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Tönges L, Buhmann C, Eggers C, Lorenzl S, Warnecke T. Guideline "Parkinson's disease" of the German Society of Neurology (Deutsche Gesellschaft für Neurologie): concepts of care. J Neurol 2024:10.1007/s00415-024-12546-3. [PMID: 38969876 DOI: 10.1007/s00415-024-12546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION In 2023, the German Society of Neurology published a new guideline on Parkinson's disease. An important section dealt with PD care concepts, which represent a particularly dynamic field of PD research, including their implementation in clinical practice. Parkinson's disease is the second most common age-associated neurodegenerative disease. Current estimates of the number of cases in the population describe a significant increase in prevalence in Germany by 2030 with higher proportions in rural areas, which also have a lack of sufficient PD care resources. RECOMMENDATIONS In comparison with other international guidelines, which have so far mentioned palliative care and Parkinson's nurses in particular, the German S2k guideline expands the recommended concepts of PD care to include PD day clinics, inpatient complex treatment, and PD networks. CONCLUSION Concepts of PD care guidelines are necessary because of the complex and rapidly evolving field of PD care provision. If applied appropriately, the potential for optimized care can be exploited and both the patient burden and the economic burden can be reduced. Given that modern care concepts have so far only been applied in a few regions, it is often impossible to generate broad evidence-based data, so that the evaluation of PD care concepts is partly dependent on expert opinion.
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Affiliation(s)
- Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany.
- Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, 44801, Bochum, Germany.
| | - Carsten Buhmann
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Eggers
- Department of Neurology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrück-Academic Teaching Hospital of the University of Münster, 49076, Osnabrück, Germany
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Lou Y, Li Y, Chen Y. The palliative care needs and experiences of patients with advanced Parkinson's disease: a qualitative scoping review. Front Med (Lausanne) 2024; 11:1362828. [PMID: 38660425 PMCID: PMC11039912 DOI: 10.3389/fmed.2024.1362828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Aim To determine the experiences and needs of palliative care in patients with advanced Parkinson's disease (PD). Methods A scoping literature review methodology, as described by the Joanna Briggs Institute, was employed to search for relevant literature. An electronic search of studies published in English was conducted across five databases from inception to 10 September 2023. Results The search yielded a total of 1,205 articles, with 20 meeting the inclusion criteria. The findings were organized into four themes: (1) unmet emotional and informational needs; (2) needs for effective coordination of care; (3) planning for the future; and (4) symptom management. This scoping review highlights the intricate nature of palliative care for patients with PD and sheds light on issues within current palliative care healthcare systems. The findings emphasize the necessity for individualized interventions and services to address the diverse unmet palliative care needs of people with PD. Conclusion The study reveals the complex landscape of palliative care for individuals with advanced PD, emphasizing the inadequacies within existing healthcare systems. The identified themes underscore the importance of tailored interventions to address the varied unmet palliative care needs of this population.
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Affiliation(s)
- Yan Lou
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Zhejiang Haining Health School, Haining City, Zhejiang, China
| | - Yiting Li
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yiping Chen
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
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Brinker D, Smilowska K, Paschen S, Antonini A, Moro E, Deuschl G. How to Use the New European Academy of Neurology/Movement Disorder Society European Section Guideline for Invasive Therapies in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:209-219. [PMID: 38214401 DOI: 10.1002/mdc3.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The decision to choose invasive treatments for Parkinson's disease (PD) is complex and needs careful consideration. OBJECTIVES Although the recommendations of the European Academy of Neurology/Movement Disorder Society European Section guideline for invasive therapies of PD are useful, the different clinical profiles of people with PD who seek advice for possible invasive therapy need further attention. METHODS AND RESULTS Here we describe 8 clinical standard situations of people with PD unsatisfied with their current oral treatment where invasive therapies may be considered. These are PD patients presenting with the following symptoms: (1) severe motor fluctuations, (2) beginning of levodopa-responsive fluctuations, severe tremor at (3) young or (4) advanced age, (5) impulse control disorders and related behavioral disorders, (6) hallucinations and psychosis, (7) minimal cognitive impairment or mild dementia, and (8) patients in need of palliative care. For some of these conditions, evidence at lower level or simple clinical considerations exist. CONCLUSIONS There are no one-fits-all answers, but physician and patient should discuss each option carefully considering symptom profile, psychosocial context, availability of therapy alternatives, and many other factors. The current paper outlines our proposed approach to these circumstances.
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Affiliation(s)
- Dana Brinker
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Katarzyna Smilowska
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Neurology, Regional Specialist Hospital im. Św. Barbary, Sonowiec, Poland
| | - Steffen Paschen
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Elena Moro
- Grenoble Alpes University, Chu of Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
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Pedrosa AJ, Feldmann S, Klippel J, Volberg C, Weck C, Lorenzl S, Pedrosa DJ. Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study. JOURNAL OF PARKINSON'S DISEASE 2024; 14:589-599. [PMID: 38457148 DOI: 10.3233/jpd-230311] [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: 03/09/2024]
Abstract
Background A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.
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Affiliation(s)
- Anna J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Sarah Feldmann
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jan Klippel
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christian Volberg
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Research Group Medical Ethics, Philipps University Marburg, Marburg, Germany
| | - Christiane Weck
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - David J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany
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Garon M, Weck C, Rosqvist K, Odin P, Schrag A, Krikmann Ü, Pedrosa DJ, Antonini A, Lorenzl S, Martins Pereira S, Paal P. A systematic practice review: Providing palliative care for people with Parkinson's disease and their caregivers. Palliat Med 2024; 38:57-68. [PMID: 38054428 PMCID: PMC10798024 DOI: 10.1177/02692163231214408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND People with Parkinson's disease has significant and increasing physical, psychosocial and spiritual needs, as well as problems with coordination and continuity of care. Despite the benefits that palliative care could offer, there is no consensus on how it should be delivered. AIM The aim of this study is to provide a pragmatic overview of the evidence to make clinical recommendations to improve palliative care for people with Parkinson's disease and their caregivers. DESIGN A systematic review method was adopted to determine the strength of evidence, supported by feedback from an expert panel, to generate the 'do', 'do not do' and 'do not know' recommendations for palliative care. DATA SOURCES Searches were conducted via OVID to access CINAHL, MEDLINE, EMBASE and the Cochrane Library from 01/01/2006 to 31/05/2021. An additional search was conducted in December 2022. The search was limited to articles that included empirical studies of approaches to enabling palliative care. RESULTS A total of 62 studies met inclusion criteria. There is evidence that education about palliative care and movement disorders is essential. palliative care should be multi-disciplinary, individualised and coordinated. Proactive involvement and support of caregivers throughout the illness is recommended. Limited data provide referral indicators for palliative care integration. Discussions about advance care planning should be held early. CONCLUSIONS Consideration of palliative care integration based on symptom burden and personal preferences, coordination and continuity of care are needed to maintain the quality of life of people with Parkinson's disease and their caregivers.
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Affiliation(s)
- Michela Garon
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Padua Neuroscience Center (PNC), University of Padua, 35131, Padua, Italy
- Parkinson’s Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padova, Italy
| | - Christiane Weck
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics, Skane University Hospital, Lund, Sweden
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics, Skane University Hospital, Lund, Sweden
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ülle Krikmann
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - David J Pedrosa
- Philipps University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, Marburg, German
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Padua Neuroscience Center (PNC), University of Padua, 35131, Padua, Italy
- Parkinson’s Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padova, Italy
| | - Stefan Lorenzl
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Sandra Martins Pereira
- Ethics and Sustainability Research Area: Palliative Care Research, CEGE: Research Centre in Management and Economics, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Piret Paal
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
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Chen Y, Hou L, Li W, Wang Q, Zhou W, Yang H. Referral criteria to palliative care for patients with Parkinson's disease: a systematic review. Curr Med Res Opin 2023; 39:267-279. [PMID: 36369847 DOI: 10.1080/03007995.2022.2146405] [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: 11/14/2022]
Abstract
OBJECTIVE This systematic review aimed to identify the referral criteria for palliative care in patients with Parkinson's disease. METHODS We conducted an electronic search for publications on referral criteria for palliative care in patients with Parkinson's disease in six electronic databases. The articles were thoroughly reviewed by two independent reviewers for inclusion using a predefined data extraction list. The referral criteria were thematically classified using a coding methodology. RESULTS This systematic review included 36 publications. We identified 14 referral criteria themes. The most common referral indicators were functional decline (n = 11 [31%]), needs assessment tools (n = 11 [31%]), physical or emotional symptoms (n = 10[28%]), need for palliative care (n = 10 [28%]), decision support (n = 9 [25%]), advanced Parkinson's disease (n = 7[19%]), and diagnosis of Parkinson's disease (n = 7 [19%]). However, there was a lack of consensus on symptom assessment tools. In addition, there were no agreed cut-offs or defined time for palliative care referral for patients with Parkinson's disease. CONCLUSIONS The 14 themes identified in this systematic review were categorized into disease- and needs-based criteria. These themes show the wide range of referral timing and procedures. Further studies should be conducted to reveal standardized referral criteria.
