Sleep disturbances in Japanese patients with Parkinson's disease--comparing with patients in the UK

Sleep disorders are common in the general population and occur more frequently with advancing age. However, patients with Parkinson's disease (PD) have been known to have various sleep disturbances beyond those to be expected from the effect of aging alone. We tried to quantify the various aspects of nocturnal sleep problems in PD using the PD sleep scale (PDSS). 64 patients with PD and 60 age- and sex-matched controls completed the PDSS. After neurological examinations, we assessed the degree of sleep disorder by the PDSS. We evaluated the severity of PD by the Hoehn and Yahr Scale and the unified PD rating scale (UPDRS). To compare the various aspects of nocturnal sleep problems in PD between in Japan and in the United Kingdom (UK), we referenced and compared our results with those by Chaudhui et al. The PDSS scores in PD group were significantly different from those in controls. Individual items of the scale showed good discriminatory power between PD and controls. Overall tendencies were the same in Japan and in the UK, but there were some different points, especially absence of refreshing quality of sleep in Japan. We believe that the PDSS provides an objective method for targeted therapeutic approaches for the treatment of disturbed sleep in PD even among countries with different cultures, such as Japan and the UK.     

Life expectancy of parkinsonism patients in the general population

IntroductionDetailed data on the life expectancy of patients with parkinsonism from the general population are largely lacking. This study aimed to determine the absolute life expectancy of patients newly-diagnosed with parkinsonism.MethodsThis study was part of the Rotterdam Study, an ongoing, population-based cohort study in the Netherlands. We included 12,789 participants of 50 years and older, free of parkinsonism. Patients diagnosed with parkinsonism were matched to controls on sex, birth year, dementia status, cancer status, and coronary heart disease status. We used Gompertz regression and lifetables to estimate the remaining life expectancy per year of age.ResultsThe mean age of our study population was 65.0 (SD 9.7) years and 57.6% were women. During an average follow-up of 12 years, 297 participants were diagnosed with parkinsonism. The mean age at parkinsonism diagnosis was 78.6 (SD 8.1) years. Once diagnosed with parkinsonism, the life expectancy was lower than matched controls across a wide age range. At 65 years, the life expectancy of patients with parkinsonism was reduced with 6.7 [95% CI: 2.4;10.7] years compared to controls. At 85, the difference in life expectancy was 1.2 [95% CI: -2.2;4.5] years compared to controls.ConclusionPatients diagnosed with parkinsonism have a reduced life expectancy compared to their peers in the general population. The absolute life expectancy is mainly reduced if parkinsonism is diagnosed before the age of 70.     

Quality of life in patients with Parkinson's disease

We evaluated the quality of life (QoL) in 278 Indian patients with Parkinson's disease (PD) using PDQL questionnaire, with measures various aspects of health status in PD patients including parkinsonian symptoms, systemic symptoms, social and emotional functions. Apart from demographic and treatment details parkinsonian disability and stage was assessed by Hoehn and Yahr stage, Schwab and England scale and UPDRS scores. We conclude that female gender, presence of depression, low degree of independence, higher levodopa dose (>400 mg/day) and higher UPDRS activity of daily living score have the most detrimental impact on QoL in patients with Parkinson's disease. Depression was the most significant factor impairing the QoL and it needs to be treated.     

Health related quality of life in adult patients with epilepsy compared with a general reference population in Taiwan

To compare the health-related quality of life (HRQL) for patients with epilepsy and health subjects, we collected the clinical and demographic data and information on health states by using the Taiwan version of World Health Organization quality of life (WHOQOL)-BREF questionnaire in 296 patients (aged 19-73 years) with confirmed active epilepsy visiting the clinic of National Taiwan University Hospital, and 296 age-, gender-, municipal- and education-matched Taiwanese healthy subjects sampled from a national health interview survey. Multiple regression analyses with stepwise selection strategy were conducted to study risk factors for impairment of HRQL. Patients with epilepsy have poorer HRQL than the healthy population in physical, psychological and social domains but not in environment domain (p<0.005). Patients with less than 4 attacks during the previous 1 month had a better score in the availability and quality of health and social care in environment domain than healthy subjects (p<0.05). After controlling other determinants, seizure frequency, and comobid with other diseases are the important factors in predicting HRQL for epilepsy patients. Patients with employment and married had a significantly better HRQL. Effective control of seizure frequency and thoughtful promotion of positive attitudes in community are essential to improve the HRQL of epilepsy patients.     

