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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 2024:10.1007/s00415-024-12474-2. [PMID: 38861033 DOI: 10.1007/s00415-024-12474-2] [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: 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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Zapf AC, Olgemöller PM, Gollan R, Kalbe E, Folkerts AK. Possible improvement of social adjustment after subthalamic deep brain stimulation in people with Parkinson's disease? A systematic review and meta-analysis. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02787-x. [PMID: 38795178 DOI: 10.1007/s00702-024-02787-x] [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: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 05/27/2024]
Abstract
Interactions with others need social adjustment (i.e., the constant accommodation to changing social situations). Mixed evidence indicates positive as well as negative changes in social adjustment after subthalamic nucleus deep brain stimulation (STN-DBS) in people with Parkinson's Disease (PwPD). To date, however, no meta-analysis of these changes exists. Thus, the study aim was to review evidence of the effects of STN-DBS on social adjustment in PwPD. For this purpose, a systematic literature search in MEDLINE was conducted. The meta-analysis was performed using a random effects model and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The MINORS tool was used to assess the methodological quality of the studies. The initial literature search identified 13,124 articles, of which 1,550 full texts were assessed for eligibility. Eight studies were finally included; for seven articles sufficient data for a meta-analysis was available. Most studies found mild impairment in social adjustment impairment pre-surgery. The meta-analysis revealed no significant changes but a statistical trend towards improvement in social adjustment up to six months (SMD = 0.25; 95%CI=-0.03,0.53; P = 0.08) and over 12 months (SMD = 0.26; 95%CI=-0.03,0.55; P = 0.07) post-surgery. Methodological quality was moderate in 87.5% of the studies and good in 12.5%. While mild impairment in social adjustment pre-surgery was reported in most studies, the data indicate that STN-DBS might yield beneficial effects toward this outcome. However, not enough data yet exists to draw firm conclusions. As a crucial skill for everyday functioning, social adjustment should be more often defined as an outcome in STN-DBS trials in PwPD and should be considered in clinical routines.
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Affiliation(s)
- Alexandra C Zapf
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paulina M Olgemöller
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Victoria, Australia
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Apathy following Bilateral Deep Brain Stimulation of Subthalamic Nucleus and Globus Pallidus Internus in Parkinson's Disease: A Meta-Analysis. PARKINSON'S DISEASE 2022; 2022:4204564. [PMID: 36225750 PMCID: PMC9550510 DOI: 10.1155/2022/4204564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/20/2022] [Accepted: 09/15/2022] [Indexed: 11/04/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder typically manifested by its motor symptoms. In addition, PD patients also suffer from many nonmotor symptoms (NMSs), such as apathy. Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are recommended as therapeutic interventions for PD, given their pronounced benefit in reducing troublesome dyskinesia. Apathy, a mood disorder recognized as a NMS of PD, has a negative impact on the prognosis of PD patients. However, the effect of STN-DBS and GPi-DBS on apathy is controversial. In the current meta-analysis, we analyzed apathy following bilateral STN-DBS and GPi-DBS in PD patients. Relevant literature was retrieved from public databases, including PubMed, Cochrane Library, and Embase. Studies were included in our analysis based on the following criterion: such studies should report apathy scores presurgery and postsurgery determined by using the Starkstein Apathy Scale or Apathy Evaluation Scale in patients receiving STN or GPi-DBS with at least three months of follow-up. Upon applying this strict criterion, a total of 13 out of 302 studies were included in our study. A mean difference (MD) and 95% confidence interval (CI) were calculated to show the change in apathy scores. We found a statistically significant difference between the presurgery and postsurgery scores in patients receiving STN-DBS (MD = 2.59, 95% CI = 2.23-2.96, P < 0.00001), but not in patients receiving GPi-DBS (MD = 0.32, 95% CI = -2.78-3.41, P=0.84). STN-DBS may worsen the condition of apathy, which may result from the reduction of dopaminergic medication. In conclusion, STN-DBS seems to relatively worsen the condition of apathy compared to GPi-DBS. Further studies should focus on the mechanisms of postoperatively apathy and the degree of apathy in STN-DBS versus GPi-DBS.
