Falls Predict Acute Hospitalization in Parkinson's Disease

[Background] There is a need for identifying risk factors for hospitalization in Parkinson’s disease (PD) and also interventions to reduce acute hospital admission.[Objective] To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort.[Methods] PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson’s DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit.[Results] Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065–5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319–6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757–8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124–4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080–8.322; p = 0.035) was an independent predictor of AH.[Conclusion] Falls is an independent predictor of AH in PD patients.Peer reviewe

Utilidad clínica del dispositivo para la monitorización personalizada de la enfermedad de Parkinson, STAT-ON, en condiciones de práctica clínica diaria: resultados de una encuesta de opinión de neurólogos expertos

Background: STAT-ONTM is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson’s disease experts about the STAT-ONTM tool after using the device in a real clinical practice setting (RCPS). Methods: STAT-ONTM was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. Results: Two thirds of neurologists (53.8% females; mean age 44.9 ± 9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16 ± 6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2—9 by neurologist; mean 4.5 ± 2.3). STAT-ONTM was considered ‘‘quite’’ to ‘‘very useful’’ by 74% of the neurologists with an overall opinion of 6.9 ± 1.7 (0, worst; 10, best). STAT-ONTM was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. Conclusion: STAT-ONTM could be a useful device for using in PD patients in clinical practice.Introducción: STAT-ON es un dispositivo que registra las fluctuaciones on-off que permite conocer el estado del paciente con enfermedad de Parkinson (EP) en cada momento del día. Nuestro objetivo fue analizar la opinión de diferentes expertos en EP sobre STAT-ON, después de usar el dispositivo en un entorno de práctica clínica real (PCR). Métodos: STAT-ON fue proporcionado por la companía ˜ Sense4Care a neurólogos espanoles ˜ para usarlo en PCR. Cada neurólogo dispuso del dispositivo durante al menos tres meses y podía usarlo en pacientes con EP, según su criterio. En febrero de 2020, se envió una encuesta con 30 preguntas a todos los participantes. Resultados: Dos tercios de los neurólogos (53,8% mujeres; edad promedio 44,9 ± 9 anos) ˜ trabajaban en una Unidad de Trastornos del Movimiento, con una experiencia en EP de 16 ± 6,9 anos, ˜ habiendo el 40,7% usado otros dispositivos previamente. Se realizaron un total de 119 evaluaciones en 114 pacientes (rango dos a nueve por neurólogo; media 4,5 ± 2,3). STAT-ON fue considerado «bastante» a «muy útil» por el 74% de los neurólogos, con una opinión general de 6,9 ± 1,7 (0, peor; 10, mejor). STAT-ON fue considerado mejor que los diarios por el 70,3% de los neurólogos y una herramienta útil para la identificación de pacientes con EP avanzada por un 81,5%. La identificación adecuada de los episodios de congelación de la marcha y las caídas fueron las limitaciones más reportadas. Conclusiones: STAT-ON podría ser un dispositivo útil para usar en la PC

Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson’s Disease

Introduction: The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. Methods: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson’s disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. Results: The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015–1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009–1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. Conclusion: Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients

Changes in Principal Caregiver Mood Affects the Mood of the Parkinson’s Disease Patient: The Vicious Cycle of Illness

Background: Although many studies have analyzed what factors contribute to caregiver burden in Parkinson’s disease (PD), there is currently no knowledge about how the status of the caregiver could impact the patient. Objective: The aim of this study was to analyze how the change in the caregiver’s status influences PD patients. Methods: PD patients and their caregivers who were recruited from January/2016 to November/2017 from 35 centers in Spain from the COPPADIS cohort were included in the study (V0). They were evaluated again at 2-year follow-up (V2). Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), and EUROHIS-QOL 8-item index (EUROHIS-QOL8) at V0 and V2. Multivariate models were used to analyze the impact of the change from V0 to V2 () on the caregiver’s status over the change in the patient’s status. Results: BDI-II and EUROHIS-QOL8 in the caregiver predicted BDI-II ( = 0.32; p < 0.0001; R2 = 0.71) and EUROHIS-QOL8 ( = 0.39; p < 0.0001; R2 = 0.68) in the patient, respectively. Variables related to the caregiver were not associated with changes in the patient´s health-related QoL (PDQ-39 [39-item Parkinson’s disease Questionnaire]) or autonomy for activities of daily-living (ADLS [Schwab & England Activities of Daily Living Scale]). Conclusion: The change in the caregiver’s mood and global QoL was associated with the change in the patient’s mood and global QoL, respectively, independently of other variables of the disease influencing both patient´s aspects. Based on this finding, it could be of great importance to detect depression in the principal caregiver of a patient and act on it as earlier as possible

Risk of Cognitive Impairment in Patients With Parkinson’s Disease With Visual Hallucinations and Subjective Cognitive Complaints

Background and Purpose: Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC). Methods: Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81. Results: At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011). Conclusions: VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.The resources obtained for the development of this project have been obtained by the Degen Foundation (https://fundaciondegen.org/). A part of the Project is financed with grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575] co-founded by ISCIII (Concesión de subvenciones de Proyectos de Investigación en Salud de la convocatoria 2020 de la Acción Estratégica en Salud 2017-2020 por el proyecto “PROGRESIÓN NO MOTORA E IMPACTO EN LA CALIDAD DE VIDA EN LA ENFERMEDAD DE PARKINSON”)

Predictors of clinically significant quality of life impairment in Parkinson’s disease

Quality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson’s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829–0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422–12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053–1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027–1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer–Lemeshow test, p = 0.665; R 2 = 0.655). An increase in ≥5 and ≥10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663–17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975–22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients

Estudio longitudinal de doentes com doença de Parkinson (ELEP): objectivos e metodologia

La enfermedad de Parkinson (EP) es crónica y progresiva. Desde la perspectiva sociosanitaria, representa una fuente de sufrimiento para el paciente y sus cuidadores, así como una importante carga para la sociedad. La información actual sobre la EP es limitada en cuanto al conocimiento del curso evolutivo relacionado con: 1) el desarrollo y la evolución de los aspectos no motores de la enfermedad; 2) el impacto de estas manifestaciones sobre la discapacidad y la calidad de vida relacionada con la salud (CVRS); 3) los determinantes de la discapacidad y de la pérdida de CVRS; 4) los factores relacionados con la velocidad de progresión de la enfermedad; 5) las pautas de aplicación y la repercusión diferencial a largo plazo (sobre complicaciones, discapacidad, CVRS) de las medidas terapéuticas disponibles; y 6) el impacto de la EP sobre los cuidadores. Además, en la información existente se detecta heterogeneidad en la calidad de las propiedades métricas de los instrumentos de medida aplicados y de los sesgos de selección.Parkinson’s disease (PD) is a chronic and progressive disorder. It produces a significant burden not only for patients, but also for their family and caregivers, with a major socio-economic impact on society. Current knowledge on PD is characterized by scarce information about the evolutionary course of: 1) the non-motor PD features; 2) impact of non-motor PD features on disability and health related quality of life (HRQL) impairment; 3) factors related to disability and HRQL determinants; 4) factors that speed or slow the progression of PD; 5) differential long-term effect of available PD therapeutic schedules and their relationships with disability, complications, and HRQL; and 6) impact of the disease on patients’ caregivers. In addition, heterogeneity in the metric quality of the applied measures and selection bias are frequently foundA doença de Parkinson (DP) é crónica e progresiva. De uma perspectiva socio-sanitária, representa uma fonte de sufrimento para o paciente e seus cuidadores, assim como uma carga importante para a sociedade. A informação actual sobre a DP é limitada em quanto ao conhecimento do curso evolutivo relacionado com: 1) o desenvolvimento e a evolução dos aspectos não motores da doença; 2) o impacto destas manifestações sobre a discapacidade e a qualidade de vida relacionada com a saúde (QVRS); 3) os determinantes da discapacidade e da diminuição de QVRS; 4) os factores relacionados com a velocidade de progressão da doença; 5) as pautas de aplicação e a repercursão diferencial a longo prazo (sobre complicações, discapacidade, QVRS) das medidas terapêuticas disponíveis; e 6) o impacto da DP sobre os cuidadores. Além disso, na informação disponível há uma heterogeneidade na qualidade das propriedades métricas dos instrumentos de medida aplicados e dos enviesamentos de selecção

Estudio piloto sobre uma medida específica para as perturbações do sono associadas à doença de Parkinson: SCOPA-sono

Introducción. En la enfermedad de Parkinson (EP) existe una alta prevalencia de trastornos del sueño. Objetivos. Comprobar los atributos métricos básicos de la escala SCOPA-sueño para pacientes con EP; objetivo secundario: analizar el impacto del trastorno del sueño en la calidad de vida relacionada con la salud (CVRS) del paciente y de su cuidador principal. Sujetos y métodos. 68 pacientes con EP y sus cuidadores principales. Se aplicaron: Hoehn y Yahr, SCOPA-motor, impresión clínica de gravedad (CISIPD), escala PDSS, Hospital Anxiety and Depression Scale, SCOPA-psicosocial y EuroQoL. El cuidador cumplimentó un cuestionario PDSS sobre el sueño del paciente y las medidas de la CVRS (SF-36, EuroQoL). Se analizaron la aceptabilidad, las asunciones escalares, la consistencia interna, la validez de constructo y la precisión de la SCOPA-sueño. Resultados. La SCOPA-sueño mostró aceptabilidad satisfactoria y asunciones escalares. La subescala sueño nocturno (SC-Sn) presentó leve efecto techo (22,1%), y la subescala somnolencia diurna (SC-Sd), defectuosa validez convergente del ítem 6; la consistencia interna de ambas resultó satisfactoria (alfa = 0,84 y 0,75, respectivamente). SC-Sn correlacionó significativamente con la PDSS (rS= –0,70) y con el cuestionario PDSS cumplimentado por el cuidador (rS = –0,53), y fueron menores los valores respectivos para la SC-Sd (rS= –0,41 y –0,50). Error estándar de la medida: SC-Sn, 1,45; SC-Sd, 1,76. La CVRS del paciente y la del cuidador mostraron una escasa correlación con las medidas de sueño. Conclusiones. La escala SCOPA-sueño es viable, consistente y útil para evaluar el trastorno del sueño en pacientes con EP. La relación entre la CVRS y la alteración del sueño fue débil. [REV NEUROL 2006; 43: 577-83]Introduction. There is a high prevalence of sleep disorders in Parkinson’s disease (PD). Aims. To assess some basic metric attributes of the SCOPA-Sleep scale, a measure for PD patients; secondary objective: to check the impact caused by the sleep disorder on the health-related quality of life (HRQoL) of patients and their caregivers. Subjects and methods. 68 PD patients and their main caregivers; measures: Hoehn and Yahr staging, SCOPA-Motor, Clinical Impression of Severity Index (CISI-PD), PDSS, Hospital Anxiety and Depression Scale, SCOPA-Psychosocial, and EuroQoL. Carers filled in a PDSS questionnaire about patient sleep and HRQoL measures (SF-36, EuroQoL). SCOPA-Sleep acceptability, scaling assumptions, internal consistency, construct validity and precision were determined. Results. SCOPA-Sleep acceptability and scaling assumptions resulted satisfactory, although the nocturnal sleep subescale (SC-Ns) showed a mild ceiling effect (22.1%) and a defective convergent validity was found for daytime sleepiness (SC-Ds) item 6. Internal consistency also was satisfactory for both scales (alpha = 0.84 and 0.75, respectively). The correlation between SC-Ns and PDSS was high (rS = –0.70), as it was between SC-Ns and PDSS questionnaire by caregiver (rS = –0.53). The corresponding coefficients with the SC-Ds gained lower values (rS = –0.41 y –0.50). Standard error of measurement was 1.45 for the SC-Ns and 1.76 for the SC-Ds. Both, patient and caregiver HRQoL showed a loose association with the sleep measures. Conclusion. SCOPA-Sleep is a feasible, consistent, and useful scale for assessment of sleep disorder in PD patients. A weak association between sleep disorder and HRQoL was found. [REV NEUROL 2006; 43: 577-83]Introdução. A doença de Parkinson (DP) associa-se a uma elevada prevalência de perturbações do sono. Objectivos. Comprovar os atributos métricos básicos da escala SCOPA-sono para doentes com DP; objectivo secundário: analisar o impacto das perturbações do sono na qualidade de vida relacionada com a saúde (QVRS) do doente e do seu principal cuidador. Sujeitos e métodos. Foram estudados 68 doentes com DP e respectivos cuidadores. Aplicaramse as escalas: Hoehn e Yahr, SCOPA-motor, Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD), escala PDSS, Hospital Anxiety and Depression Scale, SCOPA-psicosocial e EuroQoL. O cuidador preencheu um questionário PDSS sobre o sono do doente e as medidas da QVRS (SF-36, EuroQoL). Foram analisadas a aceitabilidade, as assunções escalares a consistência interna, a validade de construção e a precisão da SCOPA-sono. Resultados. A SCOPA-sono revelou aceitabilidade satisfatória e assunções das escalas. A subescala sono nocturno (SC-Sn) apresentou um discreto efeito tecto (22,1%) e a subescala sonolência diurna (SC-Sd) uma validade convergente imperfeita do item 6; a consistência interna de ambas resultou satisfatória (alfa = 0,84 e 0,75, respectivamente). SC-Sn correlacionou-se significativamente com a PDSS (rS = –0,70) e com o questionário PDSS preenchido pelo cuidador (rS = –0,53), e foram menores os valores respectivos para a SC-Sd (rS = –0,41 e –0,50). O erro standard das medidas foi: SC-Sn, 1,45; SC-Sd, 1,76. A QVRS do doente e do cuidador revelou uma ténue correlação com as medidas do sono. Conclusões. A escala SCOPA-sono é viável, consistente e útil para avaliar a perturbação do sono em doentes com DP. Detectou-se uma ténue relação entre a QVRS e a alteração do sono. [REV NEUROL 2006; 43: 577-83

Criação e protocolo de seguimento longitudinal de uma coorte multipropósito de doentes com doença de Parkinson de diagnóstico recente: projecto VIP

La enfermedad de Parkinson (EP) es una enfermedad neurodegenerativa muy heterogénea desde el punto de vista etiológico, clínico y terapéutico, lo que dificulta la interpretación de resultados de estudios transversales. Son necesarios los registros de pacientes y los estudios longitudinales de cohortes bien caracterizadas desde el punto de vista clínico y terapéutico.Parkinson’s disease (PD) is a quite heterogeneous disorder, thus difficulting the interpretation of transversal studies. Patients’ registries and longitudinal studies can be considered as a priority in order to understand many still unknown aspects of the disease.A doença de Parkinson (DP) é uma doença neurodegenerativa muito heterogénea do ponto de vista etiológico, clínico e terapêutico, o que dificulta a interpretação de resultados de estudos transversais. São necessários os registos de doentes e os estudos longitudinais de coortes bem caracterizadas do ponto de vista clínico e terapêutico