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Kapelle WM, Geerlings AD, Mutsaers I, Bloem BR, Meinders MJ, Post B. Unveiling the invisible: a qualitative interview study on the impact of young onset Parkinson's disease on (ex-partners). J Neurol 2024; 271:5312-5325. [PMID: 38861033 PMCID: PMC11319367 DOI: 10.1007/s00415-024-12474-2] [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: 01/08/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Living with young onset Parkinson's disease (YOPD) not only affects the persons with YOPD, but also their families. Although caregiver burden has been researched in Parkinson's disease in general, little is known about the specific impact of having an (ex-)partner with YOPD. This exploratory study aimed to explore the impact of having an (ex-)partner with YOPD on daily life. MATERIALS AND METHODS We used a qualitative approach including semi-structured interviews with 16 (ex-)partners of people with YOPD. Interviews were audio-taped and transcribed verbatim. Qualitative thematic analysis was used to analyze the interview data. RESULTS Qualitative analysis revealed nine themes to describe the impact of having an (ex-)partner with YOPD: (1) Psychosocial impact, (2) Impact on taking care of children, (3) Impact on working life, (4) Impact on intimacy and (sexual) relationships, (5) Impact on daily life, (6) Acceptance and other coping strategies, (7) Thoughts about the future, (8) Autonomy and (9) Caregiver support. DISCUSSION This study provides important findings that will inform future interventions that aim to reduce or even prevent caregiver burden, as well as to inform healthcare professionals to recognize the needs of caregivers of people with YOPD.
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Affiliation(s)
- Willanka Mariëlle Kapelle
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson and Movement Disorders, P.O. Box 9101 (internal code 914), 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Geerlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson and Movement Disorders, P.O. Box 9101 (internal code 914), 6500 HB, Nijmegen, The Netherlands
| | - Inge Mutsaers
- Inge Mutsaers Research and Writing, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson and Movement Disorders, P.O. Box 9101 (internal code 914), 6500 HB, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson and Movement Disorders, P.O. Box 9101 (internal code 914), 6500 HB, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson and Movement Disorders, P.O. Box 9101 (internal code 914), 6500 HB, Nijmegen, The Netherlands
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Hjelle EG, Rønn-Smidt H, Haahr A, Haavaag SB, Sørensen D, Navarta-Sánchez MV, Portillo MC, Bragstad LK. Filling the gap in service provision. Partners as family carers to people with Parkinson's disease: A Scandinavian perspective. Chronic Illn 2024; 20:258-270. [PMID: 37161264 DOI: 10.1177/17423953231174470] [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: 05/11/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson`s disease (PD) in Denmark and Norway. METHODS A qualitative exploratory design was applied. The sample consisted of 14 people from Denmark (n = 9) and Norway (n = 5) living with a partner with PD. Semi-structured individual interviews were conducted between June and September 2020, digitally recorded, transcribed verbatim and analysed using a reflexive thematic analysis approach combining inductive and deductive approaches. RESULTS The main themes were 'negotiating systems of support' and 'balancing being both a partner and a family carer'. Partners take responsibility for the people with whom they live and attempt to fill gaps in the public healthcare system. The most frequently described needs were more information, service coordination as the illness progressed and acknowledgement of the complex role. DISCUSSION A recommendation for practice is recognition of the complex roles of partners to people with PD and reaching out to both regularly to determine needs. This may enhance the collaboration between partner carers, people with PD and healthcare providers, ensure sustainability of the system and optimise living with PD in the family.
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Affiliation(s)
- Ellen Gabrielsen Hjelle
- Department of Public Health Science and CHARM - Research Centre for Habilitation and Rehabilitation Services and Models, University of Oslo, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Helle Rønn-Smidt
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Mari Carmen Portillo
- NIHR Applied Research Collaboration Wessex. School of Health Sciences, University of Southampton, Southampton, UK
| | - Line Kildal Bragstad
- Department of Public Health Science and CHARM - Research Centre for Habilitation and Rehabilitation Services and Models, University of Oslo, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
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Kandadai RM, Kola S, Alugolu R, Borgohain R. Caregiver Burden in Parkinson's Disease Patients Post-Deep Brain Stimulation: A Neglected Aspect. Ann Indian Acad Neurol 2024; 27:116-117. [PMID: 38751908 PMCID: PMC11093154 DOI: 10.4103/aian.aian_410_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/18/2024] Open
Affiliation(s)
- Rukmini M. Kandadai
- Department of Neurology, Parkinson's Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Sruthi Kola
- Department of Neurology, Parkinson's Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Department of Neurology, Parkinson's Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Parkinson's Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
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Cavallieri F, Ghirotto L, Sireci F, Parmeggiani M, Pedroni C, Mardones FA, Bassi MC, Fioravanti V, Fraix V, Moro E, Valzania F. Caregivers' burden and deep brain stimulation for Parkinson disease: A systematic review of qualitative studies. Eur J Neurol 2024; 31:e16149. [PMID: 37975788 PMCID: PMC11235895 DOI: 10.1111/ene.16149] [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: 08/30/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE The impact of subthalamic nucleus deep brain stimulation (STN-DBS) on caregivers' burden is understudied. We perform a systematic review and meta-synthesis aggregating qualitative studies involving partners of people with Parkinson disease (PwP) to explore their experiences and unmet needs. METHODS A systematic review for retrieving qualitative studies included six databases: MEDLINE, Embase, CINAHL, Cochrane, PsycInfo, and Scopus. Inclusion criteria were as follows: (i) studies on the experience of caregivers of PwP in the context of STN-DBS, (ii) English peer-reviewed articles, and (iii) qualitative or mixed methods studies reporting caregivers' quotations. After the appraisal of included studies, we performed meta-synthesis of qualitative findings. Descriptive themes and conceptual elements related to PwP partners' experiences and unmet needs were generated. RESULTS A total of 1108 articles were screened, and nine articles were included. Three categories were identified: (i) dealing with Parkinson disease (PD) every day (the starting situation characterized by the impact of PD on ordinary life; the limitations to partners' socialization; partners' efforts in stepping aside for love and care activities), (ii) facing life changes with STN-DBS (the feeling of being unprepared for changes; the fear and concern due to loved ones' behavioral changes; struggling to find an explanation for those changes), and (iii) rebuilding the role of caregiver and partner after STN-DBS. CONCLUSIONS This meta-synthesis elucidates concerns, challenges, and unmet needs of partners of PwP who underwent STN-DBS. It is important to provide them with information, education, and adequate support to face these challenges. Professionals need to involve partners in the care and decision process, because STN-DBS-related outcomes do not depend solely on the well-being of PwP but also on the well-being of individuals surrounding them.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Luca Ghirotto
- Qualitative Research UnitAzienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Francesca Sireci
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Margherita Parmeggiani
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Cristina Pedroni
- Direzione delle Professioni Sanitarie Azienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | | | - Valentina Fioravanti
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Valérie Fraix
- Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of NeuroscienceGrenoble Alpes UniversityGrenobleFrance
| | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of NeuroscienceGrenoble Alpes UniversityGrenobleFrance
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL–IRCCS di Reggio EmiliaReggio EmiliaItaly
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Soares GM, Bouça‐Machado R, Abreu D, Ferreira JJ. Contributory Factors to Caregiver Burden in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1507-1518. [PMID: 37868922 PMCID: PMC10585976 DOI: 10.1002/mdc3.13868] [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: 04/26/2023] [Revised: 06/19/2023] [Accepted: 07/16/2023] [Indexed: 10/24/2023] Open
Abstract
Background Although there is growing recognition of the relevancy of informal caregivers there is scarce information on the contributory factors of caregiver burden in Parkinson's Disease (PD). Objective To identify the main associated factors to caregivers' burden in people caring for a person with PD. Methods We analyzed the data set from a multinational online survey the Parkinson's real-world impact assesSMent (PRISM) focusing on medication use, comorbidities, health-related quality of life, relationship changes and the use of healthcare and supportive care resources by people with PD and their carers. Structured questionnaires including the Parkinson's disease quality of life questionnaire (PDQ-39), non-motor symptoms questionnaire (NMSQuest) and the Questionnaire for impulsive-compulsive disorder in Parkinson's disease (QUIP) were applied. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). Results In a cohort of 245 dyads (patient and respective caregiver), caregivers reported a mild to moderate burden. Carers' perception of PD impact in partnership, financial burden, hours of care, patient's age, hypersexuality and health-related quality of life (HRQoL) were found to be significant contributory factors to caregiver burden. Taken together these variables explained 66.8% of the variance in the Interpretation of the ZBI total score. Conclusions Caring for a person with PD entails substantial burden, particularly when the caregiver perceives greater changes in partnership dynamics, dedicates more time to caregiving tasks, has financial burden, and when the patient is older, reports worst HRQoL and has sexual compulsive urges.
