1
|
Saulnier T, Fabbri M, Le Goff M, Helmer C, Pavy-Le Traon A, Meissner WG, Rascol O, Proust-Lima C, Foubert-Samier A. Patient-perceived progression in multiple system atrophy: natural history of quality of life. J Neurol Neurosurg Psychiatry 2024; 95:804-811. [PMID: 38453477 PMCID: PMC11347237 DOI: 10.1136/jnnp-2023-332733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Health-related quality of life (Hr-QoL) scales provide crucial information on neurodegenerative disease progression, help improve patient care and constitute a meaningful endpoint for therapeutic research. However, Hr-QoL progression is usually poorly documented, as for multiple system atrophy (MSA), a rare and rapidly progressing alpha-synucleinopathy. This work aimed to describe Hr-QoL progression during the natural course of MSA, explore disparities between patients and identify informative items using a four-step statistical strategy. METHODS We leveraged the data of the French MSA cohort comprising annual assessments with the MSA-QoL questionnaire for more than 500 patients over up to 11 years. A four-step strategy (1) determined the subdimensions of Hr-QoL, (2) modelled the subdimension trajectories over time, (3) mapped item impairments with disease stages and (4) identified most informative items. RESULTS Four dimensions were identified. In addition to the original motor, non-motor and emotional domains, an oropharyngeal component was highlighted. While the motor and oropharyngeal domains deteriorated rapidly, the non-motor and emotional aspects were already impaired at cohort entry and deteriorated slowly over the disease course. Impairments were associated with sex, diagnosis subtype and delay since symptom onset. Except for the emotional domain, each dimension was driven by key identified items. CONCLUSION The multidimensional Hr-QoL deteriorates progressively over the course of MSA and brings essential knowledge for improving patient care. As exemplified with MSA, the thorough description of Hr-QoL over time using the four-step strategy can provide perspectives on neurodegenerative diseases' management to ultimately deliver better support focused on the patient's perspective.
Collapse
Affiliation(s)
- Tiphaine Saulnier
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Margherita Fabbri
- MSA French Reference Center, University Hospital Toulouse, Toulouse, France
- Departments of Clinical Pharmacology and Neurosciences, University of Toulouse, CIC-1436, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm U1048/1214, Toulouse, France
| | - Mélanie Le Goff
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Catherine Helmer
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
- CIC1401-EC, Inserm, Bordeaux, France
| | - Anne Pavy-Le Traon
- MSA French Reference Center, University Hospital Toulouse, Toulouse, France
- Departments of Clinical Pharmacology and Neurosciences, University of Toulouse, CIC-1436, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm U1048/1214, Toulouse, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, University of Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- Department of Medicine, University of Otago, New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Olivier Rascol
- MSA French Reference Center, University Hospital Toulouse, Toulouse, France
- Departments of Clinical Pharmacology and Neurosciences, University of Toulouse, CIC-1436, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm U1048/1214, Toulouse, France
| | - Cecile Proust-Lima
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
- CIC1401-EC, Inserm, Bordeaux, France
| | - Alexandra Foubert-Samier
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
- CIC1401-EC, Inserm, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, University of Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
| |
Collapse
|
2
|
Shurer J, Ivancic M, Nesspor V, Schmidt M, Li M, Lin YT, Schumock G, Xu R, Sklerov M, Pantelyat A. Determinants of care partner burden in atypical Parkinsonian syndromes: A retrospective, multi-center analysis. Clin Park Relat Disord 2024; 11:100266. [PMID: 39149560 PMCID: PMC11325345 DOI: 10.1016/j.prdoa.2024.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/29/2024] [Accepted: 07/13/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA) are rare neurodegenerative diseases associated with rapid decline and require complex symptom management. Caregiving responsibilities significantly increase with progression of these atypical Parkinsonian syndromes, yet care burden in these syndromes has not been researched extensively to date. Methods The Zarit Burden Interview (ZBI) was used to assess burden in care partners of patients clinically diagnosed with PSP, CBS, or MSA seen in specialty interdisciplinary clinics at two academic movement disorders centers. Univariable and multivariable regression analyses were performed to evaluate cross-sectional demographic and clinical determinants of care partner burden. Results A total of 139 care partners completed the ZBI (59.0% PSP, 28.1% MSA, 12.9% CBS). Cohorts at both medical centers were similar across all variables. Female gender of both patients and care partners was independently associated with higher ZBI scores. Additionally, MSA-Parkinsonian type was significantly associated with lower total care partner burden compared to PSP and CBS. Conclusion Several determinants of higher care partner burden in atypical Parkinsonian syndromes were identified, particularly female gender and diagnosis. Healthcare professionals can consider this information when assessing individualized needs of patients and care partners and referring to disease-specific resources. Additionally, this study's methods and results highlight the potential to further explore interdisciplinary care as a means of comprehensive evaluation and support for those with atypical Parkinsonism.
Collapse
Affiliation(s)
| | - Margaret Ivancic
- Department of Neurology, University of North Carolina at Chapel Hill, United States
| | - Vanessa Nesspor
- Department of Neurology, Johns Hopkins University, United States
| | - Maria Schmidt
- Department of Neurology, Johns Hopkins University, United States
| | - Mingyuan Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Yi-Ting Lin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Grant Schumock
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Richard Xu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Miriam Sklerov
- Department of Neurology, University of North Carolina at Chapel Hill, United States
| | | |
Collapse
|
3
|
Nysetvold E, Lopez LN, Cogell AN, Fryk H, Pace ND, Taylor SS, Rhoden J, Nichols CA, Pillas D, Klein A, Gasalla T, Scowcroft A. Progressive Supranuclear palsy (PSP) disease progression, management, and healthcare resource utilization: a retrospective observational study in the US and Canada. Orphanet J Rare Dis 2024; 19:215. [PMID: 38778404 PMCID: PMC11112758 DOI: 10.1186/s13023-024-03168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/30/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare neurodegenerative brain disease with rapid progression and currently limited treatment options. A comprehensive understanding of disease progression, management, and healthcare resource utilization is limited, and further research is challenging due to the small population of patients. To address these challenges in conducting PSP research, individuals with PSP were recruited using a multichannel approach tailored specifically to the PSP community. We performed a retrospective observational study using data abstracted from participant medical records collected from multiple patient care centers. RESULTS Seventy-two individuals with PSP were eligible for inclusion. On average, 144 medical documents per participant were collected from an average of 2.9 healthcare centers per participant, with a mean study period of 7.9 years. Among participants with a date of symptom onset documented in the medical records, the median time for the onset of the first fall was 2.0 years (IQR 3.2) before diagnosis, the median onset of unsteady gait or gait impairment was 1.2 years (IQR 1.8) before diagnosis, and the median onset of mobility problems was 0.8 years (IQR 1.8) before diagnosis. The most widely utilized healthcare resources, with at least 85% of participants using each of these resources at some point during the disease course, were medications (100%), imaging (99%), assistive devices (90%), supportive care (86%), and surgeries and procedures (85%). CONCLUSIONS This retrospective study adds to the current understanding of PSP symptoms, comorbidities, and healthcare resource utilization (HRU) across the disease journey. By involving individuals with PSP and their caregivers or legally authorized representatives in the research process, this study was unique in its approach to participant recruitment and enabled individuals to participate in research without the need for travel. We collected medical documents from multiple healthcare centers, allowing for broad data collection covering the entire disease journey. This approach to the collection of real-world data may be used to generate valuable insights into many aspects of disease progression and management in PSP and many other rare diseases.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Joyce Rhoden
- AllStripes Research, San Francisco, California, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | | |
Collapse
|
4
|
Gorcenco S, Karremo C, Puschmann A. Patients' Perspective in Hereditary Ataxia. CEREBELLUM (LONDON, ENGLAND) 2024; 23:82-91. [PMID: 36525215 PMCID: PMC10864479 DOI: 10.1007/s12311-022-01505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Hereditary ataxia represents a heterogeneous group of rare disorders with the chronic progression of motor symptoms that often become debilitating. Many forms include additional neurological, cognitive, or other symptoms. Most of these disorders lack specific treatment. We aimed to investigate aspects of patients' quality of life, experiences, and expectations. Patients with a diagnosis of hereditary ataxia were identified from our center's diagnostic register, direct referrals, and from a patient organization. We designed a questionnaire with 32 multiple-choice or open-ended questions on disability and impairment of daily life activities, the perceived effect of symptomatic and supportive therapies, coping strategies, and how they used and experienced various sources of information about their neurological disease. We also included the EQ-5D-3L quality-of-life instrument. Results were analyzed statistically for gender, age, and groups with and without a genetic diagnosis, and were compared to published data from the general population. Seventy-five patients returned the questionnaire. Patients reported considerable disease-related disability and impairment and had significantly lower quality-of-life scores than the general population. Physiotherapy and support from family or friends were important for patients' overall well-being. Patients with a genetic diagnosis had a lower average age at onset and felt more well-informed about their disease than patients without a genetic diagnosis. Patients used internet sources but relied primarily on their doctors to obtain information about their disease. Our study provides insights into hereditary ataxia patients' experiences that can lead to improvements in medical and nursing care for these patients.
