Parkinson's disease symptoms--patients' perceptions

Patient With Parkinson Disease and Care Partner Perceptions of Key Domains Affecting Health-Related Quality of Life: Systematic Review

BACKGROUND AND OBJECTIVES

To effectively customize Parkinson disease (PD) programs, it is important to incorporate the "individual's voice" and have a thorough understanding of the symptom priorities of people with PD (PwP) and care partners (CP). In this convergent integrated mixed-method systematic review, we aimed to analyze qualitative and quantitative evidence of PD motor and nonmotor symptoms affecting health-related quality of life (HRQOL) in PwP and CP, comparing priorities across different levels of disease severity.

METHODS

We searched MEDLINE, PsycINFO, Web of Science, Embase, and Scopus; ProQuest Dissertations and Theses Global; and the Michael J. Fox Foundation Data Resources for studies published up to June 29, 2022. We included qualitative, quantitative, and mixed-method studies investigating PD symptom priorities among PwP and CP. We critically appraised eligible studies for methodological quality using the Mixed-Methods Appraisal Tool. Derived terms were mapped and coded according to thematic attribution. Independent syntheses of qualitative and quantitative evidence and transformation of quantitative data into qualitative formats were performed.

RESULTS

Of the 7,716 identified studies, we included 70 that provided qualitative (n = 13), quantitative (n = 53), and mixed (n = 4) evidence. We included 604 mapped terms representing 11 PwP-identified and CP-identified motor and nonmotor symptom categories. Across all PD stages, both PwP and CP considered 5 domains more affecting their HRQOL, namely: "motor functionality," "mood," "cognition," "gait, balance, posture, and falls," and "nighttime sleep disorders." In early disease, PwP and CP considered "mood" the domain that most affected their HRQOL. In advanced PD, PwP considered "pain" the domain that most affects their HRQOL, while CP considered "psychiatric symptoms." The domain "gait, balance, posture, and falls" was equally considered by both PwP and CP as the second domain that most affects their HRQOL in the advanced stage of PD.

DISCUSSION

The ranking of the priority of symptoms is largely shared by PwP and CP, and motor symptom priorities dominate the full disease spectrum. However, the nonmotor symptom priorities shift according to the disease severity stage. Tailored care and research require that providers consider these shifting priorities and incorporate the "individual's voice" into treatment decisions.

Self-Reported Visual Complaints in People with Parkinson’s Disease: A Systematic Review

Background:

Scientific research increasingly focuses on visual symptoms of people with Parkinson’s disease (PD). However, this mostly involves functional measures, whereas self-reported data are equally important for guiding clinical care.

Objective:

This review provides an overview of the nature and prevalence of self-reported visual complaints by people with PD, compared to healthy controls.

Methods:

A systematic literature search was performed. Studies from three databases (PubMed, PsycInfo, and Web of Science) were screened for eligibility. Only studies that reported results of visual self-reports in people with idiopathic PD were included.

Results:

One hundred and thirty-nine eligible articles were analyzed. Visual complaints ranged from function-related complaints (e.g., blurred vision, double vision, increased sensitivity to light or changes in contrast sensitivity) to activity-related complaints (e.g., difficulty reading, reaching, or driving). Visual complaints were more prevalent in people with PD compared to healthy controls. The presence of visual complaints leads to a reduced quality of life (QoL). Increased prevalence and severity of visual complaints in people with PD are related to longer disease duration, higher disease severity, and off-state.

Conclusion:

A large proportion of people with PD have visual complaints, which negatively affect QoL. Complaints are diverse in nature, and specific and active questioning by clinicians is advised to foster timely recognition, acknowledgement, and management of these complaints.

Real-World Evidence for a Smartwatch-Based Parkinson's Motor Assessment App for Patients Undergoing Therapy Changes

Introduction

Parkinson's disease (PD) is poorly quantified by patients outside the clinic, and paper diaries have problems with subjective descriptions and bias. Wearable sensor platforms; however, can accurately quantify symptoms such as tremor, dyskinesia, and bradykinesia. Commercially available smartwatches are equipped with accelerometers and gyroscopes that can measure motion for objective evaluation. We sought to evaluate the clinical utility of a prescription smartwatch-based monitoring system for PD utilizing periodic task-based motor assessment.

Methods

Sixteen patients with PD used a smartphone- and smartwatch-based monitoring system to objectively assess motor symptoms for 1 week prior to instituting a doctor recommended change in therapy and for 4 weeks after the change. After 5 weeks the participants returned to the clinic to discuss their results with their doctor, who made therapy recommendations based on the reports and his clinical judgment. Symptom scores were synchronized with the medication diary and the temporal effects of therapy on weekly and hourly timescales were calculated.

Results

Thirteen participants successfully completed the study and averaged 4.9 assessments per day for 3 days per week during the study. The doctor instructed 8 participants to continue their new regimens and 5 to revert to their previous regimens. The smartwatch-based assessments successfully captured intraday fluctuations and short- and long-term responses to therapies, including detecting significant improvements (p < 0.05) in at least one symptom in 7 participants.

Conclusions

The smartwatch-based app successfully captured temporal trends in symptom scores following application of new therapy on hourly, daily, and weekly timescales. These results suggest that validated smartwatch-based PD monitoring can provide clinically relevant information and may reduce the need for traditional office visits for therapy adjustment.

Delivering patient-centered care in Parkinson's disease: Challenges and consensus from an international panel

An international panel of movement disorders specialists explored the views and perceptions of people with Parkinson's disease (PD) about their condition and its treatment, including the potential mismatch between the clinician's view of the patient's condition and their own view of what aspects of the disease most affect their daily lives. The initiative was focused on Asian countries, so participants comprised experts in the management of PD from key centers in Asia, with additional insight provided by European and the North American movement disorders experts. Analysis of peer-reviewed publications on patient perceptions of PD and the factors that they consider important to their wellbeing identified several contributing factors to the mismatch of views, including gaps in knowledge of PD and its treatment, an understanding of the clinical heterogeneity of PD, and the importance of a multidisciplinary approach to patient care. The faculty proposed options to bridge these gaps to ensure that PD patients receive the personalized treatment they need to achieve the best possible outcomes. It was considered essential to improve patient knowledge about PD and its treatment, as well as increasing the awareness of clinicians of PD heterogeneity in presentation and treatment response. A multidisciplinary and shared-care approach to PD was needed alongside the use of patient-centered outcome measures in clinical trials and clinical practice to better capture the patient experience and improve the delivery of individualized therapy.