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Affiliation(s)
- Yiping Chen
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Liyuan Hou
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wei Li
- International Medical Department, Peking Union Medical College Hospital, Beijing, China
| | - Qiaohong Wang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Nursing, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Neuroscience Institute, Singapore
| | - Hui Yang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
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Prevalence and Risk Factors of Neuropsychiatric Symptoms in Institutionalized Patients with Parkinson's Disease in Taiwan: A Nationwide Observational Study. Healthcare (Basel) 2023; 11:healthcare11020258. [PMID: 36673626 PMCID: PMC9859113 DOI: 10.3390/healthcare11020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Neuropsychiatric symptoms (NPSs) are known to be frequent in Parkinson's disease (PD) with great impacts on the quality of life, but reports about the prevalence in institutions are few. Our aim was to investigate the prevalence of and risk factors for NPSs in institutionalized patients with PD in Taiwan. The National Health Research Institute executed a cross-sectional, community-based, observational study on residential long-term care service institutions. The diagnosis of PD was determined by physicians with the estimated Hoehn and Yahr stage of PD according to the EQ-5D-5L questionnaire. A total of 370 patients with PD (80.1 ± 9.94 years old, 55.1% females) were included, and 139 (37.6%) had more than one NPS in the prior 3 months. The top three NPSs were nighttime behavior (65 (17.6%)), depression (53 (14.3%)), and fear/anxiety (49 (13.2%)). There were no differences between those with NPS and those without NPS in terms of age, gender, education, Mini-Mental State Examination, or Hoehn and Yahr stage. However, multivariate logistic regression analysis showed that genitourinary disease (odds ratio (OR) = 3.13; 95% confidence interval (95%CI) = 1.77-5.51) and psychiatric disorders (OR = 5.18; 95%CI = 3.09-8.69) may be associated with increased risk of NPSs. Increased physical restraint was observed in residents with advanced PD. Genitourinary disease and psychiatric disorders appear to increase the risk of NPSs in institutionalized residents with PD.
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Pytel A, Beszlej JA, Biercewicz M, Roszmann A, Krówczyńska D, Kołtuniuk A. The Effect of Frailty Syndrome on the Quality of Life of Individuals with Parkinson's Disease: A Pilot Observational and Multicenter Study on the Polish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15226. [PMID: 36429942 PMCID: PMC9690024 DOI: 10.3390/ijerph192215226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder involving decreased dopamine release and atrophy of dopaminergic neurons of the substantia nigra. Frailty syndrome (FS) is common in older adults, which, in combination with PD symptoms, can substantially affect the quality of life (QOL). This study aimed to assess the prevalence of FS among PD patients and to identify variables affecting their QOL with particular attention to FS. The study included 296 patients (n = 173 women) with a mean age of 70.3 ± 5.7 years suffering from PD for an average of 8.2 ± 5.6 years. Patients were classified as at least stage II according to the Hoehn and Yahr scale. The following standardized questionnaires were used in the study: Schwab and England Activities of Daily Living (SE-ADL), Parkinson's Disease Questionnaire (PDQ-39), Beck Depression Inventory (BDI), Unified Parkinson's Disease Rating Scale (UPDRS), and Tilburg Frailty Indicator (TFI). FS was found in 96% (n = 283) of the PD patients studied. No depression occurred in 30% (n = 89) of subjects, moderate depression in 48% (n = 141) of subjects, and severe depression in 22% (n = 66) of subjects. The mean score of the PDQ-39 questionnaire in PD subjects with FS was 41.6 pts (min-max: 5.2-81.5 pts; SD = 17.4 pts), which was statistically significantly higher than in subjects without FS (p < 0.05). FS has been shown to be present in most of the subjects with PD. FS occurs more frequently with a longer PD period, which is associated with reduced physical capacity and QOL. Physical activity improves QOL and reduces disease progression. FS, similar to PD, is a common cause of disability in older adults and their dependency. Predictors such as depression, advanced stage of the disease, higher education, and low professional and economic status significantly affect the QOL level of PD patients. However, the results obtained among the Polish population of PD patients do not confirm the impact of FS on the QOL, so there is a need to conduct further research on this subject.
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Affiliation(s)
- Aleksandra Pytel
- Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | | | - Monika Biercewicz
- Clinic of Geriatrics, Faculty of Health Science, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Toruń, Poland
| | - Anna Roszmann
- Division of Neurological and Psychiatric Nursing, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Dorota Krówczyńska
- Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland
- Department of Nursing and Obstetrics, Collegium Mazovia, 08-110 Siedlce, Poland
| | - Aleksandra Kołtuniuk
- Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
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Ramadhan M, Schrag A. The Validity of Health-Related Quality of Life Instruments in Patients With Late-Stage Parkinson's Disease. J Geriatr Psychiatry Neurol 2022; 36:225-232. [PMID: 36264078 PMCID: PMC10114249 DOI: 10.1177/08919887221119963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the validity of health-related quality of life (Hr-QoL) measures in patients with late-stage Parkinson's disease (PD). METHODS We analysed data from patients with late-stage PD and their carers who were assessed with a range of clinical measures and the EQ-5D-3 L. The DEMQOL-Proxy was completed for 157 patients with a diagnosis of dementia and the PDQ-8 by 401 patients without dementia. Convergent validity was assessed using correlations with measures of Parkinson's severity, independence and cognitive function, and construct validity using correlations with patients' own EQ-5D-3 L scores. In addition, we assessed divergent validity using correlations with carers' own EQ-5D index, EQ-VAS and Zarit caregiver burden scores. RESULTS In patients without dementia, both the PDQ-8 and EQ-5D-3 L correlated with measures of disease severity, dependence and carer burden scores, and PDQ-8 scores moderately with EQ-5D-3 L and EQ-5D-3 L VAS scores. In patients with dementia, EQ-5D-3 L scores correlated with disease severity, cognition and dependence scores, but DEMQOL-Proxy scores were moderately associated only with patients' dependence and carers' own EQ-5D-3 L scores but not patients' disease severity, EQ-5D-3 L or cognitive scores. CONCLUSIONS The PDQ-8 and EQ-5D-3 L have adequate validity in late stage PD without dementia, but in those with PD and dementia the EQ-5D-3 L may be preferable to the DEMQOL-Proxy.
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Affiliation(s)
- Mouhammed Ramadhan
- Clinical Neurosciences, Clinical and Movement Neurosciences, 61554UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Anette Schrag
- Clinical Neurosciences, Clinical and Movement Neurosciences, 61554UCL Queen Square Institute of Neurology, University College London, London, UK
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Caregiver Burden in Movement Disorders and Neurodegenerative Diseases: Editorial. Brain Sci 2022; 12:brainsci12091184. [PMID: 36138919 PMCID: PMC9497330 DOI: 10.3390/brainsci12091184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022] Open
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Höllerhage M, Klietz M, Höglinger GU. Disease modification in Parkinsonism: obstacles and ways forward. J Neural Transm (Vienna) 2022; 129:1133-1153. [PMID: 35695938 PMCID: PMC9463344 DOI: 10.1007/s00702-022-02520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 12/19/2022]
Abstract
To date, the diagnoses of Parkinson syndromes are based on clinical examination. Therefore, these specific diagnoses are made, when the neuropathological process is already advanced. However, disease modification or neuroprotection, is considered to be most effective before marked neurodegeneration has occurred. In recent years, early clinical or prodromal stages of Parkinson syndromes came into focus. Moreover, subtypes of distinct diseases will allow predictions of the individual course of the diseases more precisely. Thereby, patients will be enrolled into clinical trials with more specific disease entities and endpoints. Furthermore, novel fluid and imaging biomarkers that allow biochemical diagnoses are under development. These will lead to earlier diagnoses and earlier therapy in the future as consequence. Furthermore, therapeutic approaches will take the underlying neuropathological process of neurodegenerative Parkinson syndromes more specific into account. Specifically, future therapies will target the aggregation of aggregation-prone proteins such as alpha-synuclein and tau, the degradation of pathological aggregates, and the spreading of pathological protein aggregates throughout the brain. Many of these approaches are already in (pre)clinical development. In addition, anti-inflammatory approaches are in development. Furthermore, drug-repurposing is a feasible approach to shorten the developmental process of new drugs.
