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Lim MJR, Tan J, Neo AYY, Ng BCJ, Asano M. Acceptance of disability in stroke: a systematic review. Ann Phys Rehabil Med 2024; 67:101790. [PMID: 38118296 DOI: 10.1016/j.rehab.2023.101790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 06/27/2023] [Accepted: 08/15/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Evidence for the association between acceptance of disability (AOD) and positive rehabilitation outcomes, as well as for the use of AOD measurements in stroke rehabilitation practice, has increased in the international literature in the last decade. However, measurement tools for AOD are heterogenous and there has not been a systematic review summarizing the current evidence on the use of AOD measures and factors associated with AOD. OBJECTIVE This study aimed to summarize current evidence on measurement tools used, present existing AOD scores in people with stroke and identify risk factors for and protective factors against poor AOD in people with stroke. METHODS The original design and protocol of this systematic review were registered with PROSPERO. The included studies were published from 2008 to 2020 and identified from 5 databases-PubMed, EMBASE, CINAHL Plus, PsycInfo, and the Cochrane Library-using the following inclusion criteria: participants diagnosed with stroke and aged ≥16 years, measurement of AOD, and published in English in a peer-reviewed scientific journal. Review articles were excluded. RESULTS Five measurement tools for AOD were reported. The Revised Acceptance of Disability Scale (ADS-R) and the acceptance subscale of the Illness Cognition Questionnaire (ICQ) had the highest internal consistency. Scores ranged from 71.7 to 74.2 on the ADS-R, 16.9-18.3 on the ICQ, 16.5-26.9 on the Acceptance of Illness Scale, and 87.8-93.2 on the Attitudes towards Disabled Persons Form A. Poorer function and depressive symptoms were associated with poor AOD, whereas religious beliefs, support from others, and an understanding of stroke were associated with better AOD. CONCLUSIONS The ADS-R and the acceptance subscale of the ICQ are currently the most reliable measurement tools for measuring AOD in people with stroke. Further research to validate the measurement tools is required. This may help to identify people who require additional support. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42017077063; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77063.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Health System, 1E Kent Ridge Rd, Singapore 119228 Singapore; Ministry of Health Holdings, Singapore, 1 Maritime Square 099253, Singapore.
| | - Jaclyn Tan
- Division of Neurosurgery, University Surgical Centre, National University Health System, 1E Kent Ridge Rd, Singapore 119228 Singapore
| | | | | | - Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore
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Sotoudeh M, Rezapour-Mirsaleh Y, Choobforoushzadeh A. The relationship between acceptance, self-compassion and hope in infertile women: a structural equation analysis. J Reprod Infant Psychol 2024; 42:365-376. [PMID: 35634993 DOI: 10.1080/02646838.2022.2078485] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to determine the relationship between psychological acceptance, self-compassion and hope in infertile women. BACKGROUND Infertility distress can make women more vulnerable than men. Acceptance, self-compassion and hope can help infertile women to alleviate their distresses and to peruse the medical treatments. METHODS This study was performed using a cross-sectional descriptive correlational design; A total of 346 women with primary infertility referred to infertility centres of Yazd, Isfahan and Kerman provinces, Iran, participated in the study by completing the self-compassion scale, hope scale and Acceptance and Action Questionnaire-II (AAQ-II). Data were analysed using structural equation analysis. RESULTS The results of structural equation analysis showed that the path coefficient of self-compassion on acceptance (r = .69, p < .01) and hope (r = .29, p < .05) in infertile women was direct and significant. Acceptance also had a direct effect on hope in infertile women (r = .31, p < .05) and played a significant mediating role in the relationship between self-compassion and hope in infertile women. CONCLUSIONS The findings suggest that self-compassion is likely to be an important strategic intervention alongside medical treatments for infertile women, because it leads to problem acceptance and then increases hope in them.
