Augmented reality-based dance intervention for individuals with Parkinson’s disease: A pilot study

BackgroundThe effects of dance on improving the symptoms of individuals with Parkinson’s disease (PD) is well documented. Augmented reality devices, such as Google Glass, may be used to implement dance interventions to improve mobility and balance.ObjectiveTo evaluate the feasibility, safety, and acceptability of a mobile dance intervention and obtain preliminary efficacy estimates for assessment of the research protocol.MethodsSeven participants with PD were asked to use Google Glass preloaded with Moving Through Dance modules for three weeks. Changes in motor functions (balance, mobility) and non-motor functions (mood, quality of life) were evaluated before and after completion of the intervention.ResultsRecruitment rate was 50%, retention rate was 100%, and adherence to usage was 95%. The intervention was safe and accepted by participants. Use of Moving Through Glass improved mobility with a cognitive load (F(1, 5) = 10.76; p < 0.05). However, there were no significant changes to the participants’ balance scores, quality of life or mood.ConclusionsThe outcomes of this pilot study suggest that Moving Through Glass, as a mobile dance intervention, may be a safe way to increase physical activity through dance in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.     

Cardiometabolic factors and disease duration in patients with Parkinson’s disease

ObjectivePrevious studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease.MethodsOne hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases.ResultsIn sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = ?0.20; P < 0.05) and BF% (r = ?0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed.ConclusionsHDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.     

Paraquat exposure and Parkinson’s disease: A systematic review and meta-analysis

Abstract

To reconcile and unify available results regarding paraquat exposure and Parkinson’s disease (PD), we conducted a systematic review and meta-analysis to provide a quantitative estimate of the risk of PD associated with paraquat exposure. Six scientific databases including PubMed, Cochrane libraries, EMBASE, Scopus, ISI Web of Knowledge, and TOXLINE were systematically searched. The overall odds ratios (ORs) with corresponding 95% CIs were calculated using a random-effects model. Of 7,309 articles identified, 13 case control studies with 3,231 patients and 4,901 controls were included into our analysis. Whereas, one prospective cohort studies was included into our systematic review. A subsequent meta-analysis showed an association between PD and paraquat exposure (odds ratio?=?1.64 (95% CI: 1.27–2.13; I²?=?24.8%). There is a statistically significant association between paraquat exposure and PD. Thus, future studies regarding paraquat and Parkinson’s disease are warranted.     

Quality of life in Serbian patients with Parkinson’s disease

Background  The Parkinson’s Disease Questionnaire (PDQ-39) is a well-validated British scale for the assessment of health-related quality of life (QoL) in Parkinson’s disease (PD). Objective  To validate the Serbian version of the PDQ-39, while also providing additional information on the characteristics of this instrument. Patient and methods  A total of 102 Serbian PD patients were asked to complete the PDQ-39, a disease-specific QoL questionnaire, as well as the generic, health status questionnaire (SF-36-version 1), and the 21-item Beck Depression Inventory. Neurological examination included the Hoehn and Yahr staging, Unified Parkinson’s disease rating scale (UPDRS)-part III, Schwab and England scale, and the Mini-Mental State Examination. Results  Internal consistency analysis yielded a Cronbach’s α of 0.83. Cronbach’s α was above 0.70 for seven out of eight subscales (range from 0.73 to 0.91). A hierarchical structure of the PDQ-39 was revealed, with one global higher-order factor and two lower-order factors. The strongest predictor of the QoL in PD was the presence of depression, while motor disability (UPDRS-part III score) additionally contributed to poor QoL. Cognitive impairment has not been correlated with poor QoL. Also, QoL measures were not different between young- (≤50 years) and older-onset PD patients. Conclusions  The PDQ-39 is a reliable and valid instrument for the assessment of QoL in Serbian PD patients.     

