A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis

London Metropolitan University, Londinium, England, United Kingdom
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 6.81). 06/2007; 78(5):465-9. DOI: 10.1136/jnnp.2006.098327
Source: PubMed


The issue of when to start treatment in Parkinson's disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a "wait and watch" policy. The effect of the latter policy on the self reported health status of people with PD is unknown.
To record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up.
A multicentre, prospective, "real life" observational audit based study addressing patient reported outcomes in relation to self reported health status and other sociodemographic details.
198 untreated PD were assessed over a mean period of 18 months. During two follow-up assessments, the self reported health status scores in all eight domains of the PDQ-39 and the overall PDQ-39 summary index worsened significantly (p<0.01) in patients left untreated. In a comparative group in whom treatment was initiated at or soon after diagnosis, there was a trend towards improvement in self reported health status scores after treatment was started.
This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.

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Available from: Kallol Ray Chaudhuri, Sep 30, 2015
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    • "Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease and estimated to affect about 1-2% of the population over 65 years [1]. Early treatment of emerging symptoms is nowadays widely recommended, since PD patients left untreated at diagnosis show a significant worsening in their health related quality of life in comparison to those patients in whom treatment is initiated at or soon after diagnosis [2]. Furthermore, it has been proposed that early treatment of PD may be associated with a correction of basal ganglia functional abnormalities caused by dopaminergic cell loss and dopamine deficiency and could therefore support intrinsic physiological compensatory mechanisms during the course of the disease [3]. "
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    ABSTRACT: Early initiation of pharmacotherapy in Parkinson's disease (PD) is nowadays widely advocated by experts since the delay of treatment has shown to be associated with a significant deterioration of health related quality of life in affected patients. Due to marked advances in PD treatment during the last decades, physicians are nowadays fortunately equipped with a variety of substances that can effectively ameliorate emerging motor symptoms of the disease, among them levodopa, dopamine agonists and monoamine oxidase type B (MAO-B) inhibitors. Despite numerous drug intervention trials in early PD, there is however still ongoing controversy among neurologists which substance to use for the initial treatment of the disease. In multiple studies, MAO-B inhibitors, such as selegiline and rasagiline, have shown to provide mild symptomatic effects, delay the need for levodopa, and to reduce the incidence of motor fluctuations. Although their symptomatic efficacy is inferior compared to dopamine agonists and levodopa, MAO-B inhibitors undoubtedly have fewer side effects and are easy to administer. In contrary to their competitors, MAO-B inhibitors may furthermore offer a chance for disease modification, which so far remains a major unmet need in the management of PD and eventually makes them ideal candidates for the early treatment of the disease. MAO-B inhibitors may constitute a preferable therapeutic option for early PD, mainly due to their favourable safety profile and their putative neuroprotective capabilities. Since the symptomatic effects of MAO-B inhibitors are comparatively mild, dopamine agonists and levodopa should however be considered for initial treatment in those PD patients, in whom robust and immediate symptomatic relief needs to be prioritized.
    BMC Neurology 09/2011; 11(1):112. DOI:10.1186/1471-2377-11-112 · 2.04 Impact Factor
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    • "Mean age at first recorded purchase was 69 for both prevalent and incident cases, higher than the range 58–63 often reported in studies as age at onset/diagnosis [6], but in accordance with several population-based studies that reported age at onset between 66 and 71 [6, 24, 29–31]. Evidently, age at first medication purchase is a proxy of diagnosis age rather than onset of symptoms, and also includes a lagtime to treatment initiation, which may be longer than one year [24] [32]. The high age may also result from over-representation of patients with treatment initiation at older age, although we tried to minimize this bias by excluding cases with first purchase at 85 years of age or later, when diagnosis is very challenging and empiric treatment is common [16]. "
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    ABSTRACT: Estimating rates of Parkinson's disease (PD) is essential for health services planning and studies of disease determinants. However, few PD registries exist. We aimed to estimate annual prevalence and incidence of PD in a large Israeli population over the past decade using computerized drug purchase data. Based on profiles of anti-parkinsonian drugs, age at first purchase, purchase density, and follow-up time, we developed a refined algorithm for PD assessment (definite, probable or possible) and validated it against clinical diagnoses. We used the prescription database of the second largest Health Maintenance Organization in Israel (covers ~25% of population), for the years 1998-2008. PD rates by age, gender and year were calculated and compared using Poisson models. The algorithm was found to be highly sensitive (96%) for detecting PD cases. We identified 7,134 prevalent cases (67% definite/probable), and 5,288 incident cases (65% definite/probable), with mean age at first purchase 69 ± 13 years. Over the years 2000-2007, PD incidence rate of 33/100,000 was stable, and the prevalence rate increased from 170/100,000 to 256/100,000. For ages 50+, 60+, 70+, median prevalence rates were 1%, 2%, 3%, respectively. Incidence rates also increased with age (RR = 1.76, 95%CI 1.75-1.77, ages 50+, 5-year interval). For ages 50+, rates were higher among men for both prevalence (RR = 1.38, 95%CI 1.37-1.39) and incidence (RR = 1.45, 95%CI 1.42-1.48). In conclusion, our refined algorithm for PD assessment, based on computerized drug purchases data, may be a reliable tool for population-based studies. The findings indicate a burden of PD in Israel higher than previously assumed.
    01/2011; 1(1-1):35-47. DOI:10.3233/JPD-2011-11024
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    ABSTRACT: This paper presents the results of a novel digital signal processor (DSP) based technique for signal conditioning of Linear Variable Differential Transformers (LYDTs). Signal conditioning is achieved through a modified DSP-based Costas receiver. This system is tested and compared with two commercially available analog signal conditioners and a second DSP-based signal conditioner. The system developed by the authors has better dynamic response than existing solutions and better noise rejection than commercially available solutions. Static testing of the system using both 4-wire and 5-wire LYDTs verifies that the conditioner meets or exceeds the linearity performance of existing signal conditioning systems over the full-scale operating range. In addition, this system requires no phase compensation network or manual tuning
    Instrumentation and Measurement Technology Conference, 2000. IMTC 2000. Proceedings of the 17th IEEE; 02/2000
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