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Giardini M, Turcato AM, Arcolin I, Corna S, Godi M. Vertical Ground Reaction Forces in Parkinson's Disease: A Speed-Matched Comparative Analysis with Healthy Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 24:179. [PMID: 38203042 PMCID: PMC10781249 DOI: 10.3390/s24010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
This study aimed to investigate and compare the vertical Ground Reaction Forces (vGRFs) of patients with Parkinson's Disease (PwPD) and healthy subjects (HS) when the confounding effect of walking speed was absent. Therefore, eighteen PwPD and eighteen age- and linear walking speed-matched HS were recruited. Using plantar pressure insoles, participants walked along linear and curvilinear paths at self-selected speeds. Interestingly, PwPD exhibited similar walking speed to HS during curvilinear trajectories (p = 0.48) and similar vGRF during both linear and curvilinear paths. In both groups, vGRF at initial contact and terminal stance was higher during linear walking, while vGRF at mid-stance was higher in curvilinear trajectories. Similarly, the time to peak vGRF at each phase showed no significant group differences. The vGRF timing variability was different between the two groups, particularly at terminal stance (p < 0.001). In conclusion, PwPD and HS showed similar modifications in vGRF and a similar reduction in gait speed during curvilinear paths when matched for linear walking speed. This emphasized the importance of considering walking speed when assessing gait dynamics in PwPD. This study also suggests the possibility of the variability of specific temporal measures in differentiating the gait patterns of PwPD versus those of HS, even in the early stages of the disease.
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Affiliation(s)
- Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Anna Maria Turcato
- Rehabilitation Department, The Clavadel—The Geoghegan Group, 1 Pit Farm Road, Guildford GU1 2JH, Surrey, UK;
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
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Henriksen T, Katzenschlager R, Bhidayasiri R, Staines H, Lockhart D, Lees A. Practical use of apomorphine infusion in Parkinson's disease: lessons from the TOLEDO study and clinical experience. J Neural Transm (Vienna) 2023; 130:1475-1484. [PMID: 37658155 PMCID: PMC10645621 DOI: 10.1007/s00702-023-02686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023]
Abstract
Subcutaneous apomorphine infusion is a device-aided therapy for Parkinson's disease that can be considered when motor fluctuations become persistent and are no longer adequately controlled by oral/transdermal medication. Apomorphine infusion is less invasive than enteral levodopa, deep brain stimulation or focused ultrasound, and is often indicated even when neurosurgical approaches are contraindicated. This article aims to provide practical guidance for doctors and nurses initiating and treating patients with apomorphine infusion, and is based on both trial data and clinical experience from movement disorders specialists. A post hoc analysis of data from the TOLEDO randomized clinical trial of apomorphine infusion was conducted along with an analysis of 'real world' experience from 13 movement disorders specialists using a questionnaire that focused on starting patients on apomorphine infusion. Practical guidelines for starting treatment with apomorphine infusion are provided taking into consideration the regional disparities in healthcare. Apomorphine infusion is straightforward to administer but to be successful it requires concordance from the patient and family, and clinical support from an experienced team of doctors and nurses, particularly in the early months of treatment.
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Affiliation(s)
- Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, University Hospital of Bispebjerg, 2400, Copenhagen, Denmark.
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | | | - Donna Lockhart
- Britannia Pharmaceuticals Limited, Reading, Berkshire, UK
| | - Andrew Lees
- University College London Institute of Neurology and the National Hospital, Queen Square, London, UK
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Flatau T, Greenfield J, Dickie B, Rayner O, Matthews H, Wise J. Medical Research Charities and Biopharmaceutical Companies as Partners in Patient-Centred R&D. Pharmaceut Med 2022; 36:279-286. [PMID: 35953655 PMCID: PMC9371951 DOI: 10.1007/s40290-022-00442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
Life science research and development (R&D) companies are all too aware of the importance of patient perspectives but also of the barriers to engaging directly with patients, not least compliance, complex technical and regulatory issues, and the need to meet multifaceted expectations. Medical research charities (MRCs), highly technical and professional organisations, work directly with patients; they represent an expert resource for the science of their field, for disease-related patient advocacy issues and to advise and assist R&D companies in devising meaningful trials. The Pistoia Alliance, a non-profit organisation facilitating life sciences R&D, gathered a number of UK MRCs focused on complex lifelong conditions. The group used workshops and an opinion questionnaire for a snapshot of how the charities believe their knowledge and patient experiences could contribute insights and efficiencies to commercial R&D. MRCs argued that for chronic conditions, the patient perspective is vital in facilitating and de-risking trials, promoting patient motivation, compliance and study viability. MRCs and the patients they represent want to see successful trials, and it is in everyone’s interest that well considered studies can proceed. Today, with remote assessments, consumer wearables and digital health technologies, MRCs and patients are already collating substantial data sets that are relevant to quality-of-life benefits, regulatory and value assessments, all of great interest to biopharmaceutical companies. In turn, MRCs would benefit from the experience of biopharma in generating clinical data and implementing novel technologies.
