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Kuharic M, Kulbokas V, Hanson K, Nazari JL, Shah KK, Nguyen A, Hensle T, Marras C, Armstrong MJ, Jalundhwala YJ, Pickard AS. OFF episode quality of life impact scale (OFFELIA): A new measure of quality of life for off episodes in Parkinson's disease. Parkinsonism Relat Disord 2024; 123:106070. [PMID: 38503261 DOI: 10.1016/j.parkreldis.2024.106070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/21/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION OFF Episodes occur in people with Parkinson's disease when their medication wears off, and motor and/or non-motor symptoms emerge. Existing measures used to assess OFF Episodes focus on the time spent in OFF Episodes through diaries or by identifying symptoms, but they are limited in their ability to capture the severity and functional impact of OFF episodes. The aim of this study was to develop and validate a new instrument, called "OFFELIA," that measures the impact of OFF episodes on the quality of life of individuals with Parkinson's disease. METHODS Participants completed a cross-sectional questionnaire, "Impact and Communication on OFF Periods," while enrolled in the online clinical study Fox Insights. The data collected was used to develop OFFELIA. Psychometric testing was performed on 18 candidate items using classical, exploratory factor analysis, and item response theory methods. RESULTS 569 individuals with Parkinson's disease completed the questionnaire. All items were retained for the final measure, with 17 items aggregated into two multi-item scales (functioning and psychological well-being) and one item reported separately as it did not function well with the other items (employment). Known group comparisons based on average duration, frequency and unpredictability of OFF episodes indicated that OFFELIA subscales were more sensitive than existing generic and condition-specific measures. CONCLUSION Initial evidence supports the validity of OFFELIA, a new instrument that assesses the impact of OFF periods on daily life. This instrument can be used in assessing clinical therapeutic strategies targeting OFF episodes in Parkinson's disease.
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Affiliation(s)
- Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, USA, 60611.
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Kent Hanson
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Kanya K Shah
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Ai Nguyen
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Tara Hensle
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada.
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Fixel Institute for Neurological Diseases, Gainesville, FL, USA.
| | - Yash J Jalundhwala
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612; Moderna, Inc., Cambridge, MA, USA.
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
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Devraj R, Elkouzi A, Tracey MR. Real-World Experiences of Parkinson's Disease OFF Time and Role of Demographics. J Patient Cent Res Rev 2024; 11:8-17. [PMID: 38596350 PMCID: PMC11000704 DOI: 10.17294/2330-0698.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose OFF periods are episodes when Parkinson's disease (PD) medications work suboptimally, with symptoms returning and impacting quality of life. We aimed to characterize OFF periods using patient-reported frequency, severity, and duration, as well as determine these characteristics' associations with demographics. Methods A retrospective cohort study using Fox Insight Data Exploration Network (Fox DEN) database was conducted. Eligible patients had PD and were >18 years. The experience of OFF periods was characterized by frequency (number of episodes/day), duration (duration/episode), and severity (impact on activities). Significance level was Bonferroni-corrected for multivariate analyses. Results From a population of 6,757 persons with PD, 88% were non-Hispanic Whites (mean age: 66 ± 8.8 years); 52.7% were males versus 47.3% females; mean PD duration was 5.7 ± 5.2; and 51% experienced OFF periods. Subsequent analyses were limited to non-Hispanic Whites, as they constituted a large majority of the participants and were the subgroup that had the sample size to derive reliable inferences. The analyses showed that 67% experienced 1-2 episodes/day, 90% experienced >15-minute episodes, and 55% reported slight-mild severity/episode. Lower age was associated with a higher frequency (incidence rate ratio [IRR]: 0.992; P<0.001) and severity (odds ratio [OR]: 0.985; P=0.001) of OFF episodes. Income of <$35,000 was associated with 15.1% more episodes/day (IRR: 1.15, p<0.001) and 66.5% higher odds of a severe episode (OR: 1.66; P<0.001). Females experienced 7.5% more episodes compared to males (IRR: 1.075; P=0.003). Longer PD duration was associated with 1.3% more episodes/day (IRR: 1.013; P<0.001) and 10% higher odds of a severe episode (OR: 1.10; P<0.001). Conclusions Lower age, income <$35,000, longer PD duration, female gender, and being unemployed are associated with a higher frequency and severity of OFF periods with no associations for duration/episode among non-Hispanic Whites with PD. In time-constrained clinic environments, clinicians should tailor OFF periods management counseling to vulnerable demographic groups to enhance care delivery.(J Patient Cent Res Rev. 2024;11:8-17.).
