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Micalos PS, Logan PA, Bramble M, Wong A. Prevalence and factors associated with mental health status in Parkinson's disease: Data from the 45 and Up Study. Aust J Rural Health 2024. [PMID: 38680061 DOI: 10.1111/ajr.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/12/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression. OBJECTIVE The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD. DESIGN This retrospective data linkage study analysed a subset of data from the Sax Institute's 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute's Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors. FINDINGS A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality. DISCUSSION Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship. CONCLUSION Further research is required on the longitudinal impact of these associations on mental health in PD.
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Affiliation(s)
- Peter S Micalos
- School of Dentistry and Medical Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Patricia A Logan
- School of Dentistry and Medical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Marguerite Bramble
- School of Nursing, Paramedicine and Healthcare Services, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Alfred Wong
- School of Business, Charles Sturt University, Bathurst, New South Wales, Australia
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Colón-Semenza C, Zajac JA, Schwartz A, Darbandsari P, Ellis TD. Experiences from the implementation of physical therapy via telehealth for individuals with Parkinson disease during the COVID-19 pandemic. Disabil Rehabil 2024; 46:1593-1601. [PMID: 37088939 DOI: 10.1080/09638288.2023.2202418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To (1) determine the characteristics and participation rate of adults with Parkinson disease (PD) in physical therapy (PT) delivered via telehealth, (2) identify the outcome measures and interventions implemented, (3) determine the safety of and (4) patient and therapist satisfaction with PT via telehealth in a clinic specializing in the care of people with PD during the coronavirus pandemic. MATERIALS & METHODS A retrospective analysis of PT services via telehealth was conducted. Participating patients completed a satisfaction survey. Physical therapists (PTs) who delivered this care were interviewed. Three coders conducted thematic analysis of interviews. Descriptive statistics described the participation rate, demographics, outcome measures, interventions, and safety. RESULTS There was a 71.4% participation rate. Participants (n = 55) were white (96%), non-Hispanic (100%), older adult (mean = 69.5 years (8.3)) males (65.5%). Non-participants (n = 22) had similar demographics. Therapists selected patient-reported measures more often than performance-based measures. Therapeutic exercise was the most common intervention. All patients (80% response rate) reported satisfaction with their experience. PTs reported the home enhanced specificity of training but impeded evaluation. Therapists endorsed a hybrid model for future practice. CONCLUSIONS Patients reported satisfaction with PT via telehealth during the pandemic. A hybrid model may support optimal delivery of PT.IMPLICATIONS FOR REHABILITATIONPhysical therapy via telehealth for patients with Parkinson disease was acceptable to patients and physical therapists in our study.Physical therapy via telehealth was safe for people with Parkinson disease in our study, although availability and benefits may not be reaching all populations equitably.Both physical therapists and patients endorse a hybrid model of care (a combination of in-person and remote assessment and treatment) to profit from the strengths of in-person and virtual formats while minimizing barriers to access.
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Affiliation(s)
- C Colón-Semenza
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - J A Zajac
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - A Schwartz
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - P Darbandsari
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - T D Ellis
- Department of Physical Therapy, Boston University, Boston, MA, USA
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Di Luca DG, Luo S, Liu H, Cohn M, Davis TL, Ramirez-Zamora A, Rafferty M, Dahodwala N, Naito A, Neault M, Beck J, Marras C. Racial and Ethnic Differences in Health-Related Quality of Life for Individuals With Parkinson Disease Across Centers of Excellence. Neurology 2023; 100:e2170-e2181. [PMID: 37019661 PMCID: PMC10238163 DOI: 10.1212/wnl.0000000000207247] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/16/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Racial and ethnic minorities have been underrepresented in Parkinson disease (PD) research, limiting our understanding of treatments and outcomes across all non-White groups. The goal of this research is to investigate variability in health-related quality of life (HRQoL) and other outcomes in patients with PD across different races and ethnicities. METHODS This was a retrospective, cross-sectional and longitudinal, cohort study of individuals evaluated at PD Centers of Excellence. A multivariable regression analysis adjusted for sex, age, disease duration, Hoehn and Yahr (H&Y) stage, comorbidities, and cognitive score was used to investigate differences between racial and ethnic groups. A multivariable regression with skewed-t errors was performed to assess the individual contribution of each variable to the association of 39-item PD Questionnaire (PDQ-39) with race and ethnicity. RESULTS A total of 8,514 participants had at least 1 recorded visit. Most of them (90.2%) self-identified as White (n = 7,687), followed by 5.81% Hispanic (n = 495), 2% Asians (n = 170), and 1.9% African American (n = 162). After adjustment, total PDQ-39 scores were significantly higher (worse) in African Americans (28.56), Hispanics (26.62), and Asians (25.43) when compared with those in White patients (22.73, p < 0.001). This difference was also significant in most PDQ-39 subscales. In the longitudinal analysis, the inclusion of cognitive scores significantly decreased the strength of association of the PDQ-39 and race/ethnicity for minority groups. A mediation analysis demonstrated that cognition partially mediated the association between race/ethnicity and PDQ-39 scores (proportion mediated 0.251, p < 0.001). DISCUSSION There were differences in PD outcomes across racial and ethnic groups, even after adjustment for sex, disease duration, HY stage, age, and some comorbid conditions. Most notably, there was worse HRQoL among non-White patients when compared with White patients, which was partially explained by cognitive scores. The underlying reason for these differences needs to be a focus of future research.
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Affiliation(s)
- Daniel Garbin Di Luca
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Sheng Luo
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Hongliang Liu
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Melanie Cohn
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Thomas L Davis
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Adoldo Ramirez-Zamora
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Miriam Rafferty
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Nabila Dahodwala
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Anna Naito
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Marilyn Neault
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - James Beck
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Connie Marras
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY.
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Aamodt WW, Willis AW, Dahodwala N. Racial and Ethnic Disparities in Parkinson Disease: A Call to Action. Neurol Clin Pract 2023; 13:e200138. [PMID: 37064587 PMCID: PMC10101714 DOI: 10.1212/cpj.0000000000200138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/01/2022] [Indexed: 03/18/2023]
Abstract
Health disparities are pervasive in the United States. In the field of Parkinson disease (PD), profound racial and ethnic disparities exist in diagnosis, treatment, and research participation, leading to differential health outcomes and lack of generalizable research data. Racial and ethnic disparities not only limit our understanding of this complex heterogeneous disorder but also hamper our ability to provide new evidence-based care for America's most vulnerable populations. In this report, we summarize findings from our comprehensive white paper for the Michael J. Fox Foundation that reviews the current state of knowledge on racial and ethnic disparities in PD care in the following areas: epidemiology, etiology, phenotype and diagnosis, treatment, and research. We also identify knowledge gaps and necessary policy changes to ensure equitable, high-value care for all persons with PD. These strategies are designed to help identify and reduce health disparities among persons with PD and may serve as a model for other neurologic diseases.
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Affiliation(s)
- Whitley W Aamodt
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
| | - Allison W Willis
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
| | - Nabila Dahodwala
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
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Watanabe G, Morden FTC, Gao F, Morita M, Bruno MK. Utilization and gender disparities of Deep Brain Stimulation surgery amongst Asian Americans, Native Hawaiians, and Other Pacific Islanders with Parkinson's disease in Hawai`i. Clin Neurol Neurosurg 2022; 222:107466. [PMID: 36209519 DOI: 10.1016/j.clineuro.2022.107466] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite its efficacy in Parkinson's disease (PD) management, Deep Brain Stimulation (DBS) is underutilized in sociodemographic minorities. Previous investigations of racial disparities in PD aggregated Asian American (AA) and Native Hawaiian or other Pacific Islander (NHPI) populations into a single category; however, these groups have significant health differences. We sought to characterize the PD population in Hawai`i and the use of DBS among AA subgroups and NHPI patients to elucidate potential sociodemographic and clinical disparities. METHODS Retrospective chart review of PD patients who received DBS from 2002 to 2021 was conducted at The Queen's Medical Center on Oahu, Hawai`i. Hawai`i PD admissions from 2016 to 2020 were collected from Laulima Data Alliance database. We compared the characteristics of DBS patients, total PD admissions, and Hawai`i census data. Alpha level of < 0.05 determined statistical significance. We did a subgroup analysis of white, AA and NHPI subgroups within the patients who underwent DBS. RESULTS Analysis included 4215 PD admissions and 74 DBS surgeries. Compared to census data, Whites (OR: 1.67; p < 0.0001) and AA (OR: 1.18; p < 0.0001) were overrepresented in total PD admissions; whereas NHPI (OR: 0.64; p < 0.0001) and Blacks (OR: 0.17; p < 0.0001) were underrepresented. Overall, males received DBS more than females. All NHPI patients who received DBS were male, despite 37.65 % of total NHPI PD admissions being female (p = 0.0049). Most DBS patients were AA (45.95 %), followed by Whites (43.24 %), and NHPI (10.81 %). CONCLUSIONS NHPI and Black PD patients were disproportionately underrepresented in the Hawai`i PD population. All NHPI receiving DBS were male. These racial and gender disparities must be explored in future studies to achieve health equity and improved quality of care in a culturally sensitive manner.
