Albert F.G. Leentjens

Maastricht University, Maestricht, Limburg, Netherlands

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Publications (133)394.03 Total impact

  • Alexander W Levis · Albert F.G. Leentjens · James L Levenson · Mark A Lumley · Brett D Thombs ·
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    ABSTRACT: Some peer reviewers may inappropriately, or coercively request that authors include references to the reviewers' own work. The objective of this study was to evaluate whether, compared to reviews for a journal with single-blind peer review, reviews for a journal with open peer review included (1) fewer self-citations; (2) a lower proportion of self-citations without a rationale; and (3) a lower ratio of proportions of citations without a rationale in self-citations versus citations to others' work. Peer reviews for published manuscripts submitted in 2012 to a single-blind peer review journal, the Journal of Psychosomatic Research, were previously evaluated (Thombs et al., 2015). These were compared to publically available peer reviews of manuscripts published in 2012 in an open review journal, BMC Psychiatry. Two investigators independently extracted data for both journals. There were no significant differences between journals in the proportion of all reviewer citations that were self-citations (Journal of Psychosomatic Research: 71/225, 32%; BMC Psychiatry: 90/315, 29%; p=.50), or in the proportion of self-citations without a rationale (Journal of Psychosomatic Research: 15/71, 21%; BMC Psychiatry: 12/90, 13%; p=.21). There was no significant difference between journals in the proportion of self-citations versus citations to others' work without a rationale (p=.31). Blind and open peer review methodologies have distinct advantages and disadvantages. The present study found that, in reasonably similar journals that use single-blind and open review, there were no substantive differences in the pattern of peer reviewer self-citations. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 08/2015; DOI:10.1016/j.jpsychores.2015.08.004 · 2.74 Impact Factor
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    ABSTRACT: Introduction: Clinical presentation and progression of cognitive disorders in Parkinson's disease (PD) is heterogeneous. Our objective was to confirm prospectively a previous exploratory cluster analysis based on retrospective data that identified five cognitive phenotypes in PD. Methods: A model-based confirmatory cluster analysis was conducted on the results of neuropsychological tests administered in 156 PD patients from two European movement disorder centers (Lille, n = 81; Maastricht, n = 75). The number of clusters was determined on the basis of statistical criteria as well as clinical plausibility. A factorial discriminant analysis assessed the quality of the clusters' separation. Results: A five-cluster model was statistically superior and clinically the most relevant. These clusters can be described as follows: 1) cognitively intact patients with high level of performance in all cognitive domains (25.64%), 2) cognitively intact patients slightly slower than those in cluster 1 (26.92%), 3) patients with deficits in executive functions (37.18%), 4) patients with severe deficits in all cognitive domains, particularly executive functions (3.20%), 5) patients with severe deficits in all cognitive domains, particularly working memory and recall in verbal episodic memory (7.05%). The groups differed in terms of age, apathy and frequency of hallucinations that were all higher in the clusters with cognitive deficits, and the duration of formal education was lower in those groups. Conclusion: We confirm our previous exploratory analysis. Cognitive disorders in PD patients are heterogeneous and can be separated in five clusters ranging from patients with performance in the normal range to patients with severe disorders in all cognitive domains.
    Parkinsonism & Related Disorders 08/2015; DOI:10.1016/j.parkreldis.2015.08.032 · 3.97 Impact Factor

