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Gottesman J, Karim Y, Forbes J, Kirsch L, Stagman K, Korell M, Tanner C. Fox Insight at 5 years - a cohort of 54,000 participants contributing longitudinal patient-reported outcome, genetic, and microbiome data relating to Parkinson's disease. Sci Data 2024; 11:615. [PMID: 38866856 PMCID: PMC11169221 DOI: 10.1038/s41597-024-03407-9] [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: 01/30/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
Fox Insight is an online, longitudinal study of over 54,000 people with and without Parkinson's disease, facilitating discovery, validation, and reproducibility in Parkinson's disease research. The study administers routine longitudinal assessments, one-time questionnaires on an array of topics such as environmental exposure or COVID-19, plus genetic and microbiome data collection. Researchers can explore and download patient-reported outcomes data and Parkinson's disease related genetic variants upon completing a Data Use Agreement. The full genetic data set, including approximately 650,000 single nucleotide polymorphisms for over 10,000 participants, and the microbiome data set for over 650 participants, can be requested with a heightened level of access. Since the first Fox Insight data descriptor was published in 2020, the data captured has been extended significantly, so this paper supersedes the previous one. Since then, the number of participants has increased by more than 20,000; an additional 1,747,729 surveys were completed; 130 gigabytes of genetic data were released; responses from 16 new one-time surveys were collected; and, data from one additional sub-study was made available.
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Affiliation(s)
- Joshua Gottesman
- The Michael J. Fox Foundation for Parkinson's Research, New York, USA.
| | - Yasir Karim
- The Michael J. Fox Foundation for Parkinson's Research, New York, USA
| | | | - Leslie Kirsch
- The Michael J. Fox Foundation for Parkinson's Research, New York, USA
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Briggs FBS, Gunzler DD, Gunzler SA. A person-centered approach to characterizing longitudinal ambulatory impairment in Parkinson's disease. Sci Rep 2024; 14:11509. [PMID: 38769128 PMCID: PMC11106289 DOI: 10.1038/s41598-024-62179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
Loss of ambulation is common and highly variable in Parkinson's disease (PD), and poorly understood from the perspectives of those with PD. Gaining insights to the anticipated perceived trajectories and their drivers, will facilitate patient-centered care. Latent class growth analysis, a person-centered mixture modelling approach, was applied to 16,863 people with PD stratified by early (N = 8612; < 3 years), mid (N = 6181; 3-10 years) and later (N = 2070; > 10 years) disease to discern clusters with similar longitudinal patterns of self-reported walking difficulty, measured by EuroQoL 5D-5L that is validated for use in PD. There were four clusters in early and mid-disease strata, with a fifth identified in later disease. Trajectories ranged from none to moderate walking difficulty, with small clusters with severe problems. The percentage of subjects with moderate (early = 17.5%, mid = 26.4%, later = 32.5%) and severe (early = 3.8%, mid = 7.4%, later = 15.4%) walking difficulty at baseline increased across disease duration groups. The trajectories tended to be stable with variability in moderate and severe groups. Across strata, clusters with moderate to severe problems were associated with more severe impairment, depression, anxiety, arthritis, higher BMI, lower income, and lower education, but no consistent race or gender differences. The findings reveal distinct longitudinal patterns in perceived difficulties in walking in PD.
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Affiliation(s)
- Farren B S Briggs
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1140 NW 14th St, 912 Don Soffer Clinical Research Center, Miami, FL, 33136, USA.
