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Kleinholdermann U, Thieken F, Ruppert-Junck MC, van Munster M, Pedrosa AJ, Stümpel J, Hammes V, Timmermann L, Woopen C, Schmitz-Luhn B, Storms A, Golla H, Nater UM, Skoluda N, Pfefferle PI, Pedrosa DJ. Study protocol of the HessenKohorte2042: a prospective, longitudinal cohort study characterising quality of life in people with Parkinson's disease and their caregivers using a bio-psycho-social approach. BMJ Open 2024; 14:e080475. [PMID: 39067880 DOI: 10.1136/bmjopen-2023-080475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Quality of life (QoL) is of paramount importance as an outcome to monitor and guide therapies for people with Parkinson's disease (PwPD). In particular, due to the heterogeneous symptoms that PwPD may experience during their disease course, QoL can deteriorate not only in patients but also in their caregivers, with a variety of psychosocial consequences. However, there is a lack of longitudinal studies that explore how QoL evolves over time and what factors are significant. Furthermore, holistic approaches that consider bio-psycho-social determinants are rare. In the worst cases, these gaps can lead to suboptimal care and therefore unmet needs for patients and their caregivers, resulting in unnecessary symptom burden and increased healthcare costs for society. METHODS AND ANALYSIS This prospective, longitudinal study will follow 1000 PwPD along with their caregivers for 20 years, with up to 40 semi-annual assessments. Patient data and sample collection will include clinical assessments, self-reported outcome measures focusing on QoL, biospecimen collection and MRI. Caregiver burden will be systematically assessed through self-administered questionnaires. The use of digitised surveys will allow efficient data collection and convenient assessment at home. Our primary objective is to attain a holistic understanding of QoL in PwPD and establish a tool to measure it. The secondary objective is to explore the psycho-social and biological variables associated with QoL of patients and caregivers over the progression of the disease. This will provide key information for diagnostic and prognostic prediction, therapeutic patient stratification and adaptation of therapy in the future. ETHICS AND DISSEMINATION The study was approved by the local ethics committee of the University Hospital of Marburg (study number: 209/19). The results will be disseminated by means of publication in peer-reviewed journals, international conference contributions, annual patient meetings and a dedicated website. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00023598).
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Affiliation(s)
| | | | - Marina Christine Ruppert-Junck
- Philipps-Universitat Marburg, Marburg, Germany
- Center of Mind, Brain and Behaviour, Philipps-Universitat Marburg, Marburg, Germany
| | - Marlena van Munster
- Philipps-Universitat Marburg, Marburg, Germany
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Johanne Stümpel
- Philipps-Universitat Marburg, Marburg, Germany
- Center for Life Ethics, University of Bonn, Bonn, Germany
| | | | - Lars Timmermann
- Philipps-Universitat Marburg, Marburg, Germany
- Center of Mind, Brain and Behaviour, Philipps-Universitat Marburg, Marburg, Germany
| | | | | | - Anna Storms
- Katholische Akademie Die Wolfsburg, Diocese of Essen, Mülheim an der Ruhr, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital Cologne, Cologne, Germany
| | - Urs M Nater
- Department of Psychology, University of Vienna, Vienna, Austria
| | - Nadine Skoluda
- Department of Psychology, University of Vienna, Vienna, Austria
| | - Petra Ina Pfefferle
- Comprehensive Biobank Marburg (CBBMR), Philipps-Universität Marburg, Marburg, Germany
| | - David José Pedrosa
- Philipps-Universitat Marburg, Marburg, Germany
- Center of Mind, Brain and Behaviour, Philipps-Universitat Marburg, Marburg, Germany
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Hartmann-Nardin D, Stock S, Kalbe E, Folkerts AK. Cost-Effectiveness Analyses of Non-Pharmacological and Non-Surgical Interventions in Idiopathic Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S241-S252. [PMID: 38339939 DOI: 10.3233/jpd-230213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Background Interest in non-pharmacological/non-surgical interventions to treat Parkinson's disease (PD) has substantially increased. Although a few health-economic studies have been conducted, summary information on the cost-effectiveness is still scarce. Objective To give an overview of cost-effectiveness analyses (CEA) focusing on non-pharmacological/non-surgical interventions in PD patients. Methods A systematic literature search was conducted in five databases. Studies were included that provided cost-effectiveness analysis (CEA) or cost-utility analysis (CUA) of non-pharmacological/non-surgical interventions in PD patients. Study quality was assessed with the Drummond and CHEERS 2022 checklists, respectively for economic evaluation. Results N = 9 studies published between 2012-2023 were identified. Most studies undertook a CUA (n = 5); n = 3 reported a combination of CEA and CUA, and n = 1 a pure CEA. Most studies (n = 6) examined physical exercise. The CEA studies identified additional costs of 170€ -660€ for the improvement of one single unit of a clinical outcome and savings of 18.40€ -22.80€ per score gained as measured with established instruments. The four studies that found significant quality of life benefits show large variations in the incremental cost effectiveness ratio (ICER) of 3,220€ -214,226€ per quality-adjusted life year (QALY); notably interventions were heterogenous regarding content and intensity. Conclusions Despite increasing numbers of non-pharmacological/non-surgical intervention trials in PD patients, health-economic evaluations are rare. The examined intervention types and health-economic results vary greatly. Together with the heterogeneity of the health-economic studies these factors limit the conclusions that can be drawn. Further research and a standardization of methods is needed to allow decision makers to make meaningful interpretations, and to allocate scarce resources.
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Affiliation(s)
- Daniel Hartmann-Nardin
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Jing S, Yuan Y, Leuratti C, Vaja V, Cattaneo C. Pharmacokinetic and Safety Study of Single and Multiple Oral Doses of Safinamide in Healthy Chinese Volunteers. Clin Pharmacol Drug Dev 2023; 12:1104-1113. [PMID: 37293981 DOI: 10.1002/cpdd.1277] [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: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
This randomized, parallel-group study evaluated the plasma pharmacokinetic profile of safinamide in 24 healthy Chinese men and women, randomly assigned to receive 50 or 100 mg of safinamide as a single dose, followed, after a 7-day washout, by multiple doses once daily for 7 days. Plasma safinamide was determined up to 96 h after the first single dose (day 1) and the last multiple dose (day 14), and up to 24 h after the first multiple dose (day 8). Following single- and multiple-dose administration, peak concentrations were achieved at a median time of 1.5-2 h. Plasma exposure increased in a dose-proportional manner. After single dose, mean half-life was 23-24 h. Area under the concentration-time curve (AUC) from time zero extrapolated to infinity was only slightly higher than AUC from time zero to the last quantifiable concentration, corresponding for the 2 parameters, respectively, to 12,380 and 11,560 ng • h/mL for the 50 mg and to 22,030 and 20,790 ng • h/mL for the 100-mg dose. AUC in the dosing interval at steady state was 13,150 and 23,100 ng • h/mL for 50 and 100 mg of safinamide. Steady state was reached in 6 days, accumulation was approximately twofold, and the pharmacokinetics were time independent. The plasma safinamide pharmacokinetic profile observed in this study is in line with the published results in both Chinese and non-Asian populations.
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Affiliation(s)
- Sun Jing
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaozong Yuan
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Giaccio P, Charou D, Diakaki DI, Chita A, Gravanis A, Charalampopoulos I, Roussis V, Ioannou E. Butanolides and Butenolides from a Marine-Derived Streptomyces sp. Exert Neuroprotective Activity through Activation of the TrkB Neurotrophin Receptor. Mar Drugs 2023; 21:465. [PMID: 37755078 PMCID: PMC10532803 DOI: 10.3390/md21090465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Neurodegenerative diseases are incurable and debilitating conditions, characterized by progressive loss and degeneration of vulnerable neuronal populations. Currently, there are no effective therapies available for the treatment of most neurodegenerative disorders. A panel of extracts exhibiting interesting chemical profiles among a high number of bacterial strains isolated from East Mediterranean marine sediments and macroorganisms were evaluated for their activity on TrkB-expressing cells. Among them, the actinobacterial strain Streptomyces sp. BI0788, exhibiting neuroprotective activity in vitro, was selected and cultivated in large-scale. The chemical analysis of its organic extract resulted in the isolation of four new butanolides (1, 4-6), along with two previously reported butanolides (2 and 3) and eight previously reported butenolides (7-14). Compounds 2-4 and 7-14 were evaluated for their neuroprotective effects on TrkB-expressing NIH-3T3 cells. Among them, metabolites 3, 4, 7, 10, 11, 13 and 14 exhibited significant protective activity on the aforementioned cells through the activation of TrkB, the high-affinity receptor for the Brain-Derived Neurotrophic Factor (BDNF), which is well known to play a crucial role in neuronal cell survival and maintenance.
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Affiliation(s)
- Paolo Giaccio
- Section of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece; (P.G.); (D.-I.D.); (V.R.)
| | - Despoina Charou
- Department of Pharmacology, Medical School, University of Crete, 71003 Heraklion, Greece; (D.C.); (A.C.); (A.G.); (I.C.)
- Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology-Hellas (IMBB-FORTH), 70013 Heraklion, Greece
| | - Dafni-Ioanna Diakaki
- Section of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece; (P.G.); (D.-I.D.); (V.R.)
| | - Anna Chita
- Department of Pharmacology, Medical School, University of Crete, 71003 Heraklion, Greece; (D.C.); (A.C.); (A.G.); (I.C.)
- Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology-Hellas (IMBB-FORTH), 70013 Heraklion, Greece
| | - Achille Gravanis
- Department of Pharmacology, Medical School, University of Crete, 71003 Heraklion, Greece; (D.C.); (A.C.); (A.G.); (I.C.)
- Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology-Hellas (IMBB-FORTH), 70013 Heraklion, Greece
| | - Ioannis Charalampopoulos
- Department of Pharmacology, Medical School, University of Crete, 71003 Heraklion, Greece; (D.C.); (A.C.); (A.G.); (I.C.)
- Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology-Hellas (IMBB-FORTH), 70013 Heraklion, Greece
| | - Vassilios Roussis
- Section of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece; (P.G.); (D.-I.D.); (V.R.)
| | - Efstathia Ioannou
- Section of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece; (P.G.); (D.-I.D.); (V.R.)
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Nilashi M, Abumalloh RA, Alyami S, Alghamdi A, Alrizq M. Parkinson’s Disease Diagnosis Using Laplacian Score, Gaussian Process Regression and Self-Organizing Maps. Brain Sci 2023; 13:brainsci13040543. [PMID: 37190508 DOI: 10.3390/brainsci13040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/10/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
Parkinson’s disease (PD) is a complex degenerative brain disease that affects nerve cells in the brain responsible for body movement. Machine learning is widely used to track the progression of PD in its early stages by predicting unified Parkinson’s disease rating scale (UPDRS) scores. In this paper, we aim to develop a new method for PD diagnosis with the aid of supervised and unsupervised learning techniques. Our method is developed using the Laplacian score, Gaussian process regression (GPR) and self-organizing maps (SOM). SOM is used to segment the data to handle large PD datasets. The models are then constructed using GPR for the prediction of the UPDRS scores. To select the important features in the PD dataset, we use the Laplacian score in the method. We evaluate the developed approach on a PD dataset including a set of speech signals. The method was evaluated through root-mean-square error (RMSE) and adjusted R-squared (adjusted R²). Our findings reveal that the proposed method is efficient in the prediction of UPDRS scores through a set of speech signals (dysphonia measures). The method evaluation showed that SOM combined with the Laplacian score and Gaussian process regression with the exponential kernel provides the best results for R-squared (Motor-UPDRS = 0.9489; Total-UPDRS = 0.9516) and RMSE (Motor-UPDRS = 0.5144; Total-UPDRS = 0.5105) in predicting UPDRS compared with the other kernels in Gaussian process regression.
