1
|
Rabuffetti M, De Giovannini E, Carpinella I, Lencioni T, Fornia L, Ferrarin M. Association of 7-Day Profiles of Motor Activity in Marital Dyads with One Component Affected by Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:1087. [PMID: 36772127 PMCID: PMC9921738 DOI: 10.3390/s23031087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: A noticeable association between the motor activity (MA) profiles of persons living together has been found in previous studies. Social actigraphy methods have shown that this association, in marital dyads composed of healthy individuals, is greater than that of a single person compared to itself. This study aims at verifying the association of MA profiles in dyads where one component is affected by Parkinson's disease (PD). (2) Methods: Using a wearable sensor-based social actigraphy approach, we continuously monitored, for 7 days, the activities of 27 marital dyads including one component with PD. (3) Results: The association of motor activity profiles within a marital dyad (cross-correlation coefficient 0.344) is comparable to the association of any participant with themselves (0.325). However, when considering the disease severity quantified by the UPDRS III score, it turns out that the less severe the symptoms, the more associated are the MA profiles. (4) Conclusions: Our findings suggest that PD treatment could be improved by leveraging the MA of the healthy spouse, thus promoting lifestyles also beneficial for the component affected by PD. The actigraphy approach provided valuable information on habitual functions and motor fluctuations, and could be useful in investigating the response to treatment.
Collapse
Affiliation(s)
| | - Ennio De Giovannini
- Centro Medico Riabilita Cooperativa Sociale Mano Amica Onlus, 36015 Schio, Italy
| | | | | | - Luca Fornia
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20133 Milano, Italy
| | | |
Collapse
|
2
|
Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Feal Painceiras MJ, Íñiguez-Alvarado MC, García Díaz I, Jesús S, Buongiorno MT, Planellas L, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor García-Soto J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Menéndez González M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Changes in Principal Caregiver Mood Affects the Mood of the Parkinson's Disease Patient: The Vicious Cycle of Illness. JOURNAL OF PARKINSON'S DISEASE 2023; 13:219-231. [PMID: 36683517 PMCID: PMC10041425 DOI: 10.3233/jpd-225014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | | | - Iago García Díaz
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | | | | | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Hernández Vara
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Berta Solano Vila
- Institut d'Assistència Sanitària (IAS) - Institut Català de la Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
- Hospital de Sant Pau, Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | - Carlos Ordás
- Hospital Rey Juan Carlos, Madrid, Spain, Madrid, Spain
| | - Luis M López Díaz
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Darrian McAfee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | - Pablo Mir
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | | |
Collapse
|
3
|
Sprajcer M, Owen PJ, Crowther ME, Harper K, Gupta CC, Ferguson SA, Gibson RH, Vincent GE. Sleep disturbance in caregivers of individuals with Parkinsonism: a systematic review and meta-analysis. BMJ Open 2022; 12:e062089. [PMID: 36379644 PMCID: PMC9668020 DOI: 10.1136/bmjopen-2022-062089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The global prevalence of Parkinsonism continues to rise given ageing populations. Individuals with Parkinsonism who have moderate or severe symptoms typically require a high level of care, including assistance with activities of daily living. This care is often provided across the 24-hour period by a family member or friend. It is likely that providing care significantly impacts the sleep duration and quality of the caregiver given overnight caring responsibilities, in addition to worry and stress associated with the caregiving role. The aim of this systematic review and meta-analysis was to investigate whether providing care to an individual with Parkinsonism was associated with disturbed caregiver sleep, and to identify associated factors that may contribute to disturbed sleep in this population. SETTING Five databases were electronically searched on 30 June 2021 including CINAHL, PubMed, PsycINFO, CENTRAL and EMBASE. PARTICIPANTS Eligibility criteria included a population of caregivers whose care recipient has a form of Parkinsonism. PRIMARY AND SECONDARY OUTCOME MEASURES To be included in this systematic review, outcome measures of caregiver sleep (eg, sleep duration, sleep quality) were required. RESULTS Eighteen studies (n=1998) were included. Findings indicated that caregivers of individuals with Parkinsonism typically experience poor sleep quality (mean (95% CI): 5.6 (4.8 to 6.4) points on the Pittsburgh Sleep Quality Index), increased sleep latency and poor sleep efficiency. CONCLUSIONS The degree of poor sleep quality was clinically significant. However, further investigation of sleep outcomes is required using sleep measurement tools tailored for this population (eg, measures that capture overnight sleep disruption by care recipient/s). Additionally, there is a need for appropriate individual and societal-level interventions to improve caregiver sleep. PROSPERO REGISTRATION NUMBER CRD42021274529.
Collapse
Affiliation(s)
- Madeline Sprajcer
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Meagan E Crowther
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | - Kirsty Harper
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | | | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | - Rosemary H Gibson
- Sleep Wake Research Centre, School of Health Sciences, Massey University, Wellington, New Zealand
| | - Grace E Vincent
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| |
Collapse
|
4
|
Using former carers' expertise in peer support for carers of people with Parkinson's Disease. NPJ Parkinsons Dis 2022; 8:133. [PMID: 36243820 PMCID: PMC9569356 DOI: 10.1038/s41531-022-00381-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022] Open
Abstract
Informal carers gain unique experience and knowledge when caring for a loved person. However, this knowledge often remains unused after their loved one with Parkinson’s disease (PD) has passed away. Hence, two opportunities are currently being missed: sharing this unique experience could support current informal carers and offer the bereaved former carers the option to continue to fulfil a meaningful role. This study aimed to identify the unmet needs of current carers, and to examine the interest, willingness and requirements of both current and former carers for peer-to-peer support. Data were collected from August 2020 to February 2021 through questionnaires examining (1) resources and needs for support; (2) topics for support and advice; and (3) preferences for peer-to-peer initiatives. Open questions were analyzed thematically, after open coding. In total, 141 current and 15 former informal carers participated. Current carers were mainly women (68%) and partner of a person with PD (86%). Former carers were mainly women (80%) who had cared for a partner or parent (53%; 47%) with PD. Almost half of the current carers expressed need for additional support in finding balance, changing relationships, and learning how to cope with lack of emotions and motivation. Half of the carers were positive about the opportunity to exchange experiences and knowledge with former carers. Willingness among former carers for providing peer-to-peer support was high (87%). In both groups, having a degree of commonality with peers was considered an essential requirement. These findings provide guidance for developing peer-to-peer support programs, incorporating former carers.
Collapse
|
5
|
Hand A, Oates LL, Gray WK, Dismore LL, Baker K, Naisby J, Walker RW. Understanding Caregiver Strain in Parkinsonism-A Mixed Methods Approach. J Geriatr Psychiatry Neurol 2022; 35:363-373. [PMID: 33648358 DOI: 10.1177/0891988721996819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Parkinsonism, including Parkinson's disease (PD) are progressive neurological conditions. As these condition progress, individuals will need more support with their care needs to maintain independent community-living. Care needs are mainly met by unpaid, informal caregivers, usually close family members or friends. Caregiver strain is thought to lead to the need for care home placement when the caregiver can no longer cope. OBJECTIVE To understand predictors of caregiver strain and its influence on care home placement for people with moderate to advanced Parkinsonism. METHODS This is a convergent mixed methods study. Quantitative data, following an adapted stress-appraisal model, were collected on caregiver profile, tasks performed and causes of caregiver strain. Semi-structured, in-depth interviews were conducted with caregivers of people with PD (PwP) who went into a care home during the study period, to develop a deeper understanding of the caregiver role and the factors influencing caregiver strain. RESULTS Quantitative data were collected from 115 patient caregiver dyads. Interviews were conducted with 10 caregivers. A model to predict caregiver strain was developed and predictors of caregiver strain were identified, such as functional disability and poor caregiver sleep. CONCLUSION Our findings further demonstrate the complexity of carer strain. Particular dimensions are identified that need to be addressed within clinical practice to reduce carer strain and support people with Parkinsonism to remain within their own home for as long as possible.