Niacin metabolism and Parkinson’s disease

Epidemiological surveys suggest an important role for niacin in the causes of Parkinson’s disease, in that niacin deficiency, the nutritional condition that causes pellagra, appears to protect against Parkinson’s disease. Absorbed niacin is used in the synthesis of nicotinamide adenine dinucleotide (NAD) in the body, and in the metabolic process NAD releases nicotinamide by poly(ADP-ribosyl)ation, the activation of which has been reported to mediate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson’s disease. Recently nicotinamide N-methyltransferase (EC2.1.1.1) activity has been discovered in the human brain, and the released nicotinamide may be methylated to 1-methylnicotinamide (MNA), via this enzyme, in the brain. A deficiency in mitochondrial NADH: ubiquinone oxidoreductase (complex 1) activity is believed to be a critical factor in the development of Parkinson’s disease. MNA has been found to destroy several subunits of cerebral complex 1, leading to the suggestion that MNA is concerned in the pathogenesis of Parkinson’s disease. Based on these findings, it is hypothesized that niacin is a causal substance in the development of Parkinson’s disease through the following processes: NAD produced from niacin releases nicotinamide via poly(ADP-ribosyl)ation, activated by the hydroxyl radical. Released excess nicotinamide is methylated to MNA in the cytoplasm, and superoxides formed by MNA via complex I destroy complex 1 subunits directly, or indirectly via mitochondrial DNA damage. Hereditary or environmental factors may cause acceleration of this cycle, resulting in neuronal death.     

The nutritional status of Dutch elderly patients with Parkinson’s disease

Objectives: To assess the prevalence of (risk of) undernutrition in Dutch elder Parkinson’s disease patients as well as it’s risk factors. Design: Observational cross-sectional study. Setting: An outpatient clinic at the department Neurology of Medical Centre Leeuwarden, a large teaching hospital. Participants: 102 outpatients with Parkinson’s disease aged 65 years and older were recruited. Measurements: Data regarding various aspects of undernutrition including socio-demographic aspect, disease characterisitics, nutritional status, appetite and overall-physical and psychological functioning were collected. Results: Undernutrition was diagnosed in 2.0% and 20.5% of the patients were categorized as being at risk of undernutrition. Care dependency and appetite were the two risk factors with the highest predictive value for an unfavorable nutritional status. Conclusion: Of Dutch elderly patients with Parkinson’s Disease 22.5% had an unfavourable nutritional status. Dependency and appetite were the two risk factors with the highest predictive value fort his outcome. Because undernutrition can be regarded as a geriatric syndrome a comprehensive nutritional assessment should be done followed by nutritional interventions next to interventions focused on the risk factors. Further studies are needed to evaluate these interventions.     

Being in control of Parkinson’s disease: A qualitative study of community-dwelling patients’ coping with changes in care

Background: Chronically ill patients have to cope with transfers in the level or setting of care. Patients with prevalent disorders such as diabetes mellitus can be supported by their general practitioner (GP) when experiencing such care changes, as the GP already offers them disease-specific care. For community-dwelling patients with low-prevalent diseases such as Parkinson’s disease (PD) – for which disease-specific care is provided by medical specialists – tailoring support to handle care changes requires more insight into patients’ coping.

Objectives: To explore PD patients’ coping with care changes.

Methods: A qualitative interview study was performed in 2013–2015 with a purposive sample of 16 community-dwelling PD patients in the Netherlands. A research assistant visited patients every month to explore if they had experienced a care change. If so, patients were interviewed face-to-face. An inductive approach to comparative content analysis was used.

Results: Patients encountered a variety of care changes such as changes in the level of unpaid care, the purchase of tools, modification of pharmacotherapy or admission to hospital. Being able to anticipate, initiate and independently handle care changes contributes to patients’ sense of control and acceptance of the post-change situation. Patients, who commenced care changes themselves, had more realistic expectations of it.

Conclusion: Community-dwelling PD patients seem to be able to cope with the care changes they face. Offering education to facilitate their anticipation and initiation of changes in care and their ability to act independently, can contribute to patients’ wellbeing. GPs can play a role in this.     

