Quality of life scale in parkinson's disease PDQ-39 - (Brazilian Portuguese version) to assess patients with and without levodopa motor fluctuation

Psychometric properties of the Parkinson's disease Questionnaire-39 and its short form Parkinson's disease Questionnaire-8: A systematic review and meta-analysis

Parkinson's disease (PD) affects Quality of Life (QoL), since it is responsible for cognitive impairment, non-motor, and motor symptoms. Outcome measures are fundamental for evaluating treatment's effect on QoL over time. This systematic review aimed to identify the psychometric properties of PDQ-39 and PDQ-8 in the different populations in which they were validated. The electronic databases systematically searched are MEDLINE (via PubMed), CINAHL, SCOPUS, and Web of Science; the research was conducted in July 2023. The psychometric properties considered were those of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Risk of bias was assessed using the COSMIN checklist. The search identified 1306 articles. 398 duplicates were eliminated; 908 articles were analyzed reading title and abstract; 799 were finally excluded because used PDQ-39 and PDQ-8 as outcome measures or were not dealing with psychometric properties; 66 articles were excluded after reading the full text. 43 articles were included in the review; meta-analysis showed all the Cronbach's alpha values were statistically significant for all the subscales of PDQ-39 and PDQ-8. PDQ-39 demonstrated to be a specific HRQoL questionnaire that is correlated with generic HRQoL questionnaires, in fact in many studies included in the review, correlations with SF-36 were found. In the last studies about psychometric properties of PDQ-8 emerged that it is a practical and informative instrument that can be easily used in clinical settings, especially in busy ones, but also in large-scale studies in which a brief instrument would be preferred.

Quality of life assessment when considering the introduction of device-assisted therapies in advanced Parkinson's disease: A retrospective observational cross-sectional study

INTRODUCTION

Device-aided therapy (DAT) is an established treatment for improving the quality of life (QOL) in individuals with advanced Parkinson's disease (APD). Criteria for starting DAT, including motor and non-motor symptoms, have been proposed. However, it remains unclear whether QOL differences among patients with APD influence DAT introduction. Therefore, we aimed to investigate QOL differences between patients with and without DAT introduction.

METHODS

This retrospective observational cross-sectional study included 245 patients with PD who were followed up between January 1, 2020, and June 30, 2022. We defined cases that underwent DAT introduction after evaluation as "planned-DAT" and those that did not as "not-planned-DAT." We performed between-group comparisons of the PD questionnaire-39 (PDQ-39) summary index (SI) in patients with APD who met the 5-2-1 criteria (≥5 times the oral levodopa dose/day, ≥2 h of "off" symptoms/day, and ≥ 1 h of troublesome dyskinesia/day).

RESULTS

Seventy-nine patients met the inclusion criteria for APD (median age: 68 [61.0-73.0] years; 62.8% [N = 52] women). The PDQ-39 SI scores were higher in the planned-DAT group (N = 12) than in the not-planned-DAT group (N = 67) (29.2 [22.1-33.6] vs. 19.0 [10.3-49.6] points, P < 0.05). After propensity-score matching according to age and sex, the PDQ-39 SI scores remained higher in the planned-DAT (N = 9) than in the not-planned-DAT group (N = 18) (40.0 [25.4-60.0] vs. 18.5 [7.9-46.8] points, P < 0.05).

CONCLUSIONS

Our results suggest that QOL assessment using PDQ-39 can be used to identify patients eligible for DAT.

Telehealth For Individuals with Parkinson's Disease During Covid-19 In Brazil: A Prospective Case Series

Objective

To implement a telerehabilitation prevention, treatment, and follow-up physical therapy protocol for monitoring individuals with Parkinson's disease (PD) and to verify its effectiveness in minimizing the deleterious effects of the COVID-19 pandemic.

Design

Prospective case series, involving 40 participants with mild to moderate PD recruited from a specialized neurorehabilitation group. The study was divided into four parts: (1) Phone calls to assess the feasibility of participating in remote physical therapy. (2) Social media training. (3) Baseline and post-intervention assessment for functional lower extremity strength, fear of falling, quality of life, depression, anxiety, activities of daily living, verbal fluency. (4) Intervention protocol consisting of 20 remote weekly physical therapy sessions, graphic material for physical and cognitive training, social activities, and education.

Conclusion

The telerehabilitation protocol was viable and effective for patients with PD as an alternative to in-person treatment during the COVID-19 pandemic.

High-frequency rTMS improves quality of life and depressive symptoms in Parkinson's disease: A case report

Introduction

Parkinson's disease (PD) is a common neurodegenerative disorder, characterised by both motor and nonmotor symptoms. There is currently no cure for PD, although there are several treatment options for relieving PD symptoms. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy that shows promising results for the treatment of PD.

Methods

Here, we present a patient with PD. We investigated whether an accelerate form of high-frequency (HF) rTMS on the contralateral side to the patient's main difficulties is clinically effective in treating health-related quality of life (QoL) symptomatology and depressive symptoms in PD as well as the long-term effects of rTMS in PD during the maintenance phase.

Results

Results showed that HF-rTMS administered over the right primary motor cortex (M1) is a safe and well-tolerated treatment that improved the patient's health related QoL and depressive symptoms. These positive effects lasted at least five months post treatment.

Conclusion

Therefore, HF-rTMS over the right M1 can be a possible treatment option for patients with PD, although further investigations are necessary to validate the findings of the present case report.