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Abraham A, Bay AA, Ni L, Schindler N, Singh E, Leeth E, Bozorg A, Hart AR, Hackney ME. Gender differences in motor and non-motor symptoms in individuals with mild-moderate Parkinson's disease. PLoS One 2023; 18:e0272952. [PMID: 36630320 PMCID: PMC9833587 DOI: 10.1371/journal.pone.0272952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) affects both men and women with documented gender differences across functional domains, with findings varying among reports. Knowledge regarding gender differences in PD for different geographic locations is important for further understanding of the disease and for developing personalized gender-specific PD assessment tools and therapies. OBJECTIVE This study aimed to examine gender differences in PD-related motor, motor-cognitive, cognitive, and psychosocial function in people with PD from the southern United States (US). METHODS 199 (127 men and 72 women; M age: 69.08±8.94) individuals with mild-moderate idiopathic PD (Hoehn &Yahr (H&Y) Median = 2, stages I-III) from a large metro area in the southeastern US were included in this retrospective, cross-sectional study. Motor, motor-cognitive, cognitive, and psychosocial data were obtained using standardized and validated clinical tests. Univariate analyses were performed, adjusting for age and housing type. RESULTS After adjustment for age, housing, PD duration and fall rate, men exhibited statistically significantly greater motor (Movement Disorders Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS)-II) and non-motor (MDS-UPDRS-I) impact of PD, and more severe motor signs (MDS-UPDRS-III). Men exhibited worse PD-specific health-related quality of life related to mobility, activities of daily living, emotional well-being, cognitive impairment, communication, and more depressive symptoms. Men performed worse on a subtraction working memory task. Women had slower fast gait speed. CONCLUSIONS In the southeastern United States, men may experience worse PD-related quality of life and more depression than women. Many non-motor and motor variables that are not PD specific show no differences between genders in this cohort. These findings can contribute to the development of gender-sensitive assessment and rehabilitation policies and protocols for people with PD.
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Affiliation(s)
- Amit Abraham
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Navigation and Accessibility Research Center of Ariel University (NARCA), Ariel University, Ariel, Israel
| | - Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Nicole Schindler
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Eeshani Singh
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Ella Leeth
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ariyana Bozorg
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Rehabilitation R&D Center Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
| | - Ariel R. Hart
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Rehabilitation R&D Center Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Emory School of Nursing, Atlanta, GA, United States of America
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Decatur, Georgia, United States of America
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Gallardo-Fernández M, Hornedo-Ortega R, Cerezo AB, Troncoso AM, Garcia-Parrilla MC. Hydroxytyrosol and dopamine metabolites: Anti-aggregative effect and neuroprotective activity against α-synuclein-induced toxicity. Food Chem Toxicol 2022; 171:113542. [DOI: 10.1016/j.fct.2022.113542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
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Tian Q, Yang X, Du J, Huang H, Liu W, Zhao P. Translocator Protein Ligand Etifoxine Attenuates MPTP-Induced Neurotoxicity. Front Mol Neurosci 2022; 15:850904. [PMID: 35686060 PMCID: PMC9172994 DOI: 10.3389/fnmol.2022.850904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disease, but the currently available treatments for this disease are symptomatic treatments. There is evidence that translocator protein (18 kDa) (TSPO) expression is upregulated in some neurodegenerative diseases, and TSPO ligands have obvious neuroprotective effects. However, the neuroprotective effects and other potential effects of the TSPO ligand etifoxine in PD remain unclear. Therefore, the present study was designed to explore the impacts of etifoxine on a mouse model of PD induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). We found that etifoxine significantly reduced motor function deficits, decreased the loss of tyrosine hydroxylase-positive neurons in the substantia nigra, and attenuated the decrease in striatal dopamine levels in mice that received MPTP. Etifoxine diminished the production of inflammatory mediators and infiltration of leukocytes in the brain after MPTP exposure. In vitro studies suggested that microglia contribute to etifoxine’s neuroprotective effect. The results showed that etifoxine can alleviate MPTP-induced neurotoxicity and neuroinflammation, providing a new idea for the treatment of PD.
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Albarmawi H, Zhou S, Shulman LM, Gandhi AB, Johnson A, Myers DE, Gray D, Alvir J, Onukwugha E. The economic burden of Parkinson disease among Medicare beneficiaries. J Manag Care Spec Pharm 2022; 28:405-414. [PMID: 35332791 PMCID: PMC10372956 DOI: 10.18553/jmcp.2022.28.4.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The progressive nature of Parkinson disease (PD), together with a lack of curative treatments, contributes to its economic burden. OBJECTIVE: To estimate the longitudinal incremental costs attributable to PD among Medicare beneficiaries. METHODS: In this retrospective cohort study, we used data from the Chronic Conditions Data Warehouse to identify Medicare beneficiaries with and without PD-related claims identified from 2006 to 2014 with follow-up until 2015. We grouped PD cases and controls based on their survival profiles using a grouping algorithm that used the following baseline measures: age, race, sex, and comorbidity. We identified 3 survival groups and used them to stratify the descriptive annual cost estimates in the 9 years after the index date. We estimated the incremental 1-, 3-, and 5-year costs of PD using generalized linear models (GLM) that controlled for baseline factors. RESULTS: We identified 27,394 cases and controls who were grouped into 3 survival groups. The mean age of the full study sample was 73 years. No material differences were found in the incremental cost of PD across the survival groups. Based on the multivariable GLM, the 1-year incremental cost of PD was $9,625 (95% CI, $9,054-$10,197). The 3-year incremental cost of PD was $20,832 (95% CI, $19,390-$22,274). The 5-year incremental cost of PD was $27,466 (95% CI, 25,088-$29,844). CONCLUSIONS: Among Medicare beneficiaries, PD is associated with excess costs compared with controls. We did not identify substantial differences in the incremental cost of PD across the survival groups. DISCLOSURES:This study was funded by Pfizer Inc. The funding agreement did not impact the authors' independence in designing the study, collecting the data, interpreting the data, writing the manuscript, and submitting the manuscript for publication. Dr Onukwugha reports grants from Pfizer Inc for the conduct of this study and is an employee of University of Maryland, Baltimore, which received financial support from Pfizer Inc in connection with the development of this manuscript; Dr Shulman reports research funding from Pfizer Inc related to the current work, is an employee of University of Maryland, Baltimore, which received financial support from Pfizer Inc in connection with the development of this manuscript, and reports research funding from the NIH, The Rosalyn Newman Foundation, and the Eugenia and Michael Brin family unrelated to the current work and royalties from Oxford University Press and Johns Hopkins University Press; Ms Myers and Dr Alvir are employees and stockholders of Pfizer Inc; Dr Gray was an employee and stockholder of Pfizer Inc at the time of analysis.
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Affiliation(s)
- Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. Now with Genentech Inc
| | - Shujia Zhou
- Department of Computer Science and Electrical Engineering, University of Maryland Baltimore County
| | - Lisa M Shulman
- Department of Neurology, University of Maryland, School of Medicine, Baltimore
| | - Aakash Bipin Gandhi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.,Now with Sanofi, US
| | - Abree Johnson
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | | | - David Gray
- Pfizer Inc., Cambridge, MA. Now with Cerevel Therapeutics
| | | | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
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Jandhyala R. Concordance between the schedule for the evaluation of individual quality of life-direct weighting (SEIQoL-DW) and the EuroQoL-5D (EQ-5D) measures of quality of life outcomes in adults with X-linked hypophosphatemia. Orphanet J Rare Dis 2022; 17:81. [PMID: 35197083 PMCID: PMC8864593 DOI: 10.1186/s13023-022-02250-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate measurement of any constructs in clinical studies is of critical importance, especially if the adoption of an intervention relies on detecting a significant treatment effect where one exists. Under Neutral theory, the amount of relevant and irrelevant indicators selected to operationalise the construct contribute equally to the accuracy of the observation. The Neutral or accurate observation is achieved by observing all relevant indicators only. Generic QoL instruments such as EQ-5D are increasingly being accepted as imprecise, especially in rare diseases, based on the relevance of their indicators. QoL is a construct that embodies a patient's subjectivity, individuality, and local circumstances at measurement. SEIQoL-DW is an instrument designed to respect these characteristics of QoL through eliciting indicators or cues directly from the subject along with the proportion of the overall QoL they contribute. EQ-5D and SEIQoL can therefore be considered as being at opposing ends of accuracy in QoL measurement. XLH is a hereditary, progressive, rare disease characterised by phosphate wasting, affecting both children and adults and impacting their QoL. The purpose of this study was to observe if any change in QoL of adult XLH patients were detectable using EQ-5D, SEIQoL eliciting new cues at each visit, and SEIQoL administering baseline cues overall visits (thereby silencing its time-dependency) versus baseline over 12 months. In addition, any association between the three sets of observations was explored. RESULTS All quality of life scores were observed to decrease from baseline by 13.36%, 7.32% and 2.7% based on SEIQoLvisit_cues, SEIQoLbaseline_cues, and EQ-5D assessments, respectively. The decrease in the quality of life scores was only statistically significant (p = 0.037) for SEIQoLvisit_cues. Beyond the baseline visit, the only highly positive and statistically significant pairwise association was between SEIQoLvisit_cues and SEIQoLbaseline_cues at M6 (ρ = 0.782, P value < 0.05) and M9 (ρ = 0.879, P value < 0.05). CONCLUSIONS EQ-5D and SEIQoLbaseline_cues failed to detect the same statistically significant decrease in QoL observed by SEIQoLvisit_cues. Both sets of SEIQoL observations were more closely associated with each other than with EQ-5D. Observing constructs such as QoL in rare diseases benefit from a Neutrality in indicator selection and respecting variation in dominance of various indicators over time.
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Affiliation(s)
- Ravi Jandhyala
- Medialis Ltd, 13 Horse Fair, Banbury, OX16 0AH, UK. .,Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, Faculty of Life Science and Medicine, King's College University, London, UK.
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Ledda C, Montanaro E, Imbalzano G, Merola A, Bruno I, Artusi CA, Zibetti M, Rizzone MG, Bozzali M, Sobrero G, Vallelonga F, Maule S, Lopiano L, Romagnolo A. Burden of caregiving for cardiovascular dysautonomia in Parkinson's disease. Clin Auton Res 2022; 32:455-461. [PMID: 36030471 PMCID: PMC9719446 DOI: 10.1007/s10286-022-00888-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/18/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE We sought to estimate the impact of cardiovascular autonomic neuropathy (cAN) on informal caregivers of patients with Parkinson's disease (PD), defined as individuals providing regular care to a friend, partner, or family member with PD, and to evaluate the mutual relationship between caregiver burden and patient health-related quality of life (HRQoL). METHODS We enrolled 36 consecutive patients with PD and their informal caregivers. Patients underwent a detailed motor, autonomic, cognitive, and functional assessment. Caregivers were assessed using the Zarit Burden Interview (ZBI). Differences in caregiver burden, expressed by the ZBI score, and strength of association between caregiver burden, cAN, and HRQoL were assessed using analysis of covariance (ANCOVA), logistic regression, and linear regression analyses. Analyses were adjusted for patients' age, PD duration, and motor and cognitive disability, as well as caregivers' age. RESULTS Moderate-severe caregiver burden was reported in 41.7% of PDcAN+ versus 8.7% of PDcAN- (p < 0.001). The ZBI score was increased in PDcAN+ versus PDcAN- (31.5 ± 3.4 versus 15.2 ± 2.3; p < 0.001), with tenfold higher odds (p = 0.012) of moderate-severe caregiver burden in PDcAN+, even after adjusting for potential confounders. The ZBI score correlated with cAN severity (p = 0.005), global autonomic impairment (p = 0.012), and HRQoL impairment (p < 0.001). CONCLUSION These results highlight the significant impact of cAN on PD caregivers and the need for targeted interventions addressing this frequently overlooked and insufficiently treated source of nonmotor disability in PD.