Association of Parkinson’s disease with industry sectors: a French nationwide incidence study

In order to identify working environments at risk for Parkinson’s disease (PD), we investigated the relation between the importance of industry sectors, used as a surrogate for occupational exposures, and PD incidence in French cantons. The number of incident PD cases (2010–2014) in 3689 cantons of metropolitan France was determined using drug claims from French National Health Insurance databases. The proportions of workers in 38 industry sectors in 2006 were calculated for each canton. Associations between the proportions of workers in industry sectors and PD age/sex-standardized incidence ratios were examined using incidence rate ratios (IRR) and 95% confidence intervals (CI) estimated with multilevel negative binomial regressions with a random intercept at the canton-level and adjusted for smoking, deprivation index, and density of neurologists. We then used two-step semi-Bayes hierarchical regression (HR) to include prior information about exposure to pesticides, metals, and solvents in each industry sector. We identified 112,625 incident cases. PD incidence was higher in areas characterized by high proportions of workers in “Agriculture, forestry and fishing” (IRR_HR?=?1.042; CI 95%?=?1.014–1.070; p-Trend_HR?=?0.004), “Manufacture of textiles, wearing apparel, leather and related products” (IRR_HR?=?1.024; CI 95%?=?1.005–1.044; p-Trend_HR?=?0.010), and “Manufacture of basic metals and fabricated metal products, except machinery and equipment” (IRR_HR?=?1.024; CI 95%?=?1.003–1.046; p-Trend_HR?=?0.071). This nationwide study, based on a comprehensive analysis of industry sectors, shows significant associations between high proportions of workers in specific industry sectors (agriculture, metallurgy, textile) and PD incidence that may be targeted in further epidemiological studies to replicate and better understand these associations.     

Telehealth for patients with Parkinson’s disease: delivering efficient and sustainable long-term care

Objectives: We set out to demonstrate the benefits of providing long-term care via telehealth for patients with Parkinson’s disease living in continuous care facilities.

Methods: A cohort of 16 patients with Parkinson’s disease residing at one of 2 locations of a multi-facility continuous care retirement organization were seen virtually in follow-up over a 3-year period by Telehealth Services at a large, academic, tertiary care hospital in southeastern Pennsylvania. The data collected during that period, studied retrospectively, included demographic information, number of telehealth visits, and UPDRS scores obtained at each visit. Satisfaction and potential cost savings were also reviewed.

Results: UPDRS scores declined over the period of observation, from a range of 18-60 at study start to 28-72 at study end. Actual cost savings are difficult to define; however, the cost per telehealth visit at $117.30 was often lower than the facility’s average cost for transporting patients to a visit in the neurologist’s office. Patients, families, subspecialists, and the nursing staff expressed uniformly high satisfaction with telehealth.

Conclusion: This model for providing care proved to be sustainable and efficient, and promoted collaboration among the providers at the long-term care facility and those at the remote site. These benefits may be applicable to patients with degenerative disorders in similar settings.     

Women’s Subjective Experiences of Living with Vulvodynia: A Systematic Review and Meta-Ethnography

Vulvodynia, the experience of an idiopathic pain in the form of burning, soreness, or throbbing in the vulval area, affects around 4–16% of the population. The current review used systematic search strategies and meta-ethnography as a means of identifying, analyzing, and synthesizing the existing literature pertaining to women’s subjective experiences of living with vulvodynia. Four key concepts were identified: (1) Social Constructions: Sex, Women, and Femininity: Women experienced negative consequences of social narratives around womanhood, sexuality, and femininity, including the prioritization of penetrative sex, the belief that it is the role of women to provide sex for men, and media portrayals of sex as easy and natural. (2) Seeking Help: Women experienced the healthcare system as dismissive, sometimes being prescribed treatments that exacerbated the experience of pain. (3) Psychological and Relational Impact of Vulvodynia: Women experienced feeling shame and guilt, which in turn led to the experience of psychological distress, low mood, anxiety, and low self-esteem. Moreover, women reported feeling silenced which in turn affected their heterosexual relationships and their peer relationships by feeling social isolated. (4) A Way Forward: Women found changing narratives, as well as group and individual multidisciplinary approaches, helpful in managing vulvodynia. The findings of the review conclude that interventions at the individual level, as well as interventions aimed at equipping women to challenge social narratives, may be helpful for the psychological well-being of women with vulvodynia.     

Development of the Integrated Parkinson’s Care Network (IPCN): using co-design to plan collaborative care for people with Parkinson’s disease

Background

Parkinson’s disease (PD) is a progressive neurological illness that impacts various aspects of life. Integration of medical and self-management in a collaborative approach to care is needed to enhance functioning and the quality of life of PD patients. In developing an integrated care program at a tertiary PD clinic, we used a co-design process to gather stakeholder input.

