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Zhao Y, Wu W, Wu J, Shen B, Cao Y, Xu Y. Risk factors and intervention of caregiver burden in Parkinson's disease: a systematic review and meta-analysis. Qual Life Res 2024; 33:1753-1766. [PMID: 38573387 DOI: 10.1007/s11136-024-03616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This study summarized characteristics and risk factors of caregiver burden in PD patients and used meta-analysis to verify the effectiveness of the intervention on caregiver burden. METHODS Systematic review and meta-analysis were conducted. RESULTS Forty-nine articles that involved 5387 caregivers of patients with PD were included in this study. Results of systematic review indicated that Zarit burden Inventory (ZBI) was the most used scale to measure the caregiver burden. All scales revealed caregivers of PD patients had mild to moderate caregiver burden. For the PD patients with longer disease duration, severer disease severity, more negative emotion and cognition impairment, their caregivers intended to have higher caregiver burden. The caregiver with negative emotion and who spent more time on caregiving indicated higher caregiver burden than the others. The caregiver burden was not improved after deep brain stimulation (DBS). Meta-analysis showed that cognitive behavior therapy and palliative care had no significant effect to reduce caregiver burden in PD patients' caregiver. CONCLUSION Caregivers of PD patients experienced mild to moderate caregiver burden. Demographic factor, diseased-related factor and negative emotional factor were the risk factors of caregiver burden. Health education and care support for long-term management after DBS surgery should be provided for patients and caregivers to decrease caregiver burden.
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Affiliation(s)
- Yan Zhao
- Department of Nursing, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, China
| | - Wenxiang Wu
- Department of Nursing, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, China
| | - Jianjun Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Bin Shen
- Department of Nursing, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, China
| | - Yanpei Cao
- Department of Nursing, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, China.
| | - Yafang Xu
- Department of Nursing, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, China.
- National Center for Neurological Disorders, Shanghai, China.
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China.
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Lee CY, Shin C, Hwang YS, Oh E, Kim M, Kim HS, Chung SJ, Sung YH, Yoon WT, Cho JW, Lee JH, Kim HJ, Chang HJ, Jeon B, Woo KA, Koh SB, Kwon KY, Moon J, Kim YE, Lee JY. Caregiver Burden of Patients With Huntington's Disease in South Korea. J Mov Disord 2024; 17:30-37. [PMID: 37691330 PMCID: PMC10846961 DOI: 10.14802/jmd.23134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/26/2023] [Accepted: 09/08/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE This is the first prospective cohort study of Huntington's disease (HD) in Korea. This study aimed to investigate the caregiver burden in relation to the characteristics of patients and caregivers. METHODS From August 2020 to February 2022, we enrolled patients with HD from 13 university hospitals in Korea. We used the 12-item Zarit Burden Interview (ZBI-12) to evaluate the caregiver burden. We evaluated the clinical associations of the ZBI-12 scores by linear regression analysis and investigated the differences between the low- and high-burden groups. RESULTS Sixty-five patients with HD and 45 caregivers were enrolled in this cohort study. The average age at onset of motor symptoms was 49.3 ± 12.3 years, with an average cytosine-adenine-guanine (CAG)n of 42.9 ± 4.0 (38-65). The median ZBI-12 score among our caregivers was 17.6 ± 14.2. A higher caregiver burden was associated with a more severe Shoulson-Fahn stage (p = 0.038) of the patients. A higher ZBI-12 score was also associated with lower independence scale (B = -0.154, p = 0.006) and functional capacity (B = -1.082, p = 0.002) scores of patients. The caregiving duration was longer in the high- than in the low-burden group. Caregivers' demographics, blood relation, and marital and social status did not affect the burden significantly. CONCLUSION HD patients' neurological status exerts an enormous impact on the caregiver burden regardless of the demographic or social status of the caregiver. This study emphasizes the need to establish an optimal support system for families dealing with HD in Korea. A future longitudinal analysis could help us understand how disease progression aggravates the caregiver burden throughout the entire disease course.
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Affiliation(s)
- Chan Young Lee
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Yun Su Hwang
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sook Kim
- Department of Neurology, Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Won Tae Yoon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hyeok Lee
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jin Chang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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3
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Morales-Briceño H, Ha AD, Chiang HL, Tai Y, Chang FCF, Tsui DS, Griffith J, Galea D, Kim SD, Cruse B, Mahant N, Fung VSC. A single centre prospective study of three device-assisted therapies for Parkinson's disease. NPJ Parkinsons Dis 2023; 9:101. [PMID: 37386050 DOI: 10.1038/s41531-023-00525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Comparative studies assessing outcomes with the three device-assisted therapies could help to individualise treatment for patients living with Parkinson's disease. We designed a single-centre non-randomised prospective observational study assessing the quality of life (QoL), motor and non-motor outcomes at 6 and 12-months in patients treated with subcutaneous apomorphine continuous 16-hours infusion (APO), levodopa-carbidopa intestinal gel (LCIG) or subthalamic nucleus deep brain stimulation (STN-DBS). In this study, 66 patients were included (13 APO; 19 LCIG; 34 STN-DBS). At baseline, cognitive, non-motor and motor scores were significantly less severe in the STN-DBS group, whereas the LCIG group had a longer disease duration and higher non-motor scores. In the APO group, there were no statistically significant changes in non-motor, motor and QoL scales. The LCIG group had significant changes in QoL and motor scales that were significant after multiple comparison analysis at 6 and 12-months. The STN-DBS group showed improvement in QoL scores and non-motor and motor scores at 6 and 12-months after multiple comparison analysis. In this real-life prospective study, device-assisted therapies showed differences in their effects on QoL and motor and non-motor function at 12-months. However, there were also differences in baseline characteristics of the patient groups that were not based on pre-determined selection criteria. Differences in characteristics of patients offered and/or treatment with different device-assisted therapies may reflect within-centre biases that may, in turn, influence perceptions of treatment efficacy or outcomes. Treatment centres should be aware of this potential confounder when assessing and offering device-assisted treatment options to their patients and potential baseline differences need to be taken into consideration when comparing the results of non-randomised studies.
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Affiliation(s)
- Hugo Morales-Briceño
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Ainhi D Ha
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Han-Lin Chiang
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yicheng Tai
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Department of Neurology, E-DA Hospital/I-Shou University, No.1, Yida Rd., Yanchao Dist., Kaohsiung City, 824, Taiwan
| | - Florence C F Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - David S Tsui
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Jane Griffith
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Donna Galea
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Samuel D Kim
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Belinda Cruse
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Neil Mahant
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia.
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Maggi G, Vitale C, Delle Curti A, Amboni M, Santangelo G. Unawareness of Apathy in Parkinson's Disease: The Role of Executive Dysfunction on Symptom Recognition. Brain Sci 2023; 13:964. [PMID: 37371442 DOI: 10.3390/brainsci13060964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Altered self-awareness or anosognosia may impact patients' everyday life by interfering with their safe and independent functioning. Symptom awareness has been linked to executive dysfunctions caused by damage to frontal regions. Apathy is a frequent neuropsychiatric manifestation of Parkinson's disease (PD) and is considered a consequence of altered functioning of cortico-subcortical circuitries connecting the prefrontal cortex (PFC) with the basal ganglia. Thus, apathetic PD patients may be not be fully aware of their condition due to shared neuropathophysiological mechanisms. The present study aimed to explore the awareness of apathy in PD patients by comparing the self-reported evaluations with their caregivers' ratings. Moreover, we explored the clinical predictors of possible discrepancies and their consequences on patients' self-reported evaluation of quality of life (QoL). We found a fair agreement between patients' self-reports and caregivers' ratings on apathy scores, with patients reporting less severe apathetic symptoms, especially those related to executive and auto-activation processing, compared to their caregivers' reports. Executive functioning was found to mediate the relationship between disease stage and awareness of the apathetic state. Awareness of executive apathy impacted patients' self-reported QoL. Therefore, PD patients might be unaware of their apathetic symptoms, especially those with worse executive functioning, which plays a key role in metacognitive processes such as self-monitoring and error detection. Anosognosia for apathy in PD patients may affect their QoL perception and leads to misleading self-report evaluations that delay diagnosis and treatment.