Influência da estratégia de Estimulação Auditiva Rítmica com música associada à fisioterapia sobre os sintomas depressivos no Parkinson

RESUMO A sintomatologia depressiva (SD) é comum na doença de Parkinson (DP) e considerada fator importante para má qualidade de vida e incapacidade do indivíduo. Intervenções terapêuticas baseadas em ritmo e música, a exemplo da Estimulação Auditiva Rítmica (EAR), têm sido utilizadas no tratamento da mobilidade e parecem influenciar positivamente o estado de humor do paciente. O objetivo deste estudo é avaliar o efeito da EAR com música associada à fisioterapia no estado de humor de pessoas com DP, com ênfase na SD. Trata-se de estudo quase experimental, com amostra de 18 pacientes com idades entre 40 e 80 anos e diagnóstico clínico de DP idiopática nos estágios leve a moderado. Os pacientes foram randomizados em dois grupos: grupo EAR e grupo-controle (GC). A SD foi avaliada por meio da versão em português do Inventário de Depressão de Beck (BDI). Os escores do BDI apresentaram redução em ambos os grupos. Entretanto, apenas no grupo EAR essa redução foi significativa, com diferença média no escore três vezes maior do que no GC.

Influence of Rhythmic Auditory Stimulation using music associated with physical therapy on depressive symptoms in Parkinson’s

ABSTRACT Depressive symptoms are commonly found in Parkinson’s disease and are considered an important factor for an individual’s poor quality of life and disability. Therapeutic interventions based on rhythm and music, such as rhythmic auditory stimulation, have been used to treat the mobility and seem to positively influence on mood. This study aims to evaluate the effect of rhythmic auditory stimulation using music associated with physical therapy on mood in individuals with Parkinson’s, with an emphasis on depressive symptoms. This is a quasi-experimental study with a final sample of 18 patients aged 40-80 years, with a clinical diagnosis of idiopathic Parkinson’s disease, in the mild to moderate stages of the disease. Patients were randomized into two groups: Rhythmic Auditory Stimulation and Control Groups. Depressive symptoms were assessed using the Portuguese version of the Beck Depression Inventory. Both groups reduced their The Beck Depression Inventory scores. However, only in the Rhythmic Auditory Stimulation Group the reduction was significant, with a mean difference in the inventory score three times greater than the Control Group.

The Mediating Effect of Spiritual Well-Being and Quality of Life for Persons with Parkinson's Disease in Northern Taiwan

BACKGROUND

Parkinson's disease (PD), a degenerative disease with irreversible motor dysfunction, impacts patients' quality of life (QoL). Spirituality can provide a sense of hope and meaning when individuals are faced with adverse life events, such as a diagnosis of PD. However, few studies have examined the relationship between spiritual well-being and QoL for persons with PD.

OBJECTIVE

To explore the relationships between the disease characteristics, spirituality and QoL for persons with PD, and verify the mediating effects of spirituality on the relationship.

METHODS

This cross-sectional study recruited patients with PD (n = 110) by convenience sampling from a neurological clinic in northern Taiwan. Variables were measured using the Spirituality Index of Well-Being Chinese version (SIWB-C) and the 39-item Parkinson's disease Quality of Life Questionnaire Chinese version (PDQ-39-C) self-report questionnaires. Descriptive analysis and linear hierarchical regression were conducted to examine the studied variables and explore the mediating effect of spiritual wellbeing.

RESULTS

Those whose scores were significantly better in PDQ-39 were younger, employed, with shorter disease duration and less severe condition with better functioning on their early stages and lower LEDD; additionally, those who had better quality of life also experienced better spiritual wellbeing than the counterparts. The regression model demonstrated spiritual self-efficacy had mediating effects between disease characteristics and QoL, explaining 69.8%of the variance (adjusted R2 = 65.3%).

CONCLUSION

The results can be the references for future strategies and interventions, focusing on increasing spiritual self-efficacy and reducing the impact of disease severity to improve QoL for persons with PD.

Fields of Forel Brain Stimulation Improves Levodopa-Unresponsive Gait and Balance Disorders in Parkinson's Disease

BACKGROUND

Gait and balance disturbance are challenging symptoms in advanced Parkinson's disease (PD). Anatomic and clinical data suggest that the fields of Forel may be a potential surgical target to treat these symptoms.

OBJECTIVE

To test whether bilateral stimulation centered at the fields of Forel improves levodopa unresponsive freezing of gait (FOG), balance problems, postural instability, and falls in PD.

METHODS

A total of 13 patients with levodopa-unresponsive gait disturbance (Hoehn and Yahr stage ≥3) were included. Patients were evaluated before (on-medication condition) and 1 yr after surgery (on-medication-on-stimulation condition). Motor symptoms and quality of life were assessed with the Unified Parkinson's Disease Rating scale (UPDRS III) and Quality of Life scale (PDQ-39). Clinical and instrumented analyses assessed gait, balance, postural instability, and falls.

RESULTS

Surgery improved balance by 43% (95% confidence interval [CI]: 21.2-36.4 to 35.2-47.1; P = .0012), reduced FOG by 35% (95% CI: 15.1-20.3 to 8.1-15.3; P = .0021), and the monthly number of falls by 82.2% (95% CI: 2.2-6.9 to -0.2-1.7; P = .0039). Anticipatory postural adjustments, velocity to turn, and postural sway measurements also improved 1 yr after deep brain stimulation (DBS). UPDRS III motor scores were reduced by 27.2% postoperatively (95% CI: 42.6-54.3 to 30.2-40.5; P < .0001). Quality of life improved 27.5% (95% CI: 34.6-48.8 to 22.4-37.9; P = .0100).

CONCLUSION

Our results suggest that DBS of the fields of Forel improved motor symptoms in PD, as well as the FOG, falls, balance, postural instability, and quality of life.

Binary dance rhythm or Quaternary dance rhythm which has the greatest effect on non-motor symptoms of individuals with Parkinson's disease?

This study aimed to compare the effect of a binary and quaternary rhythm protocol on cognition, mental activity, daily life, and quality of life among individuals with Parkinson's Disease. A two-arm randomized clinical trial with 31 individuals diagnosed with Parkinson's disease, who were allocated to the binary group or quaternary group. Both groups underwent a 12-week intervention. The following variables were analyzed: personal and clinical information; MoCA; UPDRSI and II; PDQ-39. Both intervention groups improved cognition, mental activity, activities of daily living, and quality of life. In addition, there were intergroup differences in total UPDRSII, writing, and hygiene where the quaternary group was superior to the binary group. It concludes that the binary and quaternary rhythm positively influenced and presented similar effects on the complementary treatment of individuals with Parkinson's disease on the studied variables. Thus, it is believed that both interventions are possible and feasible for the health professionals involved in the area.

