Subjective perceived outcome of subthalamic deep brain stimulation in Parkinson's disease one year after surgery

ObjectivesDissatisfaction with subthalamic deep brain stimulation (STN-DBS) despite motor improvements has been observed in Parkinson's disease (PD). Hence, we compared patient's subjective perceived outcome 12 months after surgery (12mFU) with clinical measures to identify risk factors of dissatisfaction.MethodsPatients were examined at baseline and 12mFU. Quality of life (QoL), neuropsychiatric, cognitive and neurological functioning was measured. Patients were classified concerning their subjective outcome (negative = dissatisfaction; mixed; positive = satisfaction) at 12mFU using semi-structured interviews. First, the three groups were compared concerning interview statements. Second, repeated measures ANOVAs with group as between-subjects factor were applied to find significant effects of time, group, or interaction. Third, binary logistic regression determined predictors of dissatisfaction.ResultsOf the 28 enrolled patients, 25% perceived their outcome as negative, 32.1% as mixed, and 42.9% as positive. Concerning interview statements, dissatisfied patients mentioned significantly less often improved QoL and reduced medication, and reported worsening of mental state, and social interaction. For the whole sample, significant improvement over time was found for motor functioning, daily dopamine dosages, and QoL. Apathy significantly worsened over time, but dissatisfied patients were overall more apathetic and depressed than the other groups. Significant interaction of group and time was identified for QoL, which only improved in the mixed and satisfied group. Finally, preoperative apathy and axial symptoms predicted dissatisfaction with STN-DBS.ConclusionsAlthough motor symptoms and QoL improved in the whole sample, 25% of patients showed disappointment with STN-DBS. Especially apathy predicts dissatisfaction and should be considered preoperatively.     

Clinical depression while caring for loved ones with breast cancer

IntroductionThe period of the cancer patients undergoing treatment is also the most stressful time for their family caregivers. This study aimed to determine the rates of major depressive disorder and dysthymia; and their associated factors in the caregivers during this time.MethodsOne hundred and thirty caregiver–patient dyads attending the oncology centre for breast cancer treatment participated in this cross-sectional study. While the data on the patients’ socio-demographic and illness characteristics were obtained from their medical record, the caregivers completed three self-report measures: 1) socio-demography and the caregiving factor questionnaire, 2) Multi-dimensional Perceived Social Support (MSPSS) and 3) Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those with “probable depression” identified from the DASS-21 score were interviewed using The Mini-International Neuropsychiatric Interview (MINI) to obtain the diagnoses of depressive disorders.ResultsTwenty-three of the 130 caregivers (17.69%) were diagnosed to have depressive disorders, where 12.31% (n = 16) had major depressive disorder and 5.38% (n = 7) had dysthymic disorder. Factors associated with depression include ethnicity, duration of caregiving, the patients' functional status and the caregivers' education level. Logistic regression analysis showed that the patients' functional status (p < 0.05, OR = 0.23, CI = 0.06–0.86) and the caregivers' education level (p < 0.05, CI = 9.30, CI = 1.82–47.57) were significantly associated with depression in the caregivers attending to breast cancer patients on oncology treatment.ConclusionsA significant proportion of family caregivers were clinically depressed while caring for their loved ones. Depression in this population is a complex interplay between the patients' factors and the caregivers' factors.     