| | - Douglas D Gunzler
- Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Steven A Gunzler
- Neurological Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Weintraub D, Marras C, Amara A, Anderson KE, Chahine LM, Eberly S, Hosamath A, Kinel D, Mantri S, Mathur S, Oakes D, Purks JL, Standaert DG, Shoulson I, Arbatti L. Association between Subjective Cognitive Complaints and Incident Functional Impairment in Parkinson's Disease. Mov Disord 2024; 39:706-714. [PMID: 38318953 DOI: 10.1002/mds.29725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early identification of subjective cognitive complaints (SCC) in Parkinson's disease (PD) may improve patient care if it predicts cognition-related functional impairment (CFI). OBJECTIVES The aim was to determine the cross-sectional and longitudinal association between SCC and CFI in PD. METHODS Data were obtained from Fox Insight, an online longitudinal study that collects PD patient-reported outcomes. Participants completed a PD Patient Report of Problems that asked participants for their five most bothersome disease problems. SCCs were placed into eight categories through human-in-the-loop curation and classification. CFI had a Penn Parkinson's Daily Activities Questionnaire (PDAQ-15) score ≤49. Cox proportional hazards models and Kaplan-Meier survival analyses determined if baseline SCC was associated with incident CFI. RESULTS The PD-PROP cohort (N = 21,160) was 55.8% male, mean age was 65.9 years, and PD duration was 4.8 years. At baseline, 31.9% (N = 6750) of participants reported one or more SCCs among their five most bothersome problems, including memory (13.2%), language/word finding (12.5%), and concentration/attention (9.6%). CFI occurred in 34.7% (N = 7332) of participants. At baseline, SCC was associated with CFI (P-value <0.001). SCC at baseline was associated with incident CFI (hazard ratio [HR] = 1.58 [95% confidence interval: 1.45, 1.72], P-value <0.001), as did cognitive impairment not otherwise specified (HR = 2.31), executive abilities (HR = 1.97), memory (HR = 1.85), and cognitive slowing (HR = 1.77) (P-values <0.001). Kaplan-Meier curves showed that by year 3 an estimated 45% of participants with any SCC at baseline developed new-onset CFI. CONCLUSIONS Self-reported bothersome cognitive complaints are associated with new-onset CFI in PD. Remote electronic assessment can facilitate widespread use of patient self-report at population scale. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Amy Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karen E Anderson
- Departments of Psychiatry and Neurology, Georgetown University, Washington, DC, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Abhishek Hosamath
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
| | - Daniel Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | | | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Jennifer L Purks
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ira Shoulson
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Lakshmi Arbatti
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
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Schneider RB, Auinger P, Dobkin RD, Mills KA, Kulick-Soper CV, Myers TL, Korell M, Pontone GM, Nirenberg MJ. Minor Phenomena in Parkinson's Disease-Prevalence, Associations, and Risk of Developing Psychosis. J Geriatr Psychiatry Neurol 2024; 37:134-145. [PMID: 37542397 DOI: 10.1177/08919887231195220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND Minor phenomena, including passage phenomena, feeling of presence, and illusions, are common and may represent a prodromal form of psychosis in Parkinson's disease (PD). We examined the prevalence and clinical correlates of minor phenomena, and their potential role as a risk factor for PD psychosis. METHODS A novel questionnaire, the Psychosis and Mild Perceptual Disturbances Questionnaire for PD (PMPDQ), was completed by Fox Insight cohort participants with and without PD. Additional assessments included the Non-Motor Symptoms Questionnaire (NMSQuest), REM Sleep Behavior Disorder Single Question Screen (RBD1Q), Movement Disorder Society-Unified Parkinson Disease Rating Scale Part II, demographic features, and medication usage. For participants with PD, we used regression models to identify clinical associations and predictors of incident psychosis over one year of follow-up. RESULTS Among participants with PD (n = 5950) and without PD (n = 1879), the prevalence of minor phenomena was 43.1% and 31.7% (P < .001). Of the 3760 participants with PD and no baseline psychosis, independent correlates of minor phenomena included positive responses on the NMSQuest apathy/attention/memory (OR 1.7, 95% CI 1.3-2.1, P < .001) or sexual function domain (OR 1.3, 95% CI 1.1-1.6, P = .01) and positive RBD1Q (OR 1.3, 95% CI 1.05-1.5, P = .01). Independent risk factors for incident PD psychosis included the presence of minor phenomena (HR 3.0, 95% CI 2.4-3.9, P < .001), positive response on the NMSQuest apathy/attention/memory domain (HR 1.8, 95% CI 1.3-2.6, P < .001), and positive RBD1Q (HR 1.5, 95% CI 1.1-1.9, P = .004). CONCLUSIONS Minor phenomena are common, associated with specific non-motor symptoms, and an independent predictor of incident psychosis in PD.