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Affiliation(s)
- Gina Watanabe
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Fay Gao
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA
| | - Michon Morita
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA
| | - Michiko Kimura Bruno
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA.
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Feeney M, Duda J, Hiller A, Phillips J, Evers C, Yarab N, Todaro V, Rader L, Rosenfeld S. Understanding health care needs among Veterans with Parkinson's disease: A survey study. Front Neurol 2022; 13:924999. [PMID: 36034294 PMCID: PMC9405651 DOI: 10.3389/fneur.2022.924999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Among Veterans, it is estimated that 110,000 are living with Parkinson's disease (PD) in the United States. Whether or not Veterans living with PD are enrolled in the Veterans Health Administration (VHA), they may require special considerations when it comes to their care. We administered a survey to Parkinson's Foundation constituents with PD who had previously reported their Veteran status. Our goal was to identify areas where intervention can lead to improved health outcomes for Veterans living with Parkinson's disease. We specifically wanted to examine 1) the proportion of our Veteran constituents receiving services through the VHA, 2) the comprehensive care services that were utilized by Veterans living with PD, and 3) self-reported mental health and mobility status. We also wanted to compare those receiving care within and outside the VHA to see where there may be areas for improvement. With a response rate of 29.8% we received surveys from 409 United States Veterans with PD. As expected, mental health (MH) concerns in the previous 12 months were common with 36.0% of Veterans reporting concerns. Only 22.1% of respondents received care through VHA. Respondents with more falls and mental health concerns as well as those with higher levels of education and younger age were more likely to be seen at a VHA facility. In this sample, education level, household income, marital status, and VHA status were positively associated with increased health care utilization among Veterans. Those seen within the VHA were more likely to utilize MH and speech and language pathology consultation. This study highlights the importance of targeting educational outreach about care best practices for Veterans living with PD beyond VHA's current reach as well as the importance of access to good MH resources.
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Affiliation(s)
- Megan Feeney
- Parkinson's Foundation, New York, NY, United States
| | - John Duda
- Parkinson's Disease Research, Education and Clinical Center of the Michael J. Crescenz VA Medical Center, Department of Neurology of the University of Pennsylvania, Philadelphia, PA, United States
| | - Amie Hiller
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
- Department of Neurology, VA Portland Health Care System, Portland, OR, United States
| | - Jay Phillips
- Parkinson's Foundation, New York, NY, United States
| | | | - Nicole Yarab
- Parkinson's Foundation, New York, NY, United States
| | | | - Lydia Rader
- Parkinson's Foundation, New York, NY, United States
| | - Sheera Rosenfeld
- Parkinson's Foundation, New York, NY, United States
- *Correspondence: Sheera Rosenfeld
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De Miranda BR, Goldman SM, Miller GW, Greenamyre JT, Dorsey ER. Preventing Parkinson's Disease: An Environmental Agenda. JOURNAL OF PARKINSONS DISEASE 2021; 12:45-68. [PMID: 34719434 PMCID: PMC8842749 DOI: 10.3233/jpd-212922] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fueled by aging populations and continued environmental contamination, the global burden of Parkinson's disease (PD) is increasing. The disease, or more appropriately diseases, have multiple environmental and genetic influences but no approved disease modifying therapy. Additionally, efforts to prevent this debilitating disease have been limited. As numerous environmental contaminants (e.g., pesticides, metals, industrial chemicals) are implicated in PD, disease prevention is possible. To reduce the burden of PD, we have compiled preclinical and clinical research priorities that highlight both disease prediction and primary prevention. Though not exhaustive, the "PD prevention agenda" builds upon many years of research by our colleagues and proposes next steps through the lens of modifiable risk factors. The agenda identifies ten specific areas of further inquiry and considers the funding and policy changes that will be necessary to help prevent the world's fastest growing brain disease.
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Affiliation(s)
- Briana R De Miranda
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama atBirmingham, Birmingham, AL, USA
| | - Samuel M Goldman
- Division of Occupational and Environmental Medicine, San Francisco VeteransAffairs Health Care System, School of Medicine, University ofCalifornia-San Francisco, San Francisco, CA, USA
| | - Gary W Miller
- Department of Environmnetal Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J Timothy Greenamyre
- Pittsburgh Institute for Neurodegenerative Diseases and Department of Neurology, Universityof Pittsburgh, Pittsburgh, PA, USA
| | - E Ray Dorsey
- Center for Health+Technology and Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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Bailey M, Anderson S, Hall DA. Parkinson's Disease in African Americans: A Review of the Current Literature. JOURNAL OF PARKINSONS DISEASE 2021; 10:831-841. [PMID: 32417794 PMCID: PMC7458499 DOI: 10.3233/jpd-191823] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease, though evidence suggests that this disorder does not affect all racial groups similarly. Research in African Americans, in particular, has been conflicting. Some studies have found similar prevalence rates in African Americans and whites whereas other studies have found much lower prevalence and incidence rates in African Americans. A few studies identify potential factors underlying these discrepancies, including biologic differences as well as disparities in healthcare access. However, African Americans remain underrepresented in research studies, which make understanding the underlying reasons for these differences difficult. The purpose of this paper is to summarize existing research in African Americans with PD, highlight some of the reasons why differences exist in diagnostic rates of PD in this population, and briefly discuss interventions that may need to be made in order to ensure adequate care is provided to these patients.
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Affiliation(s)
- Meagan Bailey
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Sharlet Anderson
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Deborah A Hall
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
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Nwabuobi L, Agee J, Gilbert R. Racial and Social Disparities in Health and Health Care Delivery among Patients with Parkinson's Disease and Related Disorders in a Multiracial Clinical Setting. J Cross Cult Gerontol 2021; 36:253-263. [PMID: 34398367 DOI: 10.1007/s10823-021-09436-w] [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] [Accepted: 08/08/2021] [Indexed: 11/24/2022]
Abstract
There are racial and socioeconomic disparities in the care of patients with Parkinson's disease (PD). Bellevue Hospital Center (BHC) in New York City is the oldest public hospital in the United States providing care to a multiracial, socioeconomically diverse and medically underserved population. We investigated racial and social disparities in providing care to patients with PD and related disorders at BHC compared to a NYU Langone Health, a Parkinson's Foundation Center of Excellence. Retrospective chart review of patients with diagnosis of PD or PD-related disorders evaluated at BHC or at NYU outpatient clinics from January 2012 to August 2017. 100 patients were enrolled from each site: BHC (55% men); NYU (49% men). The majority of patients at NYU were White (77%), compared to 14% at BHC; Hispanic patients comprised the majority at BHC (56%) (p < 0.001). BHC patients had more clinic visits per year compared to the NYU cohort (2.88 vs. 2.40, p = 0.001). BHC patients were less likely to self-report exercise (p = 0.047) or participation in physical therapy (p = 0.015). There were no clinically significant differences in diagnosis type, time to diagnosis, average Hoehn & Yahr or levodopa equivalent dose. Compared to a Parkinson's Foundation Center of Excellence, PD patients in a public hospital system are more racially diverse, are less likely to be insured, have higher rates of care utilization and are less likely to access necessary interventions such as physical therapy and exercise.
