Health-Related Quality of Life for Parkinson's Disease Patients and Their Caregivers

The impact and value of the Parkinson's nurse specialist to people with Parkinson's and their care partners: a grounded theory qualitative study

BACKGROUND

Where available, Parkinson's Nurse Specialists (PNS) provide a range of care, support, guidance, and advocacy for people with Parkinson's (PwP), and, where appropriate, their care partners (CP). Parkinson's is a complex and progressive condition. Consequently, evaluating health outcomes is not a reliable method to understand the value and impact of PNS. Previous research has identified PNS can improve the subjective well-being of PwP in the community, also that barriers to care include heavy caseloads and a lack of time. Yet little is known about the value of the role of the PNS, particularly about the impact of pharmacological management and review. This research aims to close this research gap by providing explanatory theories of the impact and value of PNS to PwP, their CP, and other professionals.

METHODS

A social constructivist grounded theory approach was used. Semi-structured interviews were conducted with three groups, PNS, PwP, and CP. Interviews were analysed using NVivo for coding and categorising and Word for memo-writing. Data was analysed inductively and iteratively to identify contexts, social processes, actions, and behaviours, before final emergent theories were identified.

RESULTS

46 semi-structured interviews (PNS 18, PwP 19, CP 9) led to four data categories and 13 sub-categories that delineated PNS value. (1) Expert Counsel; provision of emotional support, education, and lifestyle guidance; CP inclusion; provision from diagnosis; and across all stages of Parkinson's. (2) Conduit of Care; signposting, referral, and connection to PwP, CP, others; PNS barriers and facilitators; (3) Team/Partnership; continuity and partnership, 'working together'; (4) Pharmacological Support, PNS prescribing; concordance; speed of treatment. Where PNS were accessible they could offer personalised support and partnership, so providing person-centred care that improves health and well-being.

CONCLUSION

Where a PNS is accessible due to service availability and manageable caseloads, to provide person-centred care, they deliver several benefits to PwP and CP which improve health and perceived well-being. Where PNS are not available, PwP and CP often struggle to manage their Parkinson's with negative impacts on health and well-being.

Understanding what aspects of Parkinson's disease matter most to patients and families

Understanding what matters to people with Parkinson's and their family is essential to derive relevant clinical outcome measures and guide clinical care. The purpose of this study was to explore what is important to people with Parkinson's disease vs. family over time. A qualitative content-analysis of online survey data collected by Parkinson's UK was conducted to identify types and frequencies of important symptoms and impacts of Parkinson's for people with the disease vs. family of people with Parkinson's. Independent T-tests were used to identify significance of between group differences for patients vs. family at < 2, 2-5, 6-10, 11-20, > 20-year durations. ANOVA was used to assess for within group differences by disease duration. We found that symptom priority changed significantly over time with longer disease duration. Tremor was reported less often later on, whereas mobility, dyskinesias, gait and speech/communication symptoms gained priority. In general, patients identified movement-related symptoms (e.g., walking, bradykinesia) as the most bothersome at all durations while family more strongly prioritized the physical and psychosocial impacts of disease (e.g., mobility, safety, interpersonal interactions, independence, and family impact). We conclude that important differences exist between family and patient perspectives of what matters and change over time with longer duration of disease.

Factors associated with self-rated health in people with late-stage parkinson's and cognitive impairment

PURPOSE

To investigate the contributors to self-rated health in people with late-stage Parkinson's disease (PD) and cognitive impairment.

METHODS

A secondary analysis of baseline data from the international Care of Late-Stage Parkinsonism (CLaSP) cohort study was conducted. Participants with PD and either dementia or mild cognitive impairment or MMSE < 24/30 in the absence of major depression were included if they had completed the EQ-5D-3L assessment (n = 277). Factors associated with self-rated health (EQ-5D-3L Index and Visual Analogue Scale) were investigated through multivariable linear regression.

RESULTS

More severe PD (motor and non-motor) was associated with worse self-rated health. The EQ-5D-3L dimensions of Mobility, Self-Care and Usual Activities were almost universally affected; the latter two particularly severely. Being unable to perform usual activities or having moderate to extreme anxiety or depression were significantly associated with EQ-5D-3L Visual Analogue Scale, suggesting these are particularly valued. Worse motor impairment and function and the non-motor symptom domains of mood, perception, sexual function, and miscellaneous (e.g., pain) were associated with worse self-rated health, whereas greater burden of gastrointestinal symptoms was associated with better self-rated health in multivariate analysis. Better self-rated health was associated with recent PD nurse consultation, and higher doses of dopaminergic medication.