Real-world assessment of the impact of "OFF" episodes on health-related quality of life among patients with Parkinson's disease in the United States

Background

Many patients with Parkinson’s disease (PD) who receive carbidopa/levodopa experience symptom reemergence or worsening, or “OFF” episodes. This study assessed the association of “OFF” episodes with health-related quality of life (HRQoL).

Methods

US-specific data from the 2017 and 2019 Adelphi Real World Disease Specific Programme for PD, a real-world cross-sectional survey, were used. Neurologists provided data for 10–12 consecutive patients with PD who completed the 39-item Parkinson’s Disease Questionnaire (PDQ-39) and the EuroQol 5-Dimension (EQ-5D). Data were grouped by patients who experienced “OFF” episodes versus those who did not and by average hours of daily “OFF” time. Differences between patient groups were assessed for demographics and clinical characteristics; regression analyses were used to model the relationship between HRQoL and “OFF” episodes with age, sex, body mass index, current PD stage on the Hoehn and Yahr scale, and number of concomitant conditions related and unrelated to mobility as covariates.

Results

Data from 722 patients were analyzed. Overall, 321 patients (44%) had “OFF” episodes (mean of 2.9 h of daily “OFF” time). Patients who experienced “OFF” episodes were less likely to work full-time and more likely to live with family members other than their spouse/partner or reside in a long-term care facility than those without “OFF” episodes. The presence of “OFF” episodes, regardless of the average hours of daily “OFF” time, was significantly associated with high scores (reflecting poor HRQoL) on most PDQ-39 dimensions and the summary index and low scores (reflecting poor health status) on the EQ-5D health utility index, visual analog scale (VAS), and all dimensions. Furthermore, increased average hours of daily “OFF” time was significantly correlated with higher scores for all PDQ-39 dimensions and the summary index, as well as with the EQ-5D health utility index and VAS scores. Patients with “OFF” episodes experienced reduced HRQoL even after correcting for potentially confounding variables.

Conclusions

This study demonstrated that the occurrence of “OFF” episodes in patients with PD is associated with reduced HRQoL and that the impact on HRQoL increased incrementally with increasing average hours of daily “OFF” time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02074-2.

Progressive muscle-strength protocol for the functionality of upper limbs and quality of life in individuals with Parkinson's disease: Pilot study

The effects of physical-therapy intervention on the motor function of upper limbs and the quality of life in patients with Parkinson's disease (PD) are not fully understood. We evaluated the effects of a progressive muscle-strengthening protocol for upper limbs on the functionality and quality of life. Patients were divided into two groups: Intervention (n = 6) and Control (n = 7). Assessment tools used were: Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire, Nine-Hole Peg Test (9HPT), Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA), 10-Repetition Maximum (10-RM) and handgrip dynamometer, which were applied pre- and post-intervention, with follow-up for one month after the last training session. Only, the Intervention group (post-intervention) showed significant statistical differences, with the following outcomes: UPDRS III (p = 0.042); 9HPT, right (p = 0.028) and left side (p = 0.028); TEMPA for total right side (p = 0.028), left side (p = 0.028) and total bilateral tasks (p = 0.028); TEMPA task 2 - open a jar and take a spoonful of coffee (p = 0.028), task 3 - pick up a pitcher and pour water into a glass for right (p = 0.046) and left side (p = 0.028), task 5 - write on an envelope and stick on a stamp (p = 0.028), and task 6 - shuffle and deal playing cards (p = 0.028). We observed significant statistical differences between groups (post-intervention) for TEMPA task 6 (p = 0.032), total right side (p = 0.032), and total bilateral tasks (p = 0.032). An increase in the maximum load in the post-intervention stage, based on the 10-RM test, was observed on the right (p = 0.003) and left (p = 0.007) sides. Our results showed an improvement in upper-limb functionality in PD patients submitted to progressive muscle-strength training, although not in quality of life.

Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease

OBJECTIVE

To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease.

METHOD

Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed.

RESULTS

After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise.

CONCLUSION

In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.

Feasibility of a Brazilian samba protocol for patients with Parkinson's disease: a clinical non-randomized study

OBJECTIVE

To investigate the feasibility of a Brazilian samba protocol in individuals with Parkinson's disease.

METHODS

Twenty participants, mean age of 66.4±10.7 years, diagnosed with idiopathic Parkinson 's disease, divided into: experimental group that received the intervention of Brazilian samba dance classes (10 individuals); and control group that maintained their routine activities (10 individuals). For data collection, a divided questionnaire was used: General Information; Disability stages scale; Balance and Quality of Life.

RESULTS

During class implementation, there were no falls, as all dance activities adhered to the details of the protocol steps without any changes. On average, patients completed 82.7% of activities. After 12 weeks, the experimental group had improvements in the UPDRS global score, in daily activities, and on motor examination. There was also improvement in balance scores and in the mobility domain of the quality of life in the experimental group.

CONCLUSION

The samba protocol seems to be feasible and safe for patients with PD. Moreover, it has pleasant characteristics and offers sufficient physical benefits for combination with drug treatment. There were also benefits in social relationships and as a possible rehabilitation tool in individuals with Parkinson's disease.

THE IMPACT OF BRAZILIAN SAMBA ON PARKINSON’S DISEASE: ANALYSIS BY THE DISEASE SUBTYPES

ABSTRACT Introduction: People with Parkinson's disease constantly have low levels of physical activity. Dancing has become increasingly important for treating the disease and can help improve non-motor symptoms. Objective: To analyze the influence of Brazilian samba on the non-motor symptoms of PD according to TD and PGID subtypes. Methods: A 12-week, non-randomized clinical trial, through comparison with a control group. The 23 individuals who agreed to participate in the activities formed the experimental group (EG) and the 24 individuals who opted not to participate in the Brazilian samba classes comprised the control group (CG). A questionnaire was applied, composed of validated instruments. Mini Mental State Examination – MMSE; HY – Disability Scale; Unified Parkinson's Disease Rating Scale – UPDRS 1 and total values; Parkinson's Disease Questionnaire – PDQ-39, Parkinson's Disease Sleep Scale – PDSS; Beck Depression Inventory – BDI; Fatigue Severity Scale – FSS and Magnitude of Perceived Changes. Results: After the twelve weeks of intervention, it was observed that the EG showed improvement in the scores of all the tests. The comparison between groups, however, indicated a significant difference in the post-UPDRS1 period in which the EG presented improvement in cognitive impairment, while the CG presented a deficit in these values. The results of the division between disease subtypes show a greater change in the values between individuals of the TD group, when comparing the EG with the CG. For the EG, the greatest difference between pre- and post- intervention was fatigue. Conclusion: There was a positive trend in all the variables studied after the application of the protocol. This demonstrates that interventions such as dance may have greater effects on non-motor symptoms, depending on the expected progression of the disease. The scarcity of studies that use this approach in their analyses may explain the lack of evidence in this symptomatology related to dance. Level of evidence II; Therapeutic studies – Investigating the results of treatment.

Stereotactic Lesion in the Forel's Field H: A 2-Years Prospective Open-Label Study on Motor and Nonmotor Symptoms, Neuropsychological Functions, and Quality of Life in Parkinson Disease

BACKGROUND

Stereotactic lesion in the Forel's field H (campotomy) was proposed in 1963 to treat Parkinson disease (PD) symptoms. Despite its rationale, very few data on this approach have emerged. Additionally, no study has assessed its effects on nonmotor symptoms, neuropsychological functions and quality of life.

OBJECTIVE

To provide a prospective 2-yr assessment of motor, nonmotor, neuropsychological and quality of life variables after unilateral campotomy.

METHODS

Twelve PD patients were prospectively evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), the Dyskinesia Rating Scale and the Parkinson's disease quality of life questionnaire (PDQ39) before campotomy, and after 6 and 24 mo. Nonmotor, neuropsychiatric, neuropsychological and quality of life variables were assessed. The impact of PD on global health was also rated.

RESULTS

A significant reduction in contralateral rest tremor (65.7%, P < .001), rigidity (87.8%, P < .001), bradykinesia (68%, P < .001) and axial symptoms (24.2%, P < .05) in offmedication condition led to a 43.9% reduction in UPSDRS III scores 2 yr after campotomy (P < .001). Gait improved by 31.9% (P < .05) and walking time to cover 7 m was reduced by 43.2% (P < .05). Pain decreased by 33.4% (P < .01), while neuropsychiatric and neuropsychological functions did not change. Quality of life improved by 37.8% (P < .05), in line with a 46.7% reduction of disease impact on global health (P < .001).

CONCLUSION

A significant 2-yr improvement of motor symptoms, gait performance and pain was obtained after unilateral campotomy without significant changes to cognition. Quality of life markedly improved in parallel with a significant reduction of PD burden on global health.

Understanding, Impact, and Communication of "Off" Periods in Parkinson's Disease: A Scoping Review

BACKGROUND

Off periods are a common and disabling symptom of Parkinson's disease. We reviewed published research on understanding, impact, and communication regarding off periods to identify issues warranting further research.

METHODS

We performed a scoping review, searching MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsycINFO from 2006 to January 2018 for studies examining the impact of, understanding of, or communication about off periods.

RESULTS

Twenty-six papers met eligibility criteria. Twenty-three studies evaluated the impact or experience of off periods in patients, three evaluated the impact upon carepartners, two papers addressed understanding of off periods, one study evaluated communication about off periods, and three studies evaluated a facilitator of communication about off periods. The findings indicate that (1) off periods are among the most troublesome symptoms to patients and that their impact on activities is broad; (2) the understanding of off periods by patients, carepartners, and nurses may be suboptimal; and (3) questionnaires hold promise as a mechanism for facilitating communication given the findings that they may enhance the detection of off periods and are rated as useful by physicians. No studies evaluated interventions to promote knowledge about off periods, and no studies identified barriers of communication about off periods.

CONCLUSIONS

There is a paucity of knowledge regarding the lived experiences of off periods, particularly for carepartners. Additionally, little knowledge exists in the literature regarding understanding of and communication about off periods between patients or carepartners and treating physicians. Further research is required to explore these issues to ultimately improve the treatment of off periods.

Effects of physical exercise programs on cognitive function in Parkinson's disease patients: A systematic review of randomized controlled trials of the last 10 years

Background

Given the relative importance of cognitive impairment, there was considerable interest in identifying the cognitive profile of PD patients, in order to ensure specific and appropriate therapeutic interventions.

Purpose

To determine the effects of physical exercise programs on cognitive function in PD patients, compared with the control group.

Data sources

Medline, Cochrane, Scopus, PEDro and Web of Science (last searched in September 2016).

Study selection

Randomized clinical trials examining the effects of physical exercise programs and cognitive function in PD patients. Nine studies fulfilled the selection criteria and were included in this review.

Data extraction

Characteristics of the publication, characteristics of the participants, test used for cognitive screening, cognitive domain assessed, tools used to assess cognitive function, characteristics of the experimental intervention, characteristics of the control group, mean results and standard deviation of function cognitive. The PEDro score was used to evaluate methodological quality.

Data synthesis

Most eligible studies showed good methodological quality based on the PEDro scale. Studies have shown that adapted tango for PD patients, cognitive training combined with motor training, and treadmill training promote the preservation or improvement of cognitive function in PD patients.

Limitations

The diversity of cognitive tests used to assess cognitive function and the high heterogeneity identified between the physical exercise programs.