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Affiliation(s)
- Claudia Ledda
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Elisa Montanaro
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Gabriele Imbalzano
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Aristide Merola
- grid.261331.40000 0001 2285 7943Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH USA
| | - Ilaria Bruno
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Carlo Alberto Artusi
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Maurizio Zibetti
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Mario Giorgio Rizzone
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Marco Bozzali
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Gabriele Sobrero
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Fabrizio Vallelonga
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Simona Maule
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Leonardo Lopiano
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Alberto Romagnolo
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
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12
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Wei Q, Tan Y, Xu P, Tao E, Lu Z, Pan X, Wang B, Liu C, Dong X, Tian Y, Sun X, Cattaneo C, Chen S, Shang H, Shang H, Tao E, Liu C, Wu Y, Geng D, Lu Z, Xu P, Hu X, Luo Y, Zhou J, Huang W, Chen G, Tian Y, Tuo H, Wang B, Zhang M, Liu J, Sun X, Jiao L, Jin L, Feng T, Liu Y, Zhang B, Ye Q, Xu Y, Liu J, Gu S, Xu YM, Dong X, Liu D, Pan X. The XINDI Study: A Randomized Phase III Clinical Trial Evaluating the Efficacy and Safety of Safinamide as Add-On Therapy to Levodopa in Chinese Patients with Parkinson's Disease with Motor Fluctuations. CNS Drugs 2022; 36:1217-1227. [PMID: 36346534 PMCID: PMC9641300 DOI: 10.1007/s40263-022-00958-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Levodopa remains the gold standard for the treatment of Parkinson's disease, but its long-term use is associated with motor complications whose management is still a significant challenge. Safinamide is a multimodal drug with proven efficacy as an adjunct to levodopa. OBJECTIVE The objective of this study was to investigate the efficacy and safety of safinamide as an add-on to levodopa in Chinese patients with Parkinson's disease with motor fluctuations. METHODS The XINDI study was a phase III, randomized, double-blind, placebo-controlled, multicenter study, with a 2-week screening period and a 16-week treatment period. The starting dose of safinamide (or placebo) was 50 mg once daily, increased to 100 mg once daily at day 15. Patients aged ≥ 18 years, with idiopathic Parkinson's disease of >3 years duration, Hoehn and Yahr stage 1-4, and daily OFF time ≥ 1.5 h, were eligible. Patients should follow a stable oral levodopa regimen and may receive concomitant treatment with stable doses of other anti-Parkinson drugs, except monoamine oxidase-B inhibitors. Patients with severe disabling peak-dose or biphasic dyskinesia, unpredictable or widely swinging fluctuations, other forms of parkinsonism, a history of dementia or severe cognitive dysfunction, major psychiatric illnesses, and/or clinically significant medical illnesses were excluded. The primary efficacy endpoint was the change from baseline to week 16 in the mean daily OFF time. Secondary efficacy endpoints included the Unified Parkinson's Disease Rating Scale, the Numerical Rating Scale, the Clinical Global Impression scale, and the 39-Item Parkinson's Disease Questionnaire scale. The statistical analysis of the efficacy parameters was conducted using an analysis of co-variance, except for the Clinical Global Impression scale scores that were assessed using the Wilcoxon-Mann-Whitney test. Safety was evaluated through the frequency of adverse events and serious adverse events, physical examination, vital signs, 12-lead electrocardiograms, and laboratory exams. All safety endpoints were summarized using descriptive statistics. RESULTS The trial enrolled 307 patients. At week 16, the difference in the change of the mean total daily OFF time between safinamide and placebo groups was 1.10 h (p < 0.0001). This change was significantly greater in the safinamide group starting from week 2, suggesting a rapid onset of drug efficacy. ON time, Unified Parkinson's Disease Rating Scale, Clinical Global Impression scale, and the 39-Item Parkinson's Disease Questionnaire showed statistically significant improvements. There were no significant between-group differences for adverse events or serious adverse events. CONCLUSIONS Safinamide, as add-on therapy to levodopa, significantly reduced motor fluctuations and improved motor symptoms and quality of life of Chinese patients with idiopathic Parkinson's disease. The improvements observed in the Unified Parkinson's Disease Rating Scale total and motor scores were also clinically significant. No safety concerns were identified, confirming the good tolerability profile of the drug. CLINICAL TRIAL REGISTRATION NCT03881371, registered on 19 March, 2019, https://clinicaltrials.gov/NCT03881371 .
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Affiliation(s)
- Qianqian Wei
- grid.412901.f0000 0004 1770 1022Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuyan Tan
- grid.16821.3c0000 0004 0368 8293Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pingyi Xu
- grid.470124.4Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Enxiang Tao
- grid.412536.70000 0004 1791 7851Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Zuneng Lu
- grid.412632.00000 0004 1758 2270Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoping Pan
- grid.413432.30000 0004 1798 5993Department of Neurology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Baojun Wang
- Department of Neurology, Baotou City Central Hospital, Baotou, China
| | - Chunfeng Liu
- grid.452666.50000 0004 1762 8363Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xueshuang Dong
- grid.452354.10000 0004 1757 9055Department of Neurology, Daqing Oilfield General Hospital, Daqing, China
| | - Yuling Tian
- grid.452461.00000 0004 1762 8478Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin Sun
- grid.64924.3d0000 0004 1760 5735Department of Neurology, The First Bethune Hospital of Jilin University, Jilin, China
| | - Carlo Cattaneo
- grid.476824.bMedical Department, Zambon SpA, Bresso, Italy
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 2000001, China.
| | - Huifang Shang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou, Sichuan, 610041, Chengdu, China.
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13
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Ou Z, Pan J, Tang S, Duan D, Yu D, Nong H, Wang Z. Global Trends in the Incidence, Prevalence, and Years Lived With Disability of Parkinson's Disease in 204 Countries/Territories From 1990 to 2019. Front Public Health 2021; 9:776847. [PMID: 34950630 PMCID: PMC8688697 DOI: 10.3389/fpubh.2021.776847] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/15/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Parkinson's disease (PD) is an increasing challenge to public health. Tracking the temporal trends of PD burden would inform health strategies. Methods: Data of PD burden was obtained from the Global Burden of Disease 2019. Trends in the incidence, prevalence, and years lived with disability (YLDs) of PD were estimated using the annual percentage change (EAPC) and age-standardized rate (ASR) from 1990 to 2019. The EAPCs were calculated with ASR through a linear regression model. Results: The overall ASR of the incidence, prevalence, and YLDs of PD increased from 1990 to 2019, and their EAPCs were 0.61 (95% confidence interval [CI]: 0.58–0.65), 0.52 (95% CI: 0.43–0.61), and 0.53 (95% CI: 0.44–0.62). The largest number of PD patients was seen in the groups aged more than 65 years, and the percentage rapidly increased in the population aged more than 80 years. Upward trends in the ASR of PD were observed in most settings over the past 30 years. Incident trends of ASR increased pronouncedly in the United States of America and Norway, in which the respective EAPCs were 2.87 (95% CI: 2.35–3.38) and 2.14 (95% CI: 2.00–2.29). Additionally, the largest increasing trends for prevalence and YLDs were seen in Norway, with the respective EAPCs of 2.63 (95% CI: 2.43–2.83) and 2.61 (95% CI: 2.41–2.80). However, decreasing trends in PD appeared in about 30 countries, particularly Italy and the Republic of Moldova. Conclusions: Increasing trends in the burden of PD were observed globally, and in most regions and countries from 1990 to 2019. Our findings suggested that the control and management of PD should be strengthened, especially when considering the aging tendency of the population.
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Affiliation(s)
- Zejin Ou
- Department of Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China.,Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jing Pan
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China.,Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou, China
| | - Shihao Tang
- Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou, China
| | - Danping Duan
- Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou, China
| | - Danfeng Yu
- Department of Medical Intensive Care Unit (MICU), Guangdong Women and Children Hospital, Guangzhou, China
| | - Huiqi Nong
- Department of Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Zhi Wang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China.,Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou, China
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14
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Wu F, Wang DD, Shi HH, Wang CC, Xue CH, Wang YM, Zhang TT. N-3 PUFA-Deficiency in Early Life Exhibits Aggravated MPTP-Induced Neurotoxicity in Old Age while Supplementation with DHA/EPA-Enriched Phospholipids Exerts a Neuroprotective Effect. Mol Nutr Food Res 2021; 65:e2100339. [PMID: 34378848 DOI: 10.1002/mnfr.202100339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/04/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Malnutrition in early life affects the growth and development of fetus and children, which has a long-term impact on adult health. Previous studies reveal a relationship between dietary omega-3 polyunsaturated fatty acid (n-3 PUFA) content, brain development, and the prevalence of neurodevelopmental disorders and inflammation. However, it is unclear about the effect of n-3 PUFA-deficiency in early life on the development of Parkinson's disease (PD) in old age, as well as the neuroprotective effect of DHA- and EPA-enriched phospholipids (DHA/EPA-PLs) supplemented in old age in long-term n-3 PUFA-deficient mice. METHODS AND RESULTS The PD mice induced by 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP) in n-3 PUFA-adequate (N) and -deficient (DEF) group are supplemented with a DHA/EPA-PLs diet for 2 weeks (N+DPL, DEF+DPL). DHA/EPA-PLs supplementation significantly protects against MPTP-induced impairments. The DEF+DPL group shows poorer motor performance, the loss of dopaminergic neurons, mitochondrial dysfunction, and neurodevelopment delay than the N+DPL group, and still did not recover to the Control level. CONCLUSIONS Dietary n-3 PUFA-deficiency in early life exhibits more aggravated MPTP-induced neurotoxicity in old age, than DHA/EPA-PLs supplementation recovers brain DHA levels and exerts neuroprotective effects in old age in long-term n-3 PUFA-deficient mice, which might provide a potential dietary guidance.
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Affiliation(s)
- Fang Wu
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China
| | - Dan-Dan Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China
| | - Hao-Hao Shi
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China
| | - Cheng-Cheng Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China
| | - Chang-Hu Xue
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, Shandong Province, 266237, China
| | - Yu-Ming Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, Shandong Province, 266237, China
| | - Tian-Tian Zhang
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong, 266003, China
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15
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Tolosa E, Ebersbach G, Ferreira JJ, Rascol O, Antonini A, Foltynie T, Gibson R, Magalhaes D, Rocha JF, Lees A. The Parkinson's Real-World Impact Assessment (PRISM) Study: A European Survey of the Burden of Parkinson's Disease in Patients and their Carers. JOURNAL OF PARKINSONS DISEASE 2021; 11:1309-1323. [PMID: 34024784 PMCID: PMC8461669 DOI: 10.3233/jpd-212611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: A greater understanding of the everyday experiences of people with Parkinson’s disease (PD) and their carers may help improve clinical practice. Objective: The Parkinson’s Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD and their carers. Methods: PRISM is an observational cross-sectional study, in which people with PD and their carers completed an online survey using structured questionnaires, including the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQuest) and Zarit Burden Interview (ZBI). Results: Data were collected from 861 people with PD (mean age, 65.0 years; mean disease duration, 7.7 years) and 256 carers from six European countries. People with PD reported a large number of different co-morbidities, non-motor symptoms (mean NMSQuest score, 12.8), and impaired HRQoL (median PDQ-39 summary score, 29.1). Forty-five percent of people with PD reported at least one impulse control behaviour. Treatment patterns varied considerably between different European countries. Levodopa was taken in the last 12 months by 85.9% of participants, and as monotherapy by 21.8%. Carers, who were mostly female (64.8%) and the partner/spouse of the person with PD (82.1%), reported mild to moderate burden (mean ZBI total score, 26.6). Conclusions: The PRISM study sheds light on the lives of people with PD and those who care for them, re-emphasising the many challenges they face in everyday life. The study also provides insights into the current treatment of PD in Europe.