Collapse
Affiliation(s)
- Annette Hand
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-upon-Tyne, UK
| | - Lloyd L Oates
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Lorelle L Dismore
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
| |
Collapse
|
6
|
Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
Collapse
Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
| |
Collapse
|
7
|
Cheung DST, Chau PH, Yeung WF, Deng W, Hong AWL, Tiwari AFY. Assessing the effect of a mind-body exercise, qigong Baduanjin, on sleep disturbance among women experiencing intimate partner violence and possible mediating factors: a randomized-controlled trial. J Clin Sleep Med 2021; 17:993-1003. [PMID: 33551021 DOI: 10.5664/jcsm.9102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the effects of a mind-body exercise, qigong Baduanjin, on sleep disturbances in women experiencing intimate partner violence and explore the mediating role of depressive symptoms, perceived stress, and inflammation in producing the effects. METHODS A subgroup of a parent randomized controlled trial was randomized for a 22-week Baduanjin intervention (n = 94) or wait-list control (n = 92). Questionnaires, including the General Sleep Disturbance Scale, Perceived Stress Scale, and Beck Depression Inventory version II, were administered at baseline, posttraining (6 weeks), and postintervention (22 weeks), and blood samples were collected to assess tumor necrosis factor and interleukin 6 levels at baseline and postintervention only. RESULTS Of the 186 participants, 170 completed the study. Results indicate that the total sleep disturbance scores for the intervention group were significantly lower than those for the wait-list control group at week 6 (difference = -7.96; 95% confidence interval [CI], -13.63 to -2.30; P = .006) and week 22 (difference = -7.17; 95% CI, -12.58 to -1.76; P = .01). Mediation analysis showed a statistically significant indirect effect of the intervention on sleep improvement through reducing depressive symptoms (β = 2.58, 95% CI, 0.69 to 5.09), while the mediating effects of perceived stress and inflammation were not significant. CONCLUSIONS Qigong Baduanjin can be recommended for women who experience intimate partner violence and report sleep disturbances. More research is needed to understand the clinical significance of the observed sleep improvements. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Qigong Intervention Program for Abused Chinese Women; URL: https://clinicaltrials.gov/ct2/show/NCT02060123; Identifier: NCT02060123.
Collapse
Affiliation(s)
- Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Wen Deng
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Athena Wai Lin Hong
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Agnes F Y Tiwari
- School of Nursing, Hong Kong Sanatorium & Hospital, Hong Kong, China
| |
Collapse
|
8
|
Beydoun HA, Hossain S, Huang S, Beydoun MA, Alemu BT, Eid SM, Zonderman AB. Sex Differences in Patterns of Sleep Disorders Among Hospitalizations With Parkinson's Disease: 2004-2014 Nationwide Inpatient Sample. Psychosom Med 2021; 83:477-484. [PMID: 33901054 PMCID: PMC8178234 DOI: 10.1097/psy.0000000000000949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to examine patterns of sleep disorders among hospitalized adults 65 years and older as related to Parkinson's disease (PD) status and to evaluate sex differences in the associations between PD with sleep disorders. METHODS A cross-sectional study was conducted using 19,075,169 hospital discharge records (8,169,503 men and 10,905,666 women) from the 2004-2014 Nationwide Inpatient Sample databases. PD and sleep disorder diagnoses were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification coding. Logistic regression models were constructed for each sleep disorder as a correlate of PD status; adjusted odds ratios (aOR) with their 95% confidence intervals (CIs) were calculated taking into account patient and hospital characteristics. RESULTS Period prevalences of PD and sleep disorder were estimated to be 2.1% and 8.1%, respectively. Most sleep disorder types, with the exception of sleep-related breathing disorders, were positively associated with PD diagnosis. Statistically significant interactions by sex were noted for associations of insomnia (men: aOR = 1.29, 95% CI = 1.24-1.36; women: aOR = 1.17, 95% CI = 1.12-1.22), parasomnia (men: aOR = 3.74, 95% CI = 3.44-4.07; women: aOR = 2.69, 95% CI = 2.44-2.96), sleep-related movement disorder (men: aOR = 1.09, 95% CI = 1.07-1.11; women: aOR = 1.22, 95% CI = 1.20-1.25), and any sleep disorder (men: aOR = 1.06, 95% CI = 1.05-1.08; women: aOR = 1.15, 95% CI = 1.13-1.17) with PD status. CONCLUSIONS Overall, hospitalized men are more likely to experience PD with insomnia or parasomnia, whereas hospitalized women are more likely to experience PD with sleep-related movement disorder or any sleep disorder. Prospective cohort studies are needed to replicate these cross-sectional findings.
Collapse
Affiliation(s)
- Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community
Hospital, Fort Belvoir, VA, USA 22060
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences,
National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA 21225
| | - Shuyan Huang
- Fort Belvoir Troop Command, Fort Belvoir, VA, USA
22060
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences,
National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA 21225
| | - Brook T. Alemu
- Integrated Health Sciences Program, School of Health
Sciences, Western Carolina University, Cullowhee, NC, USA 28723
| | - Shaker M. Eid
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA 21225
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences,
National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA 21225
| |
Collapse
|
9
|
Efficacy and Safety of Pramipexole Sustained Release versus Immediate Release Formulation for Nocturnal Symptoms in Chinese Patients with Advanced Parkinson's Disease: A Pilot Study. PARKINSONS DISEASE 2021; 2021:8834950. [PMID: 33763199 PMCID: PMC7946461 DOI: 10.1155/2021/8834950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Objective To explore the efficacy and safety of pramipexole sustained release (SR) versus pramipexole immediate release (IR) in treating nocturnal symptoms in levodopa-treated Chinese patients with advanced Parkinson's disease (PD) and sleep disturbances. Method SUSTAIN was an open-label, randomised, active-controlled parallel group exploratory pilot study (NCT03521635). A total of 98 patients were randomly allocated (1 : 1) to either pramipexole SR (n = 49) or pramipexole IR (n = 49) groups. The primary endpoint was a change from baseline in PD Sleep Scale 2nd version (PDSS-2) total score at 18 weeks. A reduction in score represents improvement. Secondary endpoints included Nocturnal Hypokinesia Questionnaire, Scales for Outcomes in PD Sleep Scale, Early Morning Off (EMO), Epworth Sleepiness Scale, PD Questionnaire-8, and responder rates as measured by PDSS-2 total score (<18), EMO scores (≥1 point change), Clinical Global Impression Improvement scale, and Patient Global Impression-Improvement scale. Other endpoints included motor complications (MDS-UPDRS part IV) score. Adverse events were evaluated for each group. Results The mean pramipexole dose for both groups was 1.5 mg/day at week 18, and the mean changes in PDSS-2 total score for pramipexole SR and IR were –13.7 (95% CI –16.0 to –11.4) and –14.4 (–16.8 to –12.0) (difference of 0.7; p=0.688). Change from baseline for both groups achieved the minimal clinical important difference threshold (MCID = –3.44). No significant difference was observed in change from baseline for other measures of sleep-related disturbances or responder rates. For motor complications, a greater improvement in MDS-UPDRS part IV score was observed in pramipexole SR over IR (–3.4 vs –2.3; treatment group difference: –1.1; p=0.036). Both groups had comparable safety profiles. Conclusion In Chinese patients with advanced PD and sleep disturbances, pramipexole SR and IR have similar benefits in the treatment of nocturnal symptoms and safety, and an improvement from baseline in nocturnal symptoms was observed regardless of pramipexole formulation.
Collapse
|
10
|
Wade R, Pachana NA, Dissanayaka N. Management of Sleep Disturbances in Parkinson's Disease Patients, Carers and the Patient and Carer Dyadic Relationship: A Scoping Review. Clin Gerontol 2020; 43:499-507. [PMID: 30422081 DOI: 10.1080/07317115.2018.1539424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sleep disturbances are a debilitating non-motor symptom in Parkinson's disease (PD) and negatively impact patients, their carers and the patient-carer dyadic relationship. This review outlines the phenomenology, as well as factors associated with and treatment of sleep disturbances, in PD patients and their informal carers. METHODS The following terms were used in four databases: Parkinson*, sleep* disturbance*, carer*, dyad*, intervention* and treatment*. RESULTS Across the articles reviewed, the frequency of reported sleep disturbances in PD ranged between 60% and 98%. Common sleep problems in PD included insomnia, excessive day time sleepiness, REM sleep behavior disorder (RBD), sleep apnoea, periodic limb movements and sleep attacks. Within dyads, significant correlations were found with depression, anxiety and carer burden relating to night time care in particular. Despite the negative impact of sleep disturbance in PD, the evidence-base for treatment remains limited. CONCLUSIONS While addressing individual factors associated with sleep disturbances, it is also important to emphasize the needs arising from the patient-carer dyadic relationship. While a number of non-pharmacological interventions were suggested in the literature, further well-controlled trials are still required. CLINICAL IMPLICATIONS Multiple approaches are required to reduce sleep disturbances and associated burden in PD.
