Staying hidden: The burden of stigma in PD

Development and validation of the DBS-PS (Deep Brain Stimulation-Perception Scale): Assessing parkinsonian patients' expectations to prevent post-operative disappointment?

BACKGROUND

Recent literature suggests that taking into consideration and evaluating preoperative expectations of Parkinson's disease (PD) patients candidates to deep brain stimulation (DBS), can contribute to treatment effectiveness. However, few validated instruments investigating preoperative expectations are available. We present the development and validation of the DBS-PS (Deep Brain Stimulation - Perception Scale).

METHODS

The DBS-PS is an 11 questions self-administered scale, with answers rated on a 10-point Likert scale (1 completely false, 10 completely true). Items were generated on the basis of patient's interviews analyzed by an expert group and reached consensus. The scale is divided into three domains: expectations for PD, expectations for social-life and leisure, expectations for intimate life. Exploratory factor analysis (EFA) completed by item response theory (IRT) analysis was conducted to validate the theoretical structure of the DBS-PS.

RESULTS

64 PD patients aged 59.18 (SD = 5.74) years with PD diagnosed since 9.36 (SD = 4.09) years completed the DBS-PS preoperatively. EFA confirmed a 3 factors scale structure (eigenvalue >1) explaining 69% of variance (factor 1: 43%; factor 2: 17%; factor 3: 9%). Reliability (Cronbach's α: 0.714 for factor 1, 0.781 for factor 2, 0.889 for factor 3) and discriminant validity (Pearson coefficient r < 0.50) were satisfactory. IRT showed good model fit, preserved unidimensionality, but some local dependences were observed.

CONCLUSION

The DBS-PS shows satisfactory psychometric properties. It is easy to administer in routine practice with preoperative PD patients. It constitutes an interesting basis for cognitive restructuring before neurosurgery, by highlighting dysfunctional cognitions and measuring the benefits of cognitive restructuring therapy.

Improving Conversations about Parkinson's Dementia

BACKGROUND

People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia.

OBJECTIVES

To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia.

METHODS

We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources.

RESULTS

While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals.

CONCLUSION

Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia.

Discordance between Reports of Internalized Symptoms in Persons with Parkinson's Disease and Informants: Results from an Online Survey

BACKGROUND

Self-report of motor and non-motor symptoms is integral to understanding daily challenges of persons with Parkinson's disease (PwPD). Care partners are often asked to serve as informants regarding symptom severity, raising the question of concordance with PwPD self-reports, especially regarding internalized (not outwardly visible) symptoms.

OBJECTIVES

Concordance between PwPD and informant ratings of motor and non-motor symptoms was evaluated across multiple domains.

METHODS

In 60 PwPD-informant pairs, we compared ratings on 11 online self-report measures comprising 33 total scores, 2/3 of which represented purely internalized symptoms. For discordant scores, multiple regression analyses were used to examine demographic/clinical predictors.

RESULTS

Though concordant on 85% of measures, PwPD endorsed more non-motor symptoms, bodily discomfort, stigma, and motor symptoms than informants. For PwPD, younger age, greater disease severity, and female gender predicted discordance.

CONCLUSIONS

Discordance between PwPD and informants on measures assessing symptoms that cannot be outwardly observed may require targeted education.

Compassionate mind training for people with Parkinson's disease: A pilot study and predictors of response

INTRODUCTION

People with Parkinson's disease (PD) often present with disabling neuropsychiatric symptoms. Compassionate mind training (CMT) is a psychological approach effective in reducing stress and promoting psychological well-being. Heart rate variability (HRV), a measure reflecting sympathovagal balance, has been associated with psychological well-being and a compassionate attitude.

AIM

To assess the feasibility and effectiveness of CMT in enhancing the quality of life and psychological well-being in PD patients. Additionally, we evaluated HRV as a physiomarker for assessing the CMT outcomes.

METHODS

Twenty-four PD patients participated in the study. A 6-week online CMT intervention was delivered on a weekly basis. At baseline and post-intervention patients completed questionnaires assessing depression, anxiety and quality of life. In a subsample of 11 patients, HRV was measured at baseline and post-intervention in three conditions: at rest, during stress and after 3 min of deep breathing.

RESULTS

The attendance rate was 94.3%. Quality of life and perceived stigma improved post-intervention as compared with baseline (p = 0.02 and p = 0.03 for PD Questionnaire-39 total score and Stigma subscore, respectively). After CMT, patients presented better physiological regulation to stress, as measured by higher HRV as compared with baseline (p = 0.005). Notably, patients who were more resilient to stress at baseline (less decrease in HRV during stress) experienced a more substantial reduction in anxiety and depression following CMT.

CONCLUSIONS

CMT is feasible and can improve quality of life and stigma in PD patients. HRV emerges as a promising physiomarker for predicting and measuring the outcomes of psychological interventions in PD.

Self-perceived stigma in Parkinson's Disease in an online sample: Comparison with in-person sample, role of anxiety, and relative utility of four measures of stigma perception

OBJECTIVE

Persons with Parkinson's disease (PwPD) experience motor and non-motor symptoms that may elicit stigmatization. We investigated whether online assessment would replicate in-person findings of younger age and depression as predictors of stigma perception. We further assessed the predictive value of anxiety, and compared predictors across four stigma measures.

METHODS

The online study (n = 347), like the earlier in-person study (n = 362), used the Parkinson's Disease Questionnaire stigma subscale (PDQ-39stigma). It also assessed anxiety and added the Stigma Scale for Chronic Illness (SSCI), Stigmatization Scale, and Mental Health Consumers' Experience of Stigma Scale. We correlated stigma perception scores with demographic/clinical characteristics and conducted hierarchical regression and mediation analyses.

RESULTS

Online and in-person predictors of stigma perception with the PDQ-39stigma included younger age (men) and depression (men, women). Depression mediated the relation between stigma perception and motor experiences of daily living (EDLs). In the online sample, when anxiety was added, it predicted stigma perception (PDQ-39stigma, SSCI) and mediated the relation between stigma and both motor and non-motor EDLs (PDQ-39stigma). For all four stigma-perception scales, younger age predicted scores. Multiple additional predictors of PDQ-39stigma and SSCI scores suggest their utility relative to the other two scales. Conclusions: Younger age and depression predicted self-perceived stigma in online and in-person samples, indicating the cross-modal utility of the measure, PDQ-39stigma. In the online sample, anxiety also predicted stigma perception per the PDQ-39stigma and SSCI. We recommend both measures and note that treating depression and anxiety may be important especially in younger PwPD to reduce self-perceived stigma.