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Seo HG, Yun SJ, Song Y, Lee HS, Kim DH, Chang WH. The Development of a Quantitative Disability Assessment Tool in Patients with Idiopathic Parkinson's Disease. Diagnostics (Basel) 2024; 14:2063. [PMID: 39335742 PMCID: PMC11431574 DOI: 10.3390/diagnostics14182063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/02/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: The objective of this study was to develop a novel quantitative disability assessment tool for patients with idiopathic Parkinson's disease (IPD). Methods: A total of 47 patients with IPD were recruited from two hospitals. A specialist in Rehabilitation Medicine utilized the modified Schwab and England Activities of Daily Living Scale (mSEADL) as a reference, conducting a comprehensive medical chart review and an in-depth interview. The novel-developed disability measurement was calculated as ((mSEADL during the on-state) × (time of on-state)) + ((mSEADL during the off-state) × (time of off-state))/(waking time). Additionally, the degree of disability was assessed using the Korean version of the Modified Barthel Index during the on-state. Results: Twenty-four participants (51.1%) exhibited the off-state during waking hours. In patients exhibiting an off-state, the mSEADL score was significantly lower during the off-state than during the on-state (p < 0.05). The novel-developed disability measurement demonstrated a higher correlation coefficient with the reference mSEADL (0.960) than with the K-MBI (0.808), with statistical significance (p < 0.05). Conclusions: The results demonstrated that larger IPD patients exhibited an on-off phenomenon with greater dependency during the off-state. Therefore, the on-off phenomenon should be considered when evaluating disability in patients with IPD, with methods such as the novel-developed disability measurement tool in this study.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (H.G.S.); (S.J.Y.)
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (H.G.S.); (S.J.Y.)
| | - Yoojin Song
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.S.); (H.S.L.); (D.H.K.)
| | - Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.S.); (H.S.L.); (D.H.K.)
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.S.); (H.S.L.); (D.H.K.)
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.S.); (H.S.L.); (D.H.K.)
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea
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Perskaudas R, Myers CE, Interian A, Gluck MA, Herzallah MM, Baum A, Dobkin RD. Reward and Punishment Learning as Predictors of Cognitive Behavioral Therapy Response in Parkinson's Disease Comorbid with Clinical Depression. J Geriatr Psychiatry Neurol 2024; 37:282-293. [PMID: 38158704 DOI: 10.1177/08919887231218753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Depression is highly comorbid among individuals with Parkinson's Disease (PD), who often experience unique challenges to accessing and benefitting from empirically supported interventions like Cognitive Behavioral Therapy (CBT). Given the role of reward processing in both depression and PD, this study analyzed a subset (N = 25) of participants who participated in a pilot telemedicine intervention of PD-informed CBT, and also completed a Reward- and Punishment-Learning Task (RPLT) at baseline. At the conclusion of CBT, participants were categorized into treatment responders (n = 14) and non-responders (n = 11). Responders learned more optimally from negative rather than positive feedback on the RPLT, while this pattern was reversed in non-responders. Computational modeling suggested group differences in learning rate to negative feedback may drive the observed differences. Overall, the results suggest that a within-subject bias for punishment-based learning might help to predict response to CBT intervention for depression in those with PD.Plain Language Summary Performance on a Computerized Task may predict which Parkinson's Disease Patients benefit from Cognitive Behavioral Treatment of Clinical DepressionWhy was the study done? Clinical depression regularly arises in individuals with Parkinson's Disease (PD) due to the neurobiological changes with the onset and progression of the disease as well as the unique psychosocial difficulties associated with living with a chronic condition. Nonetheless, psychiatric disorders among individuals with PD are often underdiagnosed and likewise undertreated for a variety of reasons. The results of our study have implications about how to improve the accuracy and specificity of mental health treatment recommendations in the future to maximize benefits for individuals with PD, who often face additional barriers to accessing quality mental health treatment.What did the researchers do? We explored whether performance on a computerized task called the Reward- and Punishment-Learning Task (RPLT) helped to predict response to Cognitive Behavioral Therapy (CBT) for depression better than other predictors identified in previous studies. Twenty-five individuals with PD and clinical depression that completed a 10-week telehealth CBT program were assessed for: Demographics (Age, gender, etc.); Clinical information (PD duration, mental health diagnoses, levels of anxiety/depression, etc.); Neurocognitive performance (Memory, processing speed, impulse control, etc.); and RPLT performance.What did the researchers find? A total of 14 participants significantly benefitted from CBT treatment while 11 did not significantly benefit from treatment.There were no differences before treatment in the demographics, clinical information, and neurocognitive performance of those participants who ended up benefitting from the treatment versus those who did not.There were, however, differences before treatment in RPLT performance so that those individuals that benefitted from CBT seemed to learn better from negative feedback.What do the findings mean? Our results suggest that the CBT program benefitted those PD patients with clinical depression that seemed to overall learn best from avoiding punishment rather than obtaining reward which was targeted in CBT by focusing on increasing engagement in rewarding activities. The Reward- and Punishment-Learning Task hence may be a useful tool to help predict treatment response and provide more individualized recommendations on how to best maximize the benefits of psychotherapy for individuals with PD that may struggle to connect to mental health care. Caution is recommended about interpretating these results beyond this study as the overall number of participants was small and the data for this study were collected as part of a previous study so there was no opportunity to include additional measurements of interest.
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Affiliation(s)
- Rokas Perskaudas
- Mental Health Research and Program Development, VA New Jersey Healthcare System, Lyons, NJ, USA
- War Related Illness and Injury Study Center, VA New Jersey Healthcare System, East Orange, NJ, USA
| | - Catherine E Myers
- Research Service, VA New Jersey Health Care System, East Orange, NJ, USA
- Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Alejandro Interian
- Mental Health Research and Program Development, VA New Jersey Healthcare System, Lyons, NJ, USA
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Mark A Gluck
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Mohammad M Herzallah
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Jerusalem, Palestine
| | - Allan Baum
- Ramapo College of New Jersey, Mahwah, NJ, USA
| | - Roseanne D Dobkin
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Zarotti N, Deane KHO, Ford CEL, Simpson J. Psychosocial interventions affecting global perceptions of control in people with Parkinson's disease: a scoping review. Disabil Rehabil 2024; 46:443-452. [PMID: 36688404 DOI: 10.1080/09638288.2023.2169376] [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: 04/22/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE Perceived control is an important construct for the psychological well-being of people affected by chronic conditions, and higher perceived control is associated with better outcomes. Psychosocial interventions have been trialled in these populations to improve both global and specific perceptions of control. However, most interventions involving people with Parkinson's have focused on single-domain forms of control, while those addressing global perceived control are yet to be reviewed. This study aimed to identify and map the types of psychosocial interventions in individuals with Parkinson's which have included forms of global perceived control as an outcome. MATERIALS AND METHODS Scoping review based on a search across MEDLINE, PsycINFO, CINAHL, Academic Search Ultimate. RESULTS From an initial return of 4388 citations, 12 citations were eventually included. These consisted of 8 quantitative and 4 qualitative studies, and covered 4 overarching categories of psychosocial interventions. Mixed results were found for cognitive, educational, and physical interventions, while a randomised controlled trial on mindfulness-based lifestyle programme showed more preliminary positive evidence. CONCLUSIONS Further rigorous research is required on the topic to build on these preliminary findings. In the meantime, clinicians may need to consider programmes which proved effective with populations similar to people with Parkinson's.IMPLICATIONS FOR REHABILITATIONPerceived control is a psychological construct important for people with chronic illnesses, which can be targeted by psychosocial interventions.This article reviewed psychosocial interventions targeting global forms of perceived control in Parkinson's.Mixed results were reported for the cognitive, educational, and physical interventions identified, while a randomised controlled trial on a mindfulness-based lifestyle programme showed more promising evidence.In the meantime, clinicians may need to consider programmes found to be effective with people with similar conditions to Parkinson's.
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Affiliation(s)
- Nicolò Zarotti
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Catherine Elaine Longworth Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Murray CD, Eccles FJR, Garner I, Doyle C, Simpson J. Living with Parkinson's in England during and beyond COVID-19 restrictions: a longitudinal qualitative study. Aging Ment Health 2024; 28:151-159. [PMID: 37811733 DOI: 10.1080/13607863.2023.2265319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Government-enforced lockdown restrictions associated with preventing the spread of the COVID-19 virus had a series of unintended, negative effects. One group of individuals whose physical and mental health was significantly and disproportionately impacted were those with Parkinson's. However, research has been mainly cross-sectional, with no previous study qualitatively following up participants through both lockdowns and the easing of restrictions. Consequently, this study aimed to provide a detailed understanding of the experience of lockdowns and the easing of restrictions on the physical and mental health of people with Parkinson's. METHOD Data from semi-structured interviews collected at four time points across an 18-month period (May 2020 - September 2021) from the same participants (six men and four women) were analysed using interpretative phenomenological analysis. RESULTS Three themes were derived: (1) Wrestling with a Parkinson's identity, agency and control during the pandemic; (2) The encroachment and acceleration of a Parkinson's future; and (3) Recalibrating priorities from COVID-19 to Parkinson's. CONCLUSION As currently the only published study to provide an in-depth longitudinal analysis with this population, we used a more dynamic theoretical account, Strauss and Corbin's theory of illness trajectories, to understand the findings and suggest ways of supporting individuals with Parkinson's in this stage of the pandemic. The scale and breadth of the support needed is a significant challenge for current statutory systems.