Collapse
Affiliation(s)
- Rachael Wade
- School of Psychology, The University of Queensland , Brisbane, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland , Brisbane, Australia
| | - Nadeeka Dissanayaka
- School of Psychology, The University of Queensland , Brisbane, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital , Brisbane, Australia
| |
Collapse
|
11
|
Park KW, Jo S, Lee SH, Hwang YS, Lee D, Ryu HS, Chung SJ. Therapeutic Effect of Levodopa/Carbidopa/Entacapone on Sleep Disturbance in Patients with Parkinson's Disease. J Mov Disord 2020; 13:205-212. [PMID: 32894900 PMCID: PMC7502296 DOI: 10.14802/jmd.20055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/15/2020] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the efficacy of levodopa/carbidopa/entacapone (LCE) at bedtime for treating sleep disturbance in patients with Parkinson’s disease (PD) with motor fluctuations. Methods Participants included 128 PD patients with motor fluctuations. All patients were assessed for motor, nonmotor, and sleep-specific symptoms using the United Parkinson’s Disease Rating Scale (UPDRS), the Korean version of the Nonmotor Symptom Scale, the Parkinson’s Disease Sleep Scale (PDSS), the Epworth Sleepiness Scale, and the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ). We compared the baseline characteristics of patients with sleep disturbance (PDSS score < 120) and those without sleep disturbance (PDSS score ≥ 120). Thirty-nine patients with sleep disturbance who agreed to take LCE at bedtime completed 3-month follow-ups. We analyzed changes in the scores of motor, nonmotor, and sleep symptom scales over the 3 months. Results PD patients with sleep disturbance were at more advanced disease stages and had more severe motor, nonmotor, and sleep symptoms than those without sleep disturbance. Patients who took LCE at night showed improvements in motor (UPDRS part III, p = 0.007) and sleep symptoms (total PDSS, p < 0.001). Sleep features that benefitted from LCE included not only nocturnal motor components but also insomnia (PDSS items 2 and 3, p = 0.005 and p < 0.001) and rapid eye movement behavior disorder (PDSS item 6, p = 0.002; and RBDSQ, p < 0.001). Conclusion The use of LCE at bedtime may be a useful treatment for sleep disturbance in advanced PD patients with motor fluctuations.
Collapse
Affiliation(s)
- Kye Won Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Su Hwang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dagyo Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Melka D, Tafesse A, Bower JH, Assefa D. Prevalence of sleep disorders in Parkinson's disease patients in two neurology referral hospitals in Ethiopia. BMC Neurol 2019; 19:205. [PMID: 31438888 PMCID: PMC6706909 DOI: 10.1186/s12883-019-1431-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/23/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Non motor symptoms (NMS) of Parkinson's disease (PD) are common and can be more disabling than motor symptoms. Sleep disorders can be seen in up to 98% of patients with Parkinson disease. Poor sleep quality has been associated with poverty and race, and yet there has been no prior report on sleep disorders in those with PD living in sub Saharan Africa. We wished to document the prevalence of sleep disorders in PD patients in Ethiopia. METHODS We conducted a cross-sectional point prevalence study from July 1 to October 30, 2015 of all patients attending the neurology outpatient department in Tikur Anbessa and Zewuditu Memorial Hospitals, Addis Ababa, Ethiopia. Demographic data, clinical history and physical examination findings were collected from participants using a structured questionnaire. We used the Parkinson's disease sleep scale version two (PDSS-2) and Epworth Sleepiness Scale (ESS) to assess the sleep symptoms. RESULTS Of the 155 patients surveyed, all patients reported some sleep problem. Over 43.9% of patients had a PDSS score > 18. The median score of ESS was 9 (IQR = 5-12), with 77/155 (49.7%) of the patients having possible or definite excessive daytime somnolence. A high EDSS score significantly associated with a Hoehn & Yahr score > 4 (p = 0.02). CONCLUSIONS In Ethiopian PD patients, the prevalence of those with severe sleep disorders is the highest reported to date. The prevalence of possible/definite EDS is amongst the highest in the world. Further investigation into whether poverty or race explains this finding is needed.
Collapse
Affiliation(s)
- Dereje Melka
- Department of Neurology, Addis Ababa University School of Medicine, P.O.Box 1176, Addis Ababa, Ethiopia
| | - Abenet Tafesse
- Department of Neurology, Addis Ababa University School of Medicine, P.O.Box 1176, Addis Ababa, Ethiopia
| | - James H. Bower
- Department of Neurology, Mayo Clinic School of Medicine, 200 First St SW, Rochester, MN USA
| | - Demeke Assefa
- Department of Health Service Management and Reproductive Health, School of Public Health College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
13
|
Hicks A, Phillips K, Siwik C, Salmon P, Litvan I, Jablonski ME, Filoteo JV, Kayser K, Sephton SE. The role of dispositional mindfulness in a stress-health pathway among Parkinson's disease patients and caregiving partners. Qual Life Res 2019; 28:2705-2716. [PMID: 31201728 DOI: 10.1007/s11136-019-02217-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Parkinson's disease (PD) patients and their caregivers experience significant distress that impacts physical, emotional and social functioning in the patient, and in turn, has a significant impact on the caregiver. Lower levels of stress have been associated with a better prognosis in PD. The quality of dispositional mindfulness-innate present moment, non-judgmental awareness-has consistently been associated with less perceived stress, greater well-being, and better physical health in both clinical and healthy populations. To date, associations of mindfulness with distress, depression, sleep problems, and other variables that define health-related quality of life have not been examined in the context of PD patient/caregiver dyads. METHODS We investigated the impact of dispositional mindfulness in a stress-health model among eighteen dyads consisting of PD patients and their caregivers. RESULTS Multilevel linear modeling (actor-partner interdependence models) revealed significant associations between dispositional mindfulness and stress appraisal, interpersonal support, depressive symptoms, sleep, and health-related quality of life (HRQOL) within both dyadic partners. As expected, results demonstrated significant associations of distress with interpersonal support, depressive symptoms, sleep and HRQOL for both PD patients and caregivers. CONCLUSIONS Dispositional mindfulness was associated with reduced distress and its downstream clinical consequences. These results support an ameliorative role for dispositional mindfulness among PD patients and caregivers, as a protective factor against psychosocial burdens imposed on couples related to disease and caregiving. Findings suggest future studies should explore mindfulness training as a therapeutic option.
Collapse
Affiliation(s)
- Allison Hicks
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kala Phillips
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Chelsea Siwik
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Paul Salmon
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Irene Litvan
- Department of Neurology, University of California San Diego, San Diego, CA, USA
| | - Megan E Jablonski
- Department of Psychology, Frazier Rehabilitation Hospital, Louisville, KY, USA
| | - J Vincent Filoteo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Karen Kayser
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Sandra E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA.
| |
Collapse
|
14
|
Butkovich LM, Houser MC, Tansey MG. α-Synuclein and Noradrenergic Modulation of Immune Cells in Parkinson's Disease Pathogenesis. Front Neurosci 2018; 12:626. [PMID: 30258347 PMCID: PMC6143806 DOI: 10.3389/fnins.2018.00626] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022] Open
Abstract
α-synuclein (α-syn) pathology and loss of noradrenergic neurons in the locus coeruleus (LC) are among the most ubiquitous features of Parkinson's disease (PD). While noradrenergic dysfunction is associated with non-motor symptoms of PD, preclinical research suggests that the loss of LC norepinephrine (NE), and subsequently its immune modulatory and neuroprotective actions, may exacerbate or even accelerate disease progression. In this review, we discuss the mechanisms by which α-syn pathology and loss of central NE may directly impact brain health by interrupting neurotrophic factor signaling, exacerbating neuroinflammation, and altering regulation of innate and adaptive immune cells.