基于结构方程模型的精神疾病患者照料者抑郁焦虑的影响因素研究

目的基于结构方程模型,探讨精神疾病患者照料者抑郁焦虑的影响因素。方法采用便利抽样收集602例住院精神疾病患者的照料者,使用简化版家庭负担访谈量表(FEIS)评估患者照料者的抑郁焦虑状态、患者的暴力行为、自杀倾向、照料者日常生活受到的影响以及照料者感受的亲友关系,采用结构方程模型建模法分析照料者的抑郁焦虑状态及其影响因素。结果患者的暴力行为通过对照料者日常生活的影响,间接影响照料者抑郁焦虑状态(间接效应为0. 059);患者的自杀倾向直接影响照料者抑郁焦虑状态(直接效应为0. 139),对照料者日常生活的影响部分间接作用于照料者抑郁焦虑状态(间接效应为0. 014);与来自患者症状的作用相比,照料者感知到的亲友关系对其抑郁焦虑状态影响更大(总效应为0. 281)。结论患者的自杀倾向直接影响照料者抑郁焦虑状态,照料者日常生活受到的影响在其中仅起到部分中介作用。照料者日常生活受到的影响完全中介了患者的暴力行为对照料者抑郁焦虑状态的作用。照料者感受到较好的亲友关系可以降低自身的抑郁焦虑状态。     

Advanced therapies in Parkinson’s disease: Long-term retrospective study

BackgroundLevodopa/carbidopa intestinal gel infusion (LCIG) and subthalamic nucleus deep brain stimulation (STN-DBS) are approved therapies for advanced Parkinson’s disease (PD) whose long-term comparability remains unclear.MethodsWe reviewed the 5-year data on activities of daily living (ADL) and motor complications (OFF time, dyskinesia duration, and dyskinesia severity), as measured by the Unified Parkinson Disease Rating Scale (UPDRS) section-II and section-IV (items 39, 32, and 33, respectively) in 60 PD patients exposed to STN-DBS (n = 20), LCIG (n = 20), and oral medical therapy (OMT) (n = 20) at similar baseline disability and cognitive state.ResultsSTN-DBS and LCIG showed a similar magnitude of deterioration in ADL (+6.1 vs. +5.7 UPDRS-II; p = 0.709), but lesser than with OMT (+13.7 UPDRS-II; p = 0.005). OFF time also improved to the same extent in STN-DBS and LCIG (−62% vs. −54.5%; p = 0.830), while worsened with OMT (+78.6%; p < 0.001). STN-DBS and LCIG yielded greater improvement on dyskinesia compared to OMT (dyskinesia duration: −66.1% vs. −9.0% vs. +24.2% [p = 0.001]; dyskinesia severity: −68.8% vs. −18.0% vs. +16.2% [p = 0.002]), with relative superiority of STN-DBS over LCIG (p = 0.004 for duration; p = 0.014 for severity). The annualized rate of complication was lower in STN-DBS vs. LCIG (0.13 vs. 0.68; p < 0.001) but not different between STN-DBS and OMT (0.13 vs. 0.10; p = 0.795).ConclusionsSTN-DBS and LCIG showed comparable efficacy in ADL and OFF time, superior to OMT. STN-DBS yielded greater improvement in dyskinesia and lower long-term rate of complications than LCIG.     

Burden on caregivers of older patients with bipolar disorder

Objectives: Available data suggest high burden on caregivers of patientswith bipolar disorder (BD), yet the well-being of patients with BD increasingly depends on family members, partners and close friends. Aspatients with BD get older, the need for informal care may shift. We aimed to describe the caregivers of older adults with BD (OABD) and explore what patients' and caregivers' characteristics are associated with caregiver burden.

Method: Forty-seven caregivers of OABD were questioned about their perceived burden and depressive symptoms. Linear regression analyses were performed to examine the influence of various patients' and caregivers' characteristics on caregiver burden or depression.

Results: More than half of all caregivers experienced some degree of burden,and 6.4% reported depressive symptoms. The number of psychiatric admissions and social functioning were the only patients' characteristics associated with higher burden. Caregiver burden was significantly associated with caregiver's other obligations. None of the patient or caregiver characteristics was significantly associated with depression in caregivers of OABD.

Conclusion: In OABD, even with few residual symptoms, more than half of all caregivers experience substantial burden. Future studies are needed to confirm if improving social functioning and preventing psychiatric hospitalizations decrease the burden on the caregivers of OABD.     