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Affiliation(s)
- Craig D Murray
- Division of Health Research, Lancaster University, Bailrigg, UK
| | | | - Ian Garner
- Division of Health Research, Lancaster University, Bailrigg, UK
| | | | - Jane Simpson
- Division of Health Research, Lancaster University, Bailrigg, UK
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Li Y, McLernon DJ, Counsell CE, Macleod AD. Incidence and risk factors of institutionalisation in Parkinson's disease and atypical parkinsonism. Parkinsonism Relat Disord 2024; 118:105928. [PMID: 37980851 DOI: 10.1016/j.parkreldis.2023.105928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION The basic epidemiology of institutionalisation (the need for long-term care in an institution) in parkinsonism is unclear. We aimed to identify the incidence of, and risk factors for, institutionalisation in Parkinson's disease (PD) and atypical parkinsonism (AP). METHODS We analysed data from a prospective population-based incidence cohort of parkinsonism in North-East Scotland (the PINE study). 556 newly-diagnosed participants (PD, N = 200; AP, N = 98; controls, N = 258), recruited between 2002 and 2009, were prospectively followed life-long with data collection on place of residence. We determined the incidence and baseline predictors of institutionalisation using Cox regression. RESULTS The median follow-up time was 9.3, 4.4, and 10.8 years in PD, AP, and controls respectively. 70 (35 %) PD, 53 (54 %) AP, and 43 (16 %) controls became institutionalised. The incidence rates of institutionalisation in PD, AP, and controls were 5.1, 20.8, and 1.8 per 100 person-years respectively. The median time to institutionalisation was 11.8 years in PD and 3.5 years in AP. Multivariable Cox regression showed that AP (HR versus PD = 3.05 [95 % CI 1.90,4.91]), increasing age (HR for 10-year increase = 1.82 [95 % CI 1.40,2.36]), poorer cognition (HR for MMSE<24 versus MMSE>27 = 2.62 [95 % CI 1.45, 4.73]), more-severe parkinsonian impairment (UPDRS part 3) (HR for 10-point increase = 1.25 [95 % CI 1.05, 1.48]) were independently associated with higher hazards of institutionalisation. Sex, co-morbidity, smoking history, and living alone were not associated with institutionalisation. CONCLUSION Institutionalisation is much more frequent in parkinsonism, particularly in AP, than in controls. AP, older age, severe parkinsonian impairment, and poorer cognition were independent baseline predictors of institutionalisation.
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Affiliation(s)
- Yan Li
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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Valent D, Krismer F, Grossauer A, Peball M, Heim B, Mahlknecht P, Djamshidian A, Poewe W, Seppi K. Nomogram to Predict the Probability of Functional Dependence in Early Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:49-55. [PMID: 36530091 PMCID: PMC9912730 DOI: 10.3233/jpd-223501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Early identification of Parkinson's disease (PD) patients at risk for becoming functionally dependent is important for patient counseling. Several models describing the relationship between predictors and outcome have been reported, however, most of these require computer software for practical use. OBJECTIVE Here we report the development of a risk nomogram allowing an approximate graphical computation of the risk of becoming functionally dependent in early PD. METHODS We analyzed data form the Parkinson's Progression Markers Initiative cohort of newly diagnosed PD patients from baseline through the first 5 years of follow-up. Functional dependence was defined as a score < 80 on the Schwab & England Activities of Daily Living scale. A binary logistic model was developed to estimate the risk of functional dependence and based on the results, a nomogram for the prediction of functional dependence was drawn in order to provide an easy-to-use tool in clinical and academic settings as a part of personalized medicine approach to PD treatment. RESULTS At baseline, three patients and over the five-year follow-up, 85 (22%) out of 395 patients were functionally dependent as scored by the Schwab & England Activities of Daily Living rating scale. The binary logistic model showed that clinical parameters such as MDS-UPDRS I (rater part), MDS-UPDRS II, and MDS-UPDRS axial motor score were significant predictors for functional dependence within 5 years. CONCLUSION We here provide an easy-to-use tool to estimate the risk of functional dependence in PD patients based on the MDS-UPDRS part I, II and axial motor score.
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Affiliation(s)
- Dora Valent
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria,Correspondence to: Florian Krismer, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 80932; E-mail: and Klaus Seppi, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 81498; E-mail:
| | - Anna Grossauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria,Correspondence to: Florian Krismer, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 80932; E-mail: and Klaus Seppi, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 81498; E-mail:
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Rabuffetti M, De Giovannini E, Carpinella I, Lencioni T, Fornia L, Ferrarin M. Association of 7-Day Profiles of Motor Activity in Marital Dyads with One Component Affected by Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:1087. [PMID: 36772127 PMCID: PMC9921738 DOI: 10.3390/s23031087] [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: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: A noticeable association between the motor activity (MA) profiles of persons living together has been found in previous studies. Social actigraphy methods have shown that this association, in marital dyads composed of healthy individuals, is greater than that of a single person compared to itself. This study aims at verifying the association of MA profiles in dyads where one component is affected by Parkinson's disease (PD). (2) Methods: Using a wearable sensor-based social actigraphy approach, we continuously monitored, for 7 days, the activities of 27 marital dyads including one component with PD. (3) Results: The association of motor activity profiles within a marital dyad (cross-correlation coefficient 0.344) is comparable to the association of any participant with themselves (0.325). However, when considering the disease severity quantified by the UPDRS III score, it turns out that the less severe the symptoms, the more associated are the MA profiles. (4) Conclusions: Our findings suggest that PD treatment could be improved by leveraging the MA of the healthy spouse, thus promoting lifestyles also beneficial for the component affected by PD. The actigraphy approach provided valuable information on habitual functions and motor fluctuations, and could be useful in investigating the response to treatment.