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Affiliation(s)
- Ruth B Schneider
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health & Technology, University of Rochester, Rochester, NY, USA
| | - Peggy Auinger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health & Technology, University of Rochester, Rochester, NY, USA
| | - Roseanne D Dobkin
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Kelly A Mills
- Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Taylor L Myers
- Center for Health & Technology, University of Rochester, Rochester, NY, USA
| | - Monica Korell
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gregory M Pontone
- Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa J Nirenberg
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tamplin J, Haines SJ, Baker FA, Sousa TV, Thompson Z, Crouch H, Dunn S, Tull V, Vogel AP, Morris ME. ParkinSong Online: Feasibility of Telehealth Delivery and Remote Data Collection for a Therapeutic Group Singing Study in Parkinson's. Neurorehabil Neural Repair 2024; 38:122-133. [PMID: 38156662 PMCID: PMC10874111 DOI: 10.1177/15459683231219269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Parkinson's disease can negatively affect vocal functioning and social wellbeing, particularly in the latter stages of disease progression. Face-to-face group singing interventions can improve communication and wellbeing outcomes, yet not all people can access in-person sessions. To help overcome barriers to participation, exploration of the feasibility and utility of online therapeutic singing programs is needed. OBJECTIVES To evaluate the feasibility, acceptability, and preliminary efficacy of a 12-week ParkinSong Online intervention on speech and wellbeing for people with Parkinson's disease. METHODS A total of 28 participants with idiopathic Parkinson's disease were recruited to a single-arm feasibility study. Weekly 90-minute online sessions were co-facilitated by a music therapist and speech pathologist. Speech and wellbeing assessments were conducted pre and post intervention. Participant and facilitator surveys were administered after each session, with focus group interviews at the end of the program. RESULTS The recruitment rate was high (90%) with no attrition, adverse events, or safety issues. There was good intervention fidelity, attendance (average 89%), and positive participant experience. Feasibility was good, with technology reported as the main challenge (connecting and navigating Zoom). No improvements were seen in voice measures or wellbeing outcomes in this small trial. The online format used in this study did not provide the same benefits as in-person ParkinSong sessions. CONCLUSIONS ParkinSong Online is feasible for recreational purposes and social engagement provided that people have adequate technological knowledge or support. The optimal online delivery format to achieve communication improvements in Parkinson's awaits confirmation.
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Affiliation(s)
- Jeanette Tamplin
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
- Royal Talbot Rehabilitation Centre, Austin Health, Melbourne, VIC, Australia
| | - Simon J. Haines
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
- School of Allied Health, Human Sciences and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Felicity A. Baker
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
- Centre for Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Tanara Vieira Sousa
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
| | - Zara Thompson
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
| | - Helen Crouch
- School of Allied Health, Human Sciences and Sport, La Trobe University, Bundoora, VIC, Australia
- Monash Health, Melbourne, Clayton, VIC, Australia
| | - Stephen Dunn
- Consumer Representative, Melbourne, VIC, Australia
| | | | - Adam P. Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, VIC, Australia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Postfach, Germany
- Redenlab, Melbourne, VIC, Australia
| | - Meg E. Morris
- Academic & Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Bundoora, VIC, Australia
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, VIC, Australia
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Bock MA, Hoang T, Cawthon P, Mackey DC, Patel S, Hillier TA, Yaffe K. Constricting Life Space and Likelihood of Neurodegenerative Disease in Community-Dwelling Older Men. JAMA Netw Open 2023; 6:e2342670. [PMID: 37943555 PMCID: PMC10636634 DOI: 10.1001/jamanetworkopen.2023.42670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023] Open
Abstract
