The 39-Item Parkinson's Disease Questionnaire (PDQ-39): Is it a Unidimensional Construct?

The Development of a Quantitative Disability Assessment Tool in Patients with Idiopathic Parkinson's Disease

Background/Objectives: The objective of this study was to develop a novel quantitative disability assessment tool for patients with idiopathic Parkinson's disease (IPD). Methods: A total of 47 patients with IPD were recruited from two hospitals. A specialist in Rehabilitation Medicine utilized the modified Schwab and England Activities of Daily Living Scale (mSEADL) as a reference, conducting a comprehensive medical chart review and an in-depth interview. The novel-developed disability measurement was calculated as ((mSEADL during the on-state) × (time of on-state)) + ((mSEADL during the off-state) × (time of off-state))/(waking time). Additionally, the degree of disability was assessed using the Korean version of the Modified Barthel Index during the on-state. Results: Twenty-four participants (51.1%) exhibited the off-state during waking hours. In patients exhibiting an off-state, the mSEADL score was significantly lower during the off-state than during the on-state (p < 0.05). The novel-developed disability measurement demonstrated a higher correlation coefficient with the reference mSEADL (0.960) than with the K-MBI (0.808), with statistical significance (p < 0.05). Conclusions: The results demonstrated that larger IPD patients exhibited an on-off phenomenon with greater dependency during the off-state. Therefore, the on-off phenomenon should be considered when evaluating disability in patients with IPD, with methods such as the novel-developed disability measurement tool in this study.

Mental Fatigue in Parkinson's Disease: Systematic Review and Evaluation of Self-Reported Fatigue Scales

Fatigue is a common and debilitating symptom affecting a significant proportion of individuals with Parkinson's disease (PD), often overshadowing even motor symptoms in its impact on quality of life. The accurate definition and assessment of mental fatigue in PD is crucial for both clinical management and research, yet it remains a challenge due to the subjective nature of the symptom and the heterogeneity of assessment scales. This systematic review examined the existing measures of self-reported mental fatigue in PD by searching through PubMed, Embase, and Scopus databases using specific keywords from 2001 to 2024. Out of the 4182 articles found, 40 met the inclusion criteria, and 14 different scales were identified to measure self-reported fatigue in PD patients. However, most of these scales lack a consistent definition of fatigue, indicating a need for validated combinations of unidimensional and multidimensional scales to accurately assess mental fatigue in PD. The review found that it is best to use Fatigue Severity Inventory (FSI) and Multidimensional Fatigue Inventory (MdFI) to screen for severity of PD mental fatigue and Neuro-QoL Item Bank v1.0 (Neuro-QoL) to evaluate its impact on patients' lives. Furthermore, multidimensional scales Parkinson's Disease Questionnaire (PDQ) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) are frequently coupled with Fatigue Severity Scale (FSS), Parkinson's Fatigue Scale (PFS), and/or Modified Fatigue Impact Scale (MFIS) due to their short length and holistic coverage of variables in patients' quality of life. Combining fatigue scales can be used for screening and scoring methods. The review also recommends validating fatigue scales translation and combining them with biomarkers to improve the accuracy and effectiveness of fatigue assessment in clinical practice. Future research should analyze correlations between fatigue scales, expand language types, and explore the link between fatigue scales and the pathophysiological basis of PD. Our findings underscore the need for a standardized approach to the measurement of fatigue in PD and set the stage for future research to consolidate assessment tools that can reliably guide treatment strategies and improve patient outcomes.

Comparison of the quality of Nurse-Led palliative care with standard medical care during six months in 405 patients with Parkinson's disease and burdens of their Caregivers: A retrospective study at a single center in China

BACKGROUND

Palliative care is mainly used to improve the quality of life of patients with chronic diseases by addressing their medical conditions and psychological problems. End-stage Parkinson's disease (PD) is also a progressive disease like cancer and could be managed by palliative care. This study was conducted at a single center in China and aimed to compare the quality of nurse-led palliative care with standard medical care during six months in 405 patients with Parkinson's disease (PPD) and their caregivers using the Chinese version of the 39-item Parkinson's Disease Questionnaire (PDQ-39) and the Chinese Zarit Burden Interview (ZBI) scale.

METHODS

PPD (stage 2-5) received nurse-led palliative care (NP cohort, 103 patients; 103 caregivers) or neurologist-led standard care (NS cohort, 134 patients; 134 caregivers), or primary care practitioner-led usual care (PS cohort, 168 patients; 168 caregivers) for six months.

RESULTS

Before the health professional-led care (BN), the PDQ-39 score of PPD was 68 (71-64) and their caregivers had 54.86 ± 7.64 a ZBI scale. After 6-months of the health professional-led care (AN), the PDQ-39 score of PPD and a ZBI scale of their caregivers decreased for the NP cohort as compared to those of BN condition and those of patients in the NS and PS cohorts at AN condition (p < 0.001 for all).

CONCLUSIONS

The quality of life of PPD must be improved and the burden on their caregivers must be relieved. Nurse-led palliative care successfully improved the quality of life of PPD and reduced their caregiver burden.

Neuroinflammation following anti-parkinsonian drugs in early Parkinson's disease: a longitudinal PET study

The progression of neuroinflammation after anti-parkinsonian therapy on the Parkinson's disease (PD) brain and in vivo evidence of the therapy purporting neuroprotection remain unclear. To elucidate this, we examined changes in microglial activation, nigrostriatal degeneration, and clinical symptoms longitudinally after dopamine replacement therapy in early, optimally-controlled PD patients with and without zonisamide treatment using positron emission tomography (PET). We enrolled sixteen PD patients (Hoehn and Yahr stage 1-2), and age-matched normal subjects. PD patients were randomly divided into two groups: one (zonisamide+) that did and one (zonisamide-) that did not undergo zonisamide therapy. Annual changes in neuroinflammation ([11C]DPA713 PET), dopamine transporter availability ([11C]CFT PET) and clinical severity were examined. Voxelwise differentiations in the binding of [11C]DPA713 (BPND) and [11C]CFT (SUVR) were compared with normal data and between the zonisamide+ and zonisamide- PD groups. The cerebral [11C]DPA713 BPND increased with time predominantly over the parieto-occipital region in PD patients. Comparison of the zonisamide+ group with the zonisamide- group showed lower levels in the cerebral [11C]DPA713 BPND in the zonisamide+ group. While the striatal [11C]CFT SUVR decreased longitudinally, the [11C]CFT SUVR in the nucleus accumbens showed a higher binding in the zonisamide+ group. A significant annual increase in attention score were found in the zonisamide+ group. The current results indicate neuroinflammation proceeds to the whole brain even after anti-parkinsonian therapy, but zonisamide coadministration might have the potential to ameliorate proinflammatory responses, exerting a neuroprotective effect in more damaged nigrostriatal regions with enhanced attention in PD.