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Affiliation(s)
| | | | - Brian Dickie
- Motor Neurone Disease Association, Northampton, UK
| | - Oli Rayner
- Rare disease patient advocate with Cystic Fibrosis, Plymouth, UK
| | | | - John Wise
- The Pistoia Alliance, 401 Edgewater Pl, Wakefield, Massachusetts, 01880, USA.
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Read J, Frost R, Walters K, Tuijt R, Manthorpe J, Maydon B, Pigott J, Schrag A, Davies N. Transitions and challenges for people with Parkinson's and their family members: A qualitative study. PLoS One 2022; 17:e0268588. [PMID: 35849560 PMCID: PMC9292070 DOI: 10.1371/journal.pone.0268588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/02/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore the experiences and challenges of people with Parkinson's and their family members living in the community through the lens of their transitions to better understand the phases and changes in their lives. DESIGN Qualitative study using semi-structured interviews and analysed using codebook thematic analysis. SETTING/PARTICIPANTS Purposive sampling was used in primary and secondary healthcare services across Southern England in 2019 to recruit 21 people with Parkinson's (aged between 45-89 years) and 17 family members (13 spouses and 4 adult children, aged between 26-79 years). RESULTS Participants' descriptions were classified in three main phases of transition from a place of health towards greater dependency on others: 1) 'Being told you are a person with Parkinson's' (early), 2) 'Living with Parkinson's' (mid), and 3) 'Increasing dependency' (decline). Seven sub-themes were identified to describe the transitions within these three phases: phase 1: receiving and accepting a diagnosis; navigating reactions; phase 2: changing social interactions and maintaining sense of self; information: wanting to know but not wanting to know; finding a place within the healthcare system; and 3: changes in roles and relationships; and increasingly dependent. CONCLUSION This study has identified points of change and means of supporting key transitions such as diagnosis, changes in social connections, and increased use of secondary healthcare services so that comprehensive, holistic, individualised and well-timed support can be put in place to maintain well-being.
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Affiliation(s)
- Joy Read
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Remco Tuijt
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London, London, United Kingdom
| | - Bev Maydon
- Member of Patient and Public Involvement (PPI Group), London, United Kingdom
| | - Jennifer Pigott
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- * E-mail:
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Non-motor symptoms in Parkinson's disease: Opening new avenues in treatment. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2021. [DOI: 10.1016/j.crbeha.2021.100049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Kozáková R, Bužgová R, Bártová P, Ressner P. Unmet needs of people with Parkinson's disease. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2020.11.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Social listening - revealing Parkinson's disease over day and night. BMC Neurol 2021; 21:2. [PMID: 33397315 PMCID: PMC7780378 DOI: 10.1186/s12883-020-02024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background Nocturnal symptoms in Parkinson’s disease are often treated after management of daytime manifestations. In order to better understand the unmet needs of nocturnal symptoms management, we analyzed the characteristics and burden of nocturnal symptoms from patients’ perspectives and explored their changes over time. Overall symptoms (occurring at day or night) were collected to compare whether the unmet needs related to nocturnal symptoms and to overall symptoms are different. Methods We used a Social Listening big-data technique to analyze large amounts of Parkinson’s disease symptoms in dialogues available from social media platforms in 2016 to 2018. These symptoms were classified as either overall symptoms or nocturnal symptoms. We used share of voice (SOV) of symptoms as a proportion of total dialogues per year to reflect the characteristics of symptoms. Negative sentiment score of symptoms was analyzed to find out their related burden. Results We found the SOV for overall motor symptoms was 79% and had not increased between 2016 and 2018 (79%, p = 0.5). The