Diurnal salivary cortisol concentrations in Parkinson’s disease: increased total secretion and morning cortisol concentrations

Background:Parkinson’s disease (PD) is a chronic neurodegenerative disorder. There is limited knowledge about the function of the hypothalamic-pituitary-adrenal axis in PD. The primary aim of this prospective study was to analyze diurnal salivary cortisol concentrations in patients with PD and correlate these with age, gender, body mass index (BMI), duration of PD, and pain. The secondary aim was to compare the results with a healthy reference group. Methods:Fifty-nine PD patients, 35 women and 24 men, aged 50–79 years, were recruited. The reference group comprised healthy individuals matched for age, gender, BMI, and time point for sampling. Salivary cortisol was collected at 8 am, 1 pm, and 8 pm, and 8 am the next day using cotton-based Salivette ®tubes and analyzed using Spectria®Cortisol I125. A visual analog scale was used for estimation of pain. Results:The median cortisol concentration was 16.0 (5.8–30.2) nmol/L at 8 am, 5.8 (3.0–16.4) at 1 pm, 2.8 (1.6–8.0) at 8 pm, and 14.0 (7.5–28.7) at 8 am the next day. Total secretion and rate of cortisol secretion during the day (8 am–8 pm) and the concentration of cortisol on the next morning were lower (12.5 nmol/L) in the reference group. No significant correlations with age, gender, BMI, duration of PD, Hoehn and Yahr score, Unified Parkinson’s Disease Rating Scale III score, gait, pain, or cortisol concentrations were found. Conclusion:The neurodegenerative changes in PD does not seem to interfere with the hypothalamic-pituitary-adrenal axis. Salivary cortisol concentrations in PD patients were increased in the morning compared with the reference group, and were not influenced by motor dysfunction, duration of disease, or coexistence of chronic or acute pain

Comparison of the psychological symptoms and disease-specific quality of life between early- and typical-onset parkinson's disease patients

The impact of Parkinson's disease (PD) on psychological status and quality of life (QoL) may vary depending on age of disease onset. The aim of this study was to compare psychological symptoms and disease-specific QoL between early onset versus the rest of the PD patients. A total number of 140 PD patients with the mean current age of 61.3 (SD=10.4) yr were recruited in this study. PD patients with the onset age of ≤50 yr were defined as "early-onset" (EOPD) group (n=45), while the ones with >50 yr at the time of diagnosis were categorized as the "typical-onset" (TOPD) patients (n=95). Different questionnaires and scales were used for between-group comparisons including PDQ39, HADS (hospital anxiety and depression scale), FSS (fatigue severity scale), MNA (mininutritional assessment), and the UPDRS. Depression score was significantly higher in EOPD group (6.3 (SD=4.5) versus 4.5 (SD=4.2), P=0.02). Among different domains of QoL, emotion score was also significantly higher in the EOPD group (32.3 (SD=21.6) versus 24.4 (SD=22.7), P=0.05). Our findings showed more severe depression and more impaired emotional domain of QoL in early-onset PD patients. Depression and anxiety play an important role to worsen QoL among both EOPD and TOPD patients, while no interaction was observed in the efficacy of these two psychiatric symptoms and the onset age of PD patients. © 2014 Seyed-Mohammad Fereshtehnejad et al

Quality of Life and Costs in Parkinson's Disease: A Cross Sectional Study in Hungary.

BACKGROUND: Patient reported outcomes and costs of illness are useful to capture some of the multiple effects of a disease and its treatments. Our aim was to assess quality of life (QoL) and costs of Parkinson's disease (PD) in Hungary, and to analyze their associations. METHODS: A cross-sectional questionnaire survey was conducted in one neurology university clinic. Clinical characteristics, PD related resource utilizations and productivity loss in the past 12 months were recorded; the Hoehn&Yahr (HY) scale, PDQ-39 and EQ-5D questionnaires were applied. Cost calculation was performed from the societal perspective. RESULTS: 110 patients (34.5% female) were involved with mean age of 63.3 (SD = 11.3) and disease duration of 8.2 (SD = 5.8) years. PDQ-39 summary score was 48.1 (SD = 13.4). The average EQ-5D score was 0.59 (SD = 0.28), and was significantly lower than the population norm in age-groups 45-74. The correlation was significant between EQ-5D and PDQ-39 (-0.47, p = 0.000), the HY scale and EQ-5D (-0.3416, p = 0.0008) and PDQ-39 (0.3419, p = 0.0006) scores. The total mean cost was euro6030.2 (SD = 6163.0)/patient/year (direct medical 35.7%, direct non-medical 29.4%, indirect cost 34.9%). A one year increase in disease duration and 0.1 decrease of the EQ-5D utility score increase the yearly costs by 8 to 10%, and 7.8%, respectively. The effect of the PDQ-39 score on total cost was not significant. CONCLUSIONS: Disease severity and public health importance of PD are clearly demonstrated by the magnitude of QoL loss. PD-related costs are substantial, but are much lower in Hungary than in Western European countries. Disease duration and EQ-5D score are significant proxy of costs

Medium-to-high prevalence of screening-detected parkinsonism in the urban area of Tehran, Iran: data from a community-based door-to-door study

Seyed-Mohammad Fereshtehnejad,1,2 Mahdiyeh Shafieesabet,3 Arash Rahmani,4 Ahmad Delbari,1,5 Johan Lökk1,6 1Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden; 2Firoozgar Clinical Research Development Center (FCRDC), Firoozgar Hospital, 3Medical Student Research Committee (MSRC), Faculty of Medicine, 4Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran; 5Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 6Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden Introduction: Parkinsonism occurs in all ethnic groups worldwide; however, there are wide variations in the prevalence rates reported from different countries, even for neighboring regions. The huge socioeconomic burden of parkinsonism necessitates the need for prevalence studies in each country. So far, there is neither data registry nor prevalence information on parkinsonism in the Iranian population. The aim of our study was to estimate the prevalence rate of probable parkinsonism in a huge urban area in Iran, Tehran using a community-based door-to-door survey.Materials and methods: We used a random multistage sampling of the households within the network of health centers consisting of 374 subunits in all 22 districts throughout the entire urban area of Tehran. Overall, 20,621 individuals answered the baseline checklist and screening questionnaire and data from 19,500 persons aged ≥30 years were entered in the final analysis. Health care professionals used a new six-item screening questionnaire for parkinsonism, which has been previously shown to have a high validity and diagnostic value in the same population.Results: A total of 157 cases were screened for parkinsonism using the validated six-item questionnaire. After age and sex adjustment based on the Tehran population, the prevalence of parkinsonism was calculated as 222.9 per 100,000. Using the World Health Organization’s World Standard Population, the standardized prevalence rate of parkinsonism was 285 per 100,000 (95% confidence interval 240–329). The male:female ratio of probable parkinsonism was calculated as 1.62, and there was a significant increase in the screening rate by advancing age.Conclusion: The calculated rates for the prevalence of parkinsonism in our study are closer to reports from some European and Middle Eastern countries, higher than reports from Eastern Asian and African populations, and lower than Australia. The prevalence rate of >200 in 100,000 for parkinsonism in Tehran, Iran could be considered a medium-to-high rate. Keywords: parkinsonism, Parkinson’s disease, prevalence, door-to-door survey, population-base

Drug and treatment costs in Parkinson's disease patients in Sweden.

Lökk J, Borg S, Svensson J, Persson U, Ljunggren G. Drug and treatment costs in Parkinson's disease patients in Sweden. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2011.01517.x. © 2011 John Wiley & Sons A/S. Background - Parkinson's disease (PD) is a chronic neurodegenerative disease expected to cause great costs. The aim of this study was to calculate drug and treatment costs in patients with PD in Sweden. Method - All healthcare contacts of patients with PD in Stockholm County, Sweden, were extracted from registers together with information on reimbursements from the authorities to the caregivers. PD-related costs were calculated together with non-PD-related costs. Cost per patient was calculated and extrapolated to the whole Swedish population, taking population demographics into consideration. In addition, nationwide PD drug sales statistics were included. Results - The PD prevalence of Stockholm County was estimated to 196 per 100,000 inhabitants, resulting in an estimated total of about 22,000 patients with PD in Sweden. The cost per patient was estimated to SEK 76,000 of which drug costs accounted for SEK 15,880. The annual direct costs in patients with PD in Sweden were SEK 1.7 billion in 2009. Conclusion - Our study estimates high direct costs in patients with PD in Sweden, SEK 1.7 billion, 52% for inpatient care, 27% for outpatient care and 21% for drugs. With an ageing population and the medical progress, the financial burden on society will most probably increase in the future. This study might initiate and provide information for discussions about future cost allocations and healthcare priorities

Sexual dimorphism in Parkinson’s disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females

Farzaneh Farhadi,1 Kia Vosoughi,1 Gholam Ali Shahidi,2 Ahmad Delbari,3,4 Johan Lökk,3,5 Seyed-Mohammad Fereshtehnejad3,6,7 1Medical Student Research Committee, 2Movement Disorders Clinic, Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; 3Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden; 4Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 5Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; 6Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; 7Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran Introduction: Sex-related differences in clinical manifestations and consequences of Parkinson’s disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.Patients and methods: A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares – Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.Results: While no sex difference was found in the total Unified Parkinson’s Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference =2.2 [95% confidence interval, CI: 0.5–4.0], P=0.011), worse nutritional status (23.8 [standard deviation, SD =4.2] vs 25.8 [SD =2.6], P=0.003) and poorer QoL (28.3 [SD =15.7] vs 17.9 [SD =14.2], P<0.001). Based on multivariate discriminant analysis, emotional well-being, bodily discomfort, social support, mobility and communication domains of HRQoL, together with anxiety, depression and psychosocial functioning, were the strongest features with more severe/worse status in females after adjustment for potential statistical confounders.Conclusion: Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD. Keywords: Parkinson’s disease, sexual dimorphism, male, female, quality of life, psychosocial functionin