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Affiliation(s)
- Radhika Devraj
- Department of Pharmaceutical Sciences, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL
| | - Ahmad Elkouzi
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL
| | - Marlon R. Tracey
- Department of Economics and Finance, Southern Illinois University Edwardsville School of Business, Edwardsville, IL
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Pahwa R, Pagan FL, Kremens DE, Saint-Hilaire M. Clinical Use of On-Demand Therapies for Patients with Parkinson's Disease and OFF Periods. Neurol Ther 2023; 12:1033-1049. [PMID: 37221354 PMCID: PMC10310675 DOI: 10.1007/s40120-023-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
On-demand therapies for Parkinson's disease (PD) provide rapid, reliable relief for patients experiencing OFF periods; however, practical guidelines on the use of these therapies are not generally available. This paper reviews the use of on-demand treatments. Motor fluctuations occur in nearly all patients with PD after long-term use of levodopa. As the goal of PD treatment is to provide good ON time, on-demand treatments that have a more rapid reliable onset than the slower-acting oral medications provide rapid relief for OFF periods. All current on-demand treatments bypass the gastrointestinal tract, providing dopaminergic therapy directly into the blood stream by subcutaneous injection, through the buccal mucosa, or by inhalation into the pulmonary circulation. On-demand treatments are fast acting (10- to 20-min onset), with maximum, reliable, and significant responses reached within 30 min after administration. Oral medications pass through the gastrointestinal tract and thus have slower absorption owing to gastroparesis and competition with food. On-demand therapies, by providing fast-acting relief, can have a positive impact on a patient's quality of life when patients are experiencing OFF periods.
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Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd, Mailstop 2012, Kansas City, KS, 66160, USA.
| | - Fernando L Pagan
- Department of Neurology, Georgetown University Hospital, Washington, DC, USA
| | - Daniel E Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University School of Medicine, Boston, MA, USA
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Ramesh V, Bilal E. Detecting motor symptom fluctuations in Parkinson's disease with generative adversarial networks. NPJ Digit Med 2022; 5:138. [PMID: 36085350 PMCID: PMC9463161 DOI: 10.1038/s41746-022-00674-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
Parkinson's disease is a neurodegenerative disorder characterized by several motor symptoms that develop gradually: tremor, bradykinesia, limb rigidity, and gait and balance problems. While there is no cure, levodopa therapy has been shown to mitigate symptoms. A patient on levodopa experiences cycles in the severity of their symptoms, characterized by an ON state-when the drug is active-and an OFF state-when symptoms worsen as the drug wears off. The longitudinal progression of the disease is monitored using episodic assessments performed by trained physicians in the clinic, such as the Unified Parkinson's Disease Rating Scale (UPDRS). Lately, there has been an effort in the field to develop continuous, objective measures of motor symptoms based on wearable sensors and other remote monitoring devices. In this work, we present an effort towards such a solution that uses a single wearable inertial sensor to automatically assess the postural instability and gait disorder (PIGD) of a Parkinson's disease patient. Sensor data was collected from two independent studies of subjects performing the UPDRS test and then used to train and validate a convolutional neural network model. Given the typical limited size of such studies we also employed the use of generative adversarial networks to improve the performance of deep-learning models that usually require larger amounts of data for training. We show that for a 2-min walk test, our method's predicted PIGD scores can be used to identify a patient's ON/OFF states better than a physician evaluated on the same criteria. This result paves the way for more reliable, continuous tracking of Parkinson's disease symptoms.
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Affiliation(s)
- Vishwajith Ramesh
- Department of Biomedical Informatics, University of California, San Diego, CA, USA.
| | - Erhan Bilal
- T.J. Watson Research Center, IBM Research, Yorktown Heights, NY, USA
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Isaacson SH, Pagan FL, Lew MF, Pahwa R. Should “on-demand” treatments for Parkinson’s disease OFF episodes be used earlier? Clin Park Relat Disord 2022; 7:100161. [PMID: 36033905 PMCID: PMC9405081 DOI: 10.1016/j.prdoa.2022.100161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 02/07/2023] Open
Abstract
OFF episodes are common in patients as Parkinson’s disease progresses. OFF episodes are typically managed with “ON-extenders” and changes in levodopa dosing. OFF episodes persist despite conventional treatment. “On-demand” therapies can rapidly improve OFF symptoms. A shift to earlier complementary use of “on-demand” therapies should be considered.
We discuss a shift in the treatment paradigm for OFF episode management in patients with Parkinson’s disease, based on clinical experience in the United States (US). Three “on-demand” treatments are currently available in the US as follows: subcutaneous apomorphine, levodopa inhalation powder, and sublingual apomorphine. We empirically propose that “on-demand” treatments can be utilized as a complementary treatment when OFF episodes emerge and can be utilized when needed rather than reserving these treatments only until other treatment approaches (adjustment of baseline treatment and/or addition of adjunctive treatment with “ON-extenders”) have failed. Current treatment approaches combine “ON-extenders” with increasing levodopa dosing and/or frequency to treat OFF episodes. Yet, OFF episodes often persist, with a substantial amount of daily OFF time. OFF episode treatment is hindered by variable gastrointestinal (GI) absorption of oral levodopa, reflecting GI dysmotility and protein competition. Novel “on-demand” treatments bypass the gut and can improve OFF symptoms more rapidly and reliably than oral levodopa. With the emergence of novel “on-demand” treatments, we conclude that a shift in treatment paradigm to the earlier, complementary use of these medications be considered.
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Chahine LM, Edison B, Daeschler M, Siddiqi B, Kopil C, Marras C, Mantri S. Use of Figurative Language by People With Parkinson Disease to Describe "Off" Periods: Clear as Mud. Neurol Clin Pract 2021; 11:e462-e471. [PMID: 34476127 PMCID: PMC8382437 DOI: 10.1212/cpj.0000000000001059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Abstract
Objective “Off” periods are characterized by the reemergence of motor and nonmotor symptoms in individuals with Parkinson disease (PD) and often negatively affect daily functioning. Individuals' experiences are diverse and may be difficult to articulate; figurative language is often used by patients to describe such experiences. Our objective was to understand how individuals with PD use figurative language to explain off periods and how experts interpret such expressions. Methods Individuals with self-reported PD participating in the online Fox Insight study were invited to participate in a survey about off periods. Those endorsing off periods were asked to describe their experiences with open-ended free-text responses. Instances where any type of figurative language was used were identified and classified into themes. Three movement disorder neurologists reviewed each phrase and specified what symptoms they felt were likely represented. Results A total of 109 instances of figurative language phrases were identified across descriptions from 86 patients. Allusions to viscous materials (e.g., mud and cement) and effects of chemicals (e.g., drunkenness) were common (18.35% and 17.43% of phrases, respectively). Most phrases were interpreted by the neurologists as representing motor symptoms, but neurologists agreed on what specific symptom was being referred to for only 42 (38.5%) phrases. Conclusions To describe off periods, individuals with PD use various forms of figurative language, but this language is not uniformly interpreted and understood by specialists. Given the subjective interpretation of figurative language, exploring what patients are trying to convey when they use such language is important and could improve patient-physician communication.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Briana Edison
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Margaret Daeschler
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Bernadette Siddiqi
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Catherine Kopil
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Connie Marras
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Sneha Mantri
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
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Rastgardani T, Armstrong MJ, Gagliardi AR, Grabovsky A, Marras C. Experience and Impact of OFF Periods in Parkinson's Disease: A Survey of Physicians, Patients, and Carepartners. JOURNAL OF PARKINSONS DISEASE 2021; 10:315-324. [PMID: 31815702 DOI: 10.3233/jpd-191785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND OFF periods impair quality of life in Parkinson's disease but the nature and degree of this impact is largely unquantified. Optimal treatment relies on assessing the experience and impact of these periods on patients and their carepartners. OBJECTIVES To understand the experience and impact of OFF periods on their lives. METHODS Informed by qualitative interviews we designed questionnaires and surveyed neurologists, people with Parkinson's disease and carepartners. RESULTS 50 general neurologists, 50 movement disorder neurologists, 442 patients (median disease duration 5 years) and 97 carepartners were included. The most common OFF symptoms reported by patients and carepartners were stiffness, slowness of movement and changes in gait. Non-motor symptoms were less common. A higher proportion of carepartners reported each symptom. A minority of neurologists recognized pain, sweating and anxiety as possible symptoms of OFF periods. The three OFF symptoms most frequently designated as having great impact by people with Parkinson's disease were changes in gait, slowness and stiffness. In contrast, cognitive impairment was most frequently rated as having great impact on carepartners. OFF periods were reported to impact many aspects of the lives of both patients and carepartners. CONCLUSIONS In people with Parkinson's disease of under 10 years duration, motor symptoms of OFF periods predominate in impact, however cognitive impairment has great impact on carepartners. Education is needed for neurologists regarding the non-motor aspects of OFF. The importance of involving carepartners in the assessment regarding OFF periods is supported by the higher frequency of symptom reporting by carepartners, and the significant impact on their lives.
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Affiliation(s)
- Tara Rastgardani
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, ON, Canada
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Connie Marras
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, ON, Canada
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Bhidayasiri R, Boonmongkol T, Thongchuam Y, Phumphid S, Kantachadvanich N, Panyakaew P, Jagota P, Plengsri R, Chokpatcharavate M, Phokaewvarangkul O. Impact of disease stage and age at Parkinson's onset on patients' primary concerns: Insights for targeted management. PLoS One 2020; 15:e0243051. [PMID: 33264321 PMCID: PMC7710032 DOI: 10.1371/journal.pone.0243051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/15/2020] [Indexed: 12/05/2022] Open
Abstract
Background The concerns of people with Parkinson’s disease (PD) about their disease are often different from the objective clinical picture and subject to various influencing factors, including disease progression. Currently our understanding of these concerns is limited, particularly in Asian countries. Methods A 50-item survey on Parkinson’s Disease Patients’ Concerns (PDPC Survey) was developed by a multidisciplinary care team. The subjective greatest concerns (most commonly concerning symptoms) of patients at a specialist centre in Bangkok, Thailand, were explored and categorised according to disease stage and age at onset of PD. Results Data for 222 patients showed concerns varied widely. Motor symptoms giving the greatest concern were problems with walking and/or balance (40.5% of patients), while the most commonly concerning non-motor symptom (NMS) was constipation (41.0%). Patterns were observed amongst different patient subgroups. Early PD patients (H&Y stage 1) were more concerned about NMS than motor symptoms, while the reverse was true for advanced PD patients. Young-onset PD patients showed significantly greater concerns than typical-onset patients about motor symptoms relating to social functioning, working and stigmatisation, such as speech (p = 0.003). Conclusions This study, in an Asian patient cohort, provides an assessment of a wide range of PD patients’ concerns, encompassing not only motor symptoms and NMS, but also treatment-related adverse events, care in the advanced stage, and the need for assistive devices. Identifying the concerns of individual PD patients and implementing a patient-centred approach to care is critical to their wellbeing and optimal outcomes. The PDPC survey can help healthcare teams build a more accurate picture of patients’ experiences to inform clinical management.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
- * E-mail:
| | - Thanatat Boonmongkol
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Yuwadee Thongchuam
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nitinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Rachaneewan Plengsri
- Chulalongkorn Parkinson Patients' Support Group, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Bangkok, Thailand
| | - Marisa Chokpatcharavate
- Chulalongkorn Parkinson Patients' Support Group, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Bhidayasiri R, Mari Z. Digital phenotyping in Parkinson's disease: Empowering neurologists for measurement-based care. Parkinsonism Relat Disord 2020; 80:35-40. [DOI: 10.1016/j.parkreldis.2020.08.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
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Wan Y, Yuan C, Hou X, Chen W, Wang C, Gao S, Wang Y, Jin L, Liu Z. Wearing-off Identification in Parkinson's Disease: The shapd-woq Study. Front Neurol 2020; 11:116. [PMID: 32231634 PMCID: PMC7083219 DOI: 10.3389/fneur.2020.00116] [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: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To clarify the frequency of wearing-off phenomenon (WO) and the validity of the Chinese version of the 9-item wearing-off questionnaire (CWOQ-9) in WO identification in this large population. Methods: Parkinson's patients treated with antiparkinsonian medications were consecutively recruited into this observational, cross-sectional investigation. Patients completed the CWOQ-9 prior to the independent clinician assessment. Results: A total of 1,385 patients were included in the analysis. The mean age was 69.7 ± 9.5 years and the mean disease duration was 5.8 ± 4.7 years. Clinicians identified WO in 763 patients, with an overall prevalence of 55.1%. In patients within 1 year of disease duration, clinicians diagnosed WO in eight patients, with a percentage of 12.9%. With the disease progression, the WO frequency gradually increased to 76.2% in patients with 10-15 years of disease duration. Then, it slowly decreased at a longer disease duration. The occurrence of WO was closely associated with the disease duration, H&Y staging, and levodopa daily dose. CWOQ-9 identified 1,071 patients (1071/1398, 77.33%) that had WO-related symptoms. The mean CWOQ-9 score was 3.4 ± 1.6. CWOQ-9 corresponded with clinician assessments of WO in 734 of 763 cases; clinicians disagreed with the CWOQ-9 considering the presence of WO in 337 of 1,071 cases. The sensitivity and specificity of CWOQ-9 were 96.2 and 45.8%, respectively. Conclusions: WO occurred frequently at the early and middle stage of PD. CWOQ-9 was qualified as a pre-visiting screening tool for clinicians to better identify WO.
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Affiliation(s)
- Ying Wan
- Department of Neurology, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China
| | - Canxing Yuan
- Department of Neurology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojun Hou
- Department of Neurology, The Second Military Medical University Affiliated Changhai Hospital, Shanghai, China
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ChunYan Wang
- Department of Neurology, Shanghai Yangpu Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Shan Gao
- Department of Neurology, Shanghai JiaoTong University Affiliated the Sixth People Hospital, Shanghai, China
| | - Yuhui Wang
- Department of Neurology, Shanghai Punan Hospital, Shanghai, China
| | - Lingjing Jin
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China
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Chahine LM, Edison B, Daeschler M, Mantri S, Kahl S, Rapoport R, Goyle A, Precht C, Kopil C, Marras C. The Most Bothersome Aspects of Off Periods Reported by Individuals with Parkinson's Disease. Mov Disord Clin Pract 2020; 7:284-292. [PMID: 32258226 DOI: 10.1002/mdc3.12915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction The off periods in Parkinson's disease have a significantly negative impact on quality of life. What the most bothersome aspects of off periods are from the patient's perspective are not well studied, nor is the degree to which screening tools for wearing off such as the Wearing Off Questionnaires (WOQs) capture what bothers patients most. Methods A questionnaire was deployed to eligible participants of Fox Insight, an online study of individuals with self-reported Parkinson's disease. Inclusion criteria were the use of ≥1 dopaminergic medications and an affirmative response to a question on experiencing off periods. Participants provided free-text responses regarding the top 3 most bothersome symptoms they experience when off. A determination was made regarding whether each response would have been captured by the 32-item, 19-item, and 9-item WOQs. Results The final sample had 2106 participants, a mean age of 66.6 years, 52.3% were men, and had a disease duration of 4.9 years. The WOQ-32 items covered all of the most bothersome symptoms for 53.2% of respondents. Among bothersome aspects of off not captured by the WOQs, 597 (66.2%) were specific symptoms, with freezing of gait, apathy, and memory problems being the most common. The functional consequences of off periods were most bothersome to 232 (25.7%), with walking problems being the most common. The emotional response to off periods was the most bothersome aspect to 169 respondents (18.7%). Discussion This study emphasizes the value of narrative data in understanding patient experiences, and what bothers patients most about off periods. The WOQs, although of established utility in the screening for wearing off, may not capture those symptoms most bothersome to patients.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Briana Edison
- Graduate School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | | | - Sneha Mantri
- Department of Neurology Duke University Durham North Carolina USA
| | - Steven Kahl
- Tuck School of Business Dartmouth College Dartmouth New Hampshire USA
| | | | | | | | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research New York New York USA
| | - Connie Marras
- Department of Neurology University of Toronto Ontario Canada
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