Heterogeneous Determinants of Quality of Life in Different Phenotypes of Parkinson’s Disease

Abstract

ObjectivesHealth-related quality of life (HRQoL) is considered a very important outcome indicator in patients with Parkinson’s disease (PD). A broad list of motor and non-motor features have been shown to affect HRQoL in PD, however, there is a dearth of information about the complexity of interrelationships between determinants of HRQoL in different PD phenotypes. We aimed to find independent determinates and the best structural model for HRQoL, also to investigate the heterogeneity in HRQoL between PD patients with different phenotypes regarding onset-age, progression rate and dominant symptom.MethodsA broad spectrum of demographic, motor and non-motor characteristics were collected in 157 idiopathic PD patients, namely comorbidity profile, nutritional status, UPDRS (total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial functioning through physical examination, validated questionnaires and scales. Structural equation model (SEM) and multivariate regressions were applied to find determinants of Parkinson’s disease summary index (PDSI) and different domains of HRQoL (PDQ-39).ResultsFemale sex, anxiety, depression and UPDRS-part II scores were the significant independent determinants of PDSI. A structural model consisting of global motor, global non-motor and co-morbidity indicator as three main components was able to predict 89% of the variance in HRQoL. In older-onset and slow-progression phenotypes, the motor domain showed smaller contribution on HRQoL and the majority of its effects were mediated through non-motor features. Comorbidity component was a significant determinant of HRQoL only among older-onset and non-tremor-dominant PD patients. Fatigue was not a significant indicator of non-motor component to affect HRQoL in rapid-progression PD.ConclusionsOur findings showed outstanding heterogeneities in the pattern and determinants of HRQoL among PD phenotypes. These factors should be considered during the assessments and developing personalized interventions to improve HRQOL in PD patients with different phenotypes or prominent feature.

Quality of life in Parkinson's disease: A gender‐specific perspective

“…Female gender is a recognized, although controversial, risk factor for worse QoL in healthy aging, 17 long-term follow-up in stroke survivors, 18 or PD, which has been shown in some studies, 19,20 but not others. 21,22 Worse QoL possibly resulted from the higher burden of depression and anxiety, and related fatigue, confusion, and pain in women with PD. 23 Regarding the CGs, the distress caused by looking after disabled spouses may have major adverse consequences for the CGs' psychological and physical health.…”

“…Among 319 consecutive patients with PD arriving for routine ambulatory visit to the Movement Disorders Unit of the Tel Aviv Sourasky Medical Center (TASMC) from 2010 to 2016 (206 men and 113 women, mean age 68.3 ± 10.6 years, range 32-89 years) without or with their spouses or other attendants, we identified 125 married PD patient-CG couples. Three pairs were excluded due to depression in patient with PD (score > 20 in PDQ-39 questions [17][18][19][20][21][22].…”

Impacto dos sintomas de ansiedade na qualidade de vida na doença de Parkinson: uma revisão sistemática

“…Os estudos apresentaram amostras entre 38 e 210 indivíduos 16,17 . Com relação ao perfil dos participantes, 60% dos estudos foram realizados com pacientes inseridos em clínicas ou hospitais específicos 16,[18][19][20][21][22][23][24][25][26][27][28] ; quatro estudos recrutaram pacientes de universidades ou hospitais universitários 17,[29][30][31] ; dois estudos foram realizados com indivíduos da comunidade 32,33 ; um estudo foi realizado com pacientes tanto de uma clínica quanto de um grupo de apoio 16 e outro estudo foi realizado com pacientes inseridos em uma associação de DP 34 . A prevalência do sexo masculino variou entre 39,4% e 72,8% 9,23 .…”

“…O instrumento mais utilizado para avaliação da ansiedade foi a Escala Hospitalar de Ansiedade e Depressão (HADS), presente em 28,5% dos estudos 18,20,24,25,27,32 . A Escala de Ansiedade de Beck (BAI) foi utilizada em 19% dos estudos que avaliaram apenas a ansiedade 19,26,30,31 .…”

“…Para avaliação da QV, 71,4% dos estudos utilizaram o instrumento Parkinson's Disease Questionnaire 39 (PDQ-39) 16,19,20,[22][23][24][25][26][29][30][31][32]34,35 . Essa mesma escala foi utilizada em conjunto com o Scales for Outcomes in Parkinson's Disease (SCOPAS) 18 .…”