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Van Hienen MM, Kuiper R, Middelkoop HA, Van Hilten JJ, Contarino MF, Geraedts VJ. Patient-Related Factors Influencing Caregiver Burden in Parkinson’s Disease Patients: Comparison of Effects Before and After Deep Brain Stimulation. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1285-1293. [PMID: 35275557 PMCID: PMC9484085 DOI: 10.3233/jpd-213093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Caregivers of Parkinson’s disease (PD) patients provide important support during the pre- and postoperative phase of deep brain stimulation (DBS). High levels of caregiver burden have been reported after DBS. However, a comparison between preoperative and postoperative burden and associated factors has been insufficiently studied. Objective: To investigate the influence of DBS on caregiver burden, and to identify the differential impact of patient-related factors on caregiver burden before and after DBS. Methods: Consecutive patients referred for DBS eligibility screening or during one-year follow-up assessments were included. Caregiver burden was measured with the short Zarit Burden Interview (ZBI-12). Inverse Probability Weighting (IPW) was used to compare caregiver burden between preoperative and postoperative assessments. Results: We included 47 patients (24 screening, 23 follow-up) (median age 65 years, 29.4% female sex). DBS did not impact caregiver burden (screening: median ZBI-12 9.5 (IQR 3.25, 16.75); follow-up median ZBI-12 6 (IQR 4, 14); IPW-coefficient 0.57 (95% CI –2.75, 3.89)). Worse caregiver burden during DBS screening was associated with worse patient-related scores on depressive symptoms, anxiety, QoL, and impulsiveness. Worse scores on depressive symptoms, anxiety, apathy, postural-instability-gait-disorder, and QoL were associated with worse caregiver burden at one-year follow-up. Conclusion: DBS appears not associated with changes in caregiver burden. Various symptoms are valued differently between screening and follow-up assessments in terms of caregiver burden. Early recognition of caregivers “at risk” may improve guidance of patient-caregiver dyads throughout the DBS process.
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Affiliation(s)
| | - Roy Kuiper
- Department of Neurology, LUMC, Leiden, the Netherlands
| | - Huub A.M. Middelkoop
- Department of Neurology, LUMC, Leiden, the Netherlands
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | | | - Maria Fiorella Contarino
- Department of Neurology, LUMC, Leiden, the Netherlands
- Department of Neurology, Haga Teaching Hospital, Den Haag, the Netherlands
| | - Victor J. Geraedts
- Department of Neurology, LUMC, Leiden, the Netherlands
- Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands
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5
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Caregiver Burden in Partners of Parkinsonian Patients with Deep Brain Stimulation. Brain Sci 2022; 12:brainsci12020238. [PMID: 35204001 PMCID: PMC8870343 DOI: 10.3390/brainsci12020238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/12/2023] Open
Abstract
In Parkinson’s disease (PD) patients, the progressive nature of the disease and the variability of disabling motor and non-motor symptoms contribute to the growing caregiver burden of PD partners and conflicts in their relationships. Deep brain stimulation (DBS) improves PD symptoms and patients’ quality of life but necessitates an intensified therapy optimization after DBS surgery. This review illuminates caregiver burden in the context of DBS, framing both pre- and postoperative aspects. We aim to provide an overview of perioperative factors influencing caregiver burden and wish to stimulate further recognition of caregiver burden of PD patients with DBS.
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Kay KR, Uc EY. Real-life consequences of cognitive dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:113-136. [DOI: 10.1016/bs.pbr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wang HY, Ren L, Li T, Pu L, Huang X, Wang S, Song C, Liang Z. The impact of anxiety on the cognitive function of informal Parkinson's disease caregiver: Evidence from task-based and resting-state fNIRS. Front Psychiatry 2022; 13:960953. [PMID: 36159948 PMCID: PMC9492928 DOI: 10.3389/fpsyt.2022.960953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Informal Parkinson's disease (PD) caregivers are considered to experience high levels of caregiver burden, negatively affecting the health of caregivers. However, few studies explored the relationship between anxiety in caregiver burden and cognitive function in informal PD caregivers. Although, no study has even investigated the neural mechanisms underlying this connection. This study aimed to conduct comprehensive cognitive and clinical assessments and evaluate brain activity from task-based state and resting-state using functional near-infrared spectroscopy (fNIRS). A total of ten informal PD caregivers and 15 matched, healthy, non-caregivers were recruited. Comprehensive cognitive and clinical assessments were conducted to evaluate five cognitive domains and mental states. Neural activity induced by verbal fluency task (VFT) and brain connectivity during resting state were monitored, and their correlations with the neuropsychological and clinical tests were explored. Our results showed that compared to non-caregiver, an informal PD caregiver exhibited no difference in most cognitive domains of function but performed better in attentional function, along with higher levels of anxiety. Decreased activation over prefrontal regions during VFT and hypo-connectivity within the frontoparietal network (FPN) and between default mode network (DMN) and FPN in the resting state were confirmed in this study as a result of the negative effects of anxiety on the brain. Furthermore, Spearman's correlation found that neural activity in FPN during task-based state and resting state was negatively correlated with the severity of anxiety. These findings indicate that despite normal or even better cognitive function, informal PD caregivers have impaired brain function, and this deficit in neural activity was related to anxiety.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Ren
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Li
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanlan Pu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaofeng Huang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Song Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunli Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhanhua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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8
