Albert F G Leentjens

Maastricht University, Maestricht, Limburg, Netherlands

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Publications (120)337.98 Total impact

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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. · 2.56 Impact Factor
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    ABSTRACT: 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.
    Journal of psychosomatic research. 10/2014;
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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 05/2014; · 5.63 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.
    Journal of Parkinson's disease. 01/2014;
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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 01/2014; · 3.27 Impact Factor
  • Journal of Psychosomatic Research. 01/2014;
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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 01/2014; 158:A7822.
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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; · 3.35 Impact Factor
  • Albert F G Leentjens, James L Levenson
    Journal of psychosomatic research 10/2013; 75(4):400. · 2.91 Impact Factor
  • Albert F G Leentjens, James L Levenson
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    ABSTRACT: To discuss the ethical issues in the recruitment of university students as research subjects. Narrative review and discussion. The recruitment and inclusion of students in university research projects raise ethical issues specific to this population. Students may be required or coerced to participate, receive course credits for their participation, and their privacy may be violated. Some ethically questionable procedures are standard practice at some universities, and endorsed by their institutional review boards and faculties. Some changes will not be easy to achieve because this implies a change of organization of research and will affect funding and output. The authors call for international standards to be set for research with students, that are in line with applicable standards in research with other subjects, such as medically ill patients, on which researchers, members of institutional review boards and editors can base their policies, opinions and decisions.
    Journal of psychosomatic research 10/2013; 75(4):394-398. · 2.91 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 09/2013; · 5.63 Impact Factor
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    ABSTRACT: To construct a model for depression in Parkinson disease (PD) and to study the relative contribution of PD-specific and nonspecific risk factors to this model. Structural equation modeling of direct and indirect associations of risk factors with the latent depression outcome using a cross-sectional dataset of 342 patients with PD. A model with acceptable fit was generated that explained 41% of the variance in depression. In the final model, 3 PD-specific variables (increased disease duration, more severe motor symptoms, the use of levodopa) and 6 nonspecific variables (female sex, history of anxiety and/or depression, family history of depression, worse functioning on activities of daily living, and worse cognitive status) were maintained and significantly associated with depression. Nonspecific risk factors had a 3-times-higher influence in the model than PD-specific risk factors. In this cross-sectional study, we showed that nonspecific factors may be more prominent markers of depression than PD-specific factors. Accordingly, research on depression in PD should focus not only on factors associated with or specific for PD, but should also examine a wider scope of factors including general risk factors for depression, not specific for PD.
    Neurology 08/2013; · 8.25 Impact Factor
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    ABSTRACT: Many rating scales have been applied to the evaluation of dystonia, but only few have been assessed for clinimetric properties. The Movement Disorders Society commissioned this task force to critique existing dystonia rating scales and place them in the clinical and clinimetric context. A systematic literature review was conducted to identify rating scales that have either been validated or used in dystonia. Thirty-six potential scales were identified. Eight were excluded because they did not meet review criteria, leaving 28 scales that were critiqued and rated by the task force. Seven scales were found to meet criteria to be "recommended": the Blepharospasm Disability Index is recommended for rating blepharospasm; the Cervical Dystonia Impact Scale and the Toronto Western Spasmodic Torticollis Rating Scale for rating cervical dystonia; the Craniocervical Dystonia Questionnaire for blepharospasm and cervical dystonia; the Voice Handicap Index (VHI) and the Vocal Performance Questionnaire (VPQ) for laryngeal dystonia; and the Fahn-Marsden Dystonia Rating Scale for rating generalized dystonia. Two "recommended" scales (VHI and VPQ) are generic scales validated on few patients with laryngeal dystonia, whereas the others are disease-specific scales. Twelve scales met criteria for "suggested" and 7 scales met criteria for "listed." All the scales are individually reviewed in the online information. The task force recommends 5 specific dystonia scales and suggests to further validate 2 recommended generic voice-disorder scales in dystonia. Existing scales for oromandibular, arm, and task-specific dystonia should be refined and fully assessed. Scales should be developed for body regions for which no scales are available, such as lower limbs and trunk. © 2013 Movement Disorder Society.
    Movement Disorders 06/2013; 28(7):874-83. · 5.63 Impact Factor
  • A.F.G. Leentjens, A. Moonen, A. Koehler
    Journal of Psychosomatic Research. 06/2013; 74(6):551.
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    ABSTRACT: OBJECTIVE: Anxiety is a common non-motor symptom in Parkinson's disease (PD). This study analyzed the measurement properties of three frequently used anxiety scales in PD: the Beck Anxiety Inventory (BAI), the Hamilton Anxiety Rating Scale (HARS), and the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). METHOD: The Rasch model was applied to a multicenter international cohort of 342 patients and assessed the following aspects: fit to the Rasch model, unidimensionality, reliability, response category ordering, item local independence, differential item functioning, and scale targeting. RESULTS: In their original form, the BAI, HARS, and HADS-A, did not fit the Rasch model. A good fit to the Rasch model was only found after significant modifications, including rescoring some items and deleting those failing to fit the model. For the BAI and HADS-A, these adjustments resulted in unidimensionality. The HARS was not unidimensional and separate analyses were performed for its psychic and somatic subscales. Whereas the somatic anxiety subscale fit the Rasch model, this was achieved for the psychic anxiety subscale after modifications. CONCLUSION: None of the currently used anxiety scales display satisfactory measurement properties for assessing anxiety in PD. The results suggest the need to develop a new disease-specific scale for measuring anxiety in PD.
    Journal of psychosomatic research 05/2013; 74(5):414-419. · 2.91 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: The lack of appropriate measures has hindered the research on anxiety syndromes in Parkinson's disease (PD). The objective of the present cross-sectional, international study was to identify shared elements and grouping of components from anxiety scales as a basis for designing a new scale for use in PD. METHODS: For this purpose, 342 consecutive PD patients were assessed by means of the Mini International Neuropsychiatric Inventory (depression and anxiety sections), the Clinical Global Impression of severity of the anxiety symptoms, the Hamilton Anxiety Rating Scale (HARS), the Neuropsychiatric Inventory (section E), the Beck Anxiety Inventory (BAI) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). RESULTS: As the HADS-A showed a weak correlation with the HARS and BAI, it was not considered for more analyses. HARS and BAI exploratory factor analysis identified nine factors (62% of the variance), with only two of them combining items from both scales. Therefore, a canonical correlation model (a method to identify relations between components of two groups of variables) was built and it showed four factors grouping items from both scales: the first factor corresponded to 'generalized anxiety'; the second factor included muscular, sensory and autonomic 'non-specific somatic symptoms'; the third factor was dominated by 'respiratory symptoms'; and the fourth factor included 'cardiovascular symptoms'. CONCLUSIONS: BAI is heavily focused on panic symptoms, whilst HARS is more focused towards generalized anxiety symptoms. The new scale should include additional components in order to assess both episodic and persistent anxiety as well as items for evaluation of avoidance behaviour.
    European Journal of Neurology 04/2013; · 4.16 Impact Factor
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    ABSTRACT: The objective of this study was to identify different cognitive phenotypes in Parkinson's disease (PD) using a data-driven approach. A model-based cluster analysis was conducted on the neuropsychological test results of 558 PD patients from 2 European movement disorder centers (Lille, n = 403; Maastricht, n = 155). The number of clusters was determined according to their clinical relevance as well as on the basis of 3 statistical criteria: the cubic cluster criterion, the pseudo F statistic, and the total squared correlation ratio (R(2) ). A factorial discriminant analysis was performed to assess the quality of the cluster's separation. Descriptive variables were used to further characterize the clusters. A 5-cluster model was considered the clinically most relevant. The 5 clusters comprised: (1) cognitively intact patients (19.39%); (2) patients without cognitive deficits but with slight mental slowing (41.29%); (3) patients with slightly impaired overall cognitive efficiency and deficits in all cognitive domains except recognition memory (12.93%); (4) patients with severe mental slowing, impaired overall cognitive efficiency, and severe cognitive impairment in all domains, including memory (23.88%); and (5) patients with very severe impairment in all cognitive domains (2.51%). Cognitively intact patients were significantly younger and had received more years of formal education. Patients in the last 3 clusters had more severe motor symptoms, longer disease duration, and more axial signs. In the last cluster, most patients were demented. Our results confirm the heterogeneity of cognitive presentations in PD, ranging from cognitively intact patients with rather high levels of performance in each cognitive domain to very severely impaired patients. © 2013 Movement Disorder Society.
    Movement Disorders 02/2013; 28(2):183-9. · 5.63 Impact Factor
  • Albert F G Leentjens, James L Levenson
    Journal of psychosomatic research 01/2013; 74(1):1. · 2.91 Impact Factor
  • Albert F G Leentjens, James L Levenson
    Journal of psychosomatic research 11/2012; 73(5):325. · 2.91 Impact Factor
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    Journal of psychosomatic research 08/2012; 73(2):149-52. · 2.91 Impact Factor

Publication Stats

2k Citations
337.98 Total Impact Points


  • 2000–2014
    • Maastricht University
      • • Klinische Neurowetenschappen
      • • MHeNS School for Mental Health and Neuroscience
      Maestricht, Limburg, Netherlands
  • 1999–2014
    • Maastricht Universitair Medisch Centrum
      Maestricht, Limburg, Netherlands
  • 2013
    • Instituto de Salud Carlos III
      • Area of Applied Epidemiology
      Madrid, Madrid, Spain
  • 2008–2013
    • University of Western Australia
      • School of Psychiatry and Clinical Neurosciences
      Perth City, Western Australia, Australia
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • University of Bergen
      Bergen, Hordaland, Norway
  • 2007–2012
    • University College London
      • • Institute of Neurology
      • • Department of Clinical Neuroscience
      London, ENG, United Kingdom
  • 2010
    • Trimbos-instituut
      Utrecht, Utrecht, Netherlands
  • 2007–2008
    • Leiden University Medical Centre
      • Department of Psychiatry
      Leiden, South Holland, Netherlands
  • 2002
    • Radboud University Medical Centre (Radboudumc)
      • Department of Psychiatry
      Nymegen, Gelderland, Netherlands