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Affiliation(s)
- Mansoureh Sotoudeh
- Department of Psychology, Faculty of Humanities & Social Sciences, Ardakan University, Ardakan, Iran
| | - Yasser Rezapour-Mirsaleh
- Department of Counseling, Faculty of Humanities & Social Sciences, Ardakan University, Ardakan, Iran
| | - Azadeh Choobforoushzadeh
- Department of Psychology, Faculty of Humanities & Social Sciences, Ardakan University, Ardakan, Iran
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Han A, Wilroy JD, Yuen HK. Effects of acceptance and commitment therapy on depressive symptoms, anxiety, pain intensity, quality of life, acceptance, and functional impairment in individuals with neurological disorders: a systematic review and meta-analysis. CLIN PSYCHOL-UK 2023. [DOI: 10.1080/13284207.2022.2163158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama, Birmingham, AL, USA
| | - Jereme D. Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, AL, USA
| | - Hon K. Yuen
- Department of Occupational Therapy, University of Alabama, Birmingham, AL, USA
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Pytel A, Beszlej JA, Biercewicz M, Roszmann A, Krówczyńska D, Kołtuniuk A. The Effect of Frailty Syndrome on the Quality of Life of Individuals with Parkinson's Disease: A Pilot Observational and Multicenter Study on the Polish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15226. [PMID: 36429942 PMCID: PMC9690024 DOI: 10.3390/ijerph192215226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder involving decreased dopamine release and atrophy of dopaminergic neurons of the substantia nigra. Frailty syndrome (FS) is common in older adults, which, in combination with PD symptoms, can substantially affect the quality of life (QOL). This study aimed to assess the prevalence of FS among PD patients and to identify variables affecting their QOL with particular attention to FS. The study included 296 patients (n = 173 women) with a mean age of 70.3 ± 5.7 years suffering from PD for an average of 8.2 ± 5.6 years. Patients were classified as at least stage II according to the Hoehn and Yahr scale. The following standardized questionnaires were used in the study: Schwab and England Activities of Daily Living (SE-ADL), Parkinson's Disease Questionnaire (PDQ-39), Beck Depression Inventory (BDI), Unified Parkinson's Disease Rating Scale (UPDRS), and Tilburg Frailty Indicator (TFI). FS was found in 96% (n = 283) of the PD patients studied. No depression occurred in 30% (n = 89) of subjects, moderate depression in 48% (n = 141) of subjects, and severe depression in 22% (n = 66) of subjects. The mean score of the PDQ-39 questionnaire in PD subjects with FS was 41.6 pts (min-max: 5.2-81.5 pts; SD = 17.4 pts), which was statistically significantly higher than in subjects without FS (p < 0.05). FS has been shown to be present in most of the subjects with PD. FS occurs more frequently with a longer PD period, which is associated with reduced physical capacity and QOL. Physical activity improves QOL and reduces disease progression. FS, similar to PD, is a common cause of disability in older adults and their dependency. Predictors such as depression, advanced stage of the disease, higher education, and low professional and economic status significantly affect the QOL level of PD patients. However, the results obtained among the Polish population of PD patients do not confirm the impact of FS on the QOL, so there is a need to conduct further research on this subject.
