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Renno-Busch S, Hildesheim H, van Uem JMT, Sünkel U, Röben B, Brockmann K, Mychajliw C, Eschweiler GW, Berg D, Maetzler W. Autonomic Symptoms in Older Adults Are Common and Associated With Health-Related Quality of Life. Front Neurol 2021; 12:757748. [PMID: 34887829 PMCID: PMC8649956 DOI: 10.3389/fneur.2021.757748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Autonomic symptoms are common in older adults, and a large body of literature focusing on age-related diseases shows that autonomic symptoms in these diseases constrain Health-Related Quality of Life (HRQoL). To our best knowledge, the association between autonomic symptoms in older adults, independent of specific diseases, and HRQoL has not yet been assessed. Aim: To assess the frequency and the effect of autonomic symptoms in general, as well as orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms, on HRQoL in older adults. Methods: Cross-sectional data of the fourth visit of the Tübinger evaluation of Risk factors for Early detection of Neurodegeneration (TREND) study were included. Autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 (COMPASS 31), were quantified and compared with HRQoL, as assessed with the EuroQol five-level version (EQ-5D-5L). Statistical analyses included Spearman's rank correlation and multiple linear regression analysis. Results: The analysis included 928 participants with a median of 68 years; 47% were women. Of those, 85% reported at least one autonomic symptom. Gastrointestinal and secretomotor symptoms were most common. The COMPASS 31 total score and all subdomains were significantly associated with reduced HRQoL. Among the subdomains, the strongest correlations with HRQoL were found for gastrointestinal and bladder symptoms. Overall, autonomic symptoms alone explained 20% of the variance of HRQoL; when depressive mood was added, the model explained 32%. Conclusion: Autonomic symptoms are associated with HRQoL and depressive symptoms in older adults.
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Affiliation(s)
- Sarah Renno-Busch
- Center for Neurology, Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hanna Hildesheim
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | | | - Ulrike Sünkel
- Center for Neurology, Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Benjamin Röben
- Center for Neurology, Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Center for Neurology, Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christian Mychajliw
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Gerhard W. Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Center for Neurology, Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Walter Maetzler
- Center for Neurology, Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
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Maetzler W, Rochester L, Bhidayasiri R, Espay AJ, Sánchez-Ferro A, van Uem JMT. Modernizing Daily Function Assessment in Parkinson's Disease Using Capacity, Perception, and Performance Measures. Mov Disord 2020; 36:76-82. [PMID: 33191498 DOI: 10.1002/mds.28377] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022] Open
Abstract
Many disease symptoms restrict the quality of life of the affected. This usually occurs indirectly, at least in most neurological diseases. Here, impaired daily function is interposed between the symptoms and the reduced quality of life. This is reflected in the International Classification of Function, Disability and Health model published by the World Health Organization in 2001. This correlation between symptom, daily function, and quality of life makes it clear that to evaluate the success of a therapy and develop new therapies, daily function must also be evaluated as accurately as possible. However, daily function is a complex construct and therefore difficult to quantify. To date, daily function has been measured primarily by capacity (clinical assessments) and perception (surveys and patient-reported outcomes) assessment approaches. Now, daily function can be captured in a new dimension, that is, performance, through new digital technologies that can be used in the home environment of patients. This viewpoint discusses the differences and interdependencies of capacity, perception, and performance assessment types using the example of Parkinson's disease. Options regarding how future study protocols should be designed to get the most comprehensive and validated picture of daily function in patients are presented. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Walter Maetzler
- Department of Neurology, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Alberto J Espay
- Department of Neurology, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Janet M T van Uem
- Department of Neurology, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
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Haertner L, Elshehabi M, Zaunbrecher L, Pham MH, Maetzler C, van Uem JMT, Hobert MA, Hucker S, Nussbaum S, Berg D, Liepelt-Scarfone I, Maetzler W. Effect of Fear of Falling on Turning Performance in Parkinson's Disease in the Lab and at Home. Front Aging Neurosci 2018; 10:78. [PMID: 29636676 PMCID: PMC5880950 DOI: 10.3389/fnagi.2018.00078] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/08/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Parkinson’s disease (PD) is a neurodegenerative movement disorder associated with gait and balance problems and a substantially increased risk of falling. Falls occur often during complex movements, such as turns. Both fear of falling (FOF) and previous falls are relevant risk factors for future falls. Based on recent studies indicating that lab-based and home assessment of similar movements show different results, we hypothesized that FOF and a positive fall history would influence the quantitative turning parameters differently in the laboratory and home. Methods: Fifty-five PD patients (43 underwent a standardized lab assessment; 40 were assessed over a mean of 12 days at home with approximately 10,000 turns per participant; and 28 contributed to both assessments) were classified regarding FOF and previous falls as “vigorous” (no FOF, negative fall history), “anxious” (FOF, negative fall history), “stoic” (no FOF, positive fall history) and “aware” (FOF, positive fall history). During the assessments, each participant wore a sensor on the lower back. Results: In the lab assessment, FOF was associated with a longer turning duration and lowered maximum and middle angular velocities of turns. In the home evaluations, a lack of FOF was associated with lowered maximum and average angular velocities of turns. Positive falls history was not significantly associated with turning parameters, neither in the lab nor in the home. Conclusion: FOF but not a positive fall history influences turning metrics in PD patients in both supervised and unsupervised environments, and this association is different between lab and home assessments. Our findings underline the relevance of comprehensive assessments including home-based data collection strategies for fall risk evaluation.
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Affiliation(s)
- Linda Haertner
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Morad Elshehabi
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Laura Zaunbrecher
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Minh H Pham
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Corina Maetzler
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Janet M T van Uem
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Markus A Hobert
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Svenja Hucker
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Susanne Nussbaum
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Daniela Berg
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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van Uem JMT, Isaacs T, Lewin A, Bresolin E, Salkovic D, Espay AJ, Matthews H, Maetzler W. A Viewpoint on Wearable Technology-Enabled Measurement of Wellbeing and Health-Related Quality of Life in Parkinson's Disease. J Parkinsons Dis 2017; 6:279-87. [PMID: 27003779 PMCID: PMC4927928 DOI: 10.3233/jpd-150740] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this viewpoint, we discuss how several aspects of Parkinson’s disease (PD) – known to be correlated with wellbeing and health-related quality of life–could be measured using wearable devices (‘wearables’). Moreover, three people with PD (PwP) having exhaustive experience with using such devices write about their personal understanding of wellbeing and health-related quality of life, building a bridge between the true needs defined by PwP and the available methods of data collection. Rapidly evolving new technologies develop wearables that probe function and behaviour in domestic environments of people with chronic conditions such as PD and have the potential to serve their needs. Gathered data can serve to inform patient-driven management changes, enabling greater control by PwP and enhancing likelihood of improvements in wellbeing and health-related quality of life. Data can also be used to quantify wellbeing and health-related quality of life. Additionally these techniques can uncover novel more sensitive and more ecologically valid disease-related endpoints. Active involvement of PwP in data collection and interpretation stands to provide personally and clinically meaningful endpoints and milestones to inform advances in research and relevance of translational efforts in PD.
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Affiliation(s)
- Janet M T van Uem
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | | | | | - Dina Salkovic
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Alberto J Espay
- Gardner Center for Parkinson's disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
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Bettecken K, Bernhard F, Sartor J, Hobert MA, Hofmann M, Gladow T, van Uem JMT, Liepelt-Scarfone I, Maetzler W. No relevant association of kinematic gait parameters with Health-related Quality of Life in Parkinson's disease. PLoS One 2017; 12:e0176816. [PMID: 28531171 PMCID: PMC5439666 DOI: 10.1371/journal.pone.0176816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 04/18/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Health-related Quality of Life (HrQoL) is probably the most important outcome parameter for the evaluation and management of chronic diseases. As this parameter is subjective and prone to bias, there is an urgent need to identify objective surrogate markers. Gait velocity has been shown to be associated with HrQoL in numerous chronic diseases, such as Parkinson's disease (PD). With the development and wide availability of simple-to-use wearable sensors and sophisticated gait algorithms, kinematic gait parameters may soon be implemented in clinical routine management. However, the association of such kinematic gait parameters with HrQoL in PD has not been assessed to date. METHODS Kinematic gait parameters from a 20-meter walk from 43 PD patients were extracted using a validated wearable sensor system. They were compared with the Visual Analogue Scale of the Euro-Qol-5D (EQ-5D VAS) by performing a multiple regression analysis, with the International Classification of Functioning, Disability and Health (ICF) model as a framework. RESULTS Use of assistive gait equipment, but no kinematic gait parameter, was significantly associated with HrQoL. CONCLUSION The widely accepted concept of a positive association between gait velocity and HrQoL may, at least in PD, be driven by relatively independent parameters, such as assistive gait equipment.
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Affiliation(s)
- Kristina Bettecken
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Felix Bernhard
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | - Till Gladow
- Hasomed, Magdeburg, Germany
- Institute for Physiotherapy, Department of Clinical Research, Jena University Hospital, Jena, Germany
| | - Janet M. T. van Uem
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Inga Liepelt-Scarfone
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
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van Uem JMT, Maier KS, Hucker S, Scheck O, Hobert MA, Santos AT, Fagerbakke Ø, Larsen F, Ferreira JJ, Maetzler W. Twelve-week sensor assessment in Parkinson's disease: Impact on quality of life. Mov Disord 2016; 31:1337-8. [PMID: 27241524 DOI: 10.1002/mds.26676] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Janet M T van Uem
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Katrin S Maier
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Svenja Hucker
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Olga Scheck
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Markus A Hobert
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Ana Teresa Santos
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Frank Larsen
- Norwegian Centre for Telemedicine, Tromsø, Norway
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany.
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