Importance Life space is a measure of the frequency, range, and independence of movement through the environment. There is increasing interest in life space as a holistic measure of function in older adults, but the association between change in life space and incident neurodegenerative disease is unknown. Objective To evaluate the association between change in life space and cognitive decline or incident neurodegenerative disease over 7 years among community-dwelling older men. Design, Setting, and Participants In this cohort study, logistic regression analyses were used to examine the association of baseline and change in life space with change in cognition unadjusted and adjusted for demographics, cardiovascular risk factors, depression, gait speed, and physical activity. Mixed linear effects models were used to evaluate the association between change in life space and change in cognition. Men were recruited from 6 US sites to participate in a prospective, community-based cohort study of aging and followed-up from 2007 to 2014. Individuals with prevalent dementia or Parkinson disease (PD) at baseline were excluded. Data were analyzed from May 2022 to September 2023. Exposure Life space, assessed using the University of Alabama at Birmingham Life Space Assessment and divided into tertiles. Main Outcomes and Measures Participants completed the Modified Mini-Mental State (3MS) Test, and Trail-Making Test Part B at baseline and 7 years later. At follow-up, participants were asked about a new physician diagnosis of dementia and PD. Results A total of 1684 men (mean [SD] age, 77.1 [4.2] years) were recruited and over 7 years of follow-up, 80 men (4.8%) developed dementia and 23 men (1.4%) developed PD. Mean (SD) life space score was 92.9 (18.7) points and mean (SD) change was -9.9 (22.3) points over follow up. In the adjusted model, each 1-SD decrement in life space was associated with increased odds of dementia (odds ratio [OR], 1.59; 95% CI, 1.28-1.98) but not PD (OR, 1.48; 95% CI, 0.97-2.25). For each 1-SD decrement in life space, men worsened by 20.6 (95% CI, 19.8-21.1) seconds in their Trails B score (P < .001) and declined by 1.2 (95% CI, 1.0-1.3) points in their 3MS score (P < .001) over 7 years. Conclusions and Relevance In this study of 1684 men followed up over 7 years, change in life space was associated with faster cognitive decline and increased likelihood of neurodegenerative illness. Future studies should examine the role of clinician assessments or wearable electronics in tracking life space in older adults at risk of cognitive decline and neurodegenerative illness.
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Affiliation(s)
- Meredith A. Bock
- Department of Neurology, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Tina Hoang
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Peggy Cawthon
- California Pacific Medical Center Research Institute, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
- Centre for Aging SMART, Vancouver Coastal Health Research Institute and the University of British Columbia, Vancouver, Canada
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco
| | | | - Kristine Yaffe
- Department of Neurology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Psychiatry, University of California, San Francisco
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Louis ED, Berry D, Ghanem A, Cosentino SA. Conversion Rate of Essential Tremor to Essential Tremor Parkinson Disease: Data From a Prospective Longitudinal Study. Neurol Clin Pract 2023; 13:e200162. [PMID: 37256209 PMCID: PMC10226077 DOI: 10.1212/cpj.0000000000200162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 06/01/2023]
Abstract
Background and Objectives There has been a long-standing dialog as to whether essential tremor (ET) increases the risk of developing Parkinson disease (PD). While there are relevant cross-sectional data, there are almost no longitudinal prospective data. We quantified the conversion rate from ET to ETPD in a prospective longitudinal cohort study of patients with ET. We compared the observed rate with that reported in the epidemiologic literature. Methods We enrolled patients with ET in a prospective, longitudinal study. A senior movement disorders neurologist evaluated standardized neurologic examinations every 18 months. Results One hundred ninety-three patients with ET (mean age = 78.1 ± 9.6 years, range = 55-96) had a mean follow-up duration of 4.1 years. Seven (3.6%) converted from ET to ETPD. The incidence of PD among patients with ET was 7/792.9 person-years (py; i.e., 882.8/100,000 py). A meta-analysis of the incidence (per 100,000 py) of PD in 14 studies from 13 countries across 4 continents reported an incidence of PD = 61.21 (men, 40 years or older) and 37.55 (women, 40 years or older). The incidence/100,000 py in men peaked in the 80- to 89-year-old age group (258.47) and in women in the 80- to 89-year-old age group (103.48 py). The abovementioned published values are 3.4-23.5 times lower than the value we observed for ET. Discussion The incidence of PD in an ET cohort is substantially higher than that reported in historical population-based control groups across numerous countries. Additional prospective longitudinal data are needed to further explore this association.