SOV for non-motor symptoms was 69% and had grown by 7% in 2018 (p < 0.01). The SOV for motor complications was 9% and had increased by 6% in 2018 (p < 0.01). The SOV of motor symptoms was larger than non-motor symptoms and motor complications (p < 0.01). The SOV of non-motor symptoms was larger than motor complications (p < 0.01). For nocturnal symptoms, 45% of the analyzed PD population reported nocturnal symptoms in 2018, growing by 6% (p < 0.01). The SOV for nocturnal-occurring motor symptoms was higher than most non-motor symptoms. However, non-motor symptoms had the higher increases and evoked higher negative sentiment regardless of whether they occurred during the day or night. For symptoms that can occur at either day or night, each nocturnal symptom was rated with a higher negative sentiment score than the same symptom during the day. Conclusions The growing SOV and the greater negative sentiment of nocturnal symptoms suggest management of nocturnal symptoms is an unmet need of patients. A greater emphasis on detecting and treating nocturnal symptoms with 24-h care is encouraged. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-02024-4.
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Bhidayasiri R, Phokaewvarangkul O, Sakdisornchai K, Boonpang K, Chaudhuri KR, Parsons J, Lolekha P, Chairangsaris P, Srivanitchapoom P, Benedierks S, Panyakaew P, Boonmongkol T, Thongchuam Y, Kantachadvanich N, Phumphid S, Evans AH, Viriyavejakul A, Pisarnpong A, van Laar T, Jagota P. Establishing apomorphine treatment in Thailand: understanding the challenges and opportunities of Parkinson's disease management in developing countries. Expert Rev Neurother 2020; 20:523-537. [PMID: 32421371 DOI: 10.1080/14737175.2020.1770598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The increasing global burden of Parkinson's disease (PD) poses a particular challenge for developing countries, such as Thailand, when delivering care to a geographically diverse populace with limited resources, often compounded by a lack of expertise in the use of certain PD medications, such as device-aided therapies (DAT). AREAS COVERED A panel of local, regional, and international PD experts convened to review the unmet needs of PD in Thailand and share insights into effective delivery of DAT, focusing on experience with apomorphine infusion. Despite its proven efficacy and safety, implementation of apomorphine infusion as a new option was not straightforward. This has prompted a range of health-care professional and patient-focused initiatives, led by the Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders in Bangkok, to help establish a more coordinated approach to PD management throughout the country and ensure patients have access to suitable treatments. EXPERT OPINION Overcoming the challenges of education, proficiency, resource capacity and standard of care for PD patients in developing countries requires a coordinated effort both nationally and beyond. The best practices identified in Thailand following the introduction of apomorphine infusion might be helpful for other countries when implementing similar programs.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Karn Sakdisornchai
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Jan Parsons
- The Walton Centre for Neurology and Neurosurgery , Liverpool, UK
| | - Praween Lolekha
- Division of Neurology, Department of Medicine, Thammasat University Hospital , Pathumthani, Thailand
| | - Parnsiri Chairangsaris
- Division of Neurology, Department of Medicine, Phra Mongkutklao Hospital , Bangkok, Thailand
| | - Prachaya Srivanitchapoom
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | | | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Thanatat Boonmongkol
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Yuwadee Thongchuam
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Nitinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Andrew H Evans
- Department of Neurology, Royal Melbourne Hospital , Melbourne, Australia
| | | | - Apichart Pisarnpong
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Teus van Laar
- Department of Neurology, University of Groningen , Groningen, The Netherlands
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
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Read J, Cable S, Löfqvist C, Iwarsson S, Bartl G, Schrag A. Experiences of health services and unmet care needs of people with late-stage Parkinson's in England: A qualitative study. PLoS One 2019; 14:e0226916. [PMID: 31887175 PMCID: PMC6936884 DOI: 10.1371/journal.pone.0226916] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/06/2019] [Indexed: 12/20/2022] Open