Structural and functional correlates of subthalamic deep brain stimulation-induced apathy in Parkinson’s disease

BackgroundNotwithstanding the large improvement in motor function in Parkinson’s disease (PD) patients treated with deep brain stimulation (DBS), apathy may increase. Postoperative apathy cannot always be related to a dose reduction of dopaminergic medication and stimulation itself may play a role.ObjectiveWe studied whether apathy in DBS-treated PD patients could be a stimulation effect.MethodsIn 26 PD patients we acquired apathy scores before and >6 months after DBS of the subthalamic nucleus (STN). Magnetoencephalography recordings (ON and OFF stimulation) were performed ≥6 months after DBS placement. Change in apathy severity was correlated with (i) improvement in motor function and dose reduction of dopaminergic medication, (ii) stimulation location (merged MRI and CT-scans) and (iii) stimulation-related changes in functional connectivity of brain regions that have an alleged role in apathy.ResultsAverage apathy severity significantly increased after DBS (p < 0.001) and the number of patients considered apathetic increased from two to nine. Change in apathy severity did not correlate with improvement in motor function or dose reduction of dopaminergic medication. For the left hemisphere, increase in apathy was associated with a more dorsolateral stimulation location (p = 0.010). The increase in apathy severity correlated with a decrease in alpha1 functional connectivity of the dorsolateral prefrontal cortex (p = 0.006), but not with changes of the medial orbitofrontal or the anterior cingulate cortex.ConclusionsThe present observations suggest that apathy after STN-DBS is not necessarily related to dose reductions of dopaminergic medication, but may be an effect of the stimulation itself. This highlights the importance of determining optimal DBS settings based on both motor and non-motor symptoms.     

The LRRK2 G2019S mutation status does not affect the outcome of subthalamic stimulation in patients with Parkinson's disease

BackgroundDeep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapy for advanced Parkinson's disease (PD). The most common genetic mutation associated with PD identified to date is the G2019S mutation of the LRRK2 gene, which is highly prevalent in the Ashkenazi Jewish population. The effect of STN-DBS surgery in patients carrying this mutation has not been systematically studied. We therefore performed a case-control study to evaluate the impact of the G2019S mutation status on the outcomes of bilateral STN-DBS.MethodsThe study sample included 39 Jewish PD patients with bilateral STN-DBS. Thirteen patients (5 females) were G2019S mutation heterozygous. The control group consisted of 26 PD patients with bilateral STN-DBS, negative for the mutation, matched (2:1) for gender, age at PD onset, and disease duration at surgery. Clinical data including the Unified PD Rating Scale scores (UPDRS), levodopa equivalent daily dose (LEDD), and clinical global impression of change (CGIC) concerning both motor and neuropsychiatric outcome- were available at 3 time points (preoperative baseline, 6–12 months and 3 years postoperatively).ResultsImplementing a linear mixed model, a significant improvement (p < 0.05) was found for the whole group concerning reduction in motor UPRDS (off state) and LEDD pre- vs. postoperatively, as expected. No difference in clinical outcome was found between carriers and matched non-carriers at baseline or at postoperative follow-up (up to 3 years).ConclusionsIn our study, STN-DBS outcomes were not influenced by the LRRK2 G2019S mutation, and thus knowledge of carrier status may not be relevant to the considerations of patient selection for surgery.     

Depression may negatively affect the change in freezing of gait following subthalamic nucleus stimulation in Parkinson's disease

