. [PMID: 36114993 DOI: 10.1007/s10286-022-00896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
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22
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Park YH, Suh JH, Kim YW, Kang DR, Shin J, Yang SN, Yoon SY. Machine learning based risk prediction for Parkinson's disease with nationwide health screening data. Sci Rep 2022; 12:19499. [PMID: 36376523 PMCID: PMC9663430 DOI: 10.1038/s41598-022-24105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Although many studies have been conducted on machine learning (ML) models for Parkinson's disease (PD) prediction using neuroimaging and movement analyses, studies with large population-based datasets are limited. We aimed to propose PD prediction models using ML algorithms based on the National Health Insurance Service-Health Screening datasets. We selected individuals who participated in national health-screening programs > 5 times between 2002 and 2015. PD was defined based on the ICD-code (G20), and a matched cohort of individuals without PD was selected using a 1:1 random sampling method. Various ML algorithms were applied for PD prediction, and the performance of the prediction models was compared. Neural networks, gradient boosting machines, and random forest algorithms exhibited the best average prediction accuracy (average area under the receiver operating characteristic curve (AUC): 0.779, 0.766, and 0.731, respectively) among the algorithms validated in this study. The overall model performance metrics were higher in men than in women (AUC: 0.742 and 0.729, respectively). The most important factor for predicting PD occurrence was body mass index, followed by total cholesterol, glucose, hemoglobin, and blood pressure levels. Smoking and alcohol consumption (in men) and socioeconomic status, physical activity, and diabetes mellitus (in women) were highly correlated with the occurrence of PD. The proposed health-screening dataset-based PD prediction model using ML algorithms is readily applicable, produces validated results, and could be a useful option for PD prediction models.
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Affiliation(s)
- You Hyun Park
- grid.15444.300000 0004 0470 5454Department of Biostatistics, Yonsei University, Seoul, Korea
| | - Jee Hyun Suh
- grid.255649.90000 0001 2171 7754Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yong Wook Kim
- grid.15444.300000 0004 0470 5454Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Ryong Kang
- grid.15444.300000 0004 0470 5454Department of Precision Medicine & Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jaeyong Shin
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Nam Yang
- grid.411134.20000 0004 0474 0479Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Seo Yeon Yoon
- grid.411134.20000 0004 0474 0479Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
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23
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Yu Z, Huang L, Xia Y, Cheng S, Yang C, Chen C, Zou Z, Wang X, Tian X, Jiang X, Zhou L. Analysis of m6A modification regulators in the substantia nigra and striatum of MPTP-induced Parkinson’s disease mice. Neurosci Lett 2022; 791:136907. [DOI: 10.1016/j.neulet.2022.136907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/14/2022] [Accepted: 10/02/2022] [Indexed: 10/31/2022]
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24
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Meigal AY, Gerasimova-Meigal LI, Reginya SA, Soloviev AV, Moschevikin AP. Gait Characteristics Analyzed with Smartphone IMU Sensors in Subjects with Parkinsonism under the Conditions of "Dry" Immersion. SENSORS (BASEL, SWITZERLAND) 2022; 22:7915. [PMID: 36298272 PMCID: PMC9611186 DOI: 10.3390/s22207915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Parkinson's disease (PD) is increasingly being studied using science-intensive methods due to economic, medical, rehabilitation and social reasons. Wearable sensors and Internet of Things-enabled technologies look promising for monitoring motor activity and gait in PD patients. In this study, we sought to evaluate gait characteristics by analyzing the accelerometer signal received from a smartphone attached to the head during an extended TUG test, before and after single and repeated sessions of terrestrial microgravity modeled with the condition of "dry" immersion (DI) in five subjects with PD. The accelerometer signal from IMU during walking phases of the TUG test allowed for the recognition and characterization of up to 35 steps. In some patients with PD, unusually long steps have been identified, which could potentially have diagnostic value. It was found that after one DI session, stepping did not change, though in one subject it significantly improved (cadence, heel strike and step length). After a course of DI sessions, some characteristics of the TUG test improved significantly. In conclusion, the use of accelerometer signals received from a smartphone IMU looks promising for the creation of an IoT-enabled system to monitor gait in subjects with PD.
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Affiliation(s)
- Alexander Y. Meigal
- Medical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
| | | | - Sergey A. Reginya
- Physical-Technical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
| | - Alexey V. Soloviev
- Physical-Technical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
| | - Alex P. Moschevikin
- Physical-Technical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
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25
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Zhong X, Song PP, Wang Z, Chen H. Resilience building among Chinese family caregivers of older people with Parkinson's disease in Shanghai. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2395-e2405. [PMID: 34904318 DOI: 10.1111/hsc.13679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
Despite a rapid increase in people with Parkinson's disease (PD) in China, studies focusing on caregiver burden remain scarce. Challenges faced by caregivers in other Asian societies are also underexplored in the PD-related research field. To addresses this gap, this study drew on the theory of resilience and examined the caregiving experiences of Chinese family caregivers for older people with PD. We conducted participant observation and semi-structured interviews with 15 family caregivers of older people with PD in Shanghai in 2018. We used thematic analysis to identify key patterns of stressors and factors affecting the capacity of caregivers to address burdens. Our analysis shows that stressors faced by Chinese PD caregivers included physical limitations, psychological and emotional problems, reduction in social connections, financial burden and lack of information and knowledge. Three levels of factors-personal, social and structural-played different roles in resilience among Chinese PD caregivers. However, resilience was unevenly developed among PD caregivers across gender, kinship, residential status and generation. Our study provides novel empirical evidence about the burden on Chinese PD caregivers. It can inform policymakers and social workers as they develop a holistic understanding of promoting resilience building in this rapidly growing group. Our study also enriches cross-cultural knowledge about factors contributing to caregivers' resilience building in Asian societies.
