The associations between fatigue, apathy, and depression in Parkinson's disease.

OBJECTIVES: Fatigue and apathy are two of the most common and most disabling non-motor symptoms of Parkinson's disease (PD). They have a high coincidence and can often be confused; moreover, their relationship is not fully understood. The aim of our study was to describe the coincidence of apathy with different fatigue domains in the presence/absence of depression and to separately describe the associations of different aspects of primary and secondary fatigue with apathy and other clinical and disease-related factors. MATERIALS AND METHODS: A total of 151 non-demented patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II, and Epworth Sleepiness Scale. RESULTS: The prevalence and severity of fatigue and apathy were significantly higher in depressed PD patients. However, our results show that depression, fatigue, and apathy can be clearly distinguished in PD. Apathy was associated with the MFI's-reduced motivation domain in both depressed and non-depressed patients. However, apathy was associated with mental fatigue aspects only in non-depressed patients, and it was not related to the physical aspects of fatigue in any of the studied groups. CONCLUSIONS: Although the pathophysiology of fatigue and apathy in PD is clearly multifactorial, in a proportion of PD patients, these symptoms are associated with depression, dopaminergic depletion in the mesocorticolimbic structures, and disruption of the prefrontal cortex-basal ganglia axis. Therefore, in some PD patients, adequate management of depression and optimal dopaminergic medication may improve both fatigue and apathy.

Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma.

OBJECTIVES: Coronary heart disease (CHD) is the most common cause of mortality and morbidity world-wide. Evidence on ethnic differences between the Roma and non-Roma regarding medical risk factors is scarce. The aim of this study was to assess differences in medical risk factors and the severity of CHD in Roma compared with non-Roma CHD patients, adjusted for gender, age and education. METHODS: Six hundred seventy four patients were included in this cross-sectional study (132 Roma, 542 non-Roma). Data on medical risk factors, symptoms, medication and severity of CHD were obtained from medical records. After matching Roma and non-Roma according to education, linear and logistic regression analyses with adjustments for gender and age were used. RESULTS: Compared with non-Roma, Roma patients had significantly more risk factors and more severe types of CHD. They were treated less frequently with statins and beta-blockers, were more frequently left on pharmacotherapy and surgically revascularised. These differences remained after controlling for education, gender and age. CONCLUSIONS: Roma CHD patients have a worse risk profile at entry of care and seem to be undertreated compared with non-Roma CHD patients.

Mastery, functional disability and perceived health status in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a chronic disease that is difficult to predict and to cope with. Mastery refers to the extent to which patients see themselves as being in control of the forces that affect their lives. It may play an important role in perceived health status and well-being. The purpose of this study was to clarify whether mastery is associated with functional disability and perceived health status in MS patients and how such an association might function. METHODS: Two hundred and three MS patients completed the Short-Form-36 Health Survey as well as the Pearlin-Schooler Mastery Scale. Functional disability was assessed using the Kurtzke Expanded Disability Status Scale. Hierarchical multiple linear regression analyses were performed on the data from two MS age groups: <45 and > or =45 years of age. RESULTS: Functional disability was negatively associated with perceived physical health status in both age groups and with perceived mental health status in younger age group. Mastery was positively associated with perceived health status in older age group. DISCUSSION: The findings confirm that mastery might be helpful for older MS patients. Education strategies for MS patients aimed at personal empowerment for the maintaining of physical and mental well-being may be important.

Impact of fatigue on quality of life in patients with Parkinson's disease.

BACKGROUND AND PURPOSE: Fatigue is frequent and important in the lives of Parkinson's disease (PD) patients. It is multidimensional, with physical and mental aspects. The aim of our study was to explore the impact of fatigue on quality of life (QoL) for PD patients. METHODS: The sample consisted of 175 PD patients from Eastern Slovakia (52% males, mean age 68.2 +/- 9.2, mean disease duration 7.4 +/- 6.7). The Multidimensional Fatigue Inventory (five dimensions), the Parkinson's Disease Quality of Life Questionnaire (eight dimensions) and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Fisher's exact test, t-test, and multiple linear regression analysis were used. RESULTS: Different aspects of fatigue selectively explained different domains of QoL - physical dimensions of fatigue were connected with Mobility and Activities of daily living; mental fatigue dimensions affected Cognition, Emotional well-being, Communication and Activities of daily living; general fatigue was related to Bodily discomfort. The explained variances varied from 5% (Social support) to 65% (Activities of daily living). CONCLUSION: Fatigue combined with worse functional status appears to be a significant contributor to poor quality of life. Its multidimensional construct can be used to develop strategies for improving specific aspects of fatigue to improve QoL for PD patients.

[Reliability and validition of the Slovak modified version of the Stanford Health Assessment Questionnaire using the functional disability index in patients with rheumatoid arthritis]. / Reliabilita a validita slovenskej verzie a modifikácia Stanfordského dotazníka hodnotiaceho zdravie pomocou indexu disability (HAQ) u pacientov s reumatoidnou artritídou.

BACKGROUND: Functional disability is one of the most important consequences of RA in the patient's daily life. The HAQ has been widely used in its self administered form for the assessment of disability. A sensitive and valid instrument is needed for a Slovak population with RA. OBJECTIVE: To evaluate reliability and validity of the Slovak version of the HAQ in patients with RA and to explore relationships between HAQ score and disease activity and to provide information concerning utilization of this instrument in clinical practice. METHODS: In preparing the Slovak version of the HAQ careful attention has been paid to the translation, in terms of linguistic and conceptual equivalence, in order to preserve the original purpose of the instrument. The wording of some items required adaptation to the current activities of daily living and Slovak lifestyle. The sample consisted of 160 RA-patients, out of which 135 were women and 25 were men. The inclusion criteria were the following: age from 20 to 70 years at the onset of the study, diagnosis of RA according to the ARA criteria. The exclusion criteria were the presence of another serious disease or very disabling RA (stage IV of the Steinbrocker's classification). To analyze the data t-test, correlations, one-way analysis of variance (ANOVA), and principal component analysis (PCA) available in the SPSS/PC+ statistical package were used. RESULTS: The Cronbach's coefficient of reliability alpha for the HAQ total scale was 0.94. The results of PCA showed that the 20 HAQ items loaded on four components for which the eigen values were greater than 1, accounting for 70% of overall interpersonal variability. Orthogonal varimax rotation of the principal components provided factor loadings reflecting the eight dimensions within the HAQ. Validity of the HAQ was examined further by means of known-groups technique. The HAQ was found to be sensitive to differentiate between the Steinbrocker's functional capacity groups, as well as between males and females. Moreover, significant correlations (p < or = 0.01) were found between the HAQ and the C-reactive protein, the ESR, the NHP-pain, the Ritchie articular index, the Steinbrocker's functional capacity (r = 0.31-0.62) and disease duration (p < or = 0.05, r = 0.17). CONCLUSION: The results of the current investigation provide support for reliability and construct validity of the Slovak version of the HAQ in patients with RA. The HAQ has sufficient discriminant ability. The index disability can be used as an criterion of severity of RA, as a criterion of effectiveness in therapeutical trials for patient stratification of the Slovak population with RA.

Discrete spacers for photometric characterization of humic acids separated by capillary isotachophoresis.

A group of twenty discrete spacers suitable for photometric characterization of humic acids (HAs) after their isotachophoretic (ITP) separation at pH 10 was found. The spacers, inorganic and organic acids and amino acids of suitable acid-base and migration properties exhibiting no light absorption in the UV region of the light spectrum, made possible to perform this characterization in a sensitive spike mode of the ITP analysis. Using this approach a complex mixture of humic constituents present in a test HA preparation was separated into 22 fractions migrating in the interzonal boundary layers formed by the zones of discrete spacers and 21 fractions mixed with the zones of the spacers. A photometric monitoring of the fractions in the ITP stack at a 405 nm detection wavelength provided an adequate selectivity and sensitivity into the characterization. Relative sizes of the detected fractions of the test HA preparation ranged from 0.2-0.3 to 27.5% (based on the response of the phototometric detector at 405 nm). The fractions representing ca. 0.2-0.3% of the total peak area could be still quantified when 800 ng of the test preparation was loaded onto the ITP column. A typical repeatability of the total area of the detection signal corresponding to humic constituents in the ITP stack was ca. 2.5%. Repeatabilities of the peak areas of the fractions of the humic constituents defined by the spacers ranged from 2 to 6% for the fractions representing 1% or more of the total area and from 8 to 12% for those representing less than 1%. No marks of aggregations of the humic constituents were detected and reproducible ITP profiles (fingerprints) of the studied humic preparation were achieved under the developed working conditions.

[Pain and rheumatoid arthritis]. / Bolest a reumatoidná artritída.

OBJECTIVE: Chronic pain is an important part of the clinical picture in patients with RA and therefore the authors attempted to assess the relationship of pain of patients with RA to the inflammatory process, articular damage and to predict the variance of pain in relation to psychosocial, demographic factors and functional disability. METHOD: Pain was examined using the Nottingham Health Profile (NHP), psychological health by means of the General Health Questionnaire (GHQ) and disability was assessed by the Health Assessment Questionnaire (HAQ). RESULTS: The authors examined 160 patients with RA with a mean age of 48.34 +/- 12.13 years and persistence of the disease for 21.32 +/- 15.61 months. Pain was significantly related to clinical manifestations of inflammation and articular damage. The relationship between pain and laboratory manifestations of inflammation (CRP, FW) was not very close. The relationship between age and pain and between persistence of the disease and pain was not statistically significant. Pain correlated significantly with functional disability (HAQ) (r = -0.54) and the articular index (RAI) (r = 0.58). Pain did not correlate with manifestations of depression (r = -0.15), but correlated significantly with anxiety (r = -0.35) and social dysfunction (r = -0.36). Among the investigated parameters (demographic factors, GHQ and HAQ) the most marked variation of pain was caused by HAQ (32%), GHQ (8%). Almost unrelated were demographic parameters (0.6%) (age, persistence of disease, education lifestyle, and gender).

[The Groningen Activity Restriction Scale (GARS) in the evaluation of severity of rheumatoid arthritis]. / Groningenská mierka obmedzenia cinností (GARS) pri posúdení závaznosti reumatoidnej artritídy.

BACKGROUND: The functional ability of the patient in chronic diseases reflects the severity of the pathological process and the success of treatment. OBJECTIVE: Evaluation of the functional ability of patients with RA and assessment of the influence of the pathological process on the performance of simple everyday tasks. METHODS: Physical capacity and functional ability were examined using the Groningen activity restriction scale (GARS) and Health Assessment Quesionnaire (HAQ). RESULTS: The authors examined 160 patients with RA (135 women and 25 men), mean age 48.3 +/- 12.13 years and a duration of the disease of 21.32 +/- 15.61 months. The mean value of the functional ability according to GARS was 32.67 +/- 11.61. Women had a poorer score (33.36 +/- 11.91) than men (28.96 +/- 9.44), the difference was however not statistically significant. The mean value of functional ability according to HAQ/FDI of the patients was 1.079 +/- 0.65. Women had a poorer score (1.156 +/- 0.625) than men (0.722 +/- 0.936), the difference being significant (P < 0.01). The authors found a significant correlation (P < 0.001) between HAQ and GARS as well as a significant relationship with parameters assessing the inflammatory activity. In GARS a relationship with the duration of the disease was found (P < 0.05), but not with HAQ. There was no significant relationship between GARS or HAQ with the patients age. In investigations of the restriction of functional ability during common everyday activities it was revealed that the greatest problem of patients is care of feet and nails, climbing stairs and personal hygiene. As to household activities the highest score was recorded for "strenuous house work" (scrubbing floors, cleaning windows and vacuum cleaning), shopping ironing and bedmaking. CONCLUSION: GARS is a reliable practical and simple scale of functional ability of patients with RA which can be used for the accurate description of the severity and for evaluation of the degree of functional ability.