ObjectiveTo assess the influence of preoperative depression on the change in freezing of gait (FOG) following subthalamic nucleus stimulation (STN-DBS) in patients with Parkinson's disease (PD).MethodsOne hundred and twelve PD patients were included who received bilateral STN-DBS. Of these, 33 had no preoperative depression (PD-ND) and the other 79 had preoperative depression (PD-D). Each PD-ND patient was matched with one PD-D patient by the propensity score for which sex, age at PD onset, disease duration, UPDRS-III score during off-medication state, levodopa-equivalent daily dose, and mini mental state examination were the independent variables. We compared both a FOG-questionnaire (FOG-Q) and the axial score from UPDRS-III between the two groups over 12-month follow-up.ResultsDuring the off-medication state, FOG-Q at 12-month was decreased with STN-DBS in both PD-ND (−52.9%, p < 0.001) and PD-D (−24.2%, p < 0.001) with a significant difference in the change of FOG in favor of PD-ND (p = 0.001). Similarly, there was an improvement in the axial score for both PD-ND (−66.1%, p < 0.001) and PD-D (−45.3%, p < 0.001) at 12-month with a significant difference between the groups. (p = 0.005). During the on-medication state, both the FOG-Q and axial score at 12-month were not improved with STN-DBS in the PD-ND and PD-D with no difference between the groups.ConclusionsOur findings suggest that preoperative depression negatively affects the outcome of FOG following STN-DBS in the off-medication state but not in the on-medication state.     

Eating disorders: Predictors of change in the quality of life of caregivers

Eating disorders (EDs) have a strong impact on the quality of life (QoL) of caregivers. This study explores the longitudinal changes in the QoL of ED caregivers at 1 (T1; n=109) and 2 years (T2; n=32) follow-up, and identifies predictors of improvement at 1-year follow-up. ED outpatients also completed a battery of tests at T1 (n=69) and T2 (n=11). Multivariate hierarchical linear mixed models were used, in which the caregivers' 1-year changes in QoL, anxiety and depression scores were analysed as the dependent variables. Predictor variables were the caregivers' perception of burden, perception of the severity of the patient's ED, kinship data, and the ED person's scores on QoL, anxiety depression and ED symptoms. Higher scores in mental health and low perception of burden at baseline predicted improved caregiver QoL at 1-year follow-up. The caregivers' QoL improved if the perception of burden decreased over time and if depression of the patient improved. The results suggest that interventions directed to reduce the caregivers' perception of burden and to improve the mental health of the ED patients would lead to improved caregiver QoL. The high attrition rate at T2 made prediction analyses unviable.     

What determines resilience in patients with Parkinson's disease?

ObjectiveTo investigate the relationship of resilience to disease severity, disability, quality of life (QoL) and non-motor symptoms in Parkinson's disease (PD). A secondary objective was to investigate whether resilience is distinct from other personality domains in PD.BackgroundResilience is the ability to reestablish emotional equilibrium in the face of adversity. It may play a pivotal role in disability and quality of life and has not been studied in PD.Methods83 PD patients (Age 66.3 ± 10.6, Total Unified Parkinson's Disease Rating Scale (T-UPDRS) 36.9 ± 17.8) completed the Resilience Scale 15 (RS-15). Scales measuring disability, mental and physical health-related QoL, non-motor symptoms (depression, anxiety, somatization, apathy, fatigue), and personality domains were completed. Pearson's correlations were analyzed between these scales and the RS-15.ResultsGreater resilience correlated with less disability (r = ?.30, p = .01), and better physical and mental QoL (r = .31, p < .01; r = .29, p = .01), but not with PD severity (T-UPDRS, r = ?.17, p > .05). Among non-motor symptoms and personality domains, resilience strongly correlated with less apathy (r = ?.66), less depression (r = ?.49), and more optimism (r = .54, all p < .001). Moderate correlations were seen between more resilience, reduced fatigue (r = ?.40) and anxiety (r = ?.34; both p < .001).ConclusionsResilience correlated with less disability and better QoL but not with PD severity. Resilience was also highly associated with both non-motor symptoms (less apathy, depression, fatigue) and a personality domain (more optimism). The role of resilience in helping patients adapt to living with symptoms of chronic disease may explain its lack of correlation with PD severity.     