CONCLUSION

Improvement of activities of daily living, mood and anxiety should be prioritised in clinical practice, with consideration of perception and sexual function in this population. Recent nurse consultations and higher antiparkinsonian doses are associated with better self-rated health, suggesting there is no room for a therapeutic nihilism in this population of people within a complex phase of PD.

Risk factors and intervention of caregiver burden in Parkinson's disease: a systematic review and meta-analysis

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.

Health-related quality of life in Parkinson's disease: systematic review and meta-analysis of EuroQol (EQ-5D) utility scores

INTRODUCTION

Evaluating the Health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD) holds significant importance in clinical and research settings. The EQ-5D is a widely recognized tool for comprehensive measurement of HRQoL using utility values. This study aims to systematically review and synthesize EQ-5D utility values from existing literature on patients with PD and their caregivers.

METHODS

We conducted a systematic search for studies that provided EQ-5D utility scores for patients with PD, using PubMed-Medline, Scopus, and Embase and selected the studies. The selected studies underwent systematic review, including an assessment of their quality. We performed a meta-analysis using a random-effect model and conducted a meta-regression analysis to investigate sources of heterogeneity among the studies.

RESULTS

The search result of 13,417 articles that were reviewed, 130 studies with 33,914 participants were selected for systematic review, and 79 studies were included for meta-analysis. The pooled EQ-5D utility values and visual analog score (VAS) among PD were 62.72% (60.53-64.93, I2 = 99.56%) and 0.60 (0.55-0.65, I2 = 99.81%), respectively. The pooled scores for caregivers' EQ-VAS and EQ-5D utility were 70.10% (63.99-76.20, I2 = 98.25%) and 0.71 (0.61-0.81, I2 = 94.88%), respectively. Disease duration (P < 0.05) showed a negative correlation with EQ-5D utility values on meta-regression.

CONCLUSION

The pooled utility values of PD and their caregivers help to understand their HRQoL and aid in conducting health economics research. The negative association between disease duration and utility values highlights the evolving nature of HRQoL challenges, suggesting the need for appropriate long-term disease management.

Parkinson's Disease, Impulsive-Compulsive Behaviors, and Health-Related Quality of Life

OBJECTIVE

A large body of literature has examined the links between the use of dopamine replacement therapy (DRT) in Parkinson's disease (PD) and the development of "impulsive-compulsive behaviors (ICBs)." Little is known regarding the link between the development of ICBs and health-related quality of life (HRQOL). We aimed to explore the factors that are associated with poorer HRQOL, especially in relation to DRT-induced ICBs, in a sample of PD patients.

METHODS

This PARKADD (PARK: PARKinson's disease; ADD: behavioral ADDictions) study was a prospective case‒control study initially designed to assess the factors associated with ICBs in PD patients. A prospective clinical follow-up was added, aiming to capture the long-term evolution of HRQOL in relation to ICBs occurring or worsening after the beginning of PD. We focused on sociodemographic and PD characteristics and the history or presence of ICBs. HRQOL was measured using the Parkinson's Disease Questionnaire-8. A multivariate linear regression was performed to identify factors related to poorer HRQOL.

RESULTS

A total of 169 patients were eligible for the follow-up study. The presence of an ICB, a higher levodopa equivalent daily dose (LEDD) and a longer PD duration were significantly associated with poorer HRQOL, with an interaction between LEDD and PD duration.

CONCLUSION

The presence of an ICB was related to poorer HRQOL and should be considered a crucial factor for the management of PD patients. Several studies were recently published that provide guidelines for the management of these patients, with recommendations based on two key principles: prevention and specific treatment.

Detecting Minor Symptoms of Parkinson's Disease in the Wild Using Bi-LSTM with Attention Mechanism