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Affiliation(s)
- Elan D Louis
- Department of Neurology (EDL, DB, AG), University of Texas Southwestern Medical Center, Dallas, TX; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (SAC), G.H. Sergiesvky Center, and Department of Neurology, Columbia University Irving Medical Center, New York
| | - Diane Berry
- Department of Neurology (EDL, DB, AG), University of Texas Southwestern Medical Center, Dallas, TX; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (SAC), G.H. Sergiesvky Center, and Department of Neurology, Columbia University Irving Medical Center, New York
| | - Ali Ghanem
- Department of Neurology (EDL, DB, AG), University of Texas Southwestern Medical Center, Dallas, TX; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (SAC), G.H. Sergiesvky Center, and Department of Neurology, Columbia University Irving Medical Center, New York
| | - Stephanie A Cosentino
- Department of Neurology (EDL, DB, AG), University of Texas Southwestern Medical Center, Dallas, TX; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (SAC), G.H. Sergiesvky Center, and Department of Neurology, Columbia University Irving Medical Center, New York
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Bock MA, Brown EG, Zhang L, Tanner C. Association of Motor and Nonmotor Symptoms With Health-Related Quality of Life in a Large Online Cohort of People With Parkinson Disease. Neurology 2022; 98:e2194-e2203. [PMID: 35418456 PMCID: PMC9162165 DOI: 10.1212/wnl.0000000000200113] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives There is growing interest in health-related quality of life (HRQOL) as a comprehensive view of the patient's well-being, guiding concept for the treating clinician, and therapeutic trial outcome measure for patients with Parkinson disease (PwPD). The key determinants of HRQOL have not been investigated in large populations of PwPD. Our objective was to evaluate correlates of HRQOL in a large, online cohort of PwPD. Methods As part of an ongoing online cohort study, we performed a cross-sectional analysis at enrollment of 23,058 PwPD. We conducted univariate and stepwise multivariate linear regression analyses of HRQOL as measured by the EQ-5D-5L tool. In addition, we performed an interaction analysis to evaluate heterogeneity of the effect of motor symptoms on HRQOL and Spearman correlation analysis to evaluate the association of nonmotor symptoms with HRQOL. Results In the multivariate linear regression model, participants with moderate or severe depression, more severe motor symptoms, and a higher burden of medical comorbidities had the most substantially decreased HRQOL as measured by the EQ index (β −0.11, −0.18, −0.02, −0.01, respectively; p < 0.001 for all). An interaction analysis showed that more severe motor symptoms had a higher effect on individuals with female sex, lower educational level, lower income, more severe depression, or more severe cognitive impairment (p ≤ 0.01 for interaction terms). Neuropsychiatric symptoms and falls had the most negative associations with HRQOL (ρ −0.31 to 0.37; p < 0.0001). Discussion Potentially treatable motor and nonmotor symptoms, particularly neuropsychiatric symptoms, account for a large amount of the variation in HRQOL in PwPD. Motor symptoms may have differential effects on HRQOL in different demographic and clinical subpopulations, highlighting important areas for future health disparities research. Our findings provide targets for clinician intervention and future research on symptom management to optimize HRQOL in PD. Classification of Evidence This study provides Class II evidence that motor and neuropsychiatric symptoms are associated with HRQOL in PwPD.
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Affiliation(s)
- Meredith A Bock
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco .,Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco
| | - Ethan G Brown
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco
| | - Li Zhang
- Department of Medicine, University of California, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Caroline Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco.,Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco
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Bendig J, Wolf AS, Mark T, Frank A, Mathiebe J, Scheibe M, Müller G, Stahr M, Schmitt J, Reichmann H, Loewenbrück KF, Falkenburger BH. Feasibility of a Multimodal Telemedical Intervention for Patients with Parkinson's Disease-A Pilot Study. J Clin Med 2022; 11:jcm11041074. [PMID: 35207351 PMCID: PMC8875136 DOI: 10.3390/jcm11041074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 01/13/2023] Open
Abstract
Symptoms of Parkinson’s disease (PD) can be controlled well, but treatment often requires expert judgment. Telemedicine and sensor-based assessments can allow physicians to better observe the evolvement of symptoms over time, in particular with motor fluctuations. In addition, they potentially allow less frequent visits to the expert’s office and facilitate care in rural areas. A variety of systems with different strengths and shortcomings has been investigated in recent years. We designed a multimodal telehealth intervention (TelePark) to mitigate the shortcomings of individual systems and assessed the feasibility of our approach in 12 patients with PD over 12 weeks in preparation for a larger randomized controlled trial. TelePark uses video visits, a smartphone app, a camera system, and wearable sensors. Structured training included setting up the equipment in patients’ homes and group-based online training. Usability was assessed by questionnaires and semi-standardized telephone interviews. Overall, 11 out of 12 patients completed the trial (5 female, 6 male). Mean age was 65 years, mean disease duration 7 years, mean MoCA score 27. Adherence was stable throughout the study and 79% for a short questionnaire administered every second day, 62% for medication confirmation, and 33% for an electronic Hauser diary. Quality of life did not change in the course of the study, and a larger cohort will be required to determine the effect on motor symptoms. Interviews with trial participants identified motivations to use such systems and areas for improvements. These insights can be helpful in designing similar trials.
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Affiliation(s)
- Jonas Bendig
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
| | - Anna-Sophie Wolf
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
| | - Tony Mark
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
| | - Anika Frank
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Josephine Mathiebe
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.M.); (M.S.); (G.M.); (J.S.)
| | - Madlen Scheibe
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.M.); (M.S.); (G.M.); (J.S.)
| | - Gabriele Müller
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.M.); (M.S.); (G.M.); (J.S.)
| | - Marcus Stahr
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
- Department of Psychiatry, Sächsisches Krankenhaus Arnsdorf, 01477 Arnsdorf, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.M.); (M.S.); (G.M.); (J.S.)
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
| | - Kai F. Loewenbrück
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
| | - Björn H. Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (J.B.); (A.-S.W.); (T.M.); (A.F.); (M.S.); (H.R.); (K.F.L.)
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
- Correspondence:
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10
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Mantri S, Chahine LM, Nabieva K, Feldman R, Althouse A, Torsney B, Albert SM, Kopil C, Marras C. Demographic Influences on the Relationship Between Fatigue and Quality of Life in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:76-81. [PMID: 35005068 DOI: 10.1002/mdc3.13360] [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: 06/16/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background Fatigue has a major impact on health-related quality of life (HR-QOL) in Parkinson's disease (PD). Objectives To determine whether demographic characteristics modify the relationship between fatigue and HR-QOL. Methods Patients with PD in the Fox Insight study completed the Parkinson Fatigue Scale (PFS-16) and Geriatric Depression Scale (GDS-15). Linear regression examined the relationship between the PFS-16 and Parkinson Disease Quality of Life, as modified by age, sex, and GDS-15. Results A total of 1029 participants (44% female, mean age 67.4 years, and mean disease duration 4.6 years) were included in this analysis. Multivariable regression modeling demonstrated a negative effect modification for age (β = -0.07, P < 0.001) and a positive effect modification for the GDS-15 (β = 0.057, P = 0.002), but not for sex (β = -0.021, P = 0.231). Conclusion The association between fatigue and worse HR-QOL is greater at younger ages and in individuals with more depressive symptoms. Targeted therapeutics for these individuals may provide the greatest impact on fatigue in PD.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology Duke University School of Medicine Durham North Carolina USA
| | - Lana M Chahine
- Department of Neurology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Karina Nabieva
- The Edmond J Safra Program in Parkinson's disease Toronto Western Hospital, University of Toronto Toronto Ontario Canada
| | - Robert Feldman
- Center for Clinical Trials and Data Coordination, Division of General Internal Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Andrew Althouse
- Center for Clinical Trials and Data Coordination, Division of General Internal Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Benjamin Torsney
- Temple University College of Education and Human Development Philadelphia Pennsylvania USA
| | - Steven M Albert
- Behavioral and Community Health Sciences, Graduate School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | | | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease Toronto Western Hospital, University of Toronto Toronto Ontario Canada
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11
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Podlewska AM, van Wamelen DJ. Parkinson's disease and Covid-19: The effect and use of telemedicine. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:263-281. [PMID: 36208904 PMCID: PMC9279001 DOI: 10.1016/bs.irn.2022.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As a result of the Coronavirus Disease 2019 (Covid-19) pandemic the use of telemedicine and remote assessments for patients has increased exponentially, enabling healthcare professionals to reduce the need for in-person clinical visits and, consequently, reduce the exposure to the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This development has been aided by increased guidance on digital health technologies and cybersecurity measures, as well as reimbursement options within healthcare systems. Having been able to continue to connect with people with Parkinson's Disease (PwP, PD) has been crucial, since many saw their symptoms worsen over the pandemic. Inspite of the success of telemedicine, sometimes even enabling delivery of treatment and research, further validation and a unified framework are necessary to measure the true benefit to both clinical outcomes and health economics. Moreover, the use of telemedicine seems to have been biased towards people from a white background, those with higher education, and reliable internet connections. As such, efforts should be pursued by being inclusive of all PwP, regardless of geographical area and ethnic background. In this chapter, we describe the effect he Covid-19 pandemic has had on the use of telemedicine for care and research in people with PD, the limiting factors for further rollout, and how telemedicine might develop further.
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12
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Hermanowicz N, Ospina MC, Torres-Yaghi Y, Gould S, Papesh K, Rivera JA, Miller S, Jones S, Musick K, May D. Impact of Isolation During the COVID-19 Pandemic on the Patient Burden of Parkinson's Disease: A PMD Alliance Survey. Neuropsychiatr Dis Treat 2022; 18:633-643. [PMID: 35355505 PMCID: PMC8958201 DOI: 10.2147/ndt.s351691] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/22/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE As the COVID-19 pandemic resulted in social restrictions around the globe, this cross-sectional survey aimed to assess the impact of social isolation on self- or proxy-reported symptoms of Parkinson's disease (PD) during the pandemic. PATIENTS AND METHODS The survey was distributed among 7109 subscribers of the Parkinson and Movement Disorders Alliance (PMD Alliance) News and Information list and was open only to people with PD (PwP) and care partners (CP, defined as main caregivers of PwP and serving as proxy respondents). No attempt was made to identify PwP and CP pairs. The survey was distributed online using Survey Monkey between 01/06/2021 and 02/27/2021. Respondents were grouped by level of social support from outside of their household during the pandemic (decreased or maintained [ie, the same as pre-pandemic or increased]). RESULTS Of 7109 invited participants, 718 responded to the survey (response rate 10.1%). PwP (self-reports) accounted for 70.6% of respondents and CP (proxy reports) for 29.4%. Decreased social support from outside of the household during the COVID-19 pandemic (58.5% of all responses) was significantly associated with increases in sadness/depression and anxiety, compared with maintained levels of social support (p < 0.0001 for both comparisons). It was also associated with increased burden of several non-motor (decline in memory, problem solving, or communication, p = 0.0009; new or worsening confusion, p < 0.0001; new or worsening delusions, p = 0.018) and motor PD symptoms. CONCLUSION Decline in social support from outside of the household during the COVID-19 pandemic showed a statistically significant and negative association with the burden of mood and non-motor symptoms of PD. These results call for increased vigilance towards non-motor symptoms in PwP experiencing social isolation and highlight the need for stronger provider focus on encouraging PwP and their CPs to build and maintain social connections and engagements.