Consequences of persistent depression and apathy in first-episode psychosis — A one-year follow-up study

BackgroundApathy and depression are prevalent in first-episode psychosis (FEP), have overlapping clinical features and are linked to social dysfunction, with indications that persisting symptoms have an even more negative impact. Our objective was to investigate the prevalence of persisting depression (PD), persisting apathy (PA), to what extent they overlap and their relative associations to functioning during a one-year follow-up.MethodsOne hundred and twenty-five participants with a FEP were recruited, and 88 (70%) were reassessed at follow-up. Functional outcome was assessed with the Global Assessment of Functioning Scale-split version, functioning sub-scale, apathy with the Apathy Evaluation Scale, Clinician version (AES-C), and depression with the Calgary Depression Scale for Schizophrenia (CDSS). Persisting depression was defined as a CDSS sum-score > 7 at baseline and follow-up, and persisting apathy as an AES-C sum-score ≥ 27 at baseline and follow-up. Multiple linear regression analyses were used to investigate symptoms' contributions to functioning. Differences in functioning between groups were explored with Kruskal-Wallis test and Mann-Whitney U test.ResultsWe found PD in 17 (19%) and PA in 28 (32%) of participants. The likelihood of PD was increased if PA was also present (p = 0.008, phi = 0.28). Ten participants (11%) experienced overlapping PD and PA. Participants with PD (r = −0.38, p = 0.004), PA (r = −0.51, p < 0.000) or both (r = −0.52, p < 0.000) had poorer functioning at follow-up than participants without persisting symptoms.ConclusionPD, PA and overlapping PD/PA is highly prevalent and associated with severely impaired functioning in FEP. Correct identification of these patients is a prerequisite for initiating relevant treatment early in the course of illness.     

Response shift – The experience of disease progression in Parkinson disease

ObjectiveTo investigate response shift, the recalibration of perceived quality of life (QoL) relative to symptomatic changes in Parkinson disease (PD).BackgroundHealth-related QoL in PD is influenced by improvement vs. decline in disease severity. However, it is unclear how disease course changes internal standards of QoL over time.Methods124 PD patients were subdivided based on Total UPDRS change over 1 year (stable, improved, declined). The EuroQol Visual Analog Scale assessed QoL at baseline (T1) and 1 year later (T2). At T2, patients rated current QoL (T2-current) and reappraised their T1 QoL (T2-retrospective). Recalibration response shifts were represented by the difference between T1 and T2-retrospective QoL ratings.ResultsAt follow-up (T2), the total patient sample reported no difference between current (T2 current mean (M) = 76.3) and retrospective (T2-R M = 77.8) QoL ratings. While there was no significant difference between T1 (M = 79.2) and T2-R ratings 1 year later (M = 77.8) for the total sample, there was a change by group interaction (p < 0.005) which showed that retrospectively, decliners reduced ratings (M Δ = −9.0) and improvers increased ratings (M Δ = +6.4) while stable patients did not change.ConclusionsWhen PD patients consider their health status one year ago, decliners recalibrate and downgrade last year's health assessment, while improvers upgrade last year's assessment. Changes in internal calibrations cushion periods of decline or improvement in PD such that patients tend to “stabilize” their general disease course when recalling symptom trajectory, providing insight into the process of adaptation to the effects of disease progression and treatment over time.     

Caregivers' assessments of preference-based quality of life in Alzheimer's disease

BackgroundThis study was designed to evaluate the feasibility, reliability, and validity of use of caregivers' ratings of two health preference measures as outcomes for cost-effectiveness analyses in persons with very mild to moderate Alzheimer's disease (AD).MethodsCaregivers completed ratings of preference for AD patients' health by use of the EuroQol-5D system (EQ-5D) and the Health Utilities Index Mark 2 (HUI2). They also rated patients' cognition, mood, burden, AD-specific and generic health-related quality of life (QOL), and activities of daily living.ResultsCaregivers' HUI2 scores were reliable. Neither the caregiver ratings of the patients' health by use of the EQ-5D nor the HUI2 had a relationship with severity of cognitive impairment. Both the EQ-5D and the HUI2 had expected relationships with caregivers' assessments of patients' function, AD-specific QOL, and physical and mental health and selected subscales of the measures of AD-specific QOL and overall health. In addition, caregiver scores showed relationships with patient self-rated function, mood, and physical health but not AD-specific QOL. Caregiver burden was associated with caregivers' scores.ConclusionsCaregiver-completed ratings of preference for patients' health made by use of the EQ-5D and the HUI2 have many of the characteristics of valid preference measures. However, the lack of association with patient Mini-Mental Status Exam scores and patient self-rated AD-specific QOL and the associations with caregiver subjective burden might present limitations to their use as proxy measures for cost-effectiveness analyses.     