Collapse
Affiliation(s)
- Sorina Gorcenco
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Getingevägen 4, 22185, Lund, Sweden.
| | - Christin Karremo
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Getingevägen 4, 22185, Lund, Sweden
| | - Andreas Puschmann
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Getingevägen 4, 22185, Lund, Sweden
| |
Collapse
|
5
|
Winter Y, Lang C, Kallweit U, Apel D, Fleischer V, Ellwardt E, Groppa S. Pitolisant-supported bridging during drug holidays to deal with tolerance to modafinil in patients with narcolepsy. Sleep Med 2023; 112:116-121. [PMID: 37839272 DOI: 10.1016/j.sleep.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
STUDY OBJECTIVES Modafinil is a common treatment for excessive daytime sleepiness (EDS) in narcolepsy. The long-term use of modafinil can lead to tolerance with the loss of efficacy and the continuous increase of its dose. Pharmacological strategies to deal with the tolerance to modafinil are lacking. We investigated the efficacy and safety of pitolisant-supported bridging during drug holidays in patients with tolerance to modafinil. METHODS Narcolepsy patients on monotherapy with modafinil who developed symptoms of tolerance were eligible. The following alternating therapy regimen was established: Monday to Friday patients continued on modafinil whereas Saturday and Sunday they switched to pitolisant to "bridge" the EDS symptoms. Patients were assessed at baseline and after three months with the Epworth Sleepiness Scale (ESS) and the Ullanlinna Narcolepsy Scale (UNS). Health-related quality of life (HrQol) was evaluated by EuroQol5D. Adverse events were documented in the patients' diaries. RESULTS 41 patients aged 30.9 ± 5.6 years were included. After three months of the alternating therapy regimen, the symptoms of tolerance decreased and the modafinil dose could be reduced by 41% (p < 0.01) resulting in better safety. The EDS improved on ESS (baseline: 18.2 ± 4.2, follow-up: 12.6 ± 4.0, p < 0.0001) and UNS (baseline: 25.8 ± 7.9, follow-up: 18.9 ± 5.9, p < 0.0001). The HrQol increased significantly. CONCLUSION Patients with tolerance to modafinil could benefit from pitolisant-supported bridging during drug holidays. This alternating pharmacological strategy proved to be safe and helped to reduce EDS and to decrease the modafinil dose. Further randomized controlled studies are required to evaluate the different strategies to deal with the tolerance to modafinil. CLINICAL TRIAL REGISTRATION NUMBER Clinical Trials.gov Identifier NCT05321355.
Collapse
Affiliation(s)
- Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg-University, Mainz, Germany; Department of Neurology, Philipps-University Marburg, Germany.
| | - Christina Lang
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Ulf Kallweit
- Center for Narcolepsy and Hypersomnias, Professorship for Narcolepsy and Hypersomnolence Research, Department of Medicine, University Witten/Herdecke, Witten, Germany; Center for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - David Apel
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg-University, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Erik Ellwardt
- Department of Neurology, Helios-HSK Wiesbaden, Wiesbaden, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
6
|
Winter Y, Hilz M, Beuschlein F, Tsukimura T, Seifritz E, Lenders M, Brand E, Hennermann JB, Nowak A. Screening for health-related quality of life and its determinants in Fabry disease: A cross-sectional multicenter study. Mol Genet Metab 2023; 140:107692. [PMID: 37703724 DOI: 10.1016/j.ymgme.2023.107692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by α-galactosidase A (α-Gal A) deficiency. The progressive accumulation of globotriaosylceramide results in life-threatening complications, including renal, cardiac, and cerebrovascular diseases. In order to improve health care of FD-patients, knowledge of its predictors is important. The aim of our study was to evaluate health-related quality of life (HrQol) in FD and to identify its independent determinants by exploring a wide range of demographic, social and clinical parameters. RESULTS In this cross-sectional multicenter study, 135 adult patients with FD were recruited at three specialized European centers in Germany and Switzerland. Demographics, social status and clinical parameters as well as data on HrQol (EQ5D, EQ VAS) and depression were collected by means of self-reporting questionnaires and confirmed by medical records. HrQol and its predictors were evaluated by univariate and multivariate regression analyses. The study population consisted of 78 female and 57 male FD patients (median age 48 yrs) of whom 80.7% (N = 109) were on enzyme replacement therapy (ERT) and 10.4% (N = 14) were on chaperone treatment. Univariate analysis revealed various factors reducing HrQol such as age > 40 years, classic phenotype, organ involvement (kidney and heart disease, stroke/transient ischemic attack (TIA), gastrointestinal disturbances), depression, and burning limb pain. However, only the following factors were identified as independent predictors of decreased HrQol: classic phenotype, kidney and heart disease, stroke/TIA, depression, and burning limb pain. ERT and chaperone therapy were independent determinants of increased HrQol. CONCLUSIONS Modifiable factors, such as burning limb pain and depression, identified as independent predictors of HrQol-deterioration should be addressed in programs aiming to improve HrQol in FD. A multidisciplinary approach is essential in FD-patients since diverse organ involvement prominently compromises HrQol in affected patients. Our findings showed that the classic phenotype is a strong predictor of worsening HrQol.
Collapse
Affiliation(s)
- Yaroslav Winter
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Philipps-University Marburg, Germany
| | - Max Hilz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Beuschlein
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, Tokyo, Japan
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland
| | - Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Muenster (IFAZ), University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Muenster (IFAZ), University Hospital Muenster, Muenster, Germany
| | - Julia B Hennermann
- Villa Metabolica, Department of Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
7
|
Ananthavarathan P, Patel B, Peeros S, Obrocki R, Malek N. Neurological update: non-motor symptoms in atypical parkinsonian syndromes. J Neurol 2023; 270:4558-4578. [PMID: 37316556 PMCID: PMC10421812 DOI: 10.1007/s00415-023-11807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Among people with Parkinson's disease (PD), non-motor symptoms (NMS) are a well-recognised cause of significant morbidity and poor quality of life. Yet, it is only more recently that NMS have been recognised to affect the lives of patients with atypical parkinsonian syndromes in a similar fashion. The aim of this article is to highlight and compare the relative prevalence of NMS among patients with atypical parkinsonian syndromes in the published literature, which largely remain underreported and unaddressed in routine clinical practice. All NMS that are recognised to occur in PD are also found to commonly occur in atypical parkinsonian syndromes. In particular, excessive daytime sleepiness is more prevalent among atypical parkinsonian syndromes (94.3%) compared to PD (33.9%) or normal controls (10.5%) (p < 0.001). Urinary dysfunction (not limited to urinary incontinence) is not only found to occur in MSA (79.7%) and PD (79.9%), but has also been reported in nearly half of the patients with PSP (49.3%), DLB (42%) and CBD (53.8%) (p < 0.001). Apathy is significantly more common among the atypical parkinsonian syndromes [PSP (56%), MSA (48%), DLB (44%), CBD (43%)] compared to PD (35%) (p = 0.029). Early recognition and addressing of NMS among atypical parkinsonian syndromes may help improve the holistic patient care provided and may encompass a range of conservative and pharmacotherapeutic treatments to address these symptoms.
Collapse
Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Department of Neuroinflammation, Institute of Neurology, University College London, 1st Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
| | - B Patel
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - S Peeros
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - R Obrocki
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - N Malek
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| |
Collapse
|
8
|
Alphonce B, Komanya F, Bitesigilwe M, Meda JR, Nyundo A. Magnetic resonance imaging in the diagnosis of progressive supranuclear palsy: A case report and review of literature. Clin Case Rep 2023; 11:e7792. [PMID: 37593343 PMCID: PMC10427753 DOI: 10.1002/ccr3.7792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
Key Clinical Message Progressive supranuclear palsy (PSP) has many clinical features overlapping with other Parkinson syndromes and differentiation on clinical ground is difficult. This case highlights how a brain MRI can help diagnose PSP in settings with limited resources where histological diagnosis is difficult. Abstract Progressive supranuclear palsy (PSP) may be challenging to diagnose due to its widely acknowledged clinical complexity and challenges with diagnosis confirmation, particularly in resource-poor settings where the ability to obtain confirmatory tests is highly complicated, leading to an inaccurate or incomplete diagnosis of PSP. This paper discusses using brain magnetic resonance imaging (MRI) to diagnose PSP, and a review of relevant literature addresses the diagnostic value of MRI in PSP.
Collapse
Affiliation(s)
- Baraka Alphonce
- Department of Internal MedicineBenjamin Mkapa HospitalDodomaTanzania
| | - Francisca Komanya
- Department of Internal MedicineBenjamin Mkapa HospitalDodomaTanzania
| | | | - John R. Meda
- Department of Internal Medicine, School of MedicineUniversity of DodomaDodomaTanzania
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of MedicineUniversity of DodomaDodomaTanzania
| |
Collapse
|
9
|
O'Shea N, Lyons S, Higgins S, O'Dowd S. Neurological update: the palliative care landscape for atypical parkinsonian syndromes. J Neurol 2023; 270:2333-2341. [PMID: 36688987 DOI: 10.1007/s00415-023-11574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
Atypical parkinsonian syndromes are neurodegenerative conditions, characterised by rapid disease progression and shorter life expectancy compared to idiopathic Parkinson's disease. These conditions inflict substantial physical and psychosocial burden on patients and their families; hence, there is a clear rationale for a palliative care approach from diagnosis. An interdisciplinary care model has been shown to improve symptom burden, quality of life and engagement with advance care planning, in a heterogeneous group of neurodegenerative conditions. In this update, we summarise how the landscape for treating these patients has changed and the questions that still need to be resolved.
Collapse
Affiliation(s)
- Noreen O'Shea
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6WRY72, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| |
Collapse
|
10
|
Pathomechanisms of depression in progressive supranuclear palsy. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02621-w. [PMID: 36933007 DOI: 10.1007/s00702-023-02621-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Depression is one of the most frequent neuropsychiatric symptoms in progressive supranuclear palsy (PSP), a four-repeat tauopathy and most common atypical parkinsonian disorder, but its pathophysiology and pathogenesis are poorly understood. Pubmed/Medline was systematically analyzed until January 2023, with focus on the prevalence, major clinical features, neuroimaging findings and treatment options of depression in PSP. The average prevalence of depression in PSP is around 50%; it does usually not correlate with most other clinical parameters. Depression is associated with multi-regional patterns of morphometric gray matter variations, e.g., reduced thickness of temporo-parieto-occipital cortices, and altered functional orbitofrontal and medial frontal circuits with disturbances of mood-related brain networks. Unfortunately, no specific neuropathological data about depression in PSP are available. Antidepressive and electroconvulsive therapies are effective in improving symptoms; the efficacy of transcranial stimulation needs further confirmation. Depression in PSP is a common symptom, related to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for adequate treatment to improve the quality of life in this fatal disease.