Collapse
Affiliation(s)
| | | | - Malú G. Tansey
- Tansey Laboratory, Department of Physiology, School of Medicine, Emory University, Atlanta, GA, United States
| |
Collapse
|
15
|
Carlozzi NE, Ianni PA, Tulsky DS, Brickell TA, Lange RT, French LM, Cella D, Kallen MA, Miner JA, Kratz AL. Understanding Health-Related Quality of Life in Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Fatigue and Sleep Disturbance Item Banks. Arch Phys Med Rehabil 2018; 100:S102-S109. [PMID: 29932884 DOI: 10.1016/j.apmr.2018.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/20/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the reliability and validity of Patient-Reported Outcomes Measurement Information System (PROMIS) measures of sleep disturbance and fatigue in traumatic brain injury (TBI) caregivers and to determine the severity of fatigue and sleep disturbance in these caregivers. DESIGN Cross-sectional survey data collected through an online data capture platform. SETTING A total of 4 rehabilitation hospitals and Walter Reed National Military Medical Center. PARTICIPANTS Caregivers (N=560) of civilians (n=344) and service member/veterans (SMVs) (n=216) with TBI. INTERVENTION Not applicable. MAIN OUTCOME MEASURES PROMIS sleep and fatigue measures administered as both computerized adaptive tests (CATs) and 4-item short forms (SFs). RESULTS For both samples, floor and ceiling effects for the PROMIS measures were low (<11%), internal consistency was very good (all α≥0.80), and test-retest reliability was acceptable (all r≥0.70 except for the fatigue CAT in the SMV sample r=0.63). Convergent validity was supported by moderate correlations between the PROMIS and related measures. Discriminant validity was supported by low correlations between PROMIS measures and measures of dissimilar constructs. PROMIS scores indicated significantly worse sleep and fatigue for those caring for someone with high levels versus low levels of impairment. CONCLUSIONS Findings support the reliability and validity of the PROMIS CAT and SF measures of sleep disturbance and fatigue in caregivers of civilians and SMVs with TBI.
Collapse
Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Phillip A Ianni
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - David S Tulsky
- Center for Assessment Research and Translation, Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| |
Collapse
|
16
|
Bartolomei L, Pastore A, Meligrana L, Sanson E, Bonetto N, Minicuci GM, Marsala SZ, Mesiano T, Bragagnolo L, Antonini A. Relevance of sleep quality on caregiver burden in Parkinson's disease. Neurol Sci 2018; 39:835-839. [PMID: 29445989 DOI: 10.1007/s10072-018-3252-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder which affects the quality of life of patient and their family. Sleep disorders appear in 80-90% of PD patients and have a great impact on the PD well-being. We examined the relationship of patients' sleep quality and depression on burden, mood, quality of life, and quality of sleep of their caregivers. A multicenter, regional (Veneto), observational, cross-sectional study that included 55 patient-caregiver pairs was conducted. Patients were assessed using Parkinson's Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS) for sleep disorders, Beck Depression Inventory (BDI) as a measure of depression, and Parkinson's Disease Questionnaire (PDQ-39) as a measure of quality of life. Caregivers were evaluated by the Caregiver Burden Inventory (CBI) a measure of burden, BDI, SF-36 Health Survey as measures of HRQoL, and Medical Outcomes Study-Sleep Scale (MOS-SS) for quality of sleep. CBI, HRQoL, MOS-SS, and BDI scores displayed no association with patients' age, cognition (Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB)), disease duration, and Hoehn and Yahr (H&Y), and UPDRS III scales whereas were significantly correlated with patients' quality of sleep, depression, and quality life. CBI and HRQoL were also associated respectively with patients' ESS and L-dopa daily dose. This study underscores the presence of a significant relationship between patient and caregiver quality of life. Interestingly, sleep quality and depression rather than motor disability best predicted caregivers' well-being.
Collapse
Affiliation(s)
- Luigi Bartolomei
- Department of Neurosciences, San Bortolo Hospital, Vicenza, Italy. .,U.O. Neurologia, Ospedale San Bortolo, 36100, Vicenza, Italy.
| | - Andrea Pastore
- Department of Economics, Ca' Foscari University, Venice, Italy
| | - Lucia Meligrana
- Department of Neurosciences, San Bortolo Hospital, Vicenza, Italy.,Psychology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Elena Sanson
- Department of Neurosciences, San Bortolo Hospital, Vicenza, Italy.,Psychology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Nicola Bonetto
- Department of Neurosciences, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Tiziana Mesiano
- Neurology Department, Cazzavillan Hospital, Arzignano, Italy
| | | | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Fondazione Ospedale San Camillo "I.R.C.C.S.", Venice, Italy.,Department of Neurosciences (DNS), Padova University, Padova, Italy
| |
Collapse
|
17
|
Kotronoulas G, Wengström Y, Kearney N. Alterations and Interdependence in Self-Reported Sleep-Wake Parameters of Patient-Caregiver Dyads During Adjuvant Chemotherapy for Breast Cancer
. Oncol Nurs Forum 2017; 43:288-301. [PMID: 27105191 DOI: 10.1188/16.onf.288-301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To longitudinally explore changes, similarities, differences, and interrelations in the sleep-wake parameters of patient-caregiver dyads throughout adjuvant chemotherapy for breast cancer.
. DESIGN Observational, repeated-measures, dyadic study.
. SETTING Four ambulatory oncology clinics in Scotland.
. SAMPLE 48 dyads consisting of patients and their primary informal caregivers.
. METHODS Four dyadic, self-reported sleep-wake assessments took place before chemo-therapy (T0), during chemotherapy cycles 1 (T1) and 4 (T2), and after chemotherapy (T3). Dyads completed the Pittsburgh Sleep Quality Index. Multilevel hierarchical linear modeling was used to explore dyadic data.
. MAIN RESEARCH VARIABLES Perceived sleep quality, sleep onset latency (SOL), total sleep time, habitual sleep efficiency, wake after sleep onset, daily disturbance, daytime napping duration, overall sleep-wake impairment.
. FINDINGS The majority of dyads had at least one poor sleeper throughout the study; 25%-35% were dyads of concurrent poor sleepers. Curvilinear patterns of change were evident for patients' (but not caregivers') sleep-wake parameters, steadily deteriorating from pre- to midtreatment, then leveling off close to baseline. Average trajectories were significantly different between the dyad members but indicative of a trend for concurrent deterioration at T2. Dyad members' perceived sleep quality, SOL, and overall sleep-wake impairment were closely interrelated; wake variables remained uncoupled.
. CONCLUSIONS Despite overall differences in magnitude, sleep problems may be concurrently present in both dyad members, covary, and peak midway through chemotherapy.
. IMPLICATIONS FOR NURSING Dyadic sleep assessments can shed light on potential areas of sleep interaction to enable interventions to support care dyads at risk of sleep distress during chemotherapy for breast cancer.
Collapse
|
18
|
Mosley PE, Moodie R, Dissanayaka N. Caregiver Burden in Parkinson Disease: A Critical Review of Recent Literature. J Geriatr Psychiatry Neurol 2017; 30:235-252. [PMID: 28743212 DOI: 10.1177/0891988717720302] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Burden is a negative psychological state induced in caregivers by the demands of providing care to a person with an illness or a disability. Managing caregiver burden in Parkinson disease (PD) is significant because informal caregivers make a substantial contribution to the well-being of persons with PD, incurring financial, social, and personal losses. Failure to recognize and manage caregiver burden may lead to burnout and premature institutionalization of the person with PD. We conducted a comprehensive literature review to identify and summarize factors that may amplify burden, including motor and nonmotor symptoms of PD, caregiver psychiatric symptoms, and caregiver coping style. We review instruments designed to sample the construct of burden among caregivers and evaluate interventions that may reduce burden, either by directly targeting caregivers or by treating PD symptoms associated with burden. We aim to provide a concise synopsis of these issues for the clinician or researcher working with this population in order to facilitate recognition of caregiver burden, provide accurate assessment, administer appropriate interventions, and stimulate further research in this area.