To what extent does depression influence quality of life of people with pharmacoresistant epilepsy in Argentina?

IntroductionDepression is the most frequent psychiatric co-morbidity in patients with epilepsy. Lifetime prevalence of depression is reported more frequently in temporal lobe epilepsy and is estimated at 35%. This co-morbidity appears to be related with various mechanisms. The aim of this study was to determine the quality of life (QoL) of patients with pharmacoresistant epilepsy with and without co-morbid depression in an Argentinean population.MethodsPatients admitted to the video-EEG monitoring unit during the period 2010–2013 went through a standardized psychiatric assessment using SCID-I (Structured Clinical Interview for Axis I diagnoses of DSM-IV), BDI II (Beck Depression Inventory) GAF (Global assessment of functioning), and Q LES Q-SF (for quality of life). Patients were divided in two groups: with and without depression (according to DSM-IV). Sociodemographic data, BDI II scores, GAF, and quality of life (QoL) were compared between the two groups. Comparisons were made using Student's t-test and Mann–Whitney U test. Frequency distributions were compared by Chi-square test. Spearman correlation coefficients were determined.ResultsSeventy-seven patients with pharmacoresistant epilepsy were eligible for this study, 41 patients were included in the group with depression (mean BDI II 15.93), and 36 in the group without depression (mean BDI II 3.36) (p = 0.001). The overall QoL was significantly lower in the group with depression compared to the group without depression (p < 0.01). The most affected areas were: physical health (p = 0.013), mood (p = 0.006), course activities (referring to school as well as to hobbies or classes outside of school) (p = 0.003), leisure time activities (p = 0.011), social activities (p = 0.047), general activities (p = 0.042), and medication (p = 0.022). Severity of depression according to BDI II had a negative correlation with overall QoL (r - 0.339, p < 0.01). No correlations were found between seizure frequency, QoL and BDI II.ConclusionPatients with pharmacoresistant epilepsy and co-morbid depression reported worst QoL. Depression disrupts daily functioning (leisure, social functioning) and is a negative influence for subjective perception of health and medication. Interdisciplinary treatment should be considered (neurology–psychiatry–psychotherapy).     

The impact of age and disease duration on the long term outcome of neurostimulation of the subthalamic nucleus

BackgroundSelection of patients with Parkinson's disease for neurostimulation of subthalamic nucleus (STN-DBS) is still poorly studied.AimTo identify the impact of age and disease duration on the outcome of bilateral STN-DBS.Methods110 operated patients in a single center covering a large range of age and disease duration were retrospectively included and followed for up-to 5 years. Standardized UPDRS assessments were obtained at 0.5–1 and 3–5 years. Patients were stratified into three age groups (≤55, 56–64 and ≥65 years) and the middle age group was further stratified into 2 disease duration subgroups (<15years, ≥15 years).ResultsThe age groups had comparable baseline data except for the predefined differences. Compared to baseline early and late intra-group “Med Off-Stim On” motor scores were significantly improved for all groups (p < 0.001). Mood/cognition were significantly improved in younger two groups (p = 0.008, 0.019) at 0.5–1 year. Inter-group comparisons showed significantly worse early and late axial scores for older patients (p < 0.05). All groups had comparable postoperative improvement except for the older group which had significantly less improvement of early UPDRS-II, late UPDRS-I, and early and late PIGD/axial scores. Different disease durations had no effect on the outcome except for worse Schwab and England Off-score in longer duration group (p = 0.02). Side effects of surgery and long-term management were similar.ConclusionSTN-DBS is an efficient treatment of advanced PD for all treated age-groups. Provided strict inclusion criteria are respected, older age and longer disease duration are associated with slightly worse effects mainly on L-dopa-resistant symptoms.     

