| 1. |
- Ehlers, Claas, et al.
(författare)
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Levodopa infusion in Parkinson's disease : Individual quality of life
- 2020
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 142:3, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Parkinson's disease (PD) features both motor and non-motor symptoms that substantially impact quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) reduces motor complications and improves some non-motor symptoms in advanced PD (APD). Change in patients' health-related quality of life (hrQoL) is a common endpoint in PD trials and has become an important factor in judging overall effect of LCIG. However, hrQoL is considered to be only one dimension of QoL. The primary aim of this prospective observational study was to observe the effects of LCIG on individual quality of life (iQoL) in PD and caregivers. The secondary aim was to investigate its effects on patients' motor and non-motor symptoms as well as effects on caregiver burden. Materials & Methods: Utilizing the Schedule for the Evaluation of Individual Quality of Life-Questionnaire (SEIQoL-Q) and the Personal Wellbeing Index-Adult (PWI-A), twelve patients with advanced PD and their caregivers were followed for six months after initiation of LCIG treatment. Results: At the final follow-up, improvements of iQoL for patients (median SEIQoL index improvement 0.16, P <.05) and caregivers (median SEIQoL index improvement 0.20, P <.05) were seen together with improvements of motor and non-motor symptoms. There were no significant improvements of hrQoL. Conclusions: The study results indicate that LCIG improves iQoL in PD in addition to the improvement of motor and non-motor symptoms. Furthermore, this study signals that LCIG may also contribute to improvement of iQoL in caregivers.
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| 2. |
- Hommel, Adrianus L.A.J., et al.
(författare)
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Optimizing Treatment in Undertreated Late-Stage Parkinsonism : A Pragmatic Randomized Trial
- 2020
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Ingår i: Journal of Parkinson's Disease. - 1877-7171. ; 10:3, s. 1171-1184
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment of patients with late-stage parkinsonism is often sub-optimal. Objective: To test the effectiveness of recommendations by a movement disorder specialist with expertise in late-stage parkinsonism. Methods: Ninety-one patients with late-stage parkinsonism considered undertreated were included in apragmatic a pragmatic multi-center randomized-controlled trial with six-month follow-up. The intervention group received a letter with treatment recommendations to their primary clinician based on an extensive clinical assessment. Controls received care as usual. The primary outcome was the Unified Parkinson Disease Rating Scale (UPDRS)part-II (Activities of Daily Living). Other outcomes included quality-of-life (PDQ-8), mental health (UPDRS-I), motor function (UPDRS-III), treatment complications (UPDRS-IV), cognition (Mini-mental-state-examination), non-motor symptoms (Non-Motor-Symptoms-scale), health status (EQ-5D-5L) and levodopa-equivalent-daily-dose (LEDD). We also assessed adherence to recommendations. In addition to intention-to-treat analyses, a per-protocol analysis was conducted. Results: Sample size calculation required 288 patients, but only 91 patients could be included. Treating physicians followed recommendations fully in 16 (28%) and partially in 21 (36%) patients. The intention-to-treat analysis showed no difference in primary outcome (between-group difference=-1.2, p=0.45), but there was greater improvement for PDQ-8 in the intervention group (between-group difference=-3.7, p=0.02). The per-protocol analysis confirmed these findings, and showed less deterioration in UPDRS-part I, greater improvement on UPDRS-total score and greater increase in LEDD in the intervention group. Conclusions: The findings suggest that therapeutic gains may be reached even in this vulnerable group of patients with late-stage parkinsonism, but also emphasize that specialist recommendations need to be accompanied by better strategies to implement these to further improve outcomes.
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| 3. |
- Hommel, Adrianus L.A.J., et al.
(författare)
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The Prevalence and Determinants of Neuropsychiatric Symptoms in Late-Stage Parkinsonism
- 2020
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Ingår i: Movement Disorders Clinical Practice. - : Wiley. - 2330-1619. ; 7:5, s. 531-542
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Tidskriftsartikel (refereegranskat)abstract
- Background: Late-stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown. Objective: To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD. Methods: We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms. Results: A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness. Conclusion: Neuropsychiatric symptoms are common in late-stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late-stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized.
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| 4. |
- Hultqvist, Jenny, et al.
(författare)
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Everyday Occupations and Other Factors in Relation to Mental Well-Being among Persons with Advanced Parkinson’s Disease
- 2020
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Ingår i: Occupational Therapy in Health Care. - : Informa UK Limited. - 0738-0577 .- 1541-3098. ; 34:1, s. 1-18
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Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study investigated performed activities and the level of satisfaction with everyday occupations among people (n = 67) with advanced Parkinson’s disease (PD), and how these factors and experiences of social relationships were related to mental well-being. Managing one’s hygiene and physical exercises were activities that the majority still performed, whereas few were engaged in work or other productive occupations. Perceived health problems and satisfaction with everyday occupations were important factors for mental well-being since satisfaction with everyday occupations may be an important focus for occupational therapists and other health professionals when supporting mental well-being among persons with advanced PD.
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| 5. |
- Timpka, Jonathan, et al.
(författare)
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Apomorphine in Parkinson’s disease : 4th edition
- 2020. - 4
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Apomorphine is one of the oldest and, at the same time, most potent drugs for the treatment of Parkinson s disease. Its use was for decades inhibited by the occurrence of dopaminergic side effects and the lack of practical equipment for its delivery. But we learned how to reduce the side effects of apomorphine. And the subsequent development of suitable injection pens and portable pumps has made apomorphine a practically useful therapeutic option.With the fourth edition of this book, the authors give a compact and comprehensible overview of apomorphine in Parkinson s disease and practical guidelines for its use associated with the hope that this fascinating drug and excellent therapy can be made available to more Parkinson patients.
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| 6. |
- Timpka, Jonathan, et al.
(författare)
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Apomorphine in Parkinson’s disease : 4th edition
- 2020
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Apomorphine is one of the oldest and, at the same time, most potent drugs for the treatment of Parkinson s disease. Its use was for decades inhibited by the occurrence of dopaminergic side effects and the lack of practical equipment for its delivery. But we learned how to reduce the side effects of apomorphine. And the subsequent development of suitable injection pens and portable pumps has made apomorphine a practically useful therapeutic option.With the fourth edition of this book, the authors give a compact and comprehensible overview of apomorphine in Parkinson s disease and practical guidelines for its use associated with the hope that this fascinating drug and excellent therapy can be made available to more Parkinson patients.
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