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Affiliation(s)
- Eduardo Tolosa
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Olivier Rascol
- Toulouse Parkinson Expert Center, Departments of Neurosciences and Clinical Pharmacology, Centre d'Investigation Clinique de Toulouse CIC1436, NS-Park/FCRIN Network, and NeuroToul COEN Center, University Hospital of Toulouse, INSERM, University of Toulouse, Toulouse, France
| | - Angelo Antonini
- Parkinson Disease and Movement Disorder Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | | | | | - Andrew Lees
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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16
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Khodakarami H, Shokouhi N, Horne M. A method for measuring time spent in bradykinesia and dyskinesia in people with Parkinson's disease using an ambulatory monitor. J Neuroeng Rehabil 2021; 18:116. [PMID: 34271971 PMCID: PMC8283900 DOI: 10.1186/s12984-021-00905-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/25/2021] [Indexed: 01/07/2023] Open
Abstract
Background Fluctuations in motor function in Parkinson’s Disease (PD) are frequent and cause significant disability. Frequently device assisted therapies are required to treat them. Currently, fluctuations are self-reported through diaries and history yet frequently people with PD do not accurately identify and report fluctuations. As the management of fluctuations and the outcomes of many clinical trials depend on accurately measuring fluctuations a means of objectively measuring time spent with bradykinesia or dyskinesia would be important. The aim of this study was to present a system that uses wearable sensors to measure the percentage of time that bradykinesia or dyskinesia scores are above a target as a means for assessing levels of treatment and fluctuations in PD. Methods Data in a database of 228 people with Parkinson’s Disease and 157 control subjects, who had worn the Parkinson’s Kinetigraph ((PKG, Global Kinetics Corporation™, Australia) and scores from the Unified Parkinson’s Disease Rating Scale (UPDRS) and other clinic scales were used. The PKG’s provided score for bradykinesia and dyskinesia every two minutes and these were compared to a previously established target range representing a UPDRS III score of 35. The proportion of these scores above target over the 6 days that the PKG was worn were used to derive the percent time in bradykinesia (PTB) and percent time in dyskinesia (PTD). As well, a previously describe algorithm for estimating the amplitude of the levodopa response was used to determine whether a subject was a fluctuator or non-fluctuator. Results Using this approach, a normal range of PTB and PTD based on Control subject was developed. The level of PTB and PTD experienced by people with PD was compared with their levels of fluctuation. There was a correlation (Pearson’s ρ = 0.4) between UPDRS II scores and PTB: the correlation between Parkinson Disease Questionnaire scores and UPDRS Total scores and PTB and slightly lower. PTB and PTD fell in response to treatment for bradykinesia or dyskinesia (respectively) with greater sensitivity than clinical scales. Conclusions This approach provides an objective assessment of the severity of fluctuations in Parkinson’s Disease that could be used in in clinical trials and routine care. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00905-4.
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Affiliation(s)
- Hamid Khodakarami
- Global Kinetics Pty Ltd, 31 Queen St., Melbourne, Victoria, Australia
| | - Navid Shokouhi
- Global Kinetics Pty Ltd, 31 Queen St., Melbourne, Victoria, Australia
| | - Malcolm Horne
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia. .,The Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, 3010, Australia. .,Department of Neurology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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17
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Silva Dos Santos J, Gonçalves Cirino JP, de Oliveira Carvalho P, Ortega MM. The Pharmacological Action of Kaempferol in Central Nervous System Diseases: A Review. Front Pharmacol 2021; 11:565700. [PMID: 33519431 PMCID: PMC7838523 DOI: 10.3389/fphar.2020.565700] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/20/2020] [Indexed: 01/01/2023] Open
Abstract
Kaempferol (KPF) is a flavonoid antioxidant found in fruits and vegetables. Many studies have described the beneficial effects of dietary KPF in reducing the risk of chronic diseases, especially cancer. Nevertheless, little is known about the cellular and molecular mechanisms underlying KPF actions in the central nervous system (CNS). Also, the relationship between KPF structural properties and their glycosylation and the biological benefits of these compounds is unclear. The aim of this study was to review studies published in the PubMed database during the last 10 years (2010–2020), considering only experimental articles that addressed the isolated cell effect of KPF (C15H10O6) and its derivatives in neurological diseases such as Alzheimer's disease, Parkinson, ischemia stroke, epilepsy, major depressive disorder, anxiety disorders, neuropathic pain, and glioblastoma. 27 publications were included in the present review, which presented recent advances in the effects of KPF on the nervous system. KPF has presented a multipotential neuroprotective action through the modulation of several proinflammatory signaling pathways such as the nuclear factor kappa B (NF-kB), p38 mitogen-activated protein kinases (p38MAPK), serine/threonine kinase (AKT), and β-catenin cascade. In addition, there are different biological benefits and pharmacokinetic behaviors between KPF aglycone and its glycosides. The antioxidant nature of KPF was observed in all neurological diseases through MMP2, MMP3, and MMP9 metalloproteinase inhibition; reactive oxygen species generation inhibition; endogenous antioxidants modulation as superoxide dismutase and glutathione; formation and aggregation of beta-amyloid (β-A) protein inhibition; and brain protective action through the modulation of brain-derived neurotrophic factor (BDNF), important for neural plasticity. In conclusion, we suggest that KPF and some glycosylated derivatives (KPF-3-O-rhamnoside, KPF-3-O-glucoside, KPF-7-O-rutinoside, and KPF-4′-methyl ether) have a multipotential neuroprotective action in CNS diseases, and further studies may make the KPF effect mechanisms in those pathologies clearer. Future in vivo studies are needed to clarify the mechanism of KPF action in CNS diseases as well as the impact of glycosylation on KPF bioactivity.
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Affiliation(s)
- Jéssica Silva Dos Santos
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, Post Graduate Program in Health Science, São Francisco University (USF), Bragança Paulista, Brazil
| | - João Pedro Gonçalves Cirino
- Laboratory of Multidisciplinary Research, Post Graduate Program in Health Science, São Francisco University (USF), Bragança Paulista, Brazil
| | - Patrícia de Oliveira Carvalho
- Laboratory of Multidisciplinary Research, Post Graduate Program in Health Science, São Francisco University (USF), Bragança Paulista, Brazil
| | - Manoela Marques Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, Post Graduate Program in Health Science, São Francisco University (USF), Bragança Paulista, Brazil
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18
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Hadoush H, Alqudah A, Banihani SA, Al-Jarrah M, Amro A, Aldajah S. Melatonin serum level, sleep functions, and depression level after bilateral anodal transcranial direct current stimulation in patients with Parkinson's disease: a feasibility study. Sleep Sci 2021; 14:25-30. [PMID: 34917270 PMCID: PMC8663735 DOI: 10.5935/1984-0063.20200083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Parkinson's disease (PD) is associated with non-motor complications such as sleep disturbance and depression. Transcranial direct current stimulation (tDCS) showed therapeutic effects on the motor dysfunctions. However, the potential effects of tDCS therapy on melatonin hormone, sleep dysfunctions, and depression in patients with PD still unclear. This feasibility study aimed to identify any potential changes in melatonin serum level, sleep functions and depression after the bilateral anodal tDCS in patients with PD. Material and Methods Tensessions of bilateral anodal tDCS stimulation applied over left and right prefrontal and motor areas were given to twenty-five patients with PD. Melatonin serum level, Pittsburgh sleep quality index, and geriatric depression scale examined before and after tDCS stimulation. Results After bilateral anodal tDCS, there was a significant reduction in melatonin serum level, improvement in depression, improvements in overall sleep quality, and sleep latency. Correlations test showed significant associations between melatonin serum level reduction and changes in subjective sleep quality, and sleep duration, as well as between improvements in depression and overall sleep quality, sleep latency, and sleep disturbance. Conclusion Bilateral anodal tDCS therapy was a feasible and safe tool that showed potential therapeutic effects on melatonin serum level, sleep quality, and depression level in patients with PD. Although the further large scale and randomized-control trial studies are crucially needed, there is still a need for such a feasibility study to be established before such trials can be implemented as is recommended in the new medical research council guidelines.
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Affiliation(s)
- Hikmat Hadoush
- Jordan University of Science and Technology, Rehabilitation Sciences -Irbid - Irbid - Jordan
| | - Ansam Alqudah
- Jordan University of Science and Technology, Rehabilitation Sciences -Irbid - Irbid - Jordan
| | - Saleem A Banihani
- Jordan University of Science and Technology, Medical Laboratory Sciences - Irbid - Irbid - Jordan
| | - Muhammed Al-Jarrah
- Jordan University of Science and Technology, Rehabilitation Sciences -Irbid - Irbid - Jordan
| | - Akram Amro
- Al-Quds University, Physiotherapy - Jerusalem - Jerusalem - Palestinian Territories
| | - Salameh Aldajah
- Isra University, Rehabilitation Sciences -Amman - Amman - Jordan
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Crispino P, Gino M, Barbagelata E, Ciarambino T, Politi C, Ambrosino I, Ragusa R, Marranzano M, Biondi A, Vacante M. Gender Differences and Quality of Life in Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E198. [PMID: 33383855 PMCID: PMC7795924 DOI: 10.3390/ijerph18010198] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/05/2020] [Accepted: 12/26/2020] [Indexed: 12/15/2022]
Abstract
Parkinson's disease has been found to significantly affect health-related quality of life. The gender differences of the health-related quality of life of subjects with Parkinson's disease have been observed in a number of studies. These differences have been reported in terms of the age at onset, clinical manifestations, and response to therapy. In general, women with Parkinson's disease showed more positive disease outcomes with regard to emotion processing, non-motor symptoms, and cognitive functions, although women report more Parkinson's disease-related clinical manifestations. Female gender predicted poor physical functioning and socioemotional health-related quality of life, while male gender predicted the cognitive domain of health-related quality of life. Some studies reported gender differences in the association between health-related quality of life and non-motor symptoms. Depression and fatigue were the main causes of poorer health-related quality of life in women, even in the early stages of Parkinson's disease. The aim of this review was to collect the best available evidence on gender differences in the development of Parkinson's disease symptoms and health-related quality of life.
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Affiliation(s)
- Pietro Crispino
- Internal Medicine Department, Lagonegro Hospital, 85042 Lagonegro (PZ), Italy;
| | - Miriam Gino
- Department of Internal Medicine, Rivoli Hospital, 10098 Rivoli (TO), Italy;
| | - Elena Barbagelata
- Department of Internal Medicine, ASL 4 Chiavarese, Sestri Levante Hospital, 16039 Sestri Levante (GE), Italy;
| | - Tiziana Ciarambino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatrics Sciences, Marcianise Hospital, ASL Caserta, University of Campania “L. Vanvitelli”, 81025 Naples, Italy;
| | - Cecilia Politi
- Department of Internal Medicine, Veneziale Hospital, 86170 Isernia, Italy;
| | | | - Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital G. Rodolico, 95123 Catania, Italy;
| | - Marina Marranzano
- Department of Medical, Surgical and Advanced Sciences, University of Catania, 95123 Catania, Italy;
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
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Recent Advances and Future Perspectives in the Development of Therapeutic Approaches for Neurodegenerative Diseases. Brain Sci 2020; 10:brainsci10090633. [PMID: 32932920 PMCID: PMC7565049 DOI: 10.3390/brainsci10090633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022] Open
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Cattaneo C, Jost WH, Bonizzoni E. Long-Term Efficacy of Safinamide on Symptoms Severity and Quality of Life in Fluctuating Parkinson's Disease Patients. JOURNAL OF PARKINSON'S DISEASE 2020; 10:89-97. [PMID: 31594253 PMCID: PMC7029312 DOI: 10.3233/jpd-191765] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is characterized by a wide range of motor and non-motor symptoms. Levodopa is still the most effective drug; however, its long-term use is associated with motor complications which may deteriorate patient's quality of life. Safinamide is a unique treatment modulating both dopaminergic and glutamatergic systems. Previous results from two six months, double-blind, placebo-controlled studies demonstrated that safinamide has positive effects on both motor functions and quality of life in PD patients. OBJECTIVE To investigate the effects of safinamide 100 mg/day over two-year treatment on PD symptoms severity and quality of life, using data from the study 018. METHODS Data from 352 patients were analyzed to evaluate the effects of safinamide on OFF time and ON time (with no or non-troublesome dyskinesia) in the overall population and in subgroups of patients (receiving levodopa monotherapy or with other anti-Parkinson therapies), and the effects of safinamide on motor symptoms/clinical fluctuations (by means of UPDRS III and IV) and on health-related quality of life (using UPDRS II and PDQ-39 summary index score). RESULTS Safinamide, administered as add-on to standard therapy in fluctuating PD patients, significantly improved motor symptoms and clinical fluctuations in the overall population and in some subgroups of patients. Additionally, safinamide improved quality of life and activities of daily living, maintaining the efficacy in the long-term. CONCLUSIONS The findings of these analyses suggest that safinamide may be considered an appropriate adjunct therapy in patient not sufficiently controlled. Further investigations are desirable to confirm these results in usual care setting.