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Affiliation(s)
| | - Ennio De Giovannini
- Centro Medico Riabilita Cooperativa Sociale Mano Amica Onlus, 36015 Schio, Italy
| | | | | | - Luca Fornia
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20133 Milano, Italy
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Greenland JC, Camacho M, Williams-Gray CH. The dilemma between milestones of progression versus clinical scales in Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 192:169-185. [PMID: 36796941 DOI: 10.1016/b978-0-323-85538-9.00010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
There are significant challenges in accurately documenting the progression of Parkinson's disease (PD). The disease course is highly heterogeneous, there are no validated biomarkers, and we are reliant on repeated clinical measures to assess disease state over time. Yet, the ability to chart disease progression accurately is vital in both observational and interventional study designs, where reliable measures are critical to determine whether an outcome has been met. In this chapter, we first discuss the natural history of PD, including the spectrum of clinical presentation and expected developments through the course of the disease. We then explore in detail the current strategies for measuring disease progression, which can be broadly divided into: (i) the use of quantitative clinical scales; and (ii) determination of the onset time of key milestones. We discuss the strengths and limitations of these approaches for use in clinical trials, with a particular focus on disease modification trials. The selection of outcome measures for a particular study will depend on multiple factors, but trial duration is an important determinant. Milestones are reached over a course of years rather than months, and hence clinical scales with sensitivity to change are needed for short-term studies. However, milestones represent important markers of disease stage which are not confounded by symptomatic therapies and are of critical relevance to the patient. Prolonged but low intensity follow-up beyond a limited period of treatment with a putative disease-modifying agent may allow milestones to be incorporated into evaluation of efficacy in a practical and cost-effective way.
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Affiliation(s)
- Julia C Greenland
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Marta Camacho
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
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Becker S, Bode M, Brockmann K, Gasser T, Michaelis K, Solbrig S, Nuerk HC, Schulte C, Maetzler W, Zimmermann M, Berg D, Liepelt-Scarfone I. Cognitive-Driven Activities of Daily Living Impairment as a Predictor for Dementia in Parkinson Disease: A Longitudinal Cohort Study. Neurology 2022; 99:e2548-e2560. [PMID: 36240089 PMCID: PMC9754648 DOI: 10.1212/wnl.0000000000201201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES One-third of Parkinson disease (PD) patients with PD-mild cognitive impairment (PD-MCI) convert to dementia within a few years. Markers with a high prognostic value for dementia conversion are needed. Loss of everyday function primarily caused by cognitive dysfunction is the core criterion for the diagnosis of PD dementia, with an onset of more complex instrumental activities of daily living (IADL) dysfunction in the prodromal stage. This study evaluated the phenotype associated with cognitive IADL impairment and its predictive value for defining a high-risk group for PD dementia. METHODS An observational longitudinal study using cognitive and clinical scores in addition to genetic and CSF biomarkers was conducted. The Functional Activities Questionnaire quotient (cut-off ≥1), indicating more cognitive than motor-driven IADL impairment, defined cognitive IADL impairment status at baseline. Hazard ratios (HRs) were used to compare the impact of baseline classifications on dementia conversion. RESULTS Of 268 patients with PD assessed at baseline, 108 (40.3%) had PD-MCI. After a period of 3.78 ± 0.84 years, 164 (61.2%) patients were reassessed. At follow-up, 93 (56.7%) patients had no cognitive impairment, 54 (32.9%) fulfilled PD-MCI criteria, and 17 (10.4%) had developed dementia. The HR of baseline cognitive IADL impairment (n = 37) for dementia conversion was descriptively higher than for PD-MCI, but highest in patients with both markers (HR = 12.01, 95% CI 4.47-32.22, p < 0.001). In the follow-up sample, nearly half of the patients (n = 10, 47.6%) with baseline classification of cognitive IADL impairment and PD-MCI converted to dementia. Baseline status of cognitive IADL impairment was associated with higher nonmotor burden, worse cognitive performance, and more severe IADL progression over the study period. DISCUSSION The importance of differentiating between cognitive and motor aspects on ADL function in PD and monitoring cognitive ADL impairment in the prodromal stage of dementia is paramount. Patients with PD-MCI and cognitive IADL impairment may be a valuable target group for clinical trials aiming to slow down the development of dementia. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03687203. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that impairment of cognitive activities of daily living is associated with progression from MCI to dementia among patients with Parkinson disease.
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Affiliation(s)
- Sara Becker
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Merle Bode
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Kathrin Brockmann
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Thomas Gasser
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Katja Michaelis
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Susanne Solbrig
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Hans-Christoph Nuerk
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Claudia Schulte
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Walter Maetzler
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Milan Zimmermann
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Daniela Berg
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Inga Liepelt-Scarfone
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany.