Self-reported and experimentally induced self-disgust is heightened in Parkinson's disease: Contribution of behavioural symptoms

Parkinson’s disease (PD) is associated with deficits in the recognition and expression of basic emotions, although self-reported levels of the self-conscious emotions shame and embarrassment are higher. However, one self-conscious emotion—self-disgust–which has been shown to have a negative impact on psychological wellbeing, has not been investigated in PD before. Here we employed self-report measures of self-conscious emotions, and an emotion induction paradigm involving images of the self, and narrated personal vignettes of instances when patients with PD (and controls) found themselves disgusting. We found that self-reported and induced levels of self-disgust were higher in PD patients than in matched controls, and that trait self-disgust was specifically related to disorders of impulse control in PD patients. Given the link between self-disgust and impaired psychological wellbeing, and the prevalence of anxiety and depression in PD, self-disgust might make a useful therapeutic target for psychological interventions in the condition.

Experienced facial masking indirectly compromises quality of life through stigmatization of women and men with Parkinson's disease

This study examined the relationship between self-reported facial masking and quality of life (QoL) in people with Parkinson's disease (PD), and tested experienced stigma as a mediator and gender as a moderator of this relationship. The strength of stigma as a mediator was compared against an alternative mediator, depression. Ninety people with PD (34 women) rated difficulty showing facial expression (masking), and completed the Stigma Scale for Chronic Illness, Geriatric Depression Scale (15-item), and Parkinson's Disease Questionnaire-39. A conditional process model tested the indirect effect of facial masking on QoL through stigma, separately for women and men. A parallel indirect model included both stigma and depression to compare their statistical and clinical significance as mediators. Gender-moderated mediation of stigma reduced the association between facial masking and QoL to non-significance, suggesting stigma explained the association between facial masking and QoL. While facial masking was more stigmatizing for women than for men, stigma mediated the facial masking-QoL association for both women and men. Stigma (controlling for depression) reached a statistically and clinically significant level of mediation, whereas depression (controlling for stigma) reached a statistically yet not clinically significant level of mediation. People with PD who experience more severe facial masking feel more stigmatized, especially women. Regardless of gender, an increase in stigma from facial masking increases the likelihood of compromised QoL that reaches both statistical and clinical levels of significance.

Female Parkinson's disease caregivers have much anxiety and depressive symptom

OBJECTIVE

Parkinson's Disease Caregivers (PDC) play an important role, especially in the medium and advanced phase of the disease for patients' daily life activities, treatment, and follow-up. The aim of this study is to attract attention to the factors which place PDC at risk of psychological problems and to give consideration to these factors.

MATERIALS AND METHODS

First of all, the 80 participants, who were PDC, filled in the demographic information form. The Hospital Anxiety and Depression Scale (HADS) was applied in order to determine the psychological status of the PDC.

RESULTS

The average age of PDC in the study was found as 47.94. While 11 (13.8%) of the PDC had undergone psychiatric treatment in the past, four of them (5%) were currently receiving treatment. Twenty-eight (35%) of those who provide care have experience in patient care, whereas 52 (65%) of them have no prior experience in caring for patients. Thirty-six (45%) of the PDC reported that they had difficulties, which were mostly psychological. According to the HADS which was applied, anxiety was seen in 26 of those who provide care (32.5%), while depression was seen in 41 (51.3%).

CONCLUSION

This study is the first to provide data on the psychological status of PDC in our country. It is important that PDC's psychological problems are reduced by psychotherapy or, if necessary, by treatment. This situation has a direct negative effect on the patient's daily life activities.

Severely Affected by Parkinson Disease: The Patient's View and Implications for Palliative Care

INTRODUCTION

People severely affected by Parkinson disease (PD)/atypical parkinsonism (AP) comprise a heterogeneous group with distinct needs, which so far remain largely unexamined. The aim of our study was to analyze reasons for feeling severely affected and document unmet needs in a patient subgroup severely affected by PD/AP using solely a subjective inclusion criterion.

METHODS

Patients feeling severely affected by PD/AP were recruited via a magazine published by the German Parkinson Association. A questionnaire was sent out nationwide. Besides analyzing the closed-ended questions, a subsample of 40% was analyzed regarding the open-ended questions using content analysis. Correlations between subjectively felt severe affectedness and objective criteria were calculated.

RESULTS

Eight hundred fourteen questionnaires were analyzed. Sample characteristics were: mean age 70 years; 60.3% male; time since diagnosis up to 37 years; and Hoehn and Yahr score (if known) 3 (44.6%), followed by 4 (23.9%). Significant associations were observed between subjectively felt severe affectedness and Hoehn and Yahr ( P ≤ .05), poorer health ( P ≤ .01), higher nursing care level ( P ≤ 0.01), and having no children ( P ≤ .05). Most common reasons for feeling severely affected were mobility impairment (34.9%), coordination problems (17.0%), speech problems (12.2%), and limited day-to-day activities (7.8%). Most often expressed unmet needs were support in everyday life (28.1%), medical treatment (15.2%), help with financial services (11.6%), and social integration (9.9%).

CONCLUSIONS

To meet the complex needs, an integrated multidisciplinary and multiprofessional approach is indicated befitting palliative care principles. Herein, home-based services seem of special importance for patients in advanced disease stages.

What can the treatment of Parkinson's disease learn from dementia care; applying a bio-psycho-social approach to Parkinson's disease

BACKGROUND

Within contemporary medical practice, Parkinson's disease (PD) is treated using a biomedical, neurological approach, which although bringing numerous benefits can struggle to engage with how people with PD experience the disease. A bio-psycho-social approach has not yet been established in PD; however, bio-psycho-social approaches adopted within dementia care practice could bring significant benefit to PD care.