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Affiliation(s)
- Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Carmine Vitale
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, 80131 Naples, Italy
- Department of Motor Sciences and Wellness, University "Parthenope", 80133 Naples, Italy
| | - Alessia Delle Curti
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Marianna Amboni
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, 80131 Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
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Olvera CE, Fleisher JE, Kramer NM. Motor Complications and Treatment in Advanced Parkinson's Disease #456. J Palliat Med 2023; 26:730-731. [PMID: 37130285 DOI: 10.1089/jpm.2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
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Martinez-Martin P, Skorvanek M, Henriksen T, Lindvall S, Domingos J, Alobaidi A, Kandukuri PL, Chaudhari VS, Patel AB, Parra JC, Pike J, Antonini A. Impact of advanced Parkinson's disease on caregivers: an international real-world study. J Neurol 2023; 270:2162-2173. [PMID: 36633671 PMCID: PMC9835744 DOI: 10.1007/s00415-022-11546-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/25/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Caring for a partner or family member with Parkinson's disease (PD) negatively affects the caregiver's own physical and emotional well-being, especially those caring for people with advanced PD (APD). This study was designed to examine the impact of APD on caregiver perceived burden, quality of life (QoL), and health status. METHODS Dyads of people with PD and their primary caregivers were identified from the Adelphi Parkinson's Disease Specific Program (DSP™) using real-world data from the United States, Japan and five European countries. Questionnaires were used to capture measures of clinical burden (people with PD) and caregiver burden (caregivers). RESULTS Data from 721 patient-caregiver dyads in seven countries were captured. Caregivers had a mean age 62.6 years, 71.6% were female, and 70.4% were a spouse. Caregivers for people with APD had a greater perceived burden, were more likely to take medication and had lower caregiver treatment satisfaction than those caring for people with early or intermediate PD; similar findings were observed for caregivers of people with intermediate versus early PD. Caregivers for people with intermediate PD were also less likely to be employed than those with early PD (25.3% vs 42.4%) and spent more time caring (6.6 vs 3.2 h/day). CONCLUSIONS This real-world study demonstrates that caregivers of people with APD experience a greater burden than those caring for people with early PD. This highlights the importance of including caregiver-centric measures in future studies, and emphasizes the need for implementing treatments that reduce caregiver burden in APD. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Pablo Martinez-Martin
- grid.413448.e0000 0000 9314 1427Center for Networked Biomedical Research, Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Matej Skorvanek
- grid.11175.330000 0004 0576 0391Department of Neurology, P. J. Šafárik University, Košice, Slovakia
- grid.412894.20000 0004 0619 0183Department of Neurology, University Hospital L. Pasteur, Košice, Slovakia
| | - Tove Henriksen
- grid.475435.4Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | | | - Josefa Domingos
- European Parkinson’s Disease Association (EPDA), Sevenoaks, UK
| | - Ali Alobaidi
- grid.431072.30000 0004 0572 4227AbbVie Inc., North Chicago, IL USA
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Chicago, IL USA
| | | | | | - Apeksha B. Patel
- grid.431072.30000 0004 0572 4227AbbVie Inc., North Chicago, IL USA
| | | | - James Pike
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - Angelo Antonini
- grid.5608.b0000 0004 1757 3470Movement Disorders Unit, Department of Neuroscience, University of Padova, Padua, Italy
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7
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Antonini A, Pahwa R, Odin P, Henriksen T, Soileau MJ, Rodriguez-Cruz R, Isaacson SH, Merola A, Lindvall S, Domingos J, Alobaidi A, Jalundhwala YJ, Kandukuri PL, Parra JC, Kukreja PK, Onuk K, Bergmann L, Pike J, Ray Chaudhuri K. Psychometric Properties of Clinical Indicators for Identification and Management of Advanced Parkinson's Disease: Real-World Evidence From G7 Countries. Neurol Ther 2022; 11:303-318. [PMID: 35015215 PMCID: PMC8857339 DOI: 10.1007/s40120-021-00313-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Standardized and validated criteria to define advanced Parkinson's disease (PD) or identify patient eligibility for device-aided therapy are needed. This study assessed the psychometric properties of clinical indicators of advanced PD and eligibility for device-aided therapy in a large population. METHODS This retrospective analysis of the Adelphi Parkinson's Disease Specific Programme collected data from device-aided therapy-naïve people with PD in G7 countries. We assessed the presence of 15 clinical indicators of advancing PD and seven indicators of eligibility for device-aided therapy in patients classified with advanced PD or as eligible for device-aided therapy by the treating physician. Accuracy was assessed using area under the curve (AUC) and multivariable logistic regression models. Construct validity was examined via known-group comparisons of disease severity and burden among patients with and without each clinical indicator. RESULTS Of 4714 PD patients, 14.9% were classified with advanced PD and 17.5% as eligible for device-aided therapy by physician judgment. The presence of each clinical indicator was 1.9- to 7.3-fold more likely in patients classified with advanced PD. Similarly, the presence of device-aided therapy eligibility indicators was 1.8- to 5.5-fold more likely in patients considered eligible for device-aided therapy. All indicators demonstrated high clinical screening accuracy for identifying advanced PD (AUC range 0.84-0.89) and patients eligible for device-aided therapy (AUC range 0.73-0.80). The Unified Parkinson's Disease Rating Scale (UPDRS) score, cognitive function, quality of life, and caregiver burden were significantly worse in indicator-positive patients. CONCLUSION Specific clinical indicators of advanced PD and eligibility for device-aided therapy demonstrated excellent psychometric properties in a large sample, and thus may provide an objective and reliable approach for patient identification and treatment optimization.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Centre for Neurodegeneration, Department of Neuroscience, University of Padova, Padova, Italy
| | - Rajesh Pahwa
- Medical Center, University of Kansas, Kansas, KS, USA
| | - Per Odin
- University of Lund, Lund, Sweden
| | - Tove Henriksen
- Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | | | | | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center, Boca Raton, FL, USA
| | - Aristide Merola
- Madden Center for Parkinson Disease and Other Movement Disorders, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Josefa Domingos
- European Parkinson's Disease Association, Sevenoaks, UK
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do CiiEM, Almada, Portugal
| | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | | | | | | | - James Pike
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - K Ray Chaudhuri
- King's College and Parkinson Foundation Centre of Excellence, Kings College Hospital London, London, UK.
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Hermanowicz N, Ospina MC, Torres-Yaghi Y, Gould S, Papesh K, Rivera JA, Miller S, Jones S, Musick K, May D. Impact of Isolation During the COVID-19 Pandemic on the Patient Burden of Parkinson's Disease: A PMD Alliance Survey. Neuropsychiatr Dis Treat 2022; 18:633-643. [PMID: 35355505 PMCID: PMC8958201 DOI: 10.2147/ndt.s351691] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/22/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE As the COVID-19 pandemic resulted in social restrictions around the globe, this cross-sectional survey aimed to assess the impact of social isolation on self- or proxy-reported symptoms of Parkinson's disease (PD) during the pandemic. PATIENTS AND METHODS The survey was distributed among 7109 subscribers of the Parkinson and Movement Disorders Alliance (PMD Alliance) News and Information list and was open only to people with PD (PwP) and care partners (CP, defined as main caregivers of PwP and serving as proxy respondents). No attempt was made to identify PwP and CP pairs. The survey was distributed online using Survey Monkey between 01/06/2021 and 02/27/2021. Respondents were grouped by level of social support from outside of their household during the pandemic (decreased or maintained [ie, the same as pre-pandemic or increased]). RESULTS Of 7109 invited participants, 718 responded to the survey (response rate 10.1%). PwP (self-reports) accounted for 70.6% of respondents and CP (proxy reports) for 29.4%. Decreased social support from outside of the household during the COVID-19 pandemic (58.5% of all responses) was significantly associated with increases in sadness/depression and anxiety, compared with maintained levels of social support (p < 0.0001 for both comparisons). It was also associated with increased burden of several non-motor (decline in memory, problem solving, or communication, p = 0.0009; new or worsening confusion, p < 0.0001; new or worsening delusions, p = 0.018) and motor PD symptoms. CONCLUSION Decline in social support from outside of the household during the COVID-19 pandemic showed a statistically significant and negative association with the burden of mood and non-motor symptoms of PD. These results call for increased vigilance towards non-motor symptoms in PwP experiencing social isolation and highlight the need for stronger provider focus on encouraging PwP and their CPs to build and maintain social connections and engagements.