Lower life satisfaction in physicians compared with a general population sample

Background  There is a strong need for longitudinal and representative studies that focus on doctors’ well-being. Methods  We conducted a longitudinal and nationwide cohort study (N = 631) of graduating medical students (T1), followed up in their first (T2), fourth (T3) and ninth (T4) postgraduate years. Response rates varied from 62 to 83%; the longitudinal response rate was 41%. We used comparison samples from a general population survey. Predictors of life satisfaction among the doctors were tested by linear regressions and repeated measures statistics. Results  Doctors of both genders had significantly lower levels of life satisfaction than those in the comparison samples. Life satisfaction was lowest at T1, improved at T2, and stayed at the same level thereafter. Adjusted predictors of life satisfaction at T4 were lower age (P = 0.03), low level of neuroticism personality trait (P = 0.02), being married/cohabiting (P < 0.001), perceived social support (P < 0.001), lower work stress (P = 0.002), negative life events (P = 0.002), and frequency of physical training (P = 0.04). Only one-fifth of the total explained variance (R ² = 0.34) was due to personality traits, whereas half was explained by married/cohabitant status and perceived social support. Being married/cohabiting, social support and physical training remained significant when mental distress (anxiety and depressive symptoms) was included in an additional multivariate model (R ² = 0.49). Neuroticism trait (P < 0.001) was a significant predictor in the repeated measures model, but the increase in life satisfaction from T1 to T2 was predicted by lower levels of conscientiousness trait (P = 0.009). Conclusions  Norwegian doctors were less satisfied than an educationally age-matched group of the general population. Concurrent situational factors and stress, such as social support and mental distress were of major importance. However, personality clearly predicted life satisfaction over the years.     

Fatigue in patients with sarcoidosis, compared with the general population

Objective

Fatigue is a significant symptom in sarcoidosis patients. The causes for this symptom are unclear. The aims of this study were to analyze age and gender differences in fatigue, compared with the general population, and to test the psychometric properties of two questionnaires measuring fatigue in sarcoidosis.

Method

A sample of 1197 patients diagnosed with sarcoidosis was examined in Germany with the Fatigue Assessment Scale (FAS) and the Multidimensional Fatigue Inventory (MFI).

Results

The percentages of patients exceeding the fatigue cut-offs were 70% (FAS) and 68% (MFI), respectively. While in the general population there is a nearly linear age trend (high fatigue scores with increasing age), among the patients there is only a very slight and nonlinear age trend. Female patients are more affected by fatigue than male patients, but this relationship is also true in the general population. Both questionnaires (FAS and MFI) are equally suited to test fatigue; their psychometric properties are good. They should not be replaced with a single question concerning tiredness.

Conclusion

The comparison to norm data is highly recommended for the evaluation of age and gender differences. Compared with the general population, young sarcoidosis patients are especially affected by fatigue.     

帕金森病患者的非运动症状对其生活质量的影响

目的探讨帕金森病(PD)患者及不同亚群生活质量(QOL)的影响因素,分析非运动症状(NMS)的具体影响。方法用统一PD评定量表第Ⅲ、Ⅴ部分(UPDRS-Ⅲ、H-Y分级)评定185名原发性PD患者的运动症状,用PDNMS筛查问卷(NMSQ)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、PD睡眠量表(PDSS)和蒙特利尔认知测验(MOCA)评定NMS,用36条简化医疗结局调查问卷(SF-36)评价QOL。采用逐步多元线性回归分析探讨PD患者QOL的影响因素和NMS的具体作用。结果 PD患者SF-36各维度分值均较健康同龄老人下降。相关分析显示,SF-36总分与H-Y分级、UPDRSⅢ、HAMA、HAMD及NMSQ分值成负相关,与PDSS评分成正相关,与HAMD的6个因子(除日夜变化)和NMSQ的9个症状群(除性功能)均显著负相关。回归分析显示,UPDRSⅢ和强直分能解释SF-36总分变化的21.6%,加入各NMS量表分值后,NMSQ能单独解释SF-36总分变化的21.5%;引入HAMD和NMSQ的细项后,绝望感、泌尿道症状、认知损害、体质量减轻、和阻滞症状能解释SF-36总分变化的35.8%;≤65岁、66岁～75岁和>75岁患者的QOL影响因素不同。结论 NMS中的绝望感、泌尿道症状、认知、体质量减轻、阻滞症状以及运动障碍中的强直型对QOL的影响较大,且导致不同年龄段患者QOL下降的因素不同。故需重视上述NMS的诊治,以改善PD患者QOL。     