METHODS

This paper summarises existing bio-psycho-social models of dementia care and explores how these models could also usefully be applied to care for PD. Specifically, this paper adapts the bio-psycho-social model for dementia developed by Spector and Orrell (), to suggest a bio-psycho-social model, which could be used to inform routine care in PD.

RESULTS

Drawing on the biopsychosocial model of Dementia put forward by Spector and Orrell (), this paper explores the application of a bio-psycho-social model of PD. This model conceptualises PD as a trajectory, in which several interrelated fixed and tractable factors influence both PD's symptomology and the various biological and psychosocial challenges individuals will face as their disease progresses. Using an individual case study, this paper then illustrates how such a model can assist clinicians in identifying suitable interventions for people living with PD.

CONCLUSION

This model concludes by discussing how a bio-psycho-social model could be used as a tool in PD's routine care. The model also encourages the development of a theoretical and practical framework for the future development of the role of the PD specialist nurse within routine practice.

IMPLICATIONS FOR PRACTICE

A biopsychosocial approach to Parkinson's Disease provides an opportunity to move towards a holistic model of care practice which addresses a wider range of factors affecting people living with PD. The paper puts forward a framework through which PD care practice can move towards a biopsychosocial perspective. PD specialist nurses are particularly well placed to adopt such a model within routine clinical practice, and should therefore be encouraged within PD services.

Preserving Self: Theorizing the Social and Psychological Processes of Living With Parkinson Disease

The purpose of this constructivist grounded theory article is to identify, explore, and theorize the social and psychological processes used by people with Parkinson disease. Analytic procedures generated the five-stage theory of Preserving self of people with Parkinson disease: (a) making sense of symptoms, (b) defining turning points, (c) experiencing identity dilemmas, (d) reconnecting the self, and (e) envisioning a future. Reminders of former selves and capabilities were painful; participants desperately sought normalcy. Participants developed creative methods for maintaining independence but frequently overestimated their abilities and took risks. Participants were 15 men and 10 women (ages 40-95), most of whom lived with their families. Disease status was ascertained through medication logs and two scales: Hoehn and Yahr staging and Activities of Daily Living. Data included 62 in-depth interviews, nonparticipant observation, and participant photos, videos, and related documents. Recommendations were derived from the theory to support processes of Preserving Self as interventions designed to reduce the loss of self and to enhance Preserving self. These recommendations included developing relationships, teaching expected and unexpected feelings and behaviors, and involvement with sensory integrating activities.

Ageing, masculinity and Parkinson's disease: embodied perspectives

Parkinson's disease (PD) presents as an illness which predominantly affects older men. However older men's lived experiences of PD, including how they are influenced by age and gender relations has seen little empirical study. Drawing on Watson's male body schema, this paper explores how men engage with masculinities and ageing in order to make sense and meaning from PD. Data is presented from 30 narrative and semi structured interviews with 15 men of various ages who were living with PD. Findings suggest that PD threatens a visceral embodiment located in the body's basic movements and intimate functions; a pragmatic embodiment expressed through men's everyday occupations and an experiential embodiment concerned with emotions and sensations felt within and through the body. In addition, each dimension of men's embodiment also intersected with the ageing process, a process also shaped in turn by broader social and cultural concerns regarding the positions and possibilities of men's lives as they move through the life course. This paper concludes by discussing the implications of gender and ageing in understanding men's experiences of PD.

Responsiveness of the short-form health survey and the Parkinson's disease questionnaire in patients with Parkinson's disease

Background

The responsiveness of a measurement instrument is important for understanding its ability to detect changes in the progression of a disease. We examined and compared the internal and external responsiveness of the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson’s Disease Questionnaire (PDQ-39) in patients with Parkinson’s Disease (PD).

Methods

Seventy-four patients with PD were evaluated using the SF-36 and PDQ-39 at baseline and again after one year. In addition, their motor signs, motor difficulties of daily living, and depressive symptoms were assessed as external criteria. The internal responsiveness was examined using effect size, standardized response mean, and the Wilcoxon signed rank test. The external responsiveness was examined using receiver operating characteristic curves, correlation analyses, and regression models.

Results

Both instruments were partially sensitive to changes during the 1-year follow-up and able to discriminate between patients with improved versus deteriorated motor signs. In addition, both were similarly responsive to changes in the motor difficulties of daily living; the SF-36 appeared to be more sensitive than the PDQ-39 to changes in depressive symptoms.

Conclusions

The SF-36 and the PDQ-39 were acceptably internally and externally responsive during the 1-year follow-up.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0642-8) contains supplementary material, which is available to authorized users.

'There was no great ceremony': patient narratives and the diagnostic encounter in the context of Parkinson's

This paper draws on stories of diagnosis that emerged from a broader narrative study exploring the lived experience of Parkinson's (n.37). Despite the life-changing nature of their diagnosis, participants' narratives highlighted considerable shortcomings in the way in which their diagnostic encounter was handled, echoing the findings of previous research in which it has been noted that 'the human significance' of diagnosis was passed over. Building on the literature, this paper provides empirical material that reveals the sensitivities involved at the moment of diagnosis. By examining both the structure and content of participants' narratives, this article discusses the diagnostic encounter in relation to three key concepts that connected many participants' stories: a 'bareness' or lack of 'ceremony', a sense of emotional and physical 'abandonment' and the impact on a person's illness story when faced with a 'hierarchy' of illness. This paper aims to raise awareness of contemporary issues related to the diagnosis of Parkinson's, and invites reflection on how diagnosis might be undertaken in a way that truly acknowledges its human significance.

Participation in Occupations: Some Experiences of People with Parkinson's Disease

Evidence suggests that people with Parkinson's disease can experience difficulties participating in occupations. This article describes a qualitative study that explored how seven people with Parkinson's disease perceived their participation in occupations.

The analysis of the semi-structured interviews led to the identification of three themes: changes, addressing changes and perspectives on living with Parkinson's disease. Many findings supported the existing literature; for example, difficulties with self-care occupations and the desire to maintain normality. The new findings included the participants describing positive changes in their lives that were attributable to having Parkinson's disease and using occupations purposefully to enhance wellbeing.