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Affiliation(s)
| | | | | | - Sherrie Gould
- Scripps Clinic Movement Disorder Center, La Jolla, CA, USA
| | - Kelly Papesh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jason A Rivera
- Parkinson and Movement Disorder Alliance (PMD Alliance), Tucson, AZ, USA
| | - Susan Miller
- Parkinson and Movement Disorder Alliance (PMD Alliance), Tucson, AZ, USA
| | - Sarah Jones
- Parkinson and Movement Disorder Alliance (PMD Alliance), Tucson, AZ, USA
| | | | - Damian May
- ACADIA Pharmaceuticals Inc, San Diego, CA, USA
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13
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Chepke C, Shaughnessy LW, Brunton S, Farmer JG, Rosenzweig AS, Grossberg GT, Wright WL. Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease. Int J Gen Med 2021; 14:10271-10280. [PMID: 34992442 PMCID: PMC8711560 DOI: 10.2147/ijgm.s335739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson’s disease psychosis or dementia-related psychosis.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
- Atrium Health, Charlotte, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Correspondence: Craig Chepke Email
| | - Lynn W Shaughnessy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA
- Department of Family Medicine, Touro University, Vallejo, CA, USA
| | - Jill G Farmer
- Parkinson’s Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA
- Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA
| | | | - George T Grossberg
- Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Wendy L Wright
- Wright & Associates Family Health Care, Concord and Amherst, NH, USA
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14
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Myers TL, Augustine EF, Baloga E, Daeschler M, Cannon P, Rowbotham H, Chanoff E, Jensen-Roberts S, Soto J, Holloway RG, Marras C, Tanner CM, Ray Dorsey E, Schneider RB. Recruitment for Remote Decentralized Studies in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 12:371-380. [PMID: 34744053 PMCID: PMC8842745 DOI: 10.3233/jpd-212935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Traditional in-person Parkinson’s disease (PD) research studies are often slow to recruit and place unnecessary burden on participants. The ongoing COVID-19 pandemic has added new impetus to the development of new research models. Objective: To compare recruitment processes and outcomes of three remote decentralized observational PD studies with video visits. Methods: We examined the number of participants recruited, speed of recruitment, geographic distribution of participants, and strategies used to enhance recruitment in FIVE, a cross-sectional study of Fox Insight participants with and without PD (n = 203); VALOR-PD, a longitudinal study of 23andMe, Inc. research participants carrying the LRRK2 G2019S variant with and without PD (n = 277); and AT-HOME PD, a longitudinal study of former phase III clinical trial participants with PD (n = 226). Results: Across the three studies, 706 participants from 45 U.S. states and Canada enrolled at a mean per study rate of 4.9 participants per week over an average of 51 weeks. The cohorts were demographically homogenous with regard to race (over 95%white) and level of education (over 90%with more than a high school education). The number of participants living in primary care Health Professional Shortage Areas in each study ranged from 30.3–42.9%. Participants reported interest in future observational (98.5–99.6%) and interventional (76.1–87.6%) research studies with remote video visits. Conclusion: Recruitment of large, geographically dispersed remote cohorts from a single location is feasible. Interest in participation in future remote decentralized PD studies is high. More work is needed to identify best practices for recruitment, particularly of diverse participants.
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Affiliation(s)
- Taylor L Myers
- Center for Health, +, Technology, University of Rochester, Rochester, NY, USA
| | - Erika F Augustine
- Center for Health, +, Technology, University of Rochester, Rochester, NY, USA.,Kennedy Krieger Institute, Baltimore, MD, USA
| | - Elizabeth Baloga
- Center for Health, +, Technology, University of Rochester, Rochester, NY, USA
| | | | | | | | | | | | | | - Julia Soto
- Center for Health, +, Technology, University of Rochester, Rochester, NY, USA
| | - Robert G Holloway
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.,PADRECC, San Francisco VAMC, San Francisco, CA, USA
| | - E Ray Dorsey
- Center for Health, +, Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Ruth B Schneider
- Center for Health, +, Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
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15
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Hooyman A, Talboom JS, DeBoth MD, Ryan L, Huentelman M, Schaefer SY. Remote, Unsupervised Functional Motor Task Evaluation in Older Adults across the United States Using the MindCrowd Electronic Cohort. Dev Neuropsychol 2021; 46:435-446. [PMID: 34612107 PMCID: PMC8671381 DOI: 10.1080/87565641.2021.1979005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
COVID-19 has impacted the ability to evaluate motor function in older adults, as motor assessments typically require face-to-face interaction. One hundred seventy-seven older adults nationwide completed an unsupervised functional upper-extremity assessment at home. Data were compared to data from an independent sample of community-dwelling older adults (N = 250) assessed in lab. The effect of age on performance was similar between the in-lab and at-home groups. Practice effects were also similar. Assessing upper-extremity motor function remotely is feasible and reliable in community-dwelling older adults. This test offers a practical solution for telehealth practice and other research involving remote or geographically isolated individuals.
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Affiliation(s)
- Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
- The Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
| | - Joshua S. Talboom
- The Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
- Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Matthew D. DeBoth
- The Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
- Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Lee Ryan
- The Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Matt Huentelman
- The Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
- Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Sydney Y. Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
- The Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
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