Collapse
Affiliation(s)
- Philip E Mosley
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,2 Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,3 Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,4 School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Rebecca Moodie
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nadeeka Dissanayaka
- 5 UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.,6 School of Psychology, University of Queensland, St Lucia, Queensland, Australia.,7 Department of Neurology, Royal Brisbane & Woman's Hospital, Herston, Queensland, Australia
| |
Collapse
|
19
|
Rodrigues TM, Castro Caldas A, Ferreira JJ. Pharmacological interventions for daytime sleepiness and sleep disorders in Parkinson's disease: Systematic review and meta-analysis. Parkinsonism Relat Disord 2016; 27:25-34. [PMID: 27010071 DOI: 10.1016/j.parkreldis.2016.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/11/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Daytime sleepiness and sleep disorders are frequently reported in Parkinson's disease (PD). However, their impact on quality of life has been underestimated and few clinical trials have been performed. OBJECTIVES We aimed to assess the efficacy and safety of pharmacological interventions for daytime sleepiness and sleep disorders in PD. METHODS Systematic review of randomized controlled trials comparing any pharmacological intervention with no intervention or placebo for the treatment of daytime sleepiness and sleep problems in PD patients. RESULTS Ten studies (n = 338 patients) were included. Four trials addressed interventions for excessive daytime sleepiness. Meta-analysis of the three trials evaluating modafinil showed a significant reduction in sleepiness, as assessed by the Epworth Sleepiness Scale (ESS) (- 2.24 points, 95% CI - 3.90 to - 0.57, p < 0.05). In one study, treatment with caffeine was associated with a non-significant improvement of 1.71 points in ESS (95% CI, - 3.57 to 0.13). The six remaining trials assessed interventions for insomnia and REM sleep Behaviour Disorder (RBD). Single study results suggest that doxepin and YXQN granules might be efficacious, while pergolide may be deleterious for insomnia and that rivastigmine may be used to treat RBD in PD patients. However, there is insufficient evidence to support or refute the efficacy of any of these interventions. No relevant side effects were reported. CONCLUSIONS Whilst providing recommendations, this systematic review depicts the lack of a body of evidence regarding the treatment of sleep disorders in PD patients; hence, further studies are warranted.
Collapse
Affiliation(s)
- Tiago Martins Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal; Institute of Pharmacology and Neurosciences, Faculty of Medicine, University of Lisbon, Portugal; Unit of Neurosciences, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Ana Castro Caldas
- Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal; Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
| |
Collapse
|
20
|
Santos-García D, de la Fuente-Fernández R. Factors contributing to caregivers' stress and burden in Parkinson's disease. Acta Neurol Scand 2015; 131:203-10. [PMID: 25212106 DOI: 10.1111/ane.12305] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyze the main determinants of burden and stress in caregivers of Spanish Parkinson's disease (PD) patients. METHODS One-hundred and twenty-one non-demented patients with PD (57.9% males; 70.9 ± 8.2 years old) were included in this cross-sectional, monocenter, evaluation study. Caregivers (n = 121; 71.9% females; 60.2 ± 15 years old) were assessed using the Zarit Caregiver Burden Inventory (ZCBI) and Caregiver Strain Index (CSI). Multiple linear regression methods were used to evaluate factors contributing to caregivers' stress and burden: (i) PD motor dysfunction (ON-state Hoehn & Yahr/Unified Parkinson's Disease Rating Scale [UPDRS] part III and motor complications [UPDRS part IV]); (ii) Mood (Beck Depression Inventory [BDI]); (iii) Non-motor symptoms (Non-Motor Symptoms Scale [NMSS]); (iv) Disability (Schwab & England Activities of Daily Living Scale [ADLS]); and (v) Socio-demographic and other disease-related variables. RESULTS Zarit Caregiver Burden Inventory and CSI mean scores were 16 ± 13.9 and 2.1 ± 2.3, respectively. High correlation was found between ZCBI and CSI (r = 0.819; P < 0.0001). Moderate to severe burden (ZCBI > 40) was present in 9.1% of caregivers; 5.8% had high levels of stress (CSI ≥ 7). Moderate to strong correlations were observed between patient-related variables (Hoehn&Yahr, UPDRS-III, UPDRS-IV, BDI, NMSS, and ADLS) and ZCBI and CSI (P < 0.0001). Linear regression methods showed that ADLS had the strongest influence on ZCBI and CSI, followed by BDI on ZCBI. CONCLUSIONS Disability (ADLS) and mood (BDI) of patients with PD are the main factors contributing to burden and stress in caregivers.
Collapse
Affiliation(s)
- D. Santos-García
- Section of Neurology; Complejo Hospitalario Universitario de Ferrol (CHUF); Hospital A. Marcide; Ferrol Spain
| | - R. de la Fuente-Fernández
- Section of Neurology; Complejo Hospitalario Universitario de Ferrol (CHUF); Hospital A. Marcide; Ferrol Spain
| |
Collapse
|
21
|
Salawu F, Olokoba A. Excessive daytime sleepiness and unintended sleep episodes associated with Parkinson's disease. Oman Med J 2015; 30:3-10. [PMID: 25829994 DOI: 10.5001/omj.2015.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/07/2014] [Indexed: 12/20/2022] Open
Abstract
This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinson's disease (PD) and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD.
Collapse
Affiliation(s)
- Fatai Salawu
- Department of Medicine, Federal Medical Centre, Yola, Nigeria
| | - Abdulfatai Olokoba
- Department of General Internal Medicine, University of Ilorin Teaching Hospital, Ilorin. Nigeria
| |
Collapse
|
22
|
Zea-Sevilla MA, Martínez-Martín P. Rating scales and questionnaires for assessment of sleep disorders in Parkinson's disease: what they inform about? J Neural Transm (Vienna) 2014; 121 Suppl 1:S33-40. [PMID: 24756217 DOI: 10.1007/s00702-014-1217-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
Sleep disorders are very prevalent in Parkinson's disease (PD) and include a diversity of disturbances. Rating scales and questionnaires are widely used to assess the presence and severity of the sleep disorders. The objective is to review rating scales and questionnaires used for assessment of sleep disorders in PD. To this purpose, a description and update of the sleep scales reviewed by the ad hoc Movement Disorder Society task force (MDS-TF) and other sleep disorder assessments was performed. Two specific (Parkinson's Disease Sleep Scale and Scales for Outcomes in PD Sleep) and two generic scales (Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) were "Recommended" by the MDS-TF as they were used in PD patients, by researchers others than their developers and properly validated. Two other generic scales (Inappropriate Sleep Composite Score and Stanford Sleepiness Scale), "Suggested" due to incomplete validation, are also reviewed. Other instruments included in this review are three comprehensive PD-specific instruments for assessing multiple domains in addition to sleep problems (e.g., Non-Motor Symptoms Questionnaire, Non-Motor Symptoms Scale, MDS-UPDRS), and three generic instruments focused on particular disturbances (e.g., International Restless Legs Syndrome Study Group Rating Scale, REM behavioral disorders questionnaires), although these latter lack formal validation in PD populations. The "Recommended" instruments cover satisfactorily the needs for screening and evaluation of the nocturnal sleep disorders and daytime sleepiness in PD patients. It would be convenient to validate or complete the validation in PD populations of those instruments that cannot be recommended due to the lack of information on their clinimetric attributes.
