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Ayele R, Macchi ZA, Jordan S, Jones J, Kluger B, Maley P, Hall K, Sumrall M, Lum HD. Holding back in communications with clinicians: Patient and care partner perspectives in Parkinson's disease. PEC INNOVATION 2024; 4:100255. [PMID: 38304553 PMCID: PMC10832496 DOI: 10.1016/j.pecinn.2024.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
Objectives To describe how patients with Parkinson's disease (PD) and care partners choose to share or withhold information from clinicians. Methods This is a qualitative, descriptive study nested within a multisite, randomized clinical trial of outpatient palliative care compared to standard neurologic care for PD. Interviews with patients (n = 30) and care partners (n = 30) explored experiences communicating with neurology clinicians. Thematic analyses identified themes relevant to patient-care partner-clinician communication. Results There were four themes relevant to sharing and/or withholding information from clinicians: (1) Suppressing Concerns During Visits, (2) Care Partner Awareness of Patients' Communication Barriers due to Cognitive Impairment, (3) Limited Sharing of Sensitive or Intimate Issues by Patients and Care Partners, and (4) Patient and Care Partner Suggestions to Overcome 'Holding Back'. Conclusion Limitations to communication between patients, care partners, and clinicians should be acknowledged and recognized in routine Parkinson's disease care to foster accurate disclosure of unmet palliative care and other needs. Triadic communication strategies may help patients and care partners talk about unmet palliative care needs. Innovation By recognizing that cognitive impairment and sensitive topics can be barriers, clinicians can adjust or adopt targeted communication strategies for identifying and discussing care needs.
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Affiliation(s)
- Roman Ayele
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
- College of Nursing, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
- Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, 1800 N. Wheeling Street, Aurora, CO 80045, United States of America
| | - Zachary A. Macchi
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO, 80045, United States of America
| | - Sarah Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
| | - Benzi Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Patrick Maley
- Patient and Caregiver Advisory Council, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, United States of America
| | - Kirk Hall
- Patient and Caregiver Advisory Council, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, United States of America
| | - Malenna Sumrall
- Patient and Caregiver Advisory Council, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, United States of America
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
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Akbar U, Seshadri S, Dini M, Auinger P, Norton SA, Holtrop JS, Kluger BM. Current Status of Integrated Palliative Care Among Parkinson Foundation Centers of Excellence in the United States. Neurol Clin Pract 2024; 14:e200278. [PMID: 38455124 PMCID: PMC10915817 DOI: 10.1212/cpj.0000000000200278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
Background and Objectives To assess the current structures, knowledge, and readiness to integrate palliative care (PC) into Parkinson disease (PD) care at Parkinson's Foundation Centers of Excellence (COE) in the United States. Methods Three unique surveys were administered to health care professionals/staff at COEs to assess PC (1) resources, (2) knowledge and comfort, (3) clinical experience and processes, (4) barriers, and (5) readiness for implementation. Results Response rates for the 3 surveys were 97%, 98%, and 56%. In total, 41% of COEs have access to outpatient PC specialists, 71% have mental health counseling, 82% have support groups, and 9% had very limited PC resources. Overall, 74% of providers believed persons with advanced PD should receive PC, and knowledge of PC fundamentals was good across providers. For high-needs persons with PD (PWP), only 16% of physicians and 24% of advanced practice providers made referrals to PC specialists ≥75% of the time, while 9% and 16% never made such referrals. Limited time, space, financing, and staffing were seen as major barriers to PC implementation. In total, 37% of providers were satisfied with their COE's ability to provide PC services. Most COEs report a culture open to change and appear well-positioned to implement PC in a more comprehensive fashion. Discussion These results demonstrate the emergence of structures and processes to provide PC to persons with PD at COEs. They also identify concrete opportunities to strengthen integration of PC through educational, quality improvement, and advocacy efforts.
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Affiliation(s)
- Umer Akbar
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
| | - Sandhya Seshadri
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
| | - Megan Dini
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
| | - Peggy Auinger
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
| | - Sally A Norton
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
| | - Jodi S Holtrop
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
| | - Benzi M Kluger
- Department of Neurology (UA), Brown University / Rhode Island Hospital, Providence, RI; Department of Neurology (SS, BMK), University of Rochester; Parkinson's Foundation (MD); Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Dissemination and Implementation Science Program (JSH), Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
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Seshadri S, Dini M, Macchi Z, Auinger P, Norton SA, Holtrop JS, Kluger BM. Reach of Palliative Care for Parkinson Disease: Results From a Large National Survey of Patients and Care Partners. Neurol Clin Pract 2023; 13:e200214. [PMID: 37854173 PMCID: PMC10581080 DOI: 10.1212/cpj.0000000000200214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
Background and Objectives People with Parkinson disease (PWP) and their care partners have high palliative care needs resulting from disabling motor and nonmotor symptoms. There is growing support for palliative care (PC) approaches to Parkinson disease. However, little is known regarding the extent to which the palliative needs of PWP and care partners are currently being met. This study's primary objective is to describe PWP's and care partners' perceptions of the extent to which their PC needs are being met. Secondary objectives are to describe their perceptions of the quality of clinical communication and their knowledge of PC. Methods PWPs and care partners (n = 12,995) who had consented to receiving surveys from the Parkinson's Foundation were emailed an electronic survey. PC was operationalized as comprising 5 key components: systematic assessment and management of (1) nonmotor symptoms, (2) PWPs' emotional and spiritual needs, (3) care partners' needs, (4) the completion of annual advance care planning, and (5) timely referrals to specialist palliative care and hospice when appropriate. Results A total 1,882 individuals (1,266 PWP and 616 care partners) responded to the survey (response rate 14.5%). Few PWP (22%) reported that their neurologists never asked regarding bothersome nonmotor symptoms or did so or only if they brought it up. Fifty percent of PWP reported that pain as a specific nonmotor symptom was never managed or managed only if they brought it up. Similarly, PWPs' emotional and spiritual needs (55%), care partners' well-being (57%), and completion of advance care planning documentation (79%) were never addressed or only addressed if PWP brought it up. The quality of clinical communication was generally rated as open and honest (64% PWP). Fewer PWP (30%) reported that doctors helped them deal with the uncertainties of Parkinson disease. Most PWP (85%) reported being knowledgeable regarding PC, and 68% reported that the goal of PC was to help friends and family cope with the illness. Discussion Although some elements of PC are currently being addressed in routine care for PWP, there are many gaps and opportunities for improvement. These data may facilitate focused attention and development of resources to improve the quality and availability of PC for Parkinson disease.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Megan Dini
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Zachary Macchi
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Peggy Auinger
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Sally A Norton
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Jodi S Holtrop
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Benzi M Kluger
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
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Martín-Núñez J, Calvache-Mateo A, López-López L, Heredia-Ciuró A, Cabrera-Martos I, Rodríguez-Torres J, Valenza MC. Effects of Exercise-Based Interventions on Physical Activity Levels in Persons With Parkinson's Disease: A Systematic Review With Meta-analysis. J Geriatr Phys Ther 2023; 46:207-213. [PMID: 36692247 DOI: 10.1519/jpt.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Parkinson's disease (PD) is the most common neurodegenerative movement disorder. Symptom severity leads to devastating consequences such as falls, immobility, impaired quality of life, and reduced general activity. Adopting a sedentary lifestyle creates a vicious circle, as physical inactivity can negatively affect the clinical domains of PD. Despite the recognition of the disease-modifying potential of physical activity (PA), achieving adequate exercise levels can be challenging for individuals with PD. This study aimed to investigate the repercussions of exercise-based interventions to improve PA levels in persons with PD through a systematic review with meta-analysis. METHODS A search was conducted from database inception to February 2021 across 3 databases: PubMed, Web of Science, and Scopus. Randomized controlled trials were included if they involved persons with PD, outcome measures associated with PA levels, and an exercise-based intervention. Two reviewers performed independent data extraction and methodologic quality assessment of the studies using the Downs and Black quality checklist. RESULTS A total of 6 studies were included in the study (1251 persons with PD). Four intervention types were identified: balance, strength, aerobic, and multimodal exercise (combination of several types of exercise programs). The meta-analysis showed that exercise interventions have a positive effect on PA (standard mean difference = 0.50, 95% CI =-0.02, 1.00; P = .06). The risk of bias was generally low. CONCLUSIONS The findings support the use of exercise-based interventions (aerobic exercise, balance exercise, strength exercise, and/or multimodal exercise) to improve PA levels. However, the limited number of studies and the heterogeneity of the interventions do not allow us to draw a definitive conclusion.