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Affiliation(s)
| | | | - Erminio Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics and Biometry “GA Maccacaro”, University of Milan, Milan, Italy
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22
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Park JH, Kim DH, Kwon DY, Choi M, Kim S, Jung JH, Han K, Park YG. Trends in the incidence and prevalence of Parkinson's disease in Korea: a nationwide, population-based study. BMC Geriatr 2019; 19:320. [PMID: 31752705 PMCID: PMC6868716 DOI: 10.1186/s12877-019-1332-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The lack of adequate and detailed epidemiological data of Parkinson's disease (PD), especially in Asia, is a barrier to future disease burdens and the prospect of effective public health plans. This study aimed to investigate temporal trends in the incidence and prevalence of PD in South Korea from 2010 to 2015, based on uniform diagnostic criteria. METHODS This study examined all PD patients registered in a South Korean national registry database of more than 50 million individuals. We analyzed the incidence and prevalence of PD according to age, gender, and region. RESULTS The annual incidence of PD was between 22.4-27.8 cases per 100,000 individuals. During the 6-year study period, there were 73,726 new PD patients, 42.3% of whom were men. The standardized incidence of PD increased over time in men but remained constant in women until 2013 but began to increase in 2014. The female-to-male ratio in the incidence of PD was 1.4:1 while the female-to-male ratio in the prevalence of PD was 1.6:1. The age- and gender-standardized prevalence of PD increased from 115.9 cases per 100,000 individuals in 2010 to 139.8 cases per 100,000 individuals in 2015. From 2014, the incidence and prevalence of PD peaked in individuals aged between 80 and 89 years in both men and women. Regional analysis also showed an increased prevalence of PD in all regions of Korea. CONCLUSIONS The incidence and prevalence of PD in Korea were higher in women and increased gradually from 2010 to 2015. The findings may contribute to epidemiological studies of PD in Asia, and may provide clues on risk factors for PD.
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Affiliation(s)
- Joo-Hyun Park
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| | - Do-Young Kwon
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| | - Moonyoung Choi
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Shinhye Kim
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatics, Catholic University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatics, Catholic University College of Medicine, Seoul, Republic of Korea
| | - Yong-Gyu Park
- Department of Biostatics, Catholic University College of Medicine, Seoul, Republic of Korea
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Gumber A, Ramaswamy B, Thongchundee O. Effects of Parkinson's on employment, cost of care, and quality of life of people with condition and family caregivers in the UK: a systematic literature review. Patient Relat Outcome Meas 2019; 10:321-333. [PMID: 31695537 PMCID: PMC6816078 DOI: 10.2147/prom.s160843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background Parkinson’s is an incurable, neuro-degenerative condition with multiple symptoms substantially impacting on living conditions and quality of life (QoL) for people with Parkinson’s (PwP), most whom are older adults, and their families. The study aimed to undertake a literature review of studies conducted in the UK that quantify the direct or indirect impact of Parkinson’s on people with the condition, their families, and society in terms of out-of-pocket payments and financial consequences. Methods Literature was searched for Parkinson’s-related terms plus condition impact (eg, financial, employment, pension, housing, health care costs, and QoL) in the UK setting. The strategy probed several electronic databases with all retrieved papers screened for relevancy. The instruments used to measure patient-related outcomes were then examined for their relevancy in justifying the results. Results The initial search retrieved 2,143 papers of which 79 were shortlisted through title and abstract screening. A full-text reading indicated 38 papers met the inclusion and quality criteria. Summary data extracted from the articles on focus, design, sample size, and questionnaires/instruments used were presented in four themes: (a) QoL and wellbeing of PwP, (b) QoL and wellbeing of caregivers and family members, (c) employment and living conditions, and (d) direct and indirect health care and societal cost. Conclusion UK results substantiated global evidence regarding the deterioration of QoL of PwP as the condition progressed, utilizing numerous measures to demonstrate change. Many spouses and family accept care responsibilities, affecting their QoL and finances too. The review highlighted increased health care and privately borne costs with condition progression, although UK evidence was limited on societal costs of Parkinson’s in terms of loss of employment, reduced work hours, premature retirement of PwP and caregivers that directly affected their household budget.
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Affiliation(s)
- Anil Gumber
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Bhanu Ramaswamy
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Oranuch Thongchundee
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
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Ortelli P, Ferrazzoli D, Bera R, Caremani L, Giladi N, Maestri R, Frazzitta G. Effectiveness of a Goal-Based Intensive Rehabilitation in Parkinsonian Patients in Advanced Stages of Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:113-119. [PMID: 29480227 DOI: 10.3233/jpd-171247] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinsonian patients in advanced stages of disease suffer from many motor and non-motor symptoms, whose responsiveness to dopamine replacement therapy and deep brain stimulation is poor. It is necessary to find complementary strategies in order to improve the clinical conditions of patients in advanced Parkinson's disease (PD) stages. OBJECTIVE We aimed to understand whether an inpatient, motor-cognitive, multidisciplinary, aerobic, intensive and goal-based rehabilitation treatment (MIRT), specifically designed for PD, is effective for patients in advanced stages of disease. METHODS 638 Parkinsonian patients, hospitalized to undergo a 4-week MIRT, were retrospectively identified. According to the Hoehn & Yahr (H&Y) scale, 496 were in H&Y stage 3 and 142 in H&Y stage 4-5. Outcome measures included: Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Six Minute Walk Test (6MWT), and Parkinson's Disease Disability Scale (PDDS). RESULTS At baseline all measures, except UPDRS IV, significantly worsened passing from H&Y stage 3 to H&Y stage 4-5 (p≤0.002 all). After rehabilitation all outcome measures significantly improved in both groups of patients (p < 0.0001 all). Comparing the amount of improvement in the two groups, significant differences were observed only for the changes in BBS and TUG (both p < 0.0001 after adjustment), with a better improvement in the H&Y stage 4-5 group. CONCLUSIONS A multidisciplinary, motor-cognitive, intensive and goal-based rehabilitation treatment, such as MIRT, could be an effective complementary treatment in PD patients in advanced stages of disease.
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Affiliation(s)
- Paola Ortelli
- Department of Parkinson's disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Como, Italy
| | - Davide Ferrazzoli
- Department of Parkinson's disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Como, Italy
| | - Rossana Bera
- Department of Parkinson's disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Como, Italy
| | - Luca Caremani
- Department of Parkinson's disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Como, Italy
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Centre, Sieratzki Chair in Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Montescano, Pavia, Italy
| | - Giuseppe Frazzitta
- Department of Parkinson's disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Como, Italy
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Maximiano-Barreto MA, Luchesi BM, Chagas MHN. Implicit attitudes toward the elderly among health professionals and undergraduate students in the health field: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:415-421. [PMID: 31939592 DOI: 10.1590/2237-6089-2018-0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To perform a systematic review of articles evaluating implicit attitudes of health professionals and undergraduate students in the health field toward the elderly. METHODS The PsycINFO, PubMed, Web of Science, Scopus and LILACS databases were searched for relevant articles published in English, Portuguese and Spanish using the following search terms: implicit attitude AND (elderly OR aged OR older people). Seven articles were selected. RESULTS The majority of studies were conducted in developed countries and found negative attitudes toward the elderly, with males exhibiting more negative attitudes than females. CONCLUSION The articles analyzed in this review demonstrate an implicitly negative attitude among professionals and students in the field of health toward the elderly.
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Perepezko K, Hinkle JT, Shepard MD, Fischer N, Broen MP, Leentjens AFG, Gallo J, Pontone GM. Social role functioning in Parkinson's disease: A mixed-methods systematic review. Int J Geriatr Psychiatry 2019; 34:1128-1138. [PMID: 31069845 PMCID: PMC6949188 DOI: 10.1002/gps.5137] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is a progressive neurodegenerative disease that often impedes activities of daily living (ADL) and social functioning. Impairment in these areas can alter social roles by interfering with employment status, household management, friendships, and other relationships. Understanding how PD affects social functioning can help clinicians choose management strategies that mitigate these changes. METHODS We conducted a mixed-methods systematic review of existing literature on social roles and social functioning in PD. A tailored search strategy in five databases identified 51 full-text reports that fulfilled the inclusion criteria and passed the quality appraisal. We aggregated and analyzed the results from these studies and then created a narrative summary. RESULTS Our review demonstrates how PD causes many people to withdraw from their accustomed social roles and experience deficits in corresponding activities. We describe how PD symptoms (eg, tremor, facial masking, and neuropsychiatric symptoms) interfere with relationships (eg, couple, friends, and family) and precipitate earlier departure from the workforce. Additionally, several studies demonstrated that conventional PD therapy has little positive effect on social role functioning. CONCLUSIONS Our report presents critical insight into how PD affects social functioning and gives direction to future studies and interventions (eg, couple counseling and recreational activities).
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Affiliation(s)
- Kate Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared T. Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Medical Scientist Training Program, Baltimore, MD, USA
| | - Melissa D. Shepard
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martinus P.G. Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joe Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hicks A, Phillips K, Siwik C, Salmon P, Litvan I, Jablonski ME, Filoteo JV, Kayser K, Sephton SE. The role of dispositional mindfulness in a stress-health pathway among Parkinson's disease patients and caregiving partners. Qual Life Res 2019; 28:2705-2716. [PMID: 31201728 DOI: 10.1007/s11136-019-02217-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Parkinson's disease (PD) patients and their caregivers experience significant distress that impacts physical, emotional and social functioning in the patient, and in turn, has a significant impact on the caregiver. Lower levels of stress have been associated with a better prognosis in PD. The quality of dispositional mindfulness-innate present moment, non-judgmental awareness-has consistently been associated with less perceived stress, greater well-being, and better physical health in both clinical and healthy populations. To date, associations of mindfulness with distress, depression, sleep problems, and other variables that define health-related quality of life have not been examined in the context of PD patient/caregiver dyads. METHODS We investigated the impact of dispositional mindfulness in a stress-health model among eighteen dyads consisting of PD patients and their caregivers. RESULTS Multilevel linear modeling (actor-partner interdependence models) revealed significant associations between dispositional mindfulness and stress appraisal, interpersonal support, depressive symptoms, sleep, and health-related quality of life (HRQOL) within both dyadic partners. As expected, results demonstrated significant associations of distress with interpersonal support, depressive symptoms, sleep and HRQOL for both PD patients and caregivers. CONCLUSIONS Dispositional mindfulness was associated with reduced distress and its downstream clinical consequences. These results support an ameliorative role for dispositional mindfulness among PD patients and caregivers, as a protective factor against psychosocial burdens imposed on couples related to disease and caregiving. Findings suggest future studies should explore mindfulness training as a therapeutic option.
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Affiliation(s)
- Allison Hicks
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kala Phillips
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Chelsea Siwik
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Paul Salmon
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Irene Litvan
- Department of Neurology, University of California San Diego, San Diego, CA, USA
| | - Megan E Jablonski
- Department of Psychology, Frazier Rehabilitation Hospital, Louisville, KY, USA
| | - J Vincent Filoteo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Karen Kayser
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Sandra E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA.
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Jiang JL, Chen SY, Tsai ST. Quality of life in patients with Parkinson's disease after subthalamic stimulation: An observational cohort study for outcome prediction. Tzu Chi Med J 2019; 31:107-112. [PMID: 31007491 PMCID: PMC6450151 DOI: 10.4103/tcmj.tcmj_92_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of this study was to investigate the changes in health-related quality of life (HRQoL) and motor and depressive symptoms in patients with Parkinson's disease (PD) from baseline to 12 months following subthalamic nucleus deep brain stimulation (STN-DBS). Materials and Methods: The study utilized a prospective observational cohort design. Thirty-three PD patients with a good levodopa response but drug-related morbidity were included. PD Questionnaire-39 (PDQ-39) scores, unified PD rating scale (UPDRS) scores, Hoehn and Yahr stages, Beck Depression Inventory-II scores, and levodopa equivalent daily doses (LEDD) were obtained at baseline and 1 year after surgery. Results: The enrolled patients showed a significant HRQoL improvement of 21.43% at 12 months after STN-DBS as assessed by the PDQ-39 total score. There was a 34.92% improvement in UPDRS scores after STN-DBS at 1 year follow-up. Subitem analysis revealed significant improvement in UPDRS part II, III, and IV scores. The LEDD was significantly reduced by up to 27.36% 12 months after surgery. The preoperative PDQ-39 total score and LEDD predicted postoperative HRQoL in PD following STN-DBS. Conclusions: The current study demonstrated that STN-DBS surgery significantly improved HRQoL and motor outcomes of patients with PD. The preoperative PDQ-39 score and LEDD were predictors of the efficacy of postoperative HRQoL following surgery.
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Affiliation(s)
| | - Shin-Yuan Chen
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Afentou N, Jarl J, Gerdtham U, Saha S. Economic Evaluation of Interventions in Parkinson's Disease: A Systematic Literature Review. Mov Disord Clin Pract 2019; 6:282-290. [PMID: 31061835 PMCID: PMC6476603 DOI: 10.1002/mdc3.12755] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/28/2019] [Accepted: 02/27/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) management comprises of drug treatments, surgery, and physical activity/occupational therapies to relieve PD's symptoms. The aim of this study is twofold; first, to appraise recent economic evaluation studies on PD management in order to update the existing knowledge; and second, to facilitate decision making on PD management by assessing the cost-effectiveness of all types of PD interventions. METHODS A systematic search for studies published between 2010 and 2018 was conducted. The inclusion and exclusion of the articles were based on criteria relevant to population, intervention, comparison, outcomes, and study design (PICO). The reporting quality of the articles was assessed according to Consolidated Health Economic Evaluation Reporting Standards. RESULTS Twenty-eight articles were included, 10 of which were evaluations of drug treatments, 10 deep brain stimulation (DBS), and eight physical/occupational therapies. Among early-stage treatments, Ti Ji dominated all physical activity interventions; however, its cost-effectiveness should be further explored in relation to its duration, intensity, and frequency. Multidisciplinary interventions of joint medical and nonmedical therapies provided slightly better health outcomes for the same costs. In advanced PD patients, adjunct drug treatments could become more cost-effective if introduced during early PD and, although DBS was more cost-effective than adjunct drug therapies, the results were time-bound. CONCLUSIONS Conditionally, certain PD interventions are cost-effective. However, PD progression differs in each patient; thus, the cost-effectiveness of individually tailored combinations of interventions that could provide more time in less severe disease states and improve patients' and caregivers' quality of life, should be further explored.
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Affiliation(s)
- Nafsika Afentou
- Health Economics Unit, Department of Clinical Science (Malmö)Lund UniversityLundSweden
- Health Economics UnitInstitute of Applied Health Research, University of BirminghamBirminghamUnited Kingdom
| | - Johan Jarl
- Health Economics Unit, Department of Clinical Science (Malmö)Lund UniversityLundSweden
| | - Ulf‐G Gerdtham
- Health Economics Unit, Department of Clinical Science (Malmö)Lund UniversityLundSweden
- Centre for Economic DemographyLund UniversityLundSweden
- Department of EconomicsLund UniversityLundSweden
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö)Lund UniversityLundSweden
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Lee JY, Lim NG, Chung CK, Lee JY, Kim HJ, Park SB. Parkinson's Disease as Risk Factor in Osteoporosis and Osteoporotic Vertebral Fracture : Prevalence Study Using National Inpatient Sample Database in Korea. J Korean Neurosurg Soc 2018; 62:71-82. [PMID: 30630295 PMCID: PMC6328797 DOI: 10.3340/jkns.2018.0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/17/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the prevalence of osteoporosis (OP) and osteoporotic vertebral fracture (OVF) in people with Parkinson's disease (PD) in Korea and its association with socioeconomic status. METHODS Using Health Insurance Review and Assessment Service-National Inpatient Sample (HIRA-NIS) data from 2009 to 2013, we estimated the annual prevalence of PD, OP, and OVF and investigated its association with socioeconomic status using data from National Health Insurance (NHI) beneficiaries and Medical Aid (MA) recipients. This study was supported by research funding from Korean Society for Bone and Mineral Research 2015. There were no study-specific biases related to conflicts of interest. RESULTS The number of PD patients in the HIRA-NIS increased each year from 2009 to 2013. Among patients with PD, the standardized prevalence rates of OP and OVF increased from 2009 to 2013; from 23.2 to 27.8 and from 2.8 to 4.2, respectively. Among patients with PD with OP, the prevalence of OVF were 12.2% and 15.1% in 2009 and 2013, respectively. The standardized prevalence rates of PD with OP and PD with OVF were significantly higher in MA recipients than in NHI beneficiaries. CONCLUSION The prevalence of PD both with OP and with OVF increased and the prevalence was higher in MA recipients than in NHI beneficiaries. These findings may suggest that age over 65 years, female and low income may be a significant factor related to PD occurring with OP and OVF.
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Affiliation(s)
- Jin Yong Lee
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Nam Gu Lim
- Department of Medical Administration and Information, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea
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Hadoush H, Al-Sharman A, Khalil H, Banihani SA, Al-Jarrah M. Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson's Disease. Med Sci Monit Basic Res 2018; 24:198-205. [PMID: 30449881 PMCID: PMC6259567 DOI: 10.12659/msmbr.911411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Sleep dysfunctions impose a large burden on quality of life for patients with Parkinson’s disease (PD). Several studies on PD reported potential therapeutic effects of transcranial direct current stimulation (tDCS) on motor and non-motor functions, but not related to sleep quality. Therefore, the present study examined sleep quality, depression perception, and quality of life changes after bilateral anodal tDCS in patients with PD. Material/Methods Twenty-one patients (n=21) with PD underwent 10 sessions (20 min each, 5 per week) of bilateral anodal tDCS stimulation applied simultaneously over the left and right prefrontal and motor areas. The Pittsburgh Sleep Quality Index (PSQI) total score and sub-scores, Geriatric Depression Scale (GDS), and Health-related quality of life questionnaire (SF-36) were measured pre/post bilateral tDCS anodal stimulation. Results PSQI total score (P=0.045), sleep latency sub-score (P=0.02), and GDS total score (P=0.016) significantly decreased, and physical and mental components scores of SF-36 (P=0.018 and P=0.001, respectively) significantly increased after bilateral anodal tDCS stimulation. The GDS score decrease was directly correlated with decrease in PSQI total score (P=0.01), sleep latency sub-score (P=0.002), and sleep disturbance sub-score (P=0.003). In addition, the GDS score decrease was inversely correlated with increasing mental component score of SF-36 (P=0.001), which was directly correlated with an increase in sleep efficiency sub-score (P=0.03) and the physical component score of SF-36 (P=0.0001). Conclusions Bilateral anodal tDCS stimulation showed potential therapeutic effects in patients with PD in terms of sleep quality and depression level improvement, which together improved mental and physical quality of life in patients with PD.
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Affiliation(s)
- Hikmat Hadoush
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Saleem A Banihani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Muhammed Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
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Antonini A, Gentile G, Giglio M, Marcante A, Gage H, Touray MML, Fotiadis DI, Gatsios D, Konitsiotis S, Timotijevic L, Egan B, Hodgkins C, Biundo R, Pellicano C. Acceptability to patients, carers and clinicians of an mHealth platform for the management of Parkinson's disease (PD_Manager): study protocol for a pilot randomised controlled trial. Trials 2018; 19:492. [PMID: 30217235 PMCID: PMC6138904 DOI: 10.1186/s13063-018-2767-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parkinson's disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. METHODS/DESIGN This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson's disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson's diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework. DISCUSSION Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. TRIAL REGISTRATION ISRCTN Registry, ISRCTN17396879 . Registered on 15 March 2017.
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Affiliation(s)
- Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy.,IRCCS San Camillo Hospital, Venice, Italy
| | | | | | - Andrea Marcante
- Department of Neuroscience, University of Padua, Padua, Italy.,IRCCS San Camillo Hospital, Venice, Italy
| | - Heather Gage
- Surrey Health Economics Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Morro M L Touray
- Surrey Health Economics Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
| | - Dimitrios I Fotiadis
- Department of Materials Science, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Dimitris Gatsios
- Department of Materials Science, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lada Timotijevic
- Department of Psychology, University of Surrey, Guildford, England
| | - Bernadette Egan
- Department of Psychology, University of Surrey, Guildford, England
| | - Charo Hodgkins
- Department of Psychology, University of Surrey, Guildford, England
| | | | - Clelia Pellicano
- Fondazione Santa Lucia IRCCS, Via Ardeatina 306, 00179, Rome, Italy.,Department of Neuriscience, Mental Health and Sensory Organs, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy
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Bagheri-Mohammadi S, Karimian M, Alani B, Verdi J, Tehrani RM, Noureddini M. Stem cell-based therapy for Parkinson's disease with a focus on human endometrium-derived mesenchymal stem cells. J Cell Physiol 2018; 234:1326-1335. [PMID: 30146713 DOI: 10.1002/jcp.27182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/16/2018] [Indexed: 12/12/2022]
Abstract
Parkinson's disease (PD) as an increasing clinical syndrome is a multifunctional impairment with systemic involvement. At present, therapeutic approaches such as l-3,4-dihydroxy-phenylalanine replacement therapy, dopaminergic agonist administration, and neurosurgical treatment intend to relieve PD symptoms which are palliative and incompetent in counteracting PD progression. These mentioned therapies have not been able to replace the lost cells and they could not effectively slow down the relentless neurodegenerative process. Till now, there is a lack of eligible treatment for PD, and stem cells therapy recently has been considered for PD treatment. In this review, we demonstrate how human stem cell technology especially human endometrium-derived stem cells have made advancement as a therapeutic source for PD compared with other treatments.