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Affiliation(s)
- Aleksandra Pytel
- Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | | | - Monika Biercewicz
- Clinic of Geriatrics, Faculty of Health Science, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Toruń, Poland
| | - Anna Roszmann
- Division of Neurological and Psychiatric Nursing, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Dorota Krówczyńska
- Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland
- Department of Nursing and Obstetrics, Collegium Mazovia, 08-110 Siedlce, Poland
| | - Aleksandra Kołtuniuk
- Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
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Liang Y, Chen D, Ou R, Zhao B, Song W, Yi X, Yang R, Chen X. Current Status of Acceptance of Disability and the Correlation With the Life Quality in Parkinson's Disease in Southwest China. Front Med (Lausanne) 2022; 8:767215. [PMID: 35118084 PMCID: PMC8804473 DOI: 10.3389/fmed.2021.767215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Acceptance of disability (AOD) is a process that a patient must undergo to cope with altered abilities, but its effect in Parkinson's disease (PD) remains unclear. The present study aimed to determine the level of AOD, examine the influence of sociodemographic variables and disease characteristics on the AOD level, and evaluate the relation between AOD level and quality of life in a cohort of PD patients from Southwest of China. Methods A total of 336 PD patients were consecutively recruited from November 2018 to October 2020. At enrollment, demographic and clinical data were obtained using a questionnaire, and the Acceptance of Disability Scale-Revised (AODS-R) scale was used to measure the AOD level. Results The mean total score of AOD is 87.28, indicating a moderate level of disability acceptance in PD patients. Statistical analysis showed that understanding of PD, family support, and UPDRS-II score were major factors affecting AOD level, and patients with low AOD levels were more likely to have poorer quality of life. Conclusion AOD is a serious problem in PD patients in Southwest China, especially among individuals with insufficient family support and a lack of recognition of the disease. AOD was also associated with motor function and daily living ability, thus suggesting that evaluation of the AOD and promotion of the awareness may be helpful to improve the quality of life in patients with PD.
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Affiliation(s)
- Yan Liang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Dezhi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojiang Yi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xueping Chen
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Gomes da Costa LV, Trippo KV, Duarte GP, Cruz AO, Filho JO, Ferraz DD. Depressive symptoms in elderly patients with Parkinson's disease: frequency and associated factors. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Emotional health is an important factor in clinical and functional manifestations of Parkinson's disease. The aim of this study was to correlate clinical features with depressive symptoms in elderly patients with Parkinson's disease. Methods A cross-sectional study was conducted. The Geriatric Depression Scale 15 was used to evaluate depressive symptoms, the modified Hoehn and Yahr scale was used to describe the symptom progression of Parkinson's disease and the Parkinson's Disease Questionnaire 39 to assess the quality of life. The Pearson correlation and the chi-square test were used. Significance level was set at 5%. Results A total of 81 individuals participated and 48 (60.8%) presented with depressive symptoms. Participants in the moderate stage of Parkinson's disease and women presented a higher frequency of depressive symptoms. Cognition, communication and mobility presented the highest correlation with depressive symptoms. Conclusions The participants presented a high frequency of depressive symptoms that is correlated with a decrease in mobility, communication and cognitive functions. It is recommended that the rehabilitation of elderly people with Parkinson's disease should be performed by a multidisciplinary team, whose objectives are to improve mobility, cognition and communication, which can help reduce depressive symptoms and depression in elderly people with Parkinson's disease.
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Szcześniak M, Świątek AH, Cieślak M, Świdurska D. Disease Acceptance and Eudemonic Well-Being Among Adults With Physical Disabilities: The Mediator Effect of Meaning in Life. Front Psychol 2020; 11:525560. [PMID: 33192766 PMCID: PMC7643024 DOI: 10.3389/fpsyg.2020.525560] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
The acceptance of disability is recognized as one of the most frequently mentioned factors that plays a particularly significant role in subjective well-being. However, so far, only a very small amount of research has been undertaken to clarify how and why acceptance of illness relates to eudemonic well-being. Hence, comprehension of the direct and indirect effects underlying this relationship seems essential for interventions that increase the recovery of people with impairments and enhance their quality of life. The current research was aimed at investigating the association between acceptance of illness, meaning in life, and eudemonic well-being, as well as the possible mediatory effect of meaning in life on the relationship between acceptance of illness and well-being. The sample consisted of 102 participants (71% women) aged between 20 and 64 years. The respondents had a range of different impairments (e.g., cerebral palsy, neurological disorders, spinal muscular atrophy, and sight defects). The Acceptance of Illness Scale, the Meaning in Life Questionnaire, and the Ryff Scales of Psychological Well-Being were used. It was confirmed that acceptance of illness correlated positively and significantly with the presence of meaning, self-acceptance, positive relations, environmental mastery, personal growth, general well-being, cohesion, flexibility, communication, and family satisfaction. The presence of meaning mediated the relationship between acceptance of illness and general well-being with its four other dimensions: self-acceptance, environmental mastery, purpose in life, and personal growth. Conversely, the search for meaning did not have any mediatory effect on this relationship.
