Influence of Mild Cognitive Impairment, Depression, and Anxiety on the Quality of Life of Patients with Parkinson Disease

Quality of Life in Patients With Parkinson's Disease: A Cross-Sectional Study

Patients with Parkinson's disease (PD) suffer from a range of physical, psychological, and social problems. The disease affects the quality of life (QOL) of the affected person. Several factors contribute to QOL, and these factors should be examined to develop appropriate strategies. This study aimed to determine the factors related to QOL in patients with PD. A cross-sectional, descriptive study was conducted using a tool with strong validity and reliability (39-Item Parkinson's Disease Questionnaire (PDQ-39)) to assess the quality of life. Descriptive statistics were used to analyze the data, and non-parametric chi-square tests were applied to evaluate the relationship between QOL and the variables. Frequent hospital admissions, level of education, and marital status were among the factors that affected QOL. The ability to perform Ramadan fasting correlated with the degree of QOL. The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the quality of life due to changes in access to medical care and medications. To improve QOL in patients with PD, a comprehensive approach is required in many healthcare domains that includes physiotherapy together with the conventional pharmacotherapy, other treatments, and psychological support.

COVID-19 social distancing: negative effects on people with Parkinson disease and their associations with confidence for self-management

BACKGROUND

The purpose of this study was to describe the effects of COVID-19 social distancing on the function, health, and well-being of people with Parkinson disease (PD), and test the association of these effects with patients' activation levels, i.e., their skills and confidence in managing their health.

METHODS

Community-dwelling individuals with PD answered an anonymous web-based survey. Part 1 included 27 multiple-choice questions regarding changes in function, health, medical care, and well-being. Part 2 consisted of the Patient Activation Measure, which enquired about skills and confidence in managing one's health.

RESULTS

Respondents (N = 142) reported decreases in various function (24.8%-37.3%), health (33.8%-43%), and well-being (26.1%-47.1%) domains. Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 67.8% associated this with the cessation of rehabilitative treatments or decrease in physical activity. Patients' activation levels were inversely correlated with increased assistance for activities of daily living, increased tiredness, worsening symptoms, and lack of support from family and friends.

CONCLUSIONS

Social distancing had a major negative impact on the health and function of people with PD.

PRACTICAL IMPLICATIONS

Supporting people with PD skills and confidence in managing health may preserve their physical and mental health during this period of dramatic changes in life's circumstances.

Impact of Depression and Anxiety on Dimensions of Health-Related Quality of Life in Subjects with Parkinson's Disease Enrolled in an Association of Patients

Parkinson's disease (PD) is a complex disorder characterized by a wide spectrum of symptoms. Depression and anxiety are common manifestations in PD and may be determinants of health-related quality of life (HRQoL). The objective of this study is to determine the association of depression and anxiety with the dimensions of HRQoL in subjects with PD enrolled in an association of patients. Ninety-five community-based patients with PD diagnosis at different disease stages were studied. HRQoL was assessed using the Parkinson's Disease Questionnaire (PDQ-39); depression and anxiety were assessed using the Beck Depression Inventory (BDI-II) and the State-Trait Anxiety Inventory (STAI), respectively. Our results showed that depression and anxiety were negatively associated with HRQoL measured by PDSI. Higher motor dysfunction measured by Hoehn and Yahr (H&Y) staging was also associated with worse HRQoL. Depression was the most influential variable in the model. All PDQ-39 dimensions except social support and bodily discomfort were associated with depression. Anxiety was associated with the emotional well-being and bodily discomfort dimensions. These results suggest that physicians should pay attention to the presence of psychiatric symptoms and treat them appropriately.

An empowerment-psycho-behavioral program on neuropsychiatric symptoms in persons with mild cognitive impairment: Study protocol of a randomized controlled trial

AIMS

Neuropsychiatric symptoms (NPS) are highly prevalent among persons with mild cognitive impairment (PwMCI). However, the mainstay of treatments only focuses on cognitive training. This study develops an empowerment-psycho-behavioural programme to improve the NPS and other health outcomes of this preclinical cohort. The empirical effects and the participants' perception and experience of the programme will be explored.

DESIGN

This sequential mixed-method study comprises a single-blind randomized controlled trial and a qualitative study.

METHODS

This study will recruit 250 PwMCI from the community and randomize them to either the intervention group to receive a 13-week empowerment-psycho-behavioural programme which focuses on promoting cognitive coping and stress adaptation, or the control group to receive a health education programme which serves as an attention placebo with content unrelated to dementia. The primary outcome is NPS, and the secondary outcomes include cognitive function, subjective memory complaints and health-related quality of life. These outcomes will be measured at baseline, upon completing the programme and 4 weeks thereafter. A purposive sample of 30 participants from the intervention group will be interviewed for their engagement experience in the programme. This study received funding support in July 2020.

DISCUSSION

Given the high prevalence and detrimental effects of NPS on disease progression, effective management is yet to be determined. Underpinned by the Progressively Lowered Stress Threshold (PLST) Model, the empowerment-psycho-behavioural programme is designed. Results on the outcome-based evaluation and the patients' experience can advance the science in this under-addressed area.

IMPACT

This study enhances our understanding of the PLST Model in explaining the manifestations of NPS by the stress-coping disequilibrium at the early disease stage. It will shed important insight into the care management of MCI to attend both cognition function and psychological well-being in research and clinical context.

TRIAL REGISTRATION

This study is registered in the ClinicalTrials.gov (NCT04723667) and the HKU Clinical Trials Registry (HKUCTR-2915).

Memory enhancement by multidomain group cognitive training in patients with Parkinson's disease and mild cognitive impairment: long-term effects of a multicenter randomized controlled trial

BACKGROUND

Meta-analyses indicate positive effects of cognitive training (CT) in patients with Parkinson's disease (PD), however, most previous studies had small sample sizes and did not evaluate long-term follow-up. Therefore, a multicenter randomized controlled, single-blinded trial (Train-ParC study) was conducted to examine CT effects in PD patients with mild cognitive impairment (PD-MCI). Immediately after CT, an enhancement of executive functions was demonstrated. Here, we present the long-term results 6 and 12 months after CT.

METHODS

At baseline, 64 PD-MCI patients were randomized to a multidomain CT group (n = 33) or to a low-intensity physical activity training control group (PT) (n = 31). Both interventions included 90 min training sessions twice a week for 6 weeks. 54 patients completed the 6 months (CT: n = 28, PT: n = 26) and 49 patients the 12 months follow-up assessment (CT: n = 25, PT: n = 24). Primary study outcomes were memory and executive functioning composite scores. Mixed repeated measures ANOVAs, post-hoc t tests and multiple regression analyses were conducted.

RESULTS

We found a significant time x group interaction effect for the memory composite score (p = 0.006, η² = 0.214), but not for the executive composite score (p = 0.967, η² = 0.002). Post-hoc t tests revealed significant verbal and nonverbal memory improvements from pre-intervention to 6 months, but not to 12 months follow-up assessment in the CT group. No significant predictors were found for predicting memory improvement after CT.

CONCLUSIONS

This study provides Class 1 evidence that multidomain CT enhances memory functioning in PD-MCI after 6 months but not after 12 months, whereas executive functioning did not change in the long-term.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register (ID: DRKS00010186), 21.3.2016 (The study registration is outlined as retrospective due to an administrative delay. The first patient was enrolled three months after the registration process was started. A formal confirmation of this process from the German Clinical Trials Register can be obtained from the authors.).

Enhancement of Executive Functions but Not Memory by Multidomain Group Cognitive Training in Patients with Parkinson's Disease and Mild Cognitive Impairment: A Multicenter Randomized Controlled Trial

Background

Meta-analyses have demonstrated cognitive training (CT) benefits in Parkinson's disease (PD) patients. However, the patients' cognitive status has only rarely been based on established criteria. Also, prediction analyses of CT success have only sparsely been conducted.

Objective

To determine CT effects in PD patients with mild cognitive impairment (PD-MCI) on cognitive and noncognitive outcomes compared to an active control group (CG) and to analyze CT success predictors.

Methods

Sixty-four PD-MCI patients (age: 67.61 ± 7.70; UPDRS-III: 26.58 ± 13.54; MoCA: 24.47 ± 2.78) were randomized to either a CT group or a low-intensity physical activity CG for six weeks (twice weekly, 90 minutes). Outcomes were assessed before and after training. MANOVAs with follow-up ANOVAs and multiple regression analyses were computed.

Results

Both interventions were highly feasible (participation, motivation, and evaluation); the overall dropout rate was 4.7%. Time × group interaction effects favoring CT were observed for phonemic fluency as a specific executive test (p=0.018, η_p²=0.092) and a statistical trend for overall executive functions (p=0.095, η_p²=0.132). A statistical trend for a time × group interaction effect favoring CG was shown for the digit span backward as a working memory test (p=0.098, η_p²=0.043). Regression analyses revealed cognitive baseline levels, education, levodopa equivalent daily dose, motor scores, and ApoE status as significant predictors for CT success.

Conclusions

CT is a safe and feasible therapy option in PD-MCI, yielding executive functions improvement. Data indicate that vulnerable individuals may show the largest cognitive gains. Longitudinal studies are required to determine whether CT may also attenuate cognitive decline in the long term. This trial is registered with DRKS00010186.

Chronic stress induced depressive-like behaviors in a classical murine model of Parkinson's disease

Depression occurs in around 40 % of patients with Parkinson's disease (PD) and contributes to severe disability and a poor quality of life. The underlying mechanisms and pathophysiology of depression in PD (PDD) remain obscure, due to a lack of stable animal models of PDD. In this study, we established a PDD model by inducing exposure to chronic mild (CMS) and strong stress (CSS) using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in PD mice. We detected changes in motor and non-motor symptoms, brain structure, neurotransmitters, levels of 5-HT related genes and inflammation. CMS exposed PD (PDMS) mice exhibited obviously decreased levels of neuromuscular strength and enhanced levels of inflammation, compared with that of control mice. CSS exposed MPTP (PDSS) mice exhibited the highest level of motor impairment and depression states along with the highest levels of inflammation enhancement and a decrease in the expression levels of 5-hydroxytryptamine (5-HT) related genes in all groups. Our results suggested that CSS can successfully induce stable depression like symptoms in sub-chronic MPTP PD mice and appears to be a valuable tool for investigating PDD. Furthermore, it was found that 5-HT system dysfunction may contribute to depression like symptoms in PD.

Prevalence of Depression and Anxiety in Parkinson Disease and Impact on Quality of Life: A Community-Based Study in Spain

BACKGROUND

Identifying neuropsychiatric disorders is essential for prompt treatment to reduce morbidity. Among these disorders, anxiety and depression have been frequently associated with Parkinson disease (PD), particularly among elderly population.

OBJECTIVE

The objective of this study is to determine the prevalence of anxiety and depression in a series of community-based PD cases in Spain, their relationship with different clinical and sociodemographic characteristics, and quality of life.

METHODS

This is an observational, descriptive, survey-based study with 95 community-based patients with PD diagnosis at different disease stages. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and the Beck Depression Inventory II, respectively. Quality of life was assessed using the Parkinson's Disease Questionnaire 39.

RESULTS

The prevalence of depression and anxiety was 32.63% and 68.42%, respectively. Concomitant depression and anxiety were observed in 31.58% of patients. Patients with longer than 10 years' PD duration had an increased risk of depression. We found a relationship between the presence of anxiety, depression, and the patient's quality of life.

CONCLUSIONS

Depression is present in one-third and anxiety in two-thirds of PD cases in community settings in Spain. Depression and anxiety have a very negative impact on quality of life in PD. Both anxiety and depression are independent from sociodemographic characteristics, patient's comorbidities, or antiparkinsonian treatments; presenting as intrinsic symptoms in PD.

Current and Desired Quality of Life in People with Parkinson's Disease: the Calman Gap Increases with Depression

Hopes and expectations often differ from current experiences. This so-called Calman gap influences quality of life (QoL). We investigated this gap in 77 elderly patients with Parkinson's disease (PD), 25 patients with epilepsy, and 39 age-matched healthy older adults using a novel QoL questionnaire, where current and desired states were marked on a visual analogue scale. We studied the relationships between (1) epidemiological factors, (2) current and desired QoL, as well as the difference between the latter two. Current QoL was determined by depression, education level, living situation, and condition (PD, epilepsy, control). In contrast, desired QoL was essentially determined by the presence of a disease (condition), education level, and age, but not by depression. In particular, the presence of PD, lower education level, and higher age was correlated with lower expectations. In patients with PD, the gap between the current and desired QoL was largest for pain and physical functions. Accordingly, the significant effects of depression were observed only for mean current QoL, but not for desired QoL. Therefore, depression mainly influences current but not desired QoL in patients with PD. Depressed patients with PD had significantly worse QoL than PD patients without depression, although they both had almost the same desired QoL and hence, depressed PD patients had a larger Calman gap between current and desired QoL.

Association between malnutrition, clinical parameters and health-related quality of life in elderly hospitalized patients with Parkinson's disease: A cross-sectional study

Objective

This study aimed to explore the association between malnutrition, clinical parameters, and health-related quality of life in elderly hospitalized patients with Parkinson’s disease (PD).

Methods

Cross-sectional study of 92 hospitalized elderly patients with PD (mean age 73.6 ± 6.7 years) without dementia. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Motor impairment and non-motor symptoms burden (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Non-Motor Symptoms Questionnaire, and Hoehn & Yahr staging), depression (Becks Depression Inventory-II), and health-related quality of life (PD quality of life Questionnaire-39) were assessed.

Results

Every second patient was malnourished or at risk of malnutrition. In the multivariable analysis, male gender, longer disease duration, higher Hoehn & Yahr and depression were associated with total MNA score. Besides non-motor symptoms and motor impairment, malnutrition was an independent predictor of poor health-related quality of life. In the multivariate analysis, malnutrition had a statistically significant effect on emotional well-being, mobility, social support, stigmatization, and cognition. The strongest association was found between malnutrition and emotional well-being.

Conclusion

Elderly male persons with longer PD duration and higher disease stages are more likely to be malnourished or at risk for malnutrition. Malnutrition was mainly associated with poor emotional well-being, suggesting that treatment of depression and anxiety beside diet and physical activity can help improving nutrition status in these subjects. The MNA should not be used independent of other measures of cognition and depression in people with advanced PD.

Impacto dos sintomas de ansiedade na qualidade de vida na doença de Parkinson: uma revisão sistemática

RESUMO Objetivo: Revisar estudos relacionados ao impacto da ansiedade na qualidade de vida em pacientes com doença de Parkinson. Métodos: Trata-se de uma revisão sistemática realizada nos bancos de dados PubMed, Scopus, Web of Science e PsycINFO, com os descritores: “anxiety”, “Parkinson's disease” e “quality of life”. Foram selecionados 20 artigos publicados em inglês e sem limite de tempo. Resultado: A maioria dos estudos demonstrou correlação direta entre ansiedade e qualidade de vida em indivíduos com doença de Parkinson. Apenas dois estudos não encontraram essa associação. A presença de sintomas de ansiedade parece estar relacionada com a gravidade dos sintomas motores, sexo feminino e idade mais jovem, levando a um impacto maior na qualidade de vida. Conclusão: Os artigos analisados mostraram que a ansiedade tem impacto negativo sobre a qualidade de vida de indivíduos com doença de Parkinson.

Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson's Disease

Background

Sleep dysfunctions impose a large burden on quality of life for patients with Parkinson’s disease (PD). Several studies on PD reported potential therapeutic effects of transcranial direct current stimulation (tDCS) on motor and non-motor functions, but not related to sleep quality. Therefore, the present study examined sleep quality, depression perception, and quality of life changes after bilateral anodal tDCS in patients with PD.

Material/Methods

Twenty-one patients (n=21) with PD underwent 10 sessions (20 min each, 5 per week) of bilateral anodal tDCS stimulation applied simultaneously over the left and right prefrontal and motor areas. The Pittsburgh Sleep Quality Index (PSQI) total score and sub-scores, Geriatric Depression Scale (GDS), and Health-related quality of life questionnaire (SF-36) were measured pre/post bilateral tDCS anodal stimulation.

Results

PSQI total score (P=0.045), sleep latency sub-score (P=0.02), and GDS total score (P=0.016) significantly decreased, and physical and mental components scores of SF-36 (P=0.018 and P=0.001, respectively) significantly increased after bilateral anodal tDCS stimulation. The GDS score decrease was directly correlated with decrease in PSQI total score (P=0.01), sleep latency sub-score (P=0.002), and sleep disturbance sub-score (P=0.003). In addition, the GDS score decrease was inversely correlated with increasing mental component score of SF-36 (P=0.001), which was directly correlated with an increase in sleep efficiency sub-score (P=0.03) and the physical component score of SF-36 (P=0.0001).

Conclusions

Bilateral anodal tDCS stimulation showed potential therapeutic effects in patients with PD in terms of sleep quality and depression level improvement, which together improved mental and physical quality of life in patients with PD.