Collapse
|
11
|
Ali N, Nesspor V, Bang J, Scholz SW, Pantelyat A. Factors impacting quality of life in multiple system atrophy. Front Neurol 2023; 14:1111605. [PMID: 36970533 PMCID: PMC10036583 DOI: 10.3389/fneur.2023.1111605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundMultiple system atrophy (MSA) is an atypical parkinsonian disorder marked by autonomic dysfunction, parkinsonism, cerebellar dysfunction, and poor response to dopaminergic medications such as levodopa. Patient-reported quality of life is an important benchmark for clinicians and clinical trials. The Unified Multiple System Atrophy Rating Scale (UMSARS) allows healthcare providers to rate and assess MSA progression. The MSA-QoL questionnaire is a health-related quality of life scale intended to provide patient-reported outcome measures. In this article, we investigated inter-scale correlations between the MSA-QoL and UMSARS to determine factors impacting the quality of life of patients with MSA.MethodsTwenty patients at the Johns Hopkins Atypical Parkinsonism Center's Multidisciplinary Clinic with a diagnosis of clinically probable MSA and who filled out the MSA-QoL and UMSARS questionnaires within 2 weeks of each other were included. Inter-scale correlations between MSA-QoL and UMSARS responses were examined. Linear regressions were also performed to examine relationships between both scales.ResultsSignificant inter-scale correlations were found between the MSA-QoL and UMSARS, both between MSA-QoL total score and UMSARS Part I subtotal scores and for individual scale items. There were no significant correlations between MSA-QoL life satisfaction rating and UMSARS subtotal scores or any specific UMSARS items. Linear regression analysis found significant associations between MSA-QoL total score and UMSARS Part I and total scores, and between MSA-QoL life satisfaction rating and UMSARS Part I, Part II, and total scores (after adjustment for age).ConclusionsOur study demonstrates significant inter-scale correlations between MSA-QoL and UMSARS, particularly relating to activities of daily living and hygiene. MSA-QoL total score and UMSARS Part I subtotal scores, which assess patients' functional status, were significantly correlated. The lack of significant associations between MSA-QoL life satisfaction rating and any UMSARS item suggests there may be aspects to quality of life that are not fully captured by this assessment. Larger cross-sectional and longitudinal analyses utilizing UMSARS and MSA-QoL are warranted and modification of the UMSARS should be considered.
Collapse
Affiliation(s)
- Nabila Ali
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vanessa Nesspor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sonja W. Scholz
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Alexander Pantelyat
| |
Collapse
|
12
|
Winter Y, Klotsche J, Ringel F, Spottke A, Klockgether T, Urbach H, Meyer B, Dodel R. Characterizing the individual course of health-related quality of life after subarachnoid haemorrhage: Latent growth mixture modelling. J Stroke Cerebrovasc Dis 2023; 32:106913. [PMID: 36623407 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Survivors of aneurysmal subarachnoid haemorrhage (SAH) show heterogeneous profiles of health-related quality of life (HrQoL). The aim of this study was to characterize individual differences in the course of HrQoL following SAH using latent growth mixture modelling (LGMM). METHODS A longitudinal study with 113 incident cases of aneurysmal SAH was performed in order to evaluate clinical outcome (Hunt and Hess scale, Barthel-Index, Beck Depression Inventory) and HrQoL data (EQ-5D) at baseline, 6 and 12 months. The heterogeneity in HrQoL courses after SAH was analysed using LGMM. RESULTS Four subgroups (classes) of different patterns of HrQoL course after SAH were identified. Two of these classes (1 and 3) comprised patients with considerably reduced initial HrQoL, which was associated with more severe symptoms of SAH. Class 1 showing the worst EQ5D-index values during the entire study period. Class 3 experiencing a considerable improvement in HrQoL values. In comparison to classes 1 and 3, class 2 and 4 were characterized by less severe SAH and better functional outcome. An important difference in the disease course between classes 2 and 4 was a temporary increase in depression scores at the 6-month time point in class 4, which was associated with a considerable reduction in HrQoL.The specific clinical parameters characterizing differences between classes, such as severity of SAH, functional outcome, cognitive impairment and post-stroke depression, were identified and the influence of their potential improvement on HrQoL was estimated. CONCLUSION By means of LGMM we could classify the course of HrQoL after SAH in four different patterns, which are relevant for the clinical decisions. Clinical parameters, which can be modified in order to improve the course of HrQoL were identified and could help to develop individual therapeutic strategies for the rehabilitation after SAH.
Collapse
Affiliation(s)
- Yaroslav Winter
- Department of Neurology, Johannes Gutenberg-University, Mainz, Germany; Department of Neurology, Philipps-University Marburg, Germany
| | - Jens Klotsche
- German Rheumatism Research Center, Institute of Social Medicine, Epidemiology and Health Economics, Charité, Berlin, Germany
| | - Florian Ringel
- Department of Neurosurgery, Johannes Gutenberg-University, Mainz, Germany
| | - Annika Spottke
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Horst Urbach
- Department of Neuroradiology, University of Freiburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Richard Dodel
- Chair of Geriatric Medicine, University Duisburg-Essen, Germaniastrasse 1-3, Essen D-45356, Germany.
| |
Collapse
|
13
|
Li XY, Chen MJ, Liang XN, Yao RX, Shen B, Wu B, Li G, Sun YM, Wu JJ, Liu FT, Yang YJ, Wang J. PDQ-8: A Simplified and Effective Tool Measuring Life Quality in Progressive Supranuclear Palsy. JOURNAL OF PARKINSON'S DISEASE 2023; 13:83-91. [PMID: 36591660 PMCID: PMC9912724 DOI: 10.3233/jpd-223553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The self-reported quality of life (QoL) should be carefully listened to in progressive supranuclear palsy (PSP) from the patient-centered perspective. However, there was still a lack of short QoL measurement tool in atypical parkinsonism. OBJECTIVE We aimed to test whether the short Parkinson's Disease Questionnaire-8 (PDQ-8) was effective in assessing QoL in PSP, comparing with Progressive Supranuclear Palsy Quality of Life Scale (PSP-QoL) and Parkinson's Disease Questionnaire-39 (PDQ-39). METHODS 132 patients with clinical diagnosed PSP, including PSP-Richardson syndrome (RS) subtype (n = 71) and PSP-non-RS subtype (n = 61) were recruited for clinical evaluation including QoL assessment. The detailed QoL profiles and possibility of using PDQ-8 were systemically analyzed. The determinants to the QoL were then calculated by multivariate linear regression analysis. RESULTS The PSP-QoL total score summary index (SI) was 22.8 (10.1, 41.1), while the PDQ-8 and PDQ-39 total SI score were 28.1 (12.5, 46.9) and 29.5 (15.4, 49.4). Mobility, activities of daily life, cognition and communication were the main affected QoL subdomains (median SI: 40.0, 31.3, 25.0 and 25.0 respectively). PSP-RS subtype showed more severe damage physically (p<0.001) and mentally (p = 0.002) compared to other subtypes. More importantly, the strong relevance of PDQ-8 and recommended PSP QoL tools were confirmed (p<0.001). In addition, disease severity, depression and daytime sleepiness were proved to be critical determinants for QoL in PSP. CONCLUSIONS PDQ-8 could be an easy, reliable, and valid tool to evaluate QoL in patients with PSP. Besides motor symptoms, more attention should be paid to non-motor impairment such as depression in PSP.
Collapse
Affiliation(s)
- Xin-Yi Li
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Jia Chen
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Niu Liang
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China,Institute of Neurology, Fudan University, Shanghai, China
| | - Rui-Xin Yao
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Shen
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Wu
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gen Li
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Min Sun
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Jun Wu
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng-Tao Liu
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-Jie Yang
- Key Laboratory of Arrhythmias, Ministry of Education, Department of Medical Genetics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China,Correspondence to: Prof Jian Wang, Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China. Tel.: +86 13321934789; E-mail: and Dr. Yu-Jie Yang, Key Laboratory of Arrhythmias, Ministry of Education, Department of Medical Genetics, Shanghai East Hospital, School of Medicine, Tonji University, Shanghai, China. Tel.: +86 13917793964; E-mail:
| | - Jian Wang
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China,Correspondence to: Prof Jian Wang, Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China. Tel.: +86 13321934789; E-mail: and Dr. Yu-Jie Yang, Key Laboratory of Arrhythmias, Ministry of Education, Department of Medical Genetics, Shanghai East Hospital, School of Medicine, Tonji University, Shanghai, China. Tel.: +86 13917793964; E-mail:
| | | |
Collapse
|
14
|
Jellinger KA. Pathomechanisms of depression in multiple system atrophy. J Neural Transm (Vienna) 2023; 130:1-6. [PMID: 36348076 DOI: 10.1007/s00702-022-02560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Multiple system atrophy (MSA) is a rapidly progressing neurodegenerative disorder of uncertain etiology that is characterized by various combinations of Parkinsonism, autonomic, cerebellar and motor dysfunctions, with poor prognosis. Little is known about modifiable factors, such as depression, that has negative effects on quality of life in MSA. Depression, with an estimated prevalence of about 43%, is among the most common neuropsychiatric disorders in MSA similar to other atypical Parkinsonian disorders, the frequency of which is associated with increased disease progression, disease severity and autonomic dysfunctions. Depression in MSA, like in Parkinson disease, has been related to a variety of pathogenic mechanisms associated with the underlying neurodegenerative process, such as involvement of serotonergic neuron groups in the brainstem, prefrontal cortical dysfunctions, and altered functional fronto-temporal-thalamic connectivities with disturbances of mood related and other essential resting-state brain networks. The pathophysiology and pathogenesis of depression in MSA, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for adequate treatment to improve the quality of life in this fatal disease.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
| |
Collapse
|
15
|
Xiao Y, Zhang L, Wei Q, Ou R, Hou Y, Liu K, Lin J, Yang T, Shang H. Health-related quality of life in patients with multiple system atrophy using the EQ-5D-5L. Brain Behav 2022; 12:e2774. [PMID: 36124355 PMCID: PMC9575615 DOI: 10.1002/brb3.2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/03/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is an incurable neurodegenerative disease. We aimed to investigate the health-related quality of life (HRQoL) and the determinants of HRQoL in patients with MSA. METHODS The five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was used to evaluate patients' HRQoL. The results of HRQoL were indicated by the EQ-5D-5L index values and visual analog scale (EQ VAS) scores. Specific scales were used to measure disease severity, cognition, frontal lobe function, anxiety, depression, fatigue, and sleep disorders. The beta mixture model and the linear regression model were used to explore the determinants of HRQoL in patients with MSA. RESULTS A total of 205 patients with cerebellar variants (MSA-C; 53.9%) and 175 patients with parkinsonian variants (MSA-P; 46.1%) were included in this cross-sectional study. The mean values of the EQ-5D-5L index values and EQ VAS scores were .558 and 59.5, respectively. Problem with mobility was the problem reported by the highest proportion of patients (92.1%), followed by problems with usual activities (88.7%), self-care (81.3%), anxiety/depression (72.1%), and pain/discomfort (53.9%). The determinants of the lower EQ-5D-5L index values in patients with MSA were greater disease severity, fatigue, Parkinson's disease-related sleep problems (PD-SP), depressive mood, and anxious mood. Greater disease severity, fatigue, and depressive mood were associated with lower EQ VAS scores. CONCLUSION The problem reported most frequently by Chinese individuals with MSA was mobility. In addition to the greater disease severity of MSA, fatigue, PD-SP, depression, and anxiety were determinants of poor HRQoL.