Methods

This is a cross-sectional mixed methods study using surveys and interviews. Patient and caregiver participants from the clinic completed two questionnaires to evaluate perceived receipt of self-management support (Patient Assessment of Care for Chronic Conditions) and activation for managing their health condition (Patient or Caregiver Activation Measure®). A subset of these participants and healthcare providers took part in semi-structured interviews. Survey data were described and tested for relationships between patient characteristics and questionnaire scores using Spearman’s rank-order correlation. Interviews were analyzed using conventional content analysis.

Results

Fifty-seven PD patients and thirty caregivers completed the questionnaires. Thirteen patients, six caregivers, and six healthcare providers were interviewed. 58% of participants were moderately to highly activated to manage their lives with PD. Participants’ perceptions of self-management support varied but was lacking in dimensions of goal-setting and follow-up support/coordination. Qualitative analysis revealed four overarching themes related to experiences of managing PD: activation, self-management support, coordinated care, and access to services.

Conclusions

This first study to explore patient activation in PD found high levels of activation but moderate to low levels of self-management support. The co-design process highlighted important aspects of a more collaborative approach to care.

     

Neuroticism and extraversion in association with quality of life in patients with Parkinson’s disease

Purpose  Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. The aim of this study is to explore whether neuroticism and extraversion contribute to the variance in QoL in patients with Parkinson’s disease (PD) when controlled for age, functional status and disease duration. Methods  The Parkinson’s Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL and the Unified Parkinson’s Disease Rating Scale (UPDRS) for disease severity. Neuroticism and extraversion were measured with the Eysenck Personality Questionnaire (EPQR-A). Multiple linear regression analysis was then used to assess the contribution of neuroticism and extraversion to QoL. Results  The sample consisted of 153 PD patients (48.4% women; 67.9 ± 9.3 years; mean disease duration 7.5 ± 5.8 years). Neuroticism was, after disease severity, the second most important variable associated with QoL in PD patients, in particular for domains associated with psychological processes: emotional well-being, social support, stigma and communication. A higher score in extraversion was significantly associated with better emotional well-being in males, but surprisingly, with worse emotional well-being in females. Conclusions  After functional status, personality traits were clearly associated with QoL in PD patients. Therefore, they should be taken into account by health-care professionals in their appraisal of patient complaints.     

Irritable bowel syndrome correlates with increased risk of Parkinson’s disease in Taiwan

This study investigated whether an association exists between irritable bowel syndrome (IBS) and the risk of Parkinson’s disease. This is a retrospective cohort study using the dataset of the Taiwan National Health Insurance Program from 2000 to 2010. We identified 23,875 patients (aged 20 years or older) with newly diagnosed IBS as the IBS group and 95,500 subjects without IBS as the non-IBS group for comparison. The main outcome was incident Parkinson’s disease compared between both groups by the end of 2010. We measured the hazard ratio (HR) to evaluate the association between IBS and Parkinson’s disease. The overall incidence of Parkinson’s disease in the IBS group was 1.76-fold higher than that in the non-IBS group (16.4 vs. 9.33 per 10,000 person-years). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of Parkinson’s disease associated with IBS was 1.48 (95 % CI 1.27, 1.72), compared with the non-IBS group. Age, women, hypertension, dementia, cerebrovascular disease and depression were also significantly associated with Parkinson’s disease. Patients with irritable bowel syndrome are at an increased risk of developing Parkinson’s disease. Further studies are required to explore the pathophysiological connection between these disorders.     

Determinants of health-related quality of life in people with Parkinson’s disease: a path analysis

Purpose

To identify the demographic factors, impairments and activity limitations that contribute to health-related quality of life (HRQOL) in people with idiopathic Parkinson’s disease (PD).

Method

Two hundred and ten individuals with idiopathic PD who participated in the baseline assessment of a randomized clinical trial were included. The Parkinson’s Disease Questionnaire-39 summary index was used to quantify HRQOL. In order to provide greater clarity regarding the determinants of HRQOL, path analysis was used to explore the relationships between the various predictors in relation to the functioning and disability framework of the International Classification of Functioning model.