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Affiliation(s)
- Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Yunusa I, Rashid N, Seyedin R, Paratane D, Rajagopalan K. Comparative Efficacy, Safety, and Acceptability of Pimavanserin and Other Atypical Antipsychotics for Parkinson's Disease Psychosis: Systematic Review and Network Meta-Analysis. J Geriatr Psychiatry Neurol 2023; 36:417-432. [PMID: 36720473 DOI: 10.1177/08919887231154933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The current comparative efficacy, safety, and acceptability of atypical antipsychotics (AAPs) in treating Parkinson's Disease Psychosis (PDP) are not entirely understood. OBJECTIVE To evaluate comparative efficacy, safety, and acceptability of AAPs in patients with PDP. METHODS We conducted a systematic review and a network meta-analysis to compare the efficacy, safety, and acceptability of pimavanserin, quetiapine, olanzapine, clozapine, ziprasidone, and risperidone. We estimated relative standardized mean differences (SMDs) for continuous outcomes and odds ratios (OR) for binary outcomes, with their respective 95% confidence intervals (CIs). RESULTS We included 19 unique studies evaluating AAPs in a total of 1,242 persons with PDP. Based on Clinical Global Impression Scale for Severity, pimavanserin (SMD, -4.81; 95% CI, -5.39, -4.24) and clozapine (SMD, -4.25; 95% CI, -5.24, -3.26) significantly improved symptoms compared with placebo. Also, compared to placebo, pimavanserin (OR, 1.16; 95% CI, 1.07, 1.24) significantly improved psychotic symptoms based on Scale for Assessment of Positive Symptoms for Parkinson's Disease Psychosis/Hallucinations and Delusions scores. In comparison to placebo, clozapine (SMD, -0.69; 95% CI, -1.35, -0.02), pimavanserin (SMD, -0.01; 95% CI, -0.56, 0.53), and quetiapine (SMD, 0.00; 95% CI, -0.68, 0.69) did not impair motor function per Unified Parkinson's Disease Rating scale. Based on Mini-Mental State Examination scale, quetiapine (SMD, 0.60; 95% CI, 0.07, 1.14) significantly impaired cognition compared to placebo. CONCLUSIONS In patients with PDP, pimavanserin and clozapine demonstrated significant improvement in psychosis without affecting motor function. With quetiapine being associated with a significant decline in cognition and despite not impairing motor function, our findings suggest that it should be avoided in patients with PDP and reduced cognitive abilities.
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Affiliation(s)
- Ismaeel Yunusa
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
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Pirttilä A, Tiihonen M, Paakinaho A, Hartikainen S, Tolppanen AM. Hospitalization and the Risk of Initiation of Antipsychotics in Persons With Parkinson's Disease. J Am Med Dir Assoc 2023; 24:1290-1296.e4. [PMID: 37220871 DOI: 10.1016/j.jamda.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The use of antipsychotics in persons with Parkinson's disease (PD) is common, although their use may aggravate the symptoms of PD. Clozapine and quetiapine are the only antipsychotics recommended in PD treatment guidelines. Information on factors associated with initiation of antipsychotics is needed. We investigated whether recent hospitalization is associated with initiation of antipsychotics in persons with PD, and whether discharge diagnoses differ between those who had antipsychotics initiated and those who did not. DESIGN Nested case-control study in the nationwide register-based Finnish Study on Parkinson's disease (FINPARK). SETTING AND PARTICIPANTS The FINPARK study includes 22,189 persons who received an incident, clinically verified PD diagnosed during 1996-2015 and were community-dwelling at the time of diagnosis. The cases were 5088 persons who had antipsychotics initiated after PD diagnosis, identified with 1-year washout. The controls were 5088 age-, sex-, and time from PD diagnosis-matched persons who did not use antipsychotics on the matching date (antipsychotic purchase date). Recent hospitalization was defined as discharge in the 2-week period preceding the matching date. METHODS Associations were investigated with conditional logistic regression. RESULTS Quetiapine was the most commonly initiated antipsychotic (72.0% of cases), followed by risperidone (15.0%). Clozapine was initiated rarely (1.1%). Recent hospitalization associated strongly with antipsychotic initiation [61.2% of cases and 14.9% of controls, odds ratio (OR) 9.42, 95% CI 8.33-10.65], and longer hospitalizations were more common among cases. PD was the most common discharge diagnosis category (51.2% of hospitalized cases and 33.0% controls), followed by mental and behavioral disorders (9.3%) and dementia (9.0%) among cases. Antidementia and other psychotropic medication use were more common among cases. CONCLUSIONS AND IMPLICATIONS These results suggest that antipsychotics were initiated because of neuropsychiatric symptoms or aggravation of those symptoms. Antipsychotics should be prescribed after careful consideration to avoid adverse effects in persons with Parkinson's disease.
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Affiliation(s)
- Aki Pirttilä
- Kuopio Research Center of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Miia Tiihonen
- Kuopio Research Center of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anne Paakinaho
- Kuopio Research Center of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Center of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Center of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
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Rafferty MR, Hoffman L, Feeney M, Schulte C, Hutber A, Galati T, Neric F, Ellis TD. Parallel development of Parkinson's-specific competencies for exercise professionals and criteria for exercise education programs. Parkinsonism Relat Disord 2023:105407. [PMID: 37202275 DOI: 10.1016/j.parkreldis.2023.105407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The Parkinson's Foundation sought to develop Parkinson's specific competencies for exercise professionals who work with people with Parkinson's (PwP). These competencies built upon exercise guidelines and professional competencies for healthy populations. The purpose of this article is to describe the development of the professional competencies, continuing education criteria, and a pilot accreditation process. METHODS Competency development included: (1) an expert panel conducting an environmental scan, within the USA, related to exercise professional education in Parkinson's and synthesizing Parkinson's-specific exercise guidelines, (2) surveying people with Parkinson's in the USA, and (3) developing the competencies and curriculum criteria with psychometricians. A pilot accreditation process for Parkinson's exercise educational programs and continuing education courses includes an application, baseline, 6- and 12-month assessments. Activities reported here did not require ethical review. The survey was approved by NORC at the University of Chicago's Institutional Review Board (IRB). RESULTS The environmental scan, exercise guidelines, and survey (n = 627) informed competency development. The five key condition-specific domains were: (1) foundational information on the disease and role of exercise, (2) exercise screening, (3) group and individual exercise design, (4) behavior and counseling for exercise, and (5) interprofessional communication and program development. Seven applicants were accredited as certification programs (n = 3) or continuing education courses (n = 4). DISCUSSION The competencies, curriculum criteria, and accreditation processes support exercise professionals working with PwP. Reducing variation in the knowledge and skills of exercise professionals can improve the safe implementation and effectiveness of exercise programs, which are a critical part of integrated plan for people with Parkinson's disease (PD).
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA; Department Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA; Department Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Carol Schulte
- Parkinson's Foundation Research Advocate, Red Bank, NJ, USA
| | - Adrian Hutber
- Valley Consortium for Medical Education, Modesto, CA, USA
| | - Todd Galati
- American Council on Exercise, San Diego, CA, USA
| | - Francis Neric
- Certification and Credentialing, American College of Sports Medicine, Indianapolis, IN, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
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O'Shea N, Lyons S, Higgins S, O'Dowd S. Neurological update: the palliative care landscape for atypical parkinsonian syndromes. J Neurol 2023; 270:2333-2341. [PMID: 36688987 DOI: 10.1007/s00415-023-11574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
Atypical parkinsonian syndromes are neurodegenerative conditions, characterised by rapid disease progression and shorter life expectancy compared to idiopathic Parkinson's disease. These conditions inflict substantial physical and psychosocial burden on patients and their families; hence, there is a clear rationale for a palliative care approach from diagnosis. An interdisciplinary care model has been shown to improve symptom burden, quality of life and engagement with advance care planning, in a heterogeneous group of neurodegenerative conditions. In this update, we summarise how the landscape for treating these patients has changed and the questions that still need to be resolved.
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Affiliation(s)
- Noreen O'Shea
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6WRY72, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
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Fereshtehnejad SM, Rodríguez-Violante M, Ponce-Rivera MS, Martinez-Ramirez D, Ramirez-Zamora A. COVID-19 and Integrated Multidisciplinary Care Model in Parkinson's Disease: Literature Review & Future Perspectives. Behav Sci (Basel) 2022; 12:447. [PMID: 36421743 PMCID: PMC9687116 DOI: 10.3390/bs12110447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2024] Open
Abstract
Clinical diversity and multi-systemic manifestations of Parkinson's disease (PD) necessitate the involvement of several healthcare professionals from different disciplines for optimal care. Clinical guidelines recommend that all persons with PD should have access to a broad range of medical and allied health professionals to implement an efficient and effective multidisciplinary care model. This is well supported by growing evidence showing the benefits of multidisciplinary interventions on improving quality of life and disease progression in PD. However, a "multidisciplinary" approach requires gathering healthcare professionals from different disciplines into an integrative platform for collaborative teamwork. With the Coronavirus Disease 2019 (COVID-19) pandemic, implementation of such a multidisciplinary care model has become increasingly challenging due to social distancing mandates, isolation and quarantine, clinics cancellation, among others. To address this problem, multidisciplinary teams are developing innovate virtual platforms to maintain care of people with PD. In the present review, we cover aspects on how SARS-CoV-2 has affected people with PD, their caregivers, and care team members. We also review current evidence on the importance of maintaining patient-centered care in the era of social distancing, and how can we utilize telehealth and innovative virtual platforms for multidisciplinary care in PD.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, 14186 Stockholm, Sweden
| | | | - Monica S. Ponce-Rivera
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 66220, Mexico
| | - Daniel Martinez-Ramirez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 66220, Mexico
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL 32611, USA
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Danoudis M, Iansek R. A long-term community gym program for people with Parkinson's disease: a feasibility study of the Monash Health "Health and Fitness" model. Disabil Rehabil 2022; 44:7330-7338. [PMID: 34546146 DOI: 10.1080/09638288.2021.1977396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the feasibility and acceptability of the Health and Fitness Program (HFP), a long-term community gym program for people with mild to moderate Parkinson's disease (PD). METHODS Physiotherapists, with PD expertise, developed individualised exercise programs for new HFP members in consultation with them. Gym instructors, with PD training, supervised the HFP sessions. Exercises included progressive strength training, aerobic, balance, and stretching. Participants who had been enrolled in the HFP for 12 months, were recruited to a single group pre/post design study to test the program's feasibility and acceptability. Feasibility included safety, retention, attendance, and compliance data and acceptability measured using a customised questionnaire. RESULTS 17 of the 20 HFP members enrolled maintained membership for 12 months and participated in this study. The program was shown to be feasible with no falls reported during sessions, only one participant reported pain from exercising lasting more than 48 h, retention was high (85%) and most members complied with their program. Overall satisfaction with the program was high, with seven somewhat satisfied and 10 very satisfied. CONCLUSION The HFP demonstrated that a PD community gym program is feasible and acceptable when physiotherapists and PD-trained instructors collaborate to provide individualized exercise programs.IMPLICATIONS FOR REHABILITATIONPeople with Parkinson's disease need support to maintain long-term adherence to regular exercise which can be achieved with supervised community-based gym programs.A community-based PD-specific exercise program can be safe and acceptable to people with PD when PD specialist physiotherapists are involved in planning participants' exercise programs and PD-trained gym instructors supervise the exercise sessions.Members are satisfied with programs that have strategies in place to minimise barriers to participation, such as keeping costs to members low, providing a quality service, having supportive trained staff, and creating opportunities for social interaction between members.Evidence-based community exercise programs may result in improved strength and aerobic fitness and maintain quality of life in people with mild to moderate PD however further research using an RCT study is needed.
