7 research outputs found
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
Mean total score trajectories (POS-PP, POS, PDQ-8 and HADS) by patterns of follow-up scores.
<p>Mean total score trajectories (POS-PP, POS, PDQ-8 and HADS) by patterns of follow-up scores.</p
The Parkinson's specific and generic quality of life, symptom and palliative care measures administered at all time points.
<p>The Parkinson's specific and generic quality of life, symptom and palliative care measures administered at all time points.</p
Relationship between baseline total Core-POS score and final POS-PP total score, Pain score.
<p>Relationship between baseline total Core-POS score and final POS-PP total score, Pain score.</p
Characteristics of the 82 patients, total and by diagnosis: IPD, MSA, PSP.
*<p>chi-squared comparison between groups = 11.5 df = 4, p = 0.021.</p><p>Hoehn & Yahr stage meaning is.</p><p>3 Mild to moderate bilateral disease; some postural instability; physically independent.</p><p>4 Severe disability; still able to walk or stand unassisted.</p><p>5 Wheelchair-bound or bedridden unless aided.</p
Individual trajectories of total scores of Palliative care Outcome Scale (POS).
<p>Note: Increased score equals more palliative problems/needs, only patients with 4 assessments plotted.</p
Prevalence (%) of symptoms in patients with different conditions at baseline interview.
<p>Prevalence (%) of symptoms in patients with different conditions at baseline interview.</p