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Affiliation(s)
- Xiaohui Zhong
- School of Government, Sun Yat-sen University, Guangzhou, P. R. China
| | - Priscilla P Song
- Centre for the Humanities and Medicine, The University of Hong Kong, SAR, Hong Kong, P.R. China
| | - Zhe Wang
- Department of Social Work, School of Social Development and Public Policy, Fudan University, Shanghai, P. R. China
| | - Honglin Chen
- Department of Social Work, School of Social Development and Public Policy, Fudan University, Shanghai, P. R. China
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
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26
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Seshadri S, Norton SA, Stahl T, Shah M, Dini M, Yarab N, Holtrop JS, Kluger BM. Between a Rock and a Hard Place: The Challenges of Caregiving During a Pandemic for Parkinson's Family Care Partners. Am J Hosp Palliat Care 2022:10499091221119462. [PMID: 35943434 DOI: 10.1177/10499091221119462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: To understand Parkinson's Disease (PD) care partners' a) specific challenges that led to worsening strain and b) their suggestions for supports to help them during the ongoing pandemic. Method: Using a qualitative descriptive design, semi-structured interviews with family care partners (n = 19) were completed. Participants were recruited from 10 sites across the United States that varied in size, demographics of patient population served, and geographic location (urban, suburban, rural). Interviews were audio-recorded, de-identified, transcribed verbatim, and coded in a phased manner. The research team analyzed the data and identified themes. Results: During the pandemic, the already difficult task of caregiving was made worse by having to choose between poor options. Five themes exemplified PD care partner experiences: (1) Managing risks and benefits of medical care in settings outside the home vs meeting these needs at home; (2) Struggling to maintain employment benefits with the costs of care and risks of bringing in outside caregivers; (3) Struggling to balance caregiving and self-care; (4) Struggling to be supportive and taking on new caregiving roles in the face of less support services; and (5) Wanting social connections and feeling pressured to maintain isolation. Care partners wanted timely access to, and guidance from healthcare teams to help them. Conclusions: Care partner burden was worsened by lack of guidance when confronted by choices that could lead to negative outcomes. Movement disorder and palliative care providers may be able to alleviate some care partner burden through building systems for timely access and guidance.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Sally A Norton
- University of Rochester School of Nursing, Rochester NY, USA
| | - Tyler Stahl
- 6927University of Rochester, Rochester, NY, USA
| | - Mina Shah
- 6927University of Rochester, Rochester, NY, USA
| | - Megan Dini
- Parkinson's Foundation, New York, NY, USA
| | | | - Jodi Summers Holtrop
- 12225Department of Family Medicine at the University of Colorado School of Medicine and the Adult and Child Center for Outcomes Research and Delivery (ACCORDS) at the University of Colorado Anschutz Medical Campus
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
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27
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Yoon SY. Update on Parkinson's Disease Rehabilitation. BRAIN & NEUROREHABILITATION 2022; 15:e15. [PMID: 36743207 PMCID: PMC9833476 DOI: 10.12786/bn.2022.15.e15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder. Although dopaminergic drugs are the mainstay for improving PD symptoms, there are still few effective disease-modifying therapies. With the increasing prevalence of PD and the rapid transition to an aging society, more emphasis needs to be placed on rehabilitation that could slow the disease progression combined with pharmacological therapy. In this review, we present an update on evidence related to rehabilitation programs for motor function, swallowing difficulty, and speech disorders in PD. Aerobic exercise, music therapy, dance, virtual reality, and non-invasive brain stimulation have been shown to improve motor function, and telerehabilitation could also be feasibly applied in PD. Recent studies have shown the effectiveness of expiratory muscle strengthening exercises and Lee Silverman Voice Treatment for swallowing difficulty and speech disorders, respectively. Although many rehabilitation programs have been tried, the evidence is still limited. Well-designed future randomized controlled trials with large numbers of participants are needed to establish evidence for rehabilitation in PD.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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28
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Höllerhage M, Klietz M, Höglinger GU. Disease modification in Parkinsonism: obstacles and ways forward. J Neural Transm (Vienna) 2022; 129:1133-1153. [PMID: 35695938 PMCID: PMC9463344 DOI: 10.1007/s00702-022-02520-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 12/19/2022]
Abstract
To date, the diagnoses of Parkinson syndromes are based on clinical examination. Therefore, these specific diagnoses are made, when the neuropathological process is already advanced. However, disease modification or neuroprotection, is considered to be most effective before marked neurodegeneration has occurred. In recent years, early clinical or prodromal stages of Parkinson syndromes came into focus. Moreover, subtypes of distinct diseases will allow predictions of the individual course of the diseases more precisely. Thereby, patients will be enrolled into clinical trials with more specific disease entities and endpoints. Furthermore, novel fluid and imaging biomarkers that allow biochemical diagnoses are under development. These will lead to earlier diagnoses and earlier therapy in the future as consequence. Furthermore, therapeutic approaches will take the underlying neuropathological process of neurodegenerative Parkinson syndromes more specific into account. Specifically, future therapies will target the aggregation of aggregation-prone proteins such as alpha-synuclein and tau, the degradation of pathological aggregates, and the spreading of pathological protein aggregates throughout the brain. Many of these approaches are already in (pre)clinical development. In addition, anti-inflammatory approaches are in development. Furthermore, drug-repurposing is a feasible approach to shorten the developmental process of new drugs.
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Affiliation(s)
- M Höllerhage
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - G U Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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29
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Leung T, Akram F, Lee J, Klostermann EC, Hess SP, Myrick E, Levin M, Ouyang B, Wilkinson J, Hall D, Chodosh J. Peer Mentoring Program for Informal Caregivers of Homebound Individuals With Advanced Parkinson Disease (Share the Care): Protocol for a Single-Center, Crossover Pilot Study. JMIR Res Protoc 2022; 11:e34750. [PMID: 35481819 PMCID: PMC9185354 DOI: 10.2196/34750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homebound individuals with advanced Parkinson disease (PD) require intensive caregiving, the majority of which is provided by informal, family caregivers. PD caregiver strain is an independent risk factor for institutionalization. There are currently no effective interventions to support advanced PD caregivers. Studies in other neurologic disorders, however, have demonstrated the potential for peer mentoring interventions to improve caregiver outcomes. In the context of an ongoing trial of interdisciplinary home visits, we designed and piloted a nested trial of caregiver peer mentoring for informal caregivers of individuals with advanced PD. OBJECTIVE The aim of this study was to test the feasibility of peer mentoring for caregivers of homebound individuals with advanced PD and to evaluate its effects on anxiety, depression, and caregiver strain. METHODS This was a single-center, 16-week pilot study of caregiver peer mentoring nested within a year-long controlled trial of interdisciplinary home visits. We recruited 34 experienced former or current family caregivers who completed structured mentor training. Caregivers enrolled in the larger interdisciplinary home visit trial consented to receive 16 weeks of weekly, one-to-one peer mentoring calls with a trained peer mentor. Weekly calls were guided by a curriculum on advanced PD management and caregiver support. Fidelity to and satisfaction with the intervention were gathered via biweekly study diaries. Anxiety, depression, and caregiver strain were measured pre- and postmentoring intervention at home visits 2 and 3. RESULTS Enrollment and peer-mentor training began in 2018, and 65 caregivers enrolled in the overarching trial. The majority of mentors and mentees were White, female spouses or partners of individuals with PD; mentors had a mean of 8.7 (SD 6.4) years of caregiving experience, and 33 mentors were matched with at least 1 mentee. CONCLUSIONS This is the first study of caregiver peer mentoring in PD and may establish an adaptable and sustainable model for disease-specific caregiver interventions in PD and other neurodegenerative diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34750.