Collapse
Affiliation(s)
- María Ascensión Zea-Sevilla
- Alzheimer Disease Research Unit, CIEN Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain
| | | |
Collapse
|
23
|
Viwattanakulvanid P, Kaewwilai L, Jitkritsadakul O, Brenden NR, Setthawatcharawanich S, Boonrod N, Mekawichai P, Bhidayasiri R. The impact of the nocturnal disabilities of Parkinson’s disease on caregivers’ burden: implications for interventions. J Neural Transm (Vienna) 2014; 121 Suppl 1:S15-24. [DOI: 10.1007/s00702-014-1200-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/17/2014] [Indexed: 11/30/2022]
|
24
|
Sleep patterns and sleep-impairing factors of persons providing informal care for people with cancer: a critical review of the literature. Cancer Nurs 2013; 36:E1-15. [PMID: 22495497 DOI: 10.1097/ncc.0b013e3182456c38] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sleep is increasingly recognized as an area of functioning that may be greatly affected in persons who are practically and emotionally involved in the care of patients with cancer. Clinician awareness is required to ensure that effective care for informal caregivers with sleep problems is provided. OBJECTIVE A 2-fold critical review of the published literature was conducted, which aimed at summarizing and critically analyzing evidence regarding sleep patterns of informal caregivers of adults with cancer and contributing factors to sleep-wake disturbances. METHODS Using a wide range of key terms and synonyms, 3 electronic databases (MEDLINE, CINAHL, EMBASE) were systematically searched for the period between January 1990 and July 2011. RESULTS Based on prespecified selection criteria, 44 articles were pooled to provide evidence on sleep-impairing factors in the context of informal caregiving, 17 of which specifically addressed sleep patterns of caregivers of people with cancer. CONCLUSIONS At least 4 of 10 caregivers may report at least 1 sleep problem. Short sleep duration, nocturnal awakenings, wakefulness after sleep onset, and daytime dysfunction seem to be the areas most affected irrespective of stage or type of disease, yet circadian activity remains understudied. In addition, despite a wide spectrum of potential sleep-impairing factors, underlying causal pathways are yet to be explored. IMPLICATIONS FOR PRACTICE More longitudinal, mixed-methods, and comparison studies are warranted to explore caregiver sleep disorders in relation to the gravity of the caregiving situation in the context of diverse types of cancer and disease severity.
Collapse
|
25
|
Psychosocial burden on informal caregivers of patients with bipolar mood disorders. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000433783.67281.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
26
|
Kotronoulas G, Wengström Y, Kearney N. Sleep and sleep-wake disturbances in care recipient-caregiver dyads in the context of a chronic illness: a critical review of the literature. J Pain Symptom Manage 2013; 45:579-94. [PMID: 22926086 DOI: 10.1016/j.jpainsymman.2012.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/21/2012] [Accepted: 03/09/2012] [Indexed: 11/15/2022]
Abstract
CONTEXT Alterations in sleep-wake patterns of care recipients and their informal caregivers are common in the context of a chronic illness. Given the current notion that sleep may be regulated within and affected by close human relationships, concurrent and interrelated sleep problems may be present in care recipient-caregiver dyads. OBJECTIVES To critically analyze evidence regarding concurrent sleep patterns or changes in care recipient-caregiver dyads in the context of a chronic illness and address methodological and research gaps. METHODS Using a wide range of key terms and synonyms, three electronic databases (Medline, CINAHL, and Embase) were systematically searched for the period between January 1990 and July 2011. RESULTS Ten studies met prespecified selection criteria and were included for analysis. Study quality was fair to good on average. Seven studies were conducted in the context of dementia or Parkinson's disease, two in the context of cancer, and one study included a group of community elders with mixed related comorbidities and their informal caregivers. Bidirectional associations in the sleep of care recipient-caregiver dyads seem to exist. Concurrent and comparable nocturnal sleep disruptions also may be evident. Yet, inconsistencies in the methods implemented, and the samples included, as well as uncertainty regarding factors coaffecting sleep, still preclude safe conclusions to be drawn on. CONCLUSION The dyadic investigation of sleep is a promising approach to the development of truly effective interventions to improve sleep quality of care recipients and their caregivers. Nevertheless, more systematic, longitudinal dyadic research is warranted to augment our understanding of co-occurrence and over time changes of sleep problems in care recipient-caregiver dyads, as well as to clarify covariates/factors that appear to contribute to these problems within the dyad and across time and context of illness.
Collapse
|
27
|
Sleep quality in caregivers of patients with Alzheimer's disease and Parkinson's disease and its relationship to quality of life. Int Psychogeriatr 2012; 24:1827-35. [PMID: 22652066 DOI: 10.1017/s1041610212001032] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Knowledge about sleep complaints of caregivers of patients with Alzheimer's disease (AD) and Parkinson's disease (PD) is limited, and we lack information about the relationship between caregivers' sleep problems and their quality of life (QoL). METHODS We evaluated subjective sleep quality and its relationship to QoL in a group of 80 caregivers of patients with AD (ADCG, n = 40) and PD (PDCG, n = 40), and in 150 controls. Information about night-time complaints was collected using the Pittsburgh Sleep Quality Index (PSQI). QoL was measured using the McGill QoL Questionnaire. RESULTS Eighteen ADCG (45%), 22 PDCG (55%), and 45 (30%) controls reported poor sleep quality. Mean global PSQI score of PDCG (6.25 ± 3.9) was not significantly different from that of ADCG (5.8 ± 3.5; p = 0.67). However, both PDCG and ADCG scored significantly higher than control group (4.3 ± 3.1; p < 0.01). ADCG frequently reported difficulties falling asleep (72.5%) and disturbed sleep (100%). PDCG reported reduced subjective sleep quality (80%) and increased sleep disturbances (100%). Poor sleep quality was associated with depressive symptoms and correlated with QoL in caregivers of both groups, particularly the psychological symptoms domain. CONCLUSIONS Among caregivers of patients with AD and PD, poor sleep quality is frequent and significantly linked to QoL and depressive symptoms. Identifying the nature of sleep disturbances not only in patients but also in their caregivers is important as appropriate treatment may lead to a better management of the needs of families coping with these patients.
Collapse
|
28
|
Physical Activity across Frailty Phenotypes in Females with Parkinson's Disease. J Aging Res 2012; 2012:468156. [PMID: 22919489 PMCID: PMC3420090 DOI: 10.1155/2012/468156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 06/02/2012] [Accepted: 06/21/2012] [Indexed: 11/26/2022] Open
Abstract
Females with Parkinson's disease (PD) are vulnerable to frailty. PD eventually leads to decreased physical activity, an indicator of frailty. We speculate PD results in frailty through reduced physical activity. Objective. Determine the contribution of physical activity on frailty in PD (n = 15, 65 ± 9 years) and non-PD (n = 15, 73 ± 14 years) females. Methods. Frailty phenotype (nonfrail/prefrail/frail) was categorized and 8 hours of physical activity was measured using accelerometer, global positioning system, and self-report. Two-way ANCOVA (age as covariate) was used to compare physical activity between disease and frailty phenotypes. Spearman correlation assessed relationships, and linear regression determined associations with frailty. Results. Nonfrail recorded more physical activity (intensity, counts, self-report) compared with frail. Self-reported physical activity was greater in PD than non-PD. In non-PD, step counts, light physical activity time, sedentary time, and self-reported physical activity were related to frailty (R = 0.91). In PD, only carbidopa-levodopa dose was related to frailty (r = 0.61). Conclusion. Physical activity influences frailty in females without PD. In PD females, disease management may be a better indicator of frailty than physical activity. Further investigation into how PD associated factors contribute to frailty is warranted.
Collapse
|
29
|
|
30
|
Abstract
This article considers the practicality and patient benefits of transferring evidence-based sleep management skills to community health professionals. Sleep disturbances are among the most frequently reported and poorly managed non-motor symptoms in Parkinson's. But, despite their prevalence, sleep problems in Parkinson's are often under-recognized, under-diagnosed and inadequately treated. To raise awareness and improve patient care in Parkinson's, a three-day sleep management course was developed for Parkinson's disease nurse specialists (PDNSs) practising within NHS Scotland. The course aimed to transfer skills in health education as applied to sleep and insomnia; the assessment of sleep; the practice of sleep hygiene; delivering relaxation methods; the use of stimulus control and sleep restriction procedures; and cognitive approaches to insomnia management. Between June 2010 and July 2011, 38 PDNSs and practising occupational therapists undertook the course. Interviews and evaluations with patients and professionals were carried out afterwards. Patients reported a reduction in anxiety over sleep problems, feeling able to manage their sleep, and having a sense of control over their sleep. Programme outcomes suggest that the training model used is feasible and practical; the resources designed for clinical use are practical and relevant; and that the initiative as a whole represents a valid and affordable investment in patient wellbeing.
Collapse
|
31
|
Kim H, Rose K. Sleep disturbances in family caregivers: an overview of the state of the science. Arch Psychiatr Nurs 2011; 25:456-68. [PMID: 22114799 DOI: 10.1016/j.apnu.2011.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 02/19/2011] [Indexed: 10/18/2022]
Abstract
Sleep disturbance is a prevalent and complex issue within the family caregiver population that affects the overall health of the caregivers themselves and their care recipients. However, there is limited evidence to support the efficacy of current practice and a lack of consensus regarding the optimal treatment protocol. This article will provide an overview of sleep research in family caregivers. It explores current trends in sleep research and identifies relevant conceptual and methodological issues, suggesting implications for further research and highlighting the need to improve sleep quality in the caregiver population.