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Affiliation(s)
- Mary Danoudis
- Clinical Research Centre for Movement Disorders and Gait, Parkinson's Foundation Center of Excellence, Monash Health, Kingston Centre, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Parkinson's Foundation Center of Excellence, Monash Health, Kingston Centre, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Australia
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11
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Abstract
The global burden of Parkinson's disease (PD) has increased from 2.5 to 6.1 million since the 1990s. This is expected to rise as the world population ages and lives longer. With the current consensus on the existence of a prediagnostic phase of PD, which can be divided into a preclinical stage and a prodromal stage, we can better define the risk markers and prodromal markers of PD in the broader context of PD pathogenesis. Here, we review this pathogenetic process, and discuss the evidence behind various heritability factors, exposure to pesticides and farming, high dairy consumption, and traumatic brain injuries that have been known to raise PD risk. Physical activity, early active lifestyle, high serum uric acid, caffeine consumption, exposure to tobacco, nonsteroidal anti-inflammatory drugs, and calcium channel blockers, as well as the Mediterranean and the MIND diets are observed to lower PD risk. This knowledge, when combined with ways to identify at-risk populations and early prodromal PD patients, can help the clinician make practical recommendations. Most importantly, it helps us set the parameters for epidemiological studies and create the paradigms for clinical trials.
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Affiliation(s)
- Suraj Rajan
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnie Kaas
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Liu Y, Ding L, Xianyu Y, Nie S, Yang J. Research on depression in Parkinson disease: A bibliometric and visual analysis of studies published during 2012-2021. Medicine (Baltimore) 2022; 101:e29931. [PMID: 35945720 PMCID: PMC9351875 DOI: 10.1097/md.0000000000029931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The diagnosis and treatment rate of Parkinson disease (PD) with depression has a low diagnostic rate, and there is no consensus on the choice of treatment mode. This study evaluates the global research trends of scientific outputs related to depression in PD from multiple perspectives, using a bibliometric analysis and visualization tool to scientifically analyze the knowledge from the literature. METHODS Literature related to depression in PD published from 2012 to 2021 was included and selected from the Web of Science Core Collection database in October 2021. CiteSpace software was used to visualize and analyze co-occurrence analyses for countries, institutions, authors, and keywords. RESULTS A total of 4533 articles from the Web of Science database were included. The United States made the largest contribution with the majority of publications (1215; 29.40%). Toronto University was the most productive institution. PD, depression, quality of life, dementia, nonmotor symptom, prevalence, anxiety, Alzheimer disease, symptom, and disorder would be significantly correlated with depression in PD. The current hot spots in this field focus on the following: risk factors for depression in PD, assessment scale of depression in PD, and rehabilitation of depression in PD. CONCLUSIONS This analysis not only reveals the current research trends and hotspots but also provides some instructive suggestions on the development of depression in PD.
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Affiliation(s)
- Yan Liu
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Yan Liu, Department of Nursing, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan 430060, China (e-mail: )
| | - Linlin Ding
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Yunyan Xianyu
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuke Nie
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiying Yang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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13
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Confirming Parkinson Disease Diagnosis: Patterns of Diagnostic Changes by Movement Disorder Specialists. PARKINSON'S DISEASE 2022; 2022:5535826. [PMID: 35585902 PMCID: PMC9110256 DOI: 10.1155/2022/5535826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 12/10/2021] [Accepted: 04/16/2022] [Indexed: 11/18/2022]
Abstract
Background The American Academy of Neurology Parkinson Disease (PD) quality measures include an annual diagnostic review. Objective To investigate the frequency and pattern of changes in diagnoses between PD and other causes of parkinsonism. Methods This prospective longitudinal cohort study included consented patients diagnosed with PD at least once and a minimum of two times at the Movement Disorders Center between 2002 and 2017. Movement disorder specialists confirmed and documented diagnoses at every visit. Longitudinal changes in diagnoses were identified across visits. Results Of 1567 patients with parkinsonism, 174 had non-PD parkinsonism with no change over time. Of 1393 patients diagnosed with PD at least once, 94% (N = 1308) had no change of diagnosis over time and 6% (N = 85) had a change of diagnosis including PD ⟷ drug-induced parkinsonism (DIP) (27.1%), PD ⟷ multiple system atrophy (MSA) (20.0%), PD ⟷ progressive supranuclear palsy (PSP) (18.8%), PD ⟷ Lewy body dementia (DLB) (16.5%), PD⟷ vascular parkinsonism (9.4%), more than two diagnoses (4.7%), and PD ⟷ corticobasal syndrome (CBS) (3.5%). The direction of diagnostic switches was as follows: PD ⟶ other parkinsonism diseases (36.5%), other parkinsonism diseases ⟶ PD (31.8%), and 31.8% of multiple switches. There were no significant differences in duration of follow-up, age at first visit, gender, race, marital status, education, income, cognition, or employment between the stable and unstable groups. Diagnostic change was associated with greater PD severity and greater medical comorbidity. Conclusion Over a 15-year period, movement disorder specialists changed their clinical diagnosis of PD in 6% of patients. The most common diagnostic switches, to or from PD, were DIP, MSA, PSP, and DLB. This study describes routine clinical diagnostic patterns in the absence of pathologic confirmation. The presence of diverse diagnostic changes over time underscores the value of confirming PD diagnosis.
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14
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Zaratin P, Vermersch P, Amato MP, Brichetto G, Coetzee T, Cutter G, Edan G, Giovannoni G, Gray E, Hartung HP, Hobart J, Helme A, Hyde R, Khan U, Leocani L, Mantovani LG, McBurney R, Montalban X, Penner IK, Uitdehaag BM, Valentine P, Weiland H, Bertorello D, Battaglia MA, Baneke P, Comi G. The agenda of the global Patient Reported Outcomes for Multiple Sclerosis (PROMS) Initiative: progresses and open questions. Mult Scler Relat Disord 2022; 61:103757. [DOI: 10.1016/j.msard.2022.103757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/25/2022]
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15
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Tsukita K, Sakamaki-Tsukita H, Takahashi R. Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease. Neurology 2022; 98:e859-e871. [PMID: 35022304 PMCID: PMC8883509 DOI: 10.1212/wnl.0000000000013218] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/30/2021] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives Owing to the lack of long-term observations or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson disease (PD) have yet to be drawn. Here, using data from the Parkinson's Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD. Methods In this retrospective, observational cohort study, we primarily used the multivariate linear mixed-effects models to analyze the interaction effects of their regular physical activity and moderate to vigorous exercise levels, measured with the Physical Activity Scale for the Elderly questionnaire, on the progression of clinical parameters, after adjusting for age, sex, levodopa equivalent dose, and disease duration. We also calculated bootstrapping 95% confidence intervals (CIs) and conducted sensitivity analyses using the multiple imputation method and subgroup analyses using propensity score matching to match for all baseline background factors. Results Two hundred thirty-seven patients with early PD (median [interquartile range] age, 63.0 [56.0–70.0] years, male 69.2%, follow-up duration 5.0 [4.0–6.0] years) were included. Regular physical activity and moderate to vigorous exercise levels at baseline did not significantly affect the subsequent clinical progression of PD. However, average regular overall physical activity levels over time were significantly associated with slower deterioration of postural and gait stability (standardized fixed-effects coefficients of the interaction term [βinteraction] = −0.10 [95% CI −0.14 to −0.06]), activities of daily living (βinteraction = 0.08 [95% CI 0.04–0.12]), and processing speed (βinteraction = 0.05 [95% CI 0.03–0.08]) in patients with PD. Moderate to vigorous exercise levels were preferentially associated with slower decline of postural and gait stability (βinteraction = −0.09 [95% CI −0.13 to −0.05]), and work-related activity levels were primarily associated with slower deterioration of processing speed (βinteraction = 0.07 [95% CI 0.04–0.09]). Multiple imputation and propensity score matching confirmed the robustness of our results. Discussion In the long term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects. Trial Registration Information ClinicalTrials.gov Identifier: NCT01176565. Classification of Evidence This study provides Class II evidence that sustained increase in overall regular physical activity levels in patients with early PD was associated with slower decline of several clinical parameters.
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Affiliation(s)
- Kazuto Tsukita
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan .,Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan.,Laboratory of Barriology and Cell Biology, Graduate School of Frontier Biosciences, Osaka University, Suita, Japan
| | | | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Margolius AJ, Samala RV. Delivery models of neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:61-71. [PMID: 36055720 DOI: 10.1016/b978-0-323-85029-2.00007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Drawing its beginnings from end-of-life care, palliative care has developed into a specialized interdisciplinary effort aiming to alleviate distress in all its form, and spanning the whole serious illness trajectory. With this evolution came the inevitable expansion to different sites and modes of care delivery. This section discusses the various models of bringing palliative care to patients with neurologic illness. It begins by distinguishing primary from specialist palliative care, then examines various models of inpatient and outpatient care. Hospital-based models include consultation service and dedicated inpatient units, while outpatient care mainly consists of palliative care specialists embedded in disease-specific clinics. Home-based palliative care and services provided through telemedicine are discussed. Hospice, a model of care often associated with end-of-life palliative care is detailed, together with suggestions on when to consider transitioning to hospice care. It is worth noting that there is not a single best model of palliative care delivery for persons living with neurologic illness. The models discussed in this chapter are complementary not competing and should be adopted by clinicians to fit the needs of patients and caregivers, the resources available in the healthcare system, and based on where patients are in the spectrum of their illness.