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor impairment with various implications on patients' quality of life. Since currently available therapies are only symptomatic, identifying individuals with prodromal, preclinical, or early-stage PD is crucial, as they would be ideal candidates for future disease-modifying therapies. Our analysis aims to develop a robust model for accurate PD detection using accelerometer data collected from PD and non-PD individuals with mild or no tremor during phone conversations. An open-access dataset comprising accelerometer recordings from 22 PD patients and 11 healthy controls (HCs) was utilized. The data were preprocessed to extract relevant time-, frequency-, and energy-related features, and a bidirectional long short-term memory (Bi-LSTM) model with attention mechanism was employed for classification. The performance of the model was evaluated using fivefold cross-validation, and metrics of accuracy, precision, recall, specificity, and f1-score were computed. The proposed model demonstrated high accuracy (98%), precision (99%), recall (98%), specificity (96%), and f1-score (98%) in accurately distinguishing PD patients from HCs. Our findings indicate that the proposed model outperforms existing approaches and holds promise for detection of PD with subtle symptoms, like tremor, in the wild. Such symptoms can present in the early or even prodromal stage of the disease, and appropriate mobile-based applications may be a practical tool in real-life settings to alert individuals at risk to seek medical assistance or give patients feedback in monitoring their symptoms.

Gastrointestinal Dysfunction in Parkinson's Disease: Neuro-Gastroenterology Perspectives on a Multifaceted Problem

Patients with Parkinson's disease (PD) face a multitude of gastrointestinal (GI) symptoms, including nausea, bloating, reduced bowel movements, and difficulties with defecation. These symptoms are common and may accumulate during the course of PD but are often under-recognized and challenging to manage. Objective testing can be burdensome to patients and does not correlate well with symptoms. Effective treatment options are limited. Evidence is often based on studies in the general population, and specific evidence in PD is scarce. Upper GI dysfunction may also interfere with the pharmacological treatment of PD motor symptoms, which poses significant management challenges. Several new less invasive assessment tools and novel treatment options have emerged in recent years. The current review provides an overview and a practical approach to recognizing and diagnosing common upper and lower GI problems in PD, e.g., dyspepsia, gastroparesis, small bowel dysfunction, chronic constipation, and defecatory dysfunction. Management aspects are discussed based on the latest evidence from the PD and general populations, with insights for future research pertaining to GI dysfunction in PD.

An update on pathogenesis and clinical scenario for Parkinson's disease: diagnosis and treatment

In severe cases, Parkinson's disease causes uncontrolled movements known as motor symptoms such as dystonia, rigidity, bradykinesia, and tremors. Parkinson's disease also causes non-motor symptoms such as insomnia, constipation, depression and hysteria. Disruption of dopaminergic and non-dopaminergic neural networks in the substantia nigra pars compacta is a major cause of motor symptoms in Parkinson's disease. Furthermore, due to the difficulty of clinical diagnosis of Parkinson's disease, it is often misdiagnosed, highlighting the need for better methods of detection. Treatment of Parkinson's disease is also complicated due to the difficulties of medications passing across the blood-brain barrier. Moreover, the conventional methods fail to solve the aforementioned issues. As a result, new methods are needed to detect and treat Parkinson's disease. Improved diagnosis and treatment of Parkinson's disease can help avoid some of its devastating symptoms. This review explores how nanotechnology platforms, such as nanobiosensors and nanomedicine, have improved Parkinson's disease detection and treatment. Nanobiosensors integrate science and engineering principles to detect Parkinson's disease. The main advantages are their low cost, portability, and quick and precise analysis. Moreover, nanotechnology can transport medications in the form of nanoparticles across the blood-brain barrier. However, because nanobiosensors are a novel technology, their use in biological systems is limited. Nanobiosensors have the potential to disrupt cell metabolism and homeostasis, changing cellular molecular profiles and making it difficult to distinguish sensor-induced artifacts from fundamental biological phenomena. In the treatment of Parkinson's disease, nanoparticles, on the other hand, produce neurotoxicity, which is a challenge in the treatment of Parkinson's disease. Techniques must be developed to distinguish sensor-induced artifacts from fundamental biological phenomena and to reduce the neurotoxicity caused by nanoparticles.

Impact of advanced Parkinson's disease on caregivers: an international real-world study

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.

Barriers to home exercise for patients with Parkinson's disease: a qualitative study

OBJECTIVE

This study aimed to explore the barriers to home exercise for patients with Parkinson's disease (PwPDs) and to provide guidelines for healthcare providers to build and implement home exercise strategies for PwPDs.

DESIGN

A qualitative descriptive method was used. Semistructured interviews were conducted and thematic analysis was employed.

SETTING

The study was conducted at the Department of Neurology at a grade 3 Class A general hospital in China.

PARTICIPANTS

A total of 24 participants were interviewed, including 10 PwPDs, 7 caregivers, 4 nurses, 1head nurse, and 2 Parkinson's clinicians.