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Ahn S, Springer K, Gibson JS. Social withdrawal in Parkinson's disease: A scoping review. Geriatr Nurs 2022; 48:258-268. [PMID: 36332441 PMCID: PMC9742332 DOI: 10.1016/j.gerinurse.2022.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Parkinson's disease (PD) can interfere with individuals' social functioning and lead to social withdrawal. Social withdrawal may result in negative outcomes for persons with PD and their caregivers, such as decreased quality of life. It is necessary to understand the nature of social withdrawal in PD in order to develop strategies to address this issue and prevent negative outcomes. OBJECTIVE The purpose of this scoping review was to synthesize existing evidence regarding social withdrawal in PD. METHODS We searched PubMed, CINAHL, and PsycINFO for studies of social withdrawal in individuals living with PD. Findings were organized according to study characteristics, measurement and description of social withdrawal, prevalence, associated factors, and interventions. RESULTS Fifty-eight studies were included. We found that persons with PD reduced social activities voluntarily and involuntarily, and social withdrawal was related to various factors including physical, cognitive, and psychiatric symptoms and perceived stigma. Community-based social activity programs appeared to improve social participation. Few studies employed longitudinal methods or tested interventions to reduce social withdrawal. CONCLUSIONS Social withdrawal is associated with various negative outcomes in PD, though more research is needed to understand the true scope of this problem. Limitations in social withdrawal research include vague conceptualization and methodological limitations (i.e., instrumentation and study design), as well as a paucity of interventional studies. The findings of this review can be used to guide hypothesis generation and future study design, with the ultimate goal of mitigating social withdrawal and improving quality of life for people with PD.
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Affiliation(s)
| | - Kristen Springer
- Doctor of Physical Therapy Division, Duke University School of Medicine
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9
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Scharfenort M, Timpka J, Sahlström T, Henriksen T, Nyholm D, Odin P. Close relationships in Parkinson´s disease patients with device-aided therapy. Brain Behav 2021; 11:e02102. [PMID: 33949144 PMCID: PMC8213651 DOI: 10.1002/brb3.2102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Deep brain stimulation, continuous subcutaneous apomorphine infusion, and levodopa-carbidopa intestinal gel infusion, together called device-aided therapies (DAT), are introduced when oral and transdermal pharmacotherapy are not enough for a satisfactory control of Parkinson's disease (PD) symptoms. Solid relationships are central to an individual's well-being, but the impact of close relationships in advanced PD remains underexplored. The aim of this study was to investigate the development of close relationships between PD patients and their partners following the initiation of DAT and to examine the relationship structures in these relationships. MATERIALS AND METHODS This was a retrospective quantitative multicenter pilot study wherein 41 couples, patients with advanced PD and their partners, retrospectively rated their relationship satisfaction before the start of DAT, after one year of DAT and at the time of the interview. The couples also answered the Experiences in Close Relationships-Questionnaire of Relational Structures (ECR-RS). RESULTS Partners more often report changes in relationship satisfaction than patients between baseline and both 1 year after start of DAT (p = .049) and last evaluation (p = .041). The ECR-RS data reported significantly higher avoidance score for partners (p = .005) and significantly higher anxiety score for patients (p = .024). CONCLUSIONS The close relationship wherein one part has PD and receives DAT has a high risk of being unequal. Prospective studies are needed for further clarification of the interplay between advanced PD, DAT, and close relationships, this in order to improve pre- and postinterventional support for PD patients receiving DAT, as well as their partners.
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Affiliation(s)
- Monica Scharfenort
- Division of Neurology, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Jonathan Timpka
- Division of Neurology, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | | | - Tove Henriksen
- Department of Neurology, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Dag Nyholm
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
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Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis of Mood Effects. Neuropsychol Rev 2021; 31:385-401. [PMID: 33606174 DOI: 10.1007/s11065-020-09467-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/22/2020] [Indexed: 12/15/2022]
Abstract
This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). Deep brain stimulation improves motor outcomes in Parkinson's disease but there appears to be conflicting reports as to subsequent mood outcomes. Pubmed, PsychINFO and SCOPUS were searched for studies assessing mood outcomes in PD patients who had undergone STN-DBS published between January 2003 and the end of January 2019. Random effects meta-analyses were conducted for all outcome groups with at least two studies homogenous in design and measure. Forty-eight studies, providing data on negative moods (such as depression, anxiety, apathy, and anger) and positive moods (pleasure and euphoria) were assessed. Results of the meta-analysis suggest that post-DBS, depression and anxiety symptoms improve and there is a reduction in negative affect, an increase in apathy, and in energy level. Although there have been reported cases of mania post-DBS surgery, the meta-analysis suggested no significant changes in symptoms of mania in the broader DBS population. Considerable heterogeneity was found and partially addressed through meta-regression and qualitative assessment of the included STN-DBS controlled studies. The major strengths of this meta-analysis, include attention to outcome validity, heterogeneity, independence of samples, and clinical utility, with the potential to improve post-operative safety through comprehensive consideration of mood and psychological adjustment. It appears that STN-DBS is a relatively safe and, in the case of mood symptomatology, an advantageous treatment of Parkinson's disease.