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Affiliation(s)
- Adam J Margolius
- Palliative Care Program, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Renato V Samala
- Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
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17
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Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2021; 102:6485202. [PMID: 34963139 PMCID: PMC9046970 DOI: 10.1093/ptj/pzab302] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).
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Affiliation(s)
- Jacqueline A Osborne
- Brooks Rehabilitation Hospital, Brooks Institute of Higher Learning, Jacksonville, Florida, USA
| | - Rachel Botkin
- Botkin Rehab Services, Physical Therapy, Columbus, Ohio, USA
| | - Cristina Colon-Semenza
- Department of Kinesiology, Doctor of Physical Therapy Program, University of Connecticut, Storrs, Connecticut, USA
| | - Tamara R DeAngelis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
| | - Oscar G Gallardo
- Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, California, USA
| | - Heidi Kosakowski
- Address all correspondence to Dr Kosakowski care of the Department of Practice of the American Physical Therapy Association at:
| | | | - Sujata Pradhan
- University of Washington, Rehabilitation Medicine, Seattle, Washington, USA
| | - Miriam Rafferty
- Northwestern University, Center for Education in Health Sciences, Chicago, Illinois, USA
| | | | | | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
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18
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Fereshtehnejad SM, Rodríguez-Violante M, Martinez-Ramirez D, Ramirez-Zamora A. Editorial: Managing Parkinson's Disease With a Multidisciplinary Perspective. Front Neurol 2021; 12:799017. [PMID: 34899588 PMCID: PMC8661532 DOI: 10.3389/fneur.2021.799017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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19
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Mañago MM, Swink LA, Hager ER, Gisbert R, Earhart GM, Christiansen CL, Schenkman M. The Impact of COVID-19 on Community-Based Exercise Classes for People With Parkinson Disease. Phys Ther 2021; 101:pzab203. [PMID: 34473303 PMCID: PMC8522385 DOI: 10.1093/ptj/pzab203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE he purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors. METHODS Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1 time/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8. RESULTS Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home ≤1 time/week. Although 77% of the PD group scored "active" on the Godin Leisure-Time Questionnaire, the mean Self-Efficacy for Exercise Scale score (55 [24]) indicated only moderate exercise self-efficacy, and >50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group). CONCLUSION During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization. IMPACT As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD. LAY SUMMARY During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction.
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Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| | - Laura A Swink
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| | - Emily R Hager
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| | - Robyn Gisbert
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| | - Margaret Schenkman
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
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20
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Jackowiak E, Szpara A, Kotagal V. Age and Life-Sustaining Treatment Preferences in Parkinson Disease. Neurol Clin Pract 2021; 11:e245-e250. [PMID: 34484898 DOI: 10.1212/cpj.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/18/2020] [Indexed: 11/15/2022]
Abstract
Objective Advance Care Planning (ACP) is one of 10 key elements in the American Academy of Neurology Parkinson disease (PD) clinical practice quality measures. We know little about how aging influences ACP views in people with PD. Methods We conducted a cross-sectional survey of 39 participants (mean age 70.3 years; range: 52-81) with PD to explore correlations between older age and life-sustaining treatment preferences while controlling for confounders including years of education, Montreal Cognitive Assessment score and Movement Disorders Society Unified Parkinson's disease Rating Scale motor score. Scenarios asked participants to choose their level of interest in pursuing life-sustaining measures in the setting of specific medical illnesses including stroke, metastatic cancer, severe heart attack, and dementia. All participants were men and were recruited from the Veterans Affairs Ann Arbor Healthcare System. Results In the hypothetical stroke, metastatic colon cancer, and dementia scenarios, older age correlated with more aggressive care goals related to the use cardiopulmonary resuscitation to treat cardiopulmonary arrest. Conclusions Advancing age in PD may correlate with paradoxically more aggressive goals as it relates to life-sustaining treatment preferences including cardiopulmonary resuscitation. This may reflect a response to heightened concern among older adults with PD about the potential for compromised autonomy in the setting of aging.
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Affiliation(s)
- Eric Jackowiak
- Department of Neurology (EJ, VK), University of Michigan; Veterans Affairs Ann Arbor Healthcare System (VAAAHS) (EJ, VK); and School of Public Health (AS), University of Michigan, Ann Arbor
| | - Ashley Szpara
- Department of Neurology (EJ, VK), University of Michigan; Veterans Affairs Ann Arbor Healthcare System (VAAAHS) (EJ, VK); and School of Public Health (AS), University of Michigan, Ann Arbor
| | - Vikas Kotagal
- Department of Neurology (EJ, VK), University of Michigan; Veterans Affairs Ann Arbor Healthcare System (VAAAHS) (EJ, VK); and School of Public Health (AS), University of Michigan, Ann Arbor
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21
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Chou KL, Martello J, Atem J, Elrod M, Foster ER, Freshwater K, Gunzler SA, Kim H, Mahajan A, Sarva H, Stebbins GT, Lee E, Yang L. Quality Improvement in Neurology: 2020 Parkinson Disease Quality Measurement Set Update. Neurology 2021; 97:239-245. [PMID: 34341076 DOI: 10.1212/wnl.0000000000012198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kelvin L Chou
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Justin Martello
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Juliana Atem
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Matt Elrod
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Erin R Foster
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Karen Freshwater
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Steven A Gunzler
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Hojoong Kim
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Abhimanyu Mahajan
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Harini Sarva
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Glenn T Stebbins
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Erin Lee
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA.
| | - Laurice Yang
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
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22
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Individuals With Parkinson Disease Are Adherent to a High-Intensity Community-Based Cycling Exercise Program. J Neurol Phys Ther 2021; 46:73-80. [PMID: 34369453 DOI: 10.1097/npt.0000000000000370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Parkinson disease is a progressive neurological disorder with no known cure or proven method of slowing progression. High-intensity, laboratory-based aerobic exercise interventions are currently being pursued as candidates for altering disease progression. The aim of this project was to evaluate the translation of a laboratory-based intervention to the community by monitoring exercise adherence (eg, attendance) and intensity (eg, heart rate [HR] and cadence) in 5 established Pedaling for Parkinson's exercise classes. A secondary aim was to determine the impact of disease severity and demographics variables on exercise adherence. METHODS A 12-month pragmatic design was utilized to monitor attendance, HR, and cadence during each Pedaling for Parkinson's class session. Over the course of 1 year, approximately 130 sessions were offered. Forty-nine (n = 30 males) persons with mild to moderate Parkinson disease from 5 community fitness facilities participated. RESULTS Out of the approximately 130 cycling sessions offered at each site over 12 months, 37% of the participants attended greater than 2 classes per week (80-130 total sessions), 47% attended 1 to 1.9 classes per week (40-79 total sessions), and less than 17% attended less than 1 class per week (<40 total sessions). Average pedaling cadence was 74.1 ± 9.6 rpms while average percentage of HR maximum was 68.9 ± 12.0%. There were no significant differences between cycling adherence and intensity variables based on disease severity, age, or sex. DISCUSSION AND CONCLUSIONS Consistent attendance and exercise performance at moderate to high intensities are feasible in the context of a community-based Pedaling for Parkinson's class. Consistency and intensity of aerobic exercise have been proposed as critical features to elicit potential disease modification benefits associated with exercise. Community-based fitness programs that bring laboratory protocols to the "real world" are a feasible intervention to augment current Parkinson disease treatment approaches. See the Supplementary Video, available at: http://links.lww.com/JNPT/A357.
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Snyder A, Gruber-Baldini AL, Rainer von Coelln F, Savitt JM, Reich SG, Armstrong MJ, Shulman LM. Comparison of Mini-Mental State Examination and Montreal Cognitive Assessment Ratings Across Levels of Parkinson's Disease Severity. JOURNAL OF PARKINSONS DISEASE 2021; 11:1995-2003. [PMID: 34366371 DOI: 10.3233/jpd-212705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is common in Parkinson's disease (PD) and an important cause of disability. Screening facilitates early detection of CI and has implications for management. Preclinical disability is when patients have functional limitations but maintain independence through compensatory measures. OBJECTIVE The objective of this study was to investigate the relationship between scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) with levels of PD severity and disability. METHODS PD patients (n = 2,234) in a large observational study were stratified by disease severity, based on Total Unified Parkinson's Disease Rating Scale (Total UPDRS) and Hoehn and Yahr (HY) stage. Using MMSE (n = 1,184) or MoCA (n = 1,050) and basic (ADL) and instrumental activities of daily living (IADL) scales for disability, linear regression analysis examined associations between cognitive status and disability. RESULTS Cognition and disability were highly correlated, with the strongest correlation between IADL and MoCA. Only 16.0% of mean MMSE scores were below threshold for CI (28) and only in advanced PD (Total UPDRS 60+, HY≥3). MoCA scores fell below CI threshold (26) in 66.2% of the sample and earlier in disease (Total UPDRS 30+, HY≥2), corresponding with impairments in ADLs. CONCLUSION In a large clinical dataset, a small fraction of MMSE scores fell below cutoff for CI, reinforcing that MMSE is an insensitive screening tool in PD. MoCA scores indicated CI earlier in disease and coincided with disability. This study shows that MoCA, but not MMSE is sensitive to the emergence of early cognitive impairment in PD and correlates with the concomitant onset of disability.