Conclusions

Physical exercise programs promote positive and significant effects on global cognitive function, processing speed, sustained attention and mental flexibility in PD patients, at a mild to moderate stage for patients with a 6-year clinical diagnosis of PD. However, treadmill training performed 3 times a week for about 60 minutes and for a period of 24 weeks produced larger improvements in cognition.

Group climate in the voice therapy of patients with Parkinson's Disease

Purpose

To verify the impact that group dynamics and coaching strategies have on the PD patients voice, speech and communication, as well as the group climate.

Methods

16 individuals with mild to moderate dysarthria due to the PD were divided into two groups: the CG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 additional support sessions; and the EG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 sessions with group dynamics and coaching strategies. The Living with Dysarthria questionnaire (LwD), the self-evaluation of voice, speech and communication, and the perceptual-auditory analysis of the vocal quality were assess in 3 moments: pre-traditional therapy (pre); post-traditional therapy (post 1); and post support sessions/coaching strategies (post 2); in post 1 and post 2 moments, the Group Climate Questionnaire (GCQ) was also applied.

Results

CG and EG showed an improvement in the LwD from pre to post 1 and post 2 moments. Voice self-evaluation was better for the EG - when pre was compared with post 2 and when post 1 was compared with post 2 - ranging from regular to very good; both groups presented improvement in the communication self-evaluation. The perceptual-auditory evaluation of the vocal quality was better for the EG in the post 1 moment. No difference was found for the GCQ; however, the EG presented lower avoidance scores in post 2.

Conclusion

All patients showed improvement in the voice, speech and communication self-evaluation; EG showed lower avoidance scores, creating a more collaborative and propitious environment for speech therapy.

Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark)

INTRODUCTION

Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese).

METHODS AND ANALYSIS

Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life.

ETHICS AND DISSEMINATION

The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided.

TRIAL REGISTRATION NUMBER

NCT02753192, Pre-results.

The effects of a mindfulness-based lifestyle program for adults with Parkinson's disease: a mixed methods, wait list controlled randomised control study

BACKGROUND

Parkinson's disease (PD) is the second commonest neurodegenerative disease in developed countries. Current treatment for PD is pharmacologically focused and can have significant side-effects. There is increasing interest in holistic approaches including mindfulness to help manage the challenges associated with living with PD. We hypothesised that there would be an improvement in PD associated function and wellbeing in participants after participating in a 6-week mindfulness-based lifestyle program, and that these improvements would be sustainable at 6 months. Our primary objective was to determine changes in function and wellbeing associated with PD.

METHODS

An exploratory prospective, mixed-method, randomised control trial incorporating a before and after design with a waitlist control, with an embedded qualitative component was conducted in 2012-2013. Participants included community living adults with disability congruent to H&Y Stage 2 PD, aged 18-75, fluent in spoken and written English and able to attend at least four of six sessions of the program. Participants were randomised to the intervention or wait-list control groups at two locations. All participants in the wait-list control group eventually received the intervention. Two randomisation codes were created for each location. Allocation to the intervention or wait-list control was by random number generation. The program facilitator and participants were blinded to participant data.

RESULTS

Group 1 included 35 participants and group 2 (the waitlist control), 37. Data was analysed from 24 (group 1) and 33 (group 2) participants. The intervention group, compared to the waitlist control, showed a small improvement in function and wellbeing associated with PD immediately after the program (t-score = -0.59) and at 6-month post intervention (t-score = -1.42) as reported by the PDQ-39 SI. However this finding was not significant (p = 0.56 and 0.16 respectively). A small yet significant effect size (β = 0.23) in PDQ-39 ADL was reported in group 1 after 6-months post-intervention. This showed a positive improvement in the ADL as reported by group 1 after 6-months (t-score -1.8, p = 0.04). Four secondary measures are reported.

CONCLUSIONS

Our findings suggest mindfulness-based lifestyle programs have potential to assist participants in managing the ongoing difficulties associated with a neurological condition such as Parkinson's disease. Importantly, our study shows promise for the long term benefits of such programs. Improvements to participant activities in daily living and mindfulness were retained at 6-months post intervention. A more definitive study should be conducted in a larger sample of PD patients to further explore these findings and their impact on reducing stress and anxiety in PD patients.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820 , 17(th) April 2012.

Medication Therapy Management Service for Patients with Parkinson's Disease: A Before-and-After Study

Background

Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor manifestations, autonomic and neurological disorders and sensorial symptoms. Medication therapy management (MTM) consists of a service undertaken by pharmacists to optimize pharmacological therapy results. This way, the pharmacist monitors the treatment prescribed by the doctor and formulates a healthcare plan to guarantee the treatment’s effectiveness, safety and convenience, thereby improving the patient’s quality of life (QoL).

Objective

To analyze the effect of MTM upon medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with Parkinson’s disease, and describe the pharmaceutical interventions.

Methods

Quasi-experimental uncontrolled before-and-after study carried out between September 2012 and March 2013 in a community pharmacy. Pharmacotherapy data were collected from medical prescriptions, patient diaries, medical charts and all the medicines (over-the-counter and prescription) brought by the patients to the appointment with the pharmacist. The medicine-related problems were classified as indication, effectiveness, safety and adherence. Adherence was measured through clinical interviews and the Morisky questionnaire. PD symptoms were assessed according to the patients’ and/or caregivers’ perceptions about the On/Off state of the motor symptoms and relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The interventions were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures.

Results

Seventy patients were followed up, showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p < 0.001), positive impact on adherence (from 37 to 10 non-adherent patients, p < 0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%).

Conclusions

To carry out MTM with PD patients, the pharmacist’s expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence and patients’ QoL.

Efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com Parkinson

O objetivo desta pesquisa foi verificar os efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com doença de Parkinson, antes e após o tratamento com aplicação do questionário da doença de Parkinson PDQ-39. Corresponde a um estudo experimental, do tipo ensaio clínico não controlado, de natureza quantitativa. O estudo envolveu 14 indivíduos, que passaram por 20 sessões individuais de tratamento distribuídas em duas sessões semanais, com duração entre 30 e 40 minutos cada. Na análise dos dados, foi utilizado o teste de Wilcoxon, para encontrar o valor da significância estatística p≤0,05. Os escores do Questionário da Doença de Parkinson-39 total e seus domínios diminuíram quando comparados aos do período da avaliação e da reavaliação dos pacientes. No entanto, os valores de p expressam que essa diminuição foi significativa especificamente para os domínios mobilidade, bem-estar emocional, estigma e cognição, e o escore do Questionário da Doença de Parkinson-39 total. Assim, os resultados demonstraram que a realidade virtual não imersiva contribuiu positivamente sobre a qualidade de vida desses indivíduos.

Interferência do tratamento medicamentoso imediato e tardio na doença de Parkinson no gerenciamento da disfagia

A Doença de Parkinson apresenta grande incidência na população idosa, gerando comprometimento motor progressivo, que afeta várias funções, dentre as quais se destaca a deglutição. Esse trabalho teve como objetivo relacionar a disfagia na Doença de Parkinson aos efeitos imediatos e/ou tardios do tratamento medicamentoso, que de forma direta ou indireta interferirá no gerenciamento fonoaudiológico. Fizemos uma revisão de literatura nas bases de dados eletrônicas Lilacs, Scielo, Medline e Pubmed no período de 2001 a 2011, utilizando os termos livres “Doença de Parkinson”; (Parkinson Disease), “deglutição”; (deglutition), “disfagia”; (dysphagia), “preparações farmacêuticas”; (pharmaceutical preparations), “levodopa”;, “videofluoroscopia”; (videofluoroscopy), além de um documento governamental (OPAS, 2002), artigos relevantes e exemplares da literatura americana e brasileira sobre o tema. A literatura aponta a Levodopa como o principal tratamento farmacológico da doença de Parkinson. Contudo, a melhora dos sintomas motores deve ser ponderada em função da ocorrência de efeitos colaterais importantes, sejam imediatos ou tardios. Até o momento não há respostas consistentes a favor da melhora da disfagia como resultado do tratamento farmacológico, cujos efeitos podem interferir direta ou indiretamente sobre as manifestações disfágicas e de várias formas. Assim, torna-se fundamental o registro das medicações como parte da anamnese, considerando que tais dados possam auxiliar na orientação/reorientação da conduta fonoaudiológica, especialmente em contexto interdisciplinar. A despeito da possibilidade do doente de Parkinson responder de forma inconsistente à terapia farmacológica, vale ressaltar que o profissional deve estar atento à presença de efeitos colaterais como fatores modificadores do quadro de disfagia orofaríngea na Doença de Parkinson idiopática.

Influência do fortalecimento muscular no equilíbrio e qualidade de vida em indivíduos com doença de Parkinson

Esse estudo teve como objetivo avaliar o efeito do fortalecimento muscular no equilíbrio, mobilidade e na qualidade de vida (QV) de indivíduos com doença de Parkinson (DP), e verificar a correlação entre fortalecimento muscular e qualidade de vida. Participaram do estudo nove sujeitos, de ambos os sexos, com diagnóstico médico de DP. Eles, inicialmente, passaram por avaliação do equilíbrio e da mobilidade funcional por meio da Escala de Equilíbrio de Berg (EEB) e teste Timed Up and Go (TUG) e da QV pelo questionário Parkinson's Disease Questionnaire (PDQ-39). Os sujeitos realizaram ainda o teste de determinação de carga máxima (1 RM) para os grupos musculares treinados. Depois de verificadas a normalidade e homogeneidade dos dados, foram realizados o teste t de Student e o teste de correlação de Spearman. Foi considerado nível de significância de p<0,05. Foi verificada melhora no equilíbrio (p=0,008) e na QV (p=0,013), e correlação negativa entre equilíbrio e QV (avaliação r=-0,65 e p=0,05; e na reavaliação r=-0,82 e p=0,005). O fortalecimento muscular foi eficaz na melhora no equilíbrio e na qualidade de vida de indivíduos com doença de Parkinson.

Efeitos da fisioterapia aquática na qualidade de vida de sujeitos com doença de Parkinson

A doença de Parkinson (DP) é uma doença degenerativa e progressiva do sistema nervoso central, e seus sintomas podem proporcionar um declínio da qualidade de vida (QV) dos pacientes, que pode ser influenciada positivamente pela fisioterapia aquática (FA). A FA é um recurso fisioterapêutico que utiliza os efeitos físicos, fisiológicos e cinesiológicos advindos da imersão do corpo em piscina aquecida. O questionário da doença de Parkinson 39 (PDQ-39) é o instrumento mais apropriado para a avaliação da QV do paciente com DP. O objetivo deste estudo foi avaliar os efeitos da FA na QV de pacientes com DP nos estágios de leve a moderado, utilizando-se do PDQ-39. Foram incluídos 13 pacientes com DP, com idade entre 45 e 74 anos, entre os estágios 1 a 3 da doença (Hoehn-Yahr). Os pacientes foram submetidos a 16 sessões de FA, duas vezes por semana, com duração de uma hora, em piscina terapêutica aquecida. A percepção da QV foi mensurada por meio do PDQ-39, antes e depois da FA. Depois da FA, ocorreu uma redução estatisticamente significativa (p<0,0001) tanto no escore total do PDQ-39 quanto em todos os seus domínios (p=0,032). A QV foi mais afetada em maiores estágios da doença. Antes da FA, a QV era pior no estágio mais avançado da doença, e apesar da melhora dos escores de QV depois da FA, o estágio mais avançado continuou apresentando pior percepção da QV. A FA proporcionou uma melhora na qualidade de vida dos pacientes com doença de Parkinson neste estudo.