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Santos García D, de Deus Fonticoba T, Cores Bartolomé C, Naya Ríos L, García Roca L, Martínez Miró C, Canfield H, Jesús S, Aguilar M, Pastor P, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Predictors of Loss of Functional Independence in Parkinson's Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up and Comparison with a Control Group. Diagnostics (Basel) 2021; 11:1801. [PMID: 34679503 PMCID: PMC8534700 DOI: 10.3390/diagnostics11101801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/19/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to compare the progression of independence in activities of daily living (ADL) in Parkinson's disease (PD) patients versus a control group, as well as to identify predictors of disability progression and functional dependency (FD). PATIENTS AND METHODS PD patients and control subjects, who were recruited from 35 centers of Spain from the COPPADIS cohort between January 2016 and November 2017 (V0), were included. Patients and subjects were then evaluated again at the 2-year follow-up (V2). Disability was assessed with the Schwab & England Activities of Daily Living Scale (S&E-ADLS) at V0 and V2. FD was defined as an S&E-ADLS score less than 80%. RESULTS In the PD group, a significant decrease in the S&E-ADLS score from V0 to V2 (N = 507; from 88.58 ± 10.19 to 84.26 ± 13.38; p < 0.0001; Cohen's effect size = -0.519) was observed but not in controls (N = 124; from 98.87 ± 6.52 to 99.52 ± 2.15; p = 0.238). When only patients considered functional independent at baseline were included, 55 out of 463 (11.9%) converted to functional dependent at V2. To be a female (OR = 2.908; p = 0.009), have longer disease duration (OR = 1.152; p = 0.002), have a non-tremoric motor phenotype at baseline (OR = 3.574; p = 0.004), have a higher score at baseline in FOGQ (OR = 1.244; p < 0.0001) and BDI-II (OR = 1.080; p = 0.008), have a lower score at baseline in PD-CRS (OR = 0.963; p = 0.008), and have a greater increase in the score from V0 to V2 in UPDRS-IV (OR = 1.168; p = 0.0.29), FOGQ (OR = 1.348; p < 0.0001) and VAFS-Mental (OR = 1.177; p = 0.013) (adjusted R-squared 0.52; Hosmer and Lemeshow test = 0.94) were all found to be independent predictors of FD at V2. CONCLUSIONS In conclusion, autonomy for ADL worsens in PD patients compared to controls. Cognitive impairment, gait problems, fatigue, depressive symptoms, more advanced disease, and a non-tremor phenotype are independent predictors of FD in the short-term.
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Affiliation(s)
- Diego Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | | | - Carlos Cores Bartolomé
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Lucía Naya Ríos
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Lucía García Roca
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Cristina Martínez Miró
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Hector Canfield
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41009 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, 08221 Barcelona, Spain; (M.A.); (P.P.)
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, 08221 Barcelona, Spain; (M.A.); (P.P.)
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, 08970 Barcelona, Spain;
| | - Inés Legarda
- Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain;
| | - Jorge Hernández Vara
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.V.); (O.d.F.)
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital Universitario Marqués de Valdecilla, 39011 Santander, Spain
| | - María A. Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L’Hospitalet, L’Hospitalet de Llobregat, 08906 Barcelona, Spain;
| | | | | | | | - Julio Dotor
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS)—Institut Català de la Salut, 17190 Girona, Spain;
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, 28922 Madrid, Spain;
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), 43500 Tarragona, Spain;
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, 09006 Burgos, Spain;
| | | | | | | | - Maria G. Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), 36213 Vigo, Spain;
| | | | - Itziar Gastón
- Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital de Sant Pau, 08041 Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | | | | | - Oriol de Fábregues
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.V.); (O.d.F.)
| | | | | | | | - Luis M. López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO), 32005 Orense, Spain;
| | - Darrian McAfee
- Laboratory for Cognition and Neural Stimulation, Univeristy of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41009 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
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Langer A, Hasenauer S, Flotz A, Gassner L, Pokan R, Dabnichki P, Wizany L, Gruber J, Roth D, Zimmel S, Treven M, Schmoeger M, Willinger U, Maetzler W, Zach H. A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:49. [PMID: 34112807 PMCID: PMC8192917 DOI: 10.1038/s41531-021-00193-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022] Open
Abstract
Physical activity is of prime importance in non-pharmacological Parkinson's disease (PD) treatment. The current study examines the effectiveness and feasibility of sport climbing in PD patients in a single-centre, randomised controlled, semi-blind trial. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn & Yahr stage 2-3) were assigned either to participate in a 12-week sport climbing course (SC) or to attend an unsupervised physical training group (UT). The primary outcome was the improvement of symptoms on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III). Sport climbing was associated with a significant reduction of the MDS-UPDRS-III (-12.9 points; 95% CI -15.9 to -9.8), while no significant improvement was to be found in the UT (-3.0 points; 95% CI -6.0 to 0.1). Bradykinesia, rigidity and tremor subscales significantly improved in SC, but not in the unsupervised control group. In terms of feasibility, the study showed a 99% adherence of participants to climbing sessions and a drop-out rate of only 8%. No adverse events occurred. This trial provides class III evidence that sport climbing is highly effective and feasible in mildly to moderately affected PD patients.