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Affiliation(s)
- Allison Snyder
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Rainer von Coelln
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph M Savitt
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Psychological Impact of Parkinson Disease Delusions on Spouse Caregivers: A Qualitative Study. Brain Sci 2021; 11:brainsci11070871. [PMID: 34210042 PMCID: PMC8301855 DOI: 10.3390/brainsci11070871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/15/2022] Open
Abstract
There is growing research on carers of people with Parkinson's disease (PD) experiences. However, the impact on carers by PD delusions is not specifically examined. We conducted a qualitative study using semi-structured interviews of spouse carers of PD patients with delusions. Thematic analysis was employed using MAXQDA 2018. Twelve spouse participants (SPs) were interviewed. Four themes emerged: Managing incredulity: trying to make sense of delusion content; Hypervigilance: constant alertness to bizarre and threatening discourse and behavior; Defensive strategizing: anticipating delusions and potential consequences; Concealing and exposing: ambivalence about disclosing the effect of delusions yet wanting support. SPs reported effects on their emotional well-being and marital relationship and challenges to an orderly, predictable life. SPs were reluctant to share their experiences due to delusion content (often infidelity and sexual in nature) and a desire to protect their spouses' image. SPs' awareness of the potential for delusional thought was low prior to their occurrence. Conclusions: education surrounding potential neurobehavioral changes should occur for patients and carers. Clinicians should be aware that the impact of delusions on carers is often greater than disclosed in clinical interviews. Interdisciplinary teams speaking separately to spousal carers may improve disclosure and delivery of appropriate psychological support.
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25
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Gandhi AB, Onukwugha E, Albarmawi H, Johnson A, Myers DE, Gray D, Alvir J, Hynicka L, Shulman LM. Health Care Resource Utilization Associated With Parkinson Disease Among Medicare Beneficiaries. Neurology 2021; 97:e597-e607. [PMID: 34045274 DOI: 10.1212/wnl.0000000000012290] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare differences in health care resource utilization (HcRU) over time between Medicare beneficiaries with and without Parkinson disease (PD). METHODS This retrospective observational study used the Chronic Conditions Data Warehouse (5% Medicare sample) between 2005 and 2015. In a propensity score-matched (age, sex, race, and comorbidity adjusted) sample of beneficiaries with and without PD, we examined all-cause HcRU due to inpatient admissions, emergency department (ED) admissions, skilled nursing facility (SNF) admissions, health care provider encounters, neurologist visits, rehabilitation service visits, and non-PD medication fills. Relative to beneficiaries without PD, we reported adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for beneficiaries with PD using generalized linear models with log link and negative binomial variance functions. RESULTS A total of 467,064 Medicare enrollees (unmatched sample) met the inclusion criteria. Of these, 3.3% had PD. In the matched sample and relative to beneficiaries without PD, beneficiaries with PD displayed higher rates of inpatient admissions (IRR 1.29, 95% CI 1.24-1.34), ED admissions (IRR 1.31, 95% CI 1.27-1.34), SNF admissions (IRR 2.00, 95% CI 1.92-2.09), health care provider encounters (IRR 1.18, 95% CI 1.16-1.20), neurologist visits (IRR 5.57, 95% CI 5.35-5.78), rehabilitation service visits (IRR 1.47, 95% CI 1.41-1.53), and non-PD medication fills (IRR 1.10, 95% CI 1.08-1.11) over time. CONCLUSION These results reflect patterns of medical care among Medicare beneficiaries with PD. The findings can help clinicians, payers, and policy makers make evidence-based decisions for the allocation of scarce health care resources for PD management. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that Medicare beneficiaries with PD use more health care resources than matched controls without PD.
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Affiliation(s)
- Aakash Bipin Gandhi
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Eberechukwu Onukwugha
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore.
| | - Husam Albarmawi
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Abree Johnson
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Daniela E Myers
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - David Gray
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Jose Alvir
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Lauren Hynicka
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Lisa M Shulman
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
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Analysis of voice as an assisting tool for detection of Parkinson's disease and its subsequent clinical interpretation. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Kluger BM, Dolhun R, Sumrall M, Hall K, Okun MS. Palliative Care and Parkinson's Disease: Time to Move Beyond Cancer. Mov Disord 2021; 36:1325-1329. [PMID: 33786871 DOI: 10.1002/mds.28556] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Dolhun
- The Michael J. Fox Foundation, New York, New York, USA
| | - Malenna Sumrall
- Parkinson Foundation Patient and Family Advisory Council, New York, New York, USA
| | - Kirk Hall
- Parkinson Foundation Patient and Family Advisory Council, New York, New York, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA.,Parkinson's Foundation, Miami, Florida, USA
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28
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Katzan IL, Lapin B, Griffith S, Jehi L, Fernandez H, Pioro E, Tepper S, Crane PK. Somatic symptoms have negligible impact on Patient Health Questionnaire-9 depression scale scores in neurological patients. Eur J Neurol 2021; 28:1812-1819. [PMID: 33715277 DOI: 10.1111/ene.14822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE There is concern that the Patient Health Questionnaire-9 (PHQ-9) depression scale may be impacted by the presence of somatic symptoms (differential item functioning [DIF]) in patients with neurological conditions. We evaluated the PHQ-9 for the presence and impact of DIF in large clinical samples of neurological patients. METHODS We conducted a cross-sectional study of patients seen at the Cleveland Clinic Cerebrovascular, Headache, Movement Disorder, and Neuromuscular clinics who completed the PHQ-9 and patient-reported disease severity measures as part of standard care between 29 July 2008 and 21 February 2013. We evaluated PHQ-9 items for DIF with respect to disease-specific severity for each condition. Salient DIF impact was characterized as a difference between DIF-adjusted and unadjusted PHQ-9 scores. RESULTS Included in the study were 2112 patients with stroke, 8221 with migraine, 440 with amyotrophic lateral sclerosis (ALS), and 5022 with Parkinson disease (PD). Several PHQ-9 items demonstrated DIF with respect to disease-specific severity, although salient DIF was present in very few patients (stroke, n = 0; migraine, n = 1; ALS, n = 13; PD, n = 1). CONCLUSIONS PHQ-9 items function consistently across disease severity, with salient levels of DIF impact found only for a very small proportion of people. These results suggest that the PHQ-9 provides a consistent measure of depression severity among people with neurological conditions associated with somatic symptoms that overlap with depression.
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Affiliation(s)
- Irene L Katzan
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Lapin
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sandra Griffith
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erik Pioro
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stewart Tepper
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul K Crane
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
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The experience of care partners of patients with Parkinson's disease psychosis. PLoS One 2021; 16:e0248968. [PMID: 33740031 PMCID: PMC7978339 DOI: 10.1371/journal.pone.0248968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Parkinson’s disease psychosis (PDP) has a major impact on quality of life and care partner burden; however, little is known about the lived experiences of care partners in managing PDP. Objective To understand how care partners of individuals with PDP experience their role and articulate their needs related to psychosis. Methods This was a qualitative study of semi-structured telephone interviews. Recruitment was conducted online via the clinical study matching tool, Fox Trial Finder; study activities took place remotely via telephone interviews. Transcripts of the phone interviews were analyzed by grounded theory methods, and a codebook of key themes that emerged from the analysis was developed. Results Nine care partners (all female) were interviewed. Discussion topics in the codebook included (1) care partner burden and guilt; (2) communication with medical professionals; (3) coping strategies; (4) emotional reactions of the care partner to psychosis; (5) sources of knowledge about PD psychosis; (6) attitudes towards medications for PDP; (7) strategies to care for loved ones with psychosis; (8) psychosis triggers. Conclusions This qualitative analysis uncovers important aspects of the care partner experience, including challenges in navigating the medical system and communicating with professionals. Providers treating patients with PDP should be aware of these constraints and provide added support for strained care partners.
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Slater LV, Gebska A, McCartney K, Rafferty MR. Designing a screening battery for exercisers with Parkinson's disease. Disabil Rehabil 2021; 44:4111-4117. [PMID: 33645370 DOI: 10.1080/09638288.2021.1883748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Develop a screening battery for persons with Parkinson's Disease (PD) that is easily administered in a short amount of time by community exercise professionals and measures changes in function. METHODS An integrated, stakeholder-engaged, mixed methods approach included interviews and meetings with community exercise professionals on the development of a screening battery. Persons with PD (n = 57, age = 72.1 ± 8.1 years) who were already enrolled in fitness classes or individualized training at three locations participated in the screening battery twice over 8-16 weeks and provided feedback. Trends from interviews and meeting notes were identified using summative content analysis. Quantitative changes in performance were compared with paired t-tests. Cohen's d effect sizes were calculated for all significant differences. RESULTS Current barriers for functional screenings included time and space. Using this feedback, we developed a screening battery that took under 20 min, required little equipment, had been previously validated, could be performed in individual and group settings, and provided objective feedback that was motivating for persons with PD to continue exercising. Persons with PD demonstrated improved functional performance on sit-to-stand (d = -0.71), two-minute walk test (d = -3.83), and arm curls (d = -0.78). CONCLUSION Test results can be a motivator for persons with PD and lead to increased exercise adherence. Easily administered tests can show improvements in this population. Community exercise professionals are able to safely screen persons with PD to detect functional deficits and assist with programming.Implications for RehabilitationRegular exercise can slow declines in physical function and quality of life in people with Parkinson's disease.Use of physical assessments in community exercise programs can improve motivation to exercise for this population.Physical assessments such as sit-to-stand and arm curls can be used to demonstrate improvements in people with Parkinson's disease.