Long-term effect of bilateral STN-DBS on non-motor symptoms in Parkinson's disease: A four-year observational,prospective study

BackgroundSeveral studies have shown beneficial effects of bilateral stimulation of the subthalamic nucleus (STN-DBS) on motor as well as on non-motor symptoms (NMS) up to 36 months post-surgery in advanced Parkinson's disease (PD) patients. We set to explore the long-term effect of STN-DBS on NMS in a four-year follow-up, prospective, observational study.MethodsForty patients were enrolled and assessed at baseline. Twenty-eight were followed-up at 6, 12, 24, 36 and 48 months after the operation. The effect of post-operative time on NMS was analyzed by six-level repeated measures ANOVA. In a post-hoc analysis the follow-up scores were compared to baseline using a paired t-test.ResultsThe following scores stayed improved up to 24 months after surgery, presented as baseline/24 months, p-value (t-test): total Non-Motor Symptoms Scale score (54.0 ± 5.6/44.9 ± 5.0, p = 0.029), Hamilton Anxiety Scale (14.3 ± 1.3/11.3 ± 1.2, p = 0.019) and PDQ39 (53.4 ± 4.5/40.2 ± 2.9, p = 0.012). PD Sleep Scale 2 remained improved throughout the study (17.4 ± 2.0/12.8 ± 1.3 at 48 months, p = 0.032), while Beck Depression Inventory only at six months post-surgery (9.5 ± 1.2/6.7 ± 0.7 at 6 months, p = 0.006). Montreal Cognitive Assessment remained stable up to 24 months and then declined at 36 months (26.3 ± 0.5/25.4 ± 0.5 at 36 months, p = 0.003), Starkstein Apathy Scale deteriorated throughout the study (7.6 ± 0.7/12.7 ± 0.9 at 48 months, p = 0.006).ConclusionsWe observed beneficial effect of STN-DBS in several but not all domains of NMS at least up to 24 months post-op in advanced PD. Further long-term studies on larger cohorts of PD patients and longer follow-up need to be conducted to better understand the long-term effect of STN-DBS on NMS.     

Mental health of caregivers of individuals with disabilities: Relation to Suicidal Ideation

ObjectiveThe mental health of caregivers of individuals with disabilities is frequently neglected. This study investigated mental health status and Suicidal Ideation (SI) among caregivers and examined the predictive factors for SI.MethodCaregivers of individuals with physical or mental disabilities in a tertiary hospital in southern Taiwan were recruited through snowball sampling. They were assessed by self-report questionnaires, consisting of the Taiwanese Depression Questionnaire and a subset of the three-item Chinese Health Questionnaire, to assess probable depression and common mental disorders (CMDs), with cutoff points of 19 and 3, respectively.ResultsAmong 255 caregivers, 32.9% had probable depression, 37.6% had probable CMDs, and 18.8% experienced SI. The level of SI was correlated with primary caregivers (p = 0.015), lack of support from co-caregivers (p = 0.023), caring for younger patients (p = 0.010), caring for patients with mental disability (p = 0.019) or catastrophic diseases (p = 0.005), and caregivers' probable depression (p < 0.001) and CMDs (p < 0.001). Regression analysis predicted the greatest SI among caregivers caring for younger patients (odds ratio [OR] = 0.98, p = 0.048) and for patients with catastrophic diseases (OR = 3.15, p = 0.008), as well as for caregivers with probable depression (OR = 3.90, p = 0.010) or CMDs (OR = 9.40, p < 0.001).ConclusionsWhen examining SI, clinicians should be aware of the mental health of caregivers who are responsible for people with disability. In particular, they should be vigilant regarding caregivers of individuals who are of younger age or have catastrophic diseases and regarding caregivers who exhibit probable depression and CMDs.     