RESULTS

Five themes were identified in this analysis. (1) Psychosomatic stress and low activity; (2) Lack of early rehabilitation authorisation; (3) Poor 'flow' state of home exercise; (4) iInaccessibility of continued service; (5) Sociocultural impact on family coping.

CONCLUSION

PwPDs, caregivers and specialised medical staff raised the challenges faced by patients' home exercises from different perspectives. We can improve services and integrate resources through the management of multi-disciplinary, early rehabilitation authorisation, exercise experience, continuous service mode, and family coping strategies under different cultures to gradually adjust the home exercise behaviour of PwPDs.

Perspectives of people with Parkinson's disease and family carers about disease management in community settings: A cross-country qualitative study

AIM

To explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease.

BACKGROUND

Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting.

DESIGN

A qualitative exploratory study was carried out in Denmark, Norway, Spain and the United Kingdom and was reported using the COREQ.

METHODS

Individual semi-structured interviews were conducted with people with Parkinson's disease and family carers between May and August 2020. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. A meta-ethnographic approach was used to analyse and synthesise cross-national findings.

RESULTS

Forty-seven people with Parkinson's disease and 39 family carers participated in the four countries. Four themes and eight sub-themes emerged: (1) Personalised care for needs throughout the Parkinson's disease journey; (2) Accessibility of different types of support systems (including initiatives to support emotional well-being, physical rehabilitation, information on the healthcare services, voluntary associations and community groups); (3) Multiagency collaborations, a more comprehensive approach; (4) Acknowledgment of people with Parkinson's and family carers own role in Parkinson's disease management.

CONCLUSIONS

An integrated and person-and-community-centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. These findings could contribute to the creation of more sustainable care systems at the European level that would better respond to individual and changing needs in people with Parkinson's disease and their family carers, and in other long-term conditions.

PATIENT OR PUBLIC CONTRIBUTION

The Patient and Public Involvement groups contributed to the design of the study, the interview guides and validation of findings.

RELEVANCE TO CLINICAL PRACTICE

This study will inform the management of Parkinson's disease at the community level and the use of resources not only directly linked to the health system. Taking into account all the actors that provide care and support to people with Parkinson' disease and family carers facilitates the creation of strategies that better respond to individual needs. Nurses and other health and social care professionals in the community and specialist levels of care should collaborate to develop multisectoral strategies that promote personalised and integrated care throughout the Parkinson's journey.

[Lower gastrointestinal dysfunction in patients with Parkinson's disease]

OBJECTIVE

To assess the lower gastrointestinal tract dysfunction in patients with Parkinson's disease (PD) and to reveal its relationships with motor and non-motor symptoms.

MATERIAL AND METHODS

One hundred and eighteen patients with PD of I-III Hoehn and Yahr (H&Y) stages were studied using UPDRSI-IV, Sch&En, PDQ-39, MMSE, BDI, STAI-S and STAI-T, PFS-16, NMSQ, GSRS, BSFS, AUA. Body mass index and saliva amount and lacrimation (Schirmer's test) were assessed.

RESULTS

Constipation from mild to moderate intensity was present in 71.2% of the patients; predominantly mild diarrhea occurred in 27.9%; alternations of diarrhea with the difficulty in intestine emptying were observed in 25.4%. We found significant correlations of constipation with the following parameters: Sch&En scales (rS=-0.291) and PDQ-39 (rS=0.478), patient's age (rS=0.275), H&Y stage (rS=0.2604), UPDRS (rS=0.254), axial motor symptoms of parkinsonism, and a number of affective and autonomic disorders, most of which were partly dopamine-resistant. Diarrhea did not affect the quality of patient's life, or depend on age, PD stage, main digital and non-motor symptoms, but directly correlated with the severity of constipation (rS=0.263) and other gastrointestinal disorders. There were no effects of dopaminergic therapy, including levodopa, dopamine-receptor-agonists, and amantadine, on the lower gastrointestinal tract dysfunction.

CONCLUSION

Dysfunction of the lower gastrointestinal tract (predominantly from mild to moderate intensity) was detected in most PD patients of I-III stages. Our data indicate a complex pathogenesis of the PD impaired bowel emptying, involving degeneration of non-dopaminergic structures, and the predominant influence of concomitant diseases and inadequate laxative therapy on the formation of diarrhea syndrome in PD.