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Affiliation(s)
| | | | | | | | | | - Erica Myrick
- RUSH UNIVERSITY MEDICAL CENTER, Chicago, US.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, US
| | - Melissa Levin
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US.,Chicago Medical School, Rosalind Franklin University, North Chicago, US
| | - Bichun Ouyang
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US
| | - Jayne Wilkinson
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US.,Department of Neurology, University of Pennsylvania, Pennsylvania, US
| | - Deborah Hall
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 227 E. 30th St.TRB 839, New York, US.,VA New York Harbor Healthcare System, Medicine Service, New York, US
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30
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Mak MKY, Wong-Yu ISK. Six-Month Community-Based Brisk Walking and Balance Exercise Alleviates Motor Symptoms and Promotes Functions in People with Parkinson's Disease: A Randomized Controlled Trial. JOURNAL OF PARKINSON'S DISEASE 2022; 11:1431-1441. [PMID: 33967056 DOI: 10.3233/jpd-202503] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), sustained aerobic exercise is a promising therapy in delaying motor disability. Brisk walking is a moderate intensity aerobic training, which could be translated to community practice at low cost, but its effects on motor symptoms remains unclear. OBJECTIVE To determine the effectiveness of a six-month brisk walking and balance program in alleviating motor symptoms, and promoting functional, gait, and balance performance in people with PD. METHODS Seventy individuals with mild to moderate PD were randomly assigned to a brisk walking (BW) group or an active control (CON) group. BW group received ten 90-minute supervised brisk walking and balance exercise for six months (weeks 1-6: once/week, weeks 7-26: once/month). CON group received upper limb training. Both groups performed 2-3 self-practice sessions weekly. Primary outcome was Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score. Secondary outcomes were fast gait speed (FGS), timed-up-and-go (TUG) time, six-minute walk distance (6MWD), and Mini-Balance Evaluation Systems Test (Mini-BEST) score. RESULTS Sixty-four participants (33 BW/31 CON) completed training. BW group showed greater significant decreases from baseline than CON group in MDS-UPDRS motor score after six weeks (-5.5 vs -1.6, p < 0.001) and 6 months (-6.0 vs -1.4, p < 0.001) of training. BW group also showed greater significant improvement from the baseline than CON group for TUG time, FGS, 6MWD, and mini-BEST score (all p < 0.05). CONCLUSION The six-month brisk walking and balance program alleviates motor symptoms, promotes functional and gait performance, walking capacity, and dynamic balance in people with mild to moderate PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Irene S K Wong-Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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31
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Chaudhuri KR, Antonini A, Pahwa R, Odin P, Titova N, Thakkar S, Snedecor SJ, Hegde S, Alobaidi A, Parra JC, Zadikoff C, Bergmann L, Standaert DG. Effects of Levodopa-Carbidopa Intestinal Gel on Dyskinesia and Non-Motor Symptoms Including Sleep: Results from a Meta-Analysis with 24-Month Follow-Up. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2071-2083. [PMID: 35964203 PMCID: PMC9661331 DOI: 10.3233/jpd-223295] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND In advanced Parkinson's disease (PD), dyskinesias and non-motor symptoms such as sleep dysfunction can significantly impair quality of life, and high-quality management is an unmet need. OBJECTIVE To analyze changes in dyskinesia and non-motor symptoms (including sleep) among studies with levodopa-carbidopa intestinal gel (LCIG) in patients with advanced PD. METHODS A comprehensive literature review identified relevant studies examining LCIG efficacy. Outcomes of interest were dyskinesia (UDysRS, UPDRS IV item 32), overall non-motor symptoms (NMSS), mentation/behavior/mood (UPDRS I), and sleep/daytime sleepiness (PDSS-2, ESS). The pooled mean (95% confidence interval) change from baseline per outcome was estimated for each 3-month interval with sufficient data (i.e., reported by≥3 studies) up to 24 months using a random-effects model. RESULTS Seventeen open-label studies evaluating 1243 patients with advanced PD were included. All outcomes of interest with sufficient data for meta-analysis showed statistically significant improvement within 6 months of starting LCIG. There were statistically significant improvements in dyskinesia duration as measured by UPDRS IV item 32 at 6 months (-1.10 [-1.69, -0.51] h/day) and 12 months (-1.35 [-2.07, -0.62] h/day). There were statistically and clinically significant improvements in non-motor symptoms as measured by NMSS scores at 3 months (-28.71 [-40.26, -17.15] points). Significant reduction of NMSS burden was maintained through 24 months (-17.61 [-21.52, -13.70] points). UPDRS I scores significantly improved at 3 months (-0.39 [-0.55, -0.22] points). Clinically significant improvements in PDSS-2 and ESS scores were observed at 6 and 12 months in individual studies. CONCLUSION Patients with advanced PD receiving LCIG showed significant sustained improvements in the burden of dyskinesia and non-motor symptoms up to 24 months after initiation.
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Affiliation(s)
- K. Ray Chaudhuri
- Parkinson Foundation Centre of Excellence, King’s College Hospital and King’s College, London, UK
- Correspondence to: K. Ray Chaudhuri, MBBS, MD, FRCP (Lond), FRCP (Edin), DSc, FEAN, Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King’s College London, Cutcombe Road, London SE5 9RT, UK. Tel.: +44 0 7958249738; E-mail:
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration CESNE, Department of Neuroscience, University of Padova, Padova, Italy
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Per Odin
- University of Lund, Lund, Sweden
| | - Nataliya Titova
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
- Federal State Budgetary Institution «Federal center of brain research and neurotechnologies» of the Federal Medical Biological Agency, Moscow, Russia
| | | | | | | | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
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Neuroprotective Effect of Ceftriaxone on MPTP-Induced Parkinson's Disease Mouse Model by Regulating Inflammation and Intestinal Microbiota. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9424582. [PMID: 34938384 PMCID: PMC8687851 DOI: 10.1155/2021/9424582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 01/04/2023]
Abstract
Parkinson's disease (PD) is a common degenerative disease of the central nervous system. Although some drugs can alleviate the progress of PD, their long-term use will lead to complications, so it is still necessary to find new drugs to delay or cure PD effectively. In view of the difficulty in developing new drugs, it is imperative to discover new functions of existing compounds that could be used to treat PD. In this study, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was used to induce PD symptoms in a mouse model. Subsequently, these mice were treated with the antibiotic ceftriaxone. Ceftriaxone alleviated the behavioural and neuropathological changes induced by MPTP, downregulated the expression of glial fibrillary acidic protein (GFAP) and ionised calcium-binding adapter molecule 1 (Iba1) as markers of astroglia and microglia, respectively, and reduced the expression of neuroinflammation-related Toll-like receptor 4 (TLR4), myeloid differentiation primary response 88 (MyD88), and phosphorylated nuclear factor kappa-B (p-NF-κB)/NF-κB in the brain of PD mice. In addition, ceftriaxone reduced the abundance of pathogenic bacteria of the genus Proteus and increased the abundance of probiotic Akkermansia. Finally, ceftriaxone treatment increased the expression of the tight junction proteins zona occludens-1(ZO-1) and occludin in the colon, decreased the expression of the inflammation-related proteins TLR4, MyD88, and NF-κB in the colon, and decreased the serum concentration of the proinflammatory cytokines interleukin-1β (IL-1β), IL-6, and tumour necrosis factor-α (TNF-α). These results indicate that ceftriaxone had a neuroprotective effect on MPTP-induced PD mice, and its neuroprotective effect could be through regulating inflammation and intestinal microbiota. While we showed that ceftriaxone exerts a neuroprotective effect in an MPTP-induced PD mouse model, our findings are limited to the short-term effects of ceftriaxone. Additional work using transgenic mice is required to determine the long-term effects of ceftriaxone. In addition, the dose and frequency of ceftriaxone use should be evaluated.
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Yoon SY, Park YH, Lee HJ, Kang DR, Kim YW. Lifestyle Factors and Parkinson Disease Risk: Korean Nationwide Cohort Study With Repeated Health Screening Data. Neurology 2021; 98:e641-e652. [PMID: 34649886 DOI: 10.1212/wnl.0000000000012942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Many previous studies, mostly performed in Western countries, on the effects of lifestyle factors on Parkinson's disease, used baseline lifestyle characteristics without directly accounting for changes in covariate values over time. The objective of this study was to evaluate the association of repeatedly measured lifestyle factors with Parkinson's disease risk in Korean population. METHODS We conducted a nationwide population-based cohort study. Among 512,836 Koreans in the national health checkup database, we selected individuals who underwent health screening ≥ 3 times between 2002 and 2015 and followed up until December 31, 2015. Parkinson's disease was defined using the International Classification of Diseases, Tenth Revision code G20 (with ≥ 3 times clinic visits for PD, to increase the diagnostic validity). Data on lifestyle factors such as smoking, alcohol consumption, and physical activity were collected using self-reported questionnaires. Logistic regression analysis with time-dependent covariates using generalized estimation equation models was performed to determine Parkinson's disease development. RESULTS During the 14-year follow-up, 2,655 patients developed Parkinson's disease. Smoking showed a dose-response inverse association with Parkinson's disease only in males (ex-smoker, Odds ratio [OR] =0.782, 95% confidence interval [CI] 0.713-0.858; current smoker, OR = 0.556, 95% CI 0.488-0.632). Alcohol consumption and regular physical activity were related to reduced Parkinson's disease development in both sexes; however, alcohol consumption in males (≤ 3 per week, OR=0.717, 95% CI 0.658-0.780; ≥ 4 per week, OR = 0.745, 95% CI 0.644-0.861) and physical activity in females (moderate, OR=0.792, 95% CI 0.748-0.840; vigorous, OR = 0.830, 95% CI 0.756-0.911) had more consistent associations with Parkinson's disease development compared to those of either sex. Participants with regular health screening showed a consistent relationship between lifestyle factors and Parkinson's disease development, whereas lifestyle factors in those without regular health screening had a decreased relationship with PD, even smoking habit. CONCLUSIONS Analysis using repeatedly measured lifestyle factors showed an association between lifestyle factors and Parkinson's disease development. Characteristics of lifestyle data including repeated measurements, timing, or regularity might influence results, and future studies with appropriate lifestyle factors could increase Parkinson's disease risk prediction. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that smoking, alcohol use, and physical activity are associated with reduced risk of Parkinson's disease in a Korean population.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - You Hyun Park
- Department of Biostatistics, Yonsei University, Seoul, Korea
| | - Hyo Jeong Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine & Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Abstract
A substantial number of neurological diseases lead to chronic impairment of activities of daily living (ADL) and physical or mental dependence. In Austria, homecare is provided mostly by female family members. Moreover, mainly female personnel, in the majority from southern and eastern European countries, contributes to care. Dependence and need for care vary between neurological diagnoses and accompanying diseases. Caregiver burden (CB) depends on patient- and caregiver-related and external factors, such as integrity of a family network, spatial resources, and socioeconomic factors. Depending on the neurological diagnosis, disease severity, and behavioral impairment and psychiatric symptoms, caregivers (CG) are at a significant risk of mental and somatic health problems because of limitations in personal needs, occupational and social obligations, financial burden, and restricted family life and leisure. Subjective and objective CB needs to be assessed in time and support should be provided on an individual basis. Recently, COVID-19 has caused additional multifactorial distress to dependent patients and informal and professional CG.