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Affiliation(s)
| | | | | | - Sherrie Gould
- Scripps Clinic Movement Disorder Center, La Jolla, CA, USA
| | - Kelly Papesh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jason A Rivera
- Parkinson and Movement Disorder Alliance (PMD Alliance), Tucson, AZ, USA
| | - Susan Miller
- Parkinson and Movement Disorder Alliance (PMD Alliance), Tucson, AZ, USA
| | - Sarah Jones
- Parkinson and Movement Disorder Alliance (PMD Alliance), Tucson, AZ, USA
| | | | - Damian May
- ACADIA Pharmaceuticals Inc, San Diego, CA, USA
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9
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Kalampokini S, Hommel ALAJ, Lorenzl S, Ferreira JJ, Meissner WG, Odin P, Bloem BR, Dodel R, Schrag AE. Caregiver Burden in Late-Stage Parkinsonism and Its Associations. J Geriatr Psychiatry Neurol 2022; 35:110-120. [PMID: 33094677 DOI: 10.1177/0891988720968263] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients in the late stages of parkinsonism are highly dependent on others in their self-care and activities of daily living. However, few studies have assessed the physical, psychological and social consequences of caring for a person with late-stage parkinsonism. PATIENTS AND METHODS Five hundred and six patients and their caregivers from the Care of Late Stage Parkinsonism (CLaSP) study were included. Patients' motor and non-motor symptoms were assessed using the UPDRS and Non-motor symptom scale (NMSS), Neuropsychiatric inventory (NPI-12), and caregivers' health status using the EQ-5D-3 L. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). RESULTS The majority of caregivers were the spouse or life partner (71.2%), and were living with the patient at home (67%). Approximately half of caregivers reported anxiety/depression and pain/discomfort (45% and 59% respectively). The factors most strongly associated with caregiver burden were patients' neuropsychiatric features on the total NPI score (r = 0.38, p < 0.0001), total NMSS score (r = 0.28, p < 0.0001), caring for male patients and patients living at home. Being the spouse, the hours per day assisting and supervising the patient as well as caregivers' EQ-5D mood and pain scores were also associated with higher ZBI scores (all p < 0.001). CONCLUSION The care of patients with late stage parkinsonism is associated with significant caregiver burden, particularly when patients manifest many neuropsychiatric and non-motor features and when caring for a male patient at home.
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Affiliation(s)
- Stefania Kalampokini
- UCL Queen Square Institute of Neurology, 61554University College London, United Kingdom
| | - Adrianus L A J Hommel
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, 6029Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, 162199Paracelsus Medical University, Salzburg, Austria.,Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München-Klinikum Großhadern, Munich, Germany.,Department of Neurology, Agatharied Hospital, Hausham, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular 37809Universidade di Lisboa, Lisboa, Portugal
| | - Wassilios G Meissner
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Institut des Maladies Neurodégénératives, 27086University de Bordeaux, Bordeaux, France.,Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Per Odin
- Department of Neurology, 59568Lund University Hospital, Sweden
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, 6029Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Richard Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Germany.,Department of Neurology, Philipps-University Marburg, Germany
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Bentley A, Morgan T, Salifu Y, Walshe C. Exploring the experiences of living with Lewy body dementia: An integrative review. J Adv Nurs 2021; 77:4632-4645. [PMID: 34146346 DOI: 10.1111/jan.14932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/30/2023]
Abstract
AIM Lewy body dementia is a common neurodegenerative dementia with unique challenges in managing day-to-day life. A more in-depth multifaceted picture of the Lewy body dementia lived experience will enable identification of best practice and future research direction. The review aim was to explore experiences of people living with Lewy body dementia and their family carers. DESIGN Integrative review method informed by Whittemore and Knafl, supported by the information retrieval framework PALETTE. A convergent integrated approach enabled synthesis of key findings and theme identification. DATA SOURCES Medline, CINAHL, PsycINFO, AMED, and ALOIS databases were systematically searched to find studies published between 1995 and 2020. REVIEW METHODS Twenty-six articles from twenty studies were synthesized (from 1583 retrieved). Quality and relevance were appraised using the Mixed-Methods Appraisal Tool and Gough's 'Weight of Evidence' framework. Data management was supported by ATLAS.ti 8 and COVIDENCE software. RESULTS Four themes were identified: living with an uncertain diagnosis and prognosis; fear of the now - worry for the future; living with behavioural and psychiatric symptoms; and maintaining a social and emotional life. People reported difficulty finding information and support around diagnosis, disease progression and managing complex symptoms. The result is increased caregiver burden, grief and stress and reduced quality of life. CONCLUSION Delayed diagnosis and complex symptom burden means people are not getting the timely support and information they need to live and die well. Current evidence is largely quantitative, with a focus on family caregiver burden and unmet need. The challenge remains in how to capture a more holistic picture of the lived experience for people living with Lewy body dementia and those who care for them. IMPACT This review highlighted current knowledge and identified gaps in exploring the lived experience for people with Lewy body dementia and their families.
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Affiliation(s)
- Allison Bentley
- Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Research Unit, Fulbourn Hospital, Cambridge, UK.,International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, Lancaster, UK
| | - Tessa Morgan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yakubu Salifu
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, Lancaster, UK
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11
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Juneja A, Anand K, Chandra M, Deshpande S, Dhamija R, Kathuria P, Mahajan R. Neuropsychiatric Symptoms and Caregiver Burden in Parkinson's Disease. Ann Indian Acad Neurol 2021; 23:656-660. [PMID: 33623267 PMCID: PMC7887493 DOI: 10.4103/aian.aian_91_20] [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: 02/12/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: Parkinson’s disease (PD) is a neurodegenerative disorder. It has a significant impact on the quality of life of patients and their caregivers. The present study aims to study the phenomena of neuropsychiatric symptoms and their association with caregiver burden in PD. Methods: The study was conducted in 100 patients of Parkinson’s disease and their primary caregivers. The patients of PD were diagnosed on the basis of UK Brain Bank criteria; severity/staging of Parkinson’s disease was done by Movement Disorder Society - Unified Parkinson’s disease rating scale (MDS-UPDRS-III). Patients who fulfilled inclusion and exclusion criteria were recruited for the study. The neuropsychiatric evaluation was based on Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver burden was assessed with the Zarit Caregiver Burden Inventory (ZCBI). Results: Mean age of PD patients was 61.48 ± 6.71 years, majority of them were males (68%). Mean total NPI score of patients was 44.46 ± 5.38. Mean age of caregivers was 52.26 ± 6.80 years, majority of them were females (72%) and spouse (76%) in relation to the patient. Caregiver burden was significantly related to age of the patient, duration of illness, severity of illness, and total NPI score. Conclusion: Neuropsychiatric symptoms significantly contribute to the caregiver burden in Parkinson’s disease.