Defining the unknowns for cell therapies in Parkinson's disease

First-in-human clinical trials have commenced to test the safety and efficacy of cell therapies for people with Parkinson's disease (PD). Proof of concept that this neural repair strategy is efficacious is based on decades of preclinical studies and clinical trials using primary foetal cells, as well as a significant literature exploring more novel stem cell-derived products. Although several measures of efficacy have been explored, including the successful in vitro differentiation of stem cells to dopamine neurons and consistent alleviation of motor dysfunction in rodent models, many unknowns still remain regarding the long-term clinical implications of this treatment strategy. Here, we consider some of these outstanding questions, including our understanding of the interaction between anti-Parkinsonian medication and the neural transplant, the impact of the cell therapy on cognitive or neuropsychiatric symptoms of PD, the role of neuroinflammation in the therapeutic process and the development of graft-induced dyskinesias. We identify questions that are currently pertinent to the field that require further exploration, and pave the way for a more holistic understanding of this neural repair strategy for treatment of PD.

Characteristics and quality of life of substance users and their caregivers

The correlation between substance use and depression has been emphasized in the literature. Substance use disorders can also adversely affect the caregivers of drug-addicted persons. A cross-sectional study was conducted at the Special Hospital for Addiction Diseases in Belgrade in 2015 to analyze the characteristics, consequences, and health-related quality of life of drug users and their caregivers. The sample comprised 136 users of various substances, and 136 caregivers. A questionnaire on socio-demographic characteristics, the Short Form Health Survey 36 (SF-36), and Beck Depression Inventory were administered to all participants. According to multivariate logistic regression analysis, compared with caregivers, substance users were significantly more frequently male (P < .001), ≤ 39 years old (P < .001), and more frequently reported the use of sedatives (P = .009) and smoking (P < .001). Some level of depression was present in all participants, but severe forms were more frequent in substance users (P = .010). Among substance users, mean scores of SF-36 domains ranged from 56.62‒87.17, and among their caregivers, from 50.37‒75.07; however, the difference was significant only for the health change domain (P = .037), the score for which was lower in caregivers. Substance users suffered from more severe forms of depression compared to their caregivers, who had lower SF-36 scores in the domain of health change.

The Gut Microbiome in Parkinson's Disease: A Longitudinal Study of the Impacts on Disease Progression and the Use of Device-Assisted Therapies

Background

Altered gut microbiome (GM) composition has been established in Parkinson's disease (PD). However, few studies have longitudinally investigated the GM in PD, or the impact of device-assisted therapies.

Objectives

To investigate the temporal stability of GM profiles from PD patients on standard therapies and those initiating device-assisted therapies (DAT) and define multivariate models of disease and progression.

Methods

We evaluated validated clinical questionnaires and stool samples from 74 PD patients and 74 household controls (HCs) at 0, 6, and 12 months. Faster or slower disease progression was defined from levodopa equivalence dose and motor severity measures. 19 PD patients initiating Deep Brain Stimulation or Levodopa-Carbidopa Intestinal Gel were separately evaluated at 0, 6, and 12 months post-therapy initiation.

Results

Persistent underrepresentation of short-chain fatty-acid-producing bacteria, Butyricicoccus, Fusicatenibacter, Lachnospiraceae ND3007 group, and Erysipelotrichaceae UCG-003, were apparent in PD patients relative to controls. A sustained effect of DAT initiation on GM associations with PD was not observed. PD progression analysis indicated that the genus Barnesiella was underrepresented in faster progressing PD patients at t = 0 and t = 12 months. Two-stage predictive modeling, integrating microbiota abundances and nutritional profiles, improved predictive capacity (change in Area Under the Curve from 0.58 to 0.64) when assessed at Amplicon Sequence Variant taxonomic resolution.

Conclusion

We present longitudinal GM studies in PD patients, showing persistently altered GM profiles suggestive of a reduced butyrogenic production potential. DATs exerted variable GM influences across the short and longer-term. We found that specific GM profiles combined with dietary factors improved prediction of disease progression in PD patients.

Nutritional Intake and Gut Microbiome Composition Predict Parkinson's Disease

Background

Models to predict Parkinson's disease (PD) incorporating alterations of gut microbiome (GM) composition have been reported with varying success.

Objective

To assess the utility of GM compositional changes combined with macronutrient intake to develop a predictive model of PD.

Methods

We performed a cross-sectional analysis of the GM and nutritional intake in 103 PD patients and 81 household controls (HCs). GM composition was determined by 16S amplicon sequencing of the V3-V4 region of bacterial ribosomal DNA isolated from stool. To determine multivariate disease-discriminant associations, we developed two models using Random Forest and support-vector machine (SVM) methodologies.

Results

Using updated taxonomic reference, we identified significant compositional differences in the GM profiles of PD patients in association with a variety of clinical PD characteristics. Six genera were overrepresented and eight underrepresented in PD patients relative to HCs, with the largest difference being overrepresentation of Lactobacillaceae at family taxonomic level. Correlation analyses highlighted multiple associations between clinical characteristics and select taxa, whilst constipation severity, physical activity and pharmacological therapies associated with changes in beta diversity. The random forest model of PD, incorporating taxonomic data at the genus level and carbohydrate contribution to total energy demonstrated the best predictive capacity [Area under the ROC Curve (AUC) of 0.74].

Conclusion

The notable differences in GM diversity and composition when combined with clinical measures and nutritional data enabled the development of a predictive model to identify PD. These findings support the combination of GM and nutritional data as a potentially useful biomarker of PD to improve diagnosis and guide clinical management.

Gastrointestinal Dysfunction Impact on Life Quality in a Cohort of Russian Patients with Parkinson’s Disease I-III H&Y Stage

Background

There are still no clearly proven methods to slow down or stop the progression of Parkinson's disease (PD). Thus, improving the quality of life (QoL) of patients with PD becomes of primary importance. Autonomic dysfunction and its symptoms are known to worsen the quality of life in PD, but the degree of this influence is underinvestigated. Particularly, impacts of the separate significant gastrointestinal symptoms, such as dyspepsia, constipation, and abdominal pain, in PD should be more precisely evaluated with the help of specific scales.

Objective

To assess the impacts of gastrointestinal dysfunction and its symptoms on PD patient's QoL using PDQ-39.

Methods

111 PD patients in the I-III Hoehn and Yahr (H&Y) stage were enrolled in the study. The following scales were applied: UPDRS III, PDQ-39, GSRS, GDSS, MMSE, BDI, STAI-S, and STAI-T.

Results

The linear regression model showed that the PDQ-39 SI depended on summary assessments GSRS-SI (β = 0.333, p < 0.001), BDI (β = 0.463, p < 0.001), and UPDRS III (β = 0.163, p < 0.05). The use of the stepwise method, adding GSRS-SI and UPDRS III scores to the BDI predictor, improved the model (R2 increased from 0.454 to 0.574). The investigation of GSRS domain's influence revealed that PDQ-39 SI had a significant correlation with almost all of them, but the regression analysis showed significant QoL impacts of only two factors: constipation and abdominal pain (β = 0.288, p < 0.01 and β = 0.243, p < 0.05 accordingly).

Conclusions

Our results suggest a considerable negative influence of depression and gastrointestinal dysfunction (especially constipation and abdominal pain) on QoL of patients with PD. Their impact on QoL in patients with I-III H&Y stages of PD is more significant than that of motor symptoms. Therefore, the correction of depression and gastrointestinal dysfunction should be prioritized in PD therapy.

[The new Parkinson's disease pain classification system (PD-PCS)]

BACKGROUND

Chronic pain is a common non-motor symptom in patients with Parkinson's disease (PD).

AIM

To facilitate the diagnosis of pain in PD, we developed a new classification system the Parkinson's disease pain classification system (PD-PCS) and translated the corresponding validated questionnaire into German.

METHODS

A causal relationship of the respective pain syndrome with PD can be determined by four questions before assigning it hierarchically into one of three pain categories (neuropathic, nociceptive and nociplastic).

RESULTS

In the initial validation study 77% of the patients (122/159) had PD-associated pain comprising 87 (55%) with nociceptive, 36 (22%) with nociplastic and 24 (16%) with neuropathic pain. The study revealed a high validity of the questionnaire and a moderate intrarater and interrater reliability. The questionnaire has been adapted into German and employed in 30 patients.

DISCUSSION

The PD-PCS questionnaire is a valid and reliable tool to determine the relationship of a pain syndrome with PD before classifying it according to the underlying category, facilitating further diagnostics and treatment.