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Affiliation(s)
| | - Raquel Bouça‐Machado
- CNS‐Campus NeurológicoTorres VedrasPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Daisy Abreu
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Joauqim J. Ferreira
- Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- CNS‐Campus NeurológicoTorres VedrasPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
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Geerlings AD, Kapelle WM, Sederel CJ, Tenison E, Wijngaards-Berenbroek H, Meinders MJ, Munneke M, Ben-Shlomo Y, Bloem BR, Darweesh SKL. Caregiver burden in Parkinson's disease: a mixed-methods study. BMC Med 2023; 21:247. [PMID: 37424022 PMCID: PMC10332089 DOI: 10.1186/s12916-023-02933-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Providing informal care for a person with Parkinson's disease (PD) can be a demanding process affecting several dimensions of a caregiver's life and potentially causing caregiver burden. Despite the emerging literature on caregiver burden in people with PD, little is known about the inter-relationship between quantitative and qualitative findings. Filling this knowledge gap will provide a more holistic approach to develop and design innovations aiming at reducing or even preventing caregiver burden. This study aimed to characterize the determinants of caregiver burden among informal caregivers of persons with PD, in order to facilitate the development of tailored interventions that reduce caregiver burden. METHODS We conducted a cross-sectional study in The Netherlands using a sequential mixed methods approach, entailing a quantitative study of 504 persons with PD and their informal caregivers as well as a qualitative study in a representative subsample of 17 informal caregivers. The quantitative study included a standardized questionnaire of caregiver burden (Zarit Burden Inventory) and patient-related (Beck Depression Inventory, State-Trait Anxiety Inventory, Acceptance of Illness Scale, MDS-Unified Parkinson's Disease Rating Scale part II on motor functions in daily life, Self-assessment Parkinson's Disease Disability Score), caregiver-related (Brief Coping Orientation to Problems Experience Inventory, Caregiver Activation Measurement, Multidimensional Scale of Perceived Social Support) and interpersonal determinants (sociodemographic variables including among others gender, age, education, marital status and working status). The qualitative study consisted of semi-structured interviews. Multivariable regression and thematic analysis were used to analyse quantitative and qualitative data, respectively. RESULTS A total of 337 caregivers were women (66.9%), and the majority of people with PD were men (N = 321, 63.7%). The mean age of persons with PD was 69.9 (standard deviation [SD] 8.1) years, and the mean disease duration was 7.2 (SD 5.2) years. A total of 366 (72.6%) persons with PD had no active employment. The mean age of informal caregivers was 67.5 (SD 9.2) years. Most informal caregivers were female (66.9%), had no active employment (65.9%) and were the spouse of the person with PD (90.7%). The mean Zarit Burden Inventory score was 15.9 (SD 11.7). The quantitative study showed that a lack of active employment of the person affected by PD was associated with a higher caregiver burden. The qualitative study revealed cognitive decline and psychological or emotional deficits of the person with PD as additional patient-related determinants of higher caregiver burden. The following caregiver-related and interpersonal determinants were associated with higher caregiver burden: low social support (quantitative study), concerns about the future (qualitative study), the caregiving-induced requirement of restrictions in everyday life (qualitative study), changes in the relationship with the person with PD (qualitative study) and a problem-focused or avoidant coping style (both studies). Integration of both data strands revealed that qualitative findings expanded quantitative findings by (1) distinguishing between the impact of the relationship with the person with PD and the relationship with others on perceived social support, (2) revealing the impact of non-motor symptoms next to motor symptoms and (3) revealing the following additional factors impacting caregiver burden: concern about the future, perceived restrictions and limitations in performing daily activities due to the disease, and negative feelings and emotional well-being. Qualitative findings were discordant with the quantitative finding demonstrating that problem-focused was associated with a higher caregiver burden. Factor analyses showed three sub-dimensions of the Zarit Burden Inventory: (i) role intensity and resource strain, (2) social restriction and anger and (3) self-criticism. Quantitative analysis showed that avoidant coping was a determinant for all three subscales, whereas problem-solved coping and perceived social support were significant predictors on two subscales, role intensity and resource strain and self-criticism. CONCLUSIONS The burden experienced by informal caregivers of persons with PD is determined by a complex interplay of patient-related, caregiver-related and interpersonal characteristics. Our study highlights the utility of a mixed-methods approach to unravel the multidimensional burden experienced by informal caregivers of persons with chronic disease. We also offer starting points for the development of a tailored supportive approach for caregivers.
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Affiliation(s)
- Angelika D Geerlings
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Willanka M Kapelle
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Charlotte J Sederel
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands.
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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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Hattori N, Okada Y, Kawata Y, Furusawa Y, Imai T, Yoshida H, Ota M, Arai M, Shintani A, Fernandez J. Survey on the Impact of the COVID-19 Pandemic on Patients with Parkinson's Disease and Their Caregivers in Japan. Patient Prefer Adherence 2023; 17:1221-1235. [PMID: 37187576 PMCID: PMC10179078 DOI: 10.2147/ppa.s402193] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic changed the lives of patients with Parkinson's disease (PD) and their caregivers. This study aimed to investigate changes in patient behavior and PD symptoms and their effect on caregiver burden resulting from the COVID-19 pandemic in Japan. Methods This nationwide, observational, cross-sectional survey included patients with self-reported PD and caregivers (members of the Japan Parkinson's Disease Association). The primary objective was to evaluate changes in behaviors, self-assessed PD symptoms, and caregiver burden from pre-COVID-19 (February 2020) to post-national state of emergency (August 2020 and February 2021). Results Responses from 1883 patients and 1382 caregivers from 7610 distributed surveys were analyzed. Mean (standard deviation) age of patients and caregivers was 71.6 (8.2) and 68.5 (11.4) years, respectively; 41.6% of patients had a Hoehn and Yahr (HY) scale of 3. Patients (>40.0%) reported decreased frequency of going out. Most patients (>70.0%) reported no change in treatment visit frequency, voluntary training, or rehabilitation and nursing care insurance services. Symptoms worsened for approximately 7-30% of patients; the proportion with HY scale 4-5 increased from pre-COVID-19 (25.2%) to February 2021 (40.1%). Aggravated symptoms included bradykinesia, walking, gait speed, depressed mood, fatigue, and apathy. Caregivers' burden increased because of patients' worsened symptoms and reduced time going out. Conclusion Control measures during infectious disease epidemics should consider that patients' symptoms may worsen; therefore, patient and caregiver support is needed to reduce burden of care.
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Affiliation(s)
| | | | - Yayoi Kawata
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Yoshihiko Furusawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Correspondence: Yoshihiko Furusawa, Japan Medical Office, Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo City, Tokyo, 103-0023, Japan, Tel +81-3-3278-2111, Fax +81-3-3278-2000, Email
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mihoko Ota
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masaki Arai
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Socially Assistive Robots for Parkinson's Disease: Needs, Attitudes and Specific Applications as Identified by Healthcare Professionals. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2022. [DOI: 10.1145/3570168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To explore how socially assistive robots (SARs) may assist the specific needs of individuals with Parkinson's disease (IwPD), we conducted three focus groups with 12 clinicians who treat IwPD. We present a thematic analysis of their perceptions of the needs of the patients, and their own expectations, perceived advantages, disadvantages and concerns regarding the use of SARs for IwPD. Clinicians were positive towards using SARs for IwPD, if used in the patient's home, for motor, communication, emotional, and cognitive needs, especially for practice and for help with activities of daily living. They were concerned that a SAR might be used to replace clinicians’ work, and stressed it should only
augment
the clinicians’ work. They thought a SAR may relieve some of the burden experienced by informal caregivers, and identified specific applications for SARs for PD. We asked 18 stakeholders (nine IwPD, nine family members) to rate their level of agreement with the clinicians’ statements. The greatest divergence between their views and those of the clinicians was on the topic of using a SAR as a companion, or as a feeding assistant, to which they objected. This work may be used as a basis for future studies designing SARs for IwPD.
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Whiteley N, Pluim CF, Split M, Cabrera Tuazon A, Moore RC, Irene Litvan, Lessig S, Filoteo JV, Schiehser DM. Prospective predictors of care partner burden and depression in Parkinson's disease. Int J Geriatr Psychiatry 2022; 37. [PMID: 35996353 DOI: 10.1002/gps.5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Care partners who provide informal care to individuals with Parkinson's disease (PD) report higher levels of burden and depression; however, longitudinal research on these symptoms is scarce. The current study assessed changes in care partner burden and depression, and patient and care partner predictors of these symptoms over time. Such knowledge may provide important information for assessment and treatment of depression and burden in care partners of individuals with PD. RESEARCH DESIGN AND METHODS Participants were 88 PD patients without dementia and their self-identified care partner (n = 88). Care partners completed the Geriatric Depression Scale and Zarit Burden Interview. PD participants completed mood questionnaires and a motor exam at baseline and 2 year follow-up. Relationships among care partner burden and depression over time with patient and care partner predictors (i.e., demographic, mood, and disease characteristics) were assessed using correlations and regression analyses. RESULTS Care partner burden and depression significantly increased over an approximate 2 year period. Greater baseline disease severity predicted worsening of care partner burden (p = 0.028), while baseline patient depression predicted worsening of care partner depression (p = 0.002). CONCLUSIONS Results highlight differential impacts of specific PD symptoms on worsening care partner burden compared to depression; increased PD disease severity predicts increased burden, while patient mood predicts worsening of depression over time. Targeting PD disease severity and mood symptoms may prevent the progression of care partner burden and depression.
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Affiliation(s)
- Nicole Whiteley
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Celina F Pluim
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Molly Split
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - Stephanie Lessig
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - J Vincent Filoteo
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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11
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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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12
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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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13
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Ledda C, Montanaro E, Imbalzano G, Merola A, Bruno I, Artusi CA, Zibetti M, Rizzone MG, Bozzali M, Sobrero G, Vallelonga F, Maule S, Lopiano L, Romagnolo A. Burden of caregiving for cardiovascular dysautonomia in Parkinson's disease. Clin Auton Res 2022; 32:455-461. [PMID: 36030471 PMCID: PMC9719446 DOI: 10.1007/s10286-022-00888-9] [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: 06/13/2022] [Accepted: 08/18/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE We sought to estimate the impact of cardiovascular autonomic neuropathy (cAN) on informal caregivers of patients with Parkinson's disease (PD), defined as individuals providing regular care to a friend, partner, or family member with PD, and to evaluate the mutual relationship between caregiver burden and patient health-related quality of life (HRQoL). METHODS We enrolled 36 consecutive patients with PD and their informal caregivers. Patients underwent a detailed motor, autonomic, cognitive, and functional assessment. Caregivers were assessed using the Zarit Burden Interview (ZBI). Differences in caregiver burden, expressed by the ZBI score, and strength of association between caregiver burden, cAN, and HRQoL were assessed using analysis of covariance (ANCOVA), logistic regression, and linear regression analyses. Analyses were adjusted for patients' age, PD duration, and motor and cognitive disability, as well as caregivers' age. RESULTS Moderate-severe caregiver burden was reported in 41.7% of PDcAN+ versus 8.7% of PDcAN- (p < 0.001). The ZBI score was increased in PDcAN+ versus PDcAN- (31.5 ± 3.4 versus 15.2 ± 2.3; p < 0.001), with tenfold higher odds (p = 0.012) of moderate-severe caregiver burden in PDcAN+, even after adjusting for potential confounders. The ZBI score correlated with cAN severity (p = 0.005), global autonomic impairment (p = 0.012), and HRQoL impairment (p < 0.001). CONCLUSION These results highlight the significant impact of cAN on PD caregivers and the need for targeted interventions addressing this frequently overlooked and insufficiently treated source of nonmotor disability in PD.