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11
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van Hienen MM, Contarino MF, Middelkoop HAM, van Hilten JJ, Geraedts VJ. Effect of deep brain stimulation on caregivers of patients with Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2020; 81:20-27. [PMID: 33038702 DOI: 10.1016/j.parkreldis.2020.09.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Caregivers of patients with Parkinson's Disease (PD) often provide important support in the pre- and postoperative phase of Deep Brain Stimulation (DBS). DBS-associated changes of patient-functioning may affect caregiver wellbeing and impact the support system. Factors influencing caregiver-wellbeing under these circumstances are incompletely known. OBJECTIVE to systematically review studies of sufficient methodological quality on the impact of DBS on caregivers of PD patients. METHODS using PRISMA guidelines, major databases were searched up to May 2020. Five subcategories were identified: Caregiver burden, Caregiver cognitive and psychiatric functioning, Caregiver Quality of Life (QoL), Marital Satisfaction/Conflicts, and Caregiver Satisfaction. Quality was assessed using an in-house checklist. RESULTS 293 studies were identified; 12 were ultimately included. Caregiver burden, psychiatric and cognitive functioning and QoL remained relatively unchanged. Results on marital satisfaction/conflicts were contrasting: an increase in marital conflicts despite improved relationship quality scores DBS. Caregiver satisfaction with surgery was low with 50-58% of caregivers being disappointed with DBS outcomes. Concerning caregiver related factors: a higher preoperative caregiver QoL, younger age, lower scores on psychiatric rating scales, and more favourable preoperative relationship quality scores, were associated with better caregiver wellbeing. A favourable patient-profile includes younger age and age-at-onset, shorter disease duration, lower medication requirements, and lower scores on psychiatric rating scales. CONCLUSION Although most patient- and caregiver-related subdomains remained unchanged after DBS, dissatisfaction among caregivers and marital problems may constitute a large risk for a well-functioning patient-caregiver dyad. Early recognition of potential problem situations may improve post-DBS care for both patients and caregivers.
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Affiliation(s)
- Marle M van Hienen
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Neurology, Haga Teaching Hospital, the Hague, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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12
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Desmoulin-Canselier S. DBS: a compelling example for ethical and legal reflection-a French perspective on ethical and legal concerns about DBS. Monash Bioeth Rev 2020; 38:15-34. [PMID: 32335863 DOI: 10.1007/s40592-020-00111-3] [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: 11/27/2022]
Abstract
Deep brain stimulation (DBS) is an approved treatment for neurological diseases and a promising one for psychiatric conditions, which may produce spectacular results very quickly. It is also a powerful tool for brain research and exploration. Beyond an overview of the ethical and legal literature on this topic, this paper aims at showing that DBS is a compelling example for ethical-legal reflection, as it combines a highly technical surgical procedure, a complex active medical device and neuromodulation of the human brain to restore lost abilities caused by a chronic and evolving disease. Some of the ethical and legal issues raised by DBS are not specific, but shed new light on medical ethics and law. Others are more DBS-specific, as they are linked to the intricacies of research and treatment, to the need to tune the device, to the patients' control over the device and its effects and to the involvement of family caregivers.
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Affiliation(s)
- Sonia Desmoulin-Canselier
- NormaStim Program ANR14-CE30-0016, University of Nantes (UMR 6297 DCS), Nantes, France. .,Laboratoire Droit et Changement Social, UMR CNRS 6297: Faculté de Droit de Nantes, Chemin de la Censive du Tertre, BP 8130744 313, Nantes Cedex 3, France.
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13
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Krack P, Volkmann J, Tinkhauser G, Deuschl G. Deep Brain Stimulation in Movement Disorders: From Experimental Surgery to Evidence‐Based Therapy. Mov Disord 2019; 34:1795-1810. [DOI: 10.1002/mds.27860] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Paul Krack
- Department of Neurology Bern University Hospital and University of Bern Bern Switzerland
| | - Jens Volkmann
- Department of Neurology University Hospital and Julius‐Maximilian‐University Wuerzburg Germany
| | - Gerd Tinkhauser
- Department of Neurology Bern University Hospital and University of Bern Bern Switzerland
| | - Günther Deuschl
- Department of Neurology University Hospital Schleswig Holstein (UKSH), Kiel Campus; Christian‐Albrechts‐University Kiel Germany
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14
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Barboza E Barbosa EN, Fichman HC. How is cognition in subthalamic nucleus deep brain stimulation Parkinson's disease patients? Dement Neuropsychol 2019; 13:367-377. [PMID: 31844489 PMCID: PMC6907696 DOI: 10.1590/1980-57642018dn13-040002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 11/22/2022] Open
Abstract
The impairments in cognitive functions such as memory, executive function, visuospatial skills and language in Parkinson's disease (PD) are drawing increasing attention in the current literature. Studies dedicated to investigating the relationship between subthalamic nucleus deep brain stimulation (STN-DBS) and cognitive functioning are contradictory. This systematic review aims to analyze the impact on the cognitive functioning of patients with PD and STN-DBS. Articles published in the 2007-2017 period were retrieved from the Medline/Pubmed databases using PRISMA criteria. The analysis of 27 articles revealed many conflicting results, precluding a consensus on a cognitive functioning standard and hampering the establishment of a neuropsychological profile for PD patients who underwent STN-DBS surgery. Further studies investigating this relationship are needed.
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Büttner C, Maack M, Janitzky K, Witt K. The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta-Analysis. Mov Disord Clin Pract 2019; 6:521-530. [PMID: 31538085 PMCID: PMC6749804 DOI: 10.1002/mdc3.12819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Several studies examined the influence of subthalamic nucleus-deep brain stimulation (STN-DBS) on quality of life (QoL) in patients with Parkinson's disease (PD). However, it is unclear whether this effect differs between age groups and disease durations and whether it stays consistent over time. OBJECTIVES We assessed the influence of stimulation duration, disease duration, and age at surgery on QoL after STN-DBS. METHODS We systematically searched for studies reporting the results of the Parkinson's Disease Questionnaire 39 or 8. Studies were included if they investigated the time passed since STN-DBS or if their study cohort fell into the range of one of the following age groups: younger than 60 years or between 60 and 70 years. For each condition, a standardized mean difference meta-analysis was performed. Furthermore, all studies were categorized into short or long disease duration at surgery using a median split. RESULTS A total of 23 studies reporting the cumulative outcome of 76 to 802 PD patients were included in this analysis. The results demonstrate a substantial improvement of QoL after DBS that remains stable over 36 months. QoL falls to preoperative scores 60 months after surgery. However, only 3 studies could be included in this analysis. Both younger and older PD patients profit in QoL from STN-DBS, independent of the disease duration. CONCLUSIONS The results of this analysis show an impressive improvement in QoL after STN-DBS, with a loss of QoL 60 months after DBS surgery. This highlights the need to explore the factors influencing QoL after STN-DBS to prevent or delay a decline in QoL.
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Affiliation(s)
- Charlotte Büttner
- Department of Neurology and Research Center of Neurosensory SciencesCarl von Ossietzky University OldenburgOldenburgGermany
| | - Marike Maack
- Department of Neurology and Research Center of Neurosensory SciencesCarl von Ossietzky University OldenburgOldenburgGermany
| | - Kathrin Janitzky
- Department of Neurology and Research Center of Neurosensory SciencesCarl von Ossietzky University OldenburgOldenburgGermany
| | - Karsten Witt
- Department of Neurology and Research Center of Neurosensory SciencesCarl von Ossietzky University OldenburgOldenburgGermany
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16
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Activities of Daily Living and Their Relationship to Health-Related Quality of Life in Patients with Parkinson Disease After Subthalamic Nucleus Deep Brain Stimulation. World Neurosurg 2019; 125:e552-e562. [PMID: 30716489 DOI: 10.1016/j.wneu.2019.01.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can reduce motor symptoms in patients with Parkinson disease (PD) and improve their health-related quality of life (HRQoL). The effect of STN DBS on activities of daily living (ADL), an important component of quality of life, is poorly understood. We aimed to investigate effects of STN DBS on HRQoL and ADL in patients with PD. METHODS HRQoL and ADL were assessed using the following disease-specific and generic questionnaires at baseline and 3, 6, and 12 months after surgery: the Parkinson's Disease Questionnaire 39 (PDQ-39), the Short-Form 36 health survey questionnaire, the World Health Organization Quality of Life Scale-Brief version, the Unified Parkinson's Disease Rating Scale part II, the ADL scale, and the Instrumental Activities of Daily Living scale. RESULTS We reported significant early improvements (3 months) in the HRQoL and ADL, and these benefits increased over time (6 months); however, further improvement between 6 and 12 months was nonsignificant. Two PDQ-39 subdomains (social support and communications) and a Short-Form 36 health survey questionnaire subdomain (social functioning) showed declines after surgery. Changes in the Instrumental Activities of Daily Living scale were significantly correlated with changes in the PDQ-39 summary index and other PDQ-39 subdomains, including mobility, emotional well-being, social support, and cognition, at all follow-up points. CONCLUSIONS STN DBS caused a marked improvement in HRQoL at 3 and 6 months; however, HRQoL remained stable at the 12-month postoperative follow-up. Moreover, we have shown a significant correlation between ADL performance and HRQoL after STN DBS.