Impact of Safinamide on Patient-Reported Outcomes in Parkinson's Disease

Introduction

Parkinson's disease (PD) is a chronic and progressive neurodegenerative condition due to the degeneration of nigral dopaminergic cells. Both motor and non-motor symptoms (NMS) of PD produce a marked impairment in PD patients' quality of life (QoL), but contrary to motor features, NMS do not improve with dopamine replacement. Novel therapeutic interventions for PD have successfully controlled most motor manifestations of PD, but the management of NMS is still challenging. Since NMS have a negative impact on the QoL of PD patients, researchers are currently looking for drugs that can modulate the activity of neurotransmitter systems other than dopamine in the hope that can alleviate NMS in PD. Among the recently approved drugs for patients experiencing fluctuations in motor symptoms, safinamide stands out as an effective add-on therapy to levodopa. Safinamide is a monoamine oxidase type-B inhibitor (MAOB-I), with proven efficacy in reducing motor fluctuations. Its distinctive mechanism of action impacts dopaminergic pathways via MAOB inhibition and glutamatergic pathways by blocking sodium and calcium channels. Findings from Phase III clinical trials, meta-analysis, post-hoc analysis, and real-life experiences indicate that safinamide benefits motor symptoms such as tremor, bradykinesia, rigidity, and gait. Additionally, it shows promise for improving NMS like fatigue, pain, mood, and sleep disturbances in patients with PD.

Areas Covered

In this article, the authors explore the impact of safinamide on patient-reported outcomes in PD. A thorough search was conducted on PubMed focusing on studies published between 2018 and 2023 in English. The inclusion criteria encompassed clinical trials, randomized controlled trials, systematic reviews, meta-analyses, and reviews. The search strategy revolved around the implementation of MeSH terms related to safinamide and its impact on the quality of life in PD.

Conclusion

Our data strongly support the improving effect on QoL, reducing the disabling NMS reported in patients with PD.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

INTRODUCTION

Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored.

OBJECTIVE

We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints.

METHODS

We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted.

RESULTS

PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores.

CONCLUSIONS

HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

The Impact of Nonmotor Symptoms on Health-Related Quality of Life in Parkinson’s Disease: A Network Analysis Approach

Nonmotor symptoms negatively affect health-related quality of life (HRQoL) in patients with Parkinson’s disease (PD). However, it is unknown which nonmotor symptoms are most commonly associated with HRQoL. Considering the complex interacting network of various nonmotor symptoms and HRQoL, this study aimed to reveal the network structure, explained HRQoL variance, and identify the nonmotor symptoms that primarily affect HRQoL. We included 689 patients with PD from the Cohort of Patients with Parkinson’s Disease in Spain (COPPADIS) study who were rated on the Nonmotor Symptoms Scale in Parkinson’s disease (NMSS) and the Parkinson´s Disease Questionnaire 39 (PDQ-39) at baseline. Network analyses were performed for the 30 items of the NMSS and both the PDQ-39 summary index and eight subscales. The nodewise predictability, edge weights, strength centrality, and bridge strength were determined. In PD, nonmotor symptoms are closely associated with the mobility, emotional well-being, cognition, and bodily discomfort subscales of the PDQ-39. The most influential nonmotor symptoms were found to be fatigue, feeling sad, hyperhidrosis, impaired concentration, and daytime sleepiness. Further research is needed to confirm whether influencing these non-motor symptoms can improve HRQoL.

Gender differences in motor and non-motor symptoms in individuals with mild-moderate Parkinson's disease

BACKGROUND

Parkinson's disease (PD) affects both men and women with documented gender differences across functional domains, with findings varying among reports. Knowledge regarding gender differences in PD for different geographic locations is important for further understanding of the disease and for developing personalized gender-specific PD assessment tools and therapies.

OBJECTIVE

This study aimed to examine gender differences in PD-related motor, motor-cognitive, cognitive, and psychosocial function in people with PD from the southern United States (US).

METHODS

199 (127 men and 72 women; M age: 69.08±8.94) individuals with mild-moderate idiopathic PD (Hoehn &Yahr (H&Y) Median = 2, stages I-III) from a large metro area in the southeastern US were included in this retrospective, cross-sectional study. Motor, motor-cognitive, cognitive, and psychosocial data were obtained using standardized and validated clinical tests. Univariate analyses were performed, adjusting for age and housing type.

RESULTS

After adjustment for age, housing, PD duration and fall rate, men exhibited statistically significantly greater motor (Movement Disorders Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS)-II) and non-motor (MDS-UPDRS-I) impact of PD, and more severe motor signs (MDS-UPDRS-III). Men exhibited worse PD-specific health-related quality of life related to mobility, activities of daily living, emotional well-being, cognitive impairment, communication, and more depressive symptoms. Men performed worse on a subtraction working memory task. Women had slower fast gait speed.

CONCLUSIONS

In the southeastern United States, men may experience worse PD-related quality of life and more depression than women. Many non-motor and motor variables that are not PD specific show no differences between genders in this cohort. These findings can contribute to the development of gender-sensitive assessment and rehabilitation policies and protocols for people with PD.

Measuring quality of life with the Parkinson’s Disease Questionnaire-39 in people with cognitive impairment

Introduction

Quality of life (QoL) is a key outcome in healthcare. However, whether cognitively impaired people with Parkinson’s disease (PD) can reliably self-report QoL is unclear, and patients are often excluded from studies based on cognition test scores. The aim of this analysis was to assess the validity of the Parkinson’s Disease Questionnaire-39 (PDQ-39) in PD patients with and without cognitive impairment.

Methods

In this study, 221 individuals with PD completed the PDQ-39, Montreal Cognitive Assessment (MOCA), and Beck’s Depression Inventory (BDI-II). The PDQ-39’s internal consistency, convergent validity with BDI-II, and floor and ceiling effects were analyzed for patients with and without cognitive impairment.

Results

Ninety-four patients showed cognitive impairment (MOCA <21), whereas 127 patients had mild/no impairment. Both MOCA groups differed significantly with regards to PD severity. The PDQ-39’s internal consistency was adequate for most subdomains in both MOCA groups, but floor effects were present for the subdomains Stigmatization, Social Support and Communication, regardless of impairment. For some subdomains, the PDQ-39’s convergent validity with the BDI receded in the low MOCA group but remained significant for most PDQ-39 domains, especially for the PDQ total score (r = .386, p < .001) and for the subdomain emotional well-being (r = .446, p < .001).

Conclusion

The PDQ-39 can be used to measure QoL in cognitively impaired PD patients, thus test scores indicating cognitive impairment alone should not lead to exclusion of PD patients from clinical studies. Although the correlation between BDI-II and PDQ-39 shrinks for some subdomains in cognitively impairment patients, this finding may be explained by the difference in PD severity, as factors influencing QoL may shift with increasing age and PD symptoms.

Evaluation and validation of a patient-reported quality-of-life questionnaire for Parkinson's disease

Background

Parkinson’s disease (PD) is a chronic, progressive illness with a profound impact on the health-related quality of life (HRQoL). Disease-specific patient-reported HRQoL measures, such as PDQ-39 and its short version PDQ-8, are increasingly used in clinical practice to address the consequences of PD on everyday life. Due to limitations in the content, especially in non-motor symptoms and sleep disturbances of PDQ-8, PDQoL7, a 7-item, short-term, self-reported, PD-specific HRQoL questionnaire was developed.

Methods

A representative sample of 60 adults with idiopathic PD completed the PDQoL7 questionnaire and the existing validated PDQ-8 and EQ-5D-5L questionnaires (all in Greek).