Collapse
Affiliation(s)
- Heejung Kim
- University of Virginia, University of Virginia, School of Nursing, Charlottesville, VA 22908-0782, USA.
| | | |
Collapse
|
32
|
|
33
|
Leroi I, Baker P, Kehoe P, Daniel E, Byrne EJ. A pilot randomized controlled trial of sleep therapy in Parkinson's disease: effect on patients and caregivers. Int J Geriatr Psychiatry 2010; 25:1073-9. [PMID: 20157905 DOI: 10.1002/gps.2472] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE By means of a controlled trial, to investigate the efficacy, tolerability and feasibility of a multi-component sleep therapy intervention versus basic sleep hygiene education in PD patients with sleep disturbances and their live-in carers. METHODS Patient-carer dyads were randomised to either of the two interventions. Quantitative measures of sleep, psychiatric and overall functioning were administered at baseline and two weeks after the intervention to patients and carers. RESULTS Sleep disturbances in the PD patients improved significantly in both the groups. Between group comparisons in both carers and patients revealed no significant differences on any outcome measures. The intervention was found to be well tolerated, feasible and could easily be translated into the clinical setting. CONCLUSIONS This pilot study makes the case for further, more rigorous study of pragmatic, non-pharmacological interventions for sleep disturbances in PD.
Collapse
Affiliation(s)
- Iracema Leroi
- North Manchester General Hospital, Delaunays Rd, Manchester, UK.
| | | | | | | | | |
Collapse
|
34
|
Menza M, Dobkin RD, Marin H, Gara M, Bienfait K, Dicke A, Comella CL, Cantor C, Hyer L. Treatment of insomnia in Parkinson's disease: a controlled trial of eszopiclone and placebo. Mov Disord 2010; 25:1708-14. [PMID: 20589875 PMCID: PMC2928867 DOI: 10.1002/mds.23168] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease affecting up to 1 million individuals in the United States. Sleep disturbances, typically in sleep maintenance, are found in up to 88% of these individuals and are associated with a variety of poor outcomes. Despite being common and important, there are few data to guide clinical care. We conducted a 6-week, randomized, controlled trial of eszopiclone and placebo in 30 patients with PD and insomnia. Patients with other primary sleep disorders (PSG defined) were excluded. The primary outcome was total sleep time (TST), and secondary measures included wake after sleep onset (WASO), number of awakenings, and quality of sleep, among others. The groups did not significantly differ on TST, but significant differences, favoring eszopiclone, did emerge in number of awakenings (P = 0.035), quality of sleep (P = 0.018), and in physician-rated CGI improvement (P = 0.035). There was also a trend toward significance in WASO (P = 0.071). There were no significant differences between groups in measures of daytime functioning. The drug was well tolerated, with 33% of patients on eszopiclone and 27% of patients on placebo reporting adverse events. Although modest in size, this is the first controlled study of the treatment of insomnia in patients with PD. Eszopiclone did not increase TST significantly but was superior to placebo in improving quality of sleep and some measures of sleep maintenance, which is the most common sleep difficulty experienced by patients with PD. Definitive trials of the treatment of sleep disorders in this population are warranted.
Collapse
Affiliation(s)
- Matthew Menza
- Department of Psychiatry, Robert Wood Johnson Medical School, Piscataway, New Jersey 08854, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Menza M, Dobkin RD, Marin H, Bienfait K. Sleep disturbances in Parkinson's disease. Mov Disord 2010; 25 Suppl 1:S117-22. [PMID: 20187236 DOI: 10.1002/mds.22788] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sleep disturbances are very common in patients with PD and are associated with a variety of negative outcomes. The evaluation of sleep disturbances in these patients is complex, as sleep may be affected by a host of primary sleep disorders, other primary medical or psychiatric conditions, reactions to medications, aging or the neuropathophysiology of PD itself. In this article, we review the evaluation of the common disturbances of sleep seen in PD. This includes the primary sleep disorders, the interaction of depression and insomnia, the impact that medications for PD have on sleep, as well as the role of factors such as nocturia, pain, dystonia, akinesia, difficulty turning in bed, and vivid dreaming. The treatment of sleep disturbances in PD is largely unstudied but recommendations based on clinical experience in PD and research studies in other geriatric populations can be made. Important principles include, diagnosis, treating the specific sleep disorder or co-occurring disorder, and control of the motor aspects of PD.
Collapse
Affiliation(s)
- Matthew Menza
- Department of Psychiatry, Robert Wood Johnson Medical School, Piscataway, New Jersey 08854, USA.
| | | | | | | |
Collapse
|
36
|
Psychiatric Issues in Parkinson's Disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/b978-1-4160-6641-5.00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
37
|
Predictors of caregiver burden in partners of patients with Parkinson’s disease. Neurol Sci 2009; 30:171-4. [DOI: 10.1007/s10072-009-0024-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 12/24/2008] [Indexed: 10/21/2022]
|
38
|
|
39
|
The impact of sleep on ambulatory blood pressure of female caregivers providing home care in Japan: an observational study. Int J Nurs Stud 2008; 45:1721-30. [PMID: 18534598 DOI: 10.1016/j.ijnurstu.2008.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 04/06/2008] [Accepted: 04/19/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elderly family caregivers are presumed to be susceptible to having various health problems. However, biomedical indicators of health in these caregivers are rarely examined. OBJECTIVE To examine the effect of sleep quality, measured by hours of sleep and the number of times leaving bed, on various blood pressure parameters in elderly caregivers. DESIGN Observational study. SETTING Northern Japan. PARTICIPANTS Seventy-eight female family caregivers. METHODS Ambulatory blood pressure was monitored at 30-60-min intervals for a 24-h period. An actigraph was used to determine sleep/wake status. Face-to-face interviews were conducted to obtain home care and demographic information, and self-administered questionnaires were used to collect information on activities in a 24-h period. RESULTS The mean age of the caregivers was 62.5+/-9.6 years, and the mean hours of sleep were 7.3. Out of 78 caregivers, 19 were on antihypertensive medication. Of the remaining 59, this study found 45.8% to be hypertensive, with the mean maximum systolic pressure exceeding 180mmHg. The hours of sleep at night and for the 24-h period were inversely associated with the mean systolic blood pressure. The majority of caregivers on antihypertensive medication also had high blood pressure. CONCLUSIONS This study suggests the importance of 24-h ambulatory blood pressure monitoring for elderly caregivers, so as to screen for hypertension as well as to monitor the effectiveness of antihypertensive medication.
Collapse
|
40
|
Kochar J, Fredman L, Stone KL, Cauley JA. Sleep problems in elderly women caregivers depend on the level of depressive symptoms: results of the Caregiver--Study of Osteoporotic Fractures. J Am Geriatr Soc 2007; 55:2003-9. [PMID: 17944894 DOI: 10.1111/j.1532-5415.2007.01434.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women. DESIGN Cross-sectional study conducted in four communities in 1999 to 2001. SETTING Home-based interviewer-administered questionnaires. PARTICIPANTS Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures. MEASUREMENTS Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item. RESULTS In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES-D > or = 16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems (adjusted odds ratios ranging from 2.5, 95% confidence interval (CI)=1.2-5.2 for trouble falling asleep to 4.0, 95% CI=2.0-7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations (e.g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems. CONCLUSION Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems.
Collapse
Affiliation(s)
- Jinesh Kochar
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
41
|
Willette-Murphy K, Todero C, Yeaworth R. Mental health and sleep of older wife caregivers for spouses with Alzheimer's disease and related disorders. Issues Ment Health Nurs 2006; 27:837-52. [PMID: 16938787 DOI: 10.1080/01612840600840711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This descriptive study examined sleep and mental health variables in 37 older wife caregivers for spouses with dementia compared to 37 age-matched controls. The relationships among selected caregiving variables (behavioral problems, caregiving hours, and years of caregiving), appraisal of burden, self-reported sleep efficiency for the past week, and mental health outcomes were examined. Lazarus and Folkman's stress and coping framework guided the study. Mental health and sleep were poorer for caregivers. Caregiving and appraisal of burden variables showed direct and indirect effects on mental health. However, caregiving and appraisal of burden variables were not significant for predicting sleep efficiency. Sleep efficiency was a good predictor of mental health in this sample of wife caregivers.
