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Bailo G, Saibene FL, Bandini V, Arcuri P, Salvatore A, Meloni M, Castagna A, Navarro J, Lencioni T, Ferrarin M, Carpinella I. Characterization of Walking in Mild Parkinson's Disease: Reliability, Validity and Discriminant Ability of the Six-Minute Walk Test Instrumented with a Single Inertial Sensor. SENSORS (BASEL, SWITZERLAND) 2024; 24:662. [PMID: 38276354 PMCID: PMC10821195 DOI: 10.3390/s24020662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Although the 6-Minute Walk Test (6MWT) is among the recommended clinical tools to assess gait impairments in individuals with Parkinson's disease (PD), its standard clinical outcome consists only of the distance walked in 6 min. Integrating a single Inertial Measurement Unit (IMU) could provide additional quantitative and objective information about gait quality complementing standard clinical outcome. This study aims to evaluate the test-retest reliability, validity and discriminant ability of gait parameters obtained by a single IMU during the 6MWT in subjects with mild PD. Twenty-two people with mild PD and ten healthy persons performed the 6MWT wearing an IMU placed on the lower trunk. Features belonging to rhythm and pace, variability, regularity, jerkiness, intensity, dynamic instability and symmetry domains were computed. Test-retest reliability was evaluated through the Intraclass Correlation Coefficient (ICC), while concurrent validity was determined by Spearman's coefficient. Mann-Whitney U test and the Area Under the receiver operating characteristic Curve (AUC) were then applied to assess the discriminant ability of reliable and valid parameters. Results showed an overall high reliability (ICC ≥ 0.75) and multiple significant correlations with clinical scales in all domains. Several features exhibited significant alterations compared to healthy controls. Our findings suggested that the 6MWT instrumented with a single IMU can provide reliable and valid information about gait features in individuals with PD. This offers objective details about gait quality and the possibility of being integrated into clinical evaluations to better define walking rehabilitation strategies in a quick and easy way.
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Affiliation(s)
- Gaia Bailo
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Francesca Lea Saibene
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Virginia Bandini
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Pietro Arcuri
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Anna Salvatore
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Mario Meloni
- Neurology Unit, Azienda Ospedaliero-Universitaria, 09123 Cagliari, Italy;
| | - Anna Castagna
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Jorge Navarro
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
| | - Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (G.B.); (F.L.S.); (V.B.); (P.A.); (A.S.); (A.C.); (J.N.); (T.L.); (I.C.)
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Maetzler W, Correia Guedes L, Emmert KN, Kudelka J, Hildesheim HL, Paulides E, Connolly H, Davies K, Dilda V, Ahmaniemi T, Avedano L, Bouça-Machado R, Chambers M, Chatterjee M, Gallagher P, Graeber J, Maetzler C, Kaduszkiewicz H, Kennedy N, Macrae V, Carrasco Marin L, Moses A, Padovani A, Pilotto A, Ratcliffe N, Reilmann R, Rosario M, Schreiber S, De Sousa D, Van Gassen G, Warring LA, Seppi K, van der Woude CJ, Ferreira JJ, Ng WF. Fatigue-Related Changes of Daily Function: Most Promising Measures for the Digital Age. Digit Biomark 2024; 8:30-39. [PMID: 38510264 PMCID: PMC10954320 DOI: 10.1159/000536568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024] Open
Abstract
Background Fatigue is a prominent symptom in many diseases and is strongly associated with impaired daily function. The measurement of daily function is currently almost always done with questionnaires, which are subjective and imprecise. With the recent advances of digital wearable technologies, novel approaches to evaluate daily function quantitatively and objectively in real-life conditions are increasingly possible. This also creates new possibilities to measure fatigue-related changes of daily function using such technologies. Summary This review examines which digitally assessable parameters in immune-mediated inflammatory and neurodegenerative diseases may have the greatest potential to reflect fatigue-related changes of daily function. Key Messages Results of a standardized analysis of the literature reporting about perception-, capacity-, and performance-evaluating assessment tools indicate that changes of the following parameters: physical activity, independence of daily living, social participation, working life, mental status, cognitive and aerobic capacity, and supervised and unsupervised mobility performance have the highest potential to reflect fatigue-related changes of daily function. These parameters thus hold the greatest potential for quantitatively measuring fatigue in representative diseases in real-life conditions, e.g., with digital wearable technologies. Furthermore, to the best of our knowledge, this is a new approach to analysing evidence for the design of performance-based digital assessment protocols in human research, which may stimulate further systematic research in this area.
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Affiliation(s)
- Walter Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Kirsten Nele Emmert
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Luise Hildesheim
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Emma Paulides
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hayley Connolly
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kristen Davies
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | | | - Luisa Avedano
- European Federation of Crohn’s and Ulcerative Colitis, Brussels, Belgium
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | | | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Johanna Graeber
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Victoria Macrae
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | - Anusha Moses
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
- University of Twente, Department of Medical Cell Biophysics, TechMed Centre, Enschede, The Netherlands
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Ralf Reilmann
- George-Huntington-Institute, R&D-Campus/Technology-Park Münster, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Madalena Rosario
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Dina De Sousa
- European Huntington’s Association, Moerbeke, Belgium
| | | | | | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - C. Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - on behalf of the IDEA-FAST project consortium
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- CHDI Management, CHDI Foundation, Princeton, NJ, USA
- Teknologian tutkimuskeskus VTT Oy, Espoo, Finland
- European Federation of Crohn’s and Ulcerative Colitis, Brussels, Belgium
- MC Healthcare Evaluation, London, UK
- Janssen Research and Development, Cambridge, MA, USA
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
- Asociación Parkinson Madrid, Madrid, Spain
- University of Twente, Department of Medical Cell Biophysics, TechMed Centre, Enschede, The Netherlands
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Parkinson’s UK, London, UK
- George-Huntington-Institute, R&D-Campus/Technology-Park Münster, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
- European Huntington’s Association, Moerbeke, Belgium
- Medical Department, Takeda, Brussels, Belgium
- Janssen LLC, GCSO Immunology, Horsham, PA, USA
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Alberts JL, Kaya RD, Penko AL, Streicher M, Zimmerman EM, Davidson S, Walter BL, Rosenfeldt AB. A Randomized Clinical Trial to Evaluate a Digital Therapeutic to Enhance Gait Function in Individuals With Parkinson's Disease. Neurorehabil Neural Repair 2023; 37:603-616. [PMID: 37465959 DOI: 10.1177/15459683231184190] [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] [Indexed: 07/20/2023]
Abstract
BACKGROUND Postural instability and gait dysfunction (PIGD) is a cardinal symptom of Parkinson's disease (PD) and is exacerbated under dual-task conditions. Dual-task training (DTT), enhances gait performance, however it is time and cost intensive. Digitizing DTT via the Dual-task Augmented Reality Treatment (DART) platform can expand the availability of an effective intervention to address PIGD. OBJECTIVE The aim of this project was to evaluate DART in the treatment of PIGD in people with PD compared to a Traditional DTT intervention. It was hypothesized that both groups would exhibit significant improvements in gait, and the improvements for the DART group would be non-inferior to Traditional DTT. METHODS A single-blind randomized controlled trial was conducted with 47 PD participants with PIGD. Both groups completed 16 therapeutic sessions over 8 weeks; the DART platform delivered DTT via the Microsoft HoloLens2. Primary outcomes included clinical ratings and single- and dual-task gait biomechanical outcomes. RESULTS Clinical measures of PD symptoms remained stable for DART and Traditional DTT groups. However, both groups exhibited a significant increase in gait velocity, cadence, and step length during single- and multiple dual-task conditions following the interventions. Improvements in gait velocity in the DART group were non-inferior to Traditional DTT under the majority of conditions. CONCLUSION Non-inferior improvements in gait parameters across groups provides evidence of the DART platform being an effective digital therapeutic capable of improving PIGD. Effective digital delivery of DTT has the potential to increase use and accessibility to a promising, yet underutilized and difficult to administer, intervention for PIGD. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Dual-task Augmented Reality Treatment for Parkinson's Disease (DART) NCT04634331; posted November 18, 2020.
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Affiliation(s)
- Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Ryan D Kaya
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Matthew Streicher
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Eric M Zimmerman
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Sara Davidson
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Benjamin L Walter
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
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Valent D, Krismer F, Grossauer A, Peball M, Heim B, Mahlknecht P, Djamshidian A, Poewe W, Seppi K. Nomogram to Predict the Probability of Functional Dependence in Early Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:49-55. [PMID: 36530091 PMCID: PMC9912730 DOI: 10.3233/jpd-223501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Early identification of Parkinson's disease (PD) patients at risk for becoming functionally dependent is important for patient counseling. Several models describing the relationship between predictors and outcome have been reported, however, most of these require computer software for practical use. OBJECTIVE Here we report the development of a risk nomogram allowing an approximate graphical computation of the risk of becoming functionally dependent in early PD. METHODS We analyzed data form the Parkinson's Progression Markers Initiative cohort of newly diagnosed PD patients from baseline through the first 5 years of follow-up. Functional dependence was defined as a score < 80 on the Schwab & England Activities of Daily Living scale. A binary logistic model was developed to estimate the risk of functional dependence and based on the results, a nomogram for the prediction of functional dependence was drawn in order to provide an easy-to-use tool in clinical and academic settings as a part of personalized medicine approach to PD treatment. RESULTS At baseline, three patients and over the five-year follow-up, 85 (22%) out of 395 patients were functionally dependent as scored by the Schwab & England Activities of Daily Living rating scale. The binary logistic model showed that clinical parameters such as MDS-UPDRS I (rater part), MDS-UPDRS II, and MDS-UPDRS axial motor score were significant predictors for functional dependence within 5 years. CONCLUSION We here provide an easy-to-use tool to estimate the risk of functional dependence in PD patients based on the MDS-UPDRS part I, II and axial motor score.
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Affiliation(s)
- Dora Valent
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria,Correspondence to: Florian Krismer, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 80932; E-mail: and Klaus Seppi, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 81498; E-mail:
| | - Anna Grossauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria,Correspondence to: Florian Krismer, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 80932; E-mail: and Klaus Seppi, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 81498; E-mail:
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Huang Y, Du S, Chen D, Qin Y, Cui J, Han H, Ge X, Bai W, Zhang X, Yu H. The path linking excessive daytime sleepiness and activity of daily living in Parkinson’s disease: the longitudinal mediation effect of autonomic dysfunction. Neurol Sci 2022; 43:4777-4784. [DOI: 10.1007/s10072-022-06081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Íñiguez Alvarado MC, Feal Panceiras MJ, Suárez Castro E, Canfield H, Martínez Miró C, Jesús S, Aguilar M, Pastor P, Planellas L, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor García-Soto J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, Ariztegui NL, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Martínez JR, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López DíazL LM, McAfee D, Martinez-Martin P, Mir P. Predictors of the change in burden, strain, mood, and quality of life among caregivers of Parkinson's disease patients. Int J Geriatr Psychiatry 2022; 37. [PMID: 35633051 DOI: 10.1002/gps.5761] [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] [Received: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Caregiver burden in Parkinson's disease (PD) has been studied in many cross-sectional studies but poorly in longitudinal ones. The aim of the present study was to analyze the change in burden, strain, mood, and quality of life (QoL) after a 2-year follow-up in a cohort of caregivers of patients with PD and also to identify predictors of these changes. PATIENTS AND METHODS PD patients and their caregivers who were recruited from January/2016 to November/2017 from 35 centers of Spain from the COPPADIS cohort were included in the study. They were evaluated again at 2-year follow-up. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), and EUROHIS-QOL 8-item index (EUROHIS-QOL8) at baseline (V0) and at 2-year follow-up (V2). General linear model repeated measure and lineal regression models were applied. RESULTS Significant changes, indicating an impairment, were detected on the total score of the ZCBI (p < 0.0001), CSI (p < 0.0001), BDI-II (p = 0.024), and EUROHIS-QOL8 (p = 0.002) in 192 PD caregivers (58.82 ± 11.71 years old; 69.3% were females). Mood impairment (BDI-II; β = 0.652; p < 0.0001) in patients from V0 to V2 was the strongest factor associated with caregiver's mood impairment after the 2-year follow-up. Caregiver's mood impairment was the strongest factor associated with an increase from V0 to V2 on the total score of the ZCBI (β = 0.416; p < 0.0001), CSI (β = 0.277; p = 0.001), and EUROHIS-QOL (β = 0.397; p = 0.002). CONCLUSION Burden, strain, mood, and QoL were impaired in caregivers of PD patients after a 2-year follow-up. Mood changes in both the patient and the caregiver are key aspects related to caregiver burden increase.
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Affiliation(s)
| | | | | | | | | | | | - Héctor Canfield
- CHUF, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | | | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Hernández Vara
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Berta Solano Vila
- Institut d'Assistència Sanitària (IAS) - Institut Català de la Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
- Hospital de Sant Pau, Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | | | | | - Darrian McAfee
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
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Becker S, Solbrig S, Michaelis K, Faust B, Brockmann K, Liepelt-Scarfone I. Divergence Between Informant and Self-Ratings of Activities of Daily Living Impairments in Parkinson’s Disease. Front Aging Neurosci 2022; 14:838674. [PMID: 35222002 PMCID: PMC8874137 DOI: 10.3389/fnagi.2022.838674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine the agreement between self- and informant-reported activities of daily living (ADL) deficits in Parkinson’s Disease (PD) patients, and to examine factors influencing ADL ratings.BackgroundIn PD, the loss of functional independence is an important outcome of disease progression. The valid assessment of ADL function in PD is essential, but it is unclear to what extent informants’ and patients’ perceptions of their daily functions concur, and how other factors may influence both ratings.MethodsData of 150 PD patients who underwent cognitive and motor testing, as well as their informants were analyzed. The 10-item Functional Activities Questionnaire (FAQ), completed separately by patients (FAQ-S) and their informants (FAQ-I), assessed ADL function. Weighted κ statistics summarized level of agreement, and a discrepancy score (FAQ-I – FAQ-S) quantified agreement. Correlation analyses between FAQ total scores, patient and informant characteristics, and cognitive scores were conducted, with post hoc regressions to determine the associations between both FAQ scores and cognition, independent of patient characteristics.ResultsThe sample included 87 patients with normal cognition, 50 with mild cognitive impairment, and 13 with dementia. Overall, there was fair to moderate agreement between patients and informants on individual FAQ items (0.27 ≤ κ ≤ 0.61, p < 0.004), with greater discrepancies with increasing cognitive impairment. Patients’ age, motor severity, non-motor burden, and depression also affected both ratings (0.27 ≤ r ≤ 0.50, p < 0.001), with motor severity showing the greatest influence on both ratings. Both the FAQ-I and FAQ-S were correlated with almost all cognitive domains. Post hoc regression analyses controlling for patient characteristics showed that the attention domain was a significant predictor of both the FAQ-S and FAQ-I scores, and memory was also a significant predictor of the FAQ-I score. Only 29.3% of patients agreed perfectly with informants on the FAQ total score, with informants most commonly rating ADL impairments as more severe than patients.ConclusionsPatient and informant ratings of ADL function using FAQ items showed moderate agreement, with only few items reaching substantial agreement. Ratings of both were associated with patient cognitive status, but also other characteristics. In addition to patient and informant reports, objective measures are needed to accurately classify ADL deficits in PD.
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Affiliation(s)
- Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Katja Michaelis
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Bettina Faust
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
- Studienzentrum Stuttgart, IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
- *Correspondence: Inga Liepelt-Scarfone,
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Santos García D, Álvarez Sauco M, Calopa M, Carrillo F, Escamilla Sevilla F, Freire E, García Ramos R, Kulisevsky J, Gómez Esteban JC, Legarda I, Luquín MRI, Castrillo JCM, Martínez-Martin P, Martínez-Torres I, Mir P, Ignacio ÁS. MNCD: A New Tool for Classifying Parkinson’s Disease in Daily Clinical Practice. Diagnostics (Basel) 2021; 12:diagnostics12010055. [PMID: 35054222 PMCID: PMC8774369 DOI: 10.3390/diagnostics12010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective: Parkinson’s disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.
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Affiliation(s)
- Diego Santos García
- Unidad de Trastornos de Movimiento, Servicio de Neurología, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15009 A Coruña, Spain
- Neurología, Hospital San Rafael, 15009 A Coruña, Spain
- Correspondence: ; Tel.: +34-646173341
| | - María Álvarez Sauco
- Departamento de Neurología, Hospital General Universitario de Elche, 03203 Elche, Spain; (M.Á.S.); (E.F.)
| | - Matilde Calopa
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Fátima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (F.C.); (P.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Francisco Escamilla Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria (ibs.Granada), 18013 Granada, Spain;
| | - Eric Freire
- Departamento de Neurología, Hospital General Universitario de Elche, 03203 Elche, Spain; (M.Á.S.); (E.F.)
- Departamento de Neurología, Hospital IMED Elche, 03203 Elche, Spain
| | - Rocío García Ramos
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Jaime Kulisevsky
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
- Departamento de Neurología, Unidad de Trastornos del Movimiento, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | | | - Inés Legarda
- Hospital Universitario Son Espases, 07120 Palma, Spain;
| | - María Rosario Isabel Luquín
- Departamento de Neurología, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain;
| | | | - Pablo Martínez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Irene Martínez-Torres
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario y Politècnico La Fe, 46026 Valencia, Spain;
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (F.C.); (P.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Ángel Sesar Ignacio
- Unidad de Trastornos del Movimiento, Servicio de Neurología, CHUS (Complejo Hospitalario Universitario de Santiago de Compostela), 15706 A Coruña, Spain;
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