Quality of life in young‐ compared with late‐onset Parkinson's disease

The impact of Parkinson's disease on quality of life may vary depending on age at onset. We investigated the effect of age at onset on quality of life in a large Parkinson's disease population (n = 426) using a disease‐specific rating scale (PDQ‐39) and with careful adjustment for confounding and intermediary factors. We also explored the relationship between depression and excessive daytime sleepiness by age at onset and compared this with the general population. We found that a younger age at onset was significantly associated with worse overall quality of life scores (odds ratio, 2.66; 95% confidence interval, 1.39–5.09; P = .003), but this was attenuated by adjustment for depression as an intermediary factor (odds ratio, 1.86; 95% confidence interval, 0.84–4.11; P = .13). Younger onset was also a risk factor for poor emotional well‐being independent of depression status. Risk of depression and excessive daytime sleepiness were elevated in patients with Parkinson's disease compared with controls (odds ratio, 2.99; 95% confidence interval, 1.93–4.65; P < .001; and odds ratio, 3.84; 95% confidence interval, 2.56–5.75; P < .001, respectively), with similar findings seen in both early‐ and late‐onset groups. Our study highlights the need for accurate diagnosis and treatment of depression in younger‐onset patients in order to improve quality of life. © 2011 Movement Disorder Society     

Quality of life in social anxiety disorder compared with panic disorder and the general population

OBJECTIVE: Quality of life in a treatment-seeking cohort of patients with social anxiety disorder was compared with that of patients with panic disorder who were matched for age, comorbid illnesses, and gender and with population-based norms. METHODS: The study participants were 33 patients with social anxiety disorder and 33 patients with panic disorder who had participated in clinical trials and who had completed the Medical Outcomes Study Short-Form-36 (SF-36) as part of a baseline evaluation. The patients did not have significant comorbid psychiatric disorders. Paired t tests were used to compare baseline scores on subscales of the SF-36 between the two cohorts. One-sample t tests were used to compare scores on subscales of the SF-36 with expectation scores based on 2,474 persons from the general population. RESULTS: Compared with the general population, the patients with social anxiety disorder had significantly greater impairment as measured by the SF-36 social functioning and mental health subscales. Subscale scores also indicated poorer emotional role functioning, but the difference was not significant. However, they were significantly less impaired than the patients with panic disorder in terms of physical functioning, physical role, and mental health. CONCLUSIONS: Patients with social anxiety disorder who do not have significant comorbid depression or anxiety are substantially impaired in quality of life, but to a lesser extent than patients with panic disorder, who suffer from both mental and physical impairments in quality of life.     

Neural networks associated with quality of life in patients with Parkinson's disease

IntroductionThe neural underpinnings of health-related quality of life in Parkinson's disease remain unclear. This study was conducted to unravel which motor and non-motor symptoms in Parkinson's disease influence health-related quality of life and reveal neural networks most likely linked to it.MethodsComprehensive clinical assessments were conducted for 247 Parkinson's disease patients and image analyses were performed for 181 patients. Clinical scores commonly used to assess various symptoms related to health-related quality of life were investigated. Factor and resting-state functional magnetic resonance imaging analyses were reviewed to reveal health-related quality of life-associated brain networks.ResultsThe Spearman's rank correlation coefficient for the Parkinson's disease Questionnaire-39 summary index was high in the Activities-specific Balance Confidence Scale, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part 2, Freezing of Gait Questionnaire, and Self-reported Autonomic Symptoms in Parkinson's disease. Multiple regression and Random Forest regression analyses indicated that health-related quality of life-associated factors were Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part 1, Depression Rating Scales, and the above-mentioned scales. The resting-state functional magnetic resonance imaging analysis revealed decreased functional connectivity between the anterior cingulate cortex and right temporo-parietal junction as health-related quality of life worsened.ConclusionFear of falling, daily living activities, gait freezing, and autonomic dysfunction have notable effects on health-related quality of life in Parkinson's disease. Brain networks consisting of the anterior cingulate cortex and temporo-parietal junction may be associated with the emotion-related and social factors of health-related quality of life in Parkinson's disease.     

Increased life expectancy in people with untreated phenylketonuria

The records of 17 people with intellectual disability and untreated phenylketonuria (12 females and five males), who were resident in the Stoke Park Group of Hospitals, Bristol, England, 25 years ago, were reexamined for life expectancy. Six subjects had died (five females and one male). The oldest deceased female was 69 years of age. The average age at death was 55.8 years. Eleven subjects were still alive (seven females and four males). The oldest living male was 79 years of age. The average age of the survivors was 55.7 years.     