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lucia Gassner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- School of Engineering, RMIT University, Melbourne, VIC, Australia
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Abstract
OBJECTIVE We assessed long-term incidence and prevalence trends of dementia and parkinsonism across major ethnic and immigrant groups in Ontario. METHODS Linking administrative databases, we established two cohorts (dementia 2001-2014 and parkinsonism 2001-2015) of all residents aged 20 to 100 years with incident diagnosis of dementia (N = 387,937) or parkinsonism (N = 59,617). We calculated age- and sex-standardized incidence and prevalence of dementia and parkinsonism by immigrant status and ethnic groups (Chinese, South Asian, and the General Population). We assessed incidence and prevalence trends using Poisson regression and Cochran-Armitage trend tests. RESULTS Across selected ethnic groups, dementia incidence and prevalence were higher in long-term residents than recent or longer-term immigrants from 2001 to 2014. During this period, age- and sex-standardized incidence of dementia in Chinese, South Asian, and the General Population increased, respectively, among longer-term immigrants (by 41%, 58%, and 42%) and long-term residents (28%, 7%, and 4%), and to a lesser degree among recent immigrants. The small number of cases precluded us from assessing parkinsonism incidence trends. For Chinese, South Asian, and the General Population, respectively, prevalence of dementia and parkinsonism modestly increased over time among recent immigrants but significantly increased among longer-term immigrants (dementia: 134%, 217%, and 117%; parkinsonism: 55%, 54%, and 43%) and long-term residents (dementia: 97%, 132%, and 71%; parkinsonism: 18%, 30%, and 29%). Adjustment for pre-existing conditions did not appear to explain incidence trends, except for stroke and coronary artery disease as potential drivers of dementia incidence. CONCLUSION Recent immigrants across major ethnic groups in Ontario had considerably lower rates of dementia and parkinsonism than long-term residents, but this difference diminished with longer-term immigrants.
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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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Ramsay N, Macleod AD, Alves G, Camacho M, Forsgren L, Lawson RA, Maple-Grødem J, Tysnes OB, Williams-Gray CH, Yarnall AJ, Counsell CE. Validation of a UPDRS-/MDS-UPDRS-based definition of functional dependency for Parkinson's disease. Parkinsonism Relat Disord 2020; 76:49-53. [PMID: 32645619 DOI: 10.1016/j.parkreldis.2020.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Functional dependency in basic activities of daily living (ADLs) is a key outcome in Parkinson's disease (PD). We aimed to define dependency in PD, using the original and MDS versions of the Unified Parkinson's Disease Rating Scale (UPDRS). METHODS We developed two algorithms to define dependency from items of UPDRS Part 2 and MDS-UPDRS Part 2 relating to basic ADLs (feeding, dressing, hygiene and walking, and getting out of a chair). We validated both algorithms using data from 1110 patients from six community-based PD incidence cohorts, testing concurrent validity, convergent validity, and predictive validity. RESULTS Our optimal algorithm showed high specificity and moderate to high sensitivity versus Schwab & England <80% (specificity 95% [95% confidence interval (CI) 93-97] and sensitivity 65% [95% CI 55-73] at baseline; 88% [95% CI 85-91] and 85% [95% CI 79-97] respectively at five-years follow-up). Convergent validity was demonstrated by strong associations between dependency defined by the algorithm and cognition (MMSE), quality of life (PDQ39), and impairment (UPDRS part 3) (all p < 0.001). Algorithm-defined dependency status also predicted mortality: HR for mortality in those dependent vs independent at baseline was 1.6 (95%CI 1.2-2.1) and in those dependent vs independent at five-years' follow-up was 2.2 (1.6-3.0). DISCUSSION We have demonstrated the concurrent validity, convergent validity, and predictive validity of a UPDRS-/MDS-UPDRS-based algorithm to define functional dependency in PD. This can be used for studying dependency in any study where UPDRS or MDS-UPDRS part 2 data have been collected.
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Affiliation(s)
- Neil Ramsay
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway; Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Norway.
| | - Marta Camacho
- Department of Clinical Neurosciences, University of Cambridge, UK.
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Sweden.
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway; Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Norway.
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, University of Bergen, Norway.
| | | | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
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15
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The impact of freezing of gait on functional dependency in Parkinson’s disease with regard to motor phenotype. Neurol Sci 2020; 41:2883-2892. [DOI: 10.1007/s10072-020-04404-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/08/2020] [Indexed: 01/04/2023]
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Sperens M, Georgiev D, Eriksson Domellöf M, Forsgren L, Hamberg K, Hariz G. Activities of daily living in Parkinson's disease: Time/gender perspective. Acta Neurol Scand 2020; 141:168-176. [PMID: 31693751 DOI: 10.1111/ane.13189] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/22/2019] [Accepted: 10/31/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objectives of this study were to explore the changes in the activities of daily living (ADL) in persons with Parkinson's disease (pwPD) over time and to investigate possible differences in ADL performance between men and women with PD. MATERIALS & METHODS One hundred twenty-nine persons (76 men) with a clinically established PD self-assessed their ADL performance from the time of diagnosis up to 8 years follow-up using the ADL taxonomy. Other demographic and clinical data (motor state, cognition, depression) were also collected and subjected to further analysis. RESULTS Nine of 12 domains in the ADL taxonomy showed a change over time (Eating and Drinking [P = .009], Mobility [P < .001], Toilet activities [P = .031], Dressing [P < .001], Personal hygiene [P < .001], Communication [P < .001], Cooking [P = .001], Shopping [P < .001] and Cleaning [P < .001]). In addition to time, two domains, (Shopping [P = .007] and Cleaning [P = .027]) also showed an effect of gender with worse scores in women. The nine ADL domains showing effect of time, showed temporary improvement at 12 months follow-up, most probably due to dopaminergic medication. All nine domains deteriorated at later follow-up. CONCLUSIONS As expected, there was deterioration in self-assessed performance in the majority od ADL domains over time. Women assessed their ADLs worse in two domains (Shopping and Cleaning) probably reflecting a general gender-related activity pattern rather than being a PD-specific finding.