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Affiliation(s)
| | - Kuljeet Anand
- Department of Neurology, Dr. RML Hospital, Delhi, India
| | - Mina Chandra
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | | | - Rajinder Dhamija
- Department of Neurology, LHMC and Sucheta Kriplani Hospital, Delhi, India
| | - Parul Kathuria
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | - Rahul Mahajan
- Department of Neurology, Dr. RML Hospital, Delhi, India
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12
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Saini D, Mukherjee A, Roy A, Biswas A. A Comparative Study of the Behavioral Profile of the Behavioral Variant of Frontotemporal Dementia and Parkinson's Disease Dementia. Dement Geriatr Cogn Dis Extra 2020; 10:182-194. [PMID: 33569074 PMCID: PMC7841718 DOI: 10.1159/000512042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Executive dysfunction is the common thread between pure cortical dementia like the behavioral variant of frontotemporal dementia (bvFTD) and subcortical dementia like Parkinson's disease dementia (PDD). Although there are clinical and cognitive features to differentiate cortical and subcortical dementia, the behavioral symptoms differentiating these 2 conditions are still not well known. OBJECTIVE To evaluate the behavioral profile of bvFTD and PDD and compare them to find out which behavioral symptoms can differentiate between the two. METHODS Twenty consecutive patients with bvFTD (>1 year after diagnosis) and 20 PDD patients were recruited according to standard diagnostic criteria. Behavioral symptoms were collected from the reliable caregiver by means of a set of questionnaires and then compared between the 2 groups. RESULTS bvFTD patients had more severe disease and more behavioral symptoms than PDD. bvFTD patients were different from PDD patients due to their significantly greater: loss of basic emotion (p < 0.001, odds ratio [OR] 44.33), loss of awareness of pain (p < 0.001, OR 44.33), disinhibition (p < 0.001, OR 35.29), utilization phenomenon (p = 0.008, OR 22.78), loss of taste discrimination (p < 0.001, OR 17), neglect of hygiene (p = 0.001, OR 13.22), loss of embarrassment (p = 0.003, OR 10.52), wandering (p = 0.004, OR 9.33), pacing (p = 0.014, OR 9), selfishness (p = 0.014, OR 9), increased smoking (p = 0.014, OR 9), increased alcohol consumption (p = 0.031, OR 7.36), social avoidance (p = 0.012, OR 6.93), mutism (p = 0.041, OR 5.67), and failure to recognize objects (p = 0.027, OR 4.33). The bvFTD patients were also significantly less suspicious (p = 0.001, OR 0.0295), less inclined to have a false belief that people were in their home (p = 0.014, OR 0.11) and had fewer visual illusions/hallucinations (p = 0.004, OR 0.107) than PDD patients. CONCLUSION Behavioral symptoms are helpful to distinguish bvFTD from PDD, and thus also cortical dementia with frontal-lobe dysfunction from subcortical dementia.
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Affiliation(s)
| | | | | | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences, and Institute of Post Graduate Medical Education and Research, Kolkata, India
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13
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Tulek Z, Baykal D, Erturk S, Bilgic B, Hanagasi H, Gurvit IH. Caregiver Burden, Quality of Life and Related Factors in Family Caregivers of Dementia Patients in Turkey. Issues Ment Health Nurs 2020; 41:741-749. [PMID: 32286096 DOI: 10.1080/01612840.2019.1705945] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate caregiver burden and quality of life (QoL) and their predictors in family caregivers of dementia patients. A descriptive cross-sectional survey was carried out with a sample of 102 patients and their family caregivers. The Caregiver Burden Inventory (CBI) and Short Form-12 (SF-12) were used to collect data. CBI mean score was 37.97 ± 21.30. Mean scores of SF-12 sub-domains varied between 36.02 and 77.94 and were significantly lower as compared to normative means of the general population, excluding only the physical health subdomain. Among several patient and caregiver-related correlations, the number of medications and worse cognitive function of the patient, caregiver's age and having limited space at home were found as predictors of burden, whereas caregiver's chronic disease and having a limited space were predictors of QoL. Also, the burden and QoL were correlated. This study demonstrated a high burden and low QoL in dementia caregivers. In societies where caregivers are mostly informal such as that in Turkey, supportive systems should be established.
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Affiliation(s)
- Zeliha Tulek
- Department of Medical Nursing, Istanbul University-Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Dilek Baykal
- Department of Medical Nursing, Halic University School of Health Sciences, Istanbul, Turkey
| | - Sumeyye Erturk
- Istanbul University-Cerrahpasa Institute of Graduate Studies, Istanbul, Turkey
| | - Basar Bilgic
- Istanbul University Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
| | - Hasmet Hanagasi
- Istanbul University Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
| | - I Hakan Gurvit
- Istanbul University Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
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14
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Neuropsychiatric symptoms in Parkinson's disease: association with caregiver distress and disease severity. Int Psychogeriatr 2020; 32:733-739. [PMID: 31647049 DOI: 10.1017/s1041610219001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The condition of caregivers is important to the quality of care received by people with Parkinson's disease (PD), especially at the late disease stages. This study addresses the distress placed on caregivers by participants' neuropsychiatric symptoms at different stages of PD in Taiwan. METHODS This prospective study enrolled 108 people with PD. All participants were examined with the Unified Parkinson's Disease Rating Scale (UPDRS), Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), and Clinical Dementia Rating (CDR) scale. Caregiver distress was measured using the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). Statistical analysis was used to explore the PD-related factors that contribute to caregiver distress. RESULTS The mean follow-up interval in the 108 PD participants were 24.0 ± 10.2 months with no participant lost to follow-up due to death. NPI-distress (the sum of NPI caregiver distress scale across the 12 domains of the NPI) was positively correlated with NPI-sum (the total score across the 12 domains of the NPI) (r = 0.787, p < 0.001), CDR (r = 0.403, p < 0.001), UPRDS (r = 0.276, p = 0.004), and disease duration (r = 0.246, p = 0.002), but negatively correlated with CASI (r = -0.237, p = 0.043) and MMSE (r = -0.281, p < 0.001). Multiple linear regression analysis showed that only NPI-sum and disease duration were independently correlated with NPI-distress. CONCLUSION The disease duration and NPI-sum are independent predictors of caregiver distress in Taiwanese populations with PD. Early detection and reduction of neuropsychiatric symptoms in people with PD can help decrease caregiver distress.
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15
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Lazcano-Ocampo C, Wan YM, van Wamelen DJ, Batzu L, Boura I, Titova N, Leta V, Qamar M, Martinez-Martin P, Ray Chaudhuri K. Identifying and responding to fatigue and apathy in Parkinson’s disease: a review of current practice. Expert Rev Neurother 2020; 20:477-495. [DOI: 10.1080/14737175.2020.1752669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Claudia Lazcano-Ocampo
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Department of Neurology, Hospital Sotero Del Rio, Santiago, Chile
| | - Yi Min Wan
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Department of Psychiatry, Ng Teng Fong General Hospital, Singapore
| | - Daniel J van Wamelen
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Cognition and Behaviour; Department of Neurology; Nijmegen, Radboud University Medical Centre; Donders Institute for Brain, The Netherlands
| | - Lucia Batzu
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Iro Boura
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Budgetary Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Valentina Leta
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Mubasher Qamar
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health. Madrid, Spain
| | - K Ray Chaudhuri
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
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16
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Modugno N, Antonini A, Tessitore A, Marano P, Pontieri FE, Tambasco N, Canesi M, Fabbrini G, Sensi M, Quatrale R, Solla P, Defazio G, Melzi G, Gualberti G, Lopiano L. Impact of Supporting People with Advanced Parkinson's Disease on Carer's Quality of Life and Burden. Neuropsychiatr Dis Treat 2020; 16:2899-2912. [PMID: 33293815 PMCID: PMC7719333 DOI: 10.2147/ndt.s256217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess the burden and the quality of life (QoL) perceived by caregivers assisting advanced Parkinson's disease (PD) patients. PATIENTS AND METHODS Consecutive advanced PD patients treated with levodopa/carbidopa intestinal gel (LCIG) or continuous subcutaneous apomorphine infusion (CSAI) or care as usual (CU) and their care partners were recruited during routine visits according to a cross-sectional design. Caregiver's distress was assessed by Zarit Burden Interview (ZBI) and a QoL survey to evaluate and understand the burden experienced by care partners during family and working activities. RESULTS A total of 126 patients (53 LCIG, 19 CSAI and 54 CU) and their care partners were enrolled. The ZBI score boxplot showed that LCIG and CU populations have a similar distribution (ZBI inter-quartile range [IQR] values respectively 18-42 for LCIG and 19-43 for CU group), while the CSAI group has a wider score range (IQR 16-52). Caregivers assisting patients in treatment with LCIG have more time to perform family or household duties (p=0.0022), or to engage in leisure activities (p=0.0073) compared to CU, while no difference was found when compared to CSAI group. Approximately 50% of the care partners showed mood changes in the last 6 months and LCIG and CSAI had less impact on caregiver's mood compared to CU. Patients treated with LCIG were more independent in taking a bath or shower without assistance and were more able to move and walk without assistance. CONCLUSION Care partners of advanced PD patients treated with device-aided therapies have more time for their own life and a better perception of their QoL with a tendency to an improvement of mood compared with those of patients treated with CU.
