Marjolein A van der Marck

Radboud University Medical Centre (Radboudumc), Nymegen, Gelderland, Netherlands

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Publications (19)46.35 Total impact

  • Journal of the American Geriatrics Society 05/2014; 62(5):1001-2. · 3.98 Impact Factor
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    ABSTRACT: This systematic review aims to integrate the evidence on indications, efficacy, safety and pharmacokinetics of medical cannabinoids in older subjects. The literature search was conducted using PubMed, EMBASE, CINAHL and Cochrane Library. We selected controlled trials including solely older subjects (≥ 65 years) or reporting data on older subgroups. 105 (74%) papers, on controlled intervention trials, reported the inclusion of older subjects. Five studies reported data on older persons separately. These were randomized controlled trials, including in total 267 participants (mean age 47-78 years). Interventions were oral tetrahydrocannabinol (THC) (n=3) and oral THC combined with cannabidiol (n=2). The studies showed no efficacy on dyskinesia, breathlessness and chemotherapy induced nausea and vomiting. Two studies showed that THC might be useful in treatment of anorexia and behavioral symptoms in dementia. Adverse events were more common during cannabinoid treatment compared to the control treatment, and were most frequently sedation like symptoms. Although trials studying medical cannabinoids included older subjects, there is a lack of evidence of its use specifically in older patients. Adequately powered trials are needed to assess the efficacy and safety of cannabinoids in older subjects, as the potential symptomatic benefit is especially attractive in this age group.
    Ageing research reviews 02/2014; · 5.62 Impact Factor
  • Journal of the American Geriatrics Society 02/2014; 62(2):410-1. · 3.98 Impact Factor
  • Marjolein A van der Marck, Bastiaan R Bloem
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    ABSTRACT: Neurodegenerative disorders like Parkinson's disease (PD) typically include a broad range of motor and non-motor symptoms. Disease manifestations vary considerably across individuals and, importantly, the individual needs and priorities are highly diverse among patients. It is widely felt that this multifaceted nature of PD calls for a team-oriented and personalized model of care. However, such a multispecialty approach is complex to design, and there are no evidence-based templates that describe how multispecialty care should be organized. Here we elaborate on the various challenges associated with the organization of team-based care. We illustrate this by highlighting new research evidence for two different models of multispecialty team care in PD. We also discuss several critical components of multispecialty care, including composition of the team, collaboration forms between team members, and implementation of multispecialty care within everyday healthcare settings. We close by sharing some of the lessons learned from recent clinical trials on the clinical effectiveness of multispecialty team interventions in PD. This review underscores that designing multispecialty care within the setting of a modern healthcare system is almost as complex as PD itself, and that its scientific evaluation comes with significant challenges.
    Parkinsonism & Related Disorders 01/2014; 20S1:S167-S173. · 3.27 Impact Factor
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    ABSTRACT: a b s t r a c t Falls in Parkinson's disease (PD) are common and frequently devastating. Falls prevention is an urgent priority, but there is no accepted program that specifically addresses the risk profile in PD. Therefore, we aimed to provide consensus-based clinical practice recommendations that systematically address po-tential fall risk factors in PD. We developed an overview of both generic (age-related) and PD-specific factors. For each factor, we specified: best method of ascertainment; disciplines that should be involved in assessment and treatment; and which interventions could be engaged. Using a web-based tool, we asked 27 clinically active professionals from multiple relevant disciplines to evaluate this overview. The revised version was subsequently reviewed by 12 experts. Risk factors and their associated interventions were included in the final set of recommendations when at least 66% of reviewing experts agreed. These recommendations included 31 risk factors. Nearly all required a multidisciplinary team approach, usually involving a neurologist and PD-nurse specialist. Finally, the expert panel proposed to first identify the specific fall type and to tailor screening and treatment accordingly. A routine evaluation of all risk factors remains reserved for high-risk patients without prior falls, or for patients with seemingly unexplained falls. In conclusion, this project produced a set of consensus-based clinical practice recommendations for the examination and management of falls in PD. These may be used in two ways: for pragmatic use in current clinical practice, pending further evidence; and as the active inter-vention in clinical trials, aiming to evaluate the effectiveness and cost-effectiveness of large scale implementation. Ó 2013 Published by Elsevier Ltd.
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    ABSTRACT: There is a great concern about the safety of THC-based drugs in older people (≥65 years), as most of THC-trials did not include such group. In this phase 1, randomized, double-blind, double-dummy, placebo-controlled, cross-over trial, we evaluated the safety and pharmacokinetics of three oral doses of Namisol®, a novel THC in tablet form, in older subjects. Twelve healthy older subjects (6 male; mean age 72±5 years) randomly received a single oral dose of 3 mg, 5 mg, or 6.5 mg of THC or matching placebo, in a crossover manner, on each intervention day. The data for 11 subjects were included in the analysis. The data of 1 subject were excluded due to non-compliance to study medication. THC was safe and well tolerated. The most frequently reported adverse events (AE′s) were drowsiness (27%) and dry mouth (11%). Subjects reported more AE′s with THC 6.5 mg than with 3 mg (p=0.048), 5 mg (p=0.034) and placebo (p=0.013). There was a wide inter-individual variability in plasma concentrations of THC. Subjects for whom the Cmax fell within the sampling period (over 2 hours), Cmax was 1.42–4.57 ng/mL and Tmax was 67–92 minutes. The AUC0-2 h (n=11) was 1.67–3.51 ng/mL. Overall, the pharmacodynamic effects of THC were smaller than effects previously reported in young adults. In conclusion, THC appeared to be safe and well tolerated by healthy older individuals. Data on safety and effectiveness of THC in frail older persons are urgently required, as this population could benefit from the therapeutic applications of THC.
    European Neuropsychopharmacology. 01/2014;
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    ABSTRACT: Falls in Parkinson’s disease (PD) are common and frequently devastating. Falls prevention is an urgent priority, but there is no accepted program that specifically addresses the risk profile in PD. Therefore, we aimed to provide consensus-based clinical practice recommendations that systematically address potential fall risk factors in PD. We developed an overview of both generic (age-related) and PD-specific factors. For each factor, we specified: best method of ascertainment; disciplines that should be involved in assessment and treatment; and which interventions could be engaged. Using a web-based tool, we asked 27 clinically active professionals from multiple relevant disciplines to evaluate this overview. The revised version was subsequently reviewed by 12 experts. Risk factors and their associated interventions were included in the final set of recommendations when at least 66% of reviewing experts agreed. These recommendations included 31 risk factors. Nearly all required a multidisciplinary team approach, usually involving a neurologist and PD-nurse specialist. Finally, the expert panel proposed to first identify the specific fall type and to tailor screening and treatment accordingly. A routine evaluation of all risk factors remains reserved for high-risk patients without prior falls, or for patients with seemingly unexplained falls. In conclusion, this project produced a set of consensus-based clinical practice recommendations for the examination and management of falls in PD. These may be used in two ways: for pragmatic use in current clinical practice, pending further evidence; and as the active intervention in clinical trials, aiming to evaluate the effectiveness and cost-effectiveness of large scale implementation.
    Parkinsonism & Related Disorders 01/2013; · 3.27 Impact Factor
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    ABSTRACT: Multidisciplinary care is considered an optimal model to manage Parkinson's disease (PD), but supporting evidence is limited. We performed a randomized, controlled trial (RCT) to establish whether a multidisciplinary/specialist team offers better outcomes, compared to stand-alone care from a general neurologist. Patients with PD were randomly allocated to an intervention group (care from a movement disorders specialist, PD nurses, and social worker) or a control group (care from general neurologists). Both interventions lasted 8 months. Clinicians and researchers were blinded for group allocation. The primary outcome was the change in quality of life (Parkinson's Disease Questionnaire; PDQ-39) from baseline to 8 months. Other outcomes were the UPDRS, depression (Montgomery-Asberg Depression Scale; MADRS), psychosocial functioning (Scales for Outcomes in Parkinson's disease-Psychosocial; SCOPA-PS), and caregiver strain (Caregiver Strain Index; CSI). Group differences were analyzed using analysis of covariance adjusted for baseline values and presence of response fluctuations. A total of 122 patients were randomized and 100 completed the study (intervention, n = 51; control, n = 49). Compared to controls, the intervention group improved significantly on PDQ-39 (difference, 3.4; 95% confidence interval [CI]: 0.5-6.2) and UPDRS motor scores (4.1; 95% CI: 0.8-7.3). UPDRS total score (5.6; 95% CI: 0.9-10.3), MADRS (3.7; 95% CI: 1.4-5.9), and SCOPA-PS (2.1; 95% CI: 0.5-3.7) also improved significantly. This RCT gives credence to a multidisciplinary/specialist team approach. We interpret these positive findings cautiously because of the limitations in study design. Further research is required to assess teams involving additional disciplines and to evaluate cost-effectiveness of integrated approaches. © 2012 Movement Disorder Society.
    Movement Disorders 11/2012; · 5.63 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Despite their high prevalence and clinical impact, sleep disorders in Parkinson's disease appear to receive insufficient attention in clinical practice. We compared the importance of sleep disorders relative to other symptoms and daily issues. Furthermore, we determined whether relevance as perceived by patients correlated with the subjective presence of sleep disruption scored with a rating scale. METHODS: We studied a cohort of 153 consecutive patients (95 men) who were referred for problems other than sleep to our referral center. Prior to their visit, patients ranked their individual top five clinical priorities (of 23 items), indicating the most problematic domains for which they requested medical attention. Additionally, nocturnal sleep quality and excessive daytime sleepiness (EDS) were assessed with validated questionnaires. RESULTS: The top three important domains according to the patient were movement (79.9%), medication (73.2%), and physical condition (63.4%). Sleep was the 6th most frequently reported item, marked by 37.9% of the patients. Amongst the patients who scored sleep as a priority, 47 (81%) had a poor sleep quality (Pittsburgh Sleep Quality Index > 5). Although EDS was present in almost 30% of patients, a minority of them put it on their priority list. CONCLUSION: A priority list can be used to prioritize patient-centered quality of life issues. Our results show that sleep is a clinical priority for about one-third of patients. Surprisingly, EDS was usually not prioritized by patients during the consultation, underscoring the need to use ratings scales alongside with subjective priorities.
    European Journal of Neurology 08/2012; · 4.16 Impact Factor
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    ABSTRACT: Prior work suggested that patients with Parkinson's disease (PD) have a lower Body Mass Index (BMI) than controls, but evidence is inconclusive. We therefore conducted a meta-analysis on BMI in PD. We searched MEDLINE, EMBASE, Cinahl and Scopus to identify cohort studies on BMI in PD, published before February 2011. Studies that reported mean BMI for PD patients and healthy controls were eligible. Twelve studies were included, with a total of 871 patients and 736 controls (in three studies controls consisted of subjects from other published studies). Our primary aim was to assess differences in BMI between patients and controls; this was analyzed with random effects meta-analysis. Our secondary aim was to evaluate the relation with disease severity (Hoehn and Yahr stage) and disease duration, using random effects meta-regression. PD patients had a significantly lower BMI than controls (overall effect 1.73, 95% CI 1.11-2.35, P<0.001). Pooled data of seven studies showed that patients with Hoehn and Yahr stage 3 had a lower BMI than patients with stage 2 (3.9, 95% CI 0.1-7.7, P<0.05). Disease duration was not associated with BMI. Because a low body weight is associated with negative health effects and a poorer prognosis, monitoring weight and nutritional status should be part of PD management.
    Parkinsonism & Related Disorders 11/2011; 18(3):263-7. · 3.27 Impact Factor
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    ABSTRACT: Depression is one of the most common non-motor symptoms of Parkinson's disease (PD) with a large negative impact on the quality of life. Factors such as disease stage, subtype of PD and gender might play an important role in the prevalence of depression, but a large study investigating all these factors in a within-subject design is lacking. Therefore we studied a homogeneous group of 256 Dutch PD patients (60% men, mean age=65.12 (±9.6) years). In total, 36.3% of the subjects had a BDI-score indicative for a minor depression, while 12.9% had a major depression. Notably, only 8.6% of the minor depressed patients and 30.3% of the major depressed patients were taking antidepressants. A higher prevalence of depression was observed in the later stages of the disease. However, this finding was absent in a smaller subsample after correction for cognitive impairment. Our data did not show a difference in the prevalence of depression between the motor subtypes and showed a trend towards higher prevalence of depression in the tremor dominant group. There was no significant difference in the prevalence of depression between men and women. We will discuss the relevance of these results in relation to the findings of other studies.
    Journal of the neurological sciences 07/2011; 310(1-2):220-4. · 2.32 Impact Factor
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    ABSTRACT: To evaluate the reliability and user experiences of an automated telephone system to monitor falls during a prolonged period of time. Prospective cohort study. Four neurological outpatient clinics in the Netherlands. One hundred nineteen community-dwelling people with Parkinson's disease without dementia, because falls are common in this population. Clinical and demographic data were obtained. The Falls Telephone is a computerized telephone system through which participants can enter the number of falls during a particular period. During a follow-up of 1 to 40 weekly calls, 2,465 calls were made. In total, 173 no-fall entries and 115 fall entries were verified using personal telephone interviews. User experiences were evaluated in 90 of the 119 participants using structured telephone interviews. All no-fall entries and 78% of fall entries were confirmed to be correct. Sensitivity to detect falls was 100%, and specificity was 87%. Users regarded the Falls Telephone as a convenient tool to monitor falls. The Falls Telephone is a convenient and reliable instrument to monitor falls. The automated system has high specificity, obviating the need for time-consuming personal follow-up calls in the majority of nonfallers. As such, the Falls Telephone lends itself well to data collection in large trials with prolonged follow-up in participants with Parkinson's disease.
    Journal of the American Geriatrics Society 02/2011; 59(2):340-4. · 3.98 Impact Factor
  • M. A. van der Marck, B. Post, L. Laverman, B. R. Bloem, M. Munneke
    Movement Disorders - MOVEMENT DISORD. 01/2010;
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    ABSTRACT: Parkinson's disease (PD) is a chronic and progressive neurodegenerative disorder with a complex phenotype, featuring a wide variety of both motor and non-motor symptoms. Current medical management is usually monodisciplinary, with an emphasis on drug treatment, sometimes supplemented with deep brain surgery. Despite optimal medical management, most patients become progressively disabled. Allied health care may provide complementary benefits to PD patients, even for symptoms that are resistant to pharmacotherapy or surgery. This notion is increasingly supported by scientific evidence. In addition, the role of allied health care is now documented in recent clinical practice guidelines that are available for physiotherapy, occupational therapy and speech-language therapy. Unfortunately, adequate delivery of allied health care is threatened by the insufficient expertise among most therapists, and the generally low patient volumes for each individual therapist. Moreover, most allied health interventions are used in isolation, with insufficient collaboration and communication with other disciplines involved in the care for PD patients. Clinical experience suggests that optimal management requires a multidisciplinary approach, with multifactorial health plans tailored to the needs of each individual patient. Although the merits of specific allied health care interventions have been scientifically proven for other chronic disorders, only few studies have tried to provide a scientific basis for a multidisciplinary care approach in PD. The few studies published so far were not yet convincing. We conclude by providing recommendations for current multidisciplinary care in PD, while highlighting the need for future clinical trials to evaluate the cost-effectiveness of a multidisciplinary team approach.
    Parkinsonism & Related Disorders 12/2009; 15 Suppl 3:S219-23. · 3.27 Impact Factor
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    ABSTRACT: Unintended weight loss frequently complicates the course of many neurodegenerative disorders and can contribute substantially to both morbidity and mortality. This will be illustrated here by reviewing the characteristics of unintended weight loss in the three major neurodegenerative disorders: Alzheimer's disease, Parkinson's disease and Huntington's disease. A common denominator of weight loss in these neurodegenerative disorders is its typically complex pathophysiology. Timely recognition of the underlying pathophysiological process is of crucial importance, since a tailored treatment of weight loss can considerably improve the quality of life. This treatment is, primarily, comprised of a number of methods of increasing energy intake. Moreover, there are indications for defects in the systemic energy homeostasis and gastrointestinal function, which may also serve as therapeutic targets. However, the clinical merits of such interventions have yet to be demonstrated.
    Journal of Neurology 02/2009; 255(12):1872-80. · 3.58 Impact Factor
  • M. van der Marck, B. R. Bloem, M. Munneke
    Parkinsonism & Related Disorders - PARKINSONISM RELAT DISORD. 01/2007; 13.
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    ABSTRACT: AimsDepression is the most common neuropsychiatric disturbance in Parkinson's disease. Evidence is accumulating that motor subtype may be a critical risk factor for the development of depression throughout the disease and that the gender prevalence seen for common depression may not hold for patients with Parkinson's disease. Here we set out to analyse a database containing information about motor subtype, gender and depression in a large pool of well-characterised patients with idiopathic Parkinson's disease.Methods Standardised neurological and psychiatric tests were administered to 224 patients (154 male) suffering from idiopathic Parkinson at the Parkinson Centre Nijmegen (ParC) of the Radboud University Nijmegen Medical Centre (UMCN) in the Netherlands. ParC is an outpatient centre recognised as Centre of Excellence by the National Parkinson Foundation. The data were collected during a 3-day programme for diagnosis and the development of an individual multidisciplinary treatment programme. Data were statistically analysed using SPSS.ResultsOf the 224 patients, 74 (33%) suffered from the tremor-dominant subtype, 129 (56%) had a bradykinetic/rigidity subtype and 24 (11%) patients were diagnosed as having a postural instability and gait disorder subtype. Overall and for each of the subtypes, there was a significant higher prevalence of males in the group (minimum t(255)=12.9; p=0.000). We therefore corrected subsequent analyses for this difference in prevalence. Duration of illness did not differ between groups. Our statistical analysis further indicated that the prevalence of depression did not differ between male and female in any of the groups both for minor and major depression.Conclusions Our data contained a homogenous set of patients suffering from idiopathic Parkinsons disease in a mild to moderate stage. We could not replicate recent evidence of a predominance of depression in the postural instability and gait disorder subtype in this sample possibly due the stage of the disease. Our data, however, do suggest that contrary to the general population there is an equal prevalence of male and female patients suffering from minor or major depression. These results may suggest that there is a different pathophysiology underlying depression in Parkinson's diseases independent of subtype.
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  • M. A. van der Marck, B. R. Bloem, M. Munneke