Eighteen month study of continuous intraduodenal levodopa infusion in patients with advanced Parkinson's disease: Impact on control of fluctuations and quality of life

Symptom control, daily “on” time, and quality of life (QoL) of nine patients with Advanced Parkinson's Disease was assessed following 18-months treatment with Continuous Intraduodenal Levodopa Infusion (CIDLI). Patients had severe motor fluctuations and dyskinesias and had previously received treatment with oral levodopa and dopamine agonists. There were significant improvements in patients' symptoms on the Unified Parkinson's Disease Rating Scale, and QoL (Parkinson's Disease QoL Questionnaire; Schwab & England Capacity for Daily Living Scale; p < 0.05). Mean (±SD) daily “on” time increased from 6.1 ± 1.9 to 12.0 ± 3.4 h (p < 0.05). Improved QoL in APD was associated with CIDLI-related improvements in symptom control and increase in daily “on” time.     

Female sexual function mediates the effects of medication adherence on quality of life in people with epilepsy

PurposeThe purpose of this study was to understand the mediating effects of female sexual functioning in the association between medication adherence and quality of life (QoL) in Iranian women with epilepsy (WWE).MethodsWomen's sexual functioning was measured using Female Sexual Function Index; QoL using Quality of Life in Epilepsy; epilepsy severity using Liverpool Seizure Severity Scale; subjective medication adherence using Medication Adherence Report Scale; and objective medication adherence using serum level for antiepileptic drugs in 567 WWE. Medication adherence was measured at baseline, while women's sexual functioning, QoL, and epilepsy severity were measured at the 6-month follow-up. Structural equation modeling and regression models were conducted to examine the mediating role of women's sexual functioning.ResultsThe mediating effects of sexual functioning in the relationship between medication adherence (including subjective and objective measures) and QoL were supported in the total score of Female Sexual Function Index (coefficient = 0.415, SE = 0.117, p < 0.001 for subjective medication adherence; coefficient = 1.980, SE = 0.446, p < 0.001 for objective medication adherence). Seizure severity was significantly associated with QoL but only when objective medication adherence was measured (coefficient = − 0.094, SE = 0.036, p = 0.009).ConclusionOur results extended the importance of medication adherence from symptom reduction to the beneficial effects of women's sexual functioning and QoL. Health care providers should be aware of these additional benefits of medication adherence and use these arguments to encourage female patients to take their medication, which can eventually increase their sexual satisfaction and overall QoL.     

Psychiatric morbidity and its correlates among informal caregivers of older adults

ObjectiveThis present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions.MethodsData from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who ‘knew the older adult best’ and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥ 8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score < or ≥ 8) was used as a dependent variable and all other variables served as independent covariates.ResultsAmong informal caregivers, 8.8% exhibited psychiatric morbidity. Higher proportions of spousal caregivers and caregivers of older adults having more care needs and BPSD exhibited psychiatric morbidity. After adjusting for all covariates, caregivers' marital status, and the presence of BPSD and dementia in the older adults were identified as the strongest correlates of caregivers' psychiatric morbidity. The prevalence of psychiatric morbidity was 10%, 13.9% and 12.7% respectively in these groups. Married caregivers had higher odds of psychiatric morbidity (OR 2.50, 95% CI: 1.13–5.52). In addition, caregivers of older adults' with any BPSD (OR 5.87, 95% CI: 2.60–13.24) and dementia (OR 2.28, 95% CI: 1.23–4.20) were also associated with higher odds of psychiatric morbidity.ConclusionInformal caregivers' marital status and presence of any BPSD and dementia in the older adults in their care were identified as the strongest correlates of caregivers' psychiatric morbidity. Clinicians should be cognizant of the risk in this group of caregivers and assess and intervene to alleviate caregivers' psychological problems.