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Affiliation(s)
- M Höllerhage
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - G U Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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12
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Jensen I, Bretschneider A, Stiel S, Wegner F, Höglinger GU, Klietz M. Analysis of Parkinson's Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists. Brain Sci 2022; 12:brainsci12060749. [PMID: 35741634 PMCID: PMC9221250 DOI: 10.3390/brainsci12060749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
A major proportion of people with Parkinson’s disease (PwP) in Germany has written an advance directive (AD). Unfortunately, these ADs are unclear for PD-specific endpoints. We previously established consensus-based recommendations for disease-specific content of an AD in PwP. However, the implementation of those recommendations and the consulting of AD creation and modification in PwP remains to be evaluated. This study aimed to investigate the practical use of PD-specific recommendations for ADs in outpatient settings. A total of 87 physicians (45 general practitioners (GPs) and 42 neurologists, 10% response rate) answered a self-constructed semiquantitative questionnaire. The participants were asked to evaluate the suggested PD-specific recommendations for ADs and the supply of palliative care in the outpatient setting. Overall, the vast majority of treating physicians agreed on the usefulness of the newly constructed PD-specific recommendations. Consultations to discuss information about PD-specific ADs were scarce with short durations. Only 24% of participating physicians implemented the PD-specific recommendations in their daily practice. GPs and neurologists agreed on the benefit of disease-specific recommendations for ADs. In future, a more general integration of these recommendations in routine care might improve specific AD creation of PwP and advanced care planning.
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Affiliation(s)
- Ida Jensen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
- Correspondence:
| | - Almut Bretschneider
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
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13
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Hand A, Oates LL, Gray WK, Dismore LL, Baker K, Naisby J, Walker RW. Understanding Caregiver Strain in Parkinsonism-A Mixed Methods Approach. J Geriatr Psychiatry Neurol 2022; 35:363-373. [PMID: 33648358 DOI: 10.1177/0891988721996819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Parkinsonism, including Parkinson's disease (PD) are progressive neurological conditions. As these condition progress, individuals will need more support with their care needs to maintain independent community-living. Care needs are mainly met by unpaid, informal caregivers, usually close family members or friends. Caregiver strain is thought to lead to the need for care home placement when the caregiver can no longer cope. OBJECTIVE To understand predictors of caregiver strain and its influence on care home placement for people with moderate to advanced Parkinsonism. METHODS This is a convergent mixed methods study. Quantitative data, following an adapted stress-appraisal model, were collected on caregiver profile, tasks performed and causes of caregiver strain. Semi-structured, in-depth interviews were conducted with caregivers of people with PD (PwP) who went into a care home during the study period, to develop a deeper understanding of the caregiver role and the factors influencing caregiver strain. RESULTS Quantitative data were collected from 115 patient caregiver dyads. Interviews were conducted with 10 caregivers. A model to predict caregiver strain was developed and predictors of caregiver strain were identified, such as functional disability and poor caregiver sleep. CONCLUSION Our findings further demonstrate the complexity of carer strain. Particular dimensions are identified that need to be addressed within clinical practice to reduce carer strain and support people with Parkinsonism to remain within their own home for as long as possible.
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Affiliation(s)
- Annette Hand
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-upon-Tyne, UK
| | - Lloyd L Oates
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Lorelle L Dismore
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
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14
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Neuropsychiatric Symptoms in Parkinson’s Disease Patients Are Associated with Reduced Health-Related Quality of Life and Increased Caregiver Burden. Brain Sci 2022; 12:brainsci12010089. [PMID: 35053832 PMCID: PMC8774188 DOI: 10.3390/brainsci12010089] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 01/11/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disorder resulting in reduced health-related quality of life (HR-QoL) of people with PD (PwP) and their caregivers. Furthermore, there is an accumulating burden on caregivers of patients in advanced stages of the disease. In previous studies, motor- and non-motor-symptoms of PwP have been identified to contribute to reduced HR-QoL and an increased caregiver burden. This cross-sectional observational study aimed to study the influence of neuropsychiatric symptoms measured with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson’s Disease (SEND-PD) questionnaire on the HR-QoL of PwP, as well as the caregiver burden. Analyses revealed a significant association between SEND-PD subscale mood/apathy and reduced HR-QoL in PwP, measured by the Parkinson’s disease quality of life questionnaire (PDQ-8) (p < 0.001). Furthermore, mood/apathy was significantly correlated with caregiver burden (p = 0.001) in the multiple linear regression analysis. Hence, neuropsychiatric symptoms were found to have a profound impact on the HR-QoL of PwP, as well as on caregiver burden. Since neuropsychiatric symptoms were one of the main predictors for caregiver burden, physicians of PwP should treat these symptoms to stabilize caregiver burden, as well as HR-QoL in PwP and their caregivers.
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15
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Kay KR, Uc EY. Real-life consequences of cognitive dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:113-136. [DOI: 10.1016/bs.pbr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Kasdorf A, Dust G, Hamacher S, Schippel N, Rietz C, Voltz R, Strupp J. The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives. Support Care Cancer 2022; 30:4971-4979. [PMID: 35190893 PMCID: PMC9046331 DOI: 10.1007/s00520-022-06908-8] [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: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life. METHODS A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson's chi-square test and Mann-Whitney U test. RESULTS We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001). CONCLUSIONS Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis. TRIAL REGISTRATION Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).
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Affiliation(s)
- Alina Kasdorf
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gloria Dust
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Rietz
- grid.461780.c0000 0001 2264 5158Department of Educational Science and Mixed-Methods-Research, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Center for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Strupp
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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17
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Kalampokini S, Hommel ALAJ, Lorenzl S, Ferreira JJ, Meissner WG, Odin P, Bloem BR, Dodel R, Schrag AE. Caregiver Burden in Late-Stage Parkinsonism and Its Associations. J Geriatr Psychiatry Neurol 2022; 35:110-120. [PMID: 33094677 DOI: 10.1177/0891988720968263] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients in the late stages of parkinsonism are highly dependent on others in their self-care and activities of daily living. However, few studies have assessed the physical, psychological and social consequences of caring for a person with late-stage parkinsonism. PATIENTS AND METHODS Five hundred and six patients and their caregivers from the Care of Late Stage Parkinsonism (CLaSP) study were included. Patients' motor and non-motor symptoms were assessed using the UPDRS and Non-motor symptom scale (NMSS), Neuropsychiatric inventory (NPI-12), and caregivers' health status using the EQ-5D-3 L. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). RESULTS The majority of caregivers were the spouse or life partner (71.2%), and were living with the patient at home (67%). Approximately half of caregivers reported anxiety/depression and pain/discomfort (45% and 59% respectively). The factors most strongly associated with caregiver burden were patients' neuropsychiatric features on the total NPI score (r = 0.38, p < 0.0001), total NMSS score (r = 0.28, p < 0.0001), caring for male patients and patients living at home. Being the spouse, the hours per day assisting and supervising the patient as well as caregivers' EQ-5D mood and pain scores were also associated with higher ZBI scores (all p < 0.001). CONCLUSION The care of patients with late stage parkinsonism is associated with significant caregiver burden, particularly when patients manifest many neuropsychiatric and non-motor features and when caring for a male patient at home.
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Affiliation(s)
- Stefania Kalampokini
- UCL Queen Square Institute of Neurology, 61554University College London, United Kingdom
| | - Adrianus L A J Hommel
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, 6029Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, 162199Paracelsus Medical University, Salzburg, Austria.,Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München-Klinikum Großhadern, Munich, Germany.,Department of Neurology, Agatharied Hospital, Hausham, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular 37809Universidade di Lisboa, Lisboa, Portugal
| | - Wassilios G Meissner
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Institut des Maladies Neurodégénératives, 27086University de Bordeaux, Bordeaux, France.,Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Per Odin
- Department of Neurology, 59568Lund University Hospital, Sweden
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, 6029Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Richard Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Germany.,Department of Neurology, Philipps-University Marburg, Germany
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18
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Predictors of clinically significant quality of life impairment in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:118. [PMID: 34916528 PMCID: PMC8677846 DOI: 10.1038/s41531-021-00256-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
Quality of life (QOL) plays an important role in independent living in Parkinson's disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829-0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422-12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053-1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027-1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer-Lemeshow test, p = 0.665; R2 = 0.655). An increase in ≥5 and ≥10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663-17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975-22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients.
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19
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Thieken F, van Munster M. Deriving Implications for Care Delivery in Parkinson's Disease by Co-Diagnosing Caregivers as Invisible Patients. Brain Sci 2021; 11:brainsci11121629. [PMID: 34942931 PMCID: PMC8699371 DOI: 10.3390/brainsci11121629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
For persons with Parkinson’s disease, the loss of autonomy in daily life leads to a high level of dependency on relatives’ support. Such dependency strongly correlates with high levels of perceived stress and psychosocial burden in informal caregivers. Global developments, such as demographic change and the associated thinning infrastructure in rural areas cause a continuously growing need for medical and nursing care. However, this need is not being adequately met. The resulting care gap is being made up by unpaid or underpaid work of informal caregivers. The double burden of care work and gainful employment creates enormous health-related impairments of the informal caregivers, so that they eventually become invisible patients themselves. Expectedly, those invisible patients do not receive the best care, leading to a decrease in quality of life and, in the end, to worse care for PD patients. Suggested solutions to relieve relatives, such as moving the person affected by Parkinson’s to a nursing home, often do not meet the wishes of patients and informal caregivers, nor does it appear as a structural solution in the light of demographic change against an economic background. Rather, it requires the development, implementation and evaluation of new, holistic approaches to care that make invisible patients visible.
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Affiliation(s)
- Franziska Thieken
- Department of Neurology, University Hospital of Marburg, Baldingerstraße, 35043 Marburg, Germany;
- Correspondence: ; Tel.: +49-6421-58-64855
| | - Marlena van Munster
- Faculty of Medicine, Philipps-Universität Marburg, Biegenstraße 10, 35037 Marburg, Germany
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20
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Klietz M, Elaman MH, Mahmoudi N, Nösel P, Ahlswede M, Wegner F, Höglinger GU, Lanfermann H, Ding XQ. Cerebral Microstructural Alterations in Patients With Early Parkinson's Disease Detected With Quantitative Magnetic Resonance Measurements. Front Aging Neurosci 2021; 13:763331. [PMID: 34790113 PMCID: PMC8591214 DOI: 10.3389/fnagi.2021.763331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly. In early stages of PD, patients typically display normal brain magnet resonance imaging (MRI) in routine screening. Advanced imaging approaches are necessary to discriminate early PD patients from healthy controls. In this study, microstructural changes in relevant brain regions of early PD patients were investigated by using quantitative MRI methods. Methods: Cerebral MRI at 3T was performed on 20 PD patients in early stages and 20 age and sex matched healthy controls. Brain relative proton density, T1, T2, and T2′ relaxation times were measured in 14 regions of interest (ROIs) in each hemisphere and compared between patients and controls to estimate PD related alterations. Results: In comparison to matched healthy controls, the PD patients revealed decreased relative proton density in contralateral prefrontal subcortical area, upper and lower pons, in ipsilateral globus pallidus, and bilaterally in splenium corporis callosi, caudate nucleus, putamen, thalamus, and mesencephalon. The T1 relaxation time was increased in contralateral prefrontal subcortical area and centrum semiovale, putamen, nucleus caudatus and mesencephalon, whereas T2 relaxation time was elevated in upper pons bilaterally and in centrum semiovale ipsilaterally. T2′ relaxation time did not show significant changes. Conclusion: Early Parkinson’s disease is associated with a distinct profile of brain microstructural changes which may relate to clinical symptoms. The quantitative MR method used in this study may be useful in early diagnosis of Parkinson’s disease. Limitations of this study include a small sample size and manual selection of the ROIs. Atlas-based or statistical mapping methods would be an alternative for an objective evaluation. More studies are necessary to validate the measurement methods for clinical use in diagnostics of early Parkinson’s disease.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - M Handan Elaman
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Nima Mahmoudi
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Patrick Nösel
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Mareike Ahlswede
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | | | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Xiao-Qi Ding
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
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21
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Analysis of Transition of Patients with Parkinson's Disease into Institutional Care: A Retrospective Pilot Study. Brain Sci 2021; 11:brainsci11111470. [PMID: 34827469 PMCID: PMC8615464 DOI: 10.3390/brainsci11111470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 01/16/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disease which gives a person a high risk of becoming care-dependent. During disease progression, the amount of care concerning activities of daily living can increase, possibly resulting in transition of the people with Parkinson's disease (PwP) to a care facility. However, there is a lack of knowledge concerning the factors leading to institutionalization of PwP and the consequences for them and their informal caregivers. The aim of this cross-sectional retrospective study was to investigate reasons leading to the transition into an institutional care facility, the process of decision-making and its effects on PwP symptoms and caregiver burden. Participating PwP had to be institutionalized for at most one year after transition at study inclusion. Participants completed a range of semiquantitative questionnaires as well as the caregiving tasks questionnaire. Fourteen patient-caregiver pairs were included. PwP suffered from late-stage PD symptoms with high dependence on help, experiencing several hospitalizations before transition. Analyses revealed a significant decrease in caregiver burden and depressive symptoms of the caregivers after PwP institutionalization. Factors influencing the transition were, e.g., fear of PwP health issues and concerns about caregivers' health. This study presents new insights into the process of institutionalization and its influence on caregiver burden, including aspects for discussions of physicians with PwP and their caregivers for counselling the decision to move to institutional care.
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22
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Thieken F, Timmermann L, Sohrabi K, Woopen C, Schmitz-Luhn B, Janhsen A, Eggers C. Development of a Multidimensional Assessment Tool for the Evaluation of Holistic Quality of Life in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 12:361-370. [PMID: 34602498 DOI: 10.3233/jpd-202391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parkinsonian syndromes are heterogeneous chronic neurodegenerative disorders associated with both motor and non-motor symptoms. The symptoms have major psychosocial effects on the quality of life of patients and can be a burden for caregivers. So far, several questionnaires have been developed to assess quality of life in Parkinsonism, but none of these include the positive sides on well-being such as personal and social resilience factors. OBJECTIVE The aim of this study is to develop a digital framework for a longitudinal assessment of quality of life during the progression of Parkinson's disease. METHODS The CHAPO model (Challenges and Potentials) has been established in a vast study by Wagner et al. to assess the quality of life of older people. This model includes environmental and individual factors, life chances, and life results, such as individual life evaluation, from a subjective as well as an objective point of view. Therefore, it has been adapted in several development steps to include the specific aspects that affect quality of life in Parkinsonian syndromes. The development process included 6 steps: definition, refinement, operationalization, piloting/debriefing, adjustment, and integration. RESULTS The development of the CHAPO-PD model has been completed and it represents the first main result of this study. CONCLUSION By taking a holistic understanding of quality of life into account, we expect to detect previously unrecognized factors, which correlate to the subjective well-being of Parkinson's disease patients, and aim to use these findings to improve the health care structures for patients with Parkinson's disease and related disorders.
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Affiliation(s)
- Franziska Thieken
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences -THM, Giessen, Germany
| | - Christiane Woopen
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Cologne, Germany.,Medical Faculty, Research Unit Ethics, University of Cologne, University of Cologne, Cologne, Germany
| | - Björn Schmitz-Luhn
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Cologne, Germany
| | - Anna Janhsen
- a.r.t.e.s. Graduate School for the Humanities. University of Cologne, Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,CMBB -Center for Mind, Brain and Behavior of the Universities Giessen and Marburg, Marburg, Germany
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23
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Meinders MJ, Gentile G, Schrag AE, Konitsiotis S, Eggers C, Taba P, Lorenzl S, Odin P, Rosqvist K, Chaudhuri KR, Antonini A, Bloem BR, Groot MM. Advance Care Planning and Care Coordination for People With Parkinson's Disease and Their Family Caregivers-Study Protocol for a Multicentre, Randomized Controlled Trial. Front Neurol 2021; 12:673893. [PMID: 34434156 PMCID: PMC8382049 DOI: 10.3389/fneur.2021.673893] [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: 02/28/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parkinson's disease (PD) is a progressive neurodegenerative disease with motor- and non-motor symptoms. When the disease progresses, symptom burden increases. Consequently, additional care demands develop, the complexity of treatment increases, and the patient's quality of life is progressively threatened. To address these challenges, there is growing awareness of the potential benefits of palliative care for people with PD. This includes communication about end-of-life issues, such as Advance Care Planning (ACP), which helps to elicit patient's needs and preferences on issues related to future treatment and care. In this study, we will assess the impact and feasibility of a nurse-led palliative care intervention for people with PD across diverse European care settings. Methods: The intervention will be evaluated in a multicentre, open-label randomized controlled trial, with a parallel group design in seven European countries (Austria, Estonia, Germany, Greece, Italy, Sweden and United Kingdom). The “PD_Pal intervention” comprises (1) several consultations with a trained nurse who will perform ACP conversations and support care coordination and (2) use of a patient-directed “Parkinson Support Plan-workbook”. The primary endpoint is defined as the percentage of participants with documented ACP-decisions assessed at 6 months after baseline (t1). Secondary endpoints include patients' and family caregivers' quality of life, perceived care coordination, patients' symptom burden, and cost-effectiveness. In parallel, we will perform a process evaluation, to understand the feasibility of the intervention. Assessments are scheduled at baseline (t0), 6 months (t1), and 12 months (t2). Statistical analysis will be performed by means of Mantel–Haenszel methods and multilevel logistic regression models, correcting for multiple testing. Discussion: This study will contribute to the current knowledge gap on the application of palliative care interventions for people with Parkinson's disease aimed at ameliorating quality of life and managing end-of-life perspectives. Studying the impact and feasibility of the intervention in seven European countries, each with their own cultural and organisational characteristics, will allow us to create a broad perspective on palliative care interventions for people with Parkinson's disease across settings. Clinical Trial Registration:www.trialregister.nl, NL8180.
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Affiliation(s)
- Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Spiros Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Carsten Eggers
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Knappschaftskrankenhaus Bottrop GmbH, Department of Neurology, Bottrop, Germany
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology and Department of Palliative Care, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Parkinson's Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
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24
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Mylius V, Möller JC, Bohlhalter S, Ciampi de Andrade D, Perez Lloret S. Diagnosis and Management of Pain in Parkinson's Disease: A New Approach. Drugs Aging 2021; 38:559-577. [PMID: 34224103 DOI: 10.1007/s40266-021-00867-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, 7317, Valens, Switzerland. .,Department of Neurology, Philipps University, Marburg, Germany. .,Department of Neurology, Kantonsspital, St. Gallen, Switzerland.
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany.,Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto do Cancer de Sao Paulo, Octavio Frias de Oliveira, Sao Paulo, Brazil.,Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Santiago Perez Lloret
- LIM 62, Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.,Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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25
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Relationship Satisfaction in People with Parkinson's Disease and Their Caregivers: A Cross-Sectional Observational Study. Brain Sci 2021; 11:brainsci11060822. [PMID: 34205764 PMCID: PMC8234945 DOI: 10.3390/brainsci11060822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 01/01/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder, which leads to reduced health-related quality of life (HR-QoL) and autonomy in advanced stages of the disease. Hence, people with PD (PwPD) are in need of help, which is often provided by informal caregivers, especially spouses. This might influence the relationship satisfaction in patients and their spousal caregivers. Additionally, previous studies have shown that a reduced relationship satisfaction may result in mental disorders and reduced physical health. The aim of this study is to identify factors influencing PwPD and their caregivers' relationship satisfaction in a cross-sectional observational study. Analyses revealed an overall satisfying relationship, measured by the Quality of Marriage Index, in PwPD (n = 84) and their caregivers (n = 79). Relationship satisfaction in PwPD mildly decreased with reduced HR-QoL and more severe depressive symptoms. Reduced relationship satisfaction in caregivers was significantly associated with decreased HR-QoL, higher caregiver burden, more severe depressive symptoms and increased neuropsychiatric symptoms in PwPD. Further studies are needed to investigate the influence of the identified factors over time and if relationship satisfaction has a reciprocal impact on caregiver burden, HR-QoL as well as mental and physical health.
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26
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Malkiewicz JJ, Malkiewicz M, Siuda J. Prevalence of QTc Prolongation in Patients with Parkinson's Disease. Assessment of the Effects of Drugs, Clinical Risk Factors and Used Correction Formula. J Clin Med 2021; 10:1396. [PMID: 33807236 PMCID: PMC8037693 DOI: 10.3390/jcm10071396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a possible risk factor for corrected QT interval (QTc) prolongation. PD patients frequently take QTc-prolonging drugs. The aim of the study was to assess the prevalence of QTc prolongation in PD and the influence of drugs and other potential risk factors on the QTc length in PD. METHODS 101 patients with PD and a good quality ECG were included in the study. The prolonged QTc was defined as ≥450 ms for men and ≥460 ms for women. Bazett's (QTcB) and Framingham (QTcF) formulas were utilized to calculate QTc. Data about sex, age, PD duration, disease's severity, comorbidities and QTc-prolonging drugs were collected. Multiple linear regressions with backward elimination were used to assess factors influencing the QTc. RESULTS A long QTc was presented in 13 patients (12.9%) for QTcB and 4 patients (4%) for QTcF. Longer QTc in PD patients was associated with older age, male sex and QTc-prolonging drugs regardless of the used formula. The QTcB was also significantly affected by the heart rate (HR). CONCLUSION QTc prolongation is common in PD. Age, drugs and male gender are potential risk factors for QTc prolongation in PD.
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Affiliation(s)
- Jakub J. Malkiewicz
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 14 Medyków Street, 40-752 Katowice, Poland;
| | - Maciej Malkiewicz
- Department of Gastroenterology with Subdivision of Internal Medicine, John Paul II Memorial Beskid Center of Oncology—Municipal Hospital in Bielsko Biala, 21 Stanisława Wyspiańskiego Street, 43-300 Bielsko-Biała, Poland;
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 14 Medyków Street, 40-752 Katowice, Poland;
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27
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One Year Trajectory of Caregiver Burden in Parkinson's Disease and Analysis of Gender-Specific Aspects. Brain Sci 2021; 11:brainsci11030295. [PMID: 33652825 PMCID: PMC7996933 DOI: 10.3390/brainsci11030295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) is a slowly progressive neurodegenerative movement disorder that leads to impairments in activities of daily living. In addition to reducing patients' quality of life, this disease also affects caregivers' well-being. Until recently, caregiver burden was mainly assessed by generic questionnaires, which do not take the characteristics of the chronic disease into consideration. In the case of PD, this issue has been addressed by the introduction of the "Parkinson's disease caregiver burden" questionnaire (PDCB). Data on longitudinal trajectories of caregiver burden are still missing in the literature. In this study, we assessed the one-year trajectory of caregiver burden by the PDCB as a disease-specific questionnaire. Further, gender-specific aspects of caregiver burden were analyzed by applying a caregiver task questionnaire. PDCB total score (n = 84 patients and caregivers) did not significantly change from baseline (30.4) to one year at follow-up (31.5). No significant difference was detected between female and male caregivers in global burden and-specific caregiver tasks. Our data showed only a mild increase of caregiver burden in the timeframe of one year. Gender-specific differences do not seem to impact-specific caregiver tasks in the presented study population.
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Greten S, Müller-Funogea JI, Wegner F, Höglinger GU, Simon N, Junius-Walker U, Gerbel S, Krause O, Klietz M. Drug safety profiles in geriatric patients with Parkinson's disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis. J Neural Transm (Vienna) 2020; 128:49-60. [PMID: 33263172 PMCID: PMC7815558 DOI: 10.1007/s00702-020-02276-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022]
Abstract
To reduce potentially inappropriate medications, the FORTA (Fit fOR The Aged) concept classifies drugs in terms of their suitability for geriatric patients with different labels, namely A (indispensable), B (beneficial), C (questionable), and D (avoid). The aims of our study were to assess the medication appropriateness in PD inpatients applying the FORTA list and drug-drug interaction software, further to assess the adequacy of FORTA list for patients with PD. We retrospectively collected demographic data, comorbidities, laboratory values, and the medication from the discharge letters of 123 geriatric inpatients with PD at the university hospital of Hannover Medical School. Patients suffered on average from 8.2 comorbidities. The majority of the medication was labeled A (60.6% of PD-specific and 40.9% of other medication) or B (22.3% of PD-specific and 26.9% of other medication). Administered drugs labeled with D were amantadine, clozapine, oxazepam, lorazepam, amitriptyline, and clonidine. Overall, 545 interactions were identified, thereof 11.9% severe interactions, and 1.7% contraindicated combinations. 81.3% of patients had at least one moderate or severe interaction. The FORTA list gives rational recommendations for PD-specific and other medication, especially for general practitioners. Considering the demographic characteristics and the common multimorbidity of geriatric PD patients, this study underlines the importance of awareness, education, and preventive interventions to increase drug safety.
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Affiliation(s)
- S Greten
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - J I Müller-Funogea
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - F Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - G U Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - N Simon
- Centre for Information Management (ZIMT), Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - U Junius-Walker
- Department of General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - S Gerbel
- Centre for Information Management (ZIMT), Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - O Krause
- Department of General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Sennott B, Woo K, Hess S, Mitchem D, Klostermann EC, Myrick E, Anderson S, Savica R, Fleisher JE. Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic. JOURNAL OF PARKINSONS DISEASE 2020; 10:1383-1388. [PMID: 32804103 DOI: 10.3233/jpd-202156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has upended daily life and neurologic care for most patients, including those with Parkinson's disease and parkinsonism. Disruptions to routine care, high volumes of patient and caregiver calls, and our patients' risk of infection and complications inspired a proactive COVID-19 outreach program. This program targets patients with advanced Parkinson's disease and related disorders, specifically those who are homebound, receiving or eligible for palliative care, and/or lacking support networks. We describe the program and practical strategies providers can implement to support wellbeing and successful telehealth uptake during this time of social isolation and gradual reopening.
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Affiliation(s)
- Brianna Sennott
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Katheryn Woo
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Serena Hess
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daniela Mitchem
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ellen C Klostermann
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Erica Myrick
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sharlet Anderson
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jori E Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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30
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Hackney ME, Bay AA, Jackson JM, Nocera JR, Krishnamurthy V, Crosson B, Evatt ML, Langley J, Cui X, McKay JL, Huddleston DE. Rationale and Design of the PAIRED Trial: Partnered Dance Aerobic Exercise as a Neuroprotective, Motor, and Cognitive Intervention in Parkinson's Disease. Front Neurol 2020; 11:943. [PMID: 33162925 PMCID: PMC7581698 DOI: 10.3389/fneur.2020.00943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD), an intractable condition impairing motor and cognitive function, is imperfectly treated by drugs and surgery. Two priority issues for many people with PD are OFF-time and cognitive impairment. Even under best medical management, three-fourths of people with PD experience “OFF-time” related to medication-related motor fluctuations, which severely impacts both quality of life and cognition. Cognitive deficits are found even in newly diagnosed people with PD and are often intractable. Our data suggest that partnered dance aerobic exercise (PDAE) reduces OFF-time on the Movement Disorders Society Unified Parkinson Disease Rating Scale-IV (MDS-UPDRS-IV) and ameliorates other disease features, which motivate the PAIRED trial. PDAE provides AE during an improvisational, cognitively engaging rehabilitative physical activity. Although exercise benefits motor and cognitive symptoms and may be neuroprotective for PD, studies using robust biomarkers of neuroprotection in humans are rare. We propose to perform a randomized, controlled trial in individuals with diagnosed mild–moderate PD to compare the efficacy of PDAE vs. walking aerobic exercise (WALK) for OFF-time, cognition, and neuroprotection. We will assess neuroprotection with neuromelanin-sensitive MRI (NM-MRI) and iron-sensitive (R2*) MRI sequences to quantify neuromelanin loss and iron accumulation in substantia nigra pars compacta (SNc). We will use these biomarkers, neuromelanin loss, and iron accumulation, as tools to chart the course of neurodegeneration in patients with PD who have undergone long-term (16 months) intervention. We will randomly assign 102 individuals with mild–moderate PD to 16 months of PDAE or WALK. The 16-month intervention period will consist of Training (3 months of biweekly sessions) and Maintenance (13 months of weekly sessions) phases. We will assess participants at baseline, 3 months (immediately post-Training), and 16 months (immediately post-Maintenance) for OFF-time and behaviorally and physiologically measured cognition. We will acquire NM-MRI and R2* imaging data at baseline and 16 months to assess neuroprotection. We will (1) examine effects of Training and Maintenance phases of PDAE vs. WALK on OFF-time, (2) compare PDAE vs. WALK at 3 and 16 months on behavioral and functional MRI (fMRI) measures of spatial cognition, and (3) compare PDAE vs. WALK for effects on rates of neurodegeneration.
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Affiliation(s)
- Madeleine E Hackney
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Nursing, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jordan M Jackson
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Joe R Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Bruce Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Georgia State University Department of Psychology, Atlanta, GA, United States.,Health and Rehabilitation Science, University of Queensland, Brisbane, QLD, Australia
| | - Marian L Evatt
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Jason Langley
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
| | - Xiangqin Cui
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - J Lucas McKay
- Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel E Huddleston
- Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
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Self-Reported Nonadherence Predicts Changes of Medication after Discharge from Hospital in People with Parkinson's Disease. PARKINSONS DISEASE 2020; 2020:4315489. [PMID: 32714503 PMCID: PMC7355339 DOI: 10.1155/2020/4315489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/13/2020] [Indexed: 12/26/2022]
Abstract
Background Medication is often changed after hospital discharge in people with Parkinson's disease (PD). Objective This observational study aimed to describe changes in PD medication after discharge and explore their association with self-reported adherence and clinical parameters. Methods During hospitalisation sociodemographic characteristics, the Movement Disorder Society-sponsored revision of the Unified PD Rating Scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Beck Depression Inventory II (BDI-II) score, Montreal Cognitive Assessment (MoCA) score, nonmotor symptoms questionnaire (NMSQ), and Stendal Adherence to Medication Score (SAMS) were collected in 125 people with PD. A semistructured interview was conducted 1 month after discharge to determine the extent and reasons for medication changes. Results Thirty-eight patients (30.4%) changed their PD medication after discharge. Most changes (20.8%) were performed by physicians while 9.6% of patients changed their medication by themselves due to side effects, missing effect of the medication, missing knowledge about the indication, running out of medication, or nonspecific reason. This led to decreased doses while changes by physicians resulted in both increase and decrease of doses as well as new drug prescription. Patients without changes, patients with changes performed by them, and patients with changes performed by physicians did not differ in age, disease duration, MDS-UPDRS III, LEDD, NMSQ, MoCA, BDI-II, gender, marital status, or education. However, patients who themselves made the changes were more likely to be nonadherent according to baseline SAMS. Patients who made changes after discharge had higher SAMS modification and forgetting subscores than patients without changes or with changes made by physicians. Conclusion Both intended and unintended nonadherence occur in patients who change medication after discharge. The use of an adherence questionnaire during inpatient treatment may help detect patients with higher risk of changing medication after discharge.
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Alexithymia Is Associated with Reduced Quality of Life and Increased Caregiver Burden in Parkinson's Disease. Brain Sci 2020; 10:brainsci10060401. [PMID: 32599704 PMCID: PMC7348697 DOI: 10.3390/brainsci10060401] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is the second most frequent neurodegenerative disease of people who are beyond 50 years of age. People with PD (PwP) suffer from a large variety of motor and non-motor symptoms resulting in reduced health-related quality of life (HR-QoL). In the last two decades, alexithymia was identified as an additional non-motor symptom in PD. Alexithymia is defined as a cognitive affective disturbance resulting in difficulty to identify and distinguish feelings from bodily sensations of emotional arousal. In PD, the frequency of patients suffering of alexithymia is increased compared to healthy controls. The aim of the present study was to determine the relationship of alexithymia to HR-QoL of the PwP and caregiver burden of the corresponding caregiver. This cross-sectional questionnaire-based study used disease specific questionnaires for HR-QoL and caregiver burden. In total 119 PwP and their corresponding caregivers were included in the study. HR-QoL of the PwP correlated significantly with alexithymia (p < 0.001), especially the sub-components "identifying feelings" (p < 0.001) and "difficulties describing feelings" (p = 0.001). Caregiver burden also correlated significantly with PwP alexithymia (p < 0.001). However, caregiver burden was associated with sub-components "identifying feelings" (p < 0.008) and "external oriented thinking" (p < 0.004). These data support the importance of alexithymia as a non-motor symptom in PD.
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Morè L, Lauterborn JC, Papaleo F, Brambilla R. Enhancing cognition through pharmacological and environmental interventions: Examples from preclinical models of neurodevelopmental disorders. Neurosci Biobehav Rev 2020; 110:28-45. [PMID: 30981451 DOI: 10.1016/j.neubiorev.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/29/2022]
Abstract
In this review we discuss the role of environmental and pharmacological treatments to enhance cognition with special regards to neurodevelopmental related disorders and aging. How the environment influences brain structure and function, and the interactions between rearing conditions and gene expression, are fundamental questions that are still poorly understood. We propose a model that can explain some of the discrepancies in findings for effects of environmental enrichment on outcome measures. Evidence of a direct causal correlation of nootropics and treatments that enhanced cognition also will be presented, and possible molecular mechanisms that include neurotrophin signaling and downstream pathways underlying these processes are discussed. Finally we review recent findings achieved with a wide set of behavioral and cognitive tasks that have translational validity to humans, and should be useful for future work on devising appropriate therapies. As will be discussed, the collective findings suggest that a combinational therapeutic approach of environmental enrichment and nootropics could be particularly successful for improving learning and memory in both developmental disorders and normal aging.
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Affiliation(s)
- Lorenzo Morè
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, PR1 2XT, Preston, UK.
| | - Julie C Lauterborn
- Department of Anatomy & Neurobiology, School of Medicine, University of California, Irvine, CA, 92617, USA.
| | - Francesco Papaleo
- Genetics of Cognition Laboratory, Istituto Italiano di Tecnologia, Via Morego, 30, 16163, Genova, Italy.
| | - Riccardo Brambilla
- Neuroscience and Mental Health Research Institute (NMHRI), Division of Neuroscience, School of Biosciences, Cardiff University, CF24 4HQ, Cardiff, UK.
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35
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Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson's Disease Patients. PARKINSONS DISEASE 2020; 2020:5184084. [PMID: 32184980 PMCID: PMC7060449 DOI: 10.1155/2020/5184084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
Parkinson's disease (PD) is a chronic progressive movement disorder with severe reduction in patients' health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients' HR-QoL. However, the relationship of these symptoms to caregiver burden is relatively unclear. Influence of the Montreal Cognitive Assessment scale (MoCA) as a cognitive screening tool and Movement Disorders Society Unified Parkinson's disease Rating Scale MDS-UPDRS symptoms in relation to patients' HR-QoL and caregivers` burden was analyzed. PD patients (n = 124) completed MDS-UPDRS, MoCA, and the PD questionnaire 8 (PDQ-8) as a measure of quality of life. Caregivers (n = 78) were assessed by the PD caregiver burden inventory (PDCB). PDQ-8 and PDCB scores were regressed on MDS-UPDRS subscales and MoCA subscores. PDQ-8 correlated with attention (R2 0.1282; p < 0.001) and executive (R2 0.0882; p 0.001) MoCA subscores and all parts of the MDS-UPDRS. PDCB correlated most strongly with MDS-UPDRS part III motor symptoms (R2 0.2070; p < 0.001) and the MoCA attention subscore (R2 0.1815; p < 0.001). While all facets of PD symptoms assessed by the MDS-UPDRS relate to PD patients' quality of life, motor symptoms are the most relevant factor for the prediction of caregiver burden. In addition, patients' attentional symptoms seem to affect not only them, but also their caregivers. These findings show the potential of a detailed analysis of MDS-UPDRS and MoCA performance in PD patients.
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Klietz M, Drexel SC, Schnur T, Lange F, Groh A, Paracka L, Greten S, Dressler D, Höglinger GU, Wegner F. Mindfulness and Psychological Flexibility are Inversely Associated with Caregiver Burden in Parkinson's Disease. Brain Sci 2020; 10:E111. [PMID: 32093188 PMCID: PMC7071391 DOI: 10.3390/brainsci10020111] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative movement disorder with progressive impairments in activities of daily living. With disease progression, people with PD (PwP) need more help and care from their spouses or professional caregivers. Identifying factors that help caregivers to cope with their burden is needed to frame future interventions for PwP caregivers. Mindfulness and psychological flexibility might be factors contributing to resilience against the burden of giving care. In this cross-sectional questionnaire-based study, 118 PwP and their respective primary caregivers were included. Caregivers reported moderate burden and only mild depressive symptoms. Mindfulness measured by the Mindfulness Attention and Awareness scale (p 0.003) and psychological flexibility measured by Acceptance and Actions Questionnaire II (p0.001) correlated negatively with caregiver burden. Data from this study indicate mindfulness and psychological flexibility are factors contributing to resilience against caregiver burden. Future interventions to reduce burden in PwP caregivers might be improved by the inclusion of mindfulness training programs.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Simon C Drexel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Theresa Schnur
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Lange
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000 Leuven, Belgium
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School,Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Lejla Paracka
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stephan Greten
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Dirk Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Günter U Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Klietz M, Berndt JM, Wegner F, Schneider N, Höglinger GU, Eggers C, Stiel S. Consensus-Based Recommendations for Advance Directives of People with Parkinson's Disease in Regard to Typical Complications by German Movement Disorder Specialists. J Clin Med 2020; 9:jcm9020449. [PMID: 32041237 PMCID: PMC7073675 DOI: 10.3390/jcm9020449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022] Open
Abstract
A huge proportion of people with Parkinson’s disease (PwP) in Germany have written an advance directive (AD). However, the content of these forms in regard to specific Parkinson’s disease (PD)-related complications is rather low. There is an urgent need to specify ADs of PwP and consequently to improve decision-making concerning end-of-life aspects for affected patients. Evidence- and consensus-based PD-specific recommendations for ADs might help to close this gap. A Delphi study with two online Delphi rounds was initiated. Initial recommendations were built on findings from previous studies and derived from evidence-based literature. Consensus on recommendations was defined as ≥80% concordance regarding clarity of formulated aspects and relevance for clinical practice. A total of 22 experts (15.2% response rate) predominantly from the workgroup ‘neuro-palliative care’ in Germany performed two Delphi rounds. Consensus was achieved for 14 of 24 initially presented recommendations. Recommendations relating to dopaminergic therapy as well as to non-oral therapy options were considered important by the expert panel. The recommendations should be taken into account when developing and giving advice on ADs for PwP. Health professionals should be trained in counselling ADs of PwP and in integrating these recommendations in ADs during the disease course of PD.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (J.M.B.); (F.W.); (G.U.H.)
- Correspondence: ; Tel.: +49-(0)511-532-3122
| | - Johanna M. Berndt
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (J.M.B.); (F.W.); (G.U.H.)
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (N.S.); (S.S.)
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (J.M.B.); (F.W.); (G.U.H.)
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (N.S.); (S.S.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (J.M.B.); (F.W.); (G.U.H.)
| | - Carsten Eggers
- Department of Neurology, University of Marburg, Baldingerstraße, 35037 Marburg, Germany;
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (N.S.); (S.S.)
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Drexel SC, Klietz M, Kollewe K, Paracka L, Kutschenko A, Kopp B, Lange F, Wegner F, Dressler D. Caregiver burden and health-related quality of life in idiopathic dystonia patients under botulinum toxin treatment: a cross-sectional study. J Neural Transm (Vienna) 2019; 127:61-70. [PMID: 31802240 PMCID: PMC6942568 DOI: 10.1007/s00702-019-02109-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Dystonia is a chronic movement disorder that is associated with a reduction in health-related quality of life (HR-QoL) and restriction of activities of daily living. Botulinum neurotoxin (BT) improves disease-specific HR-QoL by reducing abnormal movements, postures, and pain. We examined the burden of the corresponding primary caregiver as a potential important factor for disease management and HR-QoL of dystonia patients under treatment with BT. 114 patients with focal, segmental, or generalized dystonia were recruited, together with 93 corresponding caregivers, whose burden was investigated using the Caregiver Burden Inventory. In addition, all participants were assessed for cognitive impairment, depression, anxiety, alexithymia, and HR-QoL. Only a small proportion of caregivers suffered from caregiver burden. Despite BT therapy, patients’ HR-QoL was decreased compared to the age-matched general German population. Psychological symptoms, notably anxiety, and depression correlated significantly with reduced HR-QoL. Our data imply that caregiver burden emerged to be an issue in subgroups of dystonia patients. Furthermore, HR-QoL of dystonia patients is reduced even under optimized BT treatment in a specialized center.
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Affiliation(s)
- S C Drexel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - K Kollewe
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - L Paracka
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Kutschenko
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F Lange
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000, Leuven, Belgium
| | - F Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - D Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Validating the Parkinson's disease caregiver burden questionnaire (PDCB) in German caregivers of advanced Parkinson's disease patients. Int Psychogeriatr 2019; 31:1791-1800. [PMID: 30907331 DOI: 10.1017/s1041610219000206] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Advanced Parkinson's disease (PD) may place a high burden on patients and their caregivers. Understanding the determinants of caregiver burden is of critical importance. This understanding requires the availability of adequate assessment tools. Recently, the Parkinson's disease caregiver burden questionnaire (PDCB) has been developed as a PD-specific measure of caregiver burden. However, the PDCB has only been evaluated in a sample of Australian caregivers of patients at a less advanced stage of the disease. OBJECTIVE We tested whether a German translation of the PDCB qualifies as an adequate measure of caregiver burden in a German sample of caregivers of advanced patients with PD. METHODS We collected PDCB data from 65 caregivers of advanced patients with PD. Reliability of the scale was assessed and compared against the original version. To validate the German version of the PDCB, we examined the correlations with the caregiver burden inventory (CBI), the short form 36 health survey (SF-36), the Parkinson's disease quality of life questionnaire 39 (PDQ-39), disease duration, and the amount of caregiving time. RESULTS The total PDCB score proved to be reliable and to be significantly related to CBI and SF-36 scores. PDCB scores also increased with increasing amounts of caregiving time. CONCLUSIONS The German version of the PDCB appears to be an adequate measure of caregiver burden in caregivers of advanced PD patients.
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Fleisher JE, Sweeney MM, Oyler S, Meisel T, Friede N, Di Rocco A, Chodosh J. Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study. Neurol Clin Pract 2019; 10:277-286. [PMID: 32983607 DOI: 10.1212/cpj.0000000000000716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
Abstract
Background As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL. Methods Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4. Results Of 27 enrolled patients, 23 completed 4 visits, with high retention and high patient- and caregiver-reported satisfaction. The mean age at baseline was 80.9 years (SD 7.8) with a mean total UPDRS of 65.0 (SD 20.0). After one year of home visits, total UPDRS worsened by a mean of 11.8 points (p < 0.01) without a change in any of 8 QoL domains (p = 0.19-0.95). Conclusions Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.
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Affiliation(s)
- Jori E Fleisher
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Meghan M Sweeney
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Sarah Oyler
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Talia Meisel
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Naomi Friede
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Alessandro Di Rocco
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Joshua Chodosh
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
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Fleisher JE, Sweeney MM, Oyler S, Meisel T, Friede N, Di Rocco A, Chodosh J. Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study. Neurol Clin Pract 2019. [PMID: 32983607 DOI: 10.1212/cpj.0000000000000716 10.1212/cpj.0000000000000716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL. Methods Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4. Results Of 27 enrolled patients, 23 completed 4 visits, with high retention and high patient- and caregiver-reported satisfaction. The mean age at baseline was 80.9 years (SD 7.8) with a mean total UPDRS of 65.0 (SD 20.0). After one year of home visits, total UPDRS worsened by a mean of 11.8 points (p < 0.01) without a change in any of 8 QoL domains (p = 0.19-0.95). Conclusions Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.
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Affiliation(s)
- Jori E Fleisher
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Meghan M Sweeney
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Sarah Oyler
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Talia Meisel
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Naomi Friede
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Alessandro Di Rocco
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
| | - Joshua Chodosh
- Rush University (JEF), Section of Movement Disorders, Department of Neurological Sciences, Chicago, IL; New York University Langone Health (JEF), Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NY; Kaiser Permanente (MMS), Department of Palliative Care, Lafayette, CO; Intermountain Medical Center (SO), Movement Disorders, Murray, UT; SUNY Downstate Medical Center College of Medicine (TM), Brooklyn, NY; Yale School of Nursing (NF), Orange, CT; Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ADR), Long Island, NY; New York University School of Medicine (JC), Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY; and VA New York Harbor Healthcare System (JC), Medicine Service, New York, NY
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Advance Directives of German People with Parkinson's Disease Are Unspecific in regard to Typical Complications. PARKINSONS DISEASE 2019; 2019:2107821. [PMID: 31482006 PMCID: PMC6701430 DOI: 10.1155/2019/2107821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative movement disorder with an increased morbidity and mortality. People with PD (PwP) may suffer from decreased quality of life due to various motor and nonmotor symptoms. To a huge proportion, PwP have written an advance directive (AD); however, the content of these forms in regard to PD-specific complications is unclear. The aim of this study was to qualitatively and quantitatively analyze ADs of PwP in Germany. ADs of PwP were analyzed in a German sample of members of the German PD patient association. Participants completed a questionnaire about their AD and sent a copy of their AD to the study center for detailed analyses. ADs were qualitatively and quantitatively analyzed for general and PD-specific aspects and usefulness concerning treatment decisions. 82 PwP were included in the study, and in 76, an AD could be analyzed. Family members, notaries, lawyers, and general physicians mainly counseled writing of the ADs. 4 PwP consulted a neurologist to establish a specific AD for PD. In the analysis, ADs displayed a good specificity for general aspects, but they were unspecific to PD in the vast majority of cases. PwP should be encouraged to create an AD early in their disease and adapt it in the course of the disease. PD-specific aspects for an AD could be details in relation to dopaminergic therapies at the end of life, management of non-oral advanced therapies, neuropsychiatric symptoms, dementia, and swallowing disturbances.
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Klietz M, Bronzlik P, Nösel P, Wegner F, Dressler DW, Dadak M, Maudsley AA, Sheriff S, Lanfermann H, Ding XQ. Altered Neurometabolic Profile in Early Parkinson's Disease: A Study With Short Echo-Time Whole Brain MR Spectroscopic Imaging. Front Neurol 2019; 10:777. [PMID: 31379726 PMCID: PMC6651356 DOI: 10.3389/fneur.2019.00777] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: To estimate alterations in neurometabolic profile of patients with early stage Parkinson's disease (PD) by using a short echo-time whole brain magnetic resonance spectroscopic imaging (wbMRSI) as possible biomarker for early diagnosis and monitoring of PD. Methods: 20 PD patients in early stage (H&Y ≤ 2) without evidence of severe other diseases and 20 age and sex matched healthy controls underwent wbMRSI. In each subject brain regional concentrations of metabolites N-acetyl-aspartate (NAA), choline (Cho), total creatine (tCr), glutamine (Gln), glutamate (Glu), and myo-inositol (mIns) were obtained in atlas-defined lobar structures including subcortical basal ganglia structures (the left and right frontal lobes, temporal lobes, parietal lobes, occipital lobes, and the cerebellum) and compared between patients and matched healthy controls. Clinical characteristics of the PD patients were correlated with spectroscopic findings. Results: In comparison to controls the PD patients revealed altered lobar metabolite levels in all brain lobes contralateral to dominantly affected body side, i.e., decreases of temporal NAA, Cho, and tCr, parietal NAA and tCr, and frontal as well as occipital NAA. The frontal NAA correlated negatively with the MDS-UPDRS II (R = 22120.585, p = 0.008), MDS-UPDRS IV (R = −0.458, p = 0.048) and total MDS-UPDRS scores (R = −0.679, p = 0.001). Conclusion: In early PD stages metabolic alterations are evident in all contralateral brain lobes demonstrating that the neurodegenerative process affects not only local areas by dopaminergic denervation, but also the functional network within different brain regions. The wbMRSI-detectable brain metabolic alterations reveal the potential to serve as biomarkers for early PD.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Paul Bronzlik
- Department of Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Patrick Nösel
- Department of Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Dirk W Dressler
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Mete Dadak
- Department of Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Andrew A Maudsley
- Department of Radiology, University of Miami School of Medicine, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami School of Medicine, Miami, FL, United States
| | | | - Xiao-Qi Ding
- Department of Neuroradiology, Hannover Medical School, Hanover, Germany
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Safety and Tolerability of Pharmacotherapies for Parkinson’s Disease in Geriatric Patients. Drugs Aging 2019; 36:511-530. [DOI: 10.1007/s40266-019-00654-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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