丘脑底核深部电刺激对帕金森病患者抑郁及焦虑的影响

目的探讨丘脑底核(STN)深部电刺激(DBS)手术对帕金森病(PD)患者抑郁及焦虑的影响。方法41例接受STNDBS治疗的PD患者进行神经心理评估,分别于术前1周及术后12个月应用HY分期、统一PD评定量表运动检查部分(UPDRSⅢ)、医院焦虑和抑郁量表(HADS)及PD生活质量问卷(PDQ39)评价其病情、运动状况、情绪及生活质量,并进行统计学分析。结果术后患者UPDRSⅢ、HADS及PDQ39评分较术前极显著改善(均P<0.001),HY分期在“开”及“关”状态均明显改善(P<0.05,P<0.001);Spearman相关性检验提示HADS抑郁评分与PDQ39中情绪状态、羞耻感及总评分变化正相关(r分别为0.35、0.37、0.34,均P<0.05),与HY分期、UPDRSⅢ不相关。HADS焦虑评分与其均不相关。结论STNDBS能改善PD患者的情绪,特别是抑郁状态,进而改善其生活质量。     

丘脑底核电刺激对帕金森病患者抑郁的疗效及抑郁与其他症状改善程度的相关性研究

目的探讨丘脑底核电刺激(STN-DBS)对帕金森病(PD)患者抑郁的疗效,并观察其与其他症状改善程度的相关性。方法对70例接受STN-DBS治疗的PD患者进行术前评估及12个月以上追踪,采用统一PD评定量表第三部分(UPDRSⅢ)、39项PD调查表(PDQ-39)、汉密尔顿抑郁量表(HAMD)评估患者运动症状、生活质量及抑郁水平,并记录患者PD药物服用情况。结果 PD患者接受STN-DBS治疗1年以上,其运动症状明显改善,PD相关生活质量提高,PD相关药物用量降低(均P0.001)。HAMD总分及七类因子分在STN-DBS治疗1年后均显著下降(均P0.05)。PD患者HAMD总分的改善程度与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P0.05)。各类因子分别与其他疗效相关分析可见:焦虑/躯体化与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P0.05);体质量减轻与药物减量呈负相关(P0.05);认知障碍、睡眠障碍及绝望感分别与PDQ-39评分改善呈正相关(均P0.001);阻滞与UPDRSⅢ药物"开"、"关"期改善及PDQ-39评分改善分别呈正相关(均P0.05);日夜变化与其他症状改善之间均无相关性。结论 STN-DBS治疗PD患者1年以上,可显著改善其抑郁障碍。且不同抑郁因子分的改善与生活质量、运动症状改善及药物减量间存在特异相关性。     

轻度认知功能障碍、焦虑及抑郁对帕金森病患者生活质量的影响

目的探讨轻度认知功能障碍(MCI)、焦虑及抑郁等对帕金森病(PD)患者生活质量的影响。方法选取诊治的103例PD患者,收集年龄、病程、受教育年限、统一帕金森病评定量表第三部分(UPDRSⅢ)评分、蒙特利尔认知评估量表(MoCA)评分、汉密尔顿抑郁量表(HAMD)评分及汉密尔顿焦虑量表(HAMA)评分和39项PD生存质量调查表(PDQ-39)评分等资料,分析上述指标与PDQ-39评分的相关性。结果相关性分析结果显示,年龄、病程、HAMA评分、HAMD评分、MoCA评分和UPDRSⅢ评分均与PDQ-39评分呈显著相关;多元线性逐步回归分析结果显示,年龄、HAMA评分、HAMD评分和MoCA评分是影响PDQ-39评分的主要因素(P 0. 05);影响PDQ-39评分的因素大小依次为HAMD评分、HAMA评分、MoCA评分和年龄。结论 MCI、焦虑及抑郁是影响PD患者生活质量的重要因素,且以抑郁的影响最大。     

双侧丘脑底核脑深部电刺激术可改善中晚期帕金森病患者的症状

目的 探讨双侧丘脑底核(subthalamic nucleus,STN)脑深部电刺激(deep brain stimulation,DBS)术,对中晚期帕金森病(Parkinson's disease,PD)患者运动、生活质量、情绪、睡眠、认知及术后用药剂量的影响.方法 10例接受双侧STN-DBS治疗的中晚期PD患者分别于术前1周及术后3个月、6个月、12个月应用统一帕金森病评分量表(unified Parkinson's disease rating scale,UPDRS)、Hoehn&Yahr分级、帕金森病生活质量问卷(PDQ-39)、帕金森病睡眠评估量表中文版(PDSS-CV)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA),简易智能状态检查(MMSE)评价其临床情况,同时记录各时间点抗帕金森病药物的剂量及其变化,并对相关结果进行描述性分析.结果 10例PD患者术后均获得了显著疗效,震颤、肌强直、动作迟缓等都有明显改善,术后6个月开机未服药状态下改善率分别为68%、53%、35%,开机服药状态下改善率分别为86%、78%、69%,其中以震颤改善最为显著.术后UPDRSⅢ评分及Hoehn&Yahr分级均降低,术后6个月服药状态下改善率分别为67%、32%;日常生活质量提高,PDQ-39术后6个月改善率为71%,睡眠质量较术前改善,焦虑抑郁情况较术前有不同程度减轻,认知功能尤明显影响.抗帕金森病药物用量术后6个月较术前减少45%.结论 双侧STN-DBS能明显改善中晚期PD患者的运动症状及非运动症状.     

帕金森病相关性疼痛的相关因素及其对生活质量的影响

目的探讨帕金森病(PD)相关性疼痛的相关因素及其对生活质量的影响。方法根据是否伴有疼痛将120例PD患者分为疼痛组(49例)和非疼痛组(71例)。采用PD统一评分量表(UPDRS)和Hoehn-Yahr(H-Y)分级评估患者的严重程度,采用PD生活质量量表-39(PDQ-39)测评其生活质量,用数字评分法(NRS)评估疼痛组患者疼痛程度。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和MMSE评价患者的焦虑、抑郁及认知情况。结果与无疼痛组比较,疼痛组H-Y分期及UPDRSⅠ、UPDRSⅢ服药后(med-on)、UPDRSⅢ服药前(med-off)、PDQ-39、HAMA、HAMD评分均显著升高(P0.05～0.01)。Spearman相关分析显示,NRS评分与H-Y分级及UPDRSⅠ、UPDRSⅢmed-off、UPDRSⅢmed-on、PDQ-39、HAMA、HAMD评分呈正相关(P0.05～0.01),与年龄、发病年龄、病程、受教育年限及UPDRSⅡ、MMSE评分无相关性(均P0.05)。线性回归分析显示,UPDRSⅡ、HAMA、NRS评分对PDQ-39有显著性影响(均P0.01)。结论 PD相关性疼痛可能与精神活动、运动症状、焦虑抑郁相关。PD相关性疼痛是影响PD患者生活质量的独立预测因子。     

帕金森病患者健康相关生活质量的影响因素研究

目的探讨影响帕金森病(PD)患者健康相关生活质量(HRQoL)的主要因素。方法选用39项PD问卷(PDQ-39)、PD统一评定量表(UPDRS)和相关非运动症状评定量表对99例PD患者进行调查,分析影响HRQoL的主要因素。结果相关分析显示,PDQ-39综合指数(PDQ-39SI)与病程、每日左旋多巴剂量、UPDRSⅡ、Ⅲ、Ⅳ评分、Hoehn-Yahr分期、17项汉密尔顿抑郁量表(HRSD-17)、汉密尔顿焦虑量表(HAMA)和爱泼沃斯嗜睡量表(ESS)评分呈正相关(r为0.42～0.80,P均小于0.01),与简易精神状态量表(MMSE)、帕金森病睡眠量表(PDSS)评分呈负相关(r为-0.47、-0.68,P均小于0.01),与PD分型呈正相关(r=0.23,P<0.05)。进一步的多元回归结果表明:UPDRSⅡ、HAMD-17、ESS评分是影响PDQ-39SI的主要因素,3因素相加对HRQoL的影响起决定作用的72.1%。结论非运动症状对PD患者HRQoL有着显著的影响,应重视对抑郁和日间过度嗜睡等非运动症状的治疗。     

丘脑底核脑深部电刺激治疗帕金森病抑郁障碍的初步临床研究

目的研究丘脑底核(STN)脑深部电刺激(DBS)治疗帕金森病(PD)抑郁障碍的短期疗效。方法对15例合并抑郁障碍的帕金森病患者丘脑底核进行电极植入,术后3个月进行PD分级量表(UPDRS)运动评分和汉密尔顿抑郁量表(HAMD17)评分,与术前1个月的评价对照。结果术后15例运动功能症状如肢体僵硬、震颤、运动迟缓和姿势平衡障碍改善良好,停药后UPDRS运动评分下降显著(P<0.01)。术后HAMD17总分下降显著(P<0.01),抑郁障碍改善显进2例(HAMD17减分率≥50%),进步7例(HAMD17减分率≥25%)。术后焦虑/躯体化、阻滞、睡眠障碍和体重因子分均显著低于术前(P<0.01),认知障碍因子分与术前无显著性差异(P>0.05)。结论STNDBS可明显改善帕金森病抑郁障碍症状,对焦虑/躯体化和阻滞等症状尤其显著。     

帕金森病脑深部电极植入术后程控参数与疗效相关性研究

目的分析丘脑底核-脑深部电刺激术(STN-DBS)治疗帕金森病的术后程控参数及效果,为帕金森病STN-DBS术后程控及术后管理提供参考。方法纳入2012~2018年就诊于新疆医科大学第一附属医院87例患者,应用UPDRS-Ⅲ评分UPDRS-II日常生活活动评分UPDRS-I精神行为情绪评分量表MMSE简易精神量表PDQ-39生活质量评分量表分析手术前后帕金森病患者运动及非运动症状改善情况,评估程控参数的设置对帕金森病人症状改善及生活质量改善作用。结果帕金森病患者与术前相比,患者术后UPDRSⅠ评分UPDRSⅠⅡ评分UPDRSⅢ评分UPDRSⅣ评分改善明显,手术后随访至今,患者症状改善稳定,生活质量明显提高。结论 STN-DBS是一种安全,有效治疗帕金森病的方法,并减少药物的剂量及药物所致副作用,术后程控是脑深部电极植入器治疗的重要一环。     

帕金森病合并抑郁障碍的临床研究

目的 探讨帕金森病 (PD)合并抑郁障碍的患病率及相关危险因素.方法 应用汉密尔顿抑郁量表 (HAMD)对217例PD患者的抑郁状况进行评定,根据疾病特异性界定值将患者分为合并或无抑郁障碍两组;并对所有患者进行统一PD评估量表 (UPDRS Ⅲ)、MMSE量表和39项PD问卷 (PDQ-39)评分.结果 PD合并抑郁障碍的患病率为21.7% (47/217),合并抑郁障碍的患者中接受抗抑郁治疗的比例为10.6% (5/47).Logistic回归结果示合并抑郁障碍的独立危险因素是Schwab-England分级和临床分型 (P均<0.01, OR分别为0.720和2.482).抑郁障碍组患者的生活质量明显劣于对照组.结论 PD合并抑郁障碍的患病率较高,并严重恶化患者的生活质量,但相应治疗并未得到医生的充分重视.严重残疾和强直-少动型明显增加PD合并抑郁障碍的危险性.     

DBS对帕金森病病人精神症状及认知功能的影响

目的 探讨丘脑底核（STN）-深部脑刺激术（DBS）对帕金森病（PD）病人精神症状及认知功能的影响。方法 回顾性分析2016年1月至2019年1月STN-DBS治疗的65例PD的临床资料。术前、术后1年，采用第三版统一帕金森病评分量表（UPDRS-Ⅲ）评估PD开关期运动症状；采用H-Y分期评估病情严重度；采用日常生活能力量表（ADL）评估日常生活能力；采用汉密尔顿焦虑量表（HAMA）评估焦虑情况；采用汉密尔顿抑郁量表（HAMD）评估抑郁情况；采用帕金森睡眠量表（PDSS）评估睡眠障碍情况；采用蒙特利尔认知评估量表（MoCA）和简易智力状态检查量表（MMSE）评估认知功能；采用帕金森患者生活质量问卷（PDQ39）测评生活质量。结果 术后1年，UPDRS-Ⅲ评分、H-Y分期、ADL评分、HAMA评分、HAMD评分、PDQ39评分、MoCA评分及MMSE评分均明显改善（P<0.05）。结论 STN-DBS能够显著改善PD病人运动症状、精神症状、认知功能及生活质量。     

The importance of educational and psychological factors in Parkinson''s disease quality of life

OBJECTIVE: To define the factors correlated with quality of life (QoL) in patients with idiopathic Parkinson's disease (PD). BACKGROUND: PD has a substantial impact on QoL. Although several clinical factors have been associated with QoL in PD, the influence of patient's education still remains controversial. METHODOLOGY: A consecutive series of patients with PD were examined using the unified Parkinson's Disease Rating Scale (UPDRS part I, II, III), Schwab and England (SE), and Hoehn and Yahr stage (H&Y). QoL was rated with the PDQ-39, cognition with the Mini-Mental State examination (MMSE), and the presence of depressive symptoms with the geriatric depression scale (GDS). Patient's characteristics, estimated cumulative levodopa dose (CLD), UPDRS, H&Y, MMSE and GDS were correlated with the PDQ-39 using univariate and multiple regression analysis. RESULTS: A total of one hundred 58 patients (68 men, 90 women) with a mean age of 65.6 +/- 9.3 years, PD duration of 8.1 +/- 10.6 years, and education of 6.6 +/- 3.9 years were included. The mean PDQ-39 was 48.8 +/- 27.8, mean MMSE was 25.7 +/- 4, and mean GDS was 11.7 +/- 6.8. Using stepwise multiple regression analysis, the most important predictive factors were depression, UPDRS part I, UPDRS part II, and educational background, which accounted for a 61% of the variability of the PDQ-39 scores. CONCLUSIONS: In our PD sample, educational, behavioural, and psychological factors influenced life satisfaction more than physical ones.     

Determinants of quality of life in Brazilian patients with Parkinson's disease.

Our objective was to identify determinants of health-related quality of life (HRQoL) in a cohort of Brazilian patients with Parkinson's disease (PD). Patients were evaluated by means of the Hoehn and Yahr staging (H&Y), Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England scale (S&E), Mini-Mental State Exam, Geriatric Depression Scale, and Hospital Anxiety and Depression Scale (HADS). HRQol was assessed using the MOS-Short-Form 36 (SF-36), the Parkinson's disease Questionnaire (PDQ-39), and the Scales for Outcomes in Parkinson's Disease-Psychosocial Questionnaire (SCOPA-PS). 144 patients were evaluated (mean age 62 years; 53.5% men; mean duration of illness 6.6 years; median H&Y, 2 (range: 1-4). Mean SCOPA-PS and PDQ-39 Summary Index (SI) were 39.2 and 40.7, respectively. Both, PDQ-39 and SCOPA-PS SIs correlated at a moderate level (r = 0.30-0.50) with H&Y, S&E, total UPDRS, HADS subscales, and SF-36 Physical and Mental Components. PDQ-39 and SCOPA-PS were closely associated (r = 0.73). HRQoL significantly deteriorated as H&Y progressed, as a whole. Mood disturbances, disability, motor complications, and education were independent predictors of HRQoL in the multivariate analysis model. In PD Brazilian patients, HRQoL correlated significantly with diverse measures of severity. Depression showed to be the most consistent determinant of HRQoL, followed by disability, motor complications, and education years. There was a close association between the PDQ-39 and SCOPA-PS summary scores.     

Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson's disease.

We examined the impact of the subthalamic nuclei (STN) deep brain stimulation (DBS) on the health-related quality of life (QoL) of patients with advanced Parkinson's disease (PD). Seventeen consecutive patients with refractory motor fluctuations and dyskinesia were included in the study (mean age, 60.9 +/- 7.7 years [range, 43-74 years]; disease duration, 16.4 +/- 8.5 years [range, 7-38 years]; mean off-medication Hoehn and Yahr stage, 4.23 +/- 0.66 [range, 2.5-5]). Each patient's assessment was carried out using common rating scales, following the Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol. Dyskinesia and emotional state were evaluated through the Abnormal Involuntary Movement Scale (AIMS) and the Hospital Anxiety and Depression Scale (HAD). QoL was assessed by means of the Parkinson's Disease Questionnaire Spanish version (PDQ-39). Significant benefit was obtained in the motor manifestations and complications of disease, as well as in the functional state and mood (P < 0.001). Some QoL dimensions (mobility and activities of daily living) and the PDQ-39 Summary Index (PDQ-39SI) showed a significant improvement (P < 0.001). Benefit was modest (P < 0.05) for three other domains (emotional well-being, stigma, bodily discomfort) and nil for the rest. There was no correlation between the change obtained in the QoL (PDQ-39SI) and in the other variables. As measured by the PDQ-39, STN-DBS significantly improves important aspects of QoL in patients with advanced PD.     

Factors affecting the quality of life of patients with idiopathic Parkinson's disease--a cross-sectional study in an outpatient clinic attendees

PURPOSE: To determine the factors associated with poor quality of life (QoL) in patients with idiopathic Parkinson's disease (PD) in a clinic-based sample. SCOPE: One hundred patients were included in this study. To assess the quality of life the Parkinson's Disease Questionnaire (PDQ-39) was used. A structured questionnaire interview and a complete neurological examination, including the Hoehn and Yahr scale (H-Y), the Schwab and England disability scale, II, III, IV parts of the unified Parkinson's disease rating scale (UPDRS part II, III, IV), Montgomery-Asberg depression rating scale (MADRS) and the Mini-Mental state examination (MMSE) were performed. RESULTS AND CONCLUSIONS: The most important predictive factor was MADRS score, followed by clinical fluctuations as measured by UPDRS part IVB and the H-Y stage of disease, which account for 79% of the variance of QoL scores. Therefore, recognition of depression should become an important part of treatment of PD.     

Pallidotomy and quality of life in patients with Parkinson's disease: an early study.

The purpose of this study was to analyze the effect of stereotactic neurophysiologically guided pallidotomy on health-related quality of life (QoL) of patients with Parkinson's disease (PD). Eleven patients with PD (seven men, four women; mean age, 57.2 years; mean duration of disease, 14 years) with motor complications refractory to medical therapy underwent unilateral pallidotomy. Clinical assessment was carried out a week before surgery and 4 months after the surgical procedure and was based on the Core Assessment Program for Intracerebral Transplantations protocol. QoL was measured by means of the PDQ-39. A set of rating scales (Hoehn & Yahr, Unified Parkinson's Disease Rating Scale, Schwab and England, Northwestern University Disability Scale of Walking, Abnormal Involuntary Movement Scale), timed tests, and self-evaluations of motor function and mood were applied. Improvement was found in dyskinesias (74%) and off-period disability (42%). Cardinal motor signs improved significantly (30%-59%). Four dimensions of the PDQ-39 (Mobility, ADL, Emotions, Bodily Pain) showed a significant improvement (p <0.01-0.001). The global effect on QoL, measured through the PDQ-39 Summary Index (35.3%; 95% confidence interval: 15.60-54.97), was also significant (p<0.01) but unrelated to major clinical changes. Pallidotomy significantly improves QoL in patients with advanced PD. QoL measurement provides relevant information that is probably not attainable by clinical assessment.     

Patient-perceived involvement and satisfaction in Parkinson's disease: effect on therapy decisions and quality of life.

Patient-centered consultation styles are associated with higher patient satisfaction and improved health outcomes in diabetes and hypertension. In outpatient neurology, dissatisfaction with communication relates significantly to noncompliance. We undertook a single-center study in Parkinson's disease (PD) using standardized questionnaires to score patient-perceived involvement in therapy decisions (score 4 = low to 25 = high) and satisfaction with the consultation (score 1 = low to 7 = high). Correlation was tested against health outcomes of Unified Parkinson's Disease Rating Scale (UPDRS) Motor score, activities of daily living (UPDRS 2 and Schwab and England), Parkinson's disease quality of life (PDQ-39), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Of 117 patients enrolled, 107 (91%) fully completed the questionnaires. Mean patient-perceived involvement scored 14.4 (SD, 2.8). Mean satisfaction scored 5.3 (SD 0.7). Higher involvement was associated with increased satisfaction (r = 0.28; P = 0.003), particularly distress relief (r = 0.38; P < 0.0001). Communication scores correlated significantly with compliance intent (r = 0.6; P < 0.0001). There was no correlation between either involvement or satisfaction and UPDRS, Schwab and England, MMSE, or GDS. Quality of life was significantly associated with depression, UPDRS, duration of PD, compliance intent, and satisfaction. The significant positive association between compliance intent and quality of life in the more satisfied patient replicates findings in other disease areas. Due attention to these aspects in delivering care to the PD patient is appropriate.     

The EQ-5D--a generic quality of life measure-is a useful instrument to measure quality of life in patients with Parkinson's disease

OBJECTIVE: To test the feasibility and validity of the EQ-5D (a widely used generic (disease non-specific) quality of life (QoL) instrument which allows comparisons between different patient groups and the general population) to assess QoL in patients with Parkinson's disease. METHODS: All 124 patients with Parkinson's disease seen in a community based study on the prevalence of parkinsonism were asked to complete a QoL battery comprising the EQ-5D, the medical outcome study short form (SF-36), the PDQ-39, a disease specific instrument to assess QoL in PD, and the Beck depression inventory. A structured questionnaire interview and a complete neurological examination including the Hoehn and Yahr stage of illness scale, the Schwab and England disability scale, the motor section of the unified Parkinson's disease rating scale (UPDRS), and the mini mental state examination (MMSE) were performed on the same day. RESULTS: The response rate was 78% and the completion rate of the EQ-5D among responders was 96%. The EQ-5D summary index correlated strongly with the PDQ-39 (r=-0.75, p<0.0001) as well as the physical score of the SF-36 (r=0.61, p<0.0001). There was a significant correlation of the EQ-5D summary index with disease severity, as measured by the Hoehn and Yahr stage of illness, the Schwab and England disability scale, the motor section of the UPDRS, and the depression score. The EQ-5D summary index also distinguished between patients with and without depression, falls, postural instability, cognitive impairment hallucinations, and those with deterioration of health over the previous year. CONCLUSION: The EQ-5D is a feasible and valid instrument to measure QoL in Parkinson's disease and reflects the severity and complications of the disease.     

Independent validation of SCOPA-psychosocial and metric properties of the PDQ-39 Brazilian version.

The objective of this study was to perform an independent validation of the Scales for Outcomes in Parkinson's Disease-Psychosocial questionnaire (SCOPA-PS) and assessment of the Parkinson's Disease Questionnaire (PDQ-39), Brazilian version. Patients were evaluated by means of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging (HY), Schwab and England scale, Mini-Mental State Examination, and Hospital Anxiety and Depression Scale. Health-related quality of life was evaluated using the MOS-Short Form 36 (SF-36), PDQ-39, and SCOPA-PS. One hundred forty-four patients were included (mean age, 62 years; 53.5% males; mean duration of illness, 6.6 years; HY, 1-4). Mean SCOPA-PS and PDQ-39 Summary Index (SI) were 39.2 and 40.7, respectively. The internal consistency of SCOPA-PS (Cronbach's alpha = 0.84; item-total correlation, 0.44-0.73) and PDQ-39 dimensions (alpha = 0.61-0.85; item-total correlation, 0.46-0.82) were satisfactory. Concerning the stability of the questionnaires, intraclass correlation coefficient (ICC) values were 0.71 for the SCOPA-PS and 0.86 for the PDQ-39 SI. ICC for PDQ-39 dimensions ranged from 0.52 (social support) to 0.80 (stigma). Standard error of measurement (SEM) values for each PDQ-39 dimension ranged from 0.49 (emotional well-being) to 17.52 (social support). SEM values for SCOPA-PS and PDQ-39 SI were 11.84 and 6.72, respectively. A significant correlation of SCOPA-PS and PDQ-39 SI with the SF-36 physical (-0.42 and -0.52, respectively) and mental components (-0.41) was found. Correlation between SCOPA-PS and PDQ-39 SI was 0.73 (all coefficients, P < 0.0001). The SCOPA-PS and PDQ-39, Brazilian versions, have satisfactory metric attributes.     

Psychometric characteristics of the Parkinson's disease questionnaire (PDQ-39)--Ecuadorian version

This study sought to analyse certain metric characteristics of the Ecuadorian version (EV) of the Parkinson's Disease Questionnaire (PDQ-39 EV). A cross-sectional study was conducted on 137 Parkinson's disease (PD) patients attending a Movement Disorders Unit. Neurologists' assessments were based on Hoehn and Yahr (HY), Schwab and England and Unified Parkinson's Disease Rating Scales. Patients' self-evaluations included the Hospital Anxiety and Depression Scale, the Parkinson's Disease Quality of Life questionnaire (PDQL EV), and the PDQ-39 EV. Analyses for acceptability, internal consistency, precision, and construct validity (convergent and known-groups) were performed. Distribution of scores was satisfactory. There was no evidence of floor or ceiling effects. Although the alpha coefficient exceeded 0.70 for mobility, activities of daily living (ADL) and stigma, it was nevertheless low for bodily discomfort (0.48), communication (0.40), and social support (0.33). Fourteen items yielded low correlation coefficients (<0.40) with their respective dimensions. Correlation of social support and bodily discomfort with the Summary Index (SI) was modest (0.46 and 0.36, respectively). PDQ-39 EV SI convergent validity with the PDQL EV SI was very high (r(S)=-0.91), and known-groups validity proved satisfactory. Results agreed in part with those yielded by an international study, identifying specific flaws probably linked to socio-cultural influence.     

Freezing of gait affects quality of life of peoples with Parkinson's disease beyond its relationships with mobility and gait.

The aim of this study was to examine the association between freezing of gait (FOG) and quality of life (QoL) in patients with Parkinson's disease (PD). PD patients (n = 118) completed the PDQ-39 (QoL) and FOG-Q questionnaires. Disease severity was assessed by the Hoehn and Yahr (H&Y) staging and the Unified Parkinson's Disease Rating Scale (UPDRS). The relations between those parameters were assessed using regression models. 66 men and 52 women (mean age 65.8 +/- 10.2 years, UPDRS total score 48.4 +/- 17.1, disease duration 8.5 +/- 5.8 years, H&Y stage 2.7 +/- 0.8) participated. FOG severity had a significant effect on QoL (P < 0.0015), accounting for disease severity assessed by UPDRS. Specifically, FOG severity was correlated with all the dimensions of the PDQ-39 except for stigma and social support, as follows: with mobility, bodily discomfort, activity of daily living (ADL) (P < 0.005 in all), with emotional, communication, and cognition (P < 0.05 in all). FOG severity (FOG-Q) was also found to affect a modified PDQ total score, without the mobility aspect (P = 0.0081). FOG should be viewed as a highly important symptom with regard to QoL of PD patients beyond its effect on gait and mobility. On the basis of the present results, special attention should be given to FOG in the treatment of patients with PD.