  • 05/2015; 2(2). DOI:10.1002/mdc3.12130
  • A F G Leentjens · O A van den Heuvel ·
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    ABSTRACT: Psychiatric symptoms are common in Parkinson's disease (PD) and may complicate treatment. To review the prevalence and treatment options of psychiatric symptoms in PD patients and discuss the dilemmas that may arise. Literature review. Psychiatric complaints, including depression, anxiety, apathy, impulse control disorders, hallucina-tions, delusions, sleep disturbances, and cognitive symptoms, frequently occur in PD patients. These symptoms have a great influence on the general functioning and quality of life of the patient. When treating these symptoms, adjusting neurological treatment and starting or adjusting psychotherapeutic or psychopharmacological treatment may be necessary. Even if individual symptoms can often be treated adequately, unwanted side effects in other symptom domains have to be taken into consideration. Adequate treatment of neuropsychiatric symptoms in PD patients is complex, and requires close multidisciplinary collaboration, especially in more advanced disease stages.
    Tijdschrift voor psychiatrie 02/2015; 57(2):136-42.
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    ABSTRACT: Anxiety disorders are highly prevalent in patients with Parkinson's disease (PD) and have a major impact on wellbeing. They nevertheless receive limited scientific attention. This study aimed to establish the symptom dimensions of anxiety in PD, and their relationship with depression, autonomic failure and motor symptoms. In this cross-sectional observational study, symptoms of anxiety were measured with the Beck Anxiety Inventory (BAI) in 294 PD patients. Symptom dimensions of anxiety in PD were explored through principal component analysis (PCA) of BAI items. The relationship between anxiety and depressive, autonomic and motor symptoms was assessed through PCA and regression analyses. Clinically relevant symptoms of anxiety were present in 45% of patients. PCA of the BAI resulted in five subscales, corresponding to a single affective and four somatic symptom dimensions (thermoregulation, hypotension, hyperventilation and trembling) of anxiety. Symptoms of anxiety and depression displayed a large overlap. All somatic BAI subscales were significantly influenced by motor and autonomic symptoms, while the affective subscale was not. Anxiety in PD comprises affective and somatic symptom dimensions. The affective subscale of the BAI is not influenced by motor or autonomic symptoms, and may therefore prove useful for future research. Scores on the somatic subscales of the BAI were associated with autonomic failure and motor impairment, demonstrating a strong interplay between motor and non-motor symptoms in PD. These results stress the importance of a holistic approach of anxiety in PD. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Parkinsonism & Related Disorders 12/2014; 21(3). DOI:10.1016/j.parkreldis.2014.11.019 · 3.97 Impact Factor
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    ABSTRACT: The Parkinson Anxiety Scale is a new scale developed to measure anxiety severity in Parkinson's disease specifically. It consists of three dimensions: persistent anxiety, episodic anxiety, and avoidance behavior. This study aimed to assess the measurement properties of the scale while controlling for the rater (self- vs. clinician-rated) effect. The Parkinson Anxiety Scale was administered to a cross-sectional multicenter international sample of 362 Parkinson's disease patients. Both patients and clinicians rated the patient's anxiety independently. A many-facet Rasch model design was applied to estimate and remove the rater effect. The following measurement properties were assessed: fit to the Rasch model, unidimensionality, reliability, differential item functioning, item local independency, interrater reliability (self or clinician), and scale targeting. In addition, test–retest stability, construct validity, precision, and diagnostic properties of the Parkinson Anxiety Scale were also analyzed. A good fit to the Rasch model was obtained for Parkinson Anxiety Scale dimensions A and B, after the removal of one item and rescoring of the response scale for certain items, whereas dimension C showed marginal fit. Self versus clinician rating differences were of small magnitude, with patients reporting higher anxiety levels than clinicians. The linear measure for Parkinson Anxiety Scale dimensions A and B showed good convergent construct with other anxiety measures and good diagnostic properties. Parkinson Anxiety Scale modified dimensions A and B provide valid and reliable measures of anxiety in Parkinson's disease that are comparable across raters. Further studies are needed with dimension C. © 2014 International Parkinson and Movement Disorder Society
    Movement Disorders 12/2014; 30(4). DOI:10.1002/mds.26111 · 5.68 Impact Factor
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    ABSTRACT: Several studies have validated the Hamilton Depression Rating Scale (HAMD) in patients with Parkinson's disease (PD), and reported adequate reliability and construct validity. However, the factorial validity of the HAMD has not yet been investigated. The aim of our analysis was to explore the factor structure of the HAMD in a large sample of PD patients. A principal component analysis of the 17-item HAMD was performed on data of 341 PD patients, available from a previous cross sectional study on anxiety. An eigenvalue ≥1 was used to determine the number of factors. Factor loadings ≥0.4 in combination with oblique rotations were used to identify which variables made up the factors. Kaiser-Meyer-Olkin measure (KMO), Cronbach's alpha, Bartlett's test, communality, percentage of non-redundant residuals and the component correlation matrix were computed to assess factor validity. KMO verified the sample's adequacy for factor analysis and Cronbach's alpha indicated a good internal consistency of the total scale. Six factors had eigenvalues ≥1 and together explained 59.19% of the variance. The number of items per factor varied from 1 to 6. Inter-item correlations within each component were low. There was a high percentage of non-redundant residuals and low communality. This analysis demonstrates that the factorial validity of the HAMD in PD is unsatisfactory. This implies that the scale is not appropriate for studying specific symptom domains of depression based on factorial structure in a PD population. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Parkinsonism & Related Disorders 11/2014; 21(2). DOI:10.1016/j.parkreldis.2014.11.016 · 3.97 Impact Factor
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    ABSTRACT: Background In the absence of a gold standard, a panel of experts can be invited to assign a reference diagnosis for use in research. Available literature offers limited guidance on assembling and working with an expert panel for this purpose. We aimed to develop a protocol for an expert panel consensus diagnosis and evaluated its applicability in a pilot project.Methods An adjusted Delphi method was used, which started with the assessment of clinical vignettes by 3 experts individually, followed by a consensus discussion meeting to solve diagnostic discrepancies. A panel facilitator ensured that all experts were able to express their views, and encouraged the use of argumentation to arrive at a specific diagnosis, until consensus was reached by all experts. Eleven vignettes of patients suspected of having a primary neurodegenerative disease were presented to the experts. Clinical information was provided stepwise and included medical history, neurological, physical and cognitive function, brain MRI scan, and follow-up assessments over 2 years. After the consensus discussion meeting, the procedure was evaluated by the experts.ResultsThe average degree of consensus for the reference diagnosis increased from 52% after individual assessment of the vignettes to 94% after the consensus discussion meeting. Average confidence in the diagnosis after individual assessment was 85%. This did not increase after the consensus discussion meeting. The process evaluation led to several recommendations for improvement of the protocol.ConclusionA protocol for attaining a reference diagnosis based on expert panel consensus was shown feasible in research practice.
    BMC Neurology 10/2014; 14(1):190. DOI:10.1186/PREACCEPT-1702688938102976 · 2.04 Impact Factor
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    ABSTRACT: Objective: Peer reviewers sometimes request that authors cite their work, either appropriately or via coercive self-citation to highlight the reviewers' work. The objective of this study was to determine in peer reviews submitted to one biomedical journal (1) the extent of peer reviewer self-citation; (2) the proportion of reviews recommending revision or acceptance versus rejection that included reviewer self-citations; and (3) the proportion of reviewer self-citations versus citations to others that included a rationale. Methods: Peer reviews for manuscripts submitted in 2012 to the Journal of Psychosomatic Research were evaluated. Data extraction was performed independently by two investigators. Results: There were 616 peer reviews (526 reviewers; 276 manuscripts), of which 444 recommended revision or acceptance and 172 rejection. Of 428 total citations, there were 122 peer reviewer self-citations (29%) and 306 citations to others' work (71%). Self-citations were more common in reviews recommending revision or acceptance (105 of 316 citations; 33%) versus rejection (17/112; 15%; p<0.001). The percentage of self-citations with no rationale (26 of 122; 21%) was higher than for citations to others' work (15 of 306; 5%; p<0.001). Conclusions: Self-citation in peer reviews is common and may reflect a combination of appropriate citation to research that should be cited in published articles and inappropriate citation intended to highlight the work of the peer reviewer. Providing instructions to peer reviewers about self-citation and asking them to indicate when and why they have self-cited may help to limit self-citation to appropriate, constructive recommendations.
    Journal of Psychosomatic Research 10/2014; 78(1). DOI:10.1016/j.jpsychores.2014.09.015 · 2.74 Impact Factor

  • Journal of Psychosomatic Research 09/2014; 77(3). DOI:10.1016/j.jpsychores.2014.07.014 · 2.74 Impact Factor
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    Alzheimer's & Dementia; 07/2014
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    ABSTRACT: - A multidisciplinary workgroup has revised the 2004 practice guidelines on 'Delirium' on the initiative of the Dutch Geriatrics Society.- In comparison with the previous version, the new guidelines place more emphasis on screening and non-pharmaceutical prevention and treatment. They recommend a degree of restraint when prescribing medication.- Both the patient's and the caregiver's perspectives are discussed.- The guidelines also focus on delirium in patients in a nursing home setting, and describe what the workgroup regards as optimal care for patients suffering from delirium.- The revised guidelines consider the diagnosis and treatment of delirium as a part of basic medical care and primarily the responsibility of the attending physician.- The workgroup advises consulting an expert in the field of delirium only in cases of lack of experience, and for complex cases.- The guidelines also include recommendations for the organization of follow-up care for the delirium patient.
    Nederlands tijdschrift voor geneeskunde 07/2014; 158:A7822.
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    ABSTRACT: Existing anxiety rating scales have limited construct validity in patients with Parkinson's disease (PD). This study was undertaken to develop and validate a new anxiety rating scale, the Parkinson Anxiety Scale (PAS), that would overcome the limitations of existing scales. The general structure of the PAS was based on the outcome of a Delphi procedure. Item selection was based on a canonical correlation analysis and a Rasch analysis of items of the Hamilton Anxiety Rating Scale (HARS) and the Beck Anxiety Inventory (BAI) from a previously published study. Validation was done in a cross-sectional international multicenter study involving 362 patients with idiopathic PD. Patients underwent a single screening session in which the PAS was administered, along with the Hamilton Depression Rating Scale, the HARS, and the BAI. The Mini International Neuropsychiatric Interview was administered to establish Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses of anxiety and depressive disorders. The PAS is a 12-item observer or patient-rated scale with three subscales, for persistent, episodic anxiety and avoidance behavior. Properties for acceptability and reliability met predetermined criteria. The convergent and known groups validity was good. The scale has a satisfactory factorial structure. The area under the receiver operating characteristics curve and Youden index of the PAS are higher than that of existing anxiety rating scales. The PAS is a reliable and valid anxiety measure for use in PD patients. It is easy and brief to administer, and has better clinimetric properties than existing anxiety rating scales. The sensitivity to change of the PAS remains to be assessed. © 2014 International Parkinson and Movement Disorder Society
    Movement Disorders 07/2014; 29(8). DOI:10.1002/mds.25919 · 5.68 Impact Factor
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    ABSTRACT: Background Antidepressants have appeared to be more effective than placebo treatment in treating depressive syndromes in patients with Parkinson’s disease (PD). Objective To identify factors that predict improvement in depressive symptoms during antidepressant treatment in depressed PD patients. Methods A secondary analysis was performed on the dataset of the Randomized Placebo-controlled Study of Antidepressants in PD (SAD-PD), in which 76 patients received active treatment with either paroxetine or venlafaxine extended release (XR), and 39 patients received placebo treatment. Backward stepwise regression analyses were conducted with change in 24-item Hamilton Depression Rating Scale (HAMD-24) score between assessments at baseline and week 12 as the main outcome measure, and sex, age, baseline HAMD-24 score, Unified Parkinson’s Disease Rating Scale section III (UPDRS-III) score, Mini-Mental State Examination (MMSE), and the Clinical Anxiety Scale (CAS) as independent variables. Results In both the active treatment and placebo groups, higher baseline HAMD-24 score and lower UPDRS-III score were associated with greater reduction in HAMD-24 score. Higher anxiety scores predicted less response in the active treatment group. Higher MMSE scores predicted greater response only in the placebo treated group. Sex and age were no predictors of response. Conclusions Higher pre-treatment depression scores and lower pre-treatment anxiety scores are the two most important predictors for improvement during antidepressant treatment in depressed PD patients, which is in line with those found in treatment studies of depressed non-PD patients. Furthermore, our results indicate the requirement for different or more intensive treatment for depressed PD patients with more severe anxiety symptoms.
    Parkinsonism & Related Disorders 06/2014; 20(6). DOI:10.1016/j.parkreldis.2014.02.025 · 3.97 Impact Factor
  • A. F. G. Leentjens · A. Wijers · A. J. H. Moonen · W. M. McDonald · I. H. Richard ·

    Journal of Psychosomatic Research 06/2014; 76(6):508-508. DOI:10.1016/j.jpsychores.2014.03.061 · 2.74 Impact Factor
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    ABSTRACT: Background: Serotonin (5-HT) has long been implied in the pathophysiology of Parkinson's disease (PD). In addition, the 5-HT2A receptor is associated with the regulation of motor function and mood. Objective: To assess regional 5-HT2A receptor expression in unmedicated patients with de novo PD. Methods: Eight de novo, drug naïve patients with PD and eight healthy control subjects underwent a single photon emission computed tomography (SPECT) scan with the highly selective 5-HT2A radioligand 123I-5-I-R91150. Results: In de novo PD patients 5-HT2A receptor binding was significantly reduced in the anterior striatum and the premotor cortex in PD patients compared to controls. In addition, occipital binding was elevated in PD patients. No changes in 5-HT2A receptor binding were found in the prefrontal and parietal cortex. Conclusion: In de novo PD patients, 5-HT2A receptor expression is changed in key areas of the basal ganglia-thalamocortical motor circuit and occipital cortex. This suggests altered 5-HT neurotransmission to contribute to development of PD motor and non-motor symptoms.
    01/2014; 4(2). DOI:10.3233/JPD-130300
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    ABSTRACT: Anxiety symptoms are common in Parkinson disease (PD). Recent evidence suggests that anxiety syndromes as encountered in clinical practice may not correspond to the DSM-IV classification of anxiety disorders. To examine the syndromal pattern of the anxiety spectrum in a large series of patients with PD, as determined with a data-driven approach using latent class analysis (LCA). 342 patients with PD were recruited from referrals to movement disorders or psychiatry clinics at six tertiary centers. Participants were assessed with a structured psychiatric interview and specific scales rating the severity of anxiety, depression, cognition and parkinsonism. The main outcome measure was classes of patients with a specific syndromal profile of anxiety symptoms based on LCA. LCA identified four classes that were interpreted as "no anxiety or depression", "episodic anxiety without depression", "persistent anxiety with depression", and "both persistent and episodic anxiety with depression". Symptoms of persistent anxiety were almost invariably associated with symptoms of depression. There were significant differences between classes in terms of history of depression and anxiety, use of psychoactive medication, and on the Mentation and Complications sections of the Unified Parkinson Disease Rating Scale. Patients with PD show different syndromic profiles of anxiety that do not align with the symptom profiles represented by DSM-IV anxiety disorders and major depression. Accordingly, DSM-IV criteria for anxiety disorders may not be clinically useful in PD. The different classes identified here provide empirically validated phenotypes for future research.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 11/2013; 22(12). DOI:10.1016/j.jagp.2013.09.006 · 4.24 Impact Factor
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    ABSTRACT: The Movement Disorder Society established a task force to review rating scales for the assessment of tremor. Screening instruments used in identifying patients with tremor were also reviewed. Seven tremor severity scales, six activities of daily living (ADL)/disability scales, four quality-of-life scales, and five screening instruments were identified by searching The availability, use, acceptability, reliability, validity, and sensitivity to change were reviewed for each scale; and each scale was classified as recommended, suggested or listed based on whether 3, 2, or 1 of the following criteria were met: (1) used in the assessment of tremor (yes/no), (2) used in published studies by people other than the developers (yes/no), and (3) successful clinimetric testing (yes/no). Five tremor severity scales (the Fahn-Tolosa-Marin Tremor Rating Scale, the Bain and Findley Clinical Tremor Rating Scale, the Bain and Findley Spirography Scale, the Washington Heights-Inwood Genetic Study of Essential Tremor Rating Scale, and the Tremor Research Group Essential Tremor Rating Assessment Scale), one ADL/disability scale (the Bain and Findley Tremor ADL Scale), one quality-of-life scale (the Quality of Life in Essential Tremor Questionnaire), and one screening instrument (the Washington Heights-Inwood Genetic Study of Essential Tremor Rating Scale, version 1) are recommended using these criteria. However, all scales need a more comprehensive analysis of sensitivity to change in order to judge their utility in clinical trials and individual patient assessments. The task force recommends that further work with existing recommended scales be performed as opposed to the development of new tremor scales. © 2013 Movement Disorder Society.
    Movement Disorders 11/2013; 28(13). DOI:10.1002/mds.25648 · 5.68 Impact Factor
  • Albert F.G. Leentjens · James L Levenson ·

    Journal of psychosomatic research 10/2013; 75(4):400. DOI:10.1016/j.jpsychores.2013.07.016 · 2.74 Impact Factor

Publication Stats

4k Citations
394.03 Total Impact Points


  • 1999-2015
    • Maastricht University
      • Department of General Practice
      Maestricht, Limburg, Netherlands
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2012
    • University College London
      • Institute of Neurology
      London, ENG, United Kingdom
  • 2008
    • University of Bergen
      Bergen, Hordaland, Norway
    • Leiden University Medical Centre
      • Department of Psychiatry
      Leiden, South Holland, Netherlands
    • Johns Hopkins University
      • Department of Neurology
      Baltimore, Maryland, United States
  • 2003
    • Leiden University
      Leyden, South Holland, Netherlands
  • 2002
    • Radboud University Medical Centre (Radboudumc)
      • Department of Psychiatry
      Nymegen, Gelderland, Netherlands
  • 1998
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands