Progression of motor impairment in Parkinson's disease. A population-based study
Haukeland University Hospital, Bergen, Hordaland, Norway Neurology
(Impact Factor: 8.29).
12/2005; 65(9):1436-41. DOI: 10.1212/01.wnl.0000183359.50822.f2
To investigate risk factors and the rate of progression of motor symptoms and disability in a population-based cohort of patients with Parkinson disease (PD).
In all, 232 patients with PD, derived from a community-based prevalence study, were followed prospectively over an 8-year period. Follow-up examinations were done 4 and 8 years after baseline, and 144 patients participated in at least one follow-up examination. Information on motor function and disability was obtained using the Unified Parkinson Disease Rating Scale (UPDRS), the Hoehn and Yahr staging, and the Schwab and England score. Population-averaged logistic regression models were used to describe annual disease progression and to analyze the influence of potential risk factors on functional decline.
We found a similar mean annual decline in the UPDRS motor score and the Hoehn and Yahr staging of 3.1% and 3.2%, respectively. Also the UPDRS Activity of Daily Living (ADL) score and the Schwab and England scale changed similarly, with 3.5% and 3.6% per year, respectively. Age, age at onset, disease duration, and excessive daytime somnolence at baseline were strong and independent predictors of greater impairment in motor function and disability. Cognitive impairment at baseline predicted higher disability and higher Hoehn and Yahr scores. Time by age-at-onset interactions were found for the UPDRS motor score and the Hoehn and Yahr staging.
Motor function and disability worsened significantly with time, and to a similar extent. Age, age at onset and disease duration, as well as symptoms thought to be due to involvement of non-dopaminergic brain structures, are predictors of more impaired motor function and disability. However, age at disease onset was the main predictor of motor decline in our cohort, indicating a slower and more restricted pathologic disease process in patients with young-onset PD.
Available from: Barbara Habermann
- "Studies are small and rare that address how families manage their social lives and relationships while living and aging with PD and its progressive disability and complicated medical management [13-15]. Longitudinal studies of PD typically do not examine the dynamics and management of social life [16-19]. These studies do however provide initial evidence that people with PD become lonelier, more emotionally vulnerable and more socially isolated as the disease progresses, and show that changes in disability and socio-emotional well-being can be detected over a 3- to 4-year period. "
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Parkinson’s disease affects facial, vocal and trunk muscles. As symptoms progress, facial expression becomes masked, limiting the person’s ability to communicate emotions and intentions to others. As people with the disease live and reside in their homes longer, the burden of caregiving is unmitigated by social and emotional rewards provided by an expressive individual. Little is known about how adults living with Parkinson’s disease manage their social lives and how an inability to be emotionally expressive can affect social connections and health. Because social networks have been shown to be crucial to the overall well-being of people living with chronic diseases, research is needed on how expressive capacity affects life trajectories and health.
The overall objective is to understand the emergence and evolution of the trajectories of the self-management of the social lives of people living with Parkinson’s disease. The central hypothesis is that expressive capacity predicts systematic change in the pattern of social self-management and quality of life outcomes. The specific aims of this 3-year longitudinal study of 120 people with the disease and a maximum of 120 care partners are: 1) characterize social self-management trajectories over a 3-year period; 2) estimate the degree to which expressive nonverbal capacity predicts the trajectory; and 3) determine the moderating effect of gender on the association between expressive capacity and change in social self-management. Each participant will be assessed 14 times to detect rapid and non-linear changes in social participation and management of social activities; social network; and social comfort, general health and well-being.
This project will provide evidence to guide the development of interventions for supporting social integration of those living with Parkinson’s disease, thus leading to improved overall health. It focuses on the novel construct of social self-management and known factors—expressive capacity and gender—that contribute to stigmatization. The repeated measures design detects triggers of rapid changes in social and health outcomes.
Available from: PubMed Central
- "Compared to studies in the West with similar disease duration, HYS ≥3 disease was not more common in our patients. For example, in patients with a median 14 years disease duration, the average HYS was 3.0 in our study compared with 3.1-3.4 in other studies . in those with about 9 years of disease duration, the average HYS was 2.6 in our population compared to 2.8 in others [11,12]. Median off times in our Chinese patients with motor fluctuations were at a moderate level. "
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ABSTRACT: Little is known about the clinical features and treatment of Chinese patients with Parkinson disease (PD).
A large cross-sectional survey of clinical features, medication use, and motor complications was conducted in 901 consecutive PD patients, from 42 randomly selected university-affiliated hospitals in four urban economic regions of China, between December 2006 and May 2007.
The 901 PD patients had age range 30 to 88, and median disease duration 50 months. Most (737, 81.8%) used L-dopa (median 375 mg/day), and often added low doses of other antiparkinsonian agents. Among L-dopa-treated patients, the prevalence of motor complications was low (dyskinesias: 8.5%; motor fluctuations: 18.6%), even among patients with disease duration >=11 years (dyskinesias: 18.1%; motor fluctuations: 42.2%). Higher L-dopa use was associated with higher occurrence of dyskinesias (OR 2.44; 95% CI 1.20-5.13) and motor fluctuations (OR 2.48; 95% CI 1.49-4.14). Initiating PD treatment with L-dopa alone (OR 0.46; 95% CI 0.22-0.95) or in combination with other medications (OR 0.41; 95% CI 0.19-0.87) was associated with less dyskinesia than treatment initiated with non-L-dopa medication.
Many Chinese PD patients are treated with low-dose L-dopa and added low-dose antiparkinsonian agents, with a low prevalence of motor complications, which might be influenced by Chinese culture.
Available from: Paulo Henrique Silva Pelicioni
- "Someone can argue that our program did not reduced motor impairments and therefore, is not so attractive. However, since a decrease of 3.2% in HY stage score per year is expected (Alves et al., 2005 "
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