Quantification Analysis of Sleep Based on Smartwatch Sensors for Parkinson's Disease

Rapid eye movement (REM) sleep behavior disorder (RBD) is associated with Parkinson's disease (PD). In this study, a smartwatch-based sensor is utilized as a convenient tool to detect the abnormal RBD phenomenon in PD patients. Instead, a questionnaire with sleep quality assessment and sleep physiological indices, such as sleep stage, activity level, and heart rate, were measured in the smartwatch sensors. Therefore, this device can record comprehensive sleep physiological data, offering several advantages such as ubiquity, long-term monitoring, and wearable convenience. In addition, it can provide the clinical doctor with sufficient information on the patient's sleeping patterns with individualized treatment. In this study, a three-stage sleep staging method (i.e., comprising sleep/awake detection, sleep-stage detection, and REM-stage detection) based on an accelerometer and heart-rate data is implemented using machine learning (ML) techniques. The ML-based algorithms used here for sleep/awake detection, sleep-stage detection, and REM-stage detection were a Cole-Kripke algorithm, a stepwise clustering algorithm, and a k-means clustering algorithm with predefined criteria, respectively. The sleep staging method was validated in a clinical trial. The results showed a statistically significant difference in the percentage of abnormal REM between the control group (1.6 ± 1.3; n = 18) and the PD group (3.8 ± 5.0; n = 20) (p = 0.04). The percentage of deep sleep stage in our results presented a significant difference between the control group (38.1 ± 24.3; n = 18) and PD group (22.0 ± 15.0, n = 20) (p = 0.011) as well. Further, our results suggested that the smartwatch-based sensor was able to detect the difference of an abnormal REM percentage in the control group (1.6 ± 1.3; n = 18), PD patient with clonazepam (2.0 ± 1.7; n = 10), and without clonazepam (5.7 ± 7.1; n = 10) (p = 0.007). Our results confirmed the effectiveness of our sensor in investigating the sleep stage in PD patients. The sensor also successfully determined the effect of clonazepam on reducing abnormal REM in PD patients. In conclusion, our smartwatch sensor is a convenient and effective tool for sleep quantification analysis in PD patients.

Predictive Model of Quality of Life in Patients with Parkinson's Disease

Parkinson's disease is a chronic, progressive, and disabling neurodegenerative disease which evolves until the end of life and triggers different mood and organic alterations that influence health-related quality of life. The objective of our study was to identify the factors that negatively impact the quality of life of patients with Parkinson's disease and construct a predictive model of health-related quality of life in these patients.

METHODS

An analytical, prospective observational study was carried out, including Parkinson's patients at different stages in the Albacete Health Area. The sample consisted of 155 patients (T0) who were followed up at one (T1) and two years (T2). The instruments used were a purpose-designed data collection questionnaire and the "Parkinson's Disease Questionnaire" (PDQ-39), with a global index where a higher score indicates a worse quality of life. A multivariate analysis was performed by multiple linear regression at T0. Next, the model's predictive capacity was evaluated at T1 and T2 using the area under the ROC curve (AUROC).

RESULTS

Predictive factors were: sex, living in a residence, using a cane, using a wheelchair, having a Parkinson's stage of HY > 2, having Alzheimer's disease or a major neurocognitive disorder, having more than five non-motor symptoms, polypharmacy, and disability greater than 66%. This model showed good predictive capacity at one year and two years of follow-up, with an AUROC of 0.89 (95% CI: 0.83-0.94) and 0.83 (95% CI: 0.76-0.89), respectively.

CONCLUSIONS

A predictive model constructed with nine variables showed a good discriminative capacity to predict the quality of life of patients with Parkinson's disease at one and two years of follow-up.

Cognitive Influences in Parkinson's Disease Patients and Their Caregivers: Perspectives From an Australian Cohort

Objectives: Cognitive impairment impacts negatively on Parkinson's disease (PD) patient and caregiver quality of life (QoL). We examined cognitive impairment in PD patients and their caregivers to determine if caregiver cognition affected their PD relative. Methods: Validated cognition and clinical outcome measures were assessed in 103 PD patients and 81 caregivers. Results: PD patients showed more cognitive impairment than their carers, with 48.6% having possible Mild Cognitive Impairment (MCI) and 16.5% having PD dementia. Increasing age, male gender, lower education level, various non-motor symptoms and certain therapies, associated with poorer cognition in PD. Eighteen and a half percent of caregivers were found to have MCI, in association with a lower physical and mental QoL. This reflected in lower QoL and mood for the respective PD patients. Conclusion: Impaired cognition and QoL in caregivers was associated with decreased QoL and mood for respective PD patients, suggesting MCI in caregivers is an important consideration for the management of PD.

Diagnosis and Management of Pain in Parkinson's Disease: A New Approach

Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.

Relationship Satisfaction in People with Parkinson's Disease and Their Caregivers: A Cross-Sectional Observational Study

Parkinson's disease (PD) is a neurodegenerative disorder, which leads to reduced health-related quality of life (HR-QoL) and autonomy in advanced stages of the disease. Hence, people with PD (PwPD) are in need of help, which is often provided by informal caregivers, especially spouses. This might influence the relationship satisfaction in patients and their spousal caregivers. Additionally, previous studies have shown that a reduced relationship satisfaction may result in mental disorders and reduced physical health. The aim of this study is to identify factors influencing PwPD and their caregivers' relationship satisfaction in a cross-sectional observational study. Analyses revealed an overall satisfying relationship, measured by the Quality of Marriage Index, in PwPD (n = 84) and their caregivers (n = 79). Relationship satisfaction in PwPD mildly decreased with reduced HR-QoL and more severe depressive symptoms. Reduced relationship satisfaction in caregivers was significantly associated with decreased HR-QoL, higher caregiver burden, more severe depressive symptoms and increased neuropsychiatric symptoms in PwPD. Further studies are needed to investigate the influence of the identified factors over time and if relationship satisfaction has a reciprocal impact on caregiver burden, HR-QoL as well as mental and physical health.

The impact of device-assisted therapies on the gut microbiome in Parkinson's disease

BACKGROUND

Microbiome feedbacks are proposed to influence Parkinson's disease (PD) pathophysiology. A number of studies have evaluated the impact of oral medication on the gut microbiome (GM) in PD. However, the influence of PD device-assisted therapies (DATs) on the GM remains to be investigated.

OBJECTIVES

To profile acute gut microbial community alterations in response to PD DAT initiation.

METHODS

Clinical data and stool samples were collected from 21 PD patients initiating either deep brain stimulation (DBS) or levodopa-carbidopa intestinal gel (LCIG) and ten spousal healthy control (HC) subjects. 16S amplicon sequencing of stool DNA enabled comparison of temporal GM stability between groups and with clinical measures, including disease alterations relative to therapy initiation.

RESULTS

We assessed GM response to therapy in the PD group by comparing pre-therapy (- 2 and 0 weeks) with post-therapy initiation timepoints (+ 2 and + 4 weeks) and HCs at baseline (0 weeks). Altered GM compositions were noted between the PD and HC groups at various taxonomic levels, including specific differences for DBS (overrepresentation of Clostridium_XlVa, Bilophila, Parabacteroides, Pseudoflavonifractor and underrepresentation of Dorea) and LCIG therapy (overrepresentation of Pseudoflavonifractor, Escherichia/Shigella, and underrepresentation of Gemmiger). Beta diversity changes were also found over the 4 week post-treatment initiation period.

CONCLUSIONS

We report on initial short-term GM changes in response to the initiation of PD DATs. Prior to the introduction of the DAT, a PD-associated GM was observed. Following initiation of DAT, several DAT-specific changes in GM composition were identified, suggesting DATs can influence the GM in PD.

Increased Added Sugar Consumption Is Common in Parkinson's Disease

Objectives: There is limited information about the dietary habits of patients with Parkinson's Disease (PD), or associations of diet with clinical PD features. We report on nutritional intake in an Australian PD cohort.

Methods: 103 PD patients and 81 healthy controls (HCs) completed a validated, semi-quantitative food frequency questionnaire. Food and nutrient intake was quantified, with consideration of micronutrients and macronutrients (energy, protein, carbohydrate, fat, fibre, and added sugar). Participants also completed PD-validated non-motor symptom questionnaires to determine any relationships between dietary intake and clinical disease features.

Results: Mean daily energy intake did not differ considerably between PD patients and HCs (11,131 kJ/day vs. 10,188 kJ/day, p = 0.241). However, PD patients reported greater total carbohydrate intake (279 g/day vs. 232 g/day, p = 0.034). This was largely attributable to increased daily sugar intake (153 g/day vs. 119 g/day, p = 0.003) and in particular free sugars (61 g/day vs. 41 g/day, p = 0.001). PD patients who (1) experienced chronic pain, (2) were depressed, or (3) reported an impulse control disorder, consumed more total sugars than HCs (all p < 0.05). Increased sugar consumption was associated with an increase in non-motor symptoms, including poorer quality of life, increased constipation severity and greater daily levodopa dose requirement.

Conclusions: We provide clinically important insights into the dietary habits of PD patients that may inform simple dietary modifications that could alleviate disease symptoms and severity. The results of this study support clinician led promotion of healthy eating and careful management of patient nutrition as part of routine care.