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Affiliation(s)
- Claudia Ledda
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Elisa Montanaro
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Gabriele Imbalzano
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Aristide Merola
- grid.261331.40000 0001 2285 7943Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH USA
| | - Ilaria Bruno
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Carlo Alberto Artusi
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Maurizio Zibetti
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Mario Giorgio Rizzone
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Marco Bozzali
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Gabriele Sobrero
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Fabrizio Vallelonga
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Simona Maule
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Leonardo Lopiano
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Alberto Romagnolo
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
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14
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Hergert DC, Cimino CR. Predictors of Caregiver Burden in Huntington's Disease. Arch Clin Neuropsychol 2021; 36:1426–1437. [PMID: 33723593 DOI: 10.1093/arclin/acab009] [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: 07/25/2020] [Revised: 11/19/2020] [Accepted: 02/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Huntington's disease (HD) is a genetic neurodegenerative condition that is characterized by cognitive, motor, and psychiatric dysfunction. The purpose of this study was to explore which disease characteristics influence caregiver burden in HD. METHODS Fifty participants with HD and 50 of their caregivers participated in the study at the University of South Florida. Participants were administered a neuropsychological battery, the Unified Huntington's Disease Rating Scale (UHDRS) motor exam, and the Frontal Systems Behavior Scale (FrSBe) self-report. Caregivers completed the Caregiving Appraisal Scale and the FrSBe family-report. RESULTS There were significant correlations between caregiver burden and caregiver age and sex, UHDRS motor scores, cognitive functioning, and self and caregiver-reported FrSBe scores. The significant variables were entered into a regression model and explained 63.1% of the variance in caregiver burden scores. Caregiver age, cognitive functioning, and caregiver-reported FrSBe scores continued to be significant predictors of caregiver burden, whereas the other variables were no longer significant. CONCLUSIONS There were significant relationships between caregiver burden, cognitive functioning, and frontally mediated behaviors, but not motor scores. The results suggest that possible interventions for caregivers may include education to caregivers on how to cope with apathy/executive dysfunction and cognitive decline. Caregiver age was associated with burden, with younger age being associated with increased burden when controlling for symptom severity. This has implications for this population in that HD typically has a younger age of onset than other neurodegenerative diseases and therefore, these caregivers may be particularly at risk for caregiver burden.
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Affiliation(s)
- Danielle C Hergert
- New Mexico Department of Health, Developmental Disabilities Supports Division, Albuquerque, NM, USA
| | - Cynthia R Cimino
- Deparment of Psychology, University of South Florida, Tampa, FL, USA
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15
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Jose A, Bhargavan A, Appireddy R, Raghunath PS, Rajan R, Iype T. Neuropsychiatric Symptoms and Caregiver's Burden in Parkinson's Disease Patients in a Tertiary Care Teaching Hospital in South India: A Cross-Sectional Study. Neurol India 2021; 69:1706-1710. [PMID: 34979673 DOI: 10.4103/0028-3886.333437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background In patients with Parkinson's disease (PD), the occurrence of motor and non-motor symptoms increases with disease progression. The range of neuropsychiatric symptoms (NPS) vary among individuals and can be burdensome for caregivers. Only a few studies have identified the contributing factors of NPS and caregiver burden in India. Objectives We aimed to study the clinical profile, disability, and predictive factors of NPS in PD patients and associated caregiver's burden. Methods and Material This was a cross-sectional observational study carried out in PD patients and their respective caregivers attending a movement disorder clinic in a tertiary care teaching hospital in Kerala. A total of 104 patients diagnosed with idiopathic PD receiving levodopa therapy and who had a primary caregiver were enrolled in the study. Structured questionnaires were administered to both patients and caregivers to collect data. Data analysis was done using an independent t-test, linear, and multiple regression analysis. Results Among 104 patients recruited for the study, 61.5% of patients had shown at least one NPS and 40.44% showed multiple NPS. Results from the study showed that depression is the primary NPS occurring in IPD patients (55.8%) followed by irritability, anxiety, and apathy. On linear regression models, the prime determinant of NPS was the Everyday Abilities Scale for India (EASI). For caregiver burden, the main determinants were the presence of NPS, duration of caregiving, EASI, and RBDSQ score. Conclusions NPS in PD are highly associated with and are determinants of caregiver burden. Detailed assessment and specific interventions aimed at NPS could alleviate caregiver burden.
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Affiliation(s)
- Anmi Jose
- Department of Hospital and Clinical Pharmacy, College of Pharmaceutical Sciences, Government Medical College, Vattappara, Kerala, India
| | - Ajith Bhargavan
- Department of Hospital and Clinical Pharmacy, College of Pharmaceutical Sciences, Government Medical College, Vattappara, Kerala, India
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - P Sreelakshmi Raghunath
- Department of Community Medicine, SUT Academy of Medical Sciences, Vattappara, Kerala, India
| | - Reeja Rajan
- Department of Neurology, Government Medical College, Kerala University of Health Sciences, Thiruvananthapuram, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Kerala University of Health Sciences, Thiruvananthapuram, Kerala, India
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16
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Carboni-Jiménez A, Rice DB, Levis B, Cañedo-Ayala M, Imran M, Chiovitti M, Benedetti A, Thombs BD. Intensity of care and perceived burden among informal caregivers to persons with chronic medical conditions: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:6230-6246. [PMID: 34455877 DOI: 10.1080/09638288.2021.1966675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Informal caregivers provide ongoing assistance to a loved one with a health condition. No studies have compared caregiving intensity and perception of burden across chronic medical conditions. MATERIALS AND METHODS Databases were searched from inception through 11 September 2020 to identify studies that included the Level of Care Index or the Zarit Burden Inventory (ZBI) among caregivers for people with chronic diseases. Pooled mean ZBI scores and 95% confidence intervals by medical condition were calculated using a random effects model and heterogeneity with I2. RESULTS Ninety-seven included articles reported on 98 unique samples across 21 chronic diseases. No study used the Level of Care Index. Among 12 disease groups with more than one study, heterogeneity was too high (I2 range: 0-99.6%, ≥76.5% in 11 groups) to confidently estimate burden. The percent of studies rated high risk of bias ranged from 0% to 98%, but all external validity items were rated as high-risk in >50% of studies. CONCLUSIONS Findings highlight the need for studies on caregiver burden to improve sampling techniques; better report sampling procedures and caregiver and care recipient characteristics; and develop a standard set of outcomes, including a measure of caregiving intensity. Systematic Review Registration: CRD42017080962IMPLICATIONS FOR REHABILITATIONThe amount of burden reported by caregivers to loved ones is associated with reduced physical and mental health.We found considerable heterogeneity in perceived burden reported by informal caregivers across different studies within disease groups, which is likely related to methodological issues, including sampling techniques.Health care providers who use research on caregiver burden should assess how representative study samples may be and exercise caution in drawing conclusions.
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Affiliation(s)
- Andrea Carboni-Jiménez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Mara Cañedo-Ayala
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Matthew Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada.,Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Canada
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17
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Miyasaki JM, Lim SY, Chaudhuri KR, Antonini A, Piemonte M, Richfield E, Alburquerque Gonzalez D, Lorenzl S, Walker R, Bhidayasiri R, Bouca R, McConvey V. Access and Attitudes Toward Palliative Care Among Movement Disorders Clinicians. Mov Disord 2021; 37:182-189. [PMID: 34431560 DOI: 10.1002/mds.28773] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neuropalliative care is an emerging field for those with neurodegenerative illnesses, but access to neuropalliative care remains limited. OBJECTIVE We sought to determine Movement Disorder Society (MDS) members' attitudes and access to palliative care. METHODS A quantitative and qualitative survey instrument was developed by the MDS Palliative Care Task Force and e-mailed to all members for completion. Descriptive statistics and qualitative analysis were triangulated. RESULTS Of 6442 members contacted, 652 completed the survey. Completed surveys indicating country of the respondent overwhelmingly represented middle- and high-income countries. Government-funded homecare was available to 54% of respondents based on patient need, 25% limited access, and 21% during hospitalization or an acute defined event. Eighty-nine percent worked in multidisciplinary teams. The majority endorsed trigger-based referrals to palliative care (75.5%), while 24.5% indicated any time after diagnosis was appropriate. Although 66% referred patients to palliative care, 34% did not refer patients. Barriers were identified by 68% of respondents, the most significant being available workforce, financial support for palliative care, and perceived knowledge of palliative care physicians specific to movement disorders. Of 499 respondents indicating their training in palliative care or desire to learn these skills, 55% indicated a desire to gain more skills. CONCLUSIONS The majority of MDS member respondents endorsed a role for palliative care in movement disorders. Many members have palliative training or collaborate with palliative care physicians. Although significant barriers exist to access palliative care, the desire to gain more skills and education on palliative care is an opportunity for professional development within the MDS. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Janis M Miyasaki
- Parkinson and Movement Disorders Program, Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College, Denmark Hill Campus, London, United Kingdom
| | - Angelo Antonini
- Movement Disorders Unit-Center for Rare Neurological Diseases, Department of Neuroscience, University of Padua, Padua, Italy
| | - Maria Piemonte
- Physical Therapy, Speech Therapy, and Occupational Therapy Department, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Daniela Alburquerque Gonzalez
- Centro de Trastornos del Movimiento, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Ludwig-Maximillians-University, Munich, Germany.,Department of Neurology, Kliniku Agatharied, Hausham, Germany
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - 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
| | - Raquel Bouca
- Instituto de Medicina Molecular Joao Lobo Antunes, Lisbon, Portugal
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18
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Guger M, Raschbacher S, Kellermair L, Vosko MR, Eggers C, Forstner T, Leitner K, Fuchs A, Fellner F, Ransmayr G. Caregiver burden in patients with behavioural variant frontotemporal dementia and non-fluent variant and semantic variant primary progressive aphasia. J Neural Transm (Vienna) 2021; 128:1623-1634. [PMID: 34282470 PMCID: PMC8528762 DOI: 10.1007/s00702-021-02378-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Studies on caregiver burden in patients with frontotemporal lobar degeneration are rare, differ methodologically and show variable results. Single center longitudinal pilot study on caregiver burden and potential risk factors in patients with behavioural variant frontotemporal dementia (bvFTD) and semantic (svPPA) and non-fluent variants (nfvPPA) primary progressive aphasia. Forty-six bvFTD, nine svPPA, and six nfvPPA patients and caring relatives were analysed for up to 2 years using the Mini-Mental State Examination as global measure for cognitive performance, Frontal Assessment Battery (frontal lobe functions), Frontal Behavioural Inventory (personality and behaviour), Neuropsychiatric Inventory (dementia-related neuropsychiatric symptoms), Barthel Index and Lawton IADL Scale (basic and instrumental activities of daily living), the Caregiver Strain Index (CSI), and in most participants also the Zarit Burden Interview (ZBI). CSI baseline sum scores were highest in bvFTD (mean ± SD 5.5 ± 3.4, median 5, IQR 6), intermediate in svPPA (2.9 ± 2.3; 3; 3.5) and low in nfvPPA (1.6 ± 2.1; 1; 2). Similar differences of caregiver burden were found using the ZBI. During follow-up, CSI and ZBI sum scores deteriorated in svPPA, not in bvFTD and nfvPPA, and correlated significantly with personality and behaviour, neuropsychiatric symptoms, caregiver age, and instrumental, but not basic activities of daily living, Mini-Mental State Examination scores or frontal lobe functions. This study reveals differences in caregiver burden in variants of frontotemporal lobar degeneration. Caregivers should be systematically asked for caregiver burden from the time of the diagnosis to provide comprehensive support in time.