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Affiliation(s)
- Maria Sperens
- Department of Community Medicine and Rehabilitation Umeå University Umeå Sweden
| | - Dejan Georgiev
- Department of Community Medicine and Rehabilitation Umeå University Umeå Sweden
- Department of Neurology University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Computer Sciences and Informatics University of Ljubljana Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | | | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience Umeå University Umeå Sweden
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine Family Medicine Umeå University Umeå Sweden
| | - Gun‐Marie Hariz
- Department of Community Medicine and Rehabilitation Umeå University Umeå Sweden
- Department of Pharmacology and Clinical Neuroscience Umeå University Umeå Sweden
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REM sleep behavior disorder predicts functional dependency in early Parkinson's disease. Parkinsonism Relat Disord 2019; 66:138-142. [DOI: 10.1016/j.parkreldis.2019.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/13/2019] [Accepted: 07/20/2019] [Indexed: 02/08/2023]
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Kim R, Yoo D, Jung YJ, Lee WW, Ehm G, Yun JY, Kim HJ, Lee JY, Kim JY, Kim HJ, Paek SH, Jeon B. Determinants of Functional Independence or Its Loss following Subthalamic Nucleus Stimulation in Parkinson's Disease. Stereotact Funct Neurosurg 2019; 97:106-112. [PMID: 31266044 DOI: 10.1159/000500277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to describe the change in functional status following bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) and to identify predictors of postoperative functional dependence. METHODS We included PD patients with bilateral STN-DBS who had complete Schwab & England Activities of Daily Living (S&E ADL) Scale data at baseline and 6 months after surgery from our prospective registry. Functional dependence was defined as an S&E ADL score of less than 80%. All data were collected from the on-medication state and on-stimulation state (after surgery). Logistic regression analyses were performed to determine the factors predictive of functional dependence after surgery. RESULTS A total of 196 patients were included. At baseline, 41 patients were functionally dependent and the other 155 were functionally independent. Among the patients with preoperative dependence, 32 (78%) became functionally independent after surgery, and this conversion was associated with a lower baseline axial score (p = 0.012). Among the patients with preoperative independence, 21 (14%) developed postoperative dependence, and this conversion was associated with a higher baseline axial score (p = 0.013) and its smaller improvement (p < 0.001). Female sex (odds ratio [OR] 3.214; 95% confidence interval [CI] 1.210-8.542; p = 0.019) and a higher baseline axial score (OR 1.184; 95% CI 1.056-1.327; p = 0.004) significantly predicted the risk of postoperative functional dependence. CONCLUSIONS We found that functional status following bilateral STN-DBS is closely related to preoperative axial symptoms. When loss of independence is a potential target for STN-DBS, clinicians should take into consideration the severity of axial impairment before surgery.
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Affiliation(s)
- Ryul Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dallah Yoo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Gwanhee Ehm
- Department of Neurology, National Medical Center, Seoul, Republic of Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University - Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Young Kim
- Department of Neurology, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea,
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Abstract
ABSTRACT:Objectives:We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism.Methods:We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model.Results:From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism.Conclusion:Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.
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Abstract
Migraine is a complex neurological condition that causes a range of symptoms, the most common of which is a severe headache. The aim of this systematic review of the literature is to determine the efficacy of hypnosis in the treatment of migraine. A systematic search of 4 scientific databases was conducted using the primary search terms migraine, headache, hypnosis, and hypnotherapy. A total of 8 studies were identified that examined hypnotic techniques either alone or in combination with other nonpharmaceutical techniques, such as visual imagery, relaxation, and pain-displacement techniques. This study demonstrates that hypnotherapy and relaxation techniques are effective in reducing short- and long-term headache activity in migraine sufferers.
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Macleod AD, Dalen I, Tysnes O, Larsen JP, Counsell CE. Development and validation of prognostic survival models in newly diagnosed Parkinson's disease. Mov Disord 2018; 33:108-116. [PMID: 28976022 PMCID: PMC5813201 DOI: 10.1002/mds.27177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop valid prognostic models to predict mortality, dependency, and "death or dependency" for use in newly diagnosed Parkinson's disease (PD). METHODS The models were developed in the Parkinsonism Incidence in North-East Scotland study (UK, 198 patients) and validated in the ParkWest study (Norway, 192 patients), cohorts that attempted to identify and follow-up all new PD cases in the study area. Dependency was defined using the Schwab & England scale. We selected variables measured at time of diagnosis to include in the models. Internal validation and external validation were performed by calculating C-statistics (discrimination) and plotting observed versus predicted risk in quantiles of predicted risk (calibration). RESULTS Older age, male sex, increased severity of axial features, and Charlson comorbidity index were independent prognostic factors in the mortality model. Increasing age, higher smoking history, increased severity of axial features, and lower MMSE score were independent predictors in the models of dependency and "death or dependency." Each model had very good internal calibration and very good or good discrimination (internal and external C-statistics for the models were 0.73-0.75 and 0.68-0.78, respectively). Although each model clearly separated patients into groups according to risk, they tended to overestimate risk in ParkWest. The models were recalibrated to the baseline risk in the ParkWest study and then calibrated well in this cohort. CONCLUSIONS We have developed prognostic models for predicting medium-term risk of important clinical outcomes in newly diagnosed PD. These models have validity for use for stratification of randomization, confounder adjustment, and case-mix correction, but they are inadequate for individualized prognostication. © 2017. The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Angus D. Macleod
- Division of Applied Health SciencesUniversity of AberdeenForesterhillAberdeenUK
| | - Ingvild Dalen
- Department of Research, Section of BiostatisticsStavanger University HospitalStavangerNorway
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
| | - Ole‐Bjørn Tysnes
- Institute of Clinical MedicineUniversity of BergenBergenNorway
- Department of NeurologyHaukeland University HospitalBergenNorway
| | | | - Carl E. Counsell
- Division of Applied Health SciencesUniversity of AberdeenForesterhillAberdeenUK
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Macleod AD, Counsell CE. Predictors of functional dependency in Parkinson's disease. Mov Disord 2017; 31:1482-1488. [PMID: 27548693 PMCID: PMC5082567 DOI: 10.1002/mds.26751] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/19/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Functional dependency, the need for help in basic activities of daily living, is an important patient-oriented outcome. We aimed to describe the development of dependency in Parkinson's disease (PD) and identify independent prognostic factors for this outcome. METHODS We analyzed data from the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective, community-based incident cohort of PD with ongoing follow-up. We described the development of dependency defined by a Schwab & England score of < 80% and a Barthel Index of <19. We identified the baseline predictors of dependency using multivariable Cox regression. RESULTS In 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio for 10-year increase 2.23 [95% confidence interval 1.66-2.98]), greater smoking history (hazard ratio for 10-pack-year increase, 1.15 [1.04-1.26]), more severe axial impairment (hazard ratio for 5-point increase in sum of axial items from UPDRS scale, 1.78 [1.30-2.44]), and lower MMSE score (hazard ratio 0.88 [0.79-0.98]) were independently associated with a higher risk of dependency as defined by Schwab & England. Only older age (hazard ratio for 10-year increase 1.35 [1.04-1.76]) and severity of axial impairment (hazard ratio for 5-point increase 1.85 [1.31-2.62]) were associated with a higher risk of dependency as defined by the Barthel Index. Sex, deprivation, comorbidity, overall UPDRS motor score, and disease stage were not independently associated with dependency. CONCLUSION This is the first community-based study of dependency in PD. There was a high rate of dependency development. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
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Riedel O. Bringing light into the darkness: Dependence in Parkinson's disease. Mov Disord 2016; 31:1431-1432. [PMID: 27619415 DOI: 10.1002/mds.26795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
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Macleod AD, Goddard H, Counsell CE. Co-morbidity burden in Parkinson's disease: Comparison with controls and its influence on prognosis. Parkinsonism Relat Disord 2016; 28:124-9. [PMID: 27210815 PMCID: PMC4925465 DOI: 10.1016/j.parkreldis.2016.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/07/2016] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Abstract
Background Many aspects of co-morbidity burden in Parkinson’s disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies. Objectives To determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes. Methods Data from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling. Results The CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08–1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94). Conclusions The CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later. The Charlson Index was a reliable and valid way to measure co-morbidity burden in PD. There was no difference in co-morbidity burden between PD and matched controls. Higher co-morbidity at diagnosis was associated with higher early mortality.
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Affiliation(s)
- Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Hannah Goddard
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Reliability of Three Disability Scales for Detection of Independence Loss in Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:1941034. [PMID: 27213080 PMCID: PMC4860247 DOI: 10.1155/2016/1941034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/06/2016] [Indexed: 11/18/2022]
Abstract
Background. Loss of independence is considered an important outcome measure in Parkinson's disease (PD), but tools to assess dependency have not been tested in PD. Methods. In this study of 158 PD patients, we examined the two most widely used scales and cut-offs for dependency evaluation in PD, the Hoehn and Yahr (HY) stage > 3 and the Schwab and England (SE) scale score < 80%, against a standardized clinical interview assessing dependency in activities of daily living (ADL). We also examined the performance of the generic Barthel ADL index. In addition, we determined whether alternative cut-offs improved the utility of these tools. Results. Compared to clinical interview as gold standard, HY stage > 3 had 21% sensitivity and 98% specificity in detecting dependency in ADL. Corresponding figures for SE score < 80% were 55% and 92%, respectively. Using alternative cut-off values improved the overall diagnostic accuracy only slightly. Barthel ADL index had 67% sensitivity and 78% specificity in detecting dependency at its optimal cut-off value. Conclusion. Both the disease-specific HY staging and SE scale and the generic Barthel ADL index are suboptimal tools for assessing independence loss in PD. Clinical interview should be the assessment of choice in studies of dependency.
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