Clinical determinants of health-related quality of life in Mexican patients with Parkinson's disease

BACKGROUND AND AIMS

Parkinson's disease (PD) is the second most common chronic neurodegenerative disorder. PD is clinically characterized by a constellation of motor and nonmotor symptoms that may have a direct effect on daily activities as well as in the quality of life of the patient. Identifying the symptoms more closely associated with a poor quality of life is central on improving the medical care of the patient. We undertook this study to identify and describe the clinical and demographic factors that predict health-related quality of life among Mexican patients with PD.

METHODS

One hundred seventy-seven patients with Parkinson's disease were included. Patients were evaluated using the following clinimetric instruments: motor subscale of the Unified Parkinson's disease rating scale, Hoehn and Yahr stage, Non-motor Symptoms Questionnaire, Parkinson's disease Questionnaire (PDQ-39) and the Mini Mental Status Examination.

RESULTS

Multivariate analysis showed that the main factors associated with a poor quality of life were motor impairment (β = 0.27, p <0.001) and the number of nonmotor symptoms (β = 2.17, p <0.001). The main nonmotor domains impacting on the quality of life were depression/anxiety (β = 6.36, p <0.001), cardiovascular (β = 5.39, p = 0.001), memory (β = 4.64, p <0.001) and miscellaneous (β = 3.15, p = 0.001).

CONCLUSIONS

Both motor and mainly nonmotor symptoms are negatively associated with health-related quality of life in patients with PD and should be appropriately attended in order to improve patient care.

[Effects of Chinese herbal medicine Bushen Huoxue Granule on quality of life of patients with Parkinson disease: a randomized, double-blinded and placebo-controlled trial]

BACKGROUND

The main clinical symptoms of Parkinson disease (PD) are resting tremor, muscle rigidity and bradykinesia. There is currently no effective treatment for PD, and dyskinesia symptoms affect the quality of life of patients with PD. The Chinese medicine therapy used for reinforcing kidney and activating blood circulation in treatment of PD was reported to achieve good clinical effects.

OBJECTIVE

To study the effects of Bushen Huoxue Granule, a compound traditional Chinese herbal medicine, on the quality of life of patients with PD.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

A total of 120 patients were enrolled from General Hospital of the People's Liberation Army in China and divided into two groups randomly. Patients in the control group were treated with a placebo and in the treatment group with Bushen Huoxue Granule based on treating with levodopa. A double-blinded clinical trial was adopted over a 3-month treatment with a follow-up period lasting 6 months.

MAIN OUTCOME MEASURES

Unified Parkinson Disease Rating Scale II (UPDRS II), questionnaire-39 (PDQ-39) and Parkinson's disease sleep scale (PDSS) were adopted to measure the quality of life at baseline, after 3 months of treatment and at a 6-month follow-up.

RESULTS

Bushen Huoxue Granule showed a higher efficacy than the control in improving life quality of patients with PD by improving scores of UPDRS II, PDQ-39 and PDSS (P<0.05). No adverse effects were found in this trial.

CONCLUSION

Bushen Huoxue Granule can markedly improve the quality of life of patients with PD.

Quality of life of a person with Parkinson's disease and the relationship between the time of evolution and the severity of the disease

Parkinson's disease can cause disability and decrease the quality of life in its sufferers. The aim of this study was to evaluate the quality of life of a group of people with Parkinson's disease and whether a relationship exists between time of evolution and severity of the disease. Secondary analysis was carried out on transversal data collected from 40 individuals with Parkinson's disease registered in the Parkinson's Association of Maringá, in Maringá-PR-Brazil.

MEASURES

three instruments were applied: a socio-demographic questionnaire, the Hoenh and Yahr Scale and the Parkinson's Disease Questionnaire (PDQ-39). According to PDQ-39, men referred to a lower quality of life, although, statistically, there was no significant difference between the two genders. Differences were only observed in the dimensions of "activities of daily living" and "social support", in which men presented higher impairment, and "emotions" and "bodily discomfort", where women showed higher impairment. Furthermore, severity of disease tended to lead to a perception of lower quality of life regarding the dimensions of "activities of daily living" and "cognition", which is relevant to improve clinical guidance and intervention.

Neuropsychological and quality of life assessment in patients with Parkinson's disease submitted to bilateral deep brain stimulation in the subthalamic nucleus

Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms.

OBJECTIVE

To evaluate the influence of DBS in the STN on cognition, mood and quality of life.

METHODS

We studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test.

RESULTS

A total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale.

CONCLUSION

DBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood.

Cognitive assessment instruments in Parkinson's disease patients undergoing deep brain stimulation

Deep Brain Stimulation (DBS) is a widely used surgical technique in individuals with Parkinson's disease (PD) that can lead to significant reductions in motor symptoms.

A comprehensive study of repetitive transcranial magnetic stimulation in Parkinson's disease

The clinical benefits of repetitive transcranial magnetic stimulation (rTMS) for Parkinson's disease (PD) remain controversial. We performed a comprehensive study to examine whether rTMS is a safe and effective treatment for PD. Twelve PD patients received rTMS once a week. The crossover study design consisted of 4-week sham rTMS followed by 4-week real rTMS. The Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoehn and Yahr Stage, Schwab and England ADL Scale, Actigraph, Mini-Mental State Examination, Hamilton Depression Scale, Wechsler Adult Intelligence Scale-revised, and cerebral blood flow (CBF) and cerebrospinal fluid (CSF) examinations were used to evaluate the rTMS effects. Under both drug-on and drug-off conditions, the real rTMS improved the UPDRS scores significantly, while the sham rTMS did not. There were no significant changes in the results of the neuropsychological tests, CBF and CSF. rTMS seems to be a safe and effective therapeutic option for PD patients, especially in a wearing-off state.

Short questionnaire for Parkinson's disease as a screening instrument

OBJECTIVE

To validate and simplify a screening questionnaire for the determination of PD.