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Affiliation(s)
- Saeid Bagheri-Mohammadi
- Department of Physiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Physiology Research Centre, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Karimian
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Behrang Alani
- Department of Applied Cell Sciences, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Javad Verdi
- Department of Applied Cell Sciences, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Rana Moradian Tehrani
- Department of Applied Cell Sciences, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdi Noureddini
- Physiology Research Centre, Kashan University of Medical Sciences, Kashan, Iran.,Department of Applied Cell Sciences, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Ferrazzoli D, Ortelli P, Zivi I, Cian V, Urso E, Ghilardi MF, Maestri R, Frazzitta G. Efficacy of intensive multidisciplinary rehabilitation in Parkinson's disease: a randomised controlled study. J Neurol Neurosurg Psychiatry 2018; 89:828-835. [PMID: 29321141 PMCID: PMC6204945 DOI: 10.1136/jnnp-2017-316437] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate whether a 4-week multidisciplinary, aerobic, motor-cognitive and intensive rehabilitation treatment (MIRT) improves the quality of life (QoL) of patients with Parkinson's disease (PD), in the short-term and long-term period. METHODS This is a prospective, parallel-group, single-centre, single-blind, randomised clinical trial (ClinicalTrials.gov NCT02756676). 186 patients with PD, assigned to experimental group, underwent MIRT; conversely, 48 patients, assigned to control group, did not receive rehabilitation. Parkinson's Disease Questionnaire-39 was assessed 2 (T0), 10 (T1) and 18 (T2, only experimental group) weeks after the enrolment. We compared T1 versus T0 scores within subjects and delta scores (T1-T0) between subjects. To investigate the long-term effects, we compared T2 and T0 scores in the experimental group. RESULTS At T0, no between-group differences in the Global Index Score (GBI) were observed (experimental group: 43.6±21.4, controls: 41.6±22.9, P=0.50). At T1, we did not find significant changes in controls (delta score: 1.2±9.9, P=0.23), and we found an improvement in GBI in the experimental group (delta score: -8.3±18.0, P<0.0001), significant also between subjects (P<0.0001). Comparing T2 versus T0 in the experimental group, the GBI maintained a significant improvement (delta score: -4.8±17.5, P<0.0001). CONCLUSIONS A rehabilitation treatment such as MIRT could improve QoL in patients with PD in the short-term and long-term period. Even though the single-blind design and the possible role of the placebo effect on the conclusive results must be considered as limitations of this study, the improvement in outcome measure, also maintained after a 3-month follow-up period, suggests the effectiveness of MIRT on the QoL. CLINICAL TRIAL REGISTRATION NCT02756676: Pre-results.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Ilaria Zivi
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Veronica Cian
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Elisa Urso
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
| | - Maria Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience, CUNY Medical School, New York, New York, USA
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Montescano, Italy
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy
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35
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Examining Factors Related to Health-Related Quality of Life in People With Parkinson’s Disease. Rehabil Nurs 2018; 45:122-130. [DOI: 10.1097/rnj.0000000000000179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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36
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Hadoush H, Al-Jarrah M, Khalil H, Al-Sharman A, Al-Ghazawi S. Bilateral anodal transcranial direct current stimulation effect on balance and fearing of fall in patient with Parkinson's disease. NeuroRehabilitation 2018; 42:63-68. [PMID: 29400676 DOI: 10.3233/nre-172212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A number of studies have examined the therapeutic effects of transcranial direct current stimulation (tDCS) stimulation in patients with Parkinson's disease (PD) using unilateral anodal stimulation applied either on the left or right brain hemisphere. However, PD involves the dysfunctions of both brain hemispheres. OBJECTIVES This study investigates the therapeutic effects of bilateral anodal tDCS stimulation on balance and fear of fall outcomes in patient with PD. METHODS Eighteen patients with idiopathic PD completed the study. Ten sessions of bilateral anodal tDCS stimulation were applied over the FC1 and FC2 targeting both pre-frontal and motor areas for each patient, 5 sessions per week for 2 weeks. Berg Balance Scale (BBS), Falls Efficacy Scale-International (FES-I), and 10 meters walk test (10mwt) were applied before and after the stimulation therapy. RESULTS Paired t-test showed a significant increase in the BBS scores and decrease in the FES-I scores after the bilateral tDCS compared with those scores before tDCS therapy (P < 0.05), as well improvement in the 10mwt scores. CONCLUSION Our data showed that bilateral anodal tDCS serves as an effective, safe and feasible approach for rehabilitation of patients with PD with the issues related to balance and fear of fall.
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Affiliation(s)
- Hikmat Hadoush
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Muhammed Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Sadik Al-Ghazawi
- Department of Neurology Faculty of Medicine, University of Science and Technology (JUST), Irbid, Jordan
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Jurado-Coronel JC, Cabezas R, Ávila Rodríguez MF, Echeverria V, García-Segura LM, Barreto GE. Sex differences in Parkinson's disease: Features on clinical symptoms, treatment outcome, sexual hormones and genetics. Front Neuroendocrinol 2018; 50:18-30. [PMID: 28974386 DOI: 10.1016/j.yfrne.2017.09.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/12/2017] [Accepted: 09/29/2017] [Indexed: 01/14/2023]
Abstract
Parkinson's disease (PD) is the second most frequent age-related neurodegenerative disorder. Sex is an important factor in the development of PD, as reflected by the fact that it is more common in men than in women by an approximate ratio of 2:1. Our hypothesis is that differences in PD among men and women are highly determined by sex-dependent differences in the nigrostriatal dopaminergic system, which arise from environmental, hormonal and genetic influences. Sex hormones, specifically estrogens, influence PD pathogenesis and might play an important role in PD differences between men and women. The objective of this review was to discuss the PD physiopathology and point out sex differences in nigrostriatal degeneration, symptoms, genetics, responsiveness to treatments and biochemical and molecular mechanisms among patients suffering from this disease. Finally, we discuss the role estrogens may have on PD sex differences.
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Affiliation(s)
- Juan Camilo Jurado-Coronel
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Ricardo Cabezas
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | | | - Valentina Echeverria
- Universidad San Sebastián, Fac. Cs de la Salud, Lientur 1457, Concepción, 4080871, Chile; Research & Development Service, Bay Pines VA Healthcare System, Bay Pines, FL 33744, USA
| | - Luis Miguel García-Segura
- Instituto Cajal, CSIC, Madrid, Spain; CIBER de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile.
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Converting Parkinson-Specific Scores into Health State Utilities to Assess Cost-Utility Analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:665-675. [DOI: 10.1007/s40271-018-0317-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hadoush H, Banihani SA, Khalil H, Al-Qaisi Y, Al-Sharman A, Al-Jarrah M. Dopamine, BDNF and motor function postbilateral anodal transcranial direct current stimulation in Parkinson's disease. Neurodegener Dis Manag 2018; 8:171-179. [DOI: 10.2217/nmt-2017-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: To examine BDNF, dopamine, and motor function changes after bilateral anodal transcranial direct current stimulation (tDCS) in patients with Parkinson's disease. Methods: 20 patients undertook ten sessions of bilateral anodal tDCS stimulation applied simultaneously over FC1/FC2, targeting left and right prefrontal and motor areas. Dopamine and BDNF serum levels, and Movement Disorders Society – Unified Parkinson's Disease Rating Scale part three (MDS-UPDRS-III) total score and disability sub-scores were examined pre/post-tDCS stimulation. Results: BDNF serum level increased significantly and came with significant improvement in motor functions (decrease in MDS-UPDRS-III total score/sub-scores), whereas dopamine level showed no changes. However, there was no significant statistical correlation between the motor functions’ improvement and BDNF level increase. Conclusion: Bilateral anodal tDCS is a safe stimulation protocol that leads to motor functions’ improvement and BDNF serum level increase in patients with Parkinson's disease, however the findings of this feasible study are preliminary and further study is needed.
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Affiliation(s)
- Hikmat Hadoush
- Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Saleem A Banihani
- Department of Medical Laboratory Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Yasir Al-Qaisi
- Department of Medical Laboratory Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Muhammed Al-Jarrah
- Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
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Viewpoint and practical recommendations from a movement disorder specialist panel on objective measurement in the clinical management of Parkinson's disease. NPJ PARKINSONS DISEASE 2018; 4:14. [PMID: 29761156 PMCID: PMC5945844 DOI: 10.1038/s41531-018-0051-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/02/2023]
Abstract
Motor aspects of Parkinson's disease, such as fluctuations and dyskinesia, can be reliably evaluated using a variety of "wearable" technologies, but practical guidance on objective measurement (OM) and the optimum use of these devices is lacking. Therefore, as a first step, a panel of movement disorder specialists met to provide guidance on how OM could be assessed and incorporated into clinical guidelines. A key aspect of the incorporation of OM into the management of Parkinson's disease (PD) is defining cutoff values that separate "controlled" from "uncontrolled" symptoms that can be modified by therapy and that relate to an outcome that is relevant to the person with PD (such as quality of life). Defining cutoffs by consensus, which can be subsequently tested and refined, is the first step to optimizing OM in the management of PD. OM should be used by all clinicians that treat people with PD but the least experienced may find the most value, but this requires guidance from experts to allow non-experts to apply guidelines. While evidence is gained for devices that produce OM, expert opinion is needed to supplement the evidence base.
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41
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Walker N, Cross J. Physiotherapists' experiences of respiratory compromise in patients with Parkinson's disease: A qualitative study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.5.223] [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: To explore the experiences and perceptions of physiotherapists involved in the care of people with Parkinson's disease and respiratory compromise. Methods: This exploratory qualitative study recruited four physiotherapists who participated in a focus group and completed reflective diaries over a 3-month period. Experiences were explored using Interpretative Phenomenological Analysis. Findings: The study highlights three key themes: application of professional knowledge, application of clinical decision making and challenges to application of care. Conclusions: The results demonstrate sensitive awareness in caring for a dependent and vulnerable population whose key motor signs, compounded by ageing are perceived as influencing the presentation of respiratory compromise. There are descriptions of a reactive response to illness, alongside reflections on the challenges faced when asserting autonomy and recognising where the role of physiotherapy fits within the multidisciplinary team. Sputum clearance is perceived as being a key aspect of this role, although there is uncertainty with regard to the effectiveness and appropriateness of treatment options. Multiple perceived challenges to care provision are highlighted, with key concerns surrounding clinician and patient knowledge levels, maintenance of patient mobility, person-centred care and clarity in the direction of care.
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Affiliation(s)
- Nikki Walker
- Clinical lead physiotherapist for AMU, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, England, UK
| | - Jane Cross
- Senior Lecturer, University of East Anglia, Norwich, England, UK
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Soh SE, Morris ME, Watts JJ, McGinley JL, Iansek R. Health-related quality of life in people with Parkinson's disease receiving comprehensive care. AUST HEALTH REV 2018; 40:613-618. [PMID: 26910356 DOI: 10.1071/ah15113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/08/2016] [Indexed: 12/26/2022]
Abstract
Objectives The aim of the present study was to quantify the baseline variation in health-related quality of life (HRQOL) between individuals with Parkinson's disease (PD) referred to a comprehensive care program and those attending standard neurological services. Methods Participants included individuals with PD receiving conventional care from neurologists in private practice and individuals referred to a comprehensive inter-professional team hospital out-patient service. The Parkinson's Disease Questionnaire-39 (PDQ-39) and the EuroQoL (EQ-5D-3L) were used to quantify HRQOL. Results Participants referred to an inter-professional service were more likely to have poorer indices on PD-specific measures but not for generic HRQOL compared with individuals receiving standard neurological services. After adjusting for age, gender, disease severity and duration, people referred to a comprehensive care program were more likely to have a higher score for the PDQ-39 summary index (PDQ-39 SI; mean±s.d. 27.2±11.0; 95% confidence interval (CI) 25.5, 28.9) compared with individuals receiving standard neurological services (PDQ-39 SI mean 0.2±12.8; 95% CI 18.0, 22.4). Conclusions Compared with those attending standard neurological out-patient clinics, individuals referred to an inter-professional PD program are more likely to have advanced disease and poorer HRQOL. This observation has implications for the way in which people with PD are recruited for future clinical trials, because uneven recruitment from different sources may be a potential source of bias. What is known about the topic? Given that PD is associated with a complex array of motor and non-motor symptoms, an inter-professional team approach to service provision is argued to be optimal for individuals living with this debilitating condition. What does this paper add? This paper has shown that individuals referred to an inter-professional service are more likely to have advanced disease and complex care needs. Compared with those referred to neurologist private clinics, those referred to an inter-professional clinic had less functional independence and lower PD-specific HRQOL when first assessed, even after controlling for disease severity. What are the implications for practitioners? When recruiting for future trials to examine the efficacy of multidisciplinary care programs in people with PD, it is important to take into account whether these individuals have been referred to an inter-professional service. There may be a potential source of bias if participants were recruited predominantly from such services.
