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BACKGROUND: The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. MATERIAL AND METHODS: PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. RESULTS: The frequency of depressive symptoms was higher in PD patients (nâ¯=â¯694) than in controls (nâ¯=â¯207) (pâ¯<â¯0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1⯱â¯12.8 vs 11.6⯱â¯10; pâ¯<â¯0.0001) and global QoL (EUROHIS-QOL8; 3.7⯱â¯0.5 vs 4⯱â¯0.5; pâ¯<â¯0.0001) were significantly worse in subD (nâ¯=â¯120) than nonD (nâ¯=â¯348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9⯱â¯32 vs 29.1⯱â¯25.8;pâ¯<â¯0.0001). Non-motor symptoms burden (NMSS;ORâ¯=â¯1.019;95%CI 1.011-1.028; pâ¯<â¯0.0001), neuropsychiatric symptoms (NPI; ORâ¯=â¯1.091; 95%CI 1.045-1.139; pâ¯<â¯0.0001), impulse control behaviors (QUIP-RS; ORâ¯=â¯1.035; 95%CI 1.007-1063; pâ¯=â¯0.013), quality of sleep (PDSS; ORâ¯=â¯0.991; 95%CI 0.983-0.999; pâ¯=â¯0.042), and fatigue (VAFS-physical; ORâ¯=â¯1.185; 95%CI 1.086-1.293; pâ¯<â¯0.0001; VAFS-mental; ORâ¯=â¯1.164; 95%CI 1.058-1.280; pâ¯=â¯0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. CONCLUSIONS: SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.
Assuntos
Doença de Parkinson , Qualidade de Vida , Depressão/epidemiologia , Depressão/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: 5- (5 times oral levodopa tablet taken/day) 2- (2 hours of OFF time/day) 1- (1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). The aim of the present study is to compare quality of life (QoL) in PD patients with "5-2-1 positive criteria" vs QoL in PD patients without "5-2-1 positive criteria" (defined as meeting ≥1 of the criteria). METHODS: This is a cross-sectional, observational, monocenter study. Three different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). RESULTS: From a cohort of 102 PD patients (65.4 ± 8.2 years old, 53.9% males; disease duration 4.7 ± 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 ± 14 vs 12.1 ± 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 ± 2 vs 7.1 ± 1.3; p=0.007; EUROHIS-QOL8, 3.5 ± 0.5 vs 3.7 ± 0.4; p=0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 ± 44.8 vs 39.4 ± 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 ± 13.1 vs 89.2 ± 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 ± 3 vs 1.5 ± 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 ± 12.5 vs 10.9 ± 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 ± 7.2 vs 6.2 ± 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. CONCLUSIONS: QoL is worse in patients meeting ≥1 of the 5-2-1 criteria. This group of patients and their caregivers are more affected as a whole. These criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.
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BACKGROUND AND PURPOSE: The objective of this study was to analyze the relationship between motor complications and non-motor symptom (NMS) burden in a population of patients with Parkinson's disease (PD) and also in a subgroup of patients with early PD. METHODS: Patients with PD from the COPPADIS cohort were included in this cross-sectional study. NMS burden was defined according to the Non-Motor Symptoms Scale (NMSS) total score. Unified Parkinson's Disease Rating Scale (UPDRS) part IV was used to establish motor complication types and their severity. Patients with ≤5 years of symptoms from onset were included as patients with early PD. RESULTS: Of 690 patients with PD (62.6 ± 8.9 years old, 60.1% males), 33.9% and 18.1% presented motor fluctuations and dyskinesia, respectively. The NMS total score was higher in patients with motor fluctuations (59.2 ± 43.1 vs. 38.3 ± 33.1; P < 0.0001) and dyskinesia (63.5 ± 40.7 vs. 41.4 ± 36.3; P < 0.0001). In a multiple linear regression model and after adjustment for age, sex, disease duration, Hoehn & Yahr stage, UPDRS-III score and levodopa equivalent daily dose, UPDRS-IV score was significantly related to a higher NMSS total score (ß = 0.27; 95% confidence intervals, 2.81-5.61; P < 0.0001), as it was in a logistic regression model on dichotomous NMSS total score (≤40, mild or moderate vs. >40, severe or very severe) (odds ratio, 1.31; 95% confidence intervals, 1.17-1.47; P < 0.0001). In the subgroup of patients with early PD (n = 396; mean disease duration 2.7 ± 1.5 years), motor fluctuations were frequent (18.1%) and similar results were obtained. CONCLUSIONS: Motor complications were frequent and were associated with a greater NMS burden in patients with PD even during the first 5 years of disease duration.
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Doença de Parkinson , Idoso , Estudos Transversais , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Índice de Gravidade de DoençaRESUMO
C-reactive protein (CRP) is a biomarker of systemic inflammation that has been linked to accelerated decline in walking speed in older adults. The aim of the present study was to compare the CRP levels of PD patients with vs patients without freezing of gait (FOG). Patients and controls participating in the COPPADIS-2015 study that performed blood extraction for determining molecular serum biomarkers were included. Patients with FOG were identified as those with a score of 1 or greater on item-3 of the Freezing of Gait Questionnaire (FOG-Q). Immunoassay was used for determining ultrasensitive CRP (US-CRP) level (mg/dL). In the PD group (n = 225; 61.8 ± 9.5 years old, 61.8% males), 32% of the patients presented FOG but none in the control group (n = 65; 60.3 ± 6.1 years old, 56.9% males) (p < 0.0001). Differences in US-CRP level were significant in patients with FOG vs patients without FOG and vs controls (0.31 ± 0.52 vs 0.16 ± 0.21 vs 0.21 ± 0.22; p = 0.04). Significant differences were also observed between patients with vs without FOG (p = 0.001) but not between patients and controls (p = 0.163). US-CRP level was related to FOG (OR = 4.369; 95% CI 1.105-17.275; p = 0.036) along with H&Y (OR = 2.974; 95% CI 1.113-7.943; p = 0.030) and non-motor symptoms burden (NMSS total score; OR = 1.017; 95% CI 1.005-1.029; p = 0.006) after adjusting for age, gender, disease duration, equivalent daily levodopa dose, number of non-antiparkinsonian drugs per day, motor fluctuations, cognition, motor phenotype, and chronic use of anti-inflammatory drugs. The present study suggests that serum US-CRP level is related to FOG in PD patients. Inflammation could be linked to FOG development.
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Biomarcadores/sangue , Proteína C-Reativa/análise , Transtornos Neurológicos da Marcha/sangue , Doença de Parkinson/sangue , Idoso , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicaçõesRESUMO
INTRODUCTION: In addition to the motor disturbances experienced by the patients suffering from Parkinson's disease (PD), several non-motor symptoms also affect the PD patients: neurobehavior symptoms (dementia, depression, anxiety, psychosis), autonomic (postural hypotension, urinary symptoms, gastro intestinal symptoms, diaphoresis), sleep disorders (insomnia, somnolence, REM sleep behavior disorder, apnea), sensitive-motor (fatigue, diplopia, restless legs syndrome), and sensory symptoms. DEVELOPMENT: We review the most relevant about sensory symptoms in PD: visual dysfunction, olfactory dysfunction, taste, hearing loss, and pain and other sensitive associate symptoms. CONCLUSIONS: Pain is frequently observed in patients with PD, being its prevalence high and probably infra diagnosed. Its identification and classification is very important for a correct treatment. Hyposmia is a common symptom in PD and could be a predictor of future PD. Visual dysfunction and hearing dysfunction among others must be considered in patients with PD.
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Dor/etiologia , Dor/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Transtornos de Sensação/etiologia , Transtornos de Sensação/fisiopatologia , Diagnóstico Diferencial , Humanos , Dor/tratamento farmacológico , Dor/epidemiologia , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia , Transtornos de Sensação/tratamento farmacológico , Transtornos de Sensação/epidemiologiaRESUMO
INTRODUCTION: Restless legs syndrome (RLS) is a movement disorder with a neurological origin that manifests in the form of sensory-motor symptoms which are located mainly in the lower limbs. DEVELOPMENT: We review the epidemiological, pathophysiological, clinical and therapeutic characteristics of this disease, with special emphasis on the diagnostic criteria. CONCLUSIONS: Diagnosis of RLS is mainly clinical and is based on the criteria established by the National Institutes of Health consensus development conference in 2002. There are specific criteria for special groups (the elderly with cognitive impairment and children) in which it is not possible to determine whether RLS exists or not using the usual diagnostic criteria.