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Affiliation(s)
- Lindsay V Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Rehabilitation and Medicine, Northwestern University, Chicago, IL, USA
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Rafferty MR, Nettnin E, Goldman JG, MacDonald J. Frameworks for Parkinson's Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 2021; 21:12. [PMID: 33615420 PMCID: PMC8215896 DOI: 10.1007/s11910-021-01096-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the evidence on rehabilitation for people with Parkinson's disease, including when to refer, what rehabilitation professionals should address, and how to deliver rehabilitation care. RECENT FINDINGS Clinical practice guidelines support physical therapy, occupational therapy, and speech-language pathology for Parkinson's disease. However, integrating guidelines into practice may be difficult. Implementation studies take into account patient and clinician perspectives. Synthesizing guidelines with implementation research can improve local delivery. There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits. We propose a framework of three pathways for rehabilitation care: (1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities; (2) restorative rehabilitation to promote functional improvements; and (3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA.
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Jennifer G Goldman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lin I, Edison B, Mantri S, Albert S, Daeschler M, Kopil C, Marras C, Chahine LM. Triggers and alleviating factors for fatigue in Parkinson's disease. PLoS One 2021; 16:e0245285. [PMID: 33540422 PMCID: PMC7861907 DOI: 10.1371/journal.pone.0245285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fatigue is common in Parkinson's Disease, but few effective treatments are available for it. Exploring triggers and alleviating factors, including effects of exercise, could inform development of management strategies for Parkinson's Disease fatigue. OBJECTIVES To examine triggers and alleviating factors for fatigue reported by individuals with Parkinson's Disease, including perceived effect of exercise. METHODS A sample of individuals with self-reported Parkinson's Disease participating in the study Fox Insight were administered an online survey. The survey included the Parkinson's Fatigue Scale, the Physical Activity Scale for the Elderly, and multiple-choice questions about triggers and alleviating factors for fatigue. RESULTS Among the sample of 1,029 individuals with Parkinson's disease, mean (standard deviation (SD)) age was 67.4 (9.3) years, 44.0% were female. Parkinson's Fatigue Scale score ranged from 16-80, mean (SD) 48.8 (16.2). Poor sleep (62.1%) and physical exertion (45.1%) were frequently reported triggers for fatigue. Coping strategies including sitting quietly (58.1%), laying down with or without napping, and exercise (20%). Physical Activity Scale for the Elderly scores were higher in those who reported that exercise alleviated their fatigue (49.7%) compared to those who reported it worsened their fatigue (18.9%) (mean (SD) score 158.5 (88.8) vs 119.8 (66.6) respectively; p<0.001). CONCLUSIONS Several behavioral and environmental triggers and alleviating strategies for fatigue are reported by individuals with Parkinson's disease. Many feel that exercise alleviates fatigue, though the relationship between exercise and fatigue in Parkinson's Disease appears complex. This exploratory study may inform future development of treatments or coping strategies for Parkinson's disease fatigue.
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Affiliation(s)
- Iris Lin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, United States of America
| | - Steven Albert
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Margaret Daeschler
- Columbia University School of Social Work, New York, NY, United States of America
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, United States of America
| | - Connie Marras
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
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Roberts AC, Rafferty MR, Wu SS, Miao G, Cubillos F, Simuni T. Patterns and predictors of referrals to allied health services for individuals with Parkinson's disease: A Parkinson's foundation (PF) QII study. Parkinsonism Relat Disord 2021; 83:115-122. [PMID: 33339716 PMCID: PMC11283279 DOI: 10.1016/j.parkreldis.2020.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/27/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Rehabilitation therapies are critical for optimizing quality-of-life and daily functions for individuals living with Parkinson's disease (PD). Thus, understanding the patterns of and under what conditions physicians make rehabilitation referrals is important for optimizing care. METHOD We analyzed data from 5020 participants (4 countries) collected from 1/3/2016 to 4/20/2018 as part of the Parkinson's Foundation Quality Improvement Initiative (PF QII). Data were analyzed for single discipline and multidiscipline referrals to speech language pathology (SLP), physical therapy (PT), and occupational therapy (OT). Group comparisons (referred vs. not-referred) and regression procedures were implemented to determine demographic and clinical variables that were associated with an increased likelihood of rehabilitation referral. RESULTS 35.3% of participants were referred to rehabilitation services. Of these, 25.1% received a multidiscipline referral. There was a statistically significant effect of disease stage on both single discipline (χ2(2) = 45.1, p < 0.0001) and multidiscipline (χ2(2) = 74.2, p < 0.0001) referrals, with higher rates in later stages. Referred vs. not-referred participants differed significantly on a number of variables; however, only falls in the 6-months prior, advanced- and moderate-stage disease, older age, hospital admissions, and higher caregiver burden were associated with an increased likelihood of rehabilitation referral (adjusted odds ratios ≥ 1, Range = 1.08 to 1.62). CONCLUSIONS Despite evidence supporting multidiscipline and proactive rehabilitation in PD, the majority of referrals were made to a single service and may be reactions to falls or advancing disease. Data suggest there may be missed opportunities for optimizing care through proactive rehabilitation interventions.
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Affiliation(s)
- Angela C Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60025, USA.
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Northwestern University Department of Physical Medicine and Rehabilitation and Department of Psychiatry and Behavioral Science, 355 E Erie St. 19th Floor, Chicago, IL, 60611, USA.
| | - Samuel S Wu
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, 2004 Mowry Rd P.O. Box 117450, Gainesville, FL, 32611, USA
| | - Guanhuong Miao
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, 2004 Mowry Rd P.O. Box 117450, Gainesville, FL, 32611, USA
| | - Fernando Cubillos
- Parkinson's Foundation, 200 SE 1st Street Ste 800, Miami, FL, 33131, USA
| | - Tanya Simuni
- Feinberg School of Medicine, Department of Neurology, Northwestern University Parkinson's Disease and Movement Disorders Center, Room 1900, NMH/259 E Erie, Chicago, IL, 60611, USA
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Abstract
PURPOSE OF REVIEW This review summarizes the current state of evidence for palliative care (PC) in movement disorders, describes the application of PC to clinical practice, and suggests future research directions. RECENT FINDINGS PC needs are common in persons living with movement disorders and their families from the time of diagnosis through end-of-life and contribute to quality of life. Early advance care planning is preferred by patients, impacts outcomes and is promoted by PC frameworks. Systematic assessment of non-motor symptoms, psychosocial needs and spiritual/existential distress may address gaps in current models of care. Several complementary and emerging models of PC may be utilized to meet the needs of this population. A PC approach may identify and improve important patient and caregiver-centered outcomes. As a relatively new application of PC, there is a need for research to adapt, develop and implement approaches to meet the unique needs of this population.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado, Aurora, CO Building 400, Mail Stop F429, 12469 E 17th Place, Aurora, CO, 80045, USA.
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Medicine, Palliative Care Division, University of Rochester, Rochester, NY, USA
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Kluger BM, Drees C, Wodushek TR, Frey L, Strom L, Brown MG, Bainbridge JL, Fischer SN, Shrestha A, Spitz M. Would people living with epilepsy benefit from palliative care? Epilepsy Behav 2021; 114:107618. [PMID: 33246892 PMCID: PMC9326903 DOI: 10.1016/j.yebeh.2020.107618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Abstract
Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Cornelia Drees
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas R Wodushek
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Frey
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah N Fischer
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Archana Shrestha
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Spitz
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Katz M. Palliative Care for Parkinson's Spectrum Disorders: an Emerging Approach. Neurotherapeutics 2020; 17:1456-1463. [PMID: 33439466 PMCID: PMC7851259 DOI: 10.1007/s13311-020-00989-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
Parkinson's spectrum disorders (PSD) are neurodegenerative parkinsonian conditions that carry a tremendous symptom burden. Palliative care is an interdisciplinary medical specialty that focuses on improving quality of life for patients and caregivers affected by serious life-limiting illnesses, at any stage of disease. Research and clinical programs into this emerging therapeutic approach remain limited. This review focuses on the role of palliative care in the treatment of patients with PSD. Gaps in knowledge and recommendations for future research are discussed.
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Affiliation(s)
- Maya Katz
- Department of Neurology, University of California, San Francisco (UCSF) Medical Center, San Francisco, USA.
- Movement Disorders and Neuromodulation Center, University of California, San Francisco (UCSF), 1635 Divisadero Street, Suite 520, San Francisco, CA, 94121, USA.
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Abstract
Early descriptions of subtypes of Parkinson's disease (PD) are dominated by the approach of predetermined groups. Experts defined, from clinical observation, groups based on clinical or demographic features that appeared to divide PD into clinically distinct subsets. Common bases on which to define subtypes have been motor phenotype (tremor dominant vs akinetic-rigid or postural instability gait disorder types), age, nonmotor dominant symptoms, and genetic forms. Recently, data-driven approaches have been used to define PD subtypes, taking an unbiased statistical approach to the identification of PD subgroups. The vast majority of data-driven subtyping has been done based on clinical features. Biomarker-based subtyping is an emerging but still quite undeveloped field. Not all of the subtyping methods have established therapeutic implications. This may not be surprising given that they were born largely from clinical observations of phenotype and not in observations regarding treatment response or biological hypotheses. The next frontier for subtypes research as it applies to personalized medicine in PD is the development of genotype-specific therapies. Therapies for GBA-PD and LRRK2-PD are already under development. This review discusses each of the major subtyping systems/methods in terms of its applicability to therapy in PD, and the opportunities and challenges designing clinical trials to develop the evidence base for personalized medicine based on subtypes.