Results

PDQoL7 summary index strongly correlated with PDQ-8 (r_s = 0.833, P < 0.001) and EQ-5D-5L (r_s =  − 0.852, P < 0.001). The correlation between PDQoL7 and EQ-5D-5L was statistically significantly stronger compared to PDQ-8 and EQ-5D-5L (r_s =  − 0.852 vs rs =  − 0.789 respectively, P < 0.001). The internal consistency of PDQoL7 was not affected by item deletion (positive item to total correlations: 0.29–0.63). No redundant items (with inter-item correlation coefficients greater than 0.80) were identified. Cronbach’s α for PDQoL7 was comparable to PDQ-8 (0.804 versus 0.799 respectively). As PDQoL7 had three-dimensional structure, omega coefficient analysis confirmed its reliability (omega total: 0.88; omega hierarchical: 0.58).

Conclusions

PDQoL7 is an acceptable, easy to use, valid and reliable tool for the determination of HRQoL in PD patients that is potentially more comprehensive than PDQ-8 based on the available evidence. PDQoL7 could allow for a more thorough evaluation of the impact of PD and contribute to guiding healthcare decisions. This will be confirmed in subsequent analysis on larger patient cohorts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00427-0.

Assessment of Non-Motor Symptoms of Parkinson's Disease and Their Impact on the Quality of Life: An Observatiobnal Study

Background

During the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem disorder with diverse non-motor symptoms (NMS).

Aims

The present study aimed to evaluate and characterize the NMS and study their impact on quality of life (QoL) in a PD patient cohort.

Material and Methods

This was a cross-sectional study where 92 PD patients fulfilling the UK Parkinson's disease society brain bank criteria were enrolled from a movement disorder clinic. All patients were evaluated using unified Parkinson's disease rating scale, non-motor symptoms scale (NMSS) for the non-motor symptoms, and Parkinson's disease questionnaire-39 (PDQ-39) for the QoL. The impact of NMS on QoL was assessed statistically.

Results

A total of 92 patients were enrolled with a mean age of 55.40 ± 7.37 years, mean age of onset of disease 51.62 ± 6.38 years, and mean disease duration of 3.78 ± 1.54 years. Type of disease was akinetic rigid variant in 29.3% (n = 27), tremor predominant type in 36.9%(n = 34), and mixed type in 33.6% (n = 31). Mean Hoehn and Yahr stage was 2.12 ± 0.54. In the NMSS, most common symptom was sleep and fatigue (83%), followed by urinary tract symptoms (63%), mood and cognition (51%), cardiovascular symptoms and falls (43%), gastrointestinal tract symptoms (38%), and sexual function (33%). Univariate analyses showed that all NMS domains had a significant correlation with PDQ-39 with P < 001.

Conclusion

Our study shows that NMS in PDare fairly common and significantly impact the QoL.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

INTRODUCTION

Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored.

OBJECTIVE

We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints.

METHODS

We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted.

RESULTS

PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores.

CONCLUSIONS

HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

The Evolving Role of Induced Pluripotent Stem Cells and Cerebral Organoids in Treating and Modeling Neurosurgical Diseases

Over the past decade, the use of induced pluripotent stem cells (IPSCs), as both direct therapeutics and building blocks for 3D in vitro models, has exhibited exciting potential in both helping to elucidate pathogenic mechanisms and treating diseases relevant to neurosurgery. Transplantation of IPSCs is being studied in neurological injuries and diseases, such as spinal cord injury and Parkinson's disease, whose clinical manifestations stem from underlying neuronal and/or axonal degeneration. Both animal models and clinical trials have shown that IPSCs have the ability to regenerate damaged neural tissue. Such evidence makes IPSCs a potentially promising therapeutic modality for patients who suffer from these neurological injuries/diseases. In addition, the cerebral organoid, a 3D assembly of IPSC aggregates that develops heterogeneous brain regions, has become the first in vitro model to closely recapitulate the complexity of the brain extracellular matrix, a 3-dimensional network of molecules that structurally and biochemically support neighboring cells. Cerebral organoids have become an exciting prospect for modeling and testing drug susceptibility of brain tumors, such as glioblastoma and metastatic brain cancer. As patient-derived organoid models are becoming more faithful to the brain, they are becoming an increasingly accurate substitute for patient clinical trials; such patient-less trials would protect the patient from potentially ineffective drugs, and speed up trial results and optimize cost. In this review, we aim to describe the role of IPSCs and cerebral organoids in treating and modeling diseases that are relevant to neurosurgery.

Associated Factors on Quality of Life in Patients with Parkinson's Disease

The objective of this study is to investigate the clinical and demographic factors that influence the quality of life in patients with Parkinson's disease (PD). This is a cross-sectional observational study of 47 patients in 2 hospitals with PD. All participants were asked to complete a disease-specific quality of life (QoL) questionnaire (PDQ-39). We gave a structured questionnaire interview and did a complete neurological examination on the same day. Additionally, we measured depression and dependency with the Geriatric Depression Scale-Short Form (GDS-SF) and the Korean version of the Modified Barthel Index (K-MBI). The PDQ-39 had a significant relationship with each motor part of the Unified Parkinson's Disease Rating Scale, the Korean Mini-Mental State Examination (K-MMSE), the GDS-SF, and the K-MBI (p < 0.05). The factors that independently contributed to the PDQ-39 scores were K-MMSE, GDS-SF, and K-MBI (p < 0.05). Factors having the greatest influence on the PDQ-39 were K-MBI, K-MMSE, and GDS-SF in that order. In addition, the mobility item in the K-MBI was independently a significant relating factor in the PDQ-39 (p < 0.05). These results demonstrated that dependency, especially with the mobility issue, was the greatest influence on the QoL in patients with PD.

Prevalence and Characteristics of Polyneuropathy in Atypical Parkinsonian Syndromes: An Explorative Study

(1) Background: Peripheral nerve involvement is increasingly recognized in Parkinson's disease (PD). Although non-motor symptoms and postural instability are early features of atypical parkinsonian syndromes (APS), peripheral neuropathies in APS have not been addressed in detail thus far. Therefore, the aim of this study was to investigate the prevalence and characteristics of polyneuropathies (PNP) in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), as representative syndromes of APS. (2) Methods: In total, 8 MSA and 6 PSP patients were comprehensively analyzed regarding subjective, clinical (motor and non-motor) and paraclinical PNP features using nerve conduction studies and high resolution nerve ultrasounds (HRUS). (3) Results: A total of 87.5% of MSA and 66.7% of PSP patients complained of at least one neuropathic symptom, with electrophysiological confirmation of PNP in 50.0% of both, MSA and PSP patients. PNP symptom severity in PSP and motor nerve amplitude in MSA were associated with compromised motor function. Morphologic nerve examination by HRUS showed few alterations according to the axonal type of PNP. (4) Conclusions: The overall high PNP symptom burden may be partially credited to the significant prevalence of electrophysiologically diagnosed PNP, and impact motor aspects of APS. The findings of this exploratory study reinforce further investigations on a larger scale, in order to elucidate peripheral nerve involvement and the underlying pathophysiological mechanisms of APS.

Neural networks associated with quality of life in patients with Parkinson's disease

INTRODUCTION

The neural underpinnings of health-related quality of life in Parkinson's disease remain unclear. This study was conducted to unravel which motor and non-motor symptoms in Parkinson's disease influence health-related quality of life and reveal neural networks most likely linked to it.

METHODS

Comprehensive clinical assessments were conducted for 247 Parkinson's disease patients and image analyses were performed for 181 patients. Clinical scores commonly used to assess various symptoms related to health-related quality of life were investigated. Factor and resting-state functional magnetic resonance imaging analyses were reviewed to reveal health-related quality of life-associated brain networks.