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Affiliation(s)
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandro Tessitore
- Department of Medical and Surgery Sciences, University of Campania, "Luigi Vanvitelli", Naples, Italy
| | - Pietro Marano
- Casa di Cura Madonna del Rosario, Raggruppamento di Riabilitazione, Catania, Italy
| | - Francesco Ernesto Pontieri
- Department NESMOS, "Sapienza" University, Sant'Andrea Hospital, Roma, Italy.,IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Nicola Tambasco
- Department of Neurology, Perugia General Hospital and University of Perugia, Perugia, Italy
| | - Margherita Canesi
- Dipartimento di Riabilitazione Malattia di Parkinson e Disordini del Movimento, Gravi Cerebrolesioni Acquisite, Italia Hospital - Ospedale "Moriggia-Pelascini", Gravedona ed Uniti, Como, Italy.,Centro Parkinson e Disordini del Movimento, CTO, G Pini, Milano, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | | | - Paolo Solla
- Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy
| | - Giovanni Defazio
- Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy
| | | | | | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini" University of Torino, Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
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17
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Terum TM, Testad I, Rongve A, Aarsland D, Svendsboe E, Andersen JR. The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress. Int J Geriatr Psychiatry 2019; 34:1421-1428. [PMID: 31050041 DOI: 10.1002/gps.5134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/12/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) are identified as important care-recipient variables in terms of the impact on carer distress. The aim of this study was to determine whether specific neuropsychiatric disturbances in people with Alzheimer disease (AD) and dementia with Lewy bodies (DLB) differentially impact carer distress. METHODS This was a cross-sectional study of people diagnosed with AD and DLB and their primary carers. The Relatives' Stress Scale (RSS) was used to assess the level of reported distress in carers, and the Neuropsychiatric Inventory (NPI) was used to assess NPSs. The effect of NPSs on carer distress was analyzed using correlation analysis and partial least squares regression. RESULTS This study included 159 participants diagnosed with AD (n = 97) and DLB (n = 62) and their primary carers (spouses and adult children). The majority of people diagnosed with dementia were women (64.2%), with a mean age of 75.9 years (SD, 7.4) and a mean Mini-Mental State Examination (MMSE) score of 23.5 (SD, 2.9). The main analysis identified apathy as the most important NPS contributing to carer distress. Compared with AD, the explained variance in the DLB group was higher (r2 = 37.3 vs r2 = 53.7). In addition, more NPSs were considered clinically important in the DLB group. CONCLUSION The findings of this study identify apathy as the most important NPS contributing to carer distress among carers of people with AD and DLB. These findings help us identify the support needs of families dealing with dementia.
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Affiliation(s)
- Toril Marie Terum
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ingelin Testad
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna, Haugesund, Norway
| | - Dag Aarsland
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ellen Svendsboe
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - John Roger Andersen
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
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Trait Impulsivity Is Independent of Mild Cognitive Impairment in a Parkinson's Disease Cohort. PARKINSONS DISEASE 2019; 2019:2672075. [PMID: 31662842 PMCID: PMC6791270 DOI: 10.1155/2019/2672075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 01/16/2023]
Abstract
Introduction Patients with Parkinson's disease (PD) commonly experience cognitive deficits and some also develop impulse control disorders (ICDs); however, the relationship between impulsivity and cognitive dysfunction remains unclear. This study investigated whether trait impulsivity associates with mild cognitive impairment (MCI), or is altered in a PD patient cohort with MCI. Methods A total of 302 patients with idiopathic PD were recruited sequentially from three Australian Movement Disorder clinics. Based on cognitive scores, participants were divided into two groups, one defined as having mild cognitive impairment (PD-MCI; n = 113) and the other with normal cognitive function (PD-C; n = 189). Trait impulsivity was evaluated using the Barrett Impulsiveness Scale 11 (BIS-11). Total impulsivity scores, as well as subscale scores, were compared between PD-C and PD-MCI groups. Results The PD-MCI cohort had significantly lower scores in all cognitive domains, and mirrored expected clinical differences in medication, motor symptoms, and disease duration, when compared to the PD-C cohort. Self-reported impulsivity was not significantly different between groups, nor was there a difference within first-order subscale scores: attention (p=0.137), cognitive instability (p=0.787), self-control (p=0.503), cognitive complexity (p=0.157), motor impulsivity (p=0.559), or perseverance (p=0.734) between the PD-MCI and PD-C groups. Conclusions These findings suggest that impulsive traits and behaviors are independent of changes in cognitive state and are not altered in PD patients with mild cognitive impairment.
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19
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Martinez-Martin P, Macaulay D, Jalundhwala YJ, Mu F, Ohashi E, Marshall T, Sail K. The long-term direct and indirect economic burden among Parkinson's disease caregivers in the United States. Mov Disord 2018; 34:236-245. [PMID: 30589953 PMCID: PMC6590233 DOI: 10.1002/mds.27579] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinson's disease is a progressive, disabling neurodegenerative disorder associated with significant economic burden for patients and caregivers. The objective of this study was to compare the direct and indirect economic burden of Parkinson's patients' caregivers with demographically matched controls in the United States, in the 5 years after first diagnosis of Parkinson's disease. METHODS Policyholders (18-64 years old) linked to a Parkinson's disease patient (≥2 diagnoses of Parkinson's disease; first diagnosis is the index date) from January 1, 1998 to March 31, 2014, were selected from a private-insurer claims database and categorized as Parkinson's caregivers. Eligible Parkinson's caregivers were matched 1:5 to policyholders with a non-Parkinson's dependent (controls). Multivariable regression adjusted for baseline characteristics estimated direct costs (all-cause insurer cost [medical and prescription] and comorbidity-related medical costs; patient out-of-pocket costs) and indirect costs (disability and medically related absenteeism costs). Income progression was also compared between cohorts. RESULTS A total of 1211 eligible Parkinson's caregivers (mean age, 56 years; 54% female) were matched to 6055 controls. In adjusted analyses, Parkinson's caregivers incurred significantly higher year 1 total all-cause insurer costs ($8999 vs $7117) and medical costs ($7081 vs $5568) (both P < 0.01) and higher prescription costs (range for years 1-5, $2506-2573 vs $1405-$1687) and total out-of-pocket costs ($1259-1585 vs $902-$1192) in years 1-5 (all P < 0.01). Parkinson's caregivers had significantly higher adjusted indirect costs in years 1-3 (range for years 1-3, $2054-$2464 vs $1681-$1857; all P < 0.05) and higher cumulative income loss over 5 years ($5967 vs $2634 by year 5; P for interaction = 0.03). CONCLUSIONS Parkinson's caregivers exhibited higher direct and indirect costs and greater income loss compared with matched controls. © 2018 International Parkinson and Movement Disorder Society © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | | | | | - Fan Mu
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Erika Ohashi
- Analysis Group, Inc., Boston, Massachusetts, USA
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20
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Tessitore A, Marano P, Modugno N, Pontieri FE, Tambasco N, Canesi M, Latorre A, Lopiano L, Sensi M, Quatrale R, Solla P, Defazio G, Melzi G, Costanzo AM, Gualberti G, di Luzio Paparatti U, Antonini A. Caregiver burden and its related factors in advanced Parkinson's disease: data from the PREDICT study. J Neurol 2018. [PMID: 29516169 PMCID: PMC5937896 DOI: 10.1007/s00415-018-8816-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Caring for a person with Parkinson’s disease (PD) is associated with an increased risk of psychiatric morbidity and persistent distress. The objective of this study was to describe the burden and the related factors of caregivers of advanced PD (APD) patients either treated with continuous dopaminergic delivery systems or standard therapy. Methods This cross-sectional, epidemiologic study conducted in 13 Italian sites enrolled PD patients treated with continuous dopaminergic delivering systems [either levodopa/carbidopa intestinal gel (LCIG) infusion or continuous subcutaneous apomorphine infusion (CSAI)] or continuation of standard of care (SOC) with a caregiver. Patient quality of life (QoL) and caregiver burden were assessed using the Parkinson’s Disease Questionnaire (PDQ-8) and Zarit Burden Inventory (ZBI), respectively. Results 126 patients (mean age 69.3 ± 8 years) and their caregivers (mean age 57.9 ± 12.9) were enrolled. Most caregivers were spouses. Fifty-three patients were treated with LCIG, 19 with CSAI, and 54 with SOC. Mean ZBI scores were 29.6 ± 14.4 for LCIG, 35.8 ± 20.2 for CSAI, and 31.4 ± 16.0 for SOC. Caregivers of LCIG, CSAI, and SOC patients showed no burden or mild/moderate burden in 74, 53, and 63% of the cases, respectively. Mean PDQ-8 scores were 11.25 ± 5.67, 11.26 ± 5.55, and 14.22 ± 6.51 in LCIG, CSAI, and SOC patients. Neurologists considered patients “very much or much improved” in 89, 58, and 13% of the LCIG, CSAI, and SOC groups using the Clinical Global Impression–Global Improvement Scale. Predictors significantly associated with caregiver burden were patients and caregivers’ judgment of QoL and caregivers’ need to change work. Conclusions Caregiver burden showed a tendency to be lower when patients are treated with LCIG than with CSAI or SOC.