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Affiliation(s)
- Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Stefan Raschbacher
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - Lukas Kellermair
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Milan R Vosko
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Christian Eggers
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Thomas Forstner
- Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
| | - Karin Leitner
- Clinical and Health Psychology Unit, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Alexandra Fuchs
- Clinical and Health Psychology Unit, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Franz Fellner
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Central Radiology Institute, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria.
- Medical Faculty, Johannes Kepler University, Linz, Austria.
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Relationship Satisfaction in People with Parkinson's Disease and Their Caregivers: A Cross-Sectional Observational Study. Brain Sci 2021; 11:brainsci11060822. [PMID: 34205764 PMCID: PMC8234945 DOI: 10.3390/brainsci11060822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 01/01/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder, which leads to reduced health-related quality of life (HR-QoL) and autonomy in advanced stages of the disease. Hence, people with PD (PwPD) are in need of help, which is often provided by informal caregivers, especially spouses. This might influence the relationship satisfaction in patients and their spousal caregivers. Additionally, previous studies have shown that a reduced relationship satisfaction may result in mental disorders and reduced physical health. The aim of this study is to identify factors influencing PwPD and their caregivers' relationship satisfaction in a cross-sectional observational study. Analyses revealed an overall satisfying relationship, measured by the Quality of Marriage Index, in PwPD (n = 84) and their caregivers (n = 79). Relationship satisfaction in PwPD mildly decreased with reduced HR-QoL and more severe depressive symptoms. Reduced relationship satisfaction in caregivers was significantly associated with decreased HR-QoL, higher caregiver burden, more severe depressive symptoms and increased neuropsychiatric symptoms in PwPD. Further studies are needed to investigate the influence of the identified factors over time and if relationship satisfaction has a reciprocal impact on caregiver burden, HR-QoL as well as mental and physical health.
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20
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Altered Theory of Mind in Parkinson's Disease and Impact on Caregivers: A Pilot Study. Can J Neurol Sci 2021; 49:437-440. [PMID: 33988099 DOI: 10.1017/cjn.2021.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mild cognitive impairment (MCI) in Parkinson's disease (PD) includes deficits in theory of mind (ToM). However, associations between ToM and caregiver burden and distress are still unclear. The objective of this pilot study was to preliminarily explore the relation between ToM and caregiver burden and distress in a sample of PD-MCI patients. Twelve PD-MCI patients were evaluated on a ToM task (Faux Pas), whereas their caregivers were assessed on caregiver burden (Zarit Burden Interview-12 items) and distress (Neuropsychiatric Inventory-Distress). Cognitive ToM was significantly associated with caregiver distress, but caregiver burden was associated with the severity of patient psychiatric symptoms.
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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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One Year Trajectory of Caregiver Burden in Parkinson's Disease and Analysis of Gender-Specific Aspects. Brain Sci 2021; 11:brainsci11030295. [PMID: 33652825 PMCID: PMC7996933 DOI: 10.3390/brainsci11030295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) is a slowly progressive neurodegenerative movement disorder that leads to impairments in activities of daily living. In addition to reducing patients' quality of life, this disease also affects caregivers' well-being. Until recently, caregiver burden was mainly assessed by generic questionnaires, which do not take the characteristics of the chronic disease into consideration. In the case of PD, this issue has been addressed by the introduction of the "Parkinson's disease caregiver burden" questionnaire (PDCB). Data on longitudinal trajectories of caregiver burden are still missing in the literature. In this study, we assessed the one-year trajectory of caregiver burden by the PDCB as a disease-specific questionnaire. Further, gender-specific aspects of caregiver burden were analyzed by applying a caregiver task questionnaire. PDCB total score (n = 84 patients and caregivers) did not significantly change from baseline (30.4) to one year at follow-up (31.5). No significant difference was detected between female and male caregivers in global burden and-specific caregiver tasks. Our data showed only a mild increase of caregiver burden in the timeframe of one year. Gender-specific differences do not seem to impact-specific caregiver tasks in the presented study population.
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Contribution of neuropsychiatric symptoms in Parkinson's disease to different domains of caregiver burden. J Neurol 2021; 268:2961-2972. [PMID: 33629181 PMCID: PMC8289810 DOI: 10.1007/s00415-021-10443-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Abstract
Introduction Caregiver burden is high among caregivers of PD patients (CPD). Neuropsychiatric symptoms are leading contributors to CPD burden, but whether different symptoms differentially impact domains of caregiver burden is not known. Our objective was to examine which neuropsychiatric symptoms and demographic factors contribute to different domains of caregiver burden in PD. Methods This was a cross-sectional online survey study. Participants were recruited from the Fox Insight (FI) study and were eligible if they identified themselves as a CPD. The primary outcome was the Caregiver Burden Inventory (CBI) total score and its 5 sub-domain scores. The Neuropsychiatric Inventory Questionnaire (NPI-Q) assessed caregiver-reported neuropsychiatric symptoms in the care recipient. Multivariable linear regression models were used to characterize the associations between NPI-Q symptom severity scores and CBI scores. Covariates were caregiver age, sex, education, and caregiving duration. Results The sample consisted of 450 CPD, mean age 65.87 (SD 10.39) years, 74% females. After adjusting for covariates, CBI total score was predicted by NPI-Q total score (β = 1.96, p < 0.001); model adjusted R2 = 39.2%. Anxiety severity had the largest effect size [standardized β (sβ) = 0.224] on the time-dependency domain, which was also associated with female sex (sβ = − 0.133) and age (sβ = 0.088). Severity of disinhibition (sβ = 0.218), agitation (sβ = 0.199), and female sex (sβ = 0.104) were associated with greater emotional burden. Conclusion Our findings indicate that demographic characteristics and specific neuropsychiatric symptoms contribute differentially to domains of caregiver burden. Tailored interventions to support CPD are needed. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10443-7.
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Juneja A, Anand K, Chandra M, Deshpande S, Dhamija R, Kathuria P, Mahajan R. Neuropsychiatric Symptoms and Caregiver Burden in Parkinson's Disease. Ann Indian Acad Neurol 2021; 23:656-660. [PMID: 33623267 PMCID: PMC7887493 DOI: 10.4103/aian.aian_91_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: Parkinson’s disease (PD) is a neurodegenerative disorder. It has a significant impact on the quality of life of patients and their caregivers. The present study aims to study the phenomena of neuropsychiatric symptoms and their association with caregiver burden in PD. Methods: The study was conducted in 100 patients of Parkinson’s disease and their primary caregivers. The patients of PD were diagnosed on the basis of UK Brain Bank criteria; severity/staging of Parkinson’s disease was done by Movement Disorder Society - Unified Parkinson’s disease rating scale (MDS-UPDRS-III). Patients who fulfilled inclusion and exclusion criteria were recruited for the study. The neuropsychiatric evaluation was based on Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver burden was assessed with the Zarit Caregiver Burden Inventory (ZCBI). Results: Mean age of PD patients was 61.48 ± 6.71 years, majority of them were males (68%). Mean total NPI score of patients was 44.46 ± 5.38. Mean age of caregivers was 52.26 ± 6.80 years, majority of them were females (72%) and spouse (76%) in relation to the patient. Caregiver burden was significantly related to age of the patient, duration of illness, severity of illness, and total NPI score. Conclusion: Neuropsychiatric symptoms significantly contribute to the caregiver burden in Parkinson’s disease.
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Affiliation(s)
| | - Kuljeet Anand
- Department of Neurology, Dr. RML Hospital, Delhi, India
| | - Mina Chandra
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | | | - Rajinder Dhamija
- Department of Neurology, LHMC and Sucheta Kriplani Hospital, Delhi, India
| | - Parul Kathuria
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | - Rahul Mahajan
- Department of Neurology, Dr. RML Hospital, Delhi, India
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A dyadic study of psychological well-being of individuals with Parkinson's disease and their caregivers. Sci Rep 2021; 11:957. [PMID: 33441640 PMCID: PMC7806607 DOI: 10.1038/s41598-020-79609-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/10/2020] [Indexed: 01/11/2023] Open
Abstract
Parkinson's disease (PD) is an incapacitating neurodegenerative disease. Patients with PD and their caregivers may have interactive effects on each other’s psychological well-being. This study aimed to assess the dyadic dynamics of resilience, fatigue, and suicidal ideation on the depression severity of PD patients and their caregivers. In total, 175 PD patients and 175 caregivers were recruited at a medical center from August 2018 to May 2020. Structural equation modeling (SEM) was used to examine the actor/partner effects on the psychological well-being of both the PD patients and their caregivers. The most common psychiatric diagnoses of both the PD patients (28.6%) and their caregivers (11.4%) were depressive disorders. The PD patients’ and their caregivers’ fatigue, suicidal ideation, and lack of resilience were significantly associated with the severity of their depression, respectively. Interactive effects existed between psychological well-being of individuals with PD and their caregivers. Clinicians must be aware of, and manage, these contributing factors between PD patients and their caregivers in order to prevent them from worsening each other’s depression.
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Villaseñor T, Perrin PB, Donovan EK, McKee GB, Henry RS, Dzierzewski JM, Lageman SK. Parkinson's family dynamics and caregiver sense of coherence: A family-systems approach to coping in Mexico and the United States. Aging Med (Milton) 2020; 3:252-259. [PMID: 33392431 PMCID: PMC7771559 DOI: 10.1002/agm2.12130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The population of individuals with Parkinson's disease (PD) is growing in Mexico and the United States, and there is an increasing need for family members to provide caregiving. This study examined the connections between family dynamics and coping, or sense of coherence, among PD caregivers in Mexico (n = 148) and the United States (n = 105). METHODS Caregivers completed measures of family dynamics and sense of coherence across indices of comprehensibility, manageability, and meaningfulness. RESULTS Although caregivers in Mexico and the United States had similar levels of sense of coherence and family dynamics reflecting strengths/adaptability and being overwhelmed with difficulties, caregivers in Mexico had worse disrupted communication. Family dynamics explained: 24.2% of the variance in caregiver comprehensibility in the United States and 17.5% in Mexico; 34.1% in manageability in the United States and 23.5% in Mexico; and 22.6% in meaningfulness in the United States and 22.7% in Mexico (all Ps < 0.001). In both Mexico and the United States, family strengths/adaptability uniquely predicted caregiver comprehensibility, manageability, and meaningfulness. Being overwhelmed with difficulties uniquely predicted comprehensibility in Mexico and manageability and meaningfulness in the United States. CONCLUSION The development of family-systems interventions for PD caregivers to improve family strengths/adaptability and help families deal with difficulties may increase caregiver coping.
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Affiliation(s)
- Teresita Villaseñor
- Hospital Civil Fray Antonio AlcaldeGuadalajaraJaliscoMexico
- Neurosciences DepartmentUniversity of GuadalajaraGuadalajaraJaliscoMexico
| | - Paul B. Perrin
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUnited States
- Department of Physical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondVirginiaUnited States
| | - Emily K. Donovan
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUnited States
| | - Grace B. McKee
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUnited States
- Hunter Holmes McGuire Veterans Affairs Medical CenterMid‐Atlantic Mental Illness Research Education and Clinical CenterCentral Virginia VA Health Care SystemRichmondVirginiaUnited States
| | - Richard S. Henry
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUnited States
| | - Joseph M. Dzierzewski
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUnited States
| | - Sarah K. Lageman
- Department of NeurologyParkinson’s & Movement Disorders CenterVirginia Commonwealth UniversityRichmondVirginiaUnited States
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Cianfrocca C, Caponnetto V, Donati D, Di Stasio E, Tartaglini D, Lancia L. The opinions and feelings about their educational needs and role of familial caregivers of Parkinson's Disease patients: a qualitative study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020002. [PMID: 33263347 PMCID: PMC8023112 DOI: 10.23750/abm.v91i12-s.10264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK In the advanced stages of Parkinson's Disease, patients need complex care and support, especially at home, where they often receive assistance by familial caregivers. However, caregivers may be or feel unable to cope with their role and, despite the needs of caregivers are often assessed in the literature, their opinions and feelings about these needs are not widely explored yet. This study aimed at exploring the opinions and feelings about their educational needs and role of familial caregivers of Parkinson's Disease patients. METHODS A qualitative study was conducted from October to December 2017 in a polyclinic of central Italy. Fourteen caregivers voluntarily participated in the study; semi-structured face-to-face interviews were conducted, and audio recorded until data saturation. Two investigators reviewed the transcribed notes, created Meaning Units, Sub-categories and finally the Categories with emerged themes. RESULTS The analysis of the 14 interviews generated three categories: supportiveness of healthcare educational programs; sense of inability to manage caregiver tasks; need for interaction with other familial caregivers. CONCLUSIONS The caregivers declared their belief that healthcare educational courses can be useful in helping them live and understand the caregiving tasks and expressed their need to share their experiences with other caregivers. In fact, they often they felt abandoned and poorly trained for the patient's management at the home. The clinical practice should allow healthcare professionals to meet the training and emotional needs of caregivers and create a trust relationship with them to make caregivers skilled in caring for patients.
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Affiliation(s)
- Claudia Cianfrocca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | | | - Daniele Donati
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of 'Sacro Cuore', Rome, Italy; Univeristy Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy.
| | | | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Rita Levi Montalcini - Via G. Petrini - 67100 L'Aquila, Italy.
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Emergency Room Visit Prevention for Older Patients with Parkinsonism in a Geriatric Clinic. Can J Neurol Sci 2020; 48:666-675. [PMID: 33183363 DOI: 10.1017/cjn.2020.253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Older persons with parkinsonism (PWP) are at high risk for hospitalization and adverse outcomes. Few effective strategies exist to prevent Emergency Department (ED) visits and hospitalization. The interdisciplinary Geriatrics Clinic for Parkinson's ("our clinic") was founded to address the complexity of parkinsonism in older patients, supported by a pharmacist-led telephone intervention (TI) service. Our primary objective was to study whether TI could avert ED visits in older PWP. METHODS Using a prospective, observational cohort, we collected data from all calls in 2016, including who initiated and reasons for the calls, patient demographics, number of comorbidities and medications, diagnoses, duration of disease, and intervention provided. Calls with intention to visit ED were classified as "crisis calls". Outcome of whether patients visited ED was collected within 1 week, and user satisfaction by anonymous survey within 3 weeks. RESULTS We received 337 calls concerning 114 patients, of which 82 (24%) were "crisis calls". Eighty-one percent of calls were initiated by caregivers. Ninety-three percent of "crisis calls" resolved without ED visit after TI. The main reasons for "crisis calls" were non-motor symptoms (NMS) (39%), adverse drug effects (ADE) (29%), and motor symptoms (18%). Ninety-seven percent of callers were satisfied with the TI. CONCLUSION Pharmacist-led TI in a Geriatrics Clinic for Parkinson's was effective in preventing ED visits in a population of older PWP, with high user satisfaction. Most calls were initiated by caregivers. Main reasons for crisis calls were NMS and ADE. These factors should be considered in care planning for older PWP.
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Giménez-Llort L, Castillo-Mariqueo L. PasoDoble, a Proposed Dance/Music for People With Parkinson's Disease and Their Caregivers. Front Neurol 2020; 11:567891. [PMID: 33281705 PMCID: PMC7688894 DOI: 10.3389/fneur.2020.567891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/02/2020] [Indexed: 12/31/2022] Open
Abstract
Managing the heterogeneity of Parkinson's disease symptoms and its progressive nature demands strategies targeting the hallmark disrupted neurotransmission but also the comorbid derangements and bolstering neuroprotection and regeneration. Strong efforts are done to find disease-modifying strategies, since slowing disease progression is not enough to hamper its burden and some motor symptoms are resistant to dopamine-replacement therapy. The inclusion of non-pharmacological strategies can provide such a multitarget umbrella approach. The silent long-term biological process that precedes the clinical onset of disease is a challenge but also an opportunity to reinforce healthy lifestyle known to exert preventive/therapeutic effects. These non-pharmacological strategies are foreseen as able to reduce the prevalence and the global impact of long-term diseases demanding strong management of patient-caregiver quality of life. In this regard, European guidelines for Parkinson's disease recommend physical-related activities such as aerobic exercise and dancing known to improve functional mobility and balance in patients. Here, we propose “PasoDoble,” a novel dance/music patient-caregiver intervention with additional preventive value. The rationale is founded on evidence-based therapeutic benefits of dance/music therapy and the singular features of this widely extended Hispanic dance/music targeting motor symptoms, mood/cognition, and socialization: (i) As a dance, an easy and simple double-step pattern (back-and-forward and lateral movements) that evolves from a spontaneous individual dance to a partnered dancing, performed in social groups and involving dancing-figures of increasing complexity; (ii) “PasoDoble,” as a music that can be sung, has musical rhythmicity with high groove and familiarity that will help to synchronize the steps to the rhythm of music; (iii) Widely extended (Spain, Mexico, Puerto Rico, Colombia, and USA) and easy-to-learn for others. As a regular dancing “PasoDoble” can improve and preserve function, mood and socialization, as an intervention the method is structured to improve gait and balance; facilitate movement, reaching and grasping; muscle power and joint mobility; reduce of risk of falls, and increase of aerobic capacity. Finally, this easy-to-implement into patient care and free-living environments (elderly social centers, home care) rehabilitation programs can promote positive emotions and self-esteem, with added general improvement of social attachment and recognition, thus improving the quality of life of patient-caregiver.
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Affiliation(s)
- Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lidia Castillo-Mariqueo
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Te Groen M, Bloem BR, Wu SS, Post B. Better quality of life and less caregiver strain in young-onset Parkinson's disease: a multicentre retrospective cohort study. J Neurol 2020; 268:1102-1109. [PMID: 33108538 PMCID: PMC7914232 DOI: 10.1007/s00415-020-10266-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is typically considered as a disease of the elderly. However, there is a sizeable subgroup of patients where PD starts at a younger age, known as young-onset PD (YOPD). We evaluated the differences in quality of life and caregiver strain between YOPD and later onset PD (LOPD) patients in a large cohort. METHODS In collaboration with the Parkinson Foundation Quality Improvement Initiative (PF-QII), we conducted a retrospective three-year analysis on 962 PD patients of the QII database (starting date May 2016). Of these, 272 patients had YOPD, and 690 had LOPD. The Parkinson's Disease Questionnaire-39 (PDQ-39) total score served as primary outcome measure. Furthermore, we analysed group differences in modified caregiver strain index (MCSI) total score, three cognition functions, and number of falls. A regression analysis adjusting for covariates was used to assess the association of age at onset with PDQ-39 and MCSI. RESULTS PDQ scores were better in YOPD patients, MCSI scores on social constraint were lower in YOPD patients, but scores on financial constraint were higher in this group. After adjusting for covariates, YOPD patients had better quality of life and less caregiver strain at all follow-up moments, but not at baseline. Decline over time for all outcomes was lower in the YOPD group compared to the LOPD group. Cognitive functioning and number of falls progressed slower in the YOPD group compared to the LOPD group. CONCLUSION Compared to LOPD patients, YOPD patients had a better quality of life, less caregiver strain, fewer falls and better cognitive functioning after their first follow-up visit, and also a slower decline over time.
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Affiliation(s)
- Maarten Te Groen
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands.
| | - Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | | | - Bart Post
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
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McKeown E, Saleem T, Magee C, Haddad M. The experiences of carers looking after people with Parkinson's disease who exhibit impulsive and compulsive behaviours: An exploratory qualitative study. J Clin Nurs 2020; 29:4623-4632. [PMID: 32956513 DOI: 10.1111/jocn.15499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
AIM To understand the experiences of carers who were confronted by the development of impulsive and compulsive behaviours. BACKGROUND Impulsive and compulsive behaviours (ICBs) are a serious complication in Parkinson's disease (PD) strongly associated with dopamine replacement therapy used to treat patients. These behaviours comprise abnormal activities such as pathological gambling, binge eating, compulsive shopping and hypersexuality. These behaviours place a considerable burden on patients and on their carers and families. DESIGN An exploratory qualitative study. METHODS Using a convenience sampling approach, 13 carers were recruited to participate in semi-structured interviews. Interviews were conducted over the telephone. Verbatim transcripts were analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. RESULTS Five main themes were identified: (a) realisation-developing awareness of ICB symptoms and their causes; (b) reacting-confronting and attempts to manage ICBs; (c) reaching out-help-seeking and selective disclosure; (d) reframing-shifting perspectives on ICBs over time; and (e) resignation-impact on relationships and facing the future. CONCLUSIONS The profound impact of ICBs on quality of life, relationships and economic stability was clear in the carers' accounts. Possible avenues for future clinical research are suggested. RELEVANCE TO CLINICAL PRACTICE The potentially devastating effects of ICBs provide a strong imperative for nurses and other health professionals to ensure that close monitoring for symptom development together with patient education is always part of practice.
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Affiliation(s)
- Eamonn McKeown
- School of Health Sciences, City, University of London, London, UK
| | | | - Cathy Magee
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Haddad
- School of Health Sciences, City, University of London, London, UK
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Ehlers C, Timpka J, Odin P, Honig H. Levodopa infusion in Parkinson's disease: Individual quality of life. Acta Neurol Scand 2020; 142:248-254. [PMID: 32383152 DOI: 10.1111/ane.13260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) features both motor and non-motor symptoms that substantially impact quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) reduces motor complications and improves some non-motor symptoms in advanced PD (APD). Change in patients' health-related quality of life (hrQoL) is a common endpoint in PD trials and has become an important factor in judging overall effect of LCIG. However, hrQoL is considered to be only one dimension of QoL. The primary aim of this prospective observational study was to observe the effects of LCIG on individual quality of life (iQoL) in PD and caregivers. The secondary aim was to investigate its effects on patients' motor and non-motor symptoms as well as effects on caregiver burden. MATERIALS & METHODS Utilizing the Schedule for the Evaluation of Individual Quality of Life-Questionnaire (SEIQoL-Q) and the Personal Wellbeing Index-Adult (PWI-A), twelve patients with advanced PD and their caregivers were followed for six months after initiation of LCIG treatment. RESULTS At the final follow-up, improvements of iQoL for patients (median SEIQoL index improvement 0.16, P < .05) and caregivers (median SEIQoL index improvement 0.20, P < .05) were seen together with improvements of motor and non-motor symptoms. There were no significant improvements of hrQoL. CONCLUSIONS The study results indicate that LCIG improves iQoL in PD in addition to the improvement of motor and non-motor symptoms. Furthermore, this study signals that LCIG may also contribute to improvement of iQoL in caregivers.
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Affiliation(s)
- Claas Ehlers
- Department of Neurology Hospital Bremerhaven Reinkenheide Bremerhaven Germany
| | - Jonathan Timpka
- Division of Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Neurology Skane University Hospital Lund Sweden
| | - Per Odin
- Division of Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Neurology Skane University Hospital Lund Sweden
| | - Holger Honig
- Department of Neurology Hospital Bremerhaven Reinkenheide Bremerhaven Germany
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Jackowiak E, Maher AC, Persad C, Kotagal V, Wyant K, Heston A, Patil PG, Chou KL. Caregiver burden worsens in the second year after subthalamic nucleus deep brain stimulation for Parkinson's disease. Parkinsonism Relat Disord 2020; 78:4-8. [PMID: 32659619 DOI: 10.1016/j.parkreldis.2020.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Caregiver burden (CB) in Parkinson's disease (PD) does not improve in the short term after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS), despite motor improvement. This may be due to increased caregiver demands after surgery or the possibility that DBS unresponsive non-motor factors, such as executive dysfunction, contribute to CB. OBJECTIVE To evaluate the trajectory of CB in year 2 following bilateral STN DBS surgery for PD, and to test whether post-operative CB changes correlate with changes in executive function in a subgroup with available neuropsychological testing. METHODS This retrospective analysis included 35 patients with PD whose caregivers completed the Caregiver Burden Inventory (CBI) at baseline and between 9 and 24 months after bilateral STN DBS. 14 of these patients had neuropsychological testing both at baseline and within 6 months of their follow up CBI assessment. RESULTS CBI scores showed worsened CB from baseline to follow-up (16.4-21.5, p = 0.006). There was no correlation between change in executive function and change in CBI in the smaller subsample. CONCLUSION CB worsens in the 2 years after bilateral STN DBS despite improvement in motor symptoms and is not associated with change in executive dysfunction in the setting of advancing PD. These findings have implications on pre-operative counselling for patients and caregivers considering DBS for PD.
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Affiliation(s)
- Eric Jackowiak
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Cook Maher
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Carol Persad
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kara Wyant
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA
| | - Amelia Heston
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA.
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Ransmayr G. Belastungen in der Betreuung von Parkinson-Patientinnen und - Patienten. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:567-572. [DOI: 10.1055/a-1120-8567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ZusammenfassungPatientinnen und Patienten (Pat.) mit Parkinson-Krankheit bedürfen mit zunehmender Krankheitsdauer und Schweregrad persönlicher Betreuung, die meist von weiblichen Angehörigen gewährleistet wird. Die Belastungen für pflegende Angehörige resultieren einerseits aus den motorischen Beeinträchtigungen der Pat., andererseits von neurokognitiven und neuropsychiatrischen Symptomen sowie Verhaltensstörungen, Störungen des autonomen Nervensystems, der Miktion, des Schlafes und der Selbstständigkeit. Gesundheitliche Probleme der Betreuungsperson, u. a. Depression und Angst, emotionale Probleme mit dem Pflegling, Beeinträchtigung des Schlafs, sowie Einschränkungen in persönlichen Anliegen, Beruf, Familie, Freizeitgestaltung, sozialen Aktivitäten, finanzielle Einbußen und mangelhafte soziale Unterstützung stellen weitere Belastungsfaktoren dar. Personen mit dem Risiko einer erheblichen Betreuungsbelastung sind frühzeitig zu identifizieren, um ihnen Informationen über die Krankheit und Unterstützungsmöglichkeiten sowie entsprechende personelle, psychologische und finanzielle Unterstützung zukommen zu lassen.
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Tan SB, Williams AF, Tan EK, Clark RB, Morris ME. Parkinson's Disease Caregiver Strain in Singapore. Front Neurol 2020; 11:455. [PMID: 32714260 PMCID: PMC7344200 DOI: 10.3389/fneur.2020.00455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/28/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Caregiver strain is recognized globally with Parkinson's disease (PD). Comparatively little is understood about caregiver burden and strain in Asia. Objective: To investigate caregiver strain for families living with PD in Singapore, in light of international data. Methods: Ninety-four caregivers were recruited via people living with idiopathic PD in Singapore. Caregiver strain was assessed using the Zarit Burden Interview (ZBI); health status was assessing using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). PD disability measures were the Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn and Yahr (1967) Scale. Results: Primary caregivers of people living with PD in Singapore were mostly cohabiting spouses, partners or offspring. Around half employed foreign domestic helpers. Mean caregiving duration was 5.9 years with an average of eight hours per day spent in caregiving roles. Most care providers were comparatively healthy. Caregivers reported significant levels of strain which increased with greater level of disability (r = 0.36, n = 94, p < 0.001). Associations were significant between caregiver strain and scores on the UPDRS mentation, behavior, and mood subscales [r = 0.46, n = 94, p < 0.001, 95% CI (0.28, 0.60)]. High scores on the UPDRS activities of daily living subscale were associated with caregiver strain [r = 0.50, n = 94, p < 0.001, CI (0.33, 0.64)]. Conclusion: Most caregivers in this Singapore sample reported high levels of strain, despite comparatively good physical function. Caregiver strain in PD spans geopolitical and cultural boundaries and correlates with disease severity. These results support the need for better early recognition, education, and support for caregivers of people living with PD.
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Affiliation(s)
- Siok-Bee Tan
- Nursing Division, Singapore General Hospital, Singapore, Singapore
| | - Allison F Williams
- School Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Richard B Clark
- Victorian Rehabilitation Centre, Healthscope ARCH and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Melbourne, VIC, Australia
| | - Meg E Morris
- Victorian Rehabilitation Centre, Healthscope ARCH and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Melbourne, VIC, Australia
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Neuropsychiatric symptoms in Parkinson's disease: association with caregiver distress and disease severity. Int Psychogeriatr 2020; 32:733-739. [PMID: 31647049 DOI: 10.1017/s1041610219001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The condition of caregivers is important to the quality of care received by people with Parkinson's disease (PD), especially at the late disease stages. This study addresses the distress placed on caregivers by participants' neuropsychiatric symptoms at different stages of PD in Taiwan. METHODS This prospective study enrolled 108 people with PD. All participants were examined with the Unified Parkinson's Disease Rating Scale (UPDRS), Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), and Clinical Dementia Rating (CDR) scale. Caregiver distress was measured using the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). Statistical analysis was used to explore the PD-related factors that contribute to caregiver distress. RESULTS The mean follow-up interval in the 108 PD participants were 24.0 ± 10.2 months with no participant lost to follow-up due to death. NPI-distress (the sum of NPI caregiver distress scale across the 12 domains of the NPI) was positively correlated with NPI-sum (the total score across the 12 domains of the NPI) (r = 0.787, p < 0.001), CDR (r = 0.403, p < 0.001), UPRDS (r = 0.276, p = 0.004), and disease duration (r = 0.246, p = 0.002), but negatively correlated with CASI (r = -0.237, p = 0.043) and MMSE (r = -0.281, p < 0.001). Multiple linear regression analysis showed that only NPI-sum and disease duration were independently correlated with NPI-distress. CONCLUSION The disease duration and NPI-sum are independent predictors of caregiver distress in Taiwanese populations with PD. Early detection and reduction of neuropsychiatric symptoms in people with PD can help decrease caregiver distress.
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Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson's Disease Patients. PARKINSONS DISEASE 2020; 2020:5184084. [PMID: 32184980 PMCID: PMC7060449 DOI: 10.1155/2020/5184084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
Parkinson's disease (PD) is a chronic progressive movement disorder with severe reduction in patients' health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients' HR-QoL. However, the relationship of these symptoms to caregiver burden is relatively unclear. Influence of the Montreal Cognitive Assessment scale (MoCA) as a cognitive screening tool and Movement Disorders Society Unified Parkinson's disease Rating Scale MDS-UPDRS symptoms in relation to patients' HR-QoL and caregivers` burden was analyzed. PD patients (n = 124) completed MDS-UPDRS, MoCA, and the PD questionnaire 8 (PDQ-8) as a measure of quality of life. Caregivers (n = 78) were assessed by the PD caregiver burden inventory (PDCB). PDQ-8 and PDCB scores were regressed on MDS-UPDRS subscales and MoCA subscores. PDQ-8 correlated with attention (R2 0.1282; p < 0.001) and executive (R2 0.0882; p 0.001) MoCA subscores and all parts of the MDS-UPDRS. PDCB correlated most strongly with MDS-UPDRS part III motor symptoms (R2 0.2070; p < 0.001) and the MoCA attention subscore (R2 0.1815; p < 0.001). While all facets of PD symptoms assessed by the MDS-UPDRS relate to PD patients' quality of life, motor symptoms are the most relevant factor for the prediction of caregiver burden. In addition, patients' attentional symptoms seem to affect not only them, but also their caregivers. These findings show the potential of a detailed analysis of MDS-UPDRS and MoCA performance in PD patients.
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Klietz M, Drexel SC, Schnur T, Lange F, Groh A, Paracka L, Greten S, Dressler D, Höglinger GU, Wegner F. Mindfulness and Psychological Flexibility are Inversely Associated with Caregiver Burden in Parkinson's Disease. Brain Sci 2020; 10:E111. [PMID: 32093188 PMCID: PMC7071391 DOI: 10.3390/brainsci10020111] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative movement disorder with progressive impairments in activities of daily living. With disease progression, people with PD (PwP) need more help and care from their spouses or professional caregivers. Identifying factors that help caregivers to cope with their burden is needed to frame future interventions for PwP caregivers. Mindfulness and psychological flexibility might be factors contributing to resilience against the burden of giving care. In this cross-sectional questionnaire-based study, 118 PwP and their respective primary caregivers were included. Caregivers reported moderate burden and only mild depressive symptoms. Mindfulness measured by the Mindfulness Attention and Awareness scale (p 0.003) and psychological flexibility measured by Acceptance and Actions Questionnaire II (p0.001) correlated negatively with caregiver burden. Data from this study indicate mindfulness and psychological flexibility are factors contributing to resilience against caregiver burden. Future interventions to reduce burden in PwP caregivers might be improved by the inclusion of mindfulness training programs.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Simon C Drexel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Theresa Schnur
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Lange
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000 Leuven, Belgium
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School,Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Lejla Paracka
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stephan Greten
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Dirk Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Günter U Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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40
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Vatter S, Stanmore E, Clare L, McDonald KR, McCormick SA, Leroi I. Care Burden and Mental Ill Health in Spouses of People With Parkinson Disease Dementia and Lewy Body Dementia. J Geriatr Psychiatry Neurol 2020; 33:3-14. [PMID: 31146617 DOI: 10.1177/0891988719853043] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To explore and compare levels of mental health, care burden, and relationship satisfaction among caregiving spouses of people with mild cognitive impairment or dementia in Parkinson disease (PD-MCI or PDD) or dementia with Lewy bodies (DLB). METHODS Spouses (n = 136) completed measures of mood, stress, resilience, general health, quality of life, care burden, and relationship satisfaction, as well as sociodemographic factors. Additionally, data on motor and neuropsychiatric symptom severity of people with PD-MCI, PDD, or DLB were obtained in a subsample. RESULTS Most spouses were married women (>85%) who provided a median of 4 years of care and 84 hours of weekly care. Among these, relationship dissatisfaction, stress, anxiety, care burden, and feelings of resentment were common. Spouses of people with PDD and DLB had significantly higher rates of burden, resentment, and depression compared to spouses of people with PD-MCI. Furthermore, unique group differences emerged whereby spouses of people with PDD had significantly longer duration of care provision, higher stress, more relationship dissatisfaction, and fewer positive interactions, compared to PD-MCI group, whereas anxiety and lower levels of mental health were prominent in spouses of people with DLB, compared to PD-MCI group. Despite this, the majority of spouses reported good quality of life, resilience, and satisfaction with the caring role. CONCLUSION Both PDD and DLB significantly contribute to poorer mental health and higher levels of care burden in spouses. Clinicians should actively screen the risk of burden, stress, depression, and anxiety among caregiving spouses of people with these conditions.
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Affiliation(s)
- Sabina Vatter
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Emma Stanmore
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, United Kingdom
| | - Kathryn R McDonald
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Sheree A McCormick
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Modugno N, Antonini A, Tessitore A, Marano P, Pontieri FE, Tambasco N, Canesi M, Fabbrini G, Sensi M, Quatrale R, Solla P, Defazio G, Melzi G, Gualberti G, Lopiano L. Impact of Supporting People with Advanced Parkinson's Disease on Carer's Quality of Life and Burden. Neuropsychiatr Dis Treat 2020; 16:2899-2912. [PMID: 33293815 PMCID: PMC7719333 DOI: 10.2147/ndt.s256217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess the burden and the quality of life (QoL) perceived by caregivers assisting advanced Parkinson's disease (PD) patients. PATIENTS AND METHODS Consecutive advanced PD patients treated with levodopa/carbidopa intestinal gel (LCIG) or continuous subcutaneous apomorphine infusion (CSAI) or care as usual (CU) and their care partners were recruited during routine visits according to a cross-sectional design. Caregiver's distress was assessed by Zarit Burden Interview (ZBI) and a QoL survey to evaluate and understand the burden experienced by care partners during family and working activities. RESULTS A total of 126 patients (53 LCIG, 19 CSAI and 54 CU) and their care partners were enrolled. The ZBI score boxplot showed that LCIG and CU populations have a similar distribution (ZBI inter-quartile range [IQR] values respectively 18-42 for LCIG and 19-43 for CU group), while the CSAI group has a wider score range (IQR 16-52). Caregivers assisting patients in treatment with LCIG have more time to perform family or household duties (p=0.0022), or to engage in leisure activities (p=0.0073) compared to CU, while no difference was found when compared to CSAI group. Approximately 50% of the care partners showed mood changes in the last 6 months and LCIG and CSAI had less impact on caregiver's mood compared to CU. Patients treated with LCIG were more independent in taking a bath or shower without assistance and were more able to move and walk without assistance. CONCLUSION Care partners of advanced PD patients treated with device-aided therapies have more time for their own life and a better perception of their QoL with a tendency to an improvement of mood compared with those of patients treated with CU.
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Affiliation(s)
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandro Tessitore
- Department of Medical and Surgery Sciences, University of Campania, "Luigi Vanvitelli", Naples, Italy
| | - Pietro Marano
- Casa di Cura Madonna del Rosario, Raggruppamento di Riabilitazione, Catania, Italy
| | - Francesco Ernesto Pontieri
- Department NESMOS, "Sapienza" University, Sant'Andrea Hospital, Roma, Italy.,IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Nicola Tambasco
- Department of Neurology, Perugia General Hospital and University of Perugia, Perugia, Italy
| | - Margherita Canesi
- Dipartimento di Riabilitazione Malattia di Parkinson e Disordini del Movimento, Gravi Cerebrolesioni Acquisite, Italia Hospital - Ospedale "Moriggia-Pelascini", Gravedona ed Uniti, Como, Italy.,Centro Parkinson e Disordini del Movimento, CTO, G Pini, Milano, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | | | - Paolo Solla
- Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy
| | - Giovanni Defazio
- Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy
| | | | | | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini" University of Torino, Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
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42
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Perrin PB, Henry RS, Donovan EK, Cariello AN, Lageman SK, Villaseñor T, Dzierzewski JM, Arroyo M, Avila J. Parkinson's family needs and caregiver mental health: A cross-cultural comparison between Mexico and the United States. NeuroRehabilitation 2019; 45:433-442. [PMID: 31868689 DOI: 10.3233/nre-192894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Given the growing population of individuals with Parkinson's disease (PD) worldwide and the growing need for family members to take on a caregiving role, it is critical that cross-cultural differences be examined in order to better meet the needs of PD caregivers. The purpose of this study was to examine the connections between the unmet needs and mental health of PD caregivers differentially in Mexico and the United States. METHODS In Parkinson's clinics at public, academic medical centers, PD caregivers from Mexico (n = 148) and the United States (n = 105) completed measures of unmet family needs and mental health. RESULTS Caregivers in the United States had higher unmet needs for emotional support and for a community support network than caregivers in Mexico, although caregivers at the two sites had comparable levels of anxiety and depression. Unmet family needs explained 29.5% of the variance in caregiver anxiety in the United States (p < 0.001) but only 5.7% in Mexico (p = 0.209). Unmet family needs explained 30.4% of the variance in caregiver depression in the United States (p < 0.001) and 14.0% in Mexico (p = 0.001). In the United States, unmet needs for emotional support and for instrumental support uniquely predicted caregiver anxiety and depression, and in Mexico only the unmet need for instrumental support was a unique predictor. CONCLUSIONS PD caregivers in the United States are at increased risk for poor emotional and community support, and these unmet needs channel directly into caregiver anxiety and depression. In Mexico, where caregivers have stronger emotional and community support, caregivers' unmet need for instrumental support generates anxiety and depression. Important targets for PD caregiver interventions may differ between Mexico and the United States.
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Affiliation(s)
- Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard S Henry
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Emily K Donovan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Annahir N Cariello
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah K Lageman
- Department of Neurology, Parkinson's & Movement Disorders Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico
| | | | - Monica Arroyo
- Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico
| | - Judith Avila
- Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico
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43
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Smith ER, Perrin PB, Tyler CM, Lageman SK, Villaseñor T. Parkinson's Symptoms and Caregiver Burden and Mental Health: A Cross-Cultural Mediational Model. Behav Neurol 2019; 2019:1396572. [PMID: 31871491 PMCID: PMC6913294 DOI: 10.1155/2019/1396572] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/15/2019] [Accepted: 11/06/2019] [Indexed: 12/26/2022] Open
Abstract
Informal caregivers are critical in the care of individuals with Parkinson's disease (PD) and spend substantial time providing care, which may be associated with negative caregiver outcomes such as burden and mental health issues. Although research in the United States and Europe has generally supported these relations, there is very limited research on PD caregiving in Latin America. The current study examined the following connections in a sample of PD caregivers from the United States (N = 105) and Mexico (N = 148): (a) PD-related impairments (motor and nonmotor symptoms) and caregiver burden, (b) caregiver burden and caregiver mental health, and (c) PD-related impairments and mental health through caregiver burden. Study results uncovered significant relations among PD-related impairments, caregiver burden, and caregiver mental health. Further, caregiver burden fully mediated the relation between PD-related impairments and caregiver mental health at both study sites. Findings highlight a number of important intervention targets for caregivers and families, including caregiver burden and mental health.
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Affiliation(s)
- Erin R. Smith
- Department of Psychology, Virginia Commonwealth University, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, USA
| | - Carmen M. Tyler
- Department of Psychology, Virginia Commonwealth University, USA
| | - Sarah K. Lageman
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, USA
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, Mexico
- Department of Neurosciences, University of Guadalajara, Mexico
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Establishing Predictive Criterion Validity of the Parkinson's Disease Caregiver Strain Risk Screen-10. J Nurs Meas 2019; 27:E170-E182. [PMID: 31871295 DOI: 10.1891/1061-3749.27.3.e170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Studies reveal that caring for persons with Parkinson's disease affects informal caregivers psychologically and physically, yielding negative impacts on caregiving abilities. The purpose was to establish predictive criterion validity of the Caregiver Strain Risk Screen-10 (CSRS-10), a tool designed to monitor risk for strain in informal caregivers of persons with Parkinson's disease. METHODS Caregivers (N = 137) of persons with Parkinson's disease completed surveys that included CSRS-10 and Pennebaker Inventory of Limbic Languidness, to measure strain risk and frequency of physical health symptoms, respectively. RESULTS Hierarchical regression indicated that higher CSRS-10 scores were predictive of greater frequency of physical health symptoms in caregivers. CONCLUSIONS The study established predictive criterion validity of CSRS-10, further demonstrating it as an effective evidence-based tool for assessing risk for strain in this informal caregiver population.
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Validating the Parkinson's disease caregiver burden questionnaire (PDCB) in German caregivers of advanced Parkinson's disease patients. Int Psychogeriatr 2019; 31:1791-1800. [PMID: 30907331 DOI: 10.1017/s1041610219000206] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Advanced Parkinson's disease (PD) may place a high burden on patients and their caregivers. Understanding the determinants of caregiver burden is of critical importance. This understanding requires the availability of adequate assessment tools. Recently, the Parkinson's disease caregiver burden questionnaire (PDCB) has been developed as a PD-specific measure of caregiver burden. However, the PDCB has only been evaluated in a sample of Australian caregivers of patients at a less advanced stage of the disease. OBJECTIVE We tested whether a German translation of the PDCB qualifies as an adequate measure of caregiver burden in a German sample of caregivers of advanced patients with PD. METHODS We collected PDCB data from 65 caregivers of advanced patients with PD. Reliability of the scale was assessed and compared against the original version. To validate the German version of the PDCB, we examined the correlations with the caregiver burden inventory (CBI), the short form 36 health survey (SF-36), the Parkinson's disease quality of life questionnaire 39 (PDQ-39), disease duration, and the amount of caregiving time. RESULTS The total PDCB score proved to be reliable and to be significantly related to CBI and SF-36 scores. PDCB scores also increased with increasing amounts of caregiving time. CONCLUSIONS The German version of the PDCB appears to be an adequate measure of caregiver burden in caregivers of advanced PD patients.
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Di Stasio E, Di Simone E, Galeti A, Donati D, Guidotti C, Tartaglini D, Chiarini M, Marano M, Di Muzio M, Cianfrocca C. Stress-related vulnerability and usefulness of healthcare education in Parkinson's disease: The perception of a group of family caregivers, a cross-sectional study. Appl Nurs Res 2019; 51:151186. [PMID: 31635885 DOI: 10.1016/j.apnr.2019.151186] [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: 05/12/2019] [Revised: 08/07/2019] [Accepted: 09/02/2019] [Indexed: 12/13/2022]
Abstract
Parkinson's Disease is associated with a high assistive complexity, thus generating in caregivers a burden proportional to the intensity of the care provided. This study aims to evaluate whether the stress-related level of caregivers is related to their perception of the need for healthcare education. A cross-sectional study was conducted on 69 family caregivers that completed the Stress-related Vulnerability Scale (SVS scale) with a tool of proposed interventions stratified according to caregivers' need as "nothing", "somewhat", "moderately" and "extremely". A direct association between the SVS scale and the perception of the usefulness of interventions was detected, and significant differences were observed for "Caregivers tele-support group" and "Peer-led support group" interventions, thus suggesting an important role for caregivers' emotional status in considering of training courses. Caregivers are split between low vulnerability, with minimal perception of training need, and high burden state with the acute necessity of support to manage patients.
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Affiliation(s)
- Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Di Simone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Daniele Donati
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | | | - Massimiliano Chiarini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Massimo Marano
- Unit of Neurology, Neurophysiology, Department of Medicine, University Campus Bio-Medico of Rome, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Claudia Cianfrocca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy.
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Huang Y, Mao B, Ni P, Shou Y, Ye J, Hou L, Xie T. Investigation on the Status and Determinants of Caregiver Burden on Caring for Patients with Chronic Wound. Adv Wound Care (New Rochelle) 2019; 8:429-437. [PMID: 31440420 DOI: 10.1089/wound.2018.0873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/02/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: To investigate the caring burden and its determinants of primary informal caregiver of patients with chronic wound. Approach: A prospective cross-sectional study of 132 pairs of chronic wound care recipients and their informal caregivers was included. The characteristics of patients and their informal caregivers as well as caregiver burden assessment by the caregiver burden inventory (CBI) were measured. Single factor analysis and multiple regression analysis were carried out to explore the independent determinants of caregiver burden on caring for patients with chronic wound. Results: Most of the caregivers were female with mean age of 54.57 ± 13.35 years, and 58.3% of the caregivers were adult children. The mean CBI score was 34.21 ± 9.69 at a medium level. The following variables increased the CBI scores of caregivers: long caring time per day for patients, powerlessness status of patients, insufficient self-efficacy, and social support of caregivers, the model was able to explain 67.5% of variance in caregiver burden (F = 47.167, p = 0.000, R 2 = 0.675, adjusted R 2 = 0.660). Innovation: Caring burden of patients with chronic wound as a key consideration of patient-centered wound care has received relatively little attention. In this study we report the status of caring burden and reveal its determinants of primary informal caregiver of patients with chronic wound. Conclusion: Wound professionals are suggested to pay attention to the caregiver burden of patients with chronic wound and develop family-centered intervention support service system according to the determinants of caregiver burden to alleviate the caregiver burden.
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Affiliation(s)
- Yao Huang
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - BeiQian Mao
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - PengWen Ni
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YuYan Shou
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - JunNa Ye
- Department of Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Nursing Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Xie
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee GB, Woo H, Lee SY, Cheon SM, Kim JW. The burden of care and the understanding of disease in Parkinson's disease. PLoS One 2019; 14:e0217581. [PMID: 31150470 PMCID: PMC6544353 DOI: 10.1371/journal.pone.0217581] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background and objective Education of disease plays an important role in management of Parkinson's disease (PD). However, little is known about the link between the understanding of disease and the burden of care. This study was carried out to find the correlation between the burden of care and the understanding of disease in caregivers for PD patients. Methods Non-demented patients with PD and their caregivers participated in structured interviews. Understanding of patients and caregivers was evaluated through newly-devised questions. The caregiver burden inventory was used to assess the burden of care. Results A total of 142 pairs of patients and their caregivers were recruited. A correlation analysis showed that the burden of care was positively associated with low understanding of the disease by the caregiver. Daily care time and female patients were revealed to be independently associated with the burden of care through a multivariate analysis. Further analyses were performed in the caregiver group according to relationship with patients. The spouse group showed an increased burden of care and poor understanding compared to the offspring group. A multivariate analysis revealed that daily care time and understanding were independent predictors for the burden of care in the spouse group. There was no significant association in the offspring group. Conclusion The burden of care was associated with higher daily caregiving time and female gender of the patient, and was significantly increased in the spouse of the patient. In the spouse group, better understanding of the caregiver correlated with less burden of care.
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Affiliation(s)
- Geum-Bong Lee
- Department of Neurology, School of Medicine, Dong-A University, Busan, Korea
| | - Hyunhee Woo
- Department of Nursing, Dongju College, Busan, Korea
| | - Su-Yoon Lee
- Department of Neurology, Pohang S Hospital, Pohang, Korea
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Busan, Korea
- * E-mail:
| | - Jae Woo Kim
- Department of Neurology, School of Medicine, Dong-A University, Busan, Korea
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Hermanowicz N, Jones SA, Hauser RA. Impact of non-motor symptoms in Parkinson's disease: a PMDAlliance survey. Neuropsychiatr Dis Treat 2019; 15:2205-2212. [PMID: 31496703 PMCID: PMC6689087 DOI: 10.2147/ndt.s213917] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Parkinson's disease (PD) is associated with non-motor symptoms (NMS) that can cause progressive disability and impact quality of life of people with PD (PwP) and increase burden on care partners. This survey was designed to evaluate the prevalence, impact, and educational preferences regarding NMS on PwP and their care partners. PATIENTS AND METHODS A 17-question survey was sent to the total membership of PMDAlliance, a nonprofit organization reaching 3,685 households of PwP. Care partners and other interested individuals could also respond. The survey was conducted using Survey Monkey, an online survey platform, and included distinct questions for respondents with and without NMS. RESULTS A total of 700 individuals responded to the survey. Of the respondents, 378 (54%) were care partners and 287 (41%) were PwP. About 90% of the respondents reported having experience with NMS in PwP, including sleep problems (84%), cognitive symptoms (76%), anxiety (65%), depression (56%), hallucinations (40%), and delusions (23%). NMS in PwP were reported by more care partners (97%) than PwP (80%). NMS had at least some impact on quality of life for 84% of the respondents; 48% indicated that NMS represented a greater challenge than motor symptoms. Care partners were more likely than PwP to report that NMS were more challenging than motor symptoms (58% vs 32%). Respondents with and without NMS indicated a desire for NMS education. CONCLUSION This survey underscores the significant impact of NMS on the quality of life of PwP and highlights the need for improved recognition and education about its effects.
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Affiliation(s)
- Neal Hermanowicz
- Department of Neurology, Parkinson's Disease and Movement Disorders Program, University of California, Irvine, CA, USA
| | - Sarah A Jones
- Parkinson and Movement Disorder Alliance (PMDalliance) , Tucson, AZ, USA
| | - Robert A Hauser
- Department of Neurology, USF Health Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, Tampa, FL, USA
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Vatter S, McDonald KR, Stanmore E, Clare L, Leroi I. Multidimensional Care Burden in Parkinson-Related Dementia. J Geriatr Psychiatry Neurol 2018; 31:319-328. [PMID: 30244631 DOI: 10.1177/0891988718802104] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Providing care to people with Parkinson-related dementia (PwPRD) may result in significant stress, strain, and burden for life partners. A common measurement of life partner burden is the Zarit Burden Interview (ZBI), which considers "burden" as a unitary concept; however, burden is highly complex and most likely comprises several dimensions. This study aimed to explore the factor structure of the ZBI in life partners of PwPRD and to examine the relationships among the emerging factors and the demographic and clinical features. METHODS Life partners of PwPRD participated in home-based quantitative assessments and self-completed postal questionnaires. The assessment battery included ZBI, measures of relationship satisfaction, mood, stress, resilience, health, quality of life, feelings related to care provision, and sociodemographic questions. Data on PwPRDs' motor and neuropsychiatric symptom severity were also elicited in home-based assessments. RESULTS An exploratory factor analysis (principal axis factoring) of ZBI, conducted with 127 life partners, revealed five burden dimensions: social and psychological constraints, personal strain, interference with personal life, concerns about future, and guilt. These burden factors were associated with lower relationship satisfaction, mental health, and resilience, and higher stress, anxiety, depression, resentment, negative strain, and PwPRD motor severity. In multiple linear regression analyses, where each factor score was the dependent variable, stress, negative strain, and resentment emerged as significant predictors of specific burden dimensions. CONCLUSIONS Burden is a complex and multidimensional construct. Interventions should address specific types of burden among life partners of PwPRD to support couples' relationships and maintain quality of life.
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Affiliation(s)
- Sabina Vatter
- 1 Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,2 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kathryn R McDonald
- 1 Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Emma Stanmore
- 3 Faculty of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Linda Clare
- 4 Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, United Kingdom
| | - Iracema Leroi
- 1 Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,2 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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