Systematic Review of the Cost of Illness of Parkinson's Disease from a Societal Perspective.

Previous reviews on the cost of illness (COI) of Parkinson's disease (PD) have often focused on health-care costs due to PD, underestimating its effects on other sectors. This systematic review determines the COI of PD from a societal perspective. The protocol was registered in PROSPERO (ID: CRD42023428937). Embase, Medline, and EconLit were searched up to October 12, 2023, for studies determining the COI of PD from a societal perspective. From 2812 abstracts, 17 studies were included. The COI of PD averaged €20,911.37 per patient per year, increasing to almost €100,000 in the most severely affected patients. Health-care costs accounted for 46.1% of total costs, followed by productivity loss (37.4%) and costs to patient and family (16.4%). The COI of PD strongly varied between different geographical regions, with costs in North America 3.6 times higher compared to Asia. This study is the first to identify the relative importance of different cost items. Most important were reduced employment, government benefits, informal care, medication, nursing homes, and hospital admission. There was strong variety in the cost items that were included, with 55.2% of cost items measured in fewer than half of articles. Our review shows that PD-COI is high and appears in various cost sectors, with strong variety in the cost items included in different studies. Therefore, a guideline for the measurement of COI in PD should be developed to harmonize this. This article provides a first step toward the development of such a tool by identifying which cost items are most relevant. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Telemonitoring via Questionnaires Reduces Outpatient Healthcare Consumption in Parkinson's Disease.

BACKGROUND: Parkinson's disease (PD) is best managed by neurologists, traditionally including frequent doctor-patient contact. Because of a rise in PD prevalence and associated healthcare costs, this personnel-intensive care may not be future proof. Telemedicine tools for home monitoring have shown to reduce healthcare consumption in several chronic diseases and also seem promising for PD. OBJECTIVE: To explore whether telemonitoring can reduce outpatient healthcare consumption in PD. METHODS: We conducted a cohort study with 116 outpatients with PD who used the telemedicine tool "myParkinsoncoach." The tool involved periodic monitoring, feedback, knowledge modules, and text message functionality. Retrospective data about PD-related healthcare consumption in the year before and after introduction of the tool were retrieved from the hospital information system. Additional data about tool-related activities performed by nursing staff were logged prospectively for 3 months. RESULTS: There was a 29% reduction in the number of outpatient visits (P < 0.001) in the year after introduction of the tool compared with the year before. A 39% reduction was seen in overall PD-related healthcare costs (P = 0.001). Similar results were found for patients ≥70 years old. Nursing staff spent on average 15.5 minutes per patient a month on monitoring the tool and follow-up activities. CONCLUSIONS: Study results demonstrate a significant reduction in PD-related healthcare consumption using telemonitoring. Notably, these results were also found in elderly patients. Further research is needed to confirm these findings, preferably taking a broader perspective on healthcare consumption and within a larger, multicenter and prospective setup.

Neurobiological correlates of emotional processing in Parkinson's disease: A systematic review of experimental studies.

Deficits in emotional processing in patients with Parkinson's disease (PD) have received increasing interest over the past decades. In this systematic review, we present the results of 18 behavioral studies that have examined the neurobiological base of emotional processing in PD. Multiple aspects of emotional processing have been studied, using a variety of research methods. Deficits in PD are mainly related to autonomic and perceptive processing of intense emotional stimuli, which is accompanied by structural and functional neurobiological abnormalities in predominantly ventral regions of affective neurocircuitry. These structures are more strongly dependent on dopaminergic neurotransmission than the dorsal structures of affective neurocircuitry, which are more related to the cognitive and regulatory aspects of emotion and appear to remain largely intact in PD patients. Considering the importance of active dopaminergic neurotransmission, PD can serve as a prolific model for studying the neurobiological correlates of normal human emotional behavior as well as psychiatric disorders such as anxiety, depression, and apathy. Moreover, the fact that PD patients are able to cognitively regulate or modulate their emotional responses despite reduced dopamine supplies, can have important implications for the treatment of affective disorders not only in PD patients but in the general population likewise.