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Affiliation(s)
- Alessandro Tessitore
- First Division of Neurology, University of Campania, "Luigi Vanvitelli", Napoli, Italy
| | | | | | | | - Nicola Tambasco
- Perugia General Hospital and University of Perugia, Perugia, Italy
| | - Margherita Canesi
- Centro Specialistico Ortopedico Traumatologico G. Pini-CTO Milano, Milan, Italy
| | | | - Leonardo Lopiano
- Department of Neuroscience, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Paolo Solla
- Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy
| | - Giovanni Defazio
- Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy
| | | | | | | | | | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
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21
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Lawson RA, Yarnall AJ, Johnston F, Duncan GW, Khoo TK, Collerton D, Taylor JP, Burn DJ. Cognitive impairment in Parkinson's disease: impact on quality of life of carers. Int J Geriatr Psychiatry 2017; 32:1362-1370. [PMID: 27925292 PMCID: PMC5724657 DOI: 10.1002/gps.4623] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The quality of life (QoL) of informal caregivers of people with Parkinson's disease (PD) (PwP) can be affected by the caring role. Because of cognitive symptoms and diminished activities of daily living, in addition to the management of motor symptoms, carers of PwP and cognitive impairment may experience increased levels of burden and poorer QoL compared with carers of PwP without cognitive impairment. This study aimed to investigate the impact of cognitive impairment in PD upon QoL of carers. METHODS Approximately 36 months after diagnosis, 66 dyadic couples of PwP and carers completed assessments. PwP completed a schedule of neuropsychological assessments and QoL measures; carers of PwP completed demographic questionnaires and assessments of QoL. Factor scores of attention, memory/executive function and global cognition, as derived by principal component analysis, were used to evaluate cognitive domains. RESULTS Hierarchical regression analysis found lower Montreal Cognitive Assessment was a significant independent predictor of poorer carer QoL, in addition to number of hours spent caregiving, carer depression and PD motor severity. Attentional deficits accounted for the largest proportion of variance of carer QoL. Carers of PwP and dementia (n = 9) had significantly poorer QoL scores compared with PwP and mild cognitive impairment (n = 18) or normal cognition (n = 39) carers (p < 0.01). CONCLUSIONS Attentional deficits were the strongest predictor of carer QoL compared with other cognitive predictors. Carers for those with PD dementia reported the poorest QoL. Interventions such as respite or cognitive behavioural therapy to improve mood and self-efficacy in carers may improve carer QoL. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.
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Affiliation(s)
- RA Lawson
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - AJ Yarnall
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - F Johnston
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - GW Duncan
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - TK Khoo
- School of Medicine and Menzies Health Institute QueenslandGriffith UniversityQueenslandAustralia
| | - D Collerton
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - JP Taylor
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - DJ Burn
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
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22
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Baik JS, Kim JS, Koh SB, Cho JW, Lee PH, Ma HI, Kim YJ, Ahn TB, Kim SJ, Kim YD, Choi SM, Lee HW, Kim HT. Patients and Their Caregivers' Burdens for Parkinson's Disease in Korea. J Mov Disord 2017; 10:109-115. [PMID: 28950688 PMCID: PMC5615179 DOI: 10.14802/jmd.17053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Many patients with Parkinson’s disease (PD) suffer from motor and non-motor symptoms. According to these variable symptoms of PD, patients or caregivers have a poorer quality of life than patients with other neurodegenerative diseases. Since the difficulties are varied for all patients, prioritizing their difficulties differs among all cases. The goal of this study was to investigate the burdens of PD among the caregivers as well as patients and to identify areas requiring aid from the government. Methods We surveyed the awareness and perceptions of PD in patients and caregivers of PD by a face-to-face questionnaire. The questionnaire was divided into three sections: symptoms of PD (part A), desire for policies (part B), and difficulties faced by their caregivers (part C). Part A comprised 8 questions, Part B had 2 questions, and Part C had 3 questions. Results In total, 853 subjects (702 patients and 151 caregivers) were enrolled in this study. The major difficulties experienced by PD patients were physical (67%), psychiatric (60%) and socio-economic (52%). Assessing the physical difficulties, more than half the patients experienced severe difficulties (29% very severe, 39% severe). Psychiatric difficulties were assessed as severe (35%) and very severe (21%) among the patients. Severe difficulties were also experienced socio-economically, at 52% in patients and 49% in caregivers, especially among patients in their fifties (58%) and those with their spouse (65%) as caregivers. The topmost need was the introduction of new technology for treatment of PD (62%), followed by relief of costs for treatment (38%) and a family support system (31%). The majority (91%) of the patients were diagnosed with PD within two years after onset of symptoms. Conclusion We know that the difficulties of PD and the needs for government assistance are different between patients and caregivers. These results emphasize that perceiving the difficulties and needs of patients and caregivers early can help to prevent and ameliorate the burden of disease.
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Affiliation(s)
- Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Yun Joong Kim
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Duk Kim
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University College of Medicine, Gwangju, Korea
| | - Ho-Won Lee
- Department of Neurology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Hee Tae Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
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23
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Chen CT, Chang CC, Chang WN, Tsai NW, Huang CC, Chang YT, Wang HC, Kung CT, Su YJ, Lin WC, Cheng BC, Su CM, Hsiao SY, Hsu CW, Lu CH. Neuropsychiatric symptoms in Alzheimer's disease: associations with caregiver burden and treatment outcomes. QJM 2017; 110:565-570. [PMID: 28383687 DOI: 10.1093/qjmed/hcx077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Caregivers play a major role in providing care for patients with Alzheimer's disease (AD) and are themselves at higher risk of health comorbidities. AIM To address the impact of neuropsychiatric symptoms of patients in different stages of AD on their caregivers' burden. DESIGN This prospective study enrolled 260 AD patients with clinical dementia rating (CDR) of 0.5, 1 and 2 at a tertiary medical center. METHODS All patients were tested using the mini-mental state examination (MMSE), the cognitive abilities screening instrument (CASI), the neuropsychiatric inventory (NPI) and the CDR scale. Data regarding therapeutic outcomes of anti-Alzheimer's drugs were also collected. Caregivers were tested using NPI. RESULTS The mean follow-up interval was 25.0 ± 12.2 months, and two patients died during follow-up. NPI-burden was positively correlated with NPI-sum ( r = 0.822, P < 0.001) but negatively correlated with years of education ( r = -0.140, P = 0.024), CASI score ( r = -0.259, P < 0.001) and MMSE score ( r = -0.262, P <0.001). Multiple linear regression analysis showed that only NPI-sum was independently associated with mean NPI-burden. Both higher mean CASI and MMSE scores had better therapeutic outcome of anti-Alzheimer's drugs ( P = 0.001 and P = 0.005, respectively). CONCLUSIONS The severity of neuropsychiatric symptoms in patients with AD was positively associated with caregiver's stress, and patients with better cognitive functions, under treatment with anti-Alzheimer's drugs, had better therapeutic outcomes. To reduce the impact of neuropsychiatric symptoms, it is crucial to detect dementia in its early phases and provide early intervention with anti-Alzheimer's drugs, which might help decrease the caregiver burden, thereby improving their quality of life.