RESULTS

The Spearman's rank correlation coefficient for the Parkinson's disease Questionnaire-39 summary index was high in the Activities-specific Balance Confidence Scale, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part 2, Freezing of Gait Questionnaire, and Self-reported Autonomic Symptoms in Parkinson's disease. Multiple regression and Random Forest regression analyses indicated that health-related quality of life-associated factors were Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part 1, Depression Rating Scales, and the above-mentioned scales. The resting-state functional magnetic resonance imaging analysis revealed decreased functional connectivity between the anterior cingulate cortex and right temporo-parietal junction as health-related quality of life worsened.

CONCLUSION

Fear of falling, daily living activities, gait freezing, and autonomic dysfunction have notable effects on health-related quality of life in Parkinson's disease. Brain networks consisting of the anterior cingulate cortex and temporo-parietal junction may be associated with the emotion-related and social factors of health-related quality of life in Parkinson's disease.

Periodized Resistance Training With and Without Functional Training Improves Functional Capacity, Balance, and Strength in Parkinson's Disease

ABSTRACT

Strand, KL, Cherup, NP, Totillo, MC, Castillo, DC, Gabor, NJ, and Signorile, JF. Periodized resistance training with and without functional training improves functional capacity, balance, and strength in Parkinson's disease. J Strength Cond Res 35(6): 1611-1619, 2021-Periodized progressive resistance training (PRT) is a common method used to improve strength in persons with Parkinson's disease (PD). Many researchers advocate the addition of functional training to optimize translation to activities of daily living; however, machine-based PRT, using both force and velocity training components, may elicit similar benefits. Thirty-five persons with PD (Hoehn and Yahr I-III) were randomized into a strength, power, and hypertrophy (SPH; n = 17) or strength, power, and functional (SP + Func; n = 18) group, training 3 times weekly for 12 weeks. Both groups performed machine-based strength and power training on days 1 and 2 each week, respectively; whereas, on day 3, SPH group performed machine-based hypertrophy training and SP + Func group performed functional training. Functional performance was tested using the timed up and go, 30-second sit-to-stand (30-s STS), gallon-jug shelf-transfer, and seated medicine ball throw (SMBT) tests. Balance (Mini-BESTest), strength, motor symptoms (UPDRS-III), quality of life, and freezing of gait (FOG) were also assessed. Repeated measures analysis of variance revealed a main effect for time (p ≤ 0.05) with significant improvements for the sample in the 30-s STS (p = 0.002), SMBT (p = 0.003), Mini-BESTest (p < 0.001), upper-body strength (p = 0.002) and lower-body strength (p < 0.001). A significant group × time interaction was seen for FOG, with SP + Func alone showing improvement (p = 0.04). Furthermore, the SPH group produced a clinically important difference for the UPDRS-III (mean difference = 4.39, p = 0.18). We conclude that both exercise strategies can be equally effective at improving functional capacity, balance, and muscular strength in individuals with PD. In addition, FOG and motor symptoms may be targeted through SP + Func and SPH, respectively. The results provide options for individualized exercise prescriptions.

Effects of botulinum toxin type a on mood and cognitive function in patients with parkinson's disease and depression

OBJECTIVE

To analyze the effects of botulinum toxin type A (BtA) in the treatment of patients with Parkinson's disease and depression.

METHOD

89 patients with Parkinson's disease and depression were assigned into control group and observation group by random number table method, of which 44 patients in the control group were treated with sertraline and 45 patients in the observation group were treated with BtA. The two groups were compared in terms of mood, cognitive function and adverse reactions.

RESULTS

The Hamilton Depression Self-Assessment Scale (HAMD) scores of the two groups following treatment were lower than those before treatment while the Mini-Mental State Examination (MMSE) scores were higher than those before treatment (P<0.05). The incidence rate of adverse events was 11.11% in the observation group and 29.55% in the control group (P<0.05). The Pittsburgh sleep quality index (PSQI) scores and 39-item PD Questionnaire (PDQ-39) scores after 2 and 3 months of treatment and 2 months after completion of treatment were lower than those before treatment (P<0.05).

CONCLUSION

Patients with Parkinson's disease and depression receiving BtA treatment can gain treatment effects similar to those of the sertraline, with less adverse reactions.

Exergaming as Part of the Telerehabilitation Can Be Adequate to the Outpatient Training: Preliminary Findings of a Non-randomized Pilot Study in Parkinson's Disease

Parkinson's disease is a long-term and progressive degenerative disorder of the nervous system, affecting primarily motor coordination, noticeable as a tremor in one hand. Recent studies reported on positive outcomes of intensive physiotherapy of upper extremities. We built a telerehabilitation system with virtual pick and place tasks for small scale hand movements, and designed a pilot study to find whether such exergaming as a telerehabilitation service provides comparable outcomes as an outpatient exergaming service. A non-randomized pilot trial was designed. Hospital outpatients (28/40) with Parkinson's disease were recruited. Those meeting the inclusion criteria were divided into two groups; seven outpatients were assigned to the home (H) group and 21 outpatients to the hospital (URI) group. Both groups received 10 days of exergaming over the course of 2 weeks, each daily session lasting a maximum of 1 h. Primary outcomes were clinical tests; Box and Blocks Test (BBT), Jebsen Hand Function Test (JHFT), and Unified Parkinson's Disease Rating Scale (UPDRS part III) were carried out before and after the study. Secondary outcomes were hand kinematics and exergaming results; number of successfully moved objects and task time. Statistical analysis was carried out to find significant (p < 0.05) differences and Cohen's U3 was used to determine effect sizes. The differences between the groups in gender (p = 0.781), age (p = 0.192), and duration of the disease (p = 0.195) were tested with Bartlett's test and no statistical differences were found with an F test. Both groups demonstrated statistically significant improvements in clinical test UDPRS III (p = 0.006 and p = 0.011) and the hospital group also in BBT (p = 0.002) and JHFT (p = 0.015) and with UDPRS III and JHFT even in favor of the home group (χ² = 5.08, p = 0.024, χ² = 7.76, p = 0.005). Nevertheless, the exergaming results show significant improvement after training (U3 > 0.86). Exergaming has already been suggested as an effective approach in the planning of rehabilitation tasks for persons with Parkinson's disease. We have prepared a pilot study demonstrating that exergaming at home with telerehabilitation support may provide comparable clinical outcomes. The study shall be followed by a randomized study with higher statistical power to provide clinical evidence. Nevertheless, carrying out even part of the rehabilitation program at home is crucial for the development of future telerehabilition clinical services. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03175107.

Data imputation and compression for Parkinson's disease clinical questionnaires

Medical questionnaires are a valuable source of information but are often difficult to analyse due to both their size and the high possibility of them having missing values. This is a problematic issue in biomedical data science as it may complicate how individual questionnaire data is represented for statistical or machine learning analysis. In this paper, we propose a deeply-learnt residual autoencoder to simultaneously perform non-linear data imputation and dimensionality reduction. We present an extensive analysis of the dynamics of the performance of this autoencoder regarding the compression rate and the proportion of missing values. This method is evaluated on motor and non-motor clinical questionnaires of the Parkinson's Progression Markers Initiative (PPMI) database and consistently outperforms linear coupled imputation and reduction approaches.