Collapse
|
42
|
Nomura T, Inoue Y, Miyake M, Yasui K, Nakashima K. Prevalence and clinical characteristics of restless legs syndrome in Japanese patients with Parkinson's disease. Mov Disord 2005; 21:380-4. [PMID: 16211604 DOI: 10.1002/mds.20734] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To explore the clinical significance of restless legs syndrome (RLS) in Parkinson's disease (PD) and the causal relationship between these two disorders, we made a comparison of both the prevalence of RLS and the severity of sleep disturbance manifested on the Pittsburg Sleep Quality Index (PSQI) between patients with PD (n=165) and age- and sex-matched control subjects (n=131). The prevalence of RLS diagnosed by clinical interview was significantly higher in PD patients than in control subjects (12% vs. 2.3%). PSQI score was significantly higher in PD patients with RLS than in both patients without RLS and controls. However, PSQI score was not statistically different between the latter two groups. Among the PD patients with RLS, only 2 had a positive family history of RLS. Only 3 PD patients had requested treatment for the disorder. Our results emphasize the etiological link between RLS and PD in a Japanese cohort, and the existence of RLS is thought to be one of the most important factors aggravating sleep disturbance in PD, despite the low RLS severity.
Collapse
Affiliation(s)
- Takashi Nomura
- Department of Neurology, Institute of Neurological Sciences, Tottori University Faculty of Medicine, Yonago, Japan.
| | | | | | | | | |
Collapse
|
43
|
Vanderwerker LC, Laff RE, Kadan-Lottick NS, McColl S, Prigerson HG. Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol 2005; 23:6899-907. [PMID: 16129849 PMCID: PMC1459280 DOI: 10.1200/jco.2005.01.370] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers. METHODS Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use. RESULTS Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patient's cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patient's cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services. CONCLUSION Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.
Collapse
Affiliation(s)
- Lauren C Vanderwerker
- Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA
| | | | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
OBJECTIVE To identify patterns of psychological problems in Parkinson's disease (PD). METHOD A sample of 3075 patients was surveyed to determine frequencies of psychological problems and cross-validated cluster analyses were computed to identify patterns of these problems. RESULTS An increase of symptoms during arousal was reported by 68%, sleep disturbances by 32% of the sample, and sexual problems by 57% of men and 22% of women. Less frequently reported were difficulties in communicating (27%), needing help of others (38%), and depressive moods (20%). Four patterns of psychological problems were identified: general low stress, general high stress, sexual and social problems, and non-social problems. CONCLUSION The study confirms the clinical observation that PD patients differ not only in degree, but also in structure of psychological stress. Social and non-social stress constitute principal types of stress experienced in PD. This distinction should be taken into account for any approach to support people with PD.
Collapse
Affiliation(s)
- M Macht
- Department of Psychology, University of Würzburg, Würzburg, Germany.
| | | | | |
Collapse
|
46
|
ASKENASY JJ. Trying to understand sleep in Parkinson's disease patients*. Sleep Biol Rhythms 2005. [DOI: 10.1111/j.1479-8425.2005.00156.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
|
48
|
Pal PK, Thennarasu K, Fleming J, Schulzer M, Brown T, Calne SM. Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson's disease and in their caregivers. Parkinsonism Relat Disord 2004; 10:157-68. [PMID: 15036171 DOI: 10.1016/j.parkreldis.2003.11.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2003] [Revised: 11/06/2003] [Accepted: 11/06/2003] [Indexed: 12/29/2022]
Abstract
BACKGROUND The role of aging, disease, medications, and mood disturbances in sleep disturbances (SD) in patients with Parkinson's disease (PD) is poorly understood, and the impact of SD on the quality of life of their caregivers (CG) largely undocumented. OBJECTIVES To evaluate the pattern and determinants of disturbed sleep in PD patients complaining of SD, and in their primary CG. METHODS A prospective evaluation of 40 non-demented patients with PD complaining of SD and 23 of their primary CG (all were spouses) was conducted using Pittsburgh Sleep Quality Index, Zung's self-rating depression and anxiety scales, Parkinson's Impact Scale (PIMS) (only for PD), and an additional sleep questionnaire. RESULTS Eighty-four percent of patients were 'poor sleepers' with global sleep scores (GLSc) > 5. Other abnormalities were: excessive daytime sleepiness-57.5%, excessive daytime fatigue-72.5%, depression-51.5%, anxiety-63.1%, and abnormal PIMS score-83.8%. There was no correlation between the degree of sleep dysfunction and the age, severity, duration of PD or its treatment. Several component sleep scores correlated with anxiety scores, PIMS score with depression, and, subjects with GLSc > or = 10 had higher mean anxiety index. Daytime dysfunction (97.5%) was mainly associated with reduced enthusiasm, rather than excessive sleepiness. Among CG, 40% had a GLSc > 5, 21% had depression, and 10.5% had anxiety. Their depression, anxiety and sleep scores correlated with those of their spouses. CONCLUSIONS PD patients with significant SD may represent a subset of patients with early, progressive degeneration of sleep centres, rather than an enhanced aging process. They are more susceptible mood disturbances, which correlate with the severity of sleep dysfunction. Sleep and mood disturbances also adversely affect the quality of life of spousal caregivers.
Collapse
Affiliation(s)
- P K Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | | | | | | |
Collapse
|
49
|
Kutner NG, Bliwise DL, Zhang R. Linking race and well-being within a biopsychosocial framework: variation in subjective sleep quality in two racially diverse older adult samples. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2004; 45:99-113. [PMID: 15179910 DOI: 10.1177/002214650404500107] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Differential life experiences associated with race may critically affect the balance between physical and psychological well-being. This study investigated an age-related and disease-related symptom, restless sleep, among older African American and white members of two sociodemographically matched cohorts, community-dwelling older adults and older adults with chronic renal failure undergoing maintenance dialysis therapy. Sleep behaviors reflect age-dependent and disease-dependent homeostatic and circadian state regulation but are also socioculturally patterned. As hypothesized, restless sleep was significantly more characteristic of the older adults in the chronic disease cohort. With non-renal health conditions, depressed mood, perceived health, medication use, and sociodemographic variables controlled, however, African Americans were significantly less likely than whites in the chronic disease cohort to report restless sleep. African American and white patients differed in their expression of public and private religiousness, which in turn were associated, respectively, with depressed mood and restless sleep complaint. In addition, we suggest that differences for African American and white patients in the environmental exposure of chronic dialysis therapy, including African Americans' greater social integration within the dialysis treatment setting, contributed to their being less at risk than their white peers for subjective perception of sleep decay, a marker of overall well-being.
Collapse
Affiliation(s)
- Nancy G Kutner
- Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA 30322, USA.
| | | | | |
Collapse
|
50
|
Abstract
Disorders of sleep and daytime alertness are frequent in Parkinson's disease patients and arise from a number of diverse factors. The most common complaint of night-time sleep disturbance in Parkinson's disease is sleep fragmentation. Sleep fragmentation can be associated with recurrent parkinsonian symptoms, the effect of medications, concomitant medical disorders such as nocturia, or psychiatric disorders such as depression or anxiety. Likewise, nocturnal sleep disturbance may arise from sleep apnea, periodic limb movements of sleep, or rapid eye movement (REM) sleep behavior disorder. Nocturnal sleep deprivation may lead to excessive daytime sleepiness. Other potential sources of daytime sleepiness include the effects of medications or disruption of central sleep mechanisms due to the pathologic processes of Parkinson's disease itself. Diagnosis of sleep disturbances and daytime sleepiness requires a direct interview of the patient and the caregiver, and may involve consultation with the sleep specialist or medical physician. Treatment is aimed toward improving night-time sleep and daytime drowsiness by addressing the causative factors.
Collapse
Affiliation(s)
- Cynthia L Comella
- Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, 1725 West Harrison, Suite 755, Chicago, IL 60612, USA.
| |
Collapse
|