Results

The two models of HRQOL that were examined in this study had a reasonable fit with the data. Activity limitations were found to be the strongest predictor of HRQOL. Limitations in performing self-care activities contributed the most to HRQOL in Model 1 (β = 0.38; p < 0.05), while limitations in functional mobility had the largest contribution in Model 2 (β = ?0.31; p < 0.0005). Self-reported history of falls was also found to have a significant and direct relationship with HRQOL in both models (Model 1 β = ?0.11; p < 0.05; Model 2 β = ?0.21; p < 0.05).

Conclusions

Health-related quality of life in PD is associated with self-care limitations, mobility limitations, self-reported history of falls and disease duration. Understanding how these factors are inter-related may assist clinicians focus their assessments and develop strategies that aim to minimize the negative functional and social sequelae of this debilitating disease.     

Axial rigidity and quality of life in patients with Parkinson’s disease: a preliminary study

Purpose  

Rigidity is a cardinal symptom of Parkinson’s disease (PD) and is often clinically assessed by passively flexing and extending a patient’s limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow, knee and trunk. This study aimed to investigate the relationship between an objective measurement of trunk rigidity and health-related quality of life (HRQoL) and functional status in patients with mild to moderate PD.     

Vitamin D levels in Alzheimer’s and Parkinson’s diseases: A meta-analysis

ObjectiveRecent accumulating evidence shows that vitamin D deficiency is prevalent in individuals with AD and PD. The purpose of the present study is to perform a meta-analysis on the 25-hydroxyvitamin D (25(OH)D) status in this population of patients.MethodsWe searched all articles in English published up to March 2012 concerning the 25(OH)D level in AD and PD patients. For AD, six studies covering 319 patients and 573 controls were included in the meta-analysis. For PD, five studies discussing 434 patients and 3451 controls were included.ResultsIt was found that AD patients had lower levels of 25(OH)D than healthy controls (summary standardized mean difference [SMD], -1.39; 95% confidence interval [CI], -2.79 to 0.01). Similar results were found for PD patients versus healthy controls (summary SMD, -1.33; 95% CI, -2.44 to -0.21).ConclusionThe results indicate that despite the similar mean age between patients and healthy controls in each identified study, both AD and PD patients have lower levels of 25(OH)D than controls.     

Diabetic screening in Western Australia: A photographer’s perspective

Western Australia has a large landmass and low population density. Dating back to the 1970s and even today, specialist medical services are often lacking or non‐existent outside of Perth, the capital city. Diabetes has always been a major health problem, particularly in the Australian Aboriginal community. In conjunction with the Lions Save Sight Foundation and Diabetes Foundation of Western Australia a diabetic screening programme was initiated in 1978 for rural and remote diabetics. The programme aimed to screen for diabetic retinopathy, educate diabetics, medical and paramedical personnel and to arrange treatment for sight threatening eye disease.

Eye screening continues to date although the role of the Lions Eye Institute has changed from programme initiator to reading centre and teaching unit, and continues to evolve with changing technologies.     

Nutritional status in Parkinson’s disease patients undergoing deep brain stimulation surgery: A pilot study

Objectives

People with Parkinson’s disease (PD) are at higher risk of malnutrition due to PD symptoms and pharmacotherapy side effects. When pharmacotherapy is no longer effective for symptom control, deep-brain stimulation (DBS) surgery may be considered. The aim of this study was to assess the nutritional status of people with PD who may be at higher risk of malnutrition related to unsatisfactory symptom management with optimised medical therapy.

Design

This was an observational study using a convenience sample.

Setting

Participants were seen during their hospital admission for their deep brain stimulation surgery.

Participants

People with PD scheduled for DBS surgery were recruited from a Brisbane neurological clinic (n=15).

Measurements

The Patient-Generated Subjective Global Assessment (PG-SGA), weight, height and body composition were assessed to determine nutritional status.

Results

Six participants (40%) were classified as moderately malnourished (SGA-B). Eight participants (53%) reported previous unintentional weight loss (average loss of 13%). On average, participants classified as well-nourished (SGA-A) were younger, had shorter disease durations, lower PG-SGA scores, higher body mass (BMI) and fat free mass indices (FFMI) when compared to malnourished participants (SGA-B). Five participants had previously received dietetic advice but only one in relation to unintentional weight loