"Does the Response to Morning Medication Predict the ADL-Level of the Day in Parkinson's Disease?"

Comparison of two types of extension tubes for people with Parkinson's disease in advanced treatment with levodopa-entacapone-carbidopa intestinal gel infusions: a prospective, crossover quality study

BACKGROUND

Within Parkinson's disease (PD) management, a pivotal juncture often arises when individuals with PD (PwP) necessitate advanced therapies to stabilise symptom fluctuations and reduce off-periods, which are intrinsic to living with PD. One such intervention is the infusion of duodenal levodopa-entacapone-carbidopa intestinal gel (LECIG), which confers a more dependable levodopa plasma concentration compared with conventional oral therapy. It involves the insertion of a percutaneous endoscopic gastrojejunostomy (PEG-J) tube, facilitating direct access to the stomach and jejunum. Then, a slender tube extends into the small intestine, facilitating the continuous delivery of LECIG via a portable pump. The PEG-J incorporates an extension tube that permits patients with PD to connect the medication pump.

OBJECTIVE

The objective of this study was to assess and compare two types of extension tubes a standard; a standard tube and the ENFit extension tube.

METHOD

Employing a prospective, crossover design at a single centre in Denmark. Each participant evaluated both extension tubes for 14 days. The primary outcome measure was patient-reported evaluation measures through a nine-item questionnaire using a 5-point Likert scale and 10th open-ended qualitative question.

RESULTS

Of the 12 recruited PwP, 10 successfully completed both testing periods and submitted self-reported questionnaires. The participants, with an average age of 70.3 years, comprised three men and seven women. Among them, five had a spouse or cohabitant, while five lived independently (with one residing in a nursing home). The average duration of PD diagnosis was 16.4 years, with an average of 2.6 years since the implantation of the medication pump. The ENFit tube outperformed the standard tube across all nine evaluation criteria, particularly excelling in terms of usability (items 4-6), safety (item 2) and overall product preference (item 9).

Clinical Markers of 6 Pre-dominant Coping Behaviors in Living With Parkinson Disease: A Convergent Mixed Methods Study

People with Parkinson's disease (PwP) experience a variety of symptoms and fluctuations in these, which they have to cope with every day. In tailoring a person-centered treatment to PwP there is a lack of knowledge about the association between pre-dominant coping behaviors and clinical markers among PwP. To describe and compare specific clinical markers between 6 suggested coping behaviors. Thirty-four PwP, who previously had been classified into 6 different pre-dominant coping behaviors, were included in this mixed methods study. Six primary variables were included in the descriptive analysis; motor function (UPDRS-III), non-motor symptoms score (NMS-Quest), change in bradykinesia score, apathy score (LARS), personality traits (NEO-FFI), and cognitive status (evaluated by a neuropsychologist). The merged results of this mixed methods study indicate that clinical markers as apathy, burden of non-motor symptoms, cognitive impairments and personality traits, have the potential to impact the coping behavior in PwP. In a clinical setting the markers; NMS-burden, degree of apathy, cognition, and personality traits may indicate specific coping behavior. Three of the six suggested typologies of coping behaviors differed from the other groups when comparing descriptive data. In order to improve patient care and guide the development of person-centered therapies, each PwP should be approached based on those typologies.

The importance of a multidisciplinary approach to improve the life quality for patients with Parkinson's disease

Parkinson's disease is defined as a complex degenerative neurological disease with progressive evolution, which is part of motor system of the brain disorders, being the second degenerative disease as a frequency after Alzheimer's disease. It is characterized by tremor when muscles are at rest (rest tremor), increased muscle tone (stiffness), slow voluntary movements and difficulty maintaining balance (postural instability). Occupational therapy helps Parkinson's patients im-prove their ability to perform daily tasks. The intervention consists in assisting patients in deve-loping a self-care routine, taking into account the limitations of functional mobility, encoura-ging patients to maintain maximum function of daily activities for as long as possible, learning adaptive techniques to reduce tremor. Materials and methods. The devices used for this purpose are commercially available but they are quite expensive, which is why we wanted to make devi-ces made of material as cheap and affordable as possible. Some of the devices can be successfully made of material that every person has in their home. We also took into account the variant of making them without the need to use complicated tools and devices that are not available to pa-tients. Starting from these premises, we thought and made in our occupational therapy laborato-ry various devices designed to offer patients a variety of techniques and exercises and also a fle-xible work environment. On a pallet plate we fixed a series of elements such as zippers, snap button, hook-and-eye closure, systems that patients use on a regular basis. We also manufactu-red a device designed to help patients with household chores such as dish washing. The device is provided at one end with a washing sponge, its handle being a detergent tank. The size and sha-pe have been adapted to the needs of patients with Parkinson's disease. Results and discussions. In order to obtain the devices, cheap materials were used at the disposal of every person eager to make them. It started with simple objects that any patient uses for personal hygiene and more. The technique of making the devices was a very simple one, from the very beginning the steps that must be followed in order to make them were clearly established. Conclusions. Using the devices made during the physiotherapy sessions, significant improvements of the life quality for patients with Parkinson's disease were observed. Keywords: Parkinson, Occupational therapy, Devices, ADL

Comparing Objective and Subjective Measures of Parkinson's Disease Using the Parkinson's KinetiGraph

Background: Parkinson's disease (PD) is a neurodegenerative disease that can lead to impaired motor function and execution of activities of daily living (ADL). Since clinicians typically can only observe patients' symptoms during visits, prescribed medication schedules may not reflect the full range of symptoms experienced throughout the day. Therefore, objective tools are needed to provide comprehensive symptom data to optimize treatment. One such tool is the Parkinson's KinetiGraph^® (PKG), a wearable sensor that measures motor symptoms of Parkinson's disease.

Objective: To build a mathematical model to determine if PKG data measuring Parkinson's patients' motor symptoms can predict patients' ADL impairment.

Methods: Thirty-four patients with PD wore the PKG device for 6 days while performing their ADL. Patients' PKG scores for bradykinesia and dyskinesia, as well as their responses to a questionnaire asking if their ADL-level had been impacted by various motor symptoms, were used to build a multiple regression model predicting the patients' Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part II scores.

Results: Calculation of bradykinesia score response to medication showed that using a dosage response time of 30 min yielded a greater bradykinesia response than when the response time was set to 40, 50, 60, 70, 80, or 90 min. The overall multiple regression model predicting MDS-UPDRS part II score was significant (R² = 0.546, p < 0.001).

Conclusion: The PKG's ability to provide motor symptom data that correlates with clinical measures of ADL impairment suggests that it has strong potential as a tool for the assessment and management of Parkinson's disease motor symptoms.