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Affiliation(s)
- Sze-Ee Soh
- Department of Epidemiology and Preventative Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Meg E Morris
- Physiotherapy, School of Allied Health, La Trobe University, Melbourne Campus, Plenty Road, Bundoora, Vic. 3083, Australia. Email
| | - Jennifer J Watts
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email
| | - Jennifer L McGinley
- Physiotherapy Department, The University of Melbourne, Level 7, Alan Gilbert Building, Parkville, Vic. 3052, Australia. Email
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, NPF Centre of Excellence, 400 Warrigal Road, Cheltenham, Vic. 3192, Australia. Email
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Pawlukowska W, Skonieczna-Żydecka K, Rotter I, Honczarenko K, Nowacki P. The analysis of relationship between selected sociodemografic factors and disorders of speech organs in Parkinson`s patients. BMC Neurol 2017; 17:221. [PMID: 29268713 PMCID: PMC5740885 DOI: 10.1186/s12883-017-1003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background Evaluation of speech disorders in PD taking into account sociodemographic conditions is not frequent. This paper aims to establish correlations between articulation disorders in PD patients and factors such as the patients’ sex, age, education and residence. Methods The study included 92 patients with idiopathic PD diagnosed by means of multiple neurological examinations, biochemical tests, MRI and CT scanning carried out in accordance with the United Kingdom Parkinson’s Disease Society Brain Bank (UKPDSBB) criteria. A speech and language test involved the assessment of the mobility of the speech organs as well as the reflexes inside the oral cavity. Frenchay Dysarthria Assessment was applied for an objective evaluation of dysarthria. Results The study revealed the existence of significant relationship between the functionality of articulators in PD patients and their education and residence. Big city dwellers demonstrated lower incidence of disorders within speech organs, particularly those affecting mobility of the soft palate while eating. Disorders of moderate intensity were more frequently found in subjects living in villages. Subjects with a university education displayed better position of the lips at rest and better performance of both lips and the mandible while speaking. Conclusions Abnormal functioning of the articulatory organs was observed more frequently in PD patients residing in rural areas than in those inhabiting urban areas. As for education, our cohort university graduates displayed a better position of the lips at rest and better performance of the lips and jaw during speaking than those with secondary and vocational education.
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Affiliation(s)
- Wioletta Pawlukowska
- Department of Medical Rehabilitation, Chair and Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252, Szczecin, Poland.
| | - Karolina Skonieczna-Żydecka
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Broniewskiego 21, 71-460, Szczecin, Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation, Pomeranian Medical University, Żołnierska 54, 71-210, Szczecin, Poland
| | - Krystyna Honczarenko
- Chair and Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252, Szczecin, Poland
| | - Przemysław Nowacki
- Chair and Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252, Szczecin, Poland
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Bovolenta TM, de Azevedo Silva SMC, Saba RA, Borges V, Ferraz HB, Felicio AC. Average annual cost of Parkinson's disease in São Paulo, Brazil, with a focus on disease-related motor symptoms. Clin Interv Aging 2017; 12:2095-2108. [PMID: 29276379 PMCID: PMC5734235 DOI: 10.2147/cia.s151919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although Parkinson's disease is the second most prevalent neurodegenerative disease worldwide, its cost in Brazil - South America's largest country - is unknown. Objective The goal of this study was to calculate the average annual cost of Parkinson's disease in the city of São Paulo (Brazil), with a focus on disease-related motor symptoms. Subjects and methods This was a retrospective, cross-sectional analysis using a bottom-up approach (ie, from the society's perspective). Patients (N=260) at two tertiary public health centers, who were residents of the São Paulo metropolitan area, completed standardized questionnaires regarding their disease-related expenses. We used simple and multiple generalized linear models to assess the correlations between total cost and patient-related, as well as disease-related variables. Results The total average annual cost of Parkinson's disease was estimated at US$5,853.50 per person, including US$3,172.00 in direct costs (medical and nonmedical) and US$2,681.50 in indirect costs. Costs were directly correlated with disease severity (including the degree of motor symptoms), patients' age, and time since disease onset. Conclusion In this study, we determined the cost of Parkinson's disease in Brazil and observed that disease-related motor symptoms are a significant component of the costs incurred on the public health system, patients, and society in general.
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Affiliation(s)
| | | | - Roberta Arb Saba
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Vanderci Borges
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo
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A mixed methods evaluation of a Mindfulness-Based Stress Reduction course for people with Parkinson's disease. Complement Ther Clin Pract 2017; 29:220-228. [DOI: 10.1016/j.ctcp.2017.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022]
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Shoval G, Stubbs B, Balicer RD, Feldman B, Hoshen M, Zalsman G, Sagy R, Hochman E, Weizman A, Krivoy A. Low adherence to antidepressants is associated with increased mortality in Parkinson disease patients. Parkinsonism Relat Disord 2017; 43:92-96. [PMID: 28797565 DOI: 10.1016/j.parkreldis.2017.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/14/2017] [Accepted: 07/31/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the relationship between adherence to antidepressants (AD) and all-cause mortality in a population-based cohort of patients with Parkinson's Disease (PD). METHODS From a database of more than 4 million people, 8553 patients with PD who purchased an AD at least once between the years 2008-2011 were retrospectively followed for all-cause mortality over 4-years. Adherence was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n = 1566), poor (20%-50%, n = 1184), moderate (50%-80%, n = 1584), and good (>80%, n = 4219) adherence. Multivariable survival analyses adjusted for demographic and clinical variables including physical comorbidities known to influence mortality were conducted, however there was no adjustment for other psychiatric disorders and medications. RESULTS Unadjusted mortality rates were 20.4%, 25.1%, 23.4% and 25.6% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2 = 18.45, p < 0.0001). The non-adherent and poor adherence groups had significantly increased adjusted mortality hazard ratios (HR) of 1.43 (CI: 1.26-1.62) and 1.26 (CI: 1.1-1.44) respectively compared to the good adherence group. Using the same model, the adjusted HR for death among males was 1.49 [95% CI: 1.36-1.62] compared to females. People with PD and Charslon's Comorbidity Index score of 3-4 (HR 1.3, P < 0.001) and 5+ (HR 1.78, P < 0.001) were more likely to die than those with 0-2 comorbidities. CONCLUSIONS Our findings suggest that poor adherence to AD is associated with increased all-cause mortality in people with PD. Given the high prevalence of depression and AD effectiveness, efforts to promote adherence should be prioritized in clinical practice.
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Affiliation(s)
- Gal Shoval
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Becca Feldman
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
| | - Roi Sagy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Hochman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Krivoy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Farzanehfar P, Horne M. Evaluation of the Parkinson’s KinetiGraph in monitoring and managing Parkinson’s disease. Expert Rev Med Devices 2017; 14:583-591. [DOI: 10.1080/17434440.2017.1349608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Parisa Farzanehfar
- Florey Institute of Neurosciences and Mental Health, University of Melbourne, Parkville, Australia
| | - Malcolm Horne
- Florey Institute of Neurosciences and Mental Health, University of Melbourne, Parkville, Australia
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Lachner C, Armstrong MJ, Gruber-Baldini AL, Rezvani Z, Reich SG, Fishman PS, Salazar R, Shulman LM. Discordance Between Physician Assessment and Patient-Reported Depressive Symptoms in Parkinson Disease. J Geriatr Psychiatry Neurol 2017; 30:191-195. [PMID: 28535723 DOI: 10.1177/0891988717710335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess concordance between physician assessment and patient-reported symptoms when screening for depression in Parkinson disease (dPD). BACKGROUND Depression in Parkinson disease is highly prevalent (∼40%) and has a significant impact on quality of life and disability, yet physician recognition and treatment remain inadequate. METHODS One thousand seventy-six patients with PD completed the Brief Symptom Inventory-18 (BSI-18), a screening questionnaire for psychiatric symptoms, which was compared to item #3 (depression) on the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS The mean BSI-18 depression score was 51.4 (9.7). Of the 170 (16%) patients screening positive for dPD on the BSI-18, 104 (61%) were not recognized as depressed by neurologists on the UPDRS. Factors associated with lower neurologist recognition included male gender, better mental health quality of life, and lack of antidepressant use. CONCLUSION More than 60% of patients screening positive for depression on self-report were not recognized by neurologists on the UPDRS. A patient-reported screening tool for depression may improve recognition and management of dPD.
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Affiliation(s)
- Christian Lachner
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,2 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.,3 Division of Psychiatry, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa J Armstrong
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,4 Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Ann L Gruber-Baldini
- 5 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zahra Rezvani
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen G Reich
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul S Fishman
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard Salazar
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,6 Jackson Hospital, Montgomery, AL, USA
| | - Lisa M Shulman
- 1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Tu XJ, Hwang WJ, Ma HI, Chang LH, Hsu SP. Determinants of generic and specific health-related quality of life in patients with Parkinson's disease. PLoS One 2017. [PMID: 28650957 PMCID: PMC5484474 DOI: 10.1371/journal.pone.0178896] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives Generic and disease-specific health-related quality of life (HRQoL) instruments may reflect different aspects of lives in patients with Parkinson’s disease (PD) and thus be associated with different determinants. We used the same cluster of predictors for the generic and disease-specific HRQoL instruments to examine and compare the determinants of HRQoL. Method HRQoL was measured in 92 patients with PD by the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson’s Disease Questionnaire (PDQ-39). The predictors included demographic and disease characteristics, and motor and non-motor symptoms. Multiple regression analyses were used to identify HRQoL determinants. Results Depressive symptoms and motor difficulties of daily living were the first two significant determinants for both instruments. The other significant determinant for the SF-36 was fatigue and non-motor difficulties of daily living, and for the PDQ-39 was motor signs of PD. Conclusions The results suggest the importance of the evaluation and intervention focused on depressive symptoms and motor difficulties of daily living in patients with PD. In addition, the SF-36 seems more related to non-motor symptoms, while the PDQ-39 appears more associated with motor symptoms. This information is important for understanding results from these two instruments and for choosing which to use.
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Affiliation(s)
- Xiao-Jing Tu
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Juh Hwang
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ing Ma
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (SPH); (HIM)
| | - Ling-Hui Chang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- * E-mail: (SPH); (HIM)
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Sparling AS, Martin DW, Posey LB. An Evaluation of the Proposed Worker Protection Standard with Respect to Pesticide Exposure and Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E640. [PMID: 28613271 PMCID: PMC5486326 DOI: 10.3390/ijerph14060640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/09/2023]
Abstract
Citing a lack of information, the U.S. Environmental Protection Agency prudently did not account for the benefits of averting many chronic diseases in analyzing the Worker Protection Standards (WPS) revisions. We demonstrate that sufficient information can exist, using the example of the benefits to agricultural workers of reduced Parkinson's disease (PD) due to reduced pesticide exposure. We define the benefits as the monetary value gained by improving quality of lives of people who would otherwise develop PD, plus the value of medical care cost averted and income not lost due to being healthy. For estimation, we use readily available parameters and obtain odds ratios of developing PD by conducting a meta-analysis of studies linking pesticide exposure to PD. The sensitivity analysis varies the number of agricultural workers affected by the regulation, the probability of being diagnosed with PD, the measurement and the timing of the benefits. Our initial assessment is that the reduced PD benefits would be a small fraction of the total WPS revision costs. However, if we define benefits as the common environmental economics willingness to pay to avoid PD incidence, then they become a substantial fraction of the costs. Our analysis demonstrates that the benefits of averting PD from the WPS revisions can be estimated using existing information, and that the results are most sensitive to the choice of valuation of benefits to the worker. We encourage other researchers to extend our framework to other chronic ailments.
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Affiliation(s)
| | - David W Martin
- Departments of Economics and Environmental Studies, Davidson College, Davidson, NC 28035, USA.
| | - Lillian B Posey
- Metropolitan Housing and Communities Policy Center, Urban Institute, Washington, DC 20037, USA.
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