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Affiliation(s)
- Gerhard Ransmayr
- Department of Neurology II, MedCampus III, Kepler University Hospital, Johannes Kepler University, Medical Faculty, Krankenhausstraße 9, 4020, Linz, Austria.
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Kaur J, Sandhu RK, Kubra KT, Canenguez Benitez JS, Onyeaka HK, Akter S, Amuk Williams OC. Substance Use Disorders in Patients With Parkinson's Disease and Adverse Hospitalization Outcomes: A National Inpatient Study. Cureus 2021; 13:e16033. [PMID: 34336520 PMCID: PMC8321420 DOI: 10.7759/cureus.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To understand the demographic pattern of substance use disorders (SUD) in Parkinson’s disease (PD) inpatients and to evaluate the impact of SUD on hospitalization outcomes including the severity of illness, length of stay (LOS), total charges, and disposition to nursing facilities. Methods We used the nationwide inpatient sample and identified adult patients (age, ≥40 years) with PD as a primary diagnosis and comorbid SUD (N = 959) and grouped by co-diagnosis of alcohol (N = 789), cannabis (N = 46), opioid (N = 30), stimulants (N = 54) and barbiturate (N = 40) use disorders. We used a binomial logistic regression model to evaluate the odds ratio (OR) for major loss of functioning and disposition to nursing facilities in PD inpatients. All regression models were adjusted for demographics, including age, sex, race, and median household income. Results Alcohol, opioid, and stimulant use disorders were prevalent in old-age adults (60-79 years), males, and whites, but cannabis use was prevalent in middle-aged adults (40-59 years), and barbiturate use among older-age (>80 years). The severity of illness is statistically higher in PD inpatients with comorbid opioid and barbiturate use disorders with major loss of body functioning, closely seconded by alcohol and stimulant use disorder cohorts (27.6% and 25.9%, respectively). Disease severity and loss of body functioning increase with advancing age (>80 years adults, OR 5.8, 95%CI 5.32-6.37), and in blacks (OR 1.7, 95%CI 1.56-1.81), and those with opioid use disorder (OR 3.8, 95%CI 1.96-7.35). PD inpatients with barbiturate use disorder had a higher LOS and charges by 17.4 days and $68,922, and six-fold increased likelihood (95%CI 2.33-15.67) for disposition to nursing facilities. Conclusions SUD is prevalent among PD patients and is associated with more severe illnesses with body loss functioning and prolonged care. A multidisciplinary care model including collaborative neuropsychiatric and addiction management is required to manage SUD among PD patients to lessen disease severity, slow down the disease progression and potentially save medical costs.
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Affiliation(s)
| | - Ramneek K Sandhu
- Internal Medicine, Shri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Khadija T Kubra
- Internal Medicine, Bangladesh Medical College and Hospital, Dhaka, BGD
| | | | | | - Sabiha Akter
- Psychiatry, Bergen New Bridge Medical Center, Paramus, USA
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Deng X, Yan R, Li ZQ, Tang XW, Zhou Y, He H. Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013-2018. PLoS Negl Trop Dis 2021; 15:e0009505. [PMID: 34153039 PMCID: PMC8248708 DOI: 10.1371/journal.pntd.0009505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/01/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013-2018, to increase disease awareness and provide evidence for effective health policy. METHODOLOGY/PRINCIPLE FINDINGS We merged multiple data sources, including National Notifiable Disease Registry System (NNDRS), patient interviews and medical records from corresponding hospitals for JE cases which occurred during 2013-2018 in Zhejiang Province. Direct costs were extracted from hospitals' billing systems and patient interviews. Indirect costs and disease burden were calculated based on questionnaire survey from patient interviews and follow-up assessment by general practitioners. Given under-reporting, an expansion factor (EF) was applied to extrapolate the JE burden to the provincial level. The total economic burden of JE during 2013-2018 was estimated at US $12.01 million with an EF = 3. Of this, $8.32 million was due to direct economic cost and $3.69 million to indirect cost. The disease burden of JE was 42.75 DALYs per million population (28.44 YLD, 14.28 YLL) according to the 1990 Global Burden of Disease (GBD 1990) methodology and 80.01 DALYs (53.67YLD, 26.34YLL) according to the GBD 2010 methodology. Sensitivity analysis demonstrated that the overall economic burden varied from US$ 1.73-36.42 million. The greatest variation was due to the prognosis of illness (-85.57%-203.17%), followed by occupation (-34.07%-134.12%) and age (-72.97%-47.69%). CONCLUSIONS/SIGNIFICANCE JE imposes a heavy burden for families and society in Zhejiang Province. This study provides comprehensive empirical estimates of JE burden to increase awareness and strengthen knowledge of the public. These data may support provincial level public health decision making for prevention and control of JE. Ongoing surveillance for acute meningitis and encephalitis syndrome (AEMS) in sentinel hospitals, is needed to further refine estimates of JE burden.
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Affiliation(s)
- Xuan Deng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Rui Yan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Zi-qiao Li
- Xiamen University, Xiamen, People’s Republic of China
| | - Xue-wen Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Yang Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
- * E-mail:
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Ability of a Set of Trunk Inertial Indexes of Gait to Identify Gait Instability and Recurrent Fallers in Parkinson's Disease. SENSORS 2021; 21:s21103449. [PMID: 34063468 PMCID: PMC8156709 DOI: 10.3390/s21103449] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
The aims of this study were to assess the ability of 16 gait indices to identify gait instability and recurrent fallers in persons with Parkinson’s disease (pwPD), regardless of age and gait speed, and to investigate their correlation with clinical and kinematic variables. The trunk acceleration patterns were acquired during the gait of 55 pwPD and 55 age-and-speed matched healthy subjects using an inertial measurement unit. We calculated the harmonic ratios (HR), percent recurrence, and percent determinism (RQAdet), coefficient of variation, normalized jerk score, and the largest Lyapunov exponent for each participant. A value of ≤1.50 for the HR in the antero-posterior direction discriminated between pwPD at Hoehn and Yahr (HY) stage 3 and healthy subjects with a 67% probability, between pwPD at HY 3 and pwPD at lower HY stages with a 73% probability, and it characterized recurrent fallers with a 77% probability. Additionally, HR in the antero-posterior direction was correlated with pelvic obliquity and rotation. RQAdet in the antero-posterior direction discriminated between pwPD and healthy subjects with 67% probability, regardless of the HY stage, and was correlated with stride duration and cadence. Therefore, HR and RQAdet in the antero-posterior direction can both be used as age- and-speed-independent markers of gait instability.