Abstract
AIM To explore experiences of health services and unmet care needs by people with late-stage Parkinson's in England. METHOD Ten participants, at Hoehn and Yahr stage 4 or 5, were interviewed using semi-structured open-ended questions. Data were analysed using qualitative thematic analysis. FINDINGS Participants reported that whilst under the treatment of specialist hospitals, the majority of care provision had shifted into the community, often because hospital-based services were felt to be difficult to access and have limited benefit to them. When using health-care services, participants frequently experienced having to 'fit-in' to service structures that did not always accommodate their complex needs. Despite high levels of disability, participants expressed their desire to maintain their identity, normality of interests and activities in their lives, including remaining in their own homes. This was facilitated by bespoke care and equipment, and positive relationships with care providers. Knowledge on disease management was a key factor in their perceived ability to remain in control. Family caregivers had a central role in facilitating care at home. There was uncertainty about and little planning for the future, and moving to a residential nursing home was perceived an undesirable but potentially necessary option for future care. CONCLUSION Unmet care needs identified by people with late stage Parkinson's in England include greater flexibility of healthcare structures and bespoke service provision, to accommodate their individual complex needs. Support in their own homes and positive relationships with healthcare providers help People with Parkinson's (PwP) to maintain a degree of normality and identity, and provision of information help them maintain some control. There is a need for more informed discussions on future care planning for this specific population.
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Affiliation(s)
- Joy Read
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Sarah Cable
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | | | | | - Gergely Bartl
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
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van Wamelen DJ, Hota S, Podlewska A, Leta V, Trivedi D, Rizos A, Parry M, Chaudhuri KR. Non-motor correlates of wrist-worn wearable sensor use in Parkinson's disease: an exploratory analysis. NPJ PARKINSONS DISEASE 2019; 5:22. [PMID: 31602393 PMCID: PMC6775049 DOI: 10.1038/s41531-019-0094-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/30/2019] [Indexed: 01/08/2023]
Abstract
Wearable sensors are becoming increasingly more available in Parkinson’s disease and are used to measure motor function. Whether non-motor symptoms (NMS) can also be measured with these wearable sensors remains unclear. We therefore performed a retrospective, exploratory, analysis of 108 patients with a diagnosis of idiopathic Parkinson’s disease enroled in the Non-motor Longitudinal International Study (UKCRN No. 10084) at King’s College Hospital, London, to determine the association between the range and nature of NMS and an accelerometer-based outcome measure of bradykinesia (BKS) and dyskinesia (DKS). NMS were assessed by the validated NMS Scale, and included, e.g., cognition, mood and sleep, and gastrointestinal, urinary and sexual problems. Multiple linear regression modelling was used to identify NMS associated with BKS and DKS. We found that BKS was associated with domains 6 (gastrointestinal tract; p = 0.006) and 8 (sexual function; p = 0.003) of the NMS scale. DKS was associated with domains 3 (mood/cognition; p = 0.016), 4 (perceptual problems; p = 0.025), 6 (gastrointestinal tract; p = 0.029) and 9 (miscellaneous, p = 0.003). In the separate domains, constipation was significantly associated with BKS. Delusions, dysphagia, hyposmia, weight change and hyperhidrosis were identified as significantly associated with DKS. None of the NMSS domains were associated with disease duration (p ≥ 0.08). In conclusion, measures of BKS and DKS were mainly associated with gastrointestinal problems, independent of disease duration, showing the potential for wearable devices to pick up on these symptoms. These exploratory results deserve further exploration, and more research on this topic in the form of comprehensive large-scale studies is needed.
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Affiliation(s)
- Daniel J van Wamelen
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK.,3Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Shweta Hota
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Aleksandra Podlewska
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK.,4School of Psychology, University of Kent, Canterbury, CT2 7PM Kent, UK
| | - Valentina Leta
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK.,University of Milan, L. Sacco Hospital, Milan, Italy
| | - Dhaval Trivedi
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK
| | - Alexandra Rizos
- 2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK
| | - Miriam Parry
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK
| | - K Ray Chaudhuri
- 1King's College London, Department of neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF UK.,2Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS UK
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Seeber AA, Pols AJ, Hijdra A, Grupstra HF, Willems DL, de Visser M. Advance care planning in progressive neurological diseases: lessons from ALS. BMC Palliat Care 2019; 18:50. [PMID: 31196046 PMCID: PMC6567602 DOI: 10.1186/s12904-019-0433-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is increasing awareness of the need for an integrated palliative care approach in chronic progressive neurological diseases. Advance care planning (ACP) is an integral part of this approach. As a systematically organized and ongoing communication process about patients’ values, goals and preferences regarding medical care during serious and chronic illness, ACP aims to involve patients in decision-making before they become cognitively and communicatively incapable. However, it remains underutilized in daily neurological practice except for speciality clinics such as ALS centers. Our aim was to study ACP in the tertiary ALS center Amsterdam and to investigate patients’ reflections on it. Subsequently we used this knowledge to formulate recommendations for integration of ACP in the care of patients with other chronic progressive neurological diseases. Methods Non-participating observations of all appointments of patients with amyotrophic lateral sclerosis (ALS) or progressive muscular atrophy (PMA) with the treating physician, in various stages of disease, during 6 consecutive months, followed by single in-depth interviews, and an inductive analysis. Results Twenty-eight Dutch patients participated, varying in age, gender, disease onset and severity of physical decline. ACP started directly when the diagnosis was given, by means of a general outlook on the future with progressive disability and immediate introduction to a customized multidisciplinary team. During follow-up ACP was realized by regular appointments in which monitoring of the patient’s status and clear communication strategies formed the basis of tailor-made discussions on treatment options. Patients accepted this policy as careful professional guidance. Conclusions ACP is a professional communication process throughout the whole course of progressive disease. It is feasible to integrate ACP into follow-up of patients with ALS and PMA from diagnosis onwards. Supported by recent literature, we argue that such a well-structured approach would also enhance the quality of care and life of patients with other chronic progressive neurological diseases. Electronic supplementary material The online version of this article (10.1186/s12904-019-0433-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. .,Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands.
| | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Albert Hijdra
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Hepke F Grupstra
- Department of Rehabilitation, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Bužgová R, Kozáková R, Juríčková L. The unmet needs of family members of patients with progressive neurological disease in the Czech Republic. PLoS One 2019; 14:e0214395. [PMID: 30908542 PMCID: PMC6433266 DOI: 10.1371/journal.pone.0214395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/11/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caring for patients with a progressive neurological disease (PND) causes stress that may impact on the state of health as well as the quality of life of the caring family. OBJECTIVE The aim of the study was to explore the unmet needs of the family members of patients with PND in advanced stages. METHODS Grounded theory (constructivist approach) was used to conceptualize the patterns of unmet care needs. Data collection methodology involved focus groups (n = 4) and interviews, in which a total of 52 people participated (patients, family members, and professionals). RESULTS Based on the data analysis, three domains (family situation, role of the caregiver, and professional help) were identified, which illustrate the unmet needs. In particular, lack of information about the disease and available support available resulted in a deterioration mutual understanding between the patient, family, and the medical staff; also increased stress for the caregiver, and lowered quality of life for the caring family. CONCLUSION Family members expect health workers to provide them with support, which includes informing them about the possible help available from the health and social welfare systems.
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Affiliation(s)
- Radka Bužgová
- Department of Nursing and Midwifery, Faculty of medicine, University of Ostrava, Ostrava, Czech Republic
| | - Radka Kozáková
- Department of Nursing and Midwifery, Faculty of medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lubica Juríčková
- Department of Nursing and Midwifery, Faculty of medicine, University of Ostrava, Ostrava, Czech Republic
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Walter HAW, Seeber AA, Willems DL, de Visser M. The Role of Palliative Care in Chronic Progressive Neurological Diseases-A Survey Amongst Neurologists in the Netherlands. Front Neurol 2019; 9:1157. [PMID: 30692960 PMCID: PMC6340288 DOI: 10.3389/fneur.2018.01157] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic progressive neurological diseases like high grade glioma (HGG), Parkinson's disease (PD), and multiple sclerosis (MS) are incurable, and associated with increasing disability including cognitive impairment, and reduced life expectancy. Patients with these diseases have complex care needs. Therefore, timely advance care planning (ACP) is required. Our aim was to investigate timing and content of discussions on treatment restrictions, i.e., to initiate, withhold, or withdraw treatment in patients with HGG, PD, and MS, from the neurologists' perspective. Methods: We performed a national online survey amongst consultants in neurology and residents in The Netherlands. The questionnaire focused on their daily practice concerning timing and content of discussions on treatment restrictions with patients suffering from HGG, PD or MS. We also inquired about education and training in discussing these issues. Results: A total of 125 respondents [89 neurologists (71%), 62% male, with a median age of 44 years, and 36 residents (29%), 31% male with a median age of 29 years] responded. Initial discussions on treatment restrictions were said to take place during the first year after diagnosis in 28% of patients with HGG, and commonly no earlier than in the terminal phase in patients with PD and MS. In all conditions, significant cognitive decline was the most important trigger to advance discussions, followed by physical decline, and initiation of the terminal phase. Most discussed issues included ventilation, resuscitation, and admission to the intensive care unit. More than half of the consultants in neurology and residents felt that they needed (more) education and training in having discussions on treatment restrictions. Conclusion: In patients with HGG discussions on treatment restrictions are initiated earlier than in patients with PD or MS. However, in all three diseases these discussions usually take place when significant physical and cognitive decline has become apparent and commonly mark the initiation of end-of-life care. More than half of the responding consultants in neurology and residents feel the need for improvement of their skills in performing these discussions.
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Affiliation(s)
- Hannah A W Walter
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Chaudhuri KR, Titova N. Societal Burden and Persisting Unmet Needs of Parkinson’s Disease. ACTA ACUST UNITED AC 2019. [DOI: 10.17925/enr.2019.14.1.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Crowley EK, Nolan YM, Sullivan AM. Exercise as a therapeutic intervention for motor and non-motor symptoms in Parkinson's disease: Evidence from rodent models. Prog Neurobiol 2018; 172:2-22. [PMID: 30481560 DOI: 10.1016/j.pneurobio.2018.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/25/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) is characterised by degeneration of dopaminergic neurons of the nigrostriatal pathway, which leads to the cardinal motor symptoms of the disease - tremor, rigidity and postural instability. A number of non-motor symptoms are also associated with PD, including cognitive impairment, mood disturbances and dysfunction of gastrointestinal and autonomic systems. Current therapies provide symptomatic relief but do not halt the disease process, so there is an urgent need for preventative strategies. Lifestyle interventions such as aerobic exercise have shown potential to lower the risk of developing PD and to alleviate both motor and non-motor symptoms. However, there is a lack of large-scale randomised clinical trials that have employed exercise in PD patients. This review will focus on the evidence from studies on rodent models of PD, for employing exercise as an intervention for both motor and non-motor symptoms.
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Affiliation(s)
- E K Crowley
- Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - Y M Nolan
- Department of Anatomy and Neuroscience, University College Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland
| | - A M Sullivan
- Department of Anatomy and Neuroscience, University College Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland.
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Marshall LJ, Willett C. Parkinson's disease research: adopting a more human perspective to accelerate advances. Drug Discov Today 2018; 23:1950-1961. [PMID: 30240875 DOI: 10.1016/j.drudis.2018.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/20/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) affects 1% of the population over 60 years old and, with global increases in the aging population, presents huge economic and societal burdens. The etiology of PD remains unknown; most cases are idiopathic, presumed to result from genetic and environmental risk factors. Despite 200 years since the first description of PD, the mechanisms behind initiation and progression of the characteristic neurodegenerative processes are not known. Here, we review progress and limitations of the multiple PD animal models available and identify advances that could be implemented to better understand pathological processes, improve disease outcome, and reduce dependence on animal models. Lessons learned from reducing animal use in PD research could serve as guideposts for wider biomedical research.
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Affiliation(s)
- Lindsay J Marshall
- Humane Society International, The Humane Society of the United States, 700 Professional Drive, Gaithersburg, MD 20879, USA
| | - Catherine Willett
- Humane Society International, The Humane Society of the United States, 700 Professional Drive, Gaithersburg, MD 20879, USA.
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