Collapse
Affiliation(s)
- Yi Xiao
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyu Zhang
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Kuncheng Liu
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Junyu Lin
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Tianmi Yang
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
16
|
Sung YH, Kang SY. Pain in atypical parkinsonism, vascular parkinsonism, and Parkinson’s disease. Neurol Sci 2022; 43:4797-4802. [DOI: 10.1007/s10072-022-06035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
|
17
|
Jecmenica-Lukic M, Petrovic IN, Pekmezovic T, Tomic A, Stankovic I, Svetel M, Kostic VS. The Profile and Evolution of Neuropsychiatric Symptoms in Multiple System Atrophy: Self- and Caregiver Report. J Neuropsychiatry Clin Neurosci 2022; 33:124-131. [PMID: 33261525 DOI: 10.1176/appi.neuropsych.20030057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent research shows that patients with multiple system atrophy (MSA) have significant cognitive and neuropsychiatric comorbidities that can color the clinical presentation of the disease and affect their quality of life. The aims of this study were to determine the neuropsychiatric profile in a cohort of patients with the parkinsonian type of MSA (MSA-P) and their dynamic changes over a 1-year follow-up period and to compare rates of neuropsychiatric symptoms (NPSs) reported by caregivers and the patients themselves. METHODS Forty-seven patients were assessed at baseline; of these, 25 were assessed again after 1 year. NPS assessment tools included the Neuropsychiatric Inventory (NPI), the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Apathy Evaluation Scale. RESULTS The prevalence of NPSs in patients with MSA-P was very high, with depression, sleep disturbances, apathy, and anxiety being the most frequently occurring features. The evolution of NPSs was found to be independent of motor, autonomic, and cognitive symptoms. None of the scales measuring NPSs, including the NPI, were capable of detecting changes over the 1-year follow-up period. Although the overall prevalence of depression, apathy, and anxiety obtained from caregivers and the patients themselves was similar, reports from these two sources cannot be considered interchangeable. CONCLUSIONS The progression of neuropsychiatric symptoms was not a subject of rapid change in MSA-P, in contrast to the observed motor, autonomic, and cognitive deterioration. These findings suggest the need to investigate the utility of available instruments in capturing the evolution of NPSs in MSA over time.
Collapse
Affiliation(s)
- Milica Jecmenica-Lukic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Igor N Petrovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Tatjana Pekmezovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Aleksandra Tomic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Iva Stankovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Marina Svetel
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Vladimir S Kostic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| |
Collapse
|
18
|
Urso D, Tafuri B, De Blasi R, Nigro S, Logroscino G. Imaging correlates of depression in progressive supranuclear palsy. J Neurol 2022; 269:3522-3528. [PMID: 34997852 DOI: 10.1007/s00415-021-10939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Depression is highly common in Progressive Supranuclear Palsy (PSP) and is a meaningful determinant of quality of life. However, neurobiological and neuroimaging correlates of this neuropsychiatric disturbance in PSP patients are still unknown. In this study, we aimed to investigate the topographical distribution of morphometric changes associated with depression in PSP patients using cortical thickness. Forty patients with PSP were evaluated at baseline with clinical rating scales and MRI scans. Based on the response to the 15-item Geriatric Depression Scale we identified 21 PSP patients with depression (GDS-15 score ≥ 5) and 19 PSP patients without depression (GDS-15 score < 5). In vertex-wise analysis, comparison of cortical thickness between PSP patients with and without depression was performed using a general linear model. PSP patients with depressions showed reduced cortical thickness in temporo-parieto-occipital areas, more pronounced in the right hemisphere. These findings propose neurobiological conceptualizations of depression in PSP as being associated with a multiregional pattern of morphometric grey matter reduction.
Collapse
Affiliation(s)
- Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Benedetta Tafuri
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Roberto De Blasi
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy
| | - Salvatore Nigro
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy. .,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
| | | |
Collapse
|
19
|
Lv Q, Pan Y, Chen X, Wei J, Wang W, Zhang H, Wan J, Li S, Zhuang Y, Yang B, Ma D, Ren D, Zhao Z. Depression in multiple system atrophy: Views on pathological, clinical and imaging aspects. Front Psychiatry 2022; 13:980371. [PMID: 36159911 PMCID: PMC9492977 DOI: 10.3389/fpsyt.2022.980371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 01/09/2023] Open
Abstract
Multiple system atrophy (MSA) is a common atypical parkinsonism, characterized by a varying combination of autonomic, cerebellar, and pyramidal systems. It has been noticed that the patients with MSA can be accompanied by some neuropsychiatric disorders, in particular depression. However, there is limited understanding of MSA-related depression. To bridge existing gaps, we summarized research progress on this topic and provided a new perspective regarding pathological, clinical, and imaging aspects. Firstly, we synthesized corresponding studies in order to investigate the relationship between depression and MSA from a pathological perspective. And then, from a clinical perspective, we focused on the prevalence of depression in MS patients and the comparison with other populations. Furthermore, the associations between depression and some clinical characteristics, such as life quality and gender, have been reported. The available neuroimaging studies were too sparse to draw conclusions about the radiological aspect of depression in MSA patients but we still described them in the presence of paper. Finally, we discussed some limitations and shortcomings existing in the included studies, which call for more high-quality basic research and clinical research in this field.
Collapse
Affiliation(s)
- Qiuyi Lv
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuxin Pan
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Xing Chen
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jingpei Wei
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Wei Wang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Hua Zhang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jifeng Wan
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shiqiang Li
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yan Zhuang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Baolin Yang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Dayong Ma
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Dawei Ren
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Zijun Zhao
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
20
|
Cuoco S, Cappiello A, Abate F, Tepedino MF, Erro R, Volpe G, Pellecchia MT, Barone P, Picillo M. Psychometric properties of the Beck Depression Inventory-II in progressive supranuclear palsy. Brain Behav 2021; 11:e2344. [PMID: 34492729 PMCID: PMC8553313 DOI: 10.1002/brb3.2344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Depression is one of the most common neuropsychiatric symptoms in progressive supranuclear palsy (PSP). Yet, few studies have examined the ability of available instruments to detect depressive symptoms in PSP. Aims of the present study were to (I) report psychometric properties of the Beck Depression Inventory Second Edition (BDI-II) in PSP, (II) establish the BDI-II cut-off indicating the presence of depression in PSP and (III) describe clinical correlates as well as correlation with quality of life of depressive symptoms in PSP. DESIGN, SETTING AND PARTICIPANTS At the Center for Neurodegenerative Diseases of the University of Salerno, Italy, the BDI-II was validated in 62 PSP patients diagnosed according to the Movement Disorder Society criteria. Patients underwent a clinical interview, a motor evaluation, extensive cognitive and behavioral testing. RESULTS The mean BDI-II total score was 15.92 ± 10.31. The internal consistency was high (Cronbach's alpha = 0.868); corrected item-total correlation was >0.40 for the majority of items. The significant and moderate correlation of the BDI-II with other tools evaluating depressive symptoms indicated adequate convergent validity of the scale. The satisfactory cut-off to identify patients with clinically significant depression was >14.5. We also showed a correlation between higher scores on BDI-II and lower quality of life, irrespective of motor and cognitive burden. CONCLUSION In conclusion, the BDI-II is a reliable and valid tool for the assessment of depression symptoms in PSP. Such data are useful to standardize studies of depression in PSP and to quantify the effectiveness of any interventions on this disabling symptom.