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Affiliation(s)
| | - Agata H Świątek
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | | | - Daria Świdurska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
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Chuquilín-Arista F, Álvarez-Avellón T, Menéndez-González M. Prevalence of Depression and Anxiety in Parkinson Disease and Impact on Quality of Life: A Community-Based Study in Spain. J Geriatr Psychiatry Neurol 2020; 33:207-213. [PMID: 31597514 DOI: 10.1177/0891988719874130] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identifying neuropsychiatric disorders is essential for prompt treatment to reduce morbidity. Among these disorders, anxiety and depression have been frequently associated with Parkinson disease (PD), particularly among elderly population. OBJECTIVE The objective of this study is to determine the prevalence of anxiety and depression in a series of community-based PD cases in Spain, their relationship with different clinical and sociodemographic characteristics, and quality of life. METHODS This is an observational, descriptive, survey-based study with 95 community-based patients with PD diagnosis at different disease stages. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and the Beck Depression Inventory II, respectively. Quality of life was assessed using the Parkinson's Disease Questionnaire 39. RESULTS The prevalence of depression and anxiety was 32.63% and 68.42%, respectively. Concomitant depression and anxiety were observed in 31.58% of patients. Patients with longer than 10 years' PD duration had an increased risk of depression. We found a relationship between the presence of anxiety, depression, and the patient's quality of life. CONCLUSIONS Depression is present in one-third and anxiety in two-thirds of PD cases in community settings in Spain. Depression and anxiety have a very negative impact on quality of life in PD. Both anxiety and depression are independent from sociodemographic characteristics, patient's comorbidities, or antiparkinsonian treatments; presenting as intrinsic symptoms in PD.
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Affiliation(s)
- Fany Chuquilín-Arista
- Community and Family Medicine, Health Area VII, Asturias, Spain.,Health Science Research, University of Valladolid, Spain
| | | | - Manuel Menéndez-González
- Department of Neurology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain.,Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain.,Department of Morphology and Cell Biology, Universidad de Oviedo, Asturias, Spain
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Pain Perception and Acceptance of Illness in Patients Undergoing Phacoemulsification Cataract Surgery under Drip Anesthesia. J Clin Med 2019; 8:jcm8101575. [PMID: 31581551 PMCID: PMC6832406 DOI: 10.3390/jcm8101575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
For many years, cataracts have been the main cause of vision loss and vision impairments in the world (43% and 33%, respectively). Currently, the most common surgical method for treating cataracts is phacoemulsification. The aim of this study was to assess the pain perception and acceptance of illness connected with awaiting phacoemulsification cataract surgery under intravenous drip anesthesia, as well as to determine the effect of selected sociodemographic factors on the above. Methods: The study was conducted in a group of patients of the Department of Ophthalmology, University Clinical Hospital in Białystok, Poland suffering from cataracts, who underwent phacoemulsification surgery under intravenous drip anesthesia. The study group consisted of 151 people. The study used an original short questionnaire and three standardized psychometric scales: The acceptance of illness scale (AIS), the Beliefs about Pain Control Questionnaire (BPCQ), and the Coping Strategies Questionnaire (CSQ). Results: The median overall AIS point value was 24 points, which is considered an average score in terms of disease acceptance. Respondents assessed the influence of individual factors on the level of perceived pain and the impact of individual strategies for coping with pain similarly. The level of perceived pain decreased with the patient’s age. People with a higher education level experienced a greater level of pain; however, this relationship was not statistically significant. The place of residence did not affect the level of pain experienced during the procedure. Women had a greater level of acceptance of illness. The respondents’ education level negligibly differentiated the approach to the disease. The place of residence also did not affect the assessment of illness acceptance as measured by the AIS. Whether the surgery pertained to the first or second eye did not significantly affect the approach to the disease. Conclusions: The level of acceptance of illness and pain perception were at a moderate level among the patients. The acceptance of illness was significantly influenced by the age of patients and the waiting period for phacoemulsification, and this level of acceptance decreased significantly with the increasing age of patients. The longer the waiting period for surgery, the lower the acceptance of illness. Sex significantly differentiated the level of pain experienced during the procedure. Education and place of residence did not significantly affect the acceptance of illness and the feeling of pain.