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Affiliation(s)
| | | | | | | | | | | | | | - C-T Kung
- Department of Emergency Medicine
| | - Y-J Su
- Department of Internal Medicine
| | - W-C Lin
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - B-C Cheng
- Department of Internal Medicine
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
| | - C-M Su
- Department of Emergency Medicine
| | - S-Y Hsiao
- Department of Emergency Medicine
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
| | - C-W Hsu
- Department of Neurology
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
| | - C-H Lu
- Department of Neurology
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China
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24
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Badcock JC, Dehon H, Larøi F. Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research. Front Psychol 2017; 8:1134. [PMID: 28736541 PMCID: PMC5500657 DOI: 10.3389/fpsyg.2017.01134] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
KEY POINTS➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts. ➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond. ➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood. ➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions.
Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western AustraliaPerth, WA, Australia.,Australia and Perth Voices Clinic, Murdoch University Child and Adult Psychology Service, Murdoch UniversityMurdoch, WA, Australia
| | - Hedwige Dehon
- Psychology and Neuroscience of Cognition Research Unit, University of LiegeLiege, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, University of LiegeLiege, Belgium.,Department of Biological and Medical Psychology, University of BergenBergen, Norway.,NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of OsloOslo, Norway
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25
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Terum TM, Andersen JR, Rongve A, Aarsland D, Svendsboe EJ, Testad I. The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. Int J Geriatr Psychiatry 2017; 32:703-717. [PMID: 28317166 DOI: 10.1002/gps.4704] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 02/08/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) are common in dementia, and they have been identified as important care-recipient variables in terms of their impact on caregiver burden. The aim of this review was to describe how individual NPSs in dementia, assessed using the Neuropsychiatric Inventory, are associated with caregiver burden. METHODS We performed a systematic review of English language, peer-reviewed articles retrieved from MEDLINE, PSYCINFO, and EMBASE. RESULTS A total of 13 studies met the inclusion criteria. Four studies examined the association between individual NPSs and caregiver burden using the Spearman rank correlation test, while three used Pearson's correlation test. Of the remaining studies, five used multiple regression analyses and one the chi-squared test. The majority of included studies did not differentiate between dementia subtypes in the analysis or mainly included only caregivers of people with Alzheimer's disease. The Clinical Dementia Rating score and mean Mini-Mental State Examination score indicate mild to moderate dementia. The majority of caregivers were women, most of whom were children (53.8%) or spouses (36%). The data indicated that irritability, followed by agitation, sleep disturbances, anxiety, apathy, and delusion seem to impact caregiver burden the most. CONCLUSION Our principal finding is that irritability, agitation, sleep disturbances, anxiety, apathy, and delusion seem to exert the most impact on caregiver burden. Heterogeneity in the measures and statistical analyses used, however, makes it difficult to make conclusive interpretations. Future research in this field would benefit from standardization of the scientific methodology in use. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Toril Marie Terum
- Westeren Norway University of Applied Science, Førde, Norway.,Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - John Roger Andersen
- Westeren Norway University of Applied Science, Førde, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna, Haugesund, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Ellen J Svendsboe
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Nursing, Westeren Norway University of Applied Science, Stord, Norway.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Ingelin Testad
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Wolfson Centre for Age-Related Diseases, King's College London, London, UK
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26
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Moretti R, Caruso P, Dal Ben M. Rivastigmine as a Symptomatic Treatment for Apathy in Parkinson's Dementia Complex: New Aspects for This Riddle. PARKINSON'S DISEASE 2017; 2017:6219851. [PMID: 28409049 PMCID: PMC5376458 DOI: 10.1155/2017/6219851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/17/2017] [Accepted: 03/02/2017] [Indexed: 12/26/2022]
Abstract
Over 90% of PDD patients show at least one neuropsychiatric symptom (NPS); in the 60-70% two or more NPS are present. Their incidence is important in terms of prognosis and severity of pathology. However, among all NPS, apathy is often the most disturbing, associated with greater caregiver's burden. Similar to other NPS, apathy may be due to a dysfunction of the nigrostriatal pathway, even though, not all the PD patients become apathetic, indicating that apathy should not entirely be considered a dopamine-dependent syndrome, and in fact it might also be related to acetylcholine defects. Apathy has been treated in many ways, without sure benefits; among these, Rivastigmine may present benefic properties. We present a series of 48 patients, suffering from PDD, treated with Rivastigmine, and followed-up for one year; they have been devotedly studied for apathy, even though all the other NPS disorders have been registered. Rivastigmine did not have a prolonged benefic effect on apathy, in our work, on the contrary of what had been observed in the literature, probably due to the longer follow-up of our patients.
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Affiliation(s)
- Rita Moretti
- Clinica Neurologica, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Paola Caruso
- Clinica Neurologica, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Matteo Dal Ben
- FIF Science Park, University of Trieste, Trieste, Italy
- Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
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27
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Abstract
PURPOSE OF REVIEW This article provides an updated review of the determinants of caregiver burden and depression, with a focus on care demands and especially the differential effects of various neuropsychiatric symptoms or symptom clusters. Moreover, studies on caregivers for frontotemporal and Lewy body dementias were referred to in order to identify differences and similarities with the mainstream literature based largely on Alzheimer caregivers. RECENT FINDINGS As a group, neuropsychiatric symptoms are most predictive of caregiver burden and depression regardless of dementia diagnosis, but the effects appear to be driven primarily by disruptive behaviors (e.g., agitation, aggression, disinhibition), followed by delusions and mood disturbance. Disruptive behaviors are more disturbing partly because of the adverse impact on the emotional connection between the caregiver and the care-recipient and partly because they exacerbate difficulties in other domains (e.g., caring for activities of daily living). In behavioral variant frontotemporal dementia, not only are these disruptive behaviors more prominent but they are also more disturbing due to the care-recipient's insensitivity to others' feelings. In Lewy body dementia, visual hallucinations also appear to be distressing. The disturbing nature of disruptive behaviors cuts across dementia conditions, but the roles played by symptoms that are unique or particularly serious in a certain condition need to be explored further.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, NT, Hong Kong. .,Department of Clinical Psychology, Noriwch Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK.
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Rittman T, Coyle-Gilchrist IT, Rowe JB. Managing cognition in progressive supranuclear palsy. Neurodegener Dis Manag 2016; 6:499-508. [PMID: 27879155 PMCID: PMC5134756 DOI: 10.2217/nmt-2016-0027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairment is integral to the syndrome of progressive supranuclear palsy. It is most commonly described as a frontal dysexecutive syndrome but other impairments include apathy, impulsivity, visuospatial and memory functions. Cognitive dysfunction may be exacerbated by mood disturbance, medication and communication problems. In this review we advocate an individualized approach to managing cognitive impairment in progressive supranuclear palsy with the education of caregivers as a central component. Specific cognitive and behavioral treatments are complemented by treatment of mood disturbances, rationalizing medications and a patient-centered approach to communication. This aims to improve patients’ quality of life, reduce carer burden and assist people with progressive supranuclear palsy in decisions about their life and health, including discussions of feeding and end-of-life issues.
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Affiliation(s)
- Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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29
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Neuropsychiatric symptoms in Serbian patients with Parkinson's disease. J Neurol Sci 2016; 367:342-6. [DOI: 10.1016/j.jns.2016.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/12/2016] [Accepted: 06/10/2016] [Indexed: 01/23/2023]
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30
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Rodríguez-González AM, Rodríguez-Míguez E, Duarte-Pérez A, Díaz-Sanisidro E, Barbosa-Álvarez Á, Clavería A. [Cross-sectional study of informal caregiver burden and the determinants related to the care of dependent persons]. Aten Primaria 2016; 49:156-165. [PMID: 27423241 PMCID: PMC6875977 DOI: 10.1016/j.aprim.2016.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe the burden of informal carers of dependent people and to identify related variables. DESIGN Descriptive observational cross-sectional study. LOCATION Primary Health Care in the southern area of Pontevedra. PARTICIPANTS 97 caregivers of dependent persons. KEY MEASUREMENTS We collected socioeconomic data and health conditions from caregivers and dependent persons, time spent on the daily care and caregiver burden (Zarit abbreviate) through a personal interview. Besides the description of the sample-including their burden level-, a contrast mean was used to identify characteristics that influenced in punctuation of Zarit scale. A logistic regression was used to analyse characteristics that increase the likelihood to experiment burden. RESULTS 61.9% of caregivers are subject to intense burden. The item on the scale which contributes most to the caregiver burden is the lack of time for oneself, followed by the negative effects of interpersonal relationships. Contrast means shows that degree of relationship, number of care hours, caregiver health and aggressiveness of dependent persons produce significant differences in Zarit scale. Physic and psychological health of caregivers and aggressiveness of dependent persons is associated with the likelihood of developing caregiver burden. CONCLUSIONS Informal caregivers of dependent persons show a high level of burden, both related to their characteristics and those of the dependent persons. Caregiver burden rethinks the need for public policies focused on dependence to adopt an integrative caregiver-dependent vision.
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Affiliation(s)
| | - Eva Rodríguez-Míguez
- Departamento de Economía Aplicada, Facultad de Ciencias Económicas y Empresariales, Universidad de Vigo, Vigo, España
| | | | | | | | - Ana Clavería
- Atención Primaria, Estrutura Organizativa de Xestión Integrada (EOXI) de Vigo, Vigo, España
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31
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Zhang-James Y, Faraone SV. Genetic architecture for human aggression: A study of gene-phenotype relationship in OMIM. Am J Med Genet B Neuropsychiatr Genet 2016; 171:641-9. [PMID: 26288127 DOI: 10.1002/ajmg.b.32363] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/05/2015] [Indexed: 01/02/2023]
Abstract
Genetic studies of human aggression have mainly focused on known candidate genes and pathways regulating serotonin and dopamine signaling and hormonal functions. These studies have taught us much about the genetics of human aggression, but no genetic locus has yet achieved genome-significance. We here present a review based on a paradoxical hypothesis that studies of rare, functional genetic variations can lead to a better understanding of the molecular mechanisms underlying complex multifactorial disorders such as aggression. We examined all aggression phenotypes catalogued in Online Mendelian Inheritance in Man (OMIM), an Online Catalog of Human Genes and Genetic Disorders. We identified 95 human disorders that have documented aggressive symptoms in at least one individual with a well-defined genetic variant. Altogether, we retrieved 86 causal genes. Although most of these genes had not been implicated in human aggression by previous studies, the most significantly enriched canonical pathways had been previously implicated in aggression (e.g., serotonin and dopamine signaling). Our findings provide strong evidence to support the causal role of these pathways in the pathogenesis of aggression. In addition, the novel genes and pathways we identified suggest additional mechanisms underlying the origins of human aggression. Genome-wide association studies with very large samples will be needed to determine if common variants in these genes are risk factors for aggression. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Yanli Zhang-James
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York
| | - Stephen V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York.,Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
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Hermanowicz S, Hermanowicz N. The safety, tolerability and efficacy of pimavanserin tartrate in the treatment of psychosis in Parkinson’s disease. Expert Rev Neurother 2016; 16:625-33. [DOI: 10.1586/14737175.2016.1158102] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Effect of lumbo-peritoneal shunt surgery on neuropsychiatric symptoms in patients with idiopathic normal pressure hydrocephalus. J Neurol Sci 2016; 361:206-12. [DOI: 10.1016/j.jns.2016.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/24/2015] [Accepted: 01/01/2016] [Indexed: 11/21/2022]
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Abstract
BACKGROUND In spite of the recognized physical and psychosocial effects of caring for patients with Parkinson's disease (PD), caregiver burden (CB) in this setting is poorly understood. The objective of this research was to identify factors that were associated with CB in an Australian population of PD caregivers using a novel instrument - the Parkinson's Disease Caregiver Burden (PDCB) questionnaire. METHODS Fifty patient-caregiver couples were recruited from three movement disorders clinics in Melbourne, Australia. Burden on caregivers was rated using the PDCB questionnaire. Burden scores were correlated with patient factors, including motor symptom severity (Unified Parkinson's Disease Ratings Scale and Hoehn & Yahr (H&Y) scale), patient cognition (Neuropsychiatry Unit Cognitive Assessment Tool; NUCOG), presence of impulsive and compulsive behaviors (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease), and patient olfaction. Caregiver and patient demographics, as well as results for depression and anxiety (Hospital Anxiety and Depression Scale; HADS), were also examined for their relationship with CB. RESULTS H&Y stage, depression or anxiety in either caregiver or patient, and decreased patient NUCOG score were significantly associated with higher PDCB score. Multiple linear regression analysis identified caregiver and patient depression score and patient score for the visuoconstructional subscale of NUCOG to predict burden score. In addition, disease duration, duration of caregiving, and increased hours per day spent in giving care were significantly associated with increased burden. CONCLUSIONS We found psychiatric and cognitive factors to be the most relevant factors in the perception of burden in PD caregivers. On top of this, we found deficits in the domain of visuoconstruction predicted burden - a relationship not yet described in literature. Targeting depression and anxiety in this setting as well as identifying caregivers at high risk of burden may give clinicians the chance to optimize care of patients with PD through the caregiver.
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Oh YS, Kim JS, Lee PH. Effect of Rivastigmine on Behavioral and Psychiatric Symptoms of Parkinson's Disease Dementia. J Mov Disord 2015; 8:98-102. [PMID: 26090082 PMCID: PMC4460546 DOI: 10.14802/jmd.15041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/04/2015] [Accepted: 02/11/2015] [Indexed: 12/22/2022] Open
Abstract
Objective A recent study showed that rivastigmine and memantin improved behavioral and psychiatric symptoms of dementia (BPSD) in Alzheimer’s dementia. Furthermore, according to recent guidelines presented by the Movement Disorder Society, rivastigmine is efficacious for the treatment of dementia in Parkinson’s disease (PD). We investigated the efficacy of rivastigmine for BPSD in patients with Parkinson’s disease dementia (PDD). Methods Twenty-three patients in whom cognitive impairment occurred at least one year after a diagnosis of PD participated in this open-label trial. Cognitive, psychiatric, and motor symptoms were assessed before and after 24 weeks of treatment with rivastigmine using unstructured clinical assessments and rating scales including the Unified Parkinson’s Disease Rating Scale, Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory. Results Age (± standard deviation) was 74.7 ± 5.9 years, average duration of PD was 3.5 ± 3.7 years, Hoehn and Yahr scores were 2.2 ± 0.8, and baseline MMSE scores were 19.1 ± 4.2. Improvements in global mental symptoms and neuropsychiatric symptoms were significant; among them, hallucination, depression and appetite changes improved. Caregiver distress significantly decreased, including distress resulting from hallucinations, depression, apathy, and appetite changes. Conclusions Although controlled trials are required, the findings suggest that rivastigmine is useful for control of several neuropsychiatric symptoms and beneficial for caregiver distress in patients with PDD.
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Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
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Oh YS, Kim JS, Park IS, Shim YS, Song IU, Park JW, Lee PH, Lyoo CH, Ahn TB, Ma HI, Kim YD, Koh SB, Lee SJ, Lee KS. Prevalence and treatment pattern of Parkinson's disease dementia in Korea. Geriatr Gerontol Int 2015; 16:230-6. [DOI: 10.1111/ggi.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Joong-Seok Kim
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In-Seok Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Yong-Soo Shim
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In-Uk Song
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Jeong-Wook Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Phil-Hyu Lee
- Department of Neurology; Yonsei University College of Medicine; Seoul Korea
| | - Chul-Hyung Lyoo
- Department of Neurology; Yonsei University College of Medicine; Seoul Korea
| | - Tae-Beom Ahn
- Department of Neurology; School of Medicine; Kyung Hee University; Seoul Korea
| | - Hyo-Il Ma
- Department of Neurology; Hallym University College of Medicine; Anyang Korea
| | - Yong-Duk Kim
- Department of Neurology; Konyang University Hospital; College of Medicine; Konyang University; Daejeon Korea
| | - Seong-Beom Koh
- Department of Neurology; Korea University College of Medicine; Seoul Korea
| | - Seung-Jae Lee
- Department of Neurology; Sejong General Hospital; Bucheon Korea
| | - Kwang-Soo Lee
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
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