The results support the use of a client-centred approach to consider the implications of participation in occupations for people with Parkinson's disease, because this may encourage clients to use their own expert knowledge to enhance existing coping strategies. The recommendations for further research include an investigation as to whether the themes identified apply to a larger population and including people with Parkinson's disease in designing future research questions about the impact of occupational participation on wellbeing.

Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centred clinic

Background

Patient‐centred care is a recommended model of care for Parkinson's disease (PD). It aims to provide care that is respectful and responsive to patient preferences, values and perspectives. Provision of patient‐centred care should entail considering how patients want to be involved in their care.

Objective

To understand the participation preferences of patients with PD from a patient‐centred care clinic in health‐care decision‐making processes.

Design, setting and participants:

Mixed‐methods study with early‐stage Parkinson's disease patients from a patient‐centred care clinic. Study involved a modified Autonomy Preference Index survey (N=65) and qualitative, semi‐structured in‐depth interviews, analysed using thematic qualitative content analysis (N=20, purposefully selected from survey participants). Interviews examined (i) the patient preferences for involvement in health‐care decision making; (ii) patient perspectives on the patient–physician relationship; and (iii) patient preferences for communication of information relevant to decision making.

Results

Preferences for participation in decision making varied between individuals and also within individuals depending on decision type, relational and contextual factors. Patients had high preferences for communication of information, but with acknowledged limits. The importance of communication in the patient–physician relationship was emphasized.

Discussion

Patient preferences for involvement in decision making are dynamic and support shared decision making. Relational autonomy corresponds to how patients envision their participation in decision making. Clinicians may need to assess patient preferences on an on‐going basis.

Conclusion

Our results highlight the complexities of decision‐making processes. Improved understanding of individual preferences could enhance respect for persons and make for patient‐centred care that is truly respectful of individual patients’ wants, needs and values.

Dramaturgical Challenges of Parkinson's Disease

Being able to engage in satisfying and effective interpersonal interactions is an important component of health. Parkinson's disease (PD) is an example of a chronic illness that can make social interactions difficult and awkward. The aim of this study was to explore the nature of the challenges people with PD face during social occupations. Following a collective case study design, two men and one woman each participated in two qualitative interviews. Dramaturgical analysis of the interview data was conducted to offer insight into why some interactions are problematic. Elements seen in the stories of problematic encounters included a dramaturgical challenge created by PD symptoms, resulting discomfort or confusion, and the adoption of an attitude or action to surmount the challenge. Using dramaturgical analysis to explore the occupational form of social interactions can develop knowledge about the facilitation of social well-being.

Favorite Activity Interview as a Window into the Identity of People with Parkinson's Disease

The purpose of this study was to document the degree to which a brief segment of an occupational therapy interview about favorite activities served as a window into personal identity and experience in clients with Parkinson's disease. Two-minute segments of videotaped interviews of 12 participants with Parkinson's disease were transcribed and analyzed. A verbal content measure was developed, its reliability tested, and its items correlated with participants' self-rated personality and mood. Overall, the inter-rater reliability for this verbal content measure was acceptably high, and many expected associations between participant verbal content and participant identity as related to personality and mood were found. The results tentatively suggest that the client's discussion of favorite activity participation, as well as the tone and frequency of the client's verbal communication, can provide insight into the identity of the client, and this information is available to the practitioner even for clients who have difficulty expressing their identities nonverbally. This exploratory study establishes a foundation for further research in the area of identity expression through verbal content in individuals with diminished nonverbal expressiveness.

'Signposts on the journey'; medication adherence and the lived body in men with Parkinson's disease

Adherence to medication has been identified as a key issue in the treatment of many chronic illnesses, however such a perspective fails to account for the lived experience of medication usage and its effects on the body as lived. Parkinson's Disease, a neurological disease predominantly affecting movement and mobility, and which is treated via a wide range of medications provides a useful opportunity to explore experiences of medication usage in chronic illness. Reporting on findings of a study exploring men's experience of living with Parkinson's Disease, this paper adopts a lived body perspective to explore lived experiences of medication usage and adherence in PD. Findings are reported from 30 narrative in depth interviews with 15 men of various ages living with Parkinson's disease of mild to severe intensity. Findings first discuss PD's effects on men's sense of the lived body, in which a fluctuating embodiment is linked to medication regimes and their bodily effects. Second, as PD disrupts the body's place with the everyday and habitual experience of lived time, medication regimens come to place new structures upon the men's everyday experience of time. Finally, the paper explores the role medications play in men's attempts to create and sustain narratives for the individual progression of their illness, and how these narratives differ from clinical narratives associated with PD's treatment. This paper concludes by discussing debates around adherence to medication within the treatment of PD and the need to consider lived experience of medication usage and their effects at the level of the lived body.

Parkinson's Is Time on Your Side? Evidence for Difficulties with Sensorimotor Synchronization

There is lack of consistent evidence as to how well PD patients are able to accurately time their movements across space with an external acoustic signal. For years, research based on the finger-tapping paradigm, the most popular paradigm for exploring the brain's ability to time movement, has provided strong evidence that patients are not able to accurately reproduce an isochronous interval [i.e., Ref. (1)]. This was undermined by Spencer and Ivry (2) who suggested a specific deficit in temporal control linked to emergent, rhythmical movement not event-based actions, which primarily involve the cerebellum. In this study, we investigated motor timing of seven idiopathic PD participants in event-based sensorimotor synchronization task. Participants were asked to move their finger horizontally between two predefined target zones to synchronize with the occurrence of two sound events at two time intervals (1.5 and 2.5 s). The width of the targets and the distance between them were manipulated to investigate impact of accuracy demands and movement amplitude on timing performance. The results showed that participants with PD demonstrated specific difficulties when trying to accurately synchronize their movements to a beat. The extent to which their ability to synchronize movement was compromised was found to be related to the severity of PD, but independent of the spatial constraints of the task.

Factors associated with post-stroke depression and fatigue: lesion location and coping styles

Post-stroke depression (PSD) and post-stroke fatigue (PSF) are frequent and persistent problems among stroke survivors. Therefore, awareness of signs and symptoms of PSD and PSF is important for their treatment and recovery from stroke. Additionally, since sudden serious illness can result in disequilibrium, early institution of a coping process is essential to restoring stability. The brain damage of stroke leaves patients with unique physical and mental dysfunctions for which coping maybe a key resource while rebuilding lives. We evaluated 368 consecutive patients with acute ischemic stroke for post-stroke emotional disorders at admission and 3 months later. PSD was evaluated by using the Beck Depression Inventory, and PSF was scored with the Fatigue Severity Scale. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Locations of lesions were based on MRI. Those scans revealed infarcts located in the basal ganglia, corona radiate and internal capsule and constituted the independent factors associated with PSF 3 months after stroke occurrence. Conversely, PSD was not related to lesion location. Acceptance-resignation related to PSD and PSF both at admission and 3 months after stroke. Avoidance was the independent factor most closely related to PSD, whereas confrontation was the independent factor best related to PSF at 3 months after stroke onset.

Predictors of quality of life in people with Parkinson's disease: evidence for both domain specific and general relationships

PURPOSE

To assess the determinants of health-related quality of life (HrQoL) in people with Parkinson's disease (PD).

METHOD

Eighty-one people with a diagnosis of idiopathic PD took part in a cross-sectional questionnaire-based study. Measures were collected in a community setting and included established determinants of HrQoL (demographic, clinical and cognitive variables) but also included a wide range of mental health variables (depression, anxiety and stress) and, for the first time, positive psychological functioning (optimism and self-esteem). HrQoL was measured by the full version of the Parkinson's Disease Questionnaire (PDQ-39) which includes eight domains of functioning.

RESULTS

Mental health measures (depression, anxiety and stress) were more influential than any other block of determinants and influenced a broader array of HrQoL domains including physical ones. There was some evidence of domain-specific relationships, e.g. between physical determinants and the more physically-oriented HrQoL domains, and between mental health determinants and emotional well-being. However, cognitive ability did not influence the HrQoL domain of cognitive impairment.

CONCLUSIONS

The contribution of a multi-disciplinary approach is crucial given the many variables which affect HrQoL; in particular, significant overall improvements on HrQoL are unlikely if only physical rehabilitation is offered. Rehabilitation is likely to be beneficial in terms of HrQoL only if it is planned and delivered holistically. Implications for Rehabilitation Interventions to improve physical function may have only limited impact on quality of life and might be limited to more physical HrQoL domains. Psychological interventions have the potential to improve quality of life over a wider range of both emotional and physical HrQoL domains. Clinician-measured level of functioning does not necessarily translate into patient-perceived levels of functional ability and relatively small objective decreases in ability can be appraised much more significantly disabling by people with PD.

Perceptions of persons with Parkinson's disease, family and professionals on quality of life: an international focus group study

PURPOSE

Parkinson's disease (PD) is a progressive neurodegenerative disorder. Motor and non-motor symptoms have an impact on persons' lives. To what extent this is effecting persons' quality of life (QOL) is not clear. Therefore, the aim of this qualitative study was to identify factors that persons perceive as eminently important for QOL.

METHOD

Focus groups were employed with persons with PD, caregivers and health professionals.

RESULTS

The results, obtained through thematic and conceptual qualitative analysis, largely support the framework of domains and facets of the World Health Organization Quality of Life (WHOQOL) assessment instrument. Three new themes were identified, reflecting (i) practical adaptations to PD, (ii) personal adaptations to PD and (iii) the ability to communicate and the availability of communication supports.

CONCLUSION

This study demonstrated that focus groups are a valid and reliable way of eliciting views on QOL from persons with PD, caregivers and professionals. The focus group method confirmed the original WHOQOL parameters and also provided some new QOL themes. In addition, the results of this study pointed out that the impact of PD on QOL goes beyond the physical, social and emotional domains of health-related QOL (HRQOL).

Culturally competent care for Parkinson disease

Findings from a qualitative ethnographic study that examined the experiences of a group of persons with Parkinson disease are presented in this article. Culturally competent care for persons who share a common illness, such as Parkinson disease, is facilitated when the findings are incorporated into the Clinically Relevant Continuum Model. Use of this model allows providers to evaluate and use appropriate published evidence in addition to provider expertise and patient preferences and values.

Home-based monitoring and assessment of Parkinson's disease

As a clinically complex neurodegenerative disease, Parkinson's disease (PD) requires regular assessment and close monitoring. In our current study, we have developed a home-based tool designed to monitor and assess peripheral motor symptoms. An evaluation of the tool was carried out over a period of ten weeks on ten people with idiopathic PD. Participants were asked to use the tool twice daily over four days, once when their medication was working at its best ("on" state) and once when it had worn off ("off" state). Results showed the ability of the data collected to distinguish the "on" and "off" state and also demonstrated statistically significant differences in timed assessments. It is anticipated that this tool could be used in the home environment as an early alert to a change in clinical condition or to monitor the effects of changes in prescribed medications used to manage PD.

‘A stony road… a 19 year journey’: ‘Bridging’ through late-stage Parkinson’s disease

Abstract

Studies reporting the lived experience of late-stage Parkinson’s disease are sparse. Using constructivist grounded theory and centre-stage storyline generation as the methodological approach, this study reports on 69 interviews with 13 people with late-stage Parkinson’s disease and their family carers who were recruited from the caseload of two specialist Parkinson’s disease nurses working in North Wales and one consultant geriatrician. The interviews were conducted longitudinally between June 2007 and April 2008, and all participants were diagnosed with late-stage idiopathic Parkinson’s disease using Brain Bank clinical criteria. All interviews and the subsequent sharing, modification and testing of the results of data analysis were conducted in the person’s home and with their participation as partners in the research process. From this process, bridging emerged as the centre-stage storyline in adjusting to life with late-stage Parkinson’s disease, and this consisted of three temporal stages, namely: 1) building on the past; 2) bridging the present and 3) broaching the future. These three stages were underpinned by three linked sequential foundations, namely biographical, situational and crumbling. These stages, foundations and properties of bridging have important implications for the understanding of late-stage Parkinson’s disease and informing the nursing role in developing and providing appropriate supportive interventions.

Quality of life (QoL) in relation to disease severity in Brazilian Parkinson's patients as measured using the WHOQOL-BREF

This study aimed at evaluating and describing the QoL and its association with the severity of disease among Brazilian Parkinson's disease (PD) patients. In this cross-sectional study 68 PD patients were interviewed using the World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF) and the Hoehn-Yahr (HY) scale. Analysis of variance, chi(2), Kruskal-Wallis and Mann-Whitney U-tests, Spearman and Cronbach reliability coefficients were used to analyze the data. The results indicate: (1) physical capacity was the domain that showed the most deterioration; (2) severity of PD is associated with QoL measured by WHOQOL-BREF; (3) overall QoL, working capacity, activities of daily living (ADL) and self-esteem are affected in both transitional periods in the progression of PD (mild to moderate and moderate to advanced). Satisfaction with general health, pain, energy, positive feelings, personal relationship and satisfaction with home are affected in the first period of transition while mobility, body image, sexual activity and access to information are affected in the second. This study mainly shows specific facets that are affected depending on the specific periods of PD progression, which can help to understand the impact of the disease, the effectiveness of care, and the demand for health care resources.

Parkinson’s disease and fatigue

Fatigue is one of the most common symptoms in patients with Parkinson's disease (PD), and its impact on the quality of life is substantial. However, its cause and treatment are not established. Fatigue in PD has two components, peripheral and central, which may be related to each other, but are more likely independent. Fatigue is partially associated with depression or sleep disorders, but patients with fatigue are not always depressed and do not necessarily have sleep problems. Anti-PD drugs may exacerbate or reduce fatigue. The impact of fatigue in PD is often underestimated by health-care providers.

Dropping the Bomb: The Experience of Being Diagnosed with Parkinson’s Disease

This qualitative descriptive study examined the advice people with Parkinson's disease have for someone newly diagnosed. Qualitative content analysis of interview data from 11 persons with Parkinson's resulted in 1 major theme: "Dropping the Bomb." This theme signified sorting through the rubble and picking up the pieces of lives shattered by the diagnosis. Four subthemes emerged: Guarded Anticipation, Becoming Informed, Disease Dynamics, and Negotiating with Mr. Parkinson. In planning and implementing interventions, nurses might ease the impact of the diagnosis and the context of the disease if they contextualize their interventions within the preferences of the persons living with it.

Would people with Parkinson's disease benefit from palliative care?

Parkinson's disease (PD) is a chronic, progressive, degenerative disorder of the nervous system, causing substantial morbidity and has the capacity to shorten life. People with PD and their families can find the disease devastating. Nevertheless, this population of patients is not usually considered a group to be supported by palliative care specialists. But the nature of the illness and the challenges of managing its many physical and psychological effects raises questions about the potential benefits of a palliative care approach. The purpose of this project was to describe the experience of PD and consider the relevance of palliative care for this population. Semi-structured interviews were conducted with eight people with PD, 21 family caregivers and six health professionals. Five themes were developed from the data analysis: (1) emotional impact of diagnosis; (2) staying connected; (3) enduring financial hardship; (4) managing physical challenges; and (5) finding help for advanced stages. These data revealed that people with PD and family caregivers are confronted with similar issues to people with typical palliative care diagnoses, such as advanced cancer, and that a palliative approach may be helpful in the care of people with PD and their families.

Inferring personality traits of clients with Parkinson's disease from their descriptions of favourite activities

OBJECTIVE

To explore the extent to which practitioners effectively use cues from clients' verbal descriptions of their favourite activities to form accurate impressions of the personality of clients with Parkinson's disease.

PARTICIPANTS

Ninety-nine practitioners from disciplines of occupational, physical and speech therapy, nursing or medicine.

PROCEDURE

Six men and six women with Parkinson's disease completed a self-report measure of personality and were individually interviewed regarding their favourite activities. The practitioners viewed 2-min segments of those videotaped interviews and provided judgements of the clients' personality.

MEASURE

The NEO-Five Factor Inventory and a coding scheme to describe characteristics of clients' favourite activities.

ANALYSIS

Clients' self-reported personality was correlated with the activity characteristics to identify the degree to which each characteristic was a cue of personality. Practitioners' judgements of personality were correlated with the activity characteristics to identify how heavily the practitioners weighted each cue. These two sets of weightings were compared using Pearson's correlations to determine whether practitioners used an appropriate cue strategy related to the activity descriptions.

RESULTS

Practitioners appropriately used the personality cues found in the clients' favourite activity descriptions to assess the traits of Openness to Experience, Agreeableness and Conscientiousness (r = 0.66, r = 0.60, and r = 0.55, respectively, all p < or = 0.02). Practitioners appeared to use less effective cue strategies for the traits of Neuroticism and Extraversion.

CONCLUSION

Clients with Parkinson's disease appear to express their personality in their descriptions of favourite activities, and practitioners appear to make use of these expressive verbal cues effectively for some aspects of personality.

Changing perceptions of womanhood: living with Parkinson's Disease

This study adopted a multiple case study design to develop our understanding of the experiences and adjustments made by women with Parkinson Disease in relation to womanhood. Nineteen women participated in this investigation telling their stories through a combination of individual interviews, group interviews, reflective diaries, reflective tapes and creative writing. Data were analysed using the framework of Intrapersonal, Interpersonal, Extrapersonal and Metapersonal health proposed by Boddy and Rice (Perspectives on Health and Illness, Dunsmore Press, Palmerston North, 1992). Women reported that major changes were required in their lives in each of these aspects of health. In particular women reported labile emotions, changing body images, changing lifestyles, changing relationships with partner, family and friends, increasing dependence, decreasing role fulfillment and the need for support versus increasing isolation. The findings are of particular relevance to nurses and other health professionals involved with women with Parkinson's Disease as well as social services and voluntary agencies.

Being a Parkinson's patient: immobile and unpredictably whimsical literature and existential analysis

What is characteristic of being a Parkinson's patient? This article intends to answer this question by means of an analysis of novels about people with Parkinson's disease, personal accounts, and scientific publications. The texts were analyzed from an existential-phenomenological perspective, using an adapted version of the existential analysis. Being a Parkinson's patient is apparently characterized by an existential paradox: life appears simultaneously immobile and unpredictably whimsical. This may manifest itself in the person's corporeality, in his being-in-time and in-space, in his relating to things and events, his life-world, and in his being-together-with-others as an individual. Finally, some specific characteristics of being a Parkinson's patient are described that may be relevant for purposes of adequate care, as is to be specified by further research.

An education programme for individuals with Parkinson's disease

An education programme for individuals with Parkinson's disease. People with Parkinson's disease (PD) have to face a lot of ongoing sickness - depending on limitations in daily life and society. Ability for optimal living demands knowledge about the sickness, medications, side-effects and knowledge about the best way to go on living with PD. In this study, 43 persons with PD participated in an outpatient programme based on the structure of connection model. The programme consisted of two weekly 2-h sessions for 5 weeks. Each session consisted of 1 h of dialogue and 1 h of physical performance. The two teachers in the programme were registered nurse and registered physiotherapist. The programme was evaluated with focus on participants' psychosocial situation, mobility and activity in daily living. Participating in the programme gave these individuals an improved psychosocial situation and improved mobility pattern. However, these improvements were not transferred to habitual daily life, which suggests that task-oriented training provides the best solution.

New dimensions in palliative care: a palliative approach to neurodegenerative diseases and final illness in older people

A palliative care approach has much to offer people in the advanced stages of neurodegenerative diseases, as well as elderly people dying from diseases other than cancer. Palliative care can be part of the treatment repertoire of any health worker, supported by intermittent consultation or referral to specialist palliative care services (eg, for management of neuropathic pain). A palliative care approach encourages a focus on pain and symptom management, and prompts more open communication about end-of-life issues. This approach recruits as necessary the expertise of specialists and multidisciplinary teams to encourage a flexible, responsive service. Home carers and healthcare providers require education to ensure a palliative approach that meets the physical, psychological, spiritual and social challenges facing patients and their families, and enhances dignity and quality of life.

The relative health related quality of life of veterans with Parkinson's disease

OBJECTIVES

To use databases of the US Veterans Health Administration (VHA) to describe the impact of Parkinson's disease on health related quality of life (HRQoL) of veterans; to compare the HRQoL of veterans with Parkinson's disease with that of veterans reporting eight other neurological or chronic conditions; and to estimate the unique effect of Parkinson's disease on HRQoL.

METHODS

Respondents to the VHA 1999 large national health survey of veteran enrollees with a diagnosis of Parkinson's disease in VHA treatment files for the fiscal years 1997-1999 were identified by merging databases. The survey incorporated the Veterans SF-36, a well validated generic measure of HRQoL and functional status. This was used to compare patient groups. Mean physical (PCS) and mental (MCS) component summary scores were calculated for Parkinson's disease and eight other diseases by multivariable regressions that adjusted for age, sex, race, education, and 15 mental and physical co-morbid conditions that were self reported in the survey.

RESULTS

Of 887 775 survey respondents, 14 530 (1.64%) had a Parkinson's disease diagnosis. Controlling for sociodemographic factors and co-morbidities, veterans with Parkinson's disease had PCS and MCS below veterans with angina/coronary heart disease, arthritis, chronic low back pain, congestive heart failure, diabetes, and stroke. Veterans with spinal cord injury reported slightly lower PCS than veterans with Parkinson's disease (32.38 v 32.72; 0.03 of 1 SD). Veterans with depression reported markedly lower MCS than veterans with Parkinson's disease (35.94 v 41.48; 0.55 of 1 SD). The unique effect of having Parkinson's disease on HRQoL was to lower PCS and MCS by 4.10 and 3.42 points (0.41 and 0.34 of 1 SD), respectively.

CONCLUSIONS

The analysis quantifies the negative impact of Parkinson's disease on HRQoL, after controlling for sociodemographic factors and co-morbidities. Compared with eight other chronic conditions, Parkinson's disease imposes a relatively heavy burden on US veterans in the VHA health care system.

Coping with menstruation: understanding the needs of women with Parkinson's disease

AIMS

To understand how women with Parkinson's disease (PD) experience and cope with menstruation and associated gynaecological problems, and adjustments to womanhood. This paper focuses on menstruation.

RATIONALE

Unique hormonal fluctuations are known to affect women with idiopathic PD, however, our understanding of the impact of these changes on daily lives and opportunities for nursing support are limited.

METHODS

Descriptive multiple case study design was adopted, and data collection involved a variety of approaches. Including semi-structured interviews, conversational interviews, group interview, reflective diaries and creative writing. A flexible approach was encouraged whereby consenting women chose how and when they wanted to participate.

FINDINGS

A total of 19 women participated, 17 were experiencing naturally occurring periods. The majority had been diagnosed around the age of 39 years, and at the time of study participants ages ranged from 34 to 56 years. Three of the women reported no change in the experience of their periods following diagnosis, 15 reported worsening problems which in two extreme situations led to hysterectomy. During the monthly cycle PD symptoms were often exaggerated, medication effectiveness reduced and 'off times' increased. The period itself involved high levels of pain, fatigue and sometimes humiliating experiences when self-care was impossible.

CONCLUSIONS

This study offers a unique contribution to our understanding of the needs of young women with PD, and suggests that health professionals need to look beyond the mask of a disease associated with old age. The nursing profession has a responsibility to develop models of best practice to enable women of any age to be themselves and to adapt to the rhythm of their hormones as they live and grow older with PD.

A longitudinal evaluation of patients' perceptions of Parkinson's disease

PURPOSE

Parkinson's disease (PD) is a chronic progressive neurological disorder that frequently results in nearly total disability. This study examined changes over 3 years in patients' experiences living with PD, and explored how participants' health perceptions and predicted mortality at baseline related to their actual death by Year 3.

DESIGN AND METHODS

Data were obtained from a local sample of 109 participants by in-home interviews.