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Sociodemographic Factors Affecting the Disease Acceptance and the Quality of Life in Patients With Parkinson's Disease: A Preliminary Study. Rehabil Nurs 2019; 44:35-46. [PMID: 29782477 DOI: 10.1097/rnj.0000000000000149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Parkinson's disease (PD) significantly affects functioning of patients, thereby lowering their quality of life. The aim of this study was to evaluate the influence of sociodemographic variables on illness acceptance and quality of life in patients with idiopathic PD. DESIGN This is a cross-sectional research study. METHODS The study was conducted with 50 patients with PD. The diagnostic survey method was applied for the purposes of this study with the use of the Parkinson's Disease Questionnaire, the Acceptance of Illness Scale, and a study-specific demographic questionnaire that included questions about sociodemographic data. Multivariable logistic regression was derived to define independent predictors of quality of life. FINDINGS Men assessed quality of life in the bodily discomfort domain as significantly worse than women (p = .0214). Age negatively and significantly affected the assessment of quality of life in particular domains. Professionally active respondents significantly more often accepted their disease than others (p = .0070). CONCLUSIONS AND CLINICAL RELEVANCE Being professionally active, living in urban areas, and having higher education and higher financial status increase subjective assessment of quality of life in patients with PD. Knowing the impact of sociodemographic variables on quality of life allows rehabilitation nurses to plan nursing and rehabilitation activities more effectively and in line with the capacity of a patient and caregivers.
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Impact of anxiety, apathy and reduced functional autonomy on perceived quality of life in Parkinson's disease. Parkinsonism Relat Disord 2017; 43:114-117. [PMID: 28797564 DOI: 10.1016/j.parkreldis.2017.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is characterized by a wide spectrum of non-motor symptoms that may impact negatively on the activities of the patient's daily life and reduce Health-related quality of life (HRQoL). The present study explored the impact of specific non-motor symptoms on the HRQoL in PD. METHODS Eighty-four outpatients underwent the Montreal Cognitive Assessment (MoCA) assessing global functioning and several questionnaires to assess depression, apathy, impulse control disorders (ICD), anxiety, anhedonia and functional impact of cognitive impairment. The perceived QoL was assessed by Parkinson's Disease Questionnaire (PDQ-8). The PD sample was divided into patients with high and low HRQoL around the median of PDQ-8 and compared on clinical features, cognitive and neuropsychiatric variables. A linear regression analysis, in which the global functioning, apathy, depression, anxiety, anhedonia, ICD and the functional autonomy scores were entered as independent variables and PDQ-8 score as dependent variable, was applied. RESULTS Patients with lower HRQoL were more depressed, apathetic, anxious and showed more severe reduction of functional autonomy and global functioning than patients with high HRQoL. The regression analysis revealed that higher level of anxiety, executive apathy and more reduced functional autonomy were significantly associated with higher score on PDQ-8. CONCLUSIONS The finding indicated that anxiety, apathy associated with impaired planning, attention and organization (i.e., executive apathy evaluated by the Dimensional Apathy Scale) and reduced functional autonomy contribute significantly to reduce the HRQoL in PD. Therefore, early identification and management of these neuropsychiatric symptoms should be relevant to preserve HRQoL in PD.
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