Collapse
Affiliation(s)
- Sofia Cuoco
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Arianna Cappiello
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Filomena Abate
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Maria Francesca Tepedino
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Roberto Erro
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Giampiero Volpe
- AOU S. Giovanni di Dio e Ruggi D'Aragona, Neurology Unit, Salerno, Italy
| | - Maria Teresa Pellecchia
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Paolo Barone
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Marina Picillo
- Neuroscience Section, Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| |
Collapse
|
21
|
Akdal G, Boz H, Kiriş A, Koçoğlu K, Çolakoğlu B, Çakmur R. Balance and gait disturbances and quality of life in patients with idiopathic parkinson's disease and progressive supranuclear palsy. NEUROL SCI NEUROPHYS 2021. [DOI: 10.4103/nsn.nsn_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
22
|
Prediagnostic motor and non-motor symptoms in progressive supranuclear palsy: The step-back PSP study. Parkinsonism Relat Disord 2020; 74:67-73. [PMID: 32536421 DOI: 10.1016/j.parkreldis.2020.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improved knowledge of the prediagnostic phase of progressive supranuclear palsy (PSP) might provide information on when and how the disease starts, along with the opportunity to test therapies in disease stages with lesser neurodegeneration. OBJECTIVE To explore the symptoms in years preceding the PSP diagnosis. METHODS This is a single-center retrospective case-control study based on clinical charts review and a structured interview to PSP patients and their caregivers. Prediagnostic symptoms were defined as those present more than one year before the diagnosis. We explored 35 symptoms in the following domains: visual, dizziness, motor, mood/apathy, cognitive, behavioral, sleep, gastrointestinal/urinary and miscellaneous. Non-parametric statistics were applied, with significance set at <0.05 (FDR-corrected). RESULTS We included 150 subjects: 50 PSP patients (38% females, age 75.8) and an age- and sex-matched control group of 50 Parkinson's disease (PD) and 50 subjects (CS) without neurodegenerative disease. The frequencies of visual, motor, cognitive, behaviour and dizziness domains were significantly higher in PSP vs. PD, and so were the motor, mood/apathy, cognitive, behaviour and dizziness ones in PSP vs. CS. Over 50% of prediagnostic falls, apathy and anxiety, depression and memory-attention-executive symptoms, and over 30% of gait disturbances started more than three and up to ten years before the diagnosis. PSP patients had more consultations to ENT and ophthalmologists than PD patients. CONCLUSION PSP patients present a broad variety of motor and non-motor symptoms several years before the diagnosis. The definition of a prediagnostic PSP phase might be helpful to identify patients in early disease stages.
Collapse
|
23
|
Zhang L, Cao B, Zou Y, Wei QQ, Ou R, Zhao B, Yang J, Wu Y, Shang H. Frontal lobe function, behavioral changes and quality of life in patients with multiple system atrophy. Restor Neurol Neurosci 2019; 37:11-19. [PMID: 30741706 DOI: 10.3233/rnn-180862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment is an important and common symptom in patients with multiple system atrophy (MSA). OBJECTIVE The objective of the study was to explore the potential relationships among frontal lobe function, behavioral changes and quality of life (QoL) in patients with MSA. METHODS A total of 203 MSA patients were enrolled and evaluated using the Frontal Assessment Battery (FAB), the Frontal Behavioral Inventory (FBI) and the Parkinson's disease Questionnaire-39 item version (PDQ-39). Seventy-eight age-, sex-, and education-matched healthy controls were recruited to complete the FAB. RESULTS Among MSA patients, those with frontal lobe dysfunction were older (P = 0.005), had older age of onset (P = 0.002), lower educational level (P < 0.001), higher scores in the PDQ-39 domains of mobility (P = 0.042), ADL (P = 0.020), cognition (P < 0.001) and communication compared to those with normal frontal lobe function. The most common frontal behavioral changes were logopenia followed by apathy and inflexibility. The severity of frontal behavioral changes was associated with MSA subtype (P = 0.015), disease severity (Unified Multiple System Atrophy Rating Scale-I (UMSARS-I), UMSARS-II, UMSARS-IV, and total UMSARS scores) (P < 0.001), orthostatic hypotension (P = 0.022), severity of depressive symptoms and total score on the PDQ-39 (P < 0.001). Binary logistic regression showed that the determinants of poor QoL in patients with MSA were disease severity (UMSARS-I and total UMSARS scores) (P < 0.05), depression (P = 0.013) and total FBI score (P = 0.003). CONCLUSIONS Frontal behavioral changes were potential determinants of poor QoL in MSA, in addition to the disease severity and depressive symptoms. Early discovery and management of frontal behavioral changes in addition to motor and depressive symptoms will help to improve the QoL of MSA patients.
Collapse
Affiliation(s)
- LingYu Zhang
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yutong Zou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - RuWei Ou
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Wu
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
24
|
Fabbrini G, Fabbrini A, Suppa A. Progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration. ACTA ACUST UNITED AC 2019; 165:155-177. [DOI: 10.1016/b978-0-444-64012-3.00009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
25
|
Jecmenica-Lukic MV, Pekmezovic TD, Petrovic IN, Dragasevic NT, Kostić VS. Factors associated with deterioration of health-related quality of life in multiple system atrophy: 1-year follow-up study. Acta Neurol Belg 2018; 118:589-595. [PMID: 29949032 DOI: 10.1007/s13760-018-0962-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
The aim of this study was to identify the main contributors to the health-related quality of life (HRQoL) in multiple system atrophy with predominant parkinsonism (MSA-P) and to determine the usefulness of SF-36 in capturing the HRQoL changes over 1-year follow-up. A total of 45 MSA-P and 150 Parkinson's disease (PD) patients were studied. The hierarchical multiple regression analysis was conducted to identify predictors of the SF-36 total score. The magnitude of any change for the HRQoL over 1-year of follow-up, was calculated as an effect size. The average scores for each SF-36 domains, except for the bodily pain, were lower in MSA-P than in PD patients (p < 0.05). The most important predictors of HRQoL in MSA-P, were female gender, older age at onset, SCOPA-AUT score and UMSARS IV, which together with other selected clinical variables accounted for 84% of the variance in the total SF-36 score in the final model in hierarchical analyses. During the 1-year follow-up, the SF 36 was found capable of detecting changes in MSA-P. Our study provided some new insights into potential predictors of the HRQoL and its longitudinal changes in MSA-P, which should be considered when healthcare programs are developed.
Collapse
Affiliation(s)
- Milica V Jecmenica-Lukic
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, Belgrade, 11000, Serbia
| | - Tatjana D Pekmezovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, Belgrade, 11000, Serbia
- Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor N Petrovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, Belgrade, 11000, Serbia
| | - Natasa T Dragasevic
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, Belgrade, 11000, Serbia
| | - Vladimir S Kostić
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, Belgrade, 11000, Serbia.
| |
Collapse
|
26
|
Du JJ, Wang T, Huang P, Cui S, Gao C, Lin Y, Fu R, Zhou H, Chen S. Clinical characteristics and quality of life in Chinese patients with multiple system atrophy. Brain Behav 2018; 8:e01135. [PMID: 30378279 PMCID: PMC6305933 DOI: 10.1002/brb3.1135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Multiple system atrophy (MSA) is a progressive neurodegenerative disorder that causes early sustained disability and poor health-related quality of life (HrQoL). The clinical features and their effects on the HrQoL of patients in China have received little attention in the research literature. We evaluated the clinical characteristics and HrQoL of Chinese patients with MSA. MATERIALS AND METHODS A total of 143 patients with MSA from the Department of Neurology, Shanghai Ruijin Hospital, were enrolled in the study from March 2014 to May 2017. Basic demographic data, motor symptoms, non-motor symptoms, and HrQoL were assessed and compared with data from 198 patients with idiopathic Parkinson's disease (PD) who were matched by age, gender, and disease duration. Factors influencing the HrQoL of MSA patients were also analyzed. RESULTS The ratio of patients with predominant parkinsonism (MSA-P) and prominent cerebellar ataxia (MSA-C) was 95:48 among the 143 MSA patients. MSA-P patients had a longer disease duration (p = 0.002), higher levodopa equivalent daily dose (p < 0.001), higher scores on the Unified Multiple System Atrophy Rating Scale (UMSARS) I (p = 0.026), UMSARS II (p < 0.001), UMSARS IV (p = 0.019), the Hamilton Rating Scale for Depression (p = 0.001), the Hamilton Anxiety Scale (p = 0.013), and lower scores on measures of olfaction (p = 0.021) and cognitive function (p = 0.044) than the MSA-C patients. Stepwise regression analysis showed that depression, anxiety, degree of disability, and disease severity were independent predictors of decreased HrQoL. CONCLUSIONS The results indicate that MSA-P patients have more severe motor impairment, hyposmia, depression, anxiety, cognitive impairment, and lower HrQoL than MSA-C patients. Depression, anxiety, degree of disability, and disease severity are predictors of poor HrQoL among Chinese patients with MSA.
Collapse
Affiliation(s)
- Juan-Juan Du
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Wang
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Huang
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shishuang Cui
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Gao
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqi Lin
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rao Fu
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Zhou
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology & The Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| |
Collapse
|
27
|
Rana AQ, Qureshi AR, Siddiqui O, Sarfraz Z, Rana R, Shtilbans A. Prevalence of pain in atypical parkinsonism: a systematic review and meta-analysis. J Neurol 2018; 266:2093-2102. [PMID: 30238268 DOI: 10.1007/s00415-018-9049-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 01/11/2023]
Abstract
Pain is common in atypical parkinsonism such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and dementia with Lewy bodies (LBD). In this study, a systematic review and meta-analysis was conducted and peer-reviewed literature was searched to determine the prevalence and types of pain in four atypical parkinsonism syndromes: MSA, PSP, CBD and LBD. The results show that pain was prevalent mainly in MSA patients in comparison to PSP and CBD patients. Pain was reported at an early stage and was found in females, with limb pain being the most common, followed by neck and back pain. In comparison to PSP, pain locations were similar to MSA patients. CBD patients experienced pain the least in comparison to MSA, PSP and LBD patients.
