Physical health-related quality of life among older adults with personality disorders

Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50.

Methods: Data for 16,884 adults ages 50 and older from the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants’ PHRQoL.

Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score.

Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs.     

Relationships among depressive,passive-aggressive,sadistic and self-defeating personality disorder features with suicidal ideation and reasons for living among older adults

Objectives: Suicide among older adults is a major public health problem in the USA. In our recent study, we examined relationships between the 10 standard DSM-5 personality disorders (PDs) and suicidal ideation, and found that the PD dimensions explained a majority (55%) of the variance in suicidal ideation. To extend this line of research, the purpose of the present follow-up study was to explore relationships between the four PDs that previously were included in prior versions of the DSM (depressive, passive-aggressive, sadistic, and self-defeating) with suicidal ideation and reasons for living.

Method: Community-dwelling older adults (N = 109; age range = 60–95 years; 61% women; 88% European-American) completed anonymously the Coolidge Axis II Inventory, the Reasons for Living Inventory (RFL), and the Geriatric Suicide Ideation Scale (GSIS).

Results: Correlational analyses revealed that simple relationships between PD scales with GSIS subscales were generally stronger than with RFL subscales. Regarding GSIS subscales, all four PD scales had medium-to-large positive relationships, with the exception of sadistic PD traits, which was unrelated to the death ideation subscale. Multiple regression analyses showed that the amount of explained variance for the GSIS (48%) was higher than for the RFL (11%), and this finding was attributable to the high predictive power of depressive PD.

Conclusion: These findings suggest that depressive PD features are strongly related to increased suicidal thinking and lowered resilience to suicide among older adults. Assessment of depressive PD features should also be especially included in the assessment of later-life suicidal risk.     

The use of psychotropic drugs for behavioral and psychological symptoms of dementia among residents in long-term care facilities in Japan

Objective: To examine whether the use of psychotropic drugs (PDs) was related to behavioral and psychological symptoms of dementia (BPSD) focusing on the prevalence, numbers of symptoms, severity, and care burden among the elderly with BPSD living in long-term care facilities in Japan.

Method: We conducted a cross-sectional survey among older people with dementia or similar symptoms (n = 312) using a questionnaire for care staff in 10 selected long-term care facilities. A brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD.

Results: PDs were used in 45% among all participants and 47.5% among those exhibiting at least one BPSD. We found that use of PDs was associated with greater numbers, severity, and care burden of BPSD. Also, there was significantly more use of PDs among people who had specific BPSD symptoms, such as delusions, anxiety, and disinhibition, compared with those who did not.

Conclusion: The use of PDs among residents in long-term care facilities with dementia or similar symptoms was relatively low compared with previous reports from other countries. Nonetheless, the greater numbers, severity, and care burden of BPSD were associated with the use of PDs.     

A cross-validation Delphi method approach to the diagnosis and treatment of personality disorders in older adults

Introduction: The Delphi method is a consensus-building technique using expert opinion to formulate a shared framework for understanding a topic with limited empirical support. This cross-validation study replicates one completed in the Netherlands and Belgium, and explores US experts' views on the diagnosis and treatment of older adults with personality disorders (PD).

Methods: Twenty-one geriatric PD experts participated in a Delphi survey addressing diagnosis and treatment of older adults with PD. The European survey was translated and administered electronically.

Results: First-round consensus was reached for 16 out of 18 items relevant to diagnosis and specific mental health programs for personality disorders in older adults. Experts agreed on the usefulness of establishing criteria for specific types of treatments. The majority of psychologists did not initially agree on the usefulness of pharmacotherapy. Expert consensus was reached following two subsequent rounds after clarification addressing medication use.

Conclusions: Study results suggest consensus among regarding psychosocial treatments. Limited acceptance amongst US psychologists about the suitability of pharmacotherapy for late-life PDs contrasted with the views expressed by experts surveyed in Netherlands and Belgium studies.     

The impact of comorbidity and other clinical and sociodemographic factors on health-related quality of life in Greek patients with Parkinson's disease

Objectives: This study was designed to evaluate the impact of other common self-reported comorbid disorders (hypertension, dyslipidemia, ischemic heart disease, diabetes mellitus, minor stroke, arthritis, low back pain or osteoporosis and depression) on health-related Quality of Life (HRQoL) of Parkinson's disease (PD) patients and to explore the association of their HRQoL with various sociodemographic and clinical factors.

Methods: Data about age, gender, education, occupation, income, marital and residential status, social relations, disease duration, functional status, treatment and concomitant diseases were collected of 139 Greek patients (68 men and 71 women) with PD. Patients were consecutively recruited from the outpatient clinic of the first Neurology Department of Athens National University at Aeginition Hospital. Disease severity was assessed using the unified Parkinson's disease rating scale including Hoehn and Yahr and Schwab and England (S&;E) scales. HRQoL was measured by the specific Parkinson's disease questionnaire (PDQ-39). A multivariate multiple regression model with normal errors was used for the statistical analysis.

Results: The main determinants of HRQoL were low degree of independence measured by the S&;E scale (F?=?35.942, p?F?=?20.508, p?F?=?14.983, p?F?=?6.507, p?=?0.013) and gastrointestinal disturbances (F?=?4.643, p?=?0.035) and the presence of depression (F?=?6.022, p?=?0.017).

Conclusion: Among the other chronic comorbidities only depression was associated with a poor HRQoL in PD patients. Functional dependence and social isolation contributed most to worse HRQoL. Our findings suggest that adequate social support and management of depression, sleep and gastrointestinal disturbances could reduce the distress and improve HRQoL in patients with PD.     

RAB7L1 promoter polymorphism and risk of Parkinson’s disease; a case-control study

Introduction: Recent genome-wide association studies have explored some new loci in association with Parkinson’s disease (PD). RAB7L1 is an important gene involved in one of the important neurological pathways, located in PARK16 locus. We performed a case-control study to examine the association between rs823144 SNP located in the promoter region of the RAB7L1 gene and PD risk in Iranian population.

Methods: A total of 960 samples including 480 PD patients and 480 healthy controls were collected for analysis of the RAB7L1 rs823144 polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR – RFLP) method.

Results: We found significant differences in genotypic and allelic frequencies between patients and controls. Significant association was found between presence of minor allele (C) and decreased risk of PD development (p = 0.008, OR = 0.74 (0.605–0.924)). Also another significant association was observed between the CC genotype and PD (p = 0.004, OR = 0.441 (0.252–0.772)).

Conclusion: Our data support the association between rs823144 and decreased risk of PD.     

Validity of the PHQ-2 for the screening of major depression in Parkinson's disease: two questions and one important answer

Introduction: Depression is the most common psychiatric comorbidity in Parkinson's disease (PD), but is often under-diagnosed and under-recognized.

Objectives: To evaluate and compare the psychometric qualities of the Patient Health Questionnaire (PHQ-2) and the depression item of the Unified Parkinson's Disease Rating Scale (UPDRS).

Method: Cross-sectional study conducted at a movement disorders outpatient clinic. One hundred ten patients with a diagnosis of PD without dementia were evaluated. A neurologist administered the PHQ-2 and the UPDRS, and the diagnosis of major depression was performed using the structured clinical interview for DSM disorders – clinical version. Two self-rating scales (Zung Self-rating Depression Scale and 15-item Geriatric Depression Scale) were also used.

Results: The prevalence of current depression in the sample was 25.5% (n?=?28). The scores of the PHQ-2 discriminated between subjects with and without depression, with an area under the receiver operating characteristic curve of 0.90. The sensitivity and specificity for a cut-off score of three were 75% and 89%, respectively. The values for the depression item of the UPDRS were slightly lower.

Conclusion: The PHQ-2 is a valid tool for screening depression in PD.     

Awareness and current knowledge of Parkinson’s disease: a neurodegenerative disorder

Context: Parkinson’s disease (PD) is the second common progressive neurodegenerative disease, distressing older men and is prevalent Worldwide.

Objectives: This article is aimed to review the epidemiology, etiology, pathogenesis, clinical manifestation, diagnosis and management of PD.

Methods: A google search was performed to recognise studies that review the characteristics of PD. Search terms included ‘Parkinson’s disease’, ‘epidemiology’, ‘etiology’, ‘pathogenesis’, ‘clinical manifestations’, ‘diagnosis’ and ‘management of Parkinson disease’.

Results: PD is linked to factors such as environmental chemicals, aging, family history and pesticide exposure such as the use of synthetic heroin. PD is characterised clinically by tremors at rest, postural instability, expressionless countenance, lead pipe rigidity and less commonly cognitive impairment. After 60 years of age, PD is commonly prevalent in 1–% of the population, no racial differences are apparent, but the prevalence of PD is more common in men than women. There has also been a better understanding that the disorder may be linked with major non-motor trouble in addition to the additional generally recognised motor complications. There are various management options for the timely management of PD. As the ailment advances, further management strategies are existing; however, the management of non-motor manifestations and late stage motor complications remains mainly testing and will advantage from additional clinical studies.

Conclusions: In this article, we have discussed current progress in the understanding of the epidemiology, clinical manifestations, pathogenesis and management strategies of the disease.     

Postural sway in patients with early Parkinson’s disease performing cognitive tasks while standing

Objectives: We investigated postural sway in patients with early Parkinson’s disease (PD) to test the hypothesis that the postural control system was affected already at an early stage of PD. Moreover, we identified cases of dysfunction of stereopsis in PD patients.

Methods: We examined 23 patients with early PD and 23 healthy, sex- and age-matched control subjects. Postural sway was measured with an accelerometer at the center of mass at the lower spine. Subjects were asked to stand quietly for 30 s under two usual conditions (eyes open and eyes closed) and two dual tasks conditions (eyes open with dual task, eyes closed with dual task). Stereopsis was assessed using the Titmus fly test.

Results: In the usual conditions, no differences were found between the control group and PD group. With increasing task difficulty, PD patients showed an increase of RMS values of sway acceleration, compared to control subjects. These differences reached significance during cognitive task performance. PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance. Relative to controls, PD patients showed decreased stereopsis function. But, there were no statistically significant correlations between log seconds of arc of the Titmus test and JERK, even during cognitive task performance.

Conclusion: Our results indicate that patients with early PD have subtle signs of postural instability when their attention is diverted or reduced. In addition, deficits of stereopsis may be common in early PD patients. St

Abbreviations: ACC: Accelerometers; ANOVA: Analysis of variance; AP: Antero-posterior; COP: Center of pressure; EC: Eyes closed; ECDT: eyes closed with dual task; EO: Eyes open; EODT: Eyes open with dual task; GDS: Geriatric depression scale; JERK: Jerkiness of sway; ML: Medio-lateral; MMSE: Mini mental state examination; MoCA: Montreal cognitive assessment; PD: Parkinson’s disease; PDAbS: PD Patients with abnormal stereopsis; PDNrS: PD Patients with normal stereopsis; PIGD: Postural instability and gait disorder; RMS: Root mean square; UPDRS: Unified Parkinson’s disease rating scale.     

Structural and functional alterations of the heart in Parkinson’s disease

Parkinson’s disease (PD) patients have most frequently heart failure. The cause of this increased prevalence is not known. We designed a study to assess the cardiac function and cardiac structure in patients with PD compared to a control group.

Methods: Cross-sectional study with 50 PD patients and 50 healthy matched controls. We performed electro and echocardiograms to all patients and controls. The measurements were blind. In addition, we performed a neurological assessment.

Results: PD patients had higher left ventricular mass index (114.2 ± 38.4 vs. 94.1 ± 26.4 g/m²; P = 0.003) and higher left atrial volume (30.1 ± 7.9 vs. 26.7 ± 6.2 ml/m²; P = 0.01). PD was an independent risk factor for elevated left ventricular filling pressures (OR = 2.7, CI 95% 2.2–6.3; P = 0.004). Concentric remodeling and left ventricular hypertrophy were associated with more advanced Hoehn and Yahr stages. Moreover, patients with more dysautonomia symptoms showed more left ventricular hypertrophy. Finally, PD group had longer QT interval than control group regardless of the drugs.

Conclusions: PD is significantly associated with increased concentric left ventricular hypertrophy and diastolic dysfunction. Advanced stages of PD are associated with a more severe cardiac affection. These findings can explain the increase of heart failure in PD patients. Cardiomyopathy could be a non-motor parkinsonian symptom.     

Quantitative assessment of the effect of FGF20 rs12720208 variant on the risk of Parkinson’s disease: a meta-analysis

Objectives: Many studies have investigated the association between fibroblast growth factor 20(FGF20) rs12720208(C/T) polymorphism and the susceptibility of Parkinson’s disease (PD). However, published data are still controversial. Here, we performed a meta-analysis to evaluate the association of rs12720208 polymorphism with the risk of PD.

Methods: Up to April 2016, Pubmed, EMbase, Web of science, the Chinese National Knowledge Infrastructure, and Wanfang Medicine were reviewed to identify appropriate documents. A total of seven papers involving 11 studies with 3360 PD cases and 3681 controls were included based on the strict inclusion and exclusion standards. And STATA 12.0 statistics software was used to calculate available data from each study. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated to assess the association between FGF20 rs12720208 polymorphism and PD risk.

Results: When all studies were pooled into this meta-analysis, neither the minor T allele frequencies nor the genotypic distributions were different between PD cases and controls. But the subgroup analysis stratified by ethnicity showed FGF20 rs12720208 polymorphism was associated with increased risk in the allele model (T vs. C:OR = 1.167, 95% CI = 1.020–1.335) and dominant model (TT + TC vs. CC:OR = 1.156, 95% CI = 1.001–1.335) in Caucasians but not in Asians.

Conclusions: This meta-analysis indicates that rs12720208 C/T variant might be associated with PD susceptibility in Caucasians.     

The association of type D personality with quality of life in patients with Parkinson's disease

Objectives: Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. Type D personality is characterized by ineffective coping strategies that reduce QoL in patients with coronary heart disease. The aim of this study was to evaluate whether Type D personality also predicts QoL in patients with Parkinson's disease (PD). In addition, gender differences in Type D personalities are explored.

Methods: The sample consisted of 153 PD patients (51.4% males; mean age 67.9 ± 9.3 years). DS-14 was used to measure Type D personality, negative affectivity (NA) and social inhibition (SI). The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL, and the Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess functional status. The regression model consisted of disease severity, disease duration, age and DS-14 and its two scales (NA and SI).

Results: Type D is negatively associated with overall QoL in PD patients and most subscales of the PDQ-39. Type D explained emotional well-being in both genders but was significant in the models for stigma, cognition, and communication only in men. NA and SI played a less important role in women in comparison with men.

Conclusion: Type D personality is an important part of the QoL model in PD patients of both genders, especially in the NA scale. The gender differences suggest that male and female PD patients require different coping strategies.     

Pharmacogenetics and levodopa induced motor complications

Aim: L-dopa remains the most effective symptomatic therapy for Parkinson's disease (PD) but unfortunately, its chronic use is often associated with motor complications. This review highlights the importance of pharmacogenetics in an individualised PD therapeutic approach.

Material and Methods: review of the literature was done.

Results: PD patients show remarkable heterogeneity in their response to L-dopa and this profound interindividual heterogeneity suggests that there is a genetic predisposition.

Conclusions: The impact of the genetic makeup of every individual on PD treatment appears to be of great importance in order to achieve not only the optimum therapeutic effect, but also with minimal side effects.     

Parkinson’s pain is more aching and interfering with social life in Caucasians compared to Indians

Objectives: Although there have been numerous studies conducted to better understand Parkinson’s disease (PD), the epidemiology of its debilitating non-motor symptoms across different ethnicities remains understudied. Herein we explore the relationship between depression, anxiety and pain in PD patients of Caucasian or Indian ethnicity (PD Caucasians and PD Indians).

Patients and Methods: All patients and healthy age and gender matched controls were assessed via semi-structured interviews for anxiety, pain and depression using structured questionnaires.

Results: PD Indians did not differ from PD Caucasians on anxiety or depression. However, PD Caucasians were more likely to report aching pain by 80 times and dull pain by 108 times compared to PD Indians. PD Indians were 82% less likely to have pain interfering with social activities, and 90% less likely to have pain interfering with relations with others compared to PD Caucasians.

Conclusion: Although an Indo-Caucasian difference may not be detected from mood dysfunction, important differences may exist from the influence of pain interfering with several dimensions of life.     

Diagnostic accuracy of the Gerontological Personality Disorder Scale (GPS) in Dutch general practice

Objective: Personality disorders (PDs) often remain unrecognized in older adults by doctors in general practice. Therefore, this study evaluated the diagnostic accuracy of a screening instrument, the Gerontological Personality Disorder Scale (GPS), in a Dutch general-practice population of older adults.

Method: The psychometric properties of the GPS patient (GPS-pv) and informant (GPS-iv) versions were assessed in a sample of 302 (144 male) patients (average age: 69.9 years) and 302 (124 male) informants (average age: 64.7 years), respectively, using an informant-based personality questionnaire (the Hetero-Anamnestische Persoonlijkheidsvragenlijst ) as a reference criterion.

Results: The internal consistency (average item correlation) of the subscale and total scores of the GPS-pv and GPS-iv were .12 (HAB), .16 (BIO), and .10 (total); and .16 (HAB), .15 (BIO), and .12 (total), respectively. The test--retest reliability was strong for both the GPS-pv (r_s = .56 [HAB], r_s = .67 [BIO], r_s = .66 [total]) and the GPS-iv (r_s = .52 [HAB], r_s = .65 [BIO], r_s = .68 [total]) versions. The sensitivity and specificity of the GPS-pv were .83 and .27, respectively, with a cutoff score of ≥1. Raising the cutoff score to ≥2, the sensitivity dropped to .59, whereas the specificity rose to .57. For the GPS-iv, a cutoff score of ≥3 maximized the sensitivity (.78) and specificity (.65).

Conclusion: The diagnostic accuracy of the GPS-iv was preferable to that of the GPS-pv. This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs.     

Selection of gait parameters for differential diagnostics of patients with de novo Parkinson’s disease

Background: Gait disturbances are an integral part of clinical manifestations of Parkinson’s disease (PD), even in the initial stages of the disease. Our goal was to identify the set of spatio-temporal gait parameters that bear the highest relevance for characterizing de novo PD patients.

Methods: Forty patients with de novo PD and forty healthy controls were recorded while walking over an electronic walkway in three different conditions: (1) base walking, (2) walking with an additional motor task, (3) walking with an additional mental task. Both groups were well balanced concerning age and gender. To select a smaller number of relevant parameters, affinity propagation clustering was applied on parameter pairwise correlation. The exemplars were then sorted by importance using the random forest algorithm. Classification accuracy of a support vector machine was tested using the selected parameters and compared to the accuracy of the model using a set of parameters derived from literature.

Results: Final selection of parameters included: stride length and stride length coefficient of variation (CV), stride time and stride time CV, swing time and swing time CV, step time asymmetry, and heel-to-heel base support CV. Classification performed using these parameters showed higher overall accuracy (85%) than classification using the common parameter set containing: stride time, stride length, swing time and double support time, along with their CVs (78%).

Conclusion: In early stages of PD, double support time and its CV appear to be weak indicators of the disease. We instead found step time asymmetry and support base CV to significantly contribute to classification accuracy.     

Landscape of pain in Parkinson’s disease: impact of gender differences

Background/Aims: Pain is a non-motor symptom of Parkinson’s disease (PD). Few systematic studies have been carried out and there are still no guidelines on pain therapy in PD. Additionally, within the studies that do exist, gender-specific differences in pain perception are often the focus, though no consistent results have to date been obtained. The first main aim of our study was therefore to map pain in the largest PD study group to date, with the second being the analysis of the impact of different pain therapies in PD. The third and main aim was to correlate the obtained results with gender.

Methods: A structured questionnaire with questions focusing on pain was sent to PD patients, with a subsequent statistical analysis correlating the data on pain features and pain therapy with gender.

Results: The study included 1204 female and 1610 male PD patients. Spinal–paravertebral pain emerged as the dominant form of pain. A significant correlation was further demonstrated between gender and pain localization, pain intensity (p-value < 0.05), and pain as impairment to quality of life (p-value < 0.05). Nonsteroidal anti-inflammatory drugs were the painkillers most frequently used by the patients. Aside from non-opioid analgesics (p-value < 0.05), there was no demonstrated significant correlation between pain treatments and gender.

Conclusion: This study found that gender influenced pain perception in the PD patients tested but did not impact the approach to pain therapy.     

Development of the PHASE-Proxy scale for rating drug-related signs and symptoms in severe cognitive impairment

Objectives: The need for assessment of possible drug-related signs and symptoms in older people with severe cognitive impairment has increased. In 2009, the PHASE-20 rating scale for identifying symptoms possibly related to medication was the first such scale to be found valid and reliable for use with elderly people. In this project, the aim was to develop and examine the psychometric properties and clinical utility of PHASE-Proxy, a similar scale for proxy use in assessing elderly people with cognitive impairment.

Methods: Three expert groups revised PHASE-20 into a preliminary proxy version, which was then tested for inter-rater reliability, internal consistency, and content validity. Its clinical usefulness was investigated by pharmacist-led medication reviews. Group interviews and a study-specific questionnaire with nursing home staff were used to investigate the feasibility of use.

Results: The PHASE-Proxy scale had satisfactory levels of inter-rater reliability (Spearman's rank correlation coefficient; r_s = 0.8), and acceptable internal consistency (Cronbach's alpha coefficient; α = 0.73). The factor analysis resulted in a logical solution with seven factors, grouped into two dimensions: signs of emotional distress and signs of physical discomfort. The medication reviews, interviews, and questionnaires also found the proxy scale to be clinically useful, and feasible to use.

Conclusion: The PHASE-Proxy scale appears to be a valid instrument that enables proxies to reliably assess nursing home residents who cannot participate in the assessment, to identify possible drug-related signs and symptoms. It also appears to be clinically useful and feasible for use in this population.