Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors

BACKGROUND Palliative care is increasingly offered earlier in the cancer trajectory but rarely in Idiopathic Parkinson's Disease(IPD), Progressive Supranuclear Palsy(PSP) or Multiple System Atrophy(MSA). There is little longitudinal data of people with late stage disease to understand levels of need. We aimed to determine how symptoms and quality of life of these patients change over time; and what demographic and clinical factors predicted changes. METHODS We recruited 82 patients into a longitudinal study, consenting patients with a diagnosis of IPD, MSA or PSP, stages 3-5 Hoehn and Yahr(H&Y). At baseline and then on up to 3 occasions over one year, we collected self-reported demographic, clinical, symptom, palliative and quality of life data, using Parkinson's specific and generic validated scales, including the Palliative care Outcome Scale (POS). We tested for predictors using multivariable analysis, adjusting for confounders. FINDINGS Over two thirds of patients had severe disability, over one third being wheelchair-bound/bedridden. Symptoms were highly prevalent in all conditions - mean (SD) of 10.6(4.0) symptoms. More than 50% of the MSA and PSP patients died over the year. Over the year, half of the patients showed either an upward (worsening, 24/60) or fluctuant (8/60) trajectory for POS and symptoms. The strongest predictors of higher levels of symptoms at the end of follow-up were initial scores on POS (AOR 1.30; 95%CI:1.05-1.60) and being male (AOR 5.18; 95% CI 1.17 to 22.92), both were more predictive than initial H&Y scores. INTERPRETATION The findings point to profound and complex mix of non-motor and motor symptoms in patients with late stage IPD, MSA and PSP. Symptoms are not resolved and half of the patients deteriorate. Palliative problems are predictive of future symptoms, suggesting that an early palliative assessment might help screen for those in need of earlier intervention

Verschleissschutz fuer hochbeanspruchte Kunststoff- und Metallbauteile. Teilvorhaben: Entwicklung und Optimierung von speziellen PVD-Quellen und -Technologien fuer Niedertemperaturprozesse Abschlussbericht

SIGLEAvailable from TIB Hannover: F98B868+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Verfahrens- und Anlagenentwicklung zum plasmagestuetzten Reflowloeten elektronischer Baugruppen. Teilvorhaben: Untersuchung der Plasmawirkung und Entwicklung eines Prototyps Schlussbericht

Available from TIB Hannover: DtF QN1(92,41) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Scheinwerfer fuer ein Kraftfahrzeug und Verfahren zum Herstellen desselben

DE 102008019664 A1 UPAB: 20081121 NOVELTY - The headlamp has a layer system on the inner side of the closure discs including a metal layer between top and bottom layers, one or both of which consists of aluminum nitride or silicon nitride, or an oxide or a mixture of oxides of the following elements: silicon, titanium, aluminum, zinc, tin, indium, niobium, zirconium or tantalum. USE - For a motor vehicle. ADVANTAGE - Closure discs have high transmission in visible light waveband, and can be de-iced, even if LEDs are used as the light source