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Jansen AE, Koop MM, Rosenfeldt AB, Alberts JL. High intensity aerobic exercise improves bimanual coordination of grasping forces in Parkinson's disease. Parkinsonism Relat Disord 2021; 87:13-19. [PMID: 33932704 DOI: 10.1016/j.parkreldis.2021.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 11/03/2020] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) disrupts the control and coordination of grasping forces, likely due to a disruption in basal ganglia circuitry and diminished activity within the supplementary motor area (SMA). High intensity aerobic exercise has been shown to enhance connectivity between basal ganglia nuclei and cortical areas, including the SMA. The aim of this project was to determine the effects of high intensity lower extremity exercise on motor control patterns underlying a manual dexterity task. METHODS PD participants completed eight weeks of high intensity aerobic exercise under forced or voluntary exercise (FE or VE) modalities. Grasping forces for each limb were quantified during a functional bimanual dexterity task. Data were collected while OFF antiparkinsonian medication at baseline, end of treatment (EOT), and eight weeks after exercise cessation (EOT+8). RESULTS Eight weeks of high intensity exercise improved MDS-UPDRS Motor III clinical ratings by more than 4 points (~15%) for the FE and VE groups. Time to complete the task decreased nearly 30% across both groups as well. The control and coordination of grasping forces, simultaneity of force initiation, and rate of grip and load force exhibited significant improvements following exercise. In general, improvements in biomechanical outcomes were sustained following exercise cessation. CONCLUSION High intensity aerobic exercise, achieved via a forced or voluntary mode, improved PD symptoms and bimanual dexterity. Sustained improvement of upper extremity motor control following exercise cessation indicates high intensity exercise enhances CNS functioning and suggests exercise may be a candidate for altering PD progression.
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Affiliation(s)
- A Elizabeth Jansen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
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Hulshoff MJ, Book E, Dahodwala N, Tanner CM, Robertson C, Marras C. Current Knowledge on the Evolution of Care Partner Burden, Needs, and Coping in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:510-520. [PMID: 33981783 DOI: 10.1002/mdc3.13201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background Care partners support people with Parkinson's disease through a long journey ranging from independence to dependence for many daily tasks. Longitudinal studies are important to understand the evolution of this process and predictors of future needs of care partners. Methods A scoping review was conducted, searching PubMed for longitudinal studies examining care partner burden, needs or coping in Parkinson's disease published through May 2020. Results Eight observational studies and 19 interventional studies met the eligibility criteria. Longitudinal observation ranged from 7 weeks to 10 years, involving between six and 8515 care partners. All studies addressed care partner burden, while two and three studies respectively addressed needs and coping. Only one study related burden to specific stages or duration of disease. Results from identified studies show that care partners in Parkinson's disease are at risk for increasing burden over time. Multiple predictors of future burden have been identified related to the person with Parkinson's disease, the care partner, or an intervention. No studies examined the evolution of needs and coping in caregiving in Parkinson's disease. Conclusion The scarcity of longer term, observational research on the temporal evolution of burden and particularly needs and coping in caregiving for someone with PD is a main identified gap. Even within these observational studies, the impact of caregiving is not often reported. Longitudinal studies on these topics are needed to help understand their change over time and relation to each other, which can inform support planning for care partners.
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Affiliation(s)
- Max J Hulshoff
- Department of Neurology and Parkinson Center Radboud University Medical Center Nijmegen The Netherlands
| | - Elaine Book
- Pacific Parkinson's Research Centre University of British Columbia Vancouver British Columbia Canada
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neuroscience University of California - San Francisco, and Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Medical Center San Francisco California USA
| | | | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research Toronto Western Hospital Toronto Ontario Canada
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Counterpunching to improve the health of people with Parkinson's disease. J Am Assoc Nurse Pract 2021; 33:1230-1239. [PMID: 33859075 DOI: 10.1097/jxx.0000000000000598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Boxing programs designed specifically for people with Parkinson's disease (PD) can be beneficial in improving the physical, mental, and functional health of persons with PD. PURPOSE This study examined the effect of a boxing program, Rock Steady Boxing (RSB), on the health of people with PD from both the boxers' and their caregivers' perspectives as well as evaluated balance, quality of life (QoL), and depressive symptoms after 12 weeks of RSB. METHODS A mixed methods, one-group experimental design with focus groups were embedded within an intervention study. Six boxers completed baseline and 12-week postassessments. RESULTS The majority of boxers maintained or improved scores for balance, QoL, and reduced depressive symptoms. Findings indicate physical and mental benefits of RSB among persons with PD and this was further validated by qualitative data from boxers and caregivers, along with quantitative data of boxers. Caregivers and boxers reported that boxers' ability to perform activities of daily living (ADLs) improved and is supported by quantitative improvements in the Parkinson's disease Questionnaire-39 ADL subscale. All boxers reported reduced stigma, and caregivers and boxers valued the opportunity to work out in an environment free of stigma, a finding not previously reported. CONCLUSIONS It is important for nurse practitioners to recognize exercise benefits for people with PD and recommend the program to patients and include caregivers in their overall assessment of health and wellness. IMPLICATIONS FOR PRACTICE Nurse practitioners and other health practitioners may consider recommending a boxing program, such as RSB, for their PD patients as a sole or supplemental exercise program.
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Shah-Zamora D, Allen AM, Rardin L, Ivancic M, Durham K, Hickey P, Cooney JW, Scott BL, Mantri S. Mindfulness based stress reduction in people with Parkinson's disease and their care partners. Complement Ther Clin Pract 2021; 43:101377. [PMID: 33831804 DOI: 10.1016/j.ctcp.2021.101377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) leads to poor quality of life and caregiver burden. Mindfulness-based stress reduction (MBSR) may improve these symptoms. We assessed the impact of a 9-week MBSR course on people with PD (PwP) and their care partners (CPs). METHODS Participants completed questionnaires at screening, at the end of the course, and at 3-month follow-up: Parkinson's Disease Quality-39 (PDQ-39, PD only), Zarit Burden Inventory (ZBI, CP only) and Mindful Attention Awareness Scale (MAAS, both). The primary outcome measure was change in PDQ-39 (for PwP) or ZBI (for CP). Patient-reported scales were analyzed quantitatively; qualitative data on perceived effectiveness was collected. RESULTS 53.8% PwP and 100% CPs completed the course. Among PwP, there was a significant reduction in MAAS(p < 0.001) and in PDQ-39 (p = 0.008). CPs experienced an increase in MAAS (p = 0.02) but no change in ZBI (p = 0.239). Qualitatively, both PwP and CPs expressed satisfaction with the course. DISCUSSION MBSR improves mindful awareness in CPs and improves health-related quality of life in PwP.
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Affiliation(s)
| | - Allison M Allen
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Lacy Rardin
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Margaret Ivancic
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Katie Durham
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Patrick Hickey
- Department of Neurology, Duke University School of Medicine, USA
| | - Jeffrey W Cooney
- Department of Neurology, Duke University School of Medicine, USA
| | - Burton L Scott
- Department of Neurology, Duke University School of Medicine, USA
| | - Sneha Mantri
- Department of Neurology, Duke University School of Medicine, USA.
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The experience of care partners of patients with Parkinson's disease psychosis. PLoS One 2021; 16:e0248968. [PMID: 33740031 PMCID: PMC7978339 DOI: 10.1371/journal.pone.0248968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Parkinson’s disease psychosis (PDP) has a major impact on quality of life and care partner burden; however, little is known about the lived experiences of care partners in managing PDP. Objective To understand how care partners of individuals with PDP experience their role and articulate their needs related to psychosis. Methods This was a qualitative study of semi-structured telephone interviews. Recruitment was conducted online via the clinical study matching tool, Fox Trial Finder; study activities took place remotely via telephone interviews. Transcripts of the phone interviews were analyzed by grounded theory methods, and a codebook of key themes that emerged from the analysis was developed. Results Nine care partners (all female) were interviewed. Discussion topics in the codebook included (1) care partner burden and guilt; (2) communication with medical professionals; (3) coping strategies; (4) emotional reactions of the care partner to psychosis; (5) sources of knowledge about PD psychosis; (6) attitudes towards medications for PDP; (7) strategies to care for loved ones with psychosis; (8) psychosis triggers. Conclusions This qualitative analysis uncovers important aspects of the care partner experience, including challenges in navigating the medical system and communicating with professionals. Providers treating patients with PDP should be aware of these constraints and provide added support for strained care partners.
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Liu N, Babazono A, Kim SA, Li Y. Effect of Care Rehabilitation on Medical Expenses, Care Costs, and Total Costs of Elderly Individuals with Parkinson's Disease. Popul Health Manag 2021; 24:738-747. [PMID: 33689402 DOI: 10.1089/pop.2020.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The fast-growing prevalence of Parkinson's disease (PD) creates a heavy burden for society and the health care system. Although different ways to mitigate the economic burden of PD have been discussed in the literature, including several effective treatments, few studies have paid attention to the effect of care rehabilitation (CR) on PD costs over a long-term care period. This study tracked medical expenses, care costs, and total costs of elderly individuals with PD for 3 years based on medical claims data merged with long-term care insurance (LTCI) claims data, and determined whether CR reduced PD costs. Using a retrospective, longitudinal cohort design, 3950 elderly individuals with PD who received LTCI services from April 2014 to March 2017 in Fukuoka Prefecture, Japan were followed. PD costs were compared between the CR group and the non-CR group, and a hierarchical linear model was used to examine whether CR was associated with medical expenses, care costs, and total costs. The mean value of total costs in fiscal years 2014, 2015, and 2016 were ¥3,124,944 (US$29,504), ¥3,328,398 (US$31,425), and ¥3,615,892 (US$34,140), respectively. In a hierarchical linear model, CR alone was not associated with medical expenses and care costs; additionally, CR had a positive association with higher total costs. However, the interaction term between CR and baseline care needs level significantly reduced care costs and total costs. That indicates that if older PD patients with higher care needs level receive CR, their care costs and total costs will be reduced. Further research is needed to clarify how CR reduces these patients' costs.
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Affiliation(s)
- Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sung-A Kim
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yunfei Li
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Meigal AY, Tretjakova OG, Gerasimova-Meigal LI, Sayenko IV. Program of Seven 45-min Dry Immersion Sessions Improves Choice Reaction Time in Parkinson's Disease. Front Physiol 2021; 11:621198. [PMID: 33519524 PMCID: PMC7841462 DOI: 10.3389/fphys.2020.621198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/11/2020] [Indexed: 01/26/2023] Open
Abstract
The study hypothesis held that in subjects with Parkinson's disease (PD), the reaction time (RT) tests of the higher cognition demand would have more readily improved under the program of analog microgravity (μG) modeled with "dry" immersion (DI). To test this hypothesis, 10 subjects with PD have passed through a program of seven DI sessions (each 45 min long) within 25-30 days, with overall μG dose 5 1/4 h. Five patients were enrolled as controls, without DI (noDI group). Simple RT (SRT), disjunctive RT (DRT), and choice RT (CRT) were assessed in four study points: before the DI program (preDI), 1 day after the DI program (postDI), 2 weeks after the DI program (DI2w), and 2 months after the DI program (DI2m). The motor time (MT) was assessed with the tapping test (TT). Additionally, signal detection time (SDT) and central processing time (CPT) were extracted from the data. Before the program of DI, the RT tests are in accordance with their cognition load: SRT (284 ± 37 ms), DRT (338 ± 38 ms), and CRT (540 ± 156 ms). In accordance with the hypothesis, CRT and DRT have improved under DI by, respectively, 20 and 8% at the study point "DI2w," whereas SRT, SDT, and MT did not change (<5% in the preDI point, p > 0.05). Thus, the program of DI provoked RT improvement specifically in the cognitively loaded tasks, in a "dose of cognition-reaction" manner. The accuracy of reaction has changed in none of the RT tests. The neurophysiologic, hormonal/neuroendocrine, behavioral, neural plasticity, and acclimation mechanisms may have contributed to such a result.
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Affiliation(s)
- Alexander Yu. Meigal
- Laboratory of Novel Methods in Physiology, Institute of Higher Biomedical Technologies, Petrozavodsk State University, Petrozavodsk, Russia
| | - Olesya G. Tretjakova
- Laboratory of Novel Methods in Physiology, Institute of Higher Biomedical Technologies, Petrozavodsk State University, Petrozavodsk, Russia
| | - Liudmila I. Gerasimova-Meigal
- Laboratory of Novel Methods in Physiology, Institute of Higher Biomedical Technologies, Petrozavodsk State University, Petrozavodsk, Russia
| | - Irina V. Sayenko
- State Scientific Center, “Institute of Biomedical Problems,” Russian Academy of Sciences, Moscow, Russia
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McMahon J, Chazot P. Dance and Parkinson's: Biological perspective and rationale. LIFESTYLE MEDICINE 2020. [DOI: 10.1002/lim2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Paul Chazot
- Department of Biosciences Durham University Durham UK
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Teive HA, Jimenez-Shahed J. Parkinson's disease mortality and socioeconomic status: New information from a Korean study. Parkinsonism Relat Disord 2020; 80:212-213. [DOI: 10.1016/j.parkreldis.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
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Kosari E, Vafai K. Thermal tissue damage analysis for magnetothermal neuromodulation and lesion size minimization. BRAIN MULTIPHYSICS 2020. [DOI: 10.1016/j.brain.2020.100014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Effects of socioeconomic status on mortality after Parkinson's disease: A nationwide population-based matched cohort study in Korean populations. Parkinsonism Relat Disord 2020; 80:206-211. [PMID: 33129703 DOI: 10.1016/j.parkreldis.2020.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To evaluate the mortality rate and impact of SES on mortality in PD using a nationwide cohort in Korea. METHODS We selected patients diagnosed with PD (ICD-10 code: G20) and registration code for PD (V124) in the program for rare intractable diseases between 2004 and 2015. After that, atypical parkinsonism was excluded. A matched cohort of individuals without PD were enrolled by randomly matching patients by sex, age, and year of diagnosis to the PD group with a ratio of 1:9. Cox proportional hazard models were used to identify the effects of SES on mortality using Hazard Ratios and 95% confidence intervals. RESULTS In total, 26,570 participants were enrolled. The mortality rate was 30.37% in PD cohort and 16.69% in the comparison cohort. According to income level, PD patients in low-middle group revealed significantly decreased HRs of 0.704 (95% CI, 0.533-0.930) compared to those in the lowest group. The medical aid group showed an increased mortality rate (HR = 1.552, 95% CI, 1.191-2.021) compared to the national health insurance group. In the subgroup analyses, medical aid was associated with mortality only in PD with female (HR = 1.740, 95% CI, 1.242-2.438) or aged 60-79 years (HR = 1.434, 95% CI 1.005-2.045). There was no significant difference in mortality rate according to residential area in PD. CONCLUSIONS In Korea, individual level low SES including income level and insurance type were significantly associated with increased mortality, whereas regional level SES (residential area) was not related with mortality on PD.
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Katz M. Palliative Care for Parkinson's Spectrum Disorders: an Emerging Approach. Neurotherapeutics 2020; 17:1456-1463. [PMID: 33439466 PMCID: PMC7851259 DOI: 10.1007/s13311-020-00989-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
Parkinson's spectrum disorders (PSD) are neurodegenerative parkinsonian conditions that carry a tremendous symptom burden. Palliative care is an interdisciplinary medical specialty that focuses on improving quality of life for patients and caregivers affected by serious life-limiting illnesses, at any stage of disease. Research and clinical programs into this emerging therapeutic approach remain limited. This review focuses on the role of palliative care in the treatment of patients with PSD. Gaps in knowledge and recommendations for future research are discussed.
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Affiliation(s)
- Maya Katz
- Department of Neurology, University of California, San Francisco (UCSF) Medical Center, San Francisco, USA.
- Movement Disorders and Neuromodulation Center, University of California, San Francisco (UCSF), 1635 Divisadero Street, Suite 520, San Francisco, CA, 94121, USA.
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Saturdays-in-Motion: Education and Empowerment through an Interdisciplinary Team Approach for Parkinson's Disease in Cali-Colombia. PARKINSONS DISEASE 2020; 2020:2497386. [PMID: 32733667 PMCID: PMC7378612 DOI: 10.1155/2020/2497386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/27/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
Introduction Parkinson's disease (PD) is one of the most prevalent age-related neurodegenerative disorders. The progression of PD produces an important disease burden in patients due to functional impairment, which also has repercussions on caregivers. In addition, it has become a challenge for health systems, especially in developing countries, which have limited resources. Multidisciplinary teams with a community approach have proved effective in high-income countries; however, there is no reported literature in low- and middle-income countries about this kind of initiative. Objective This paper aims to document the experience of patients, caregivers, and experts in a community approach as an innovative model in a middle-income country. Methods A quantitative descriptive research was conducted. The selection criteria were having a PD diagnosis, attending with a caregiver to Saturdays in Motion (SIM), or being a clinical expert invited to SIM. PD patients and their caregivers answered three surveys on their points of view with respect to SIM: SIM and their quality of life (QoL) and PDQ-39 and Zarit, whereas clinical experts completed two questions related to the SIM program. Descriptive statistics were used to summarize the results of the surveys and clinical tests. Results Forty-eight, twenty-four, and twenty-one subjects answered surveys one, two, and three, respectively. In total, four clinical experts were interviewed. 87.9% of the patients consider that SIM activities improved their QoL. The most affected areas in PDQ-39 were those related to the social area. Around 66.6% of the caregivers reported a mild burden on Zarit and think that SIM enhances the PD patient's QoL. Clinical experts highlighted the sense of community and empathy. Conclusion Our preliminary experience shows a multidisciplinary model with a community approach which redefines the traditional relationship between patients, caregivers, and clinical experts. This aim of this initiative is that education and empowerment patients and caregivers reach a better perception of QoL.
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