Collapse
Affiliation(s)
| | | | - Omer Siddiqui
- Parkinson's Clinic of Eastern Toronto, Toronto, Canada.
| | | | - Ruqqiyah Rana
- Parkinson's Clinic of Eastern Toronto, Toronto, Canada
| | - Alexander Shtilbans
- Weill Cornell Medical College, Parkinson's Disease & Movement Disorders Institute, New York City, USA
| |
Collapse
|
28
|
Lopez-Cuina M, Foubert-Samier A, Tison F, Meissner WG. Present and future of disease-modifying therapies in multiple system atrophy. Auton Neurosci 2018; 211:31-38. [DOI: 10.1016/j.autneu.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/22/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
|
29
|
Tilley E, McLoughlin J, Koblar SA, Doeltgen SH, Stern C, White S, Peters MDJ. Effectiveness of allied health therapy in the symptomatic management of progressive supranuclear palsy: a systematic review. ACTA ACUST UNITED AC 2018; 14:148-95. [PMID: 27532657 DOI: 10.11124/jbisrir-2016-2002352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is an adult onset neurodegenerative condition associated with mobility, balance, speech, swallowing, vision and cognitive changes. The condition is diagnosed using the National Institute for Neurological Disorders and Stroke (NINDS) and the Society of Progressive Supranuclear Palsy (SPSP) criteria. Therapeutic interventions for PSP are important, and a healthcare team should include a physiotherapist, occupational therapist and speech therapist. Mobility, speech and swallowing problems are commonly experienced, and aspiration pneumonia is the leading cause of death. A preliminary search of the literature has indicated that beyond small case series, there is very little evidence to guide specific allied health therapies in PSP. Many strategies for optimizing independence and function for PSP predominately rely on data extrapolated from the study of Parkinson's disease. OBJECTIVES The objective of this review was to examine the effectiveness of physical, occupational and speech therapy interventions in the symptomatic management of PSP. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review included participants with PSP as per the NINDS and the SPSP criteria, aged over 40 years of age from all community and clinical settings. TYPES OF INTERVENTIONS This review included studies evaluating any allied health therapy that addressed mobility, vision, swallowing, communication or cognitive/neuropsychiatric difficulties experienced by patients with PSP. Studies examining interventions within the current scope of practice, and emerging interventions (non-invasive brain stimulation therapy) were eligible for inclusion. TYPES OF COMPARATOR The effectiveness of interventions of interest was compared with usual care and/or baseline measurements. OUTCOMES Outcomes of interest included the degree of change, or no change, in the symptoms experienced by patients with PSP relevant to allied health. These included difficulties with mobility, vision, swallowing, communication and cognition. TYPES OF STUDIES All types of quantitative study designs published in English from the time of development of the NINDS and the SPSP criteria in 1996-2014 were considered for inclusion. SEARCH STRATEGY A broad range of synonyms for PSP and a three-step search strategy was utilized to identify possible published and unpublished studies from 11 different databases. An initial limited search via MEDLINE (PubMed), CINAHL, Health Informit, PsycINFO, PEDRO, OTSeeker and SpeechBite was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Third, hand-searching was conducted and the reference list of all identified reports and articles was searched for additional studies. METHODOLOGICAL QUALITY Critical appraisal was conducted by two independent reviewers using standardized instruments. DATA EXTRACTION Quantitative data were extracted from articles included in the review using standardized data extraction tools. DATA SYNTHESIS As the quantitative articles examined different interventions, pooling of data was not appropriate. Instead, the findings were presented in narrative summary and tabular form. RESULTS Following methodological appraisal, six studies were included in the review. Aside from one small quasi-randomized control study, most studies were small case series and one was a case report. Five of the six studies examined the effectiveness of a range of different physiotherapy rehabilitation programs targeting gait, balance and physical capability, with one study also targeting gaze control. The sixth study examined non-invasive brain stimulation in improving gait and midline symptoms in PSP. No studies examined the effectiveness of occupational therapy or speech therapy interventions in PSP. CONCLUSIONS Research into the effectiveness of allied health therapeutic interventions for PSP symptoms is in its infancy. This review found preliminary evidence to support the use of various physiotherapy rehabilitation programs to improve balance, gait and gaze control in people affected by PSP. Further research is urgently required to identify effective interventions to manage mobility, vision, swallowing, communication and cognitive/neuropsychiatric symptoms associated with this devastating condition.
Collapse
Affiliation(s)
- Erica Tilley
- 1The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia 2Faculty of Medicine, School of Health Sciences, Nursing and Health Sciences, Flinders University, South Australia, Australia 3Faculty of Health Sciences, School of Medicine, University of Adelaide, South Australia, Australia
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE Pain is one of the most common nonmotor symptoms of Parkinson disease (PD) and other Parkinson plus syndromes, with a major effect on quality of life. The aims of the study were to examine the prevalence and characteristics of pain in PD and other Parkinson plus syndromes and patient use and response to pain medications. METHODS The cohort consisted of 371 patients: 300 (81%) with PD and 71 (19%) with Parkinson plus syndromes. Data on clinical parameters and pain were collected by questionnaire. Disease severity was measured with the Unified PD Rating Scale for patients with PD. RESULTS Pain was reported by 277 patients (74%): 241 with PD and 36 with Parkinson plus syndromes. The prevalence of pain was significantly higher in the patients with PD than in the patients with Parkinson plus syndromes (80% vs. 50%, P<0.001) and higher in patients with synucleinopathies than in patients with tauopathies (70% vs. 40%, P<0.001). In the synucleinopathies, the most common pain was central pain (32%), whereas in the tauopathies only 4% of patients had central pain. Anti-Parkinson treatment relieved the pain in 21% of the patients with PD. Only 114 patients (48%) who experienced pain were treated with pain medications. The most beneficial analgesics were nonsteroidal anti-inflammatory drugs and medical cannabis. CONCLUSION Pain is prevalent among patients with PD and Parkinsonian plus syndromes. Pain relief can be achieved by more intensive anti-Parkinson medications or pain medications.
Collapse
|
31
|
Winter Y, Daneshkhah N, Galland N, Kotulla I, Krüger A, Groppa S. Health-related quality of life in patients with poststroke epilepsy. Epilepsy Behav 2018; 80:303-306. [PMID: 29429905 DOI: 10.1016/j.yebeh.2017.12.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/28/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lesional epilepsy is an important long-term sequela of stroke. Data on health-related quality of life (HrQoL) in patients with poststroke epilepsy are limited. We investigated HrQoL in patients with epilepsy after ischemic stroke and identified independent HrQoL-determinants. METHODS AND PATIENTS All patients with acute ischemic stroke, who were permanent residents in the district Marburg-Biedenkopf (Hessia, Germany, reference population 240,000 inhabitants) were recruited within 12months in the population-based Marburg Stroke Register (MARSTREG). Follow-up visits were performed after 6, 12, and 24months, and patients who developed poststroke epilepsy were identified. Data on demographics, antiepileptic drugs (AEDs), stroke severity (National Institute of Heath Stroke Scale (NIHSS), Barthel-Index, modified Rankin Scale), depression (Geriatric Depression Scale), and HrQoL (EQ-5D and EQ VAS) were collected. A multiple regression analysis was performed to identify HrQoL-determinants. RESULTS Among the study participants (n=374), 23 (6.1%) developed poststroke epilepsy. The HrQoL of patients with poststroke epilepsy was reduced in comparison with patients without seizures (24-month follow-up: EuroQol Visual Analogue Scale (EuroQol-VAS): 55.3±10.7 versus 64.2±11.4, p=0.03). Seizure frequency, depression, and functional impairment (Barthel-Index) were identified as independent determinants of HrQoL. The adjustment of AEDs between 6-month and 24-month follow-ups resulted in decrease of seizure frequency by 40% and reduction of complications (dizziness by 27.8%, nausea by 52.2%, fatigue by 84.2%). CONCLUSION Lesional epilepsy is associated with decreased HrQoL in patients with stroke. We identified HrQoL-determinants, which would improve the management of patients with poststroke epilepsy. These determinants include proper adjustment of AEDs with reduction of seizure frequency, treatment of depression, and focused rehabilitation programs for poststroke epilepsy.
Collapse
Affiliation(s)
- Yaroslav Winter
- Mainz Comprehensive Epilepsy Center, Johannes Gutenberg-University, Mainz, Germany.
| | | | | | - Isabel Kotulla
- Department of Neurology, Philipps-University Marburg, Germany
| | - Anna Krüger
- Department of Neurology, Philipps-University Marburg, Germany
| | - Sergiu Groppa
- Mainz Comprehensive Epilepsy Center, Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|
32
|
Zhang LY, Cao B, Zou YT, Wei QQ, Ou RW, Zhao B, Wu Y, Shang HF. Depression and anxiety in multiple system atrophy. Acta Neurol Scand 2018; 137:33-37. [PMID: 28748633 DOI: 10.1111/ane.12804] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND It has been noticed that the patients with multiple system atrophy (MSA) can accompany with depression and anxiety. This study aimed to establish the incidence and determinants of depression and anxiety symptoms in Chinese MSA patients. METHODS A total of 237 MSA patients were enrolled in the study. Neuropsychological assessment was performed using Hamilton Depression Rating Scale-24 items and Hamilton Anxiety Rating Scale. RESULTS We found that 62.0% and 71.7% patients had at least mild depression and anxiety symptoms, respectively. The severity of depression of MSA patients was associated with lower educational years (P=.024), longer disease duration (P<.001), and disease severity (P<.001). The severity of anxiety was associated with increased disease duration (P<.001), disease severity (P=.013), and orthostatic hypotension (P=.005). Binary logistic regression showed the determinants of depression and anxiety were female gender, longer disease duration, and disease severity. CONCLUSION Depression and anxiety symptoms are common in patients with MSA. Neurologists should pay attention to depression and anxiety in patients with MSA, especially in female patients and those with longer disease duration and severe disease condition.
Collapse
Affiliation(s)
- L.-Y. Zhang
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - B. Cao
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Y.-T. Zou
- West China School of Medicine; Sichuan University; Chengdu China
| | - Q.-Q. Wei
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - R.-W. Ou
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - B. Zhao
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Y. Wu
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - H.-F. Shang
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| |
Collapse
|
33
|
Belvisi D, Berardelli I, Suppa A, Fabbrini A, Pasquini M, Pompili M, Fabbrini G. Neuropsychiatric disturbances in atypical parkinsonian disorders. Neuropsychiatr Dis Treat 2018; 14:2643-2656. [PMID: 30349262 PMCID: PMC6186304 DOI: 10.2147/ndt.s178263] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) are the most common atypical parkinsonisms. These disorders are characterized by varying combinations of autonomic, cerebellar and pyramidal system, and cognitive dysfunctions. In this paper, we reviewed the evidence available on the presence and type of neuropsychiatric disturbances in MSA, PSP, and CBD. A MedLine, Excerpta Medica, PsycLit, PsycInfo, and Index Medicus search was performed to identify all articles published on this topic between 1965 and 2018. Neuropsychiatric disturbances including depression, anxiety, agitation, and behavioral abnormalities have been frequently described in these disorders, with depression as the most frequent disturbance. MSA patients show a higher frequency of depressive disorders when compared to healthy controls. An increased frequency of anxiety disorders has also been reported in some patients, and no studies have investigated apathy. PSP patients may have depression, apathy, disinhibition, and to a lesser extent, anxiety and agitation. In CBD, neuropsychiatric disorders are similar to those present in PSP. Hallucinations and delusions are rarely reported in these disorders. Neuropsychiatric symptoms in MSA, PSP, and CBD do not appear to be related to the severity of motor dysfunction and are one of the main factors that determine a low quality of life. The results suggest that neuropsychiatric disturbances should always be assessed in patients with atypical parkinsonisms.
Collapse
Affiliation(s)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Suppa
- IRCCS Neuromed, Pozzilli, Italy, .,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, Italy, .,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| |
Collapse
|
34
|
Ou R, Liu H, Hou Y, Wei Q, Cao B, Zhao B, Shang H. Executive dysfunction, behavioral changes and quality of life in Chinese patients with progressive supranuclear palsy. J Neurol Sci 2017; 380:182-186. [DOI: 10.1016/j.jns.2017.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
|
35
|
Bhatia KP, Stamelou M. Nonmotor Features in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1285-1301. [PMID: 28805573 DOI: 10.1016/bs.irn.2017.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Atypical parkinsonism (AP) comprises mainly multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which are distinct pathological entities, presenting with a wide phenotypic spectrum. The classic syndromes are now called MSA-parkinsonism (MSA-P), MSA-cerebellar type (MSA-C), Richardson's syndrome, and corticobasal syndrome. Nonmotor features in AP have been recognized almost since the initial description of these disorders; however, research has been limited. Autonomic dysfunction is the most prominent nonmotor feature of MSA, but also gastrointestinal symptoms, sleep dysfunction, and pain, can be a feature. In PSP and CBD, the most prominent nonmotor symptoms comprise those deriving from the cognitive/neuropsychiatric domain. Apart from assisting the clinician in the differential diagnosis with Parkinson's disease, nonmotor features in AP have a big impact on quality of life and prognosis of AP and their treatment poses a major challenge for clinicians.
Collapse
Affiliation(s)
| | - Maria Stamelou
- HYGEIA Hospital, Athens, Greece; Neurology Clinic, Philipps University Marburg, Marburg, Germany; University of Athens, Athens, Greece.
| |
Collapse
|
36
|
Zhang L, Cao B, Ou R, Wei QQ, Zhao B, Yang J, Wu Y, Shang H. Non-motor symptoms and the quality of life in multiple system atrophy with different subtypes. Parkinsonism Relat Disord 2017; 35:63-68. [DOI: 10.1016/j.parkreldis.2016.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/06/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
|
37
|
Pekmezović T, Ječmenica-Lukić M, Petrović I, Špica V, Tomić A, Kostić VS. Quality of life in patients with progressive supranuclear palsy: one-year follow-up. J Neurol 2015; 262:2042-8. [PMID: 26070289 DOI: 10.1007/s00415-015-7815-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 11/28/2022]
Abstract
The aim of this prospective cohort study that included 46 patients with progressive supranuclear palsy (PSP) was to estimate which demographic and clinical factors were the main contributors to the health-related quality of life (HRQoL) and how did the HRQoL change over a follow-up period of 1 year in these patients. The hierarchical regression analyses showed that the final models demonstrated that gender, included clinical variables and psychiatric/neuropsychological scales, accounted for 68% of the variance in the Physical Composite Score and 73% of the variance of the Mental Composite Score of the 36-item Short Form Health Survey (SF-36). Among variables in both final models, only the score of the Apathy Evaluation Scale showed statistically significant negative predictive value (p < 0.05). Changes in the HRQoL scores were assessed in 28 PSP patients who completed 1-year follow-up period after the baseline examination. Statistically significant decline in the HRQoL was detected for the following scales of the SF-36: physical functioning, vitality, social functioning, and role emotional, as well as in both composite scores (Physical Composite Score and Mental Composite Score). The analyses of magnitude of changes in the HRQoL during 1-year follow-up period showed large effect size (≥0.80) for total scores, as well as for the physical functioning, vitality, and social functioning. In conclusion, despite certain limitations, our study provided some new insights into potential predictors of the HRQoL and its longitudinal changes in patients with PSP.
Collapse
Affiliation(s)
- Tatjana Pekmezović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Višegradska 26A, Belgrade, 11000, Serbia
| | - Milica Ječmenica-Lukić
- Institute of Neurology, Clinical Centre of Serbia, Faculty of Medicine, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia
| | - Igor Petrović
- Institute of Neurology, Clinical Centre of Serbia, Faculty of Medicine, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia
| | - Vladana Špica
- Institute of Neurology, Clinical Centre of Serbia, Faculty of Medicine, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia
| | - Aleksandra Tomić
- Institute of Neurology, Clinical Centre of Serbia, Faculty of Medicine, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia
| | - Vladimir S Kostić
- Institute of Neurology, Clinical Centre of Serbia, Faculty of Medicine, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia.
| |
Collapse
|
38
|
Hall DA, Forjaz MJ, Golbe LI, Litvan I, Payan CAM, Goetz CG, Leentjens AFG, Martinez-Martin P, Traon APL, Sampaio C, Post B, Stebbins G, Weintraub D, Schrag A. Scales to Assess Clinical Features of Progressive Supranuclear Palsy: MDS Task Force Report. Mov Disord Clin Pract 2015; 2:127-134. [PMID: 30363842 DOI: 10.1002/mdc3.12130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 04/16/2015] [Accepted: 09/23/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deborah A Hall
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Maria João Forjaz
- National School of Public Health Health Institute Carlos III and REDISSEC Madrid Spain
| | - Lawrence I Golbe
- Department of Neurology Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Irene Litvan
- Department of Neurosciences University of California San Diego San Diego California USA
| | - Christine Ann M Payan
- Department de Pharmacologie Clinique Hôpital Pitié-Salpêtrière Assistance-Publique Hôpitaux de Paris (APHP) Paris France
| | | | - Albert F G Leentjens
- Department of Psychiatry Maastricht University Hospital Maastricht The Netherlands
| | - Pablo Martinez-Martin
- National Center of Epidemiology, and CIBERNED Carlos III Institute of Health Madrid Spain
| | - Anne Pavy-Le Traon
- Reference Center for MSA University Hospital and INSERM U1048 Eq8 Toulouse France
| | - Cristina Sampaio
- Laboratory of Clinical Pharmacology and Therapeutics Lisbon School of Medicine Lisbon Portugal
| | - Bart Post
- Department of Neurology Radboudumc, Radboud University Medical Center Nijmegen The Netherlands
| | - Glenn Stebbins
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Daniel Weintraub
- Department of Psychiatry University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
| | - Anette Schrag
- Department of Clinical Neuroscience Institute of Neurology University College London London United Kingdom
| |
Collapse
|
39
|
Vogel AP, Fendel L, Paige Brubacher K, Chan V, Maule R. Dysphagia in spinocerebellar ataxia and multiple system atrophy-cerebellar. SPEECH LANGUAGE AND HEARING 2014. [DOI: 10.1179/2050572814y.0000000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
40
|
Moore T, Guttman M. Challenges Faced by Patients With Progressive Supranuclear Palsy and their Families. Mov Disord Clin Pract 2014; 1:188-193. [PMID: 30363938 DOI: 10.1002/mdc3.12037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/07/2022] Open
Abstract
The literature is inadequate for understanding the challenges experienced by people with PSP and their families. Therefore, the aim of this study was to understand the challenges of people with PSP and their caregivers and identify their priority need. In this qualitative study, five focus groups were conducted with people with PSP and/or their family caregivers, one group with long-term care staff, and one with community caregivers. Data were analyzed using fundamental qualitative description. Four themes were identified: knowledge, services, research, and symptoms. Knowledge challenges were identified as the priority need, with the most common challenges in this category being lack of knowledge of PSP among community workers, physicians, patients, and family members. Service challenges involved service access and interactions with physicians, community workers, private caregivers, and long-term care staff. Research challenges related to the lack of research and the failure of health care providers or PSP organizations to communicate research findings. Symptoms most often identified as challenging were falls, mobility, vision, mood or thinking, speech, and swallowing. Participants identified their priority need as dissemination of information about PSP. This has not been captured in previous research. This information needs to reach doctors, long-term care staff, community workers, patients, families, and the general public. Subsequent activities to meet this need are summarized. These activities resulted in three new resources: a brochure for patients and families; an information packet for physicians; and a webinar for staff in long-term care and community.