METHODS

The screening questionnaire for PD was developed with the permission of the author. Reliability of the questionnaire was tested. To validate the questionnaire, 40 patients with PD and 93 controls completed the questionnaire. Multiple logistic regression analysis was used to determine the questions independently associated with PD and a risk score was calculated. The predictive performance of the risk score was evaluated via the area under the curve (AUC) of a receiver operating characteristics (ROC) curve.

RESULTS

The questionnaire showed a Cronbach's alpha coefficient of 0.73 with no difference between the initial and follow up scores. The mean content validity was 0.86. Of the 11 questions, 4 were independently associated with PD and were used to calculate the risk score. The scores of these questions were 2 (clumsiness)+4 (tremor)+2 (masked face)+2 (loss of balance while turning). The AUC of a ROC curve for the sum of risk score was 0.95. With a cutoff score of 5 or higher, the sensitivity and specificity were 0.88 and 0.95, respectively.

CONCLUSIONS

The screening questionnaire for PD is a reliable and valid instrument. The predictive performance of the simplified questionnaire is as good as the original.

WHOQOL-OLD assessment of quality of life in elderly patients with Parkinson's disease: influence of sleep and depressive symptoms

OBJECTIVE

Parkinson's disease is a neurodegenerative disease with a number of motor and non-motor features that can affect quality of life. In this study, we aimed to assess quality of life, as well as to evaluate the potential determinants of quality of life, such as sleep quality, motor and depressive symptoms, in elderly patients with Parkinson's disease.

METHOD

This was a cross-sectional study in which we applied the World Health Organization Quality of Life Assessment for Older Adults in 57 Parkinson's disease patients over 60 years of age.

RESULTS

Total World Health Organization Quality of Life Assessment for Older Adults score was found to be associated with Parkinson's disease severity (rs = -0.43; p < 0.001). World Health Organization Quality of Life Assessment for Older Adults scores for sensory abilities (facet 1) and social participation (facet 4) were higher among the patients with mild Parkinson's disease than among those in the more advanced stages (rs = -0.43; p < 0.001). Facet 1 scores were found to be associated with Pittsburgh Sleep Quality Index and Parkinson's Disease Sleep Scale score (rp = -0.46 and rp = 0.41; p < 0.001, respectively). The Geriatric Depression Scale score showed an association with the total score on the World Health Organization Quality of Life Assessment for Older Adults (rp = -0.70; p < 0.001)

CONCLUSION

Quality of life in Parkinson's disease patients can be assessed by the World Health Organization Quality of Life Assessment for Older Adults. Greater Parkinson's disease severity can worsen patient quality of life, as can the presence of depressive symptoms.

Parkinson's disease: Impact of clinical and cognitive aspects on quality of life

Parkinson's disease (PD) is a chronic disease manifested principally by motor signs and symptoms, but with frequent neuropsychological alterations.

OBJECTIVES

To study the relationship between clinical and cognitive aspects and the perception of quality of life (QOL) in PD patients.

METHODS

Twenty consecutive patients (13 men) with idiopathic PD (mean age: 64.5y), mean disease time of 7.8 years and at stages 1-3 according to the modified Hoehn and Yahr staging scale (HYS), all outpatients from the Neurology Department of the Celso Pierro General and Maternity Hospital (PUC-Campinas), were analyzed. The following were applied: a clinical-neurological assessment, the Mini-Mental State Examination (MMSE), standard neuropsychological battery of the CERAD (Consortium to Establish a Registry for Alzheimer's Disease), Hamilton Depression Rating Scale (HAM-D) and a QOL questionnaire (Parkinson's Disease Questionnaire - PDQ-39). Statistical analysis was carried out at a significance level of p<0.05.

RESULTS

On the PDQ-39 under the sections total, mobility and activities of daily living, and the items motor compromise (HYS) and language of the MMSE were predictors of worse QOL. Verbal fluency was a factor for emotional well-being on the PDQ-39, whereas higher scores for HAM-D and worse performance on the item attention and calculation of the MMSE were associated with worse QOL in the social support section. Total score on the MMSE and educational level were QOL factors in cognition.

CONCLUSIONS

The findings of the present study suggest that clinical, cognitive, motor or other depression-related factors contribute differently to the domains of QOL.

Depressive symptoms and perception of quality of life in Parkinson's disease

BACKGROUND: Depression has been proposed as a major contributor to poor quality of life (QoL) in Parkinson's disease (PD). OBJECTIVE: To evaluate the relationship between depressive symptoms and QoL in subjects with PD. METHOD: Beck Depression Inventary (BDI) was used to evaluate depressive symptoms and Parkinson's Disease Quality of Life Questionnaire (PDQ-39) to assess the perception of the QoL. RESULTS: Thirty seven patients (19 male/ 18 female) with a typical onset PD and mean disease duration of 7.7 years were studied. Higher scores on BDI correlated with poorer perception of the QoL. This association occurred at the expense of the following PDQ39 domains: mobility, activities of daily living, social support, cognition and emotional well-being dimensions. PD severity also correlated with QoL. CONCLUSION: Our study corroborates the assumption that depressive symptoms contributed significantly to QoL in PD.

Evolução da doença de Parkinson e comprometimento da qualidade de vida

Objetivo. Analisar o comprometimento da qualidade de vida de parkinsonianos e observar sua relação com o tempo de evolução e estágio de acometimento. Método. Estudo transversal de análise descritiva e quantitativa, com 10 indivíduos parkinsonianos, submetidos à avaliação do quadro clínico, tempo de evolução da doença, Escala de Hoehn & Yahr e questionário de Qualidade de Vida PDQ-39. Resultados. Quanto maior o comprometimento da doença pior as atividades de vida diária, comunicação e desconforto corporal, e quanto maior o tempo de evolução da doença, pior a mobilidade, suporte social e desconforto corporal, sendo que não houve relação entre o tempo de evolução da doença com o estágio de acometimento. Conclusão. O tempo de convívio com o Parkinson não teve relação com o grau de gravidade e determinou alterações cognitivas e comprometimentos emocionais