Linking clinical variables to health-related quality of life in Parkinson's disease
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States Parkinsonism & Related Disorders
(Impact Factor: 3.97).
02/2002; 8(3):199-209. DOI: 10.1016/S1353-8020(01)00044-X
Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).
Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms.
A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews.
The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures.
PD patients' well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.
Available from: Alice Cronin-Golomb
- "In addition to the difficulties in motor control, which occur as a result of progressive loss of the dopamine-producing neurons in the substantia nigra and dysfunction of the basal ganglia, PD patients also frequently experience disturbances in mood and cognition. These prevalent and disabling nonmotor symptoms may have a greater impact on the patients' quality of life than do the principal motor features of PD      . Depression is the most commonly explored mood disorder influencing quality of life in PD and has been found to be the best predictor overall for quality of life in several studies     . "
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ABSTRACT: In Parkinson's disease (PD), both the patient and the health care provider look for ways to preserve the patient's quality of life. Many studies focus on the impact of depression and motor disability on poor life quality but neglect to examine the role of anxiety. We investigated the impact of anxiety and depression on health-related quality of life in PD, using the Parkinson's Disease Quality of Life measure (PDQ-39). Symptoms of anxiety, more than depression, cognitive status, or motor stage, significantly affected quality of life in 38 nondemented patients with mild-to-moderate motor disability. Stepwise regression analyses revealed that anxiety explained 29% of the variance in the PDQ-39 sum score, and depression explained 10% of the variance beyond that accounted for by anxiety. The findings suggest that primary management of anxiety as well as depression may be important to optimizing the quality of life of PD patients.
Available from: Marcos Serrano-Dueñas
- "Lastly, unlike the study by Hobson et al. , where the questionnaire was mailed to and completed by the patient, in our case the PDQL questionnaire was completed by the patients under the direct supervision of the researchers. Overall perception of patients' health status is strongly influenced by their mental health and, less so, by their physical condition . Both generally and specifically in the case of PD, mood and functional situation are viewed as being determinants of HRQoL [26,34 – 37]. "
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ABSTRACT: To validate the Ecuadorian Spanish-language version of the Parkinson's Disease Quality of Life Questionnaire (PDQL-EV).
Cross-sectional study of patients with Parkinson's Disease attending a Movement Disorders Clinic. MEASURES APPLIED: Hoehn and Yahr (HY), Unified Parkinson's Disease Rating Scale (UPDRS-3.0), Schwab and England Scale (SES), Pfeiffer Questionnaire (SPMSQ), Hospital Anxiety and Depression Scale (HADS). PDQ-39 and PDQL-EV were applied, the latter after translation and back translation.
The study included 137 patients with an age range of 69.43 +/- 10.18 years (mean +/- SD), duration of illness 5.87 +/- 2.58 years, and HY 2.28 +/- 0.77. The PDQL-EV internal consistency (Cronbach's alpha) yielded: Parkinson's symptoms (PS) 0.85; systemic symptoms (SS) 0.69; social function (SF) 0.81; and emotional function (EF) 0.78. The correlation between measurements varied from 0.68 (PS-SS) to 0.46 (SS-EF), and total measurement correlation from 0.58 (EF) to 0.74 (PS) (altogether, p < 0.0001). The correlation of PDQL with clinical variables was: HY -0.62; UPDRS (subscales 1, 2 and 3) -0.55, -0.76, and -0.48, respectively; SES 0.65; SPMSQ -0.35; HADS-anxiety -0.55; HADS-depression -0.67; and PDQ-39 -0.91 (altogether p < 0.0001). PDQL-EV scores were significantly different (p < 0.0001) between moderate and advanced stages, for all domains except for EF (p = 0.006).
The PDQ-EV has satisfactory internal consistency, and converging and discriminating validity.
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ABSTRACT: Motor fluctuations are a common problem in the long-term management of Parkinson's disease (PD). They result in disability and impaired quality of life. The relatively short serum half-life (~90 minutes) of oral levodopa/carbidopa and its inconsistent absorption in the intestines owing to delayed and erratic gastric emptying (a non-motor feature of PD) are thought to be important factors in the development of motor fluctuations. Continuous infusion of levodopa/carbidopa directly into the small intestine of PD patients reduces plasma levodopa variability by an order of magnitude over oral therapy, resulting in a marked reduction of motor fluctuations. Previously, the utility of long-term intraduodenal (ID) infusion was limited by the relatively large volumes of infusate required, as levodopa is poorly soluble in water/saline. The development of a micronised levodopa (20mg/ml) and carbidopa (5mg/ml) suspension in a methylcellulose gel (Duodopa) provides the high levodopa concentration and physical and chemical stability necessary for long-term enteral therapy. Clinical evidence indicates that a marked reduction of motor fluctuations and dyskinesias can be achieved and maintained by ID administration of this suspension. This article reviews the published data describing the effects of motor fluctuations on quality of life in PD and discusses the current and potential role of ID levodopa in meeting the needs of patients. ■
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