RESULTS

The collected results (1) suggested a disconnection between the participants' responses to open-ended questions about the disorder, compared with their responses to questions structured by the investigators; (2) demonstrated changes in responses to structured and open-ended questions; and (3) demonstrated that respondents who declined to predict whether they would be living in 10 years were three times more likely to die by Year 3 than those who answered the question.

IMPLICATIONS

Results demonstrate the importance of identifying the most important issues for the individual with PD and suggest that these issues may change over time. Results also raise issues surrounding how patients' perceptions influence the course of their disease.

Older Swedish women's experiences of living with symptoms related to Parkinson's disease

BACKGROUND

Approximately 1% of the population over 65 years of age is afflicted with Parkinson's disease (PD). The number of patients with the disease will most probably increase in the future because of the increased longevity of the population. There is no curative therapy for the disease.

AIM

To explore women's experiences of living with symptoms related to PD, and to analyse how the symptoms influence their quality of life.

METHODS

A phenomenological-hermeneutic method, inspired by the philosophy of Ricoeur was used. The study focuses on eight women between 63 and 80 years of age who have been diagnosed with PD for 5-15 years. The women all lived at home, were moderately to severely disabled and cognitively intact.

FINDINGS

In the analysis, four themes emerged: (1) wish for a stable body image; (2) wish to keep traditional female competence; (3) need to feel accepted for the person she is; and (4) perceived stigmatization. All themes showed that trying to adapt to unpredictable fluctuations in physical and psychosocial competence has a great impact on the females' lives. It became clear that fluctuations in competence and not knowing when to expect impaired mobility are connected with frustration and social withdrawal.

CONCLUSION

The experience of PD from eight disabled female patients has revealed that the disease affects quality of life not only for the person who has it, but also for her family. Thus, it is equally urgent that patients, relatives, nurses and caregivers gain better knowledge and more understanding of PD, so as to ease the impact of the disease on the patient's daily life.

Case studies of food shopping, cooking and eating habits in older women with Parkinson's disease

AIMS

The principal aim of this study was to investigate how married and single-living older women diagnosed with Parkinson's disease managed to shop for food, cook and carry out their meals; and to observe whether their nutritional needs were satisfied. A secondary aim was to identify women with severe motor problems and describe their food-related situation.

BACKGROUND

Parkinson's disease is associated with motor and eating problems, which, combined with age-related declines in physical functioning, may affect activities of daily living and dietary intake.

METHODS

Qualitative interviews and food survey were carried out in the homes of 10 women aged 67-80 years. The sample was recruited from outpatient registers.

RESULTS

Decreased sense of smell, appetite and taste in combination with problems transporting food to the mouth and swallowing were risks for nutritional well-being. Food shopping was most difficult to manage, but six cooked even if their cooking style was changed. Married women with healthy husbands received support from their spouses. Single-living women suffering from motor problems had to call for help, which represented a threat to their well-being. Independence was given high priority.

CONCLUSIONS

The whole situation - including psychosocial and stress factors - must be taken into account when discussing shopping, cooking and eating among old women with Parkinson's disease. A home-helper should not take over but facilitate procedures so that the woman can manage as long as possible. This gave them self-esteem.

Environmental influences on the experiences of people with Parkinson's disease

This study elucidates environmental influences on lived illness experiences. For two consecutive years, persons with Parkinson's disease (PD) participated in 1 week of daily walking in the Swedish mountains. Daily, low-intensive walking that is free of intense effort or time pressures associated with group interaction characterized the week. Participants were interviewed 3 months after the mountain stay regarding experiences in the mountains, daily living, and how their experience in the mountains influenced their daily living after returning home. A phenomenological method was used for data analysis. Results point to the close connection between mind, body, and environment. The connection becomes highlighted when people are afflicted with sickness, such as PD, which causes impaired control of body language, impaired voluntary mobility, and lowered energy levels. The results also show how a social context in an environment with suitable physical challenges led to a change in individuals' perceptions of the manageability of their experienced sicknesses. These results provide a deepened understanding of how individuals with PD experience illness, its influences on daily life, and how a suitable environment opens opportunities for managing daily issues.

Spoken language production in Huntington's and Parkinson's diseases

The purpose of this study was to investigate the presence and nature of spoken language deficits in Huntington's (HD) and Parkinson's (PD) diseases. Specifically, the study examined whether (a) the spoken language abilities of patients with HD or PD differ from those of age-matched control participants with no brain damage, (b) HD and PD are associated with similar spoken language profiles, and (c) the spoken language abilities of patients with HD or PD are related to the severity of their motor speech deficits, cognitive impairments, or both. All participants completed picture description tasks and a battery of cognitive and motor speech tests. Syntactic, quantitative, and informativeness measures of spoken language were analyzed. In terms of syntax, patients with HD produced shorter utterances, a smaller proportion of grammatical utterances, a larger proportion of simple sentences, and fewer embeddings per utterance than their non-brain-damaged peers. The HD group also produced utterances that were shorter and syntactically simpler than those of the PD group, despite similar performances on the cognitive and motor speech tests. The only syntactic difference between the PD group and their control group was that patients with PD produced a smaller proportion of grammatical sentences. Although the patient and control participants tended to produce similar amounts of verbal output, less of what the patients said was considered informative. Correlations between language measures and test battery results suggested that the spoken language abilities of patients with HD or PD are related to a variety of neuropsychological and motor speech changes. The implications of these findings for the clinical management of HD and PD are discussed.

Stressors, social support, coping, and health dysfunction in individuals with Parkinson's disease

The purposes of this descriptive correlational study were to describe the illness-related stressors of individuals with Parkinson's disease and to report the extent to which social support and coping responses predict physical and psychosocial health dysfunction. The sample consisted of 70 men and women, age 44 to 80, residing in the community. Participants reported a variety of illness-related stressors, most of which occurred on a daily basis and involved some loss in functional abilities. Less perceived availability of social support, more evasive coping, and more confrontive coping predicted greater health dysfunction, suggesting that these factors may be important to consider when assessing individuals with Parkinson's disease and designing interventions for individuals with functional declines.