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Yin Z, Cao Y, Zheng S, Duan J, Zhou D, Xu R, Hong T, Lu G. Persistent adverse effects following different targets and periods after bilateral deep brain stimulation in patients with Parkinson's disease. J Neurol Sci 2018; 393:116-127. [DOI: 10.1016/j.jns.2018.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/22/2018] [Accepted: 08/14/2018] [Indexed: 02/04/2023]
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Sebring K, Shattuck J, Berk J, Boersma I, Sillau S, Kluger BM. Assessing the validity of proxy caregiver reporting for potential palliative care outcome measures in Parkinson's disease. Palliat Med 2018; 32:1522-1528. [PMID: 30015552 DOI: 10.1177/0269216318785830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is increasing interest in applying palliative care approaches for patients with Parkinson's disease. Methodological studies are needed to validate palliative care outcome measures for Parkinson's disease to build this evidence base. As many patients with Parkinson's disease have cognitive and/or communication issues, proxy outcome measures may improve the inclusivity and relevance of research. AIM To assess the validity of proxy caregiver reports for several potential palliative care outcome measures. DESIGN A cross-sectional study of Parkinson's disease patients and caregivers completed a battery of outcome measures relevant to palliative care including the Memorial Symptom Assessment Scale, Hospital Anxiety and Depression Scale, Prolonged Grief Questionnaire 12, Parkinson Disease Questionnaire 39, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, and Schwab and England. Intraclass correlation coefficients were used to assess agreement. SETTING/PARTICIPANTS A total of 50 Parkinson's disease patient and caregiver dyads recruited at an academic medical center, Veterans Affairs Medical Center, and community support groups. RESULTS There was moderate to good agreement for Schwab and England, Parkinson Disease Questionnaire 39 total, and majority of Parkinson Disease Questionnaire 39 subscales; moderate to good agreement for the Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, Prolonged Grief Questionnaire 12, and Memorial Symptom Assessment Scale; and poor to moderate agreement for the Parkinson Disease Questionnaire 39 stigma, social support, and bodily pain subscales. Caregivers tended to attribute higher symptom severity than patients. We did not detect differences in intraclass correlation coefficient based on cognitive status but patients with advanced illness had significantly lower intraclass correlation coefficients for several outcomes. CONCLUSIONS Caution is indicated when considering caregiver proxy reporting for most outcomes assessed, particularly in Parkinson's disease patients with advanced disease.
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Affiliation(s)
- Kelly Sebring
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Jo Shattuck
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Julie Berk
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Isabel Boersma
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Stefan Sillau
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Benzi M Kluger
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
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19
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Apathy following Bilateral Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis. PARKINSONS DISEASE 2018; 2018:9756468. [PMID: 29951186 PMCID: PMC5987292 DOI: 10.1155/2018/9756468] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/10/2018] [Accepted: 04/30/2018] [Indexed: 01/04/2023]
Abstract
Bilateral deep brain stimulation of subthalamic nucleus (STN-DBS) has proven effective in improving motor symptoms in Parkinson's disease (PD) patients. However, psychiatric changes after surgery are controversial. In this study, we specifically analyzed apathy following bilateral STN-DBS in PD patients using a meta-analysis. Relevant articles utilized for this study were obtained through literature search on PubMed, ScienceDirect, and Embase databases. The articles included were those contained both pre- and postsurgery apathy data acquired using the Starkstein Apathy Scale or Apathy Evaluation Scale with patient follow-up of at least three months. A total of 9 out of 86 articles were included in our study through this strict screening process. Standardized mean difference (SMD), that is, Cohen's d, with a 95% confidence interval (CI) was calculated to show the change. We found a significant difference between the presurgery stage and the postsurgery stage scores (SMD = 0.35, 95% CI: 0.17∼0.52, P < 0.001). STN-DBS seems to relatively worsen the condition of apathy, which may result from both the surgery target (subthalamic nucleus) and the reduction of dopaminergic medication. Further studies should focus on the exact mechanisms of possible postoperative apathy in the future.