Collapse
Affiliation(s)
- Theresa Moore
- Center for Movement Disorders Markham Ontario Canada
| | - Mark Guttman
- Center for Movement Disorders Markham Ontario Canada
| |
Collapse
|
41
|
Zeng Q, Xu Y, Chun Wang W. Quality of life in outpatients with depression in China. J Affect Disord 2013; 150:513-21. [PMID: 23714374 DOI: 10.1016/j.jad.2013.04.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quality of life (QOL) is an important outcome measure for patients with depression, but QOL research involving large samples of patients has been uncommon. The purpose of this study was to evaluate the QOL of Chinese outpatients with depression and its determinants. METHODS Using a cross-sectional survey design, data were collected continuously from 19,984 outpatients; 19,950 usable questionnaires were obtained. Along with the QOL index (WHOQOL-BREF), the questionnaire also included participants' sociodemographic characteristics, outpatient visits, and medication use information. RESULTS Less than 5% of depressed patients reported "good" or "very good" QOL, while less than 3% were satisfied with their general health. The overall score was low (54.12); four QOL domain (physical health, psychological, social relationships, and environment) scores (range, 35.03-40.10) were significantly lower than in other community population surveys. QOL scores were significantly lower among first-visit than non-first-visit patients. Medication users reported significantly higher QOL scores than non-users, with NaSSA more effective than SSRIs, followed by other types, SNRIs, and no medication, in that order. LIMITATIONS Since this was an observational, cross-sectional survey with continuous outpatient data collection method instead of random sampling, generalization of the results is limited, and causality cannot be determined. However, the "natural" observational design, large sample size, and similarity in findings with other studies reveal the "real world" QOL of depressed outpatients in mainland China. CONCLUSIONS Depressed patients had a low QOL, and the scores of first-visit patients with severe symptoms were significantly lower than non-first-visit patients. Though medication can improve patients' QOL, different types of medications have different impacts.
Collapse
Affiliation(s)
- Qingzhi Zeng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | | | | |
Collapse
|
42
|
Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, Köllensperger M, Goebel G, Pfeiffer KP, Barone P, Pellecchia MT, Quinn NP, Koukouni V, Fowler CJ, Schrag A, Mathias CJ, Giladi N, Gurevich T, Dupont E, Ostergaard K, Nilsson CF, Widner H, Oertel W, Eggert KM, Albanese A, del Sorbo F, Tolosa E, Cardozo A, Deuschl G, Hellriegel H, Klockgether T, Dodel R, Sampaio C, Coelho M, Djaldetti R, Melamed E, Gasser T, Kamm C, Meco G, Colosimo C, Rascol O, Meissner WG, Tison F, Poewe W. The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 2013; 12:264-74. [PMID: 23391524 PMCID: PMC3581815 DOI: 10.1016/s1474-4422(12)70327-7] [Citation(s) in RCA: 350] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. METHODS Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. FINDINGS 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size estimation showed that an interventional trial with 258 patients (129 per group) would be able to detect a 30% effect size in 1-year UMSARS motor examination decline rates at 80% power. INTERPRETATION Our prospective dataset provides new insights into the evolution of MSA based on a follow-up period that exceeds that of previous studies. It also represents a useful resource for patient counselling and planning of multicentre trials.
Collapse
Affiliation(s)
- Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Rodríguez-Violante M, Cervantes-Arriaga A, Corona T, Martínez-Ramírez D, Morales-Briceño H, Martínez-Martín P. Clinical determinants of health-related quality of life in Mexican patients with Parkinson's disease. Arch Med Res 2013; 44:110-4. [PMID: 23376054 DOI: 10.1016/j.arcmed.2013.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Parkinson's disease (PD) is the second most common chronic neurodegenerative disorder. PD is clinically characterized by a constellation of motor and nonmotor symptoms that may have a direct effect on daily activities as well as in the quality of life of the patient. Identifying the symptoms more closely associated with a poor quality of life is central on improving the medical care of the patient. We undertook this study to identify and describe the clinical and demographic factors that predict health-related quality of life among Mexican patients with PD. METHODS One hundred seventy-seven patients with Parkinson's disease were included. Patients were evaluated using the following clinimetric instruments: motor subscale of the Unified Parkinson's disease rating scale, Hoehn and Yahr stage, Non-motor Symptoms Questionnaire, Parkinson's disease Questionnaire (PDQ-39) and the Mini Mental Status Examination. RESULTS Multivariate analysis showed that the main factors associated with a poor quality of life were motor impairment (β = 0.27, p <0.001) and the number of nonmotor symptoms (β = 2.17, p <0.001). The main nonmotor domains impacting on the quality of life were depression/anxiety (β = 6.36, p <0.001), cardiovascular (β = 5.39, p = 0.001), memory (β = 4.64, p <0.001) and miscellaneous (β = 3.15, p = 0.001). CONCLUSIONS Both motor and mainly nonmotor symptoms are negatively associated with health-related quality of life in patients with PD and should be appropriately attended in order to improve patient care.
Collapse
|
44
|
Duff K, Gerstenecker A, Litvan I. Functional impairment in progressive supranuclear palsy. Neurology 2013; 80:380-4. [PMID: 23303854 DOI: 10.1212/wnl.0b013e31827f0859] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The current study sought to describe the functional profiles of patients with early-stage progressive supranuclear palsy (PSP) in a large prospective, multisite study. METHODS Using data from 202 individuals meeting criteria for clinically definite or probable PSP, 3 functional scales were examined. Functional scores were then compared to measures of motor, cognition, and psychiatric symptoms. RESULTS Functional disability was high in early-stage PSP, with 100% of patients having less than perfect scores on all functional scales. Whereas functional scores tended not to be related to cognition or psychiatric symptoms, they were strongly related to motoric ratings. CONCLUSIONS Both clinically and in research settings, the definition of functional intactness/impairment has important implications. Future studies should examine if functional impairment is this high in PSP or if new scales of functional abilities need to be developed for this condition.
Collapse
Affiliation(s)
- Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, USA.
| | | | | | | |
Collapse
|
45
|
Meissner WG, Foubert-Samier A, Dupouy S, Gerdelat-Mas A, Debs R, Marquant F, De Cock VC, Rascol O, Tison F, Pavy-Le Traon A. Assessment of quality of life with the multiple system atrophy health-related quality of life scale. Mov Disord 2012; 27:1574-7. [DOI: 10.1002/mds.25174] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/30/2012] [Accepted: 08/05/2012] [Indexed: 11/07/2022] Open
|
46
|
Winter Y, Epifanova-Bertschi N, Sankowski R, Zhukova TV, Oertel WH, Dodel R, Korchounov A. Health-related quality of life and its determinants in the urban Russian population with major depressive disorder: a cross-sectional study. Int J Psychiatry Med 2012; 43:35-49. [PMID: 22641929 DOI: 10.2190/pm.43.1.c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Depressive disorders pose a major challenge to healthcare in the countries of the former Soviet Union. The objective of the current study was to evaluate health-related quality of life (HrQoL) and its determinants in outpatients with major depressive disorder in an urban Russian population. METHODS We consecutively recruited 100 urban Russian outpatients with major depression and 100 non-depressed controls who were matched for age and sex. The severity of their depression was assessed using the Hamilton Depression Rating Scale (HDRS). HrQoL was evaluated using the EuroQol (the EQ-5D and the visual analogue scale, EQ VAS). Independent determinants of HrQoL were identified using multiple regression analysis. RESULTS The mean EQ VAS score was 43.0 +/- 27.4 in patients with depression compared to 81.4 +/- 14.7 in the controls (p < 0.01). Out of the domains of the EQ-5D, "anxiety/depression," "usual activities," and "self-care" were the most impaired. Independent determinants of reduced HrQoL were: severity of depression according to the HDRS; violent suicide attempts; suicide attempts in the past; and drug addiction. CONCLUSIONS HrQoL is considerably reduced in Russians with major depression. The disease-specific patterns of HrQoL impairment and the independent determinants of HrQoL identified in our study could be addressed in focused healthcare programs and clinical trials. Comorbid drug addiction as a determinant of HrQoL should receive greater attention in the management of depressive disorders in urban Russian populations.
Collapse
|
47
|
Clinical pain and experimental pain sensitivity in progressive supranuclear palsy. Parkinsonism Relat Disord 2012; 18:606-8. [DOI: 10.1016/j.parkreldis.2011.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 11/21/2022]
|
48
|
Youn J, Shin H, Kim JS, Cho JW. Preliminary study of intravenous amantadine treatment for ataxia management in patients with probable multiple system atrophy with predominant cerebellar ataxia. J Mov Disord 2012; 5:1-4. [PMID: 24868404 PMCID: PMC4027678 DOI: 10.14802/jmd.12001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/30/2012] [Accepted: 04/30/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Multiple system atrophy with predominant cerebellar ataxia is a disabling neurologic disease. However, effective management has not yet been established. We conducted a short-term, open-label preliminary study to assess the benefits of intravenous amantadine treatment in patients with probable multiple system atrophy with predominant cerebellar ataxia. METHODS Twenty patients (10 male, 10 female) with probable multiple system atrophy with predominant cerebellar ataxia received 400 mg of amantadine by intravenous per day for 5 days. Ataxia severity was evaluated by the International Cooperative Ataxia Rating Scale before and after intravenous amantadine therapy and all subjects reported subjective improvement after intravenous amantadine treatment using a patient global impression scale. We analyzed the total and subscale scores by the ataxia scale and patient global impression scale. RESULTS The mean age was 57.4 years (range: 47-72) and the mean disease duration was 30.8 months (range: 11-79). The ataxia severity significantly decreased after intravenous amantadine therapy from 42.5 to 37.3 (p < 0.001). The mean patient global impression scale for improvement was 2.9 and there were no side effects of intravenous amantadine treatment observed. When we assessed responders, the duration of intravenous amantadine effect was more than 1 month in 4 subjects of 7 responders. CONCLUSIONS Our findings suggest that intravenous amantadine treatment can be a safe management option in cerebellar ataxia, although the mechanism is unclear. Thus, further double-blind, long-term studies with a larger sample size are needed.
Collapse
Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hyeeun Shin
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| |
Collapse
|