Sex Disparities in the Self-Evaluation of Subthalamic Deep Brain Stimulation Effects on Mood and Personality in Parkinson's Disease Patients

Changes in personality are one of the main concerns Parkinson's disease (PD) patients raise when facing the decision to undergo neurosurgery for deep brain stimulation (DBS) of the subthalamic nucleus (STN). While clinical instruments for monitoring functional changes following DBS surgery are well-established in the daily therapeutic routine, personality issues are far less systematically encompassed. Moreover, while sex disparities in the outcomes of STN-DBS therapy have been reported, little is known about the different effects that DBS treatment may have on mood and personality traits in female and male patients. To this aim, the effect of STN-DBS on personality traits was assessed in 46 PD patients (12 women and 34 men) by means of the Freiburg Personality Inventory. The Becks Depression Inventory (BDI-I) and the Parkinson's Disease Questionnaire were used to evaluate patients' level of depression and quality of life (QoL). Patients completed the questionnaires a few days before, within the first year, and 2 years after surgery. The 12 personality traits defined by the FPI-R questionnaire did not change significantly after STN-DBS surgery (p = 0.198). Women declared higher depression scores through all study stages (p = 0.009), but also showed a stronger QoL amelioration after surgery than male patients (p = 0.022). The BDI-I scores of female patients clearly correlated with their levodopa equivalent daily dose (LEDD; r = 0.621, p = 0.008). Remarkably, in both male and female patients, higher pre-operative LEDDs were related to worse post-operative QoL scores (p = 0.034). These results mitigate the concerns about systematic personality changes due to STN-DBS treatment in PD patients and encourage an early DBS approach, before severe levodopa-induced sequelae may irreparably compromise the patients' QoL. In the future, more focus should lie on sex-related effects, since female patients seem to profit more than male patients from STN-DBS, in terms of reduced depressive symptoms associated with a reduction of the LEDD and amelioration of QoL. These aspects may help to redress the sex imbalance in PD patients treated with DBS, given that women are still strongly under-represented.

Parkinson's disease with early motor complications: predicting EQ-5D- 3L utilities from PDQ-39 data in the EARLYSTIM trial

Background

A utility value is a health-related quality of life metric (HRQoL) metric used in a cost-effectiveness analysis. While utilities as outcomes in the treatment of advanced Parkinson’s disease (PD) with deep brain stimulation (DBS) are available, they do not currently exist for PD with early motor complications. The objectives of this study were to predict utilities from observed disease-specific HRQoL data using two mapping algorithms, and investigate their performance in terms of longitudinal changes within and between treatment groups, and distribution by PD severity.

Methods

This is a post hoc analysis of data from the EARLYSTIM trial of DBS compared with best medical therapy (BMT) in PD patients with early motor complications We used two published algorithms comprising ordinal and multinomial regression models to map EQ-5D-3L utilities from observed PD-specific 39 item Questionnaire (PDQ-39) scores in EARLYSTIM. Utilities were calculated using the predicted functioning levels of EQ-5D-3L dimensions and the established EQ-5D-3L UK tariffs. Statistical analyses (analysis of variance, two-tailed Student’s t-test) were used to test the change from baseline within groups and difference in change from baseline between groups in utilities. Boxplots were developed to investigate the distribution of predicted utilities by PD severity, measured using the Hoehn and Yahr scale.

Results

The change from baseline in predicted mean utilities was statistically significant at all visits up to 24 months for the DBS group (p < 0.001) with both algorithms, and statistically significant at 12 months only (p = 0.04) for the BMT group with one algorithm. With both algorithms, the between-groups difference in change from baseline in predicted mean utilities favored DBS at all follow-up visits (p < 0.001). Based on the Hoehn and Yahr scale, predicted utilities deteriorated with increasing disease severity.

Conclusions

Among PD patients with early motor complications, utilities predicted by both mapping algorithms using PDQ-39 data demonstrated a statistically and clinically meaningful improvement with DBS compared with BMT. It was not possible to conclude if one algorithm was more responsive than other. In the absence of utilities collected directly from patients, mapping is an acceptable option permitting economic evaluations to be undertaken.

Parkinson's Disease Multimodal Complex Treatment improves motor symptoms, depression and quality of life

Parkinson's disease (PD) is the world's fastest growing neurological disorder disabling patients through a broad range of motor and non-motor symptoms. For the clinical management, a multidisciplinary approach has increasingly been shown to be beneficial. In Germany, inpatient Parkinson's Disease Multimodal Complex Treatment (PD-MCT) is a well-established and frequent approach, although data on its effectiveness are rare. We conducted a prospective real-world observational study in 47 subjects [age (M ± SD): 68.5 ± 9.0 years, disease duration: 8.5 ± 5.3 years, modified Hoehn and Yahr stage (median, IQR): 3, 2.5-3] aiming at evaluating the effectiveness of 14-day PD-MCT in terms of quality of life (Parkinson's Disease Questionnaire, EuroQol), motor [Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III], Timed Up and Go Test, Purdue Pegboard Test) and non-motor symptoms (revised Beck Depression Inventory). Six weeks after hospital discharge, a follow-up examination was performed. PD patients with a predominantly moderate disability level benefited from PD-MCT in terms of health-related quality of life, motor symptoms and non-motor symptoms (depression). Significant improvements were found for social support, emotional well-being and bodily discomfort domains of health-related quality of life. Sustainable improvement occurred for motor symptoms and the subjective evaluation of health state. We found a higher probability of motor response especially for patients with moderate motor impairment (MDS-UPDRS III ≥ 33). In conclusion, Parkinson's Disease Multimodal Complex Treatment improves motor symptoms, depression and quality of life. A more detailed selection of patients who will benefit best from this intervention should be examined in future studies.

Effects of Simulated Horseback Riding on Balance, Postural Sway, and Quality of Life in Older Adults With Parkinson's Disease

The purpose of this study was to determine changes in balance, postural sway, and quality of life after 6 wk of simulated horseback riding in adults diagnosed with Parkinson's disease. Eight older adults completed two 60-min riding sessions weekly for 6 wk. Variables of balance, postural sway, and quality of life were measured 6 wks before and within 1 wk before and after the intervention. Berg Balance Scale scores decreased from baseline to preintervention (48.36 ± 5.97 vs. 45.86 ± 6.42, p = .050) and increased from preintervention to postintervention (45.86 ± 6.42 vs. 50.00 ± 4.38, p = .002). Cognitive impairment, a dimension of quality of life, improved from baseline to postintervention (37.5 ± 20.5 vs. 21.5 ± 14.4, p = .007). Six weeks of simulated horseback riding may improve balance and cognitive impairment in older adults with Parkinson's disease.

Prevalence of sleep disorders in Parkinson's disease patients in two neurology referral hospitals in Ethiopia

BACKGROUND

Non motor symptoms (NMS) of Parkinson's disease (PD) are common and can be more disabling than motor symptoms. Sleep disorders can be seen in up to 98% of patients with Parkinson disease. Poor sleep quality has been associated with poverty and race, and yet there has been no prior report on sleep disorders in those with PD living in sub Saharan Africa. We wished to document the prevalence of sleep disorders in PD patients in Ethiopia.

METHODS

We conducted a cross-sectional point prevalence study from July 1 to October 30, 2015 of all patients attending the neurology outpatient department in Tikur Anbessa and Zewuditu Memorial Hospitals, Addis Ababa, Ethiopia. Demographic data, clinical history and physical examination findings were collected from participants using a structured questionnaire. We used the Parkinson's disease sleep scale version two (PDSS-2) and Epworth Sleepiness Scale (ESS) to assess the sleep symptoms.

RESULTS

Of the 155 patients surveyed, all patients reported some sleep problem. Over 43.9% of patients had a PDSS score > 18. The median score of ESS was 9 (IQR = 5-12), with 77/155 (49.7%) of the patients having possible or definite excessive daytime somnolence. A high EDSS score significantly associated with a Hoehn & Yahr score > 4 (p = 0.02).

CONCLUSIONS

In Ethiopian PD patients, the prevalence of those with severe sleep disorders is the highest reported to date. The prevalence of possible/definite EDS is amongst the highest in the world. Further investigation into whether poverty or race explains this finding is needed.

Existing and emerging applications for the neuromodulation of nerve activity through targeted delivery of electric stimuli

The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Already neuromodulation has proven successful in the treatment of a broad range of conditions from Parkinson's disease to chronic pain and urinary incontinence. Many of these approaches seek to exploit the activities of the autonomic nervous system, which influences organ function through the release of neurotransmitters and associated signalling cascades. This review will outline existing and emerging applications for each of these neuromodulation devices, proposed mechanisms of action and clinical studies evaluating both their safety and therapeutic efficacy.

Evaluating the content validity of generic preference-based measures for use in Parkinson's disease

BACKGROUND

Generic preference-based measures are used to assess the cost-utility of different interventions in Parkinson's disease (PD). However, the difficulty of using them in people with a particular health condition is that these measures may not encapsulate all of the domains that are impacted by the disease.

OBJECTIVE

To contribute evidence towards the content validity of generic preference-based measures in people with PD.

METHODS

Participants with PD were interviewed on a personalized measure of quality of life, the Patient Generated Index (PGI). The domains identified with the PGI were then categorized using the WHO's International Classification of Functioning, Disability and Health. The extent to which the generic measures (EQ-5D-5L, SF-6D, HUI II, and HUI III) included domains important to persons with PD was qualitatively evaluated.

RESULTS

The study included seventy-six participants with PD (mean age 69 years). Dexterity, the top domain nominated by participants, was only included in 1 out of 4 of the generic measures. Fatigue, another commonly reported problem, was not included in 3 out of 4 measures. Sleep, dyskinesia and bowel/bladder problems were not included in any of the measures.

CONCLUSION

Content validity is an essential step in the evaluation of whether a questionnaire truly measures the construct it purports to measure, in this case the construct being health related quality of life (HRQL). This study evaluated the content validity of the EQ-5D-5L, SF-6D, HUI II and HUI III in people with PD, and demonstrated that several important PD specific domains are missing from these measures.

Health-Related Quality of Life Subdomains in Patients with Parkinson's Disease: The Role of Gender

The most frequently used instrument to assess health-related quality of life (HrQoL) in Parkinson's disease (PD) is the Parkinson's Disease Questionnaire 39 (PDQ-39). However, both the dimensionality of the eight PDQ-39 subscales and their summary score recently faced criticism. Furthermore, data on disease-related and neuropsychological determinants and the role of gender on HrQoL in PD are inconclusive yet. Therefore, our aim was to reevaluate the PDQ-39 structure and to further explore determinants of HrQoL in PD. 245 PD patients (age: M = 69.64, SD = 8.43; 62.9% male; H&Y: Md = 3.00; cognitive assessment with PANDA: M = 24.82, SD = 3.57) from the baseline database of the Cologne Parkinson Network were used to reevaluate the dimensionality of the PDQ-39 with a principal component analysis (PCA). Multiple regression analyses were conducted to clarify general and domain-specific relationships between clinical, (neuro)psychological, and sociodemographic variables, gender in particular, and HrQoL. The PCA identified three HrQoL domains: physical-functioning, cognition, and socioemotional HrQoL. Depressive symptoms were identified as the most important determinant of HrQoL across all models. Disease-related HrQoL determinants (UPDRS-III, H&Y stage, and LEDD) were less strong and consistent HrQoL determinants than nonmotor symptoms. Analyses did not reveal a global gender effect; however, female gender was a negative predictor for physical-functioning and socioemotional HrQoL, whereas male gender was a negative predictor for cognition HrQoL. Our analyses suggest the consideration of a reevaluation of the PDQ-39. Only the full understanding of HrQoL, its determinants, and their interrelationships will allow the development of PD intervention strategies focusing on what matters the most for patients' HrQoL. Gender is one relevant variable that should be considered in this context.

Quantifying Motor Impairment in Movement Disorders

Until recently the assessment of many movement disorders has relied on clinical rating scales that despite careful design are inherently subjective and non-linear. This makes accurate and truly observer-independent quantification difficult and limits the use of sensitive parametric statistical methods. At last, devices capable of measuring neurological problems quantitatively are becoming readily available. Examples include the use of oculometers to measure eye movements and accelerometers to measure tremor. Many applications are being developed for use on smartphones. The benefits include not just more accurate disease quantification, but also consistency of data for longitudinal studies, accurate stratification of patients for entry into trials, and the possibility of automated data capture for remote follow-up. In this mini review, we will look at movement disorders with a particular focus on Parkinson's disease, describe some of the limitations of existing clinical evaluation tools, and illustrate the ways in which objective metrics have already been successful.

Non-Motor Symptoms of Parkinson's Disease and Their Impact on Quality of Life in a Cohort of Moroccan Patients

Background

Non-motor symptoms (NMSs) are a real burden in Parkinson’s disease (PD). They may appear in early pre-symptomatic stage as well as throughout the disease course. However, their relationship with the deterioration of the patient’s quality of life (QoL) is still under debate. This study aimed to investigate the prevalence of NMSs and their impact on the QoL in a cohort of Moroccan patients.

Methods

We carried out a cross-transactional study, where a total of 117 patients were submitted to a structured clinical interview and examination investigating motor and NMSs based on common and conventional scales. Motor symptoms were assessed by the UPDRS I–VI during ON condition. The NMSs were evaluated with common scales and their relationship with the QoL was investigated.

Results

The mean patient’s age was 60.77 ± 11.36 years old, and the median disease duration was 6 years [2.5–9.5]. Motor’s phenotype subtypes were the mixed form in 40.2% of patients, akinetic-rigid in 20.5% and a tremor-dominant form in 39.3%. The median Hoehn and Yahr staging was 2 [1–2.5]. Regarding NMSs, the most common were urinary dysfunctions (82.6%), sleep (80.6%), and gastrointestinal (80%) disorders. Other autonomic dysfunctions were also frequent: thermoregulatory dysfunctions 58.6%, cardiovascular troubles 50.9%, and sexual dysfunctions 47.9%. Depression was present in 47.9% and fatigue symptoms in 23.1%. The median score of SCOPA-AUT was 14 [7.75–21.80]. The median PD questionnaire 39-score index (PDQ39-SI) was 23.22% and the most affected dimension was “mobility.” Univariate and multivariate analyses showed that the SCOPA-AUT score impacted the QoL (p = 0.001), especially the gastrointestinal (p = 0.007), and cardiovascular (p = 0.049) dimensions.

Conclusion

Our data show that all patients have presented at least one NMS. Autonomic and sleep disorders were the most frequent, and in contrast to other studies, digestive and cardiovascular disorders were rather the factors influencing negatively the QoL of patients. Understanding the pathophysiology of these NMSs should be placed at the forefront in order to develop new therapeutic approaches by improving the QoL of PD patients.

Factors influencing psychological well-being in patients with Parkinson's disease

BACKGROUND

Both motor and non-motor symptoms could contribute to significant deterioration of psychological well-being in patients with Parkinson's disease (PD). However, its assessment has been only indirectly evaluated using tools based on health-related quality of life (HRQoL), such as the PDQ-39 scale.

OBJECTIVES

To evaluate psychological well-being in PD using a specific tool of assessment, the Psychological Well-being Scale (PWS), and its clinical correlates.

METHODS

This article reports data of patients' perception of health state, as measured by means of the PWS, from an epidemiological, cross-sectional study conducted in Italian PD patients (FORTE Study). We tested possible relationship between well-being and clinical characteristics including fatigue, depression, sleep disruption and HRQoL.

RESULTS

272 patients completed the PWS questionnaire. Significant and clinically-relevant correlations were found between PWS total score and Parkinson's Fatigue Scale, Beck Depression Inventory, UPDRS Section I, PD Sleep Scale and PDQ-39 for HRQoL scores. Only clinically negligible correlations were found between PWS and motor scores.

CONCLUSIONS

Non-motor symptoms have a significant impact on psychological well-being in PD patients.

Proprioception of the Ankle is Impaired in People with Parkinson's Disease

Background

Proprioception has not been examined in the lower limb in people with Parkinson's disease (PD). Impaired proprioception may contribute to activity limitations, including falls in individuals with PD.

Objectives

The aims of this study were to determine whether: (1) people with PD have impaired proprioception in the ankles during active movements; (2) there are correlations between ankle proprioception and history of falls, fear of falling, and parkinsonian symptoms.

Methods

This was a cross-sectional observational study of ankle proprioception in people with mild to moderate PD and healthy age-matched controls. Included in the study were thirteen participants with mild to moderate PD, aged 71 SD (31) years, and 14 age-matched controls, aged 66 SD (21) years. Proprioception of the ankle was measured using the Active Movement Extent Discrimination Apparatus. Symptom severity was measured using the PDQ-39. Fear of falling was measured using the Falls Efficacy Scale, and participants were questioned about their history of falls during the previous 12 months. All measures were completed on one occasion.

Results

People with PD had significantly worse proprioception in plantarflexion (mean difference 0.045, 95% CI 0.00 to 0.09), inversion (mean difference 0.059, 95% CI 0.02 to 0.10), and overall proprioception (mean difference 0.048, 95% CI 0.00 to 0.10) than control participants. In people with PD, there was a significant moderate negative correlation between impaired proprioception and Parkinson's symptoms (r = -0.441, P = 0.021).

Conclusions

Impaired proprioception of the ankle is evident in people with PD. Further research is warranted to determine whether proprioception can be improved in people with PD.

Impact of Combined Subthalamic Nucleus and Substantia Nigra Stimulation on Neuropsychiatric Symptoms in Parkinson's Disease Patients

The goal of the study was to compare the tolerability and the effects of conventional subthalamic nucleus (STN) and combined subthalamic nucleus and substantia nigra (STN+SNr) high-frequency stimulation in regard to neuropsychiatric symptoms in Parkinson's disease patients. In this single center, randomized, double-blind, cross-over clinical trial, twelve patients with advanced Parkinson's disease (1 female; age: 61.3 ± 7.3 years; disease duration: 12.3 ± 5.4 years; Hoehn and Yahr stage: 2.2 ± 0.39) were included. Apathy, fatigue, depression, and impulse control disorder were assessed using a comprehensive set of standardized rating scales and questionnaires such as the Lille Apathy Rating Scale (LARS), Modified Fatigue Impact Scale (MFIS), Becks Depression Inventory (BDI-I), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS), and Parkinson's Disease Questionnaire (PDQ-39). Three patients that were initially assigned to the STN+SNr stimulation mode withdrew from the study within the first week due to discomfort. Statistical comparison of data retrieved from patients who completed the study revealed no significant differences between both stimulation conditions in terms of mean scores of scales measuring apathy, fatigue, depression, impulse control disorder, and quality of life. Individual cases showed an improvement of apathy under combined STN+SNr stimulation. In general, combined STN+SNr stimulation seems to be safe in terms of neuropsychiatric side effects, although careful patient selection and monitoring in the short-term period after changing stimulation settings are recommended.

Changes in Quality of Life in Parkinson's Disease: How Large Must They Be to Be Relevant?

BACKGROUND

Minimal clinically important difference (MCID) is the smallest change in an outcome, which a patient identifies as meaningful. Although the 2 most frequently applied Parkinson's disease (PD) "quality of life" questionnaires (the PDQ-39 and PDQ-8) provide encouragingly similar results, their MCID thresholds appear to be vastly different. Our aim was to calculate the MCID estimates for both PDQ-39 and PDQ-8 Summary Indices (PDQ-39-SI and PDQ-8-SI) by the utilization of both anchor- and distribution-based techniques.

METHODS

Nine hundred eighty-five paired investigations of 365 patients were included. Three different techniques were used simultaneously to calculate the MCID values.

RESULTS

First, we replicated the previously published results demonstrating how both PDQ-39-SI and PDQ-8-SI provide similar values and respond in a similar way to changes. Subsequently, we calculated the MCID thresholds. The most optimal estimates for MCID thresholds for PDQ-39-SI were -4.72 and +4.22 for detecting minimal clinically important improvement and worsening. For PDQ-8-SI, these estimates were -5.94 and +4.91 points for detecting minimal clinically important improvement and worsening respectively.

CONCLUSIONS

Our study is the first one that directly compared the MCID estimates for both PDQ-39-SI and PDQ-8-SI on a large pool of patients including all disease severity stages. These MICD estimates varied across PD severity.

Extrastriatal spreading of microglial activation in Parkinson's disease: a positron emission tomography study

BACKGROUND

The neuroinflammatory glial response contributes to the degenerative process in Parkinson's disease (PD). However, the pattern of microglial progression remains unclear.

METHODS

We evaluated microglial activation in early stage PD patients by quantifying changes in neuroinflammation using PET with [(11)C]DPA713, a selective PET tracer for microglial activation. Eleven PD patients (Hoehn and Yahr stages 1-2) without dementia underwent the [(11)C]DPA713 PET scan two times with 1 year apart. The binding potential (BPND) was estimated with the simplified reference tissue model. Voxelwise and regions of interest analyses were used to compare the regional BPND among groups.

RESULTS

Significant increase in [(11)C]DPA713 BPND was found extrastriatally in the occipital, temporal and parietal cortex in PD patients, and the degree of BPND became much higher over the brain regions predominantly in the temporal and occipital cortex 1 year later.

CONCLUSION

The current results indicated that an extrastriatal spreading of microglial activation reflects one of PD pathophysiology occurring at an early stage.

Activity engagement and health quality of life in people with Parkinson's disease

PURPOSE

This descriptive study examined differences in health quality of life (HQoL) and activity engagement in two groups of people with Parkinson's disease (PD): those who regularly participated in classes offered by the community-based program, Brooklyn Parkinson's Group (BPg), and a comparison group. Individuals in the comparison group did not participate in any community-based programs for people with PD, and were recruited from a clinic for PD and related disorders (PDRD) in an urban medical center.

METHOD

We enrolled 26 participants; 13 participants were recruited from BPg and 13 from PDRD Clinic. Activity engagement was measured using the Activity Card Sort (ACS) and HQoL was measured using the PD Questionnaire (PDQ-39). Additionally, each participant completed a brief, interview-based questionnaire.

RESULTS

A statistically significant difference was found in ACS scores between the BPg and comparison groups. BPg participants showed higher activity retention scores in all domains measured by the ACS. There was no statistically significant difference in PDQ-39 scores.

CONCLUSION

This study provides preliminary evidence that regular participation in community programs like BPg may increase retention rates of activity engagement in people with PD. Participation in BPg programs, though, was not shown to improve HQoL as measured by the PDQ-39. Implications for Rehabilitation Continued participation in a wide repertoire of activities is a valuable rehabilitation goal for clients with Parkinson's disease (PD). People with PD who participate in specially designed community-based programs are more likely to retain a wide repertoire of activity and role engagement, as compared to people with PD who do not have acess to these programs.

Conceptualizing and prioritizing clinical trial outcomes from the perspectives of people with Parkinson's disease versus health care professionals: a concept mapping study

BACKGROUND

Focusing clinical investigations on outcomes that are meaningful from an end-user perspective is central in clinical research, particularly in chronic disorders such as Parkinson's disease (PD). However, little is known about how end-users such as people with PD (PwPD) and health care professionals (HCPs) view and prioritize therapeutic outcomes.

PURPOSE

To compare the perspectives of PwPD and HCPs regarding prioritized areas for outcome measurement in clinical PD trials.

METHODS

Concept mapping was used to identify prioritized outcomes (statements) through focus groups (n = 27; 12 PwPD, 12 HCPs, three researchers), statement sorting and importance rating (n = 38; 19 PwPD, 19 HCPs), followed by quantitative (multidimensional scaling, cluster analysis, procrustes analysis) and qualitative analysis.

RESULTS

Sorting of 99 statements by PwPD and HCPs yielded 2D maps (PwPD/HCPs stress values, 0.31/0.21) with eight clusters per group. The correlation between raw sorting data of PwPD and HCPs was 0.80, and there was a significant concordance (m 12 = 0.53; P < 0.001; i.e., r = 0.68) between the spatial arrangements in their respective maps. Qualitatively, the maps from the two groups represented partially different perspectives. There were no significant differences between PwPD and HCP item importance ratings.

CONCLUSION

Although similarities dominated, there were differences in how the relationships between items were perceived by the two groups, emanating from different perspectives, i.e., the clinical biomedical ("disease") versus the lived experience ("illness"). This study illustrates the clinical importance of attention to the perspective of PwPD; taking this into account is likely to provide evidence from clinical investigations that are meaningful and interpretable for end-users.

Parkinson's disease and forced exercise: a preliminary study

Objective. The concept of forced exercise has drawn attention for the treatment of Parkinson's disease symptoms with anecdotal reports of success. This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson's disease symptoms in a blinded, randomized, and controlled setting. Setting. Parkinson's disease outpatient clinic, Veterans Administration Medical Center. Method. We assessed 23 patients (13 experimental and 10 controls) on a number of standard Parkinson's measures at baseline, after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care, and then after a three-month period had elapsed. Dependent measures were UPDRS-III, Berg Balance Scale, finger taping test, and the PDQ-39. Results. Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time. A within subjects effect was demonstrated for the forced exercise group on overall UPDRS-III scores at the three-month end point. No other within group effects were noted. Results suggest that early enthusiasm for forced exercise may need tempering. Limitations of the study are discussed as well as numerous logistical challenges to this type of study.

The clinical use of quality-of-life scales in neurological disorders

Objective

Quality of life (QoL) is a growing issue in medicine, particularly in the evaluation of rehabilitative care. The concept of QoL is included in and expands the definition of health given by the WHO (World Health Organization) and comprises complete physical, mental, and social well-being. It expresses the degree of satisfaction in various areas as a result of the opportunities that arise during one's lifetime despite the restrictions and impediments that life itself puts forth. The last decade has exponentially increased the number of studies on QoL, although they are still limited.

Methods

We performed a literature review on the QoL scales used in patients with neurological disorders.

Results

Recent studies have shown the importance of QoL assessment because standard treatments do not assess the treatment impact felt by the patient. In fact, by understanding the impact of treatment on survival and QoL, one can make a clearer interpretation of the health of the patient.

Conclusion

This review has adopted an innovative holistic methodological approach, which allowed a global evaluation of the comfort reported by the patients. The scales applied in this study allowed to choose the most suitable therapeutic strategies and programme individual therapeutic treatment.

Uncovering indicators of the international classification of functioning, disability, and health from the 39-item Parkinson's disease questionnaire

The 39-item Parkinson's disease questionnaire (PDQ-39) is the most widely used patient-reported rating scale in Parkinson's disease (PD). However, recent studies have questioned its validity and it is unclear what scores represent. This study explored the possibility of regrouping PDQ-39 items into scales representing the International Classification of Functioning, Disability, and Health (ICF) components of Body Functions and Structures (BF), Activities and Participation (AP), and Environmental (E) factors. An iterative process using Rasch analysis produced five new items sets, two each for the BF and AP components and one representing E. Four of these were found to represent clinically meaningful variables: Emotional Impairment (BF), Gross Motor Disability (AP), Fine Motor Disability (AP), and Socioattitudinal Environment (E) with acceptable reliability (0.73-0.96) and fit to the Rasch model (total item-trait chi-square, 8.28-33.2; P > .05). These new ICF-based scales offer a means to reanalyze PDQ-39 data from an ICF perspective and to study its health components using a widely available health status questionnaire for people with PD.

Interpretation of response categories in patient-reported rating scales: a controlled study among people with Parkinson's disease

BACKGROUND

Unambiguous interpretation of ordered rating scale response categories requires distinct meanings of category labels. Also, summation of item responses into total scores assumes equal intervals between categories. While studies have identified problems with rating scale response category functioning there is a paucity of empirical studies regarding how respondents interpret response categories. We investigated the interpretation of commonly used rating scale response categories and attempted to identify distinct and roughly equally spaced response categories for patient-reported rating scales in Parkinson's disease (PD) and age-matched control subjects.

METHODS

Twenty-one rating scale response categories representing frequency, intensity and level of agreement were presented in random order to 51 people with PD (36 men; mean age, 66 years) and 36 age-matched controls (14 men; mean age, 66). Respondents indicated their interpretation of each category on 100-mm visual analog scales (VAS) anchored by Never--Always, Not at all--Extremely, and Totally disagree--Completely agree. VAS values were compared between groups, and response categories with mean values and non-overlapping 95% CIs corresponding to equally spaced locations on the VAS line were sought to identify the best options for three-, four-, five-, and six-category scales.

RESULTS

VAS values did not differ between the PD and control samples (P = 0.286) or according to educational level (P = 0.220), age (P = 0.220), self-reported physical functioning (P = 0.501) and mental health (P = 0.238), or (for the PD sample) PD duration (P = 0.213) or presence of dyskinesias (P = 0.212). Attempts to identify roughly equally spaced response categories for three-, four-, five-, and six-category scales were unsuccessful, as the 95% CIs of one or several of the identified response categories failed to include the criterion values for equal distances.

CONCLUSIONS

This study offers an evidence base for selecting more interpretable patient-reported rating scale response categories. However, problems associated with raw rating scale data, primarily related to their ordinal structure also became apparent. This argues for the application of methodologies such as Rasch measurement. Rating scale response categories need to be treated with rigour in the construction and analysis of rating scales.