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20
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Liddle J, Phillips J, Gustafsson L, Silburn P. Understanding the lived experiences of Parkinson's disease and deep brain stimulation (DBS) through occupational changes. Aust Occup Ther J 2017; 65:45-53. [PMID: 29165825 DOI: 10.1111/1440-1630.12437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS), a surgically based treatment for people living with Parkinson's disease (PD), can result in a significant improvement of motor symptoms. However, the broader impact of DBS and the changes it creates are not well understood. Greater understanding of the experiences and needs related to DBS would enable development of relevant outcome measures and supports. OBJECTIVES To explore the lived experiences of people undergoing DBS for Parkinson's disease. METHODS A descriptive phenomenological study was undertaken exploring experiences, perspectives and outcomes with key stakeholders. Semi-structured, audiotaped interviews were undertaken with people with PD who have had DBS, their family members and health professionals across four states and territories in Australia. RESULTS Perspectives and experiences of 14 people with PD undergoing DBS, 10 family members and 11 health professionals were analysed. Occupations emerged as a key aspect throughout the DBS experience. Two major themes captured the role of occupation in relation to DBS: Occupations as a barometer, where occupational experiences and performances shaped people's understanding of their condition, the impact of treatments and their overall adjustment; and Shifting occupational identity where the life transition of DBS altered the occupational experiences of relationships, volition, roles and responsibilities of people with PD and their family members. CONCLUSION Occupational experiences and changes served as an important way for people with PD and their families to understand and communicate their experiences of PD and related treatments. There is an identified need for outcome measures and clinical education and interventions to reflect this.
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Affiliation(s)
- Jacki Liddle
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland
| | - Jessie Phillips
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland
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21
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Tackling psychosocial maladjustment in Parkinson's disease patients following subthalamic deep-brain stimulation: A randomised clinical trial. PLoS One 2017; 12:e0174512. [PMID: 28399152 PMCID: PMC5388322 DOI: 10.1371/journal.pone.0174512] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/08/2017] [Indexed: 01/10/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for the motor and non-motor signs of Parkinson’s disease (PD), however, psychological disorders and social maladjustment have been reported in about one third of patients after STN-DBS. We propose here a perioperative psychoeducation programme to limit such social and familial disruption. Methods Nineteen PD patients and carers were included in a randomised single blind study. Social adjustment scale (SAS) scores from patients and carers that received the psychoeducation programme (n = 9) were compared, both 1 and 2 years after surgery, with patients and carers with usual care (n = 10). Depression, anxiety, cognitive status, apathy, coping, parkinsonian disability, quality-of-life, carers’ anxiety and burden were also analysed. Results Seventeen patients completed the study, 2 were excluded from the final analysis because of adverse events. At 1 year, 2/7 patients with psychoeducation and 8/10 with usual care had an aggravation in at least one domain of the SAS (p = .058). At 2 years, only 1 patient with psychoeducation suffered persistent aggravated social adjustment as compared to 8 patients with usual care (p = .015). At 1 year, anxiety, depression and instrumental coping ratings improved more in the psychoeducation than in the usual care group (p = .038, p = .050 and p = .050, respectively). No significant differences were found between groups for quality of life, cognitive status, apathy or motor disability. Conclusions Our results suggest that a perioperative psychoeducation programme prevents social maladjustment in PD patients following STN-DBS and improves anxiety and depression compared to usual care. These preliminary data need to be confirmed in larger studies.
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Maier F, Lewis CJ, Eggers C, Kühn AA, Krug H, Volkmann J, Kirsch AD, Wojtecki L, Schnitzler A, Deuschl G, Krauss JK, Woopen C, Timmermann L. Development and validation of the deep brain stimulation impairment scale (DBS-IS). Parkinsonism Relat Disord 2017; 36:69-75. [DOI: 10.1016/j.parkreldis.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
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23
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Kahle-Wrobleski K, Ye W, Henley D, Hake AM, Siemers E, Chen YF, Liu-Seifert H. Assessing quality of life in Alzheimer's disease: Implications for clinical trials. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 6:82-90. [PMID: 28229126 PMCID: PMC5312555 DOI: 10.1016/j.dadm.2016.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Introduction Characterization of the quality of life (QOL) in Alzheimer's disease (AD) scale within the context of a clinical trial may inform its applicability in future trials. Methods Using data from 1322 patients enrolled in two phase-III studies (EXPEDITION 1 [NCT00905372] and 2 [NCT00904683]) of intravenous solanezumab in outpatients with mild AD dementia, correlations between patient- and caregiver-assessed QOL and between QOL and clinical outcome measures were examined. Longitudinal effects of solanezumab over 80 weeks were explored, controlling for patient and caregiver baseline characteristics. Results Caregivers rated patients' QOL worse than did patients themselves. Patients' QOL was correlated, albeit modestly, with clinical/health measures. Patients' QOL changed minimally over 80 weeks, although a treatment effect of solanezumab on QOL was detected. Discussion Further investigations are needed to determine the optimal measures with which to quantify and qualify QOL of patients with mild AD.
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Affiliation(s)
- Kristin Kahle-Wrobleski
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wenyu Ye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - David Henley
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ann Marie Hake
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric Siemers
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yun-Fei Chen
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Hong Liu-Seifert
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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24
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Schrag A, Sauerbier A, Chaudhuri KR. New clinical trials for nonmotor manifestations of Parkinson's disease. Mov Disord 2016; 30:1490-504. [PMID: 26371623 DOI: 10.1002/mds.26415] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/22/2015] [Accepted: 08/03/2015] [Indexed: 11/07/2022] Open
Abstract
Nonmotor manifestations in Parkinson's disease (PD) encompass a range of clinical features, including neuropsychiatric problems, autonomic dysfunction, sleep disorders, fatigue, and pain. Despite their importance for patients' quality of life, the evidence base for their treatment is relatively sparse. Nevertheless, the last few years have seen a number of new trials starting that specifically address nonmotor features as an outcome measure in clinical trials. Large randomized, controlled trials in the last 3 years reported improvement of psychosis with the new selective serotonin 5-HT2A inverse agonist pimavanserin and of postural hypotension with the oral norepinephrine precursor droxidopa. Smaller new randomized, controlled trials support the effectiveness of Deep Brain Stimulation and opiates for pain, of rivastigmine for apathy and piribedil for apathy post-DBS, group cognitive behavioral therapy for depression and/or anxiety, continuous positive airway pressure for sleep apnea in PD and doxepin for insomnia, and of solifenacin succinate and transcutaneous tibial nerve stimulation for urinary symptoms. A number of new smaller or open trials as well as post-hoc analyses of randomized, controlled trials have suggested usefulness of other treatments, and new randomized, controlled trials are currently ongoing.
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Affiliation(s)
- Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, United Kingdom
| | - Anna Sauerbier
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
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25
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Maier F, Lewis CJ, Horstkoetter N, Eggers C, Dembek TA, Visser-Vandewalle V, Kuhn J, Zurowski M, Moro E, Woopen C, Timmermann L. Subjective perceived outcome of subthalamic deep brain stimulation in Parkinson's disease one year after surgery. Parkinsonism Relat Disord 2016; 24:41-7. [DOI: 10.1016/j.parkreldis.2016.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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26
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Magnard R, Vachez Y, Carcenac C, Krack P, David O, Savasta M, Boulet S, Carnicella S. What can rodent models tell us about apathy and associated neuropsychiatric symptoms in Parkinson's disease? Transl Psychiatry 2016; 6:e753. [PMID: 26954980 PMCID: PMC4872443 DOI: 10.1038/tp.2016.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022] Open
Abstract
In addition to classical motor symptoms, Parkinson's disease (PD) patients display incapacitating neuropsychiatric manifestations, such as apathy, anhedonia, depression and anxiety. These hitherto generally neglected non-motor symptoms, have gained increasing interest in medical and scientific communities over the last decade because of the extent of their negative impact on PD patients' quality of life. Although recent clinical and functional imaging studies have provided useful information, the pathophysiology of apathy and associated affective impairments remains elusive. Our aim in this review is to summarize and discuss recent advances in the development of rodent models of PD-related neuropsychiatric symptoms using neurotoxin lesion-based approaches. The data collected suggest that bilateral and partial lesions of the nigrostriatal system aimed at inducing reliable neuropsychiatric-like deficits while avoiding severe motor impairments that may interfere with behavioral evaluation, is a more selective and efficient strategy than medial forebrain bundle lesions. Moreover, of all the different classes of pharmacological agents, D2/D3 receptor agonists such as pramipexole appear to be the most efficient treatment for the wide range of behavioral deficits induced by dopaminergic lesions. Lesion-based rodent models, therefore, appear to be relevant tools for studying the pathophysiology of the non-motor symptoms of PD. Data accumulated so far confirm the causative role of dopaminergic depletion, especially in the nigrostriatal system, in the development of behavioral impairments related to apathy, depression and anxiety. They also put forward D2/D3 receptors as potential targets for the treatment of such neuropsychiatric symptoms in PD.
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Affiliation(s)
- R Magnard
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Y Vachez
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - C Carcenac
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - P Krack
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Grenoble, France
| | - O David
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - M Savasta
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Boulet
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Carnicella
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Inserm U1216, Grenoble Institute of Neuroscience, Site Santé La Tronche - BP 170, 38042 Grenoble, France. E-mail:
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