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Affiliation(s)
- Connie Marras
- Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - K Ray Chaudhuri
- Parkinson's Foundation International Centre of Excellence, King's College Hospital and King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - Tiago A Mestre
- The Ottawa Hospital Research Institute and University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
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Crotty GF, Schwarzschild MA. Chasing Protection in Parkinson's Disease: Does Exercise Reduce Risk and Progression? Front Aging Neurosci 2020; 12:186. [PMID: 32636740 PMCID: PMC7318912 DOI: 10.3389/fnagi.2020.00186] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
Exercise may be the most commonly offered yet least consistently followed therapeutic advice for people with Parkinson's disease (PD). Epidemiological studies of prospectively followed cohorts have shown a lower risk for later developing PD in healthy people who report moderate to high levels of physical activity, and slower rates of motor and non-motor symptom progression in people with PD who report higher baseline physical activity. In animal models of PD, exercise can reduce inflammation, decrease α-synuclein expression, reduce mitochondrial dysfunction, and increase neurotrophic growth factor expression. Randomized controlled trials of exercise in PD have provided clear evidence for short-term benefits on many PD measurements scales, ranging from disease severity to quality of life. In this review, we present these convergent epidemiological and laboratory data with particular attention to translationally relevant features of exercise (e.g., intensity requirements, gender differences, and associated biomarkers). In the context of these findings we will discuss clinical trial experience, design challenges, and emerging opportunities for determining whether exercise can prevent PD or slow its long-term progression.
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Affiliation(s)
- Grace F. Crotty
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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Di Luca DG, Feldman M, Jimsheleishvili S, Margolesky J, Cordeiro JG, Diaz A, Shpiner DS, Moore HP, Singer C, Li H, Luca C. Trends of inpatient palliative care use among hospitalized patients with Parkinson's disease. Parkinsonism Relat Disord 2020; 77:13-17. [PMID: 32575002 DOI: 10.1016/j.parkreldis.2020.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/16/2020] [Accepted: 06/12/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Palliative care in Parkinson's Disease (PD) is an effective intervention to improve quality of life, although historically, access and availability have been very restricted. METHODS We performed a retrospective cohort study using the National Inpatient Sample (NIS) data from 2007 to 2014. Diagnostic codes were used to identify patients with PD and palliative care referral. Trends were calculated and logistic analysis performed to identify predictors of palliative care use. RESULTS We identified 397,963 hospitalizations from 2007 to 2014 for patients with PD. Of these, 10,639 (2.67%) were referred to palliative care. The rate of consultation increased from 0.85% in 2007 to 4.49% in 2014. For 1 unit in year increase, there was 1.23 time the odds of receiving palliative consultation (OR 1.23, CI 1.21-1.25, p < 0.0001). Hispanics (OR 0.90, CI 0.81-1.01, p = 0.0550), Black (OR 0.90, CI 0.81-1.01, p = 0.0747) and White patients had similar rates of referral after adjustment. Women were less likely to be referred to palliative care (OR 0.90, CI 0.87-0.94, p < 0.0001). Other factors strongly associated with a higher rate of referrals included private insurance when compared to Medicare (OR 2.14, CI 1.89-2.41, p < 0.0001) and higher income (OR 1.41, CI 1.30-1.53, p < 0.0001). CONCLUSION There has been a significant increase in palliative care referrals among hospitalized patients with PD in the US, although the overall rate remains low. After controlling for confounders, racial and ethnic disparities were not found. Women, patients with Medicare/Medicaid, and those with lower income were less likely to be referred to palliative care.
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Affiliation(s)
- Daniel G Di Luca
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Matthew Feldman
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Anthony Diaz
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danielle S Shpiner
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Henry P Moore
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos Singer
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hua Li
- Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Corneliu Luca
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Aye YM, Liew S, Neo SX, Li W, Ng HL, Chua ST, Zhou WT, Au WL, Tan EK, Tay KY, Tan LCS, Xu Z. Patient-Centric Care for Parkinson's Disease: From Hospital to the Community. Front Neurol 2020; 11:502. [PMID: 32582014 PMCID: PMC7296117 DOI: 10.3389/fneur.2020.00502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease (PD) is a chronic neurodegenerative disease with complex motor and non-motor symptoms often leading to significant caregiver burden. An integrated, multidisciplinary care setup involving different healthcare professionals is the mainstay in the holistic management of PD. Many challenges in delivering multidisciplinary team (MDT) care exist, such as insufficient expertise among different healthcare professionals, poor interdisciplinary collaboration, and communication. The need to attend different clinics, incurring additional traveling and waiting time for allied health therapies can also make MDT care more burdensome. By shifting MDT care to local community settings and into patients' homes, patient-centered care can be achieved. In Singapore, the National Neuroscience Institute created the Community Care Partners Programme in 2007 to bring the allied MDT team to the community and nurse-led Integrated Community Care Programme for Parkinson's Disease in 2012 to provide care in community and at patient's home. However, attaining MDT care in the community setting is difficult to achieve where there is a shortage of PD-trained professionals. As such, interdisciplinary and transdisciplinary management would be other best practice options to deliver patient-centric care in PD. Telemedicine could be another viable option to bring the MDT closer to the patient.
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Affiliation(s)
- Yin Minn Aye
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Sylvia Liew
- Parkinson Society Singapore, Singapore, Singapore
| | - Shermyn Xiumin Neo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Wei Li
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
| | - Hwee-Lan Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Shu-Ting Chua
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Wen-Tao Zhou
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Kay-Yaw Tay
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
| | - Louis Chew-Seng Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
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Gupta U, Bansal H, Joshi D. An improved sex-specific and age-dependent classification model for Parkinson's diagnosis using handwriting measurement. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105305. [PMID: 31935580 DOI: 10.1016/j.cmpb.2019.105305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/14/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Diagnosis of Parkinson's with higher accuracy is always desirable to slow down the progression of the disease and improved quality of life. There are evidences of inherent neurological differences between male and females as well as between elderly and adults. However, the potential of such gender and age infomration have not been exploited yet for Parkinson's identification. METHODS In this paper, we develop a sex-specific and age-dependent classification method to diagnose the Parkinson's disease using the online handwriting recorded from individuals with Parkinson's (n = 37; m/f-19/18;age-69.3 ± 10.9yrs) and healthy controls (n = 38; m/f-20/18;age-62.4 ± 11.3yrs). A support vector machine ranking method is used to present the features specific to their dominance in sex and age group for Parkinson's diagnosis. RESULTS The sex-specific and age-dependent classifier was observed significantly outperforming the generalized classifier. An improved accuracy of 83.75% (SD = 1.63) with the female-specific classifier, and 79.55% (SD = 1.58) with the old-age dependent classifier was observed in comparison to 75.76% (SD = 1.17) accuracy with the generalized classifier. CONCLUSIONS Combining the age and sex information proved to be encouraging in classification. A distinct set of features were observed to be dominating for higher classification accuracy in a different category of classification.
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Affiliation(s)
- Ujjwal Gupta
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauzkhas 110016, New Delhi, India.
| | - Hritik Bansal
- Department of Electrical Engineering, Indian Institute of Technology Delhi, Hauzkhas 110016, New Delhi, India.
| | - Deepak Joshi
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauzkhas 110016, New Delhi, India; Department of Biomedical Engineering, All India Institute of Medical Sciences, Delhi, India.
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Sico JJ, Sarwal A, Benish SM, Busis NA, Cohen BH, Das RR, Finsilver S, Halperin JJ, Kelly AG, Meunier L, Phipps MS, Thirumala PD, Villanueva R, von Gaudecker J, Bennett A, Shenoy AM. Quality improvement in neurology. Neurology 2020; 94:982-990. [DOI: 10.1212/wnl.0000000000009525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/30/2020] [Indexed: 01/06/2023] Open
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43
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Higgins R, Hennessey M. From Passive Patient to Engaged Partner: My Journey With Parkinson Disease. J Particip Med 2020; 12:e12566. [PMID: 33064094 PMCID: PMC7434067 DOI: 10.2196/12566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/08/2019] [Accepted: 02/17/2020] [Indexed: 11/21/2022] Open
Abstract
This patient narrative by Richard Higgins with Maureen Hennessey describes Richard's journey of learning to live with a chronic and progressive illness. It begins with Richard's diagnosis and shares many of the lessons learned along the way. Richard copes daily with this condition, relying on the support and expertise of his wife and the treatment team he has assembled while also encouragingly drawing on the skills and knowledge gained as a longtime running coach. A clinical commentary is provided at the article's conclusion, drafted by Richard's friend, Maureen Hennessey, PhD, CPCC, CPHQ, offering observations about the relevance of Richard's story to participatory medicine and suggesting pertinent resources for patients and health care professionals.
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Hamedani AG, Willis AW. Self-reported visual dysfunction in Parkinson disease: the Survey of Health, Ageing and Retirement in Europe. Eur J Neurol 2020; 27:484-489. [PMID: 31571317 PMCID: PMC7012725 DOI: 10.1111/ene.14092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Visual dysfunction is a non-motor symptom of Parkinson disease (PD), but its prevalence is unknown as population-based data on the epidemiology of visual symptoms in PD are lacking. The objective was to determine the prevalence of visual dysfunction in PD. METHODS This was a cross-sectional analysis of data from adults ≥50 years old in the Survey of Health, Ageing and Retirement in Europe (SHARE), a multinational population-based health survey of adults living in one of 27 European countries and Israel. PD diagnosis was self-reported. Impairment in overall, distance or near eyesight was defined as a score of 4 or 5 on a 1-5 scale. Adjusted logistic regression was used to determine the association between PD and self-reported vision. RESULTS There were 115 240 age-eligible participants in the SHARE study (mean age 64.3 years, 54% female), of whom 1438 (1.25%) reported a diagnosis of PD. In adjusted logistic regression models, PD was associated with increased odds of impaired overall [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.91-3.72], distance (OR 2.55, 95% CI 2.04-3.19) and near (OR 2.07, 95% CI 1.69-2.55) eyesight. Individuals with PD were also less likely to report having an eye examination within the previous 2 years (OR 0.59, 95% CI 0.38-0.92), but this did not remain statistically significant after adjusting for confounders (OR 0.76, 95% CI 0.47-1.24). CONCLUSIONS Visual dysfunction is significantly more common in PD than in the general adult population. Visual symptoms are a potentially under-recognized and under-treated source of reduced quality of life in PD patients that require further attention and study.
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Affiliation(s)
- Ali G. Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allison W. Willis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
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45
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Abstract
IMPORTANCE Parkinson disease is the most common form of parkinsonism, a group of neurological disorders with Parkinson disease-like movement problems such as rigidity, slowness, and tremor. More than 6 million individuals worldwide have Parkinson disease. OBSERVATIONS Diagnosis of Parkinson disease is based on history and examination. History can include prodromal features (eg, rapid eye movement sleep behavior disorder, hyposmia, constipation), characteristic movement difficulty (eg, tremor, stiffness, slowness), and psychological or cognitive problems (eg, cognitive decline, depression, anxiety). Examination typically demonstrates bradykinesia with tremor, rigidity, or both. Dopamine transporter single-photon emission computed tomography can improve the accuracy of diagnosis when the presence of parkinsonism is uncertain. Parkinson disease has multiple disease variants with different prognoses. Individuals with a diffuse malignant subtype (9%-16% of individuals with Parkinson disease) have prominent early motor and nonmotor symptoms, poor response to medication, and faster disease progression. Individuals with mild motor-predominant Parkinson disease (49%-53% of individuals with Parkinson disease) have mild symptoms, a good response to dopaminergic medications (eg, carbidopa-levodopa, dopamine agonists), and slower disease progression. Other individuals have an intermediate subtype. For all patients with Parkinson disease, treatment is symptomatic, focused on improvement in motor (eg, tremor, rigidity, bradykinesia) and nonmotor (eg, constipation, cognition, mood, sleep) signs and symptoms. No disease-modifying pharmacologic treatments are available. Dopamine-based therapies typically help initial motor symptoms. Nonmotor symptoms require nondopaminergic approaches (eg, selective serotonin reuptake inhibitors for psychiatric symptoms, cholinesterase inhibitors for cognition). Rehabilitative therapy and exercise complement pharmacologic treatments. Individuals experiencing complications, such as worsening symptoms and functional impairment when a medication dose wears off ("off periods"), medication-resistant tremor, and dyskinesias, benefit from advanced treatments such as therapy with levodopa-carbidopa enteral suspension or deep brain stimulation. Palliative care is part of Parkinson disease management. CONCLUSIONS AND RELEVANCE Parkinson disease is a heterogeneous disease with rapidly and slowly progressive forms. Treatment involves pharmacologic approaches (typically with levodopa preparations prescribed with or without other medications) and nonpharmacologic approaches (such as exercise and physical, occupational, and speech therapies). Approaches such as deep brain stimulation and treatment with levodopa-carbidopa enteral suspension can help individuals with medication-resistant tremor, worsening symptoms when the medication wears off, and dyskinesias.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville
- Fixel Institute for Neurologic Diseases, University of Florida, Gainesville
| | - Michael S Okun
- Department of Neurology, University of Florida College of Medicine, Gainesville
- Fixel Institute for Neurologic Diseases, University of Florida, Gainesville
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Abstract
Palliative care (PC) is an approach to the care of persons affected by serious illness that focuses on reducing suffering by addressing medical, psychosocial, and spiritual needs. Persons living with Parkinson disease have PC needs that begin at the time of diagnosis and continue throughout the course of the illness including nonmotor symptom burden, caregiver distress, grief, and increased mortality. Primary PC refers to essential PC skills that may be practiced by nonpalliative medicine specialists to improve outcomes for their patients.
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Affiliation(s)
- Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Denver, University of Colorado Anschutz Medical Campus, Mail Stop C-293, 12631 East 17th Avenue, Aurora, CO 80045, USA; Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado Denver, University of Colorado Anschutz Medical Campus, Mail Stop B-185, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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Abstract
PURPOSE OF REVIEW This article describes current diagnostic criteria relating to the diagnosis of Lewy body dementia, highlights diagnostic controversies, and reviews treatment approaches. RECENT FINDINGS Clinical diagnostic criteria for both Parkinson disease and dementia with Lewy bodies have been recently updated. These criteria result in overlap between individuals diagnosed with Parkinson disease and those with dementia with Lewy bodies. Although clinical features and symptomatic treatment overlap, differences remain in epidemiology and expected progression. The high prevalence of cognitive impairment in Parkinson disease supports regular screening for cognitive changes and counseling patients and families regarding what to expect. Treatment for Lewy body dementia involves avoiding medications that may cause or exacerbate symptoms; prescribing pharmacologic agents to address bothersome cognitive, behavioral, movement, and other nonmotor symptoms; recommending physical exercise and therapy; and providing education, counseling, caregiver support, and palliative care. SUMMARY Lewy body dementia includes both dementia with Lewy bodies and Parkinson disease dementia, overlapping clinicopathologic entities with differences relating to diagnosis and expected progression. Treatment is symptomatic and thus largely overlapping for the two conditions.
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Radder DL, Nonnekes J, van Nimwegen M, Eggers C, Abbruzzese G, Alves G, Browner N, Chaudhuri KR, Ebersbach G, Ferreira JJ, Fleisher JE, Fletcher P, Frazzitta G, Giladi N, Guttman M, Iansek R, Khandhar S, Klucken J, Lafontaine AL, Marras C, Nutt J, Okun MS, Parashos SA, Munneke M, Bloem BR. Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1087-1098. [PMID: 32444563 PMCID: PMC7415700 DOI: 10.3233/jpd-202078] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Optimal management in expert centers for Parkinson's disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely. OBJECTIVE To optimize care delivery, we aimed to provide recommendations for the organization of multidisciplinary care in PD. METHODS Twenty expert centers in the field of multidisciplinary PD care participated. Their leading neurologists completed a survey covering eight themes: elements for optimal multidisciplinary care; team members; role of patients and care partners; team coordination; team meetings; inpatient versus outpatient care; telehealth; and challenges towards multidisciplinary care. During a consensus meeting, outcomes were incorporated into concept recommendations that were reviewed by each center's multidisciplinary team. Three patient organizations rated the recommendations according to patient priorities. Based on this feedback, a final set of recommendations (essential elements for delivery of multidisciplinary care) and considerations (desirable elements) was developed. RESULTS We developed 30 recommendations and 10 considerations. The patient organizations rated the following recommendations as most important: care is organized in a patient-centered way; every newly diagnosed patient has access to a core multidisciplinary team; and each team has a coordinator. A checklist was created to further facilitate its implementation. CONCLUSION We provide a practical tool to improve multidisciplinary care for persons with PD at the organizational level. Future studies should focus on implementing these recommendations in clinical practice, evaluating their potential applicability and effectiveness, and comparing alternative models of PD care.
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Affiliation(s)
- Danique L.M. Radder
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation; Nijmegen, The Netherlands
| | - Marlies van Nimwegen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Alves
- The Norwegian Center for Movement Disorders, Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Nina Browner
- University of North Carolina, Movement Disorders Center, Chapel Hill, NC, USA
| | - K. Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Parkinson Foundation International Center of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Georg Ebersbach
- Movement Disorder Clinic Beelitz-Heilstaetten, Beelitz, Germany
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- CNS – Campus Neurológico Sénior, Torres Vedras, Portugal
| | | | | | | | - Nir Giladi
- Neurological Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Suketu Khandhar
- Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
- Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany
| | - Anne-Louise Lafontaine
- Department of Neurology and Neurosurgery, McGill Movement Disorders Clinic, McGill University, Montreal, Canada
| | - Connie Marras
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Canada
| | - John Nutt
- Oregon & Health Science University Hospital, Portland, OR, USA
| | - Michael S. Okun
- University of Florida Department of Neurology, Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | | | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
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49
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Rafferty MR, MacDonald J, Byskosh A, Sloan L, Toledo S, Marciniak C, Simuni T. Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report. Phys Ther 2019; 99:1644-1655. [PMID: 31508801 PMCID: PMC7372734 DOI: 10.1093/ptj/pzz129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation. CASE DESCRIPTION The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods. OUTCOMES In the program's first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program. DISCUSSION Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 E Erie St, 19th Floor Strength and Endurance Lab, Chicago, IL 60611 (USA); and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University
| | - Jillian MacDonald
- Shirley Ryan AbilityLab. Dr MacDonald is a board-certified clinical specialist in neurologic physical therapy
| | | | | | - Santiago Toledo
- Shirley Ryan AbilityLab; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Christina Marciniak
- AbilityLab; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; and Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University
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50
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Advance care planning in Parkinson's disease: ethical challenges and future directions. NPJ PARKINSONS DISEASE 2019; 5:24. [PMID: 31799376 PMCID: PMC6874532 DOI: 10.1038/s41531-019-0098-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
Recent discoveries support the principle that palliative care may improve the quality of life of patients with Parkinson's disease and those who care for them. Advance care planning, a component of palliative care, provides a vehicle through which patients, families, and clinicians can collaborate to identify values, goals, and preferences early, as well as throughout the disease trajectory, to facilitate care concordant with patient wishes. While research on this topic is abundant in other life-limiting disorders, particularly in oncology, there is a paucity of data in Parkinson's disease and related neurological disorders. We review and critically evaluate current practices on advance care planning through the analyses of three bioethical challenges pertinent to Parkinson's disease and propose recommendations for each.
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