Nutrient intake in patients with irritable bowel syndrome compared with the general population

Background Food and diet are central issues that concern patients with irritable bowel syndrome (IBS). Few studies have thoroughly analyzed dietary intake in IBS. Our aims were to determine the nutrient intake in IBS patients in comparison to the general population, assess nutritional differences between IBS subgroups based on the predominant bowel habit or symptom severity, as well as to evaluate if their nutrient intake meet nutrition recommendations. Methods We included 187 IBS patients (mean 40.2 years; 139 women). They completed a 4‐days food registration record, which was compared with an age‐, and gender‐matched control group (n = 374; 278 women) from a nation‐wide dietary survey and with Nordic Nutrient Recommendations. Key Results Daily nutrient intake in IBS patients was similar to the general population and met national nutrients recommendations. Irritable bowel syndrome patients had similar energy distribution from macronutrients compared to the control group, but the protein percentage tended to be higher. Irritable bowel syndrome patients also had significantly higher daily intake of vitamin E, folate, iron, vitamin C, and dietary fibers, as well as lower intake of vitamin A, riboflavin, calcium, and potassium. There was no association between nutrient intake and IBS subtypes or symptom severity. Conclusions & Inferences Although many IBS patients state that they avoid food items, this does not seem to influence their intake of nutrients to any large extent. The observed minor differences in nutrient intake indicate a tendency toward higher intake of fruit and vegetables and a lower intake of meat and dairy products in IBS patients.     

Quality of life in Polish patients with long-lasting Parkinson's disease.

The objective of this study was to evaluate possible relationships between quality of life (QoL) of Polish patients with long-lasting Parkinson's disease and various demographic and clinical factors. The study comprised 141 patients of Movement Disorders outpatient clinics in Warsaw and Gdansk with at least 5 years of the disease duration. Mean age of patients was 68.09 +/- 8.51 years, mean duration of disease was 11.87 +/- 5.14 years. To assess the quality of life, the Parkinson's Disease Questionnaire (PDQ-39) was used. Additional questions concerned duration of disease, initial and current treatment and expenses associated with therapy. Self-perceived symptoms of depression were in our study the most important factor determining QoL. Duration of the disease and expenses related to the treatment also have a significant impact on the QoL. Patient's age and presence of dyskinesia seem to be irrelevant to the quality of life.     

Quality of life among young patients with ischaemic stroke compared with patients with multiple sclerosis

Objectives –  We aimed to evaluate the quality of life among young ischaemic stroke (IS) patients at long-term follow-up by comparing them with multiple sclerosis (MS) patients with secondary progressive course. The mean age at stroke onset was 41.6 years.
Methods –  Nottingham Health Profile scores were obtained from 191 IS patients 6 years (mean) after the index stroke, from 337 MS patients 5 years (mean) after the onset of the secondary progressive course and from 216 controls.
Results –  The mean age of IS patients was 47.8 years and MS patients 44.5 years at follow-up. The MS patients as a group had worse subscores than the IS patients. When adjusting for physical mobility, complaints of fatigue ( P  = 0.012) were more frequent among MS patients, whereas pain ( P  < 0.001) and sleep ( P  = 0.007) disturbances were more frequent among IS patients.
Conclusion –  The comparison of IS and MS patients highlights the importance of pain and sleep disturbances among IS patients when adjusting for physical mobility.     

Influence of motor symptoms upon the quality of life of patients with Parkinson's disease

We studied the impact of various motor and nonmotor symptoms upon quality of life in patients with Parkinson's disease (PD). The study comprised 110 patients with PD (age: 68.6 years, course of the disease: 7.6 years). The Unified Parkinson Disease Rating Scale (UPDRS; I-IV) and Parkinson's Disease Questionnaire (PDQ-39) were recorded. We recorded the correlations between years of disease and UPDRS IV, as well as PDQ-39 and UPDRS I, II, III and IV. Introduction of all variables into a linear regression model showed that 3 variables accounted for 51% of the variance in PDQ-39. Mental condition, gait disorders and complications of dopaminergic drugs are the variables that most affect the quality of life of patients with PD.     

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.     

Impact of fatigue on quality of life in patients with Parkinson's disease

Background and purpose:  Fatigue is frequent and important in the lives of Parkinson's disease (PD) patients. It is multidimensional, with physical and mental aspects. The aim of our study was to explore the impact of fatigue on quality of life (QoL) for PD patients.
Methods:  The sample consisted of 175 PD patients from Eastern Slovakia (52% males, mean age 68.2 ± 9.2, mean disease duration 7.4 ± 6.7). The Multidimensional Fatigue Inventory (five dimensions), the Parkinson's Disease Quality of Life Questionnaire (eight dimensions) and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Fisher's exact test, t -test, and multiple linear regression analysis were used.
Results:  Different aspects of fatigue selectively explained different domains of QoL – physical dimensions of fatigue were connected with Mobility and Activities of daily living; mental fatigue dimensions affected Cognition, Emotional well-being, Communication and Activities of daily living; general fatigue was related to Bodily discomfort. The explained variances varied from 5% (Social support) to 65% (Activities of daily living).
Conclusion:  Fatigue combined with worse functional status appears to be a significant contributor to poor quality of life. Its multidimensional construct can be used to develop strategies for improving specific aspects of fatigue to improve QoL for PD patients.