Scales to measure parkinsonism

Unmet needs of people with Parkinson's disease: A cross-sectional study

AIMS

To identify the type and extent of unmet needs in people with Parkinson's disease and to examine the impact of health locus of control and family support on these needs.

DESIGN

A cross-sectional study.

METHODS

This study was conducted from October 2015 - February 2016 in Korea. Data were collected through questionnaires focusing on unmet needs, health locus of control, family support and clinical features.

RESULTS

Therapeutic needs represented the highest percentage of unmet needs in people with Parkinson's disease (85.05%), followed by social/spiritual/emotional needs (82.72%). Physical needs were the lowest reported score (75.01%). Unmet needs were more frequent in those with more severe non-motor symptoms. Also, higher family support, internal locus of control and doctor locus of control were correlated with more unmet needs.

CONCLUSION

Understanding factors that determine the type and degree of unmet needs in people with PD is important to provide appropriate nursing care. The findings of this study can be used for providing nursing interventions reflecting unmet needs and reducing their unmet needs to improve the overall well-being of people with PD.

IMPACT

This study addressed unmet needs unmet needs specific to Parkinson's disease with respect to their nursing needs. Therapeutic needs were the highest unmet needs in people with PD, followed by social/spiritual/emotional needs, need for certainty and physical needs. The findings may be useful for nurses to identify the unmet needs of people with PD which need to be addressed. By reflecting on unmet needs, nurses can give personally tailored nursing care.

N-Methyl-D-Aspartate Antagonists in Levodopa Induced Dyskinesia: A Meta-Analysis

Background:

Levodopa-induced dyskinesias (LID) are amongst the most disabling side-effects of levodopa therapy for Parkinson's disease (PD). It has been suggested that that N-Methyl-D-Aspartate (NMDA)-receptor antagonist may reduce peak-dose dyskinesia in PD patients and may lead to motor improvement. In this study, we compared the efficacy of NMDA receptor antagonists versus placebo in the treatment of LID in PD through a meta-analysis of controlled trials.

Methods:

Electronic search of Pubmed (1990 - 2010), Medline (1966-2010), EMBASE (1974-2010) and other databases for relevant studies were performed. Controlled clinical trials of the effects of NMDA antagonists on LID that fulfill the study protocol were selected. Pooled data from included studies was then used to perform random and fixed effect models meta-analysis.

Results:

The search resulted in 11 randomized, placebo controlled clinical trials that involved a total of 253 PD patients with peak-dose LID. The outcome measures were various dyskinesia rating scales and the Unified Parkinson Disease Rating Scale (UPDRS) subscales III and IV. The analysis showed significant reduction in Standard Mean Difference (SMD) for UPDRS IV (SMD -1.45; 95% CI -2.28 to -0.63) and UPDRS III (SMD -0.41; 95% CI -0.69 to -0.12) after treatment with amantadine. Other included drugs did not show significant change in the outcomes measured.

Conclusion:

This meta-analysis provides an update on the clinical trials and confirms the short-term benefits of amantadine therapy in the treatment of dyskinesia. The effects of other NMDA receptor antagonists need to be evaluated further in clinical trials.

Comparison of office-based versus home Web-based clinical assessments for Parkinson's disease

BACKGROUND

The feasibility and validity of Web-based assessments in Parkinson's disease is unknown. The objectives of this study were to develop and to compare home Web-based assessments with office-based assessments.

METHODS

We tested feasibility and validity using a longitudinal, randomized crossover design. Patients were assessed at baseline and after 6 and 12 weeks using both assessments including the Unified Parkinson's Disease Rating Scale, the Unified Dyskinesia Rating scale, timed tests, and quality-of life and Non-Motor Symptoms questionnaires.

RESULTS

Forty-two patients were included (22 men, 20 women; mean age, 64.7 ± 9.0 years). Only 2 patients (5%) dropped out. The mean intraclass correlation coefficient between Web- and office-based assessments ranged from 0.67 (first visit) to 0.75 (last visit) and 0.81 and 0.82 for doctor- and patient-administered scales, respectively. No differences in responsiveness (P = 0.63), and data precision (P = 0.11) were found, but Web-based assessments had fewer missing values (P = 0.01).

CONCLUSIONS

Web-based assessments offer a feasible format for assessing PD-related impairment from home.

[Psychometric attributes of the Spanish version of A-TAC screening scale for autism spectrum disorders]

BACKGROUND

As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication.

OBJECTIVE

To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening.

MATERIAL AND METHODS

A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n=15), Mental Retardation (n=40), Psychiatric Illness (n=22), Tics (n=12) and controls (n=51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, internal consistency, and precision were analysed.

RESULTS

The internal consistency was high (α=0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P<.001). The area under the curve was 0.96 for the ASD group.

CONCLUSION

The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population.

Psychometric Attributes of the DISC Predictive Scales

Introduction:

This study was designed to evaluate the psychometric attributes and screening efficiency of a Spanish version of the Children Predictive Scales (DPS) against the Spanish Diagnostic Interview Schedule for Children (DISC-IV).

Method:

This pilot cross-sectional study included 61 children aged 9 to 14 years in a mainstream school. The following psychometric attributes were analyzed: acceptability, scale assumptions, internal consistency, and precision, as well the predictive validity (AUC).

Results:

The scale did not show ceiling or floor effects (6.4%, 1.3%, respectively). The internal consistency was high (α=0.92), and the standard error of measurement was adequate (SEM=1.54). The overall DPS AUC was 0.72 against DISC IV corresponding diagnosis.

Conclusion:

The Spanish version of the DPS-4.32 seems to be a reliable and precise tool for screening mental health disorders in a school-age population.

Two questionnaires for Parkinson’s disease: are the PDQ-39 and PDQL equivalent?

BACKGROUND

Although there is a wide range of specific health-related quality of life (HRQoL) measures for Parkinson's disease (PD), their psychometric attributes have never been compared.

OBJECTIVE

To compare the psychometric characteristics of the Parkinson's Disease Questionnaire-39 items (PDQ-39) and Parkinson's Disease Quality of Life Questionnaire (PDQL).

METHODS

The PDQ-39 and PDQL were simultaneously applied to 187 PD patients. Additional assessments included Hoehn and Yahr staging, Schwab and England Scale (SES), Unified Parkinson's Disease Rating Scale, Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ) and Hospital Anxiety and Depression Scale (HADS). Criteria for acceptability, scaling assumptions, reliability, construct validity and precision were drawn up.

RESULTS

Both the PDQ-39 and PDQL proved very similar in the following aspects: acceptability (no floor or ceiling effect); scaling assumptions (79.5% and 80% respectively of item-total correlations fitted the standard); internal consistency (PDQ-39 domains, alpha = 0.43-0.93; PDQL domains, alpha = 0.70-0.88); stability (intraclass correlation coefficient = 0.76-0.90); and internal validity (PDQ-39, r = 0.09-0.70; PDQL, r = 0.52-0.71). Convergent validity between the two questionnaires was moderate to high (r = -0.91 for summary indices). Precision was higher for the PDQ-39 Summary Index, and predictors were the same for both measures (mood disorders and disability).

CONCLUSIONS

Although the psychometric properties tested are quite similar in both measures, mainly insofar as summary indices are concerned, differences in some attributes and structural content should nevertheless be considered when comparing both instruments.