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Affiliation(s)
- Lynda Nwabuobi
- Department of Neurology, New York University School of Medicine, New York, NY, USA. .,Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
| | - Julia Agee
- Department of Neurology, New York University School of Medicine, New York, NY, USA.,New York University School of Medicine, New York, NY, USA
| | - Rebecca Gilbert
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Neurology, Bellevue Hospital Center, New York, NY, USA.,American Parkinson Disease Association, Staten Island, NY, USA
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10
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Ben-Joseph A, Marshall CR, Lees AJ, Noyce AJ. Ethnic Variation in the Manifestation of Parkinson's Disease: A Narrative Review. JOURNAL OF PARKINSONS DISEASE 2021; 10:31-45. [PMID: 31868680 PMCID: PMC7029316 DOI: 10.3233/jpd-191763] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The global prevalence of Parkinson's disease is increasing, yet the characteristics, risk factors and genetics of PD in Black, Asian and Hispanic populations is little understood. In this paper we review the published literature on clinical variation in the symptoms and signs of Parkinson's disease in different ethnic groups and responses to treatment. We included any study that sampled patients with Parkinson's disease from distinct ethnic backgrounds. We conclude that whilst there is little published evidence for ethnic variation in the clinical features of Parkinson's disease, there are substantial limitations and gaps in the current literature, which mean that the evidence does necessarily not fit with clinical observation. Possible explanations for expected differences in manifestation include genetic determinants, the co-existence of cerebrovascular disease and/or Alzheimer's disease pathology, healthcare inequalities and socio-cultural factors.
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Affiliation(s)
- Aaron Ben-Joseph
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies and Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Reta Lila Weston Institute of Neurological Studies and Department of Clinical and Movement Neurosciences, University College London, London, UK
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11
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Ojukwu DI, Andruska KM, Halpern CH. Lessons From George Floyd: Racial Inequalities in the Treatment of Parkinson's Disease. Mov Disord 2020; 36:599-603. [PMID: 33200830 DOI: 10.1002/mds.28388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Disep I Ojukwu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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12
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Vaswani PA, Tropea TF, Dahodwala N. Overcoming Barriers to Parkinson Disease Trial Participation: Increasing Diversity and Novel Designs for Recruitment and Retention. Neurotherapeutics 2020; 17:1724-1735. [PMID: 33150545 PMCID: PMC7851248 DOI: 10.1007/s13311-020-00960-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
Parkinson disease (PD) is highly prevalent among neurodegenerative diseases, affecting a diverse patient population. Despite a general willingness of patients to participate in clinical trials, only a subset of patients enroll in them. Understanding the barriers to trial participation will help to alleviate this discrepancy and improve trial participation. Underrepresented minorities, older patients, and patients with more medical comorbidities in particular are underrepresented in research. In clinical trials, this has the effect of delaying trial completion, exacerbating disparities, and limiting our ability to generalize study results. Efforts to improve trial design and recruitment are necessary to ensure study enrollment reflects the diversity of patients with PD. At the trial design level, broadening inclusion criteria, attending to participant burden, and focusing on trial efficiency may help. At the recruitment stage, increasing awareness, with traditional outreach or digital approaches; improving engagement, particularly with community physicians; and developing targeted recruitment efforts can also help improve enrollment of underrepresented patient groups. The use of technology, for virtual visits, technology-based objective measures, and community engagement, can also reduce participant burden and increase recruitment. By designing trials to consider these barriers to trial participation, we can improve not only the access to research for all our patients but also the quality and generalizability of clinical research in PD.
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Affiliation(s)
- Pavan A Vaswani
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas F Tropea
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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13
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Tarolli CG, Zimmerman GA, Auinger P, McIntosh S, Horowitz RK, Kluger BM, Dorsey ER, Holloway RG. Symptom burden among individuals with Parkinson disease: A national survey. Neurol Clin Pract 2019; 10:65-72. [PMID: 32190422 DOI: 10.1212/cpj.0000000000000746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/01/2019] [Indexed: 12/12/2022]
Abstract
Objective To explore disease burden in Parkinson disease (PD) by evaluating the prevalence of symptoms and key disease milestones (critical events, e.g., hospitalization or frequent falls) and their association with quality of life (QOL) in those with PD. Methods We created and pretested an online needs assessment survey to evaluate the clinical characteristics, QOL, symptom prevalence, and critical event frequency among those with PD. We recruited individuals with self-reported Hoehn and Yahr stage II-V PD through online postings and email through the Davis Phinney Foundation. We used logistic regression to evaluate the association between a large number of uncontrolled symptoms and events on QOL. Results A total of 612 individuals (mean age 70.1 years, 49.8% women) completed the survey. Among respondents, 13.6% reported poor QOL. Nearly 20% of respondents reported >3 falls, and 15% of respondents had been hospitalized over the previous 6 months. Participants had an average of 5.1 uncontrolled symptoms, with 86.1% of respondents reporting at least 1 uncontrolled symptom; more than 10% of respondents reported >10 uncontrolled symptoms. Depression, confusion, pain, and bothersome hallucinations were associated with poor QOL among the cohort. Conclusions In this national survey of individuals with PD, we identified poor QOL, frequent critical events, and numerous uncontrolled symptoms among a substantial proportion of respondents. Although motor symptoms were common, only nonmotor symptoms were associated with poor QOL. Many of these symptoms and events are treatable or preventable, highlighting the need for better identification and management to improve QOL among those with PD.
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Affiliation(s)
- Christopher G Tarolli
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - Grace A Zimmerman
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - Peggy Auinger
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - Scott McIntosh
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - Robert K Horowitz
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - Benzi M Kluger
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - E Ray Dorsey
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
| | - Robert G Holloway
- Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora
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Orayj K, Lane E. Patterns and Determinants of Prescribing for Parkinson's Disease: A Systematic Literature Review. PARKINSON'S DISEASE 2019; 2019:9237181. [PMID: 31781365 PMCID: PMC6875178 DOI: 10.1155/2019/9237181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson's disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients' factors and prescribers' factors, with patients' age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.
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Affiliation(s)
- Khalid Orayj
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Ave, Cardiff CF10 3NB, UK
- College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Emma Lane
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Ave, Cardiff CF10 3NB, UK
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15
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Dahodwala N, Willis AW, Li P, Doshi JA. Prevalence and Correlates of Anti-Parkinson Drug Use in a Nationally Representative Sample. Mov Disord Clin Pract 2017; 4:335-341. [PMID: 30363446 PMCID: PMC6174430 DOI: 10.1002/mdc3.12422] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 06/16/2016] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although numerous prescription drugs are available to treat Parkinson's disease (PD), little is known about national use in clinical practice and which factors may influence variability in care. The objectives of this study were to describe the prevalence of anti-Parkinson drug use among Medicare beneficiaries with PD and to identify demographic and clinical factors associated with drug use. METHODS This retrospective study was based on a random sample of annual 5% Medicare Part A and B claims linked with Medicare Part D drug files from 2007 through 2010. The study sample included fee-for-service Medicare beneficiaries with continuous stand-alone Part D enrollment who had been diagnosed with PD in the given year. First, any PD drug use and drug use by class (levodopa, dopamine agonist, anticholinerigc, monoamine oxidase B inhibitors, catechol-O-methyltransferase inhibitors, and amantadine) were described. Using generalized estimating equation regressions, patient and provider characteristics associated with anti-Parkinson drug use and choice were examined. RESULTS Over 81% of patients with PD were treated with anti-Parkinson drugs, and this proportion was stable over the 4 years of the study. The majority were treated with levodopa (90%); followed by dopamine agonists (29-31%); then monoamine oxidase B inhibitors, anticholinergics, amantadine, and catechol-O-methyltransferase inhibitors (all between 5% and 11%). Holding all else equal, patients who were not seen by a neurologist (odds ratio, 0.41; 95% confidence interval, 0.38-0.44; P < 0.001) and African-American patients (odds ratio, 0.80; 95% confidence interval, 0.69-0.93; P = 0.003) were significantly less likely to be treated. CONCLUSIONS Among a national sample of Medicare beneficiaries with PD, the majority received anti-Parkinson drugs. However, there was relative under-treatment of African-Americans and patients who were not seen by a neurologist for care.
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Affiliation(s)
- Nabila Dahodwala
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Allison W. Willis
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Pengxiang Li
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jalpa A. Doshi
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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16
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Hamilton RH. Enhancing diversity in academic neurology: From agnosia to action. Ann Neurol 2016; 79:705-708. [DOI: 10.1002/ana.24635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Roy H. Hamilton
- Department of Neurology; University of Pennsylvania; Philadelphia PA
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17
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Branson CO, Ferree A, Hohler AD, Saint-Hilaire MH. Racial Disparities in Parkinson Disease: A Systematic Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/apd.2016.54011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Weintraub D, Simuni T, Caspell-Garcia C, Coffey C, Lasch S, Siderowf A, Aarsland D, Barone P, Burn D, Chahine LM, Eberling J, Espay AJ, Foster ED, Leverenz JB, Litvan I, Richard I, Troyer MD, Hawkins KA. Cognitive performance and neuropsychiatric symptoms in early, untreated Parkinson's disease. Mov Disord 2015; 30:919-27. [PMID: 25737166 PMCID: PMC4855523 DOI: 10.1002/mds.26170] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/22/2014] [Accepted: 12/17/2014] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED This study was undertaken to determine the prevalence and correlates of cognitive impairment (CI) and neuropsychiatric symptoms (NPS) in early, untreated patients with Parkinson's disease (PD). BACKGROUND Both CI and NPS are common in PD and impact disease course and quality of life. However, limited knowledge is available about cognitive abilities and NPS. METHODS Parkinson's Progression Markers Initiative (PPMI) is a multi-site study of early, untreated PD patients and healthy controls (HCs), the latter with normal cognition. At baseline, participants were assessed with a neuropsychological battery and for symptoms of depression, anxiety, impulse control disorders (ICDs), psychosis, and apathy. RESULTS Baseline data of 423 PD patients and 196 HCs yielded no between-group differences in demographic characteristics. Twenty-two percent of PD patients met the PD-recommended screening cutoff for CI on the Montral Cognitive Assessment (MoCA), but only 9% met detailed neuropsychological testing criteria for mild cognitive impairment (MCI)-level impairment. The PD patients were more depressed than HCs (P < 0.001), with twice as many (14% vs. 7%) meeting criteria for clinically significant depressive symptoms. The PD patients also experienced more anxiety (P < 0.001) and apathy (P < 0.001) than HCs. Psychosis was uncommon in PD (3%), and no between-group difference was seen in ICD symptoms (P = 0.51). CONCLUSIONS Approximately 10% of PD patients in the early, untreated disease state met traditional criteria of CI, which is a lower frequency compared with previous studies. Multiple dopaminergic-dependent NPS are also more common in these patients compared with the general population, but others associated with dopamine replacement therapy are not or are rare. Future analyses of this cohort will examine biological predictors and the course of CI and NPS. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Shirley Lasch
- Institute for Neurodegenerative Disorders (IND) and Molecular NeuroImaging, LLC (MNI), New Haven, Connecticut, USA
| | | | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society and the Alzheimer Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Paolo Barone
- Neurodegenerative Diseases Centre, Neuroscience Section, Department of Medicine, University of Salerno, Italy
| | - David Burn
- Institute for Ageing and Health, Newcastle University, Newcastle, England
| | - Lama M. Chahine
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jamie Eberling
- Michael J. Fox Foundation for Parkinson’s Research, New York, New York, USA
| | - Alberto J. Espay
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Eric D. Foster
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - James B. Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Litvan
- UCSD Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Irene Richard
- Departments of Neurology and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Keith A. Hawkins
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Pan S, Stutzbach J, Reichwein S, Lee BK, Dahodwala N. Knowledge and attitudes about Parkinson's disease among a diverse group of older adults. J Cross Cult Gerontol 2015; 29:339-52. [PMID: 24752756 DOI: 10.1007/s10823-014-9233-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Underserved minorities are vulnerable to diagnostic delays and under-treatment of Parkinson's disease (PD). The purpose of this mixed-methods study was to understand knowledge and attitudes about PD among a racially/ethnically diverse group of community members. In the qualitative arm, ten homogeneous focus groups of 6 to 8 White, African-American and Chinese American older adults at senior centers in Philadelphia were conducted. Next, for the quantitative arm, a questionnaire of knowledge and attitudes about PD was administered among a larger group of senior center members. Themes were identified from the focus group discussions. ANOVA and chi-square tests were used to assess differences in PD knowledge and attitudes among the different racial/ethnic groups. Logistic regression analyzed for independent factors associated with barriers to treatment. Seventy-five adults participated in the focus groups (23 Whites, 36 African-Americans and 16 Chinese-Americans) and 154 completed the questionnaire (62 Whites, 47 African-Americans and 45 Chinese-Americans). One common theme about developing PD was fear of losing independence. Racial/ethnic groups identified unique barriers to care: mistrust in the healthcare system by African-Americans and language difficulties by Chinese-Americans. Eighty percent of all participants had no to some knowledge of PD. African-Americans and Chinese-Americans were more likely to perceive PD as a part of normal aging than whites. Chinese-Americans were more likely to perceive barriers to treatment than whites. A diverse sample of older adults demonstrated low levels of PD knowledge through both qualitative and quantitative methods. Many barriers to PD care were identified. Targeted community outreach and education efforts should incorporate information about PD and how to receive care.
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Affiliation(s)
- Sarah Pan
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
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20
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Dahodwala N. What is known about racial disparities in Parkinson’s disease diagnosis and treatment? Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nabila Dahodwala
- Parkinson’s Disease & Movement Disorders Center, University of Pennsylvania, 330 S 9th Street, 2nd floor, Philadelphia, PA 19107, USA
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Dahodwala N, Xie M, Noll E, Siderowf A, Mandell DS. Treatment disparities in Parkinson's disease. Ann Neurol 2009; 66:142-5. [PMID: 19743462 DOI: 10.1002/ana.21774] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to identify racial disparities in the treatment of Parkinson's disease (PD). We identified 307 incident PD cases using Pennsylvania State Medicaid claims, and extracted claims for medications, physical therapy, and healthcare visits for the 6 months after diagnosis. After controlling for age, sex, and geography, African-Americans were four times less likely than whites to receive any PD treatment (odds ratio, 0.24; 95% confidence interval, 0.09-0.64), especially indicated medications. In a group with the same healthcare insurance, disparities in PD treatment exist. Physician and community awareness of these racial differences in PD treatment is the first step in addressing healthcare disparities.
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Affiliation(s)
- Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Hardy D, Liu CC, Xia R, Cormier JN, Chan W, White A, Burau K, Du XL. Racial disparities and treatment trends in a large cohort of elderly black and white patients with nonsmall cell lung cancer. Cancer 2009; 115:2199-211. [PMID: 19365824 DOI: 10.1002/cncr.24248] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study investigated whether there was a significant gap in receipt of treatment for nonsmall cell lung cancer (NSCLC) between blacks and whites, and whether the gap or disparity changed during the past 12 years from 1991 to 2002. METHODS The study population consisted of 83,101 patients including 75,141 (90.4%) whites and 7960 (9.6%) blacks aged > or =65 years who were diagnosed with American Joint Committee on Cancer (AJCC) stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Results (SEER) program's Medicare database. Age-adjusted and sex-adjusted rates and crude and adjusted odds ratios for receiving appropriate stage-specific treatment of NSCLC were reported. RESULTS For stages I-II NSCLC combined, blacks were 37% less likely (OR, 0.63; 95% confidence interval [CI], 0.55-0.73) to receive surgery, 42% less likely (OR, 0.58; 95% CI, 0.36-0.92) to receive chemotherapy, and for stages III-IV combined, 57% less likely (OR, 0.43; 95% CI, 0.30-0.61) to receive chemotherapy compared with whites. Older patients, women, and those in lower socioeconomic quartiles had greater disparities in receipt of treatment compared with the highest income quartile. Disparity trends were not significantly narrowed during the past 12 years between blacks and whites for receipt of the above treatments. CONCLUSIONS There have been substantial disparities in receiving recommended treatments between blacks and whites, and these disparities have been relatively stable without a significant trend of narrowing during the past 12 years. Efforts should focus on providing appropriate quality treatment and educating blacks on the value of having these treatments to reduce these disparities in receipt of treatment for NSCLC.
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Affiliation(s)
- Dale Hardy
- Division of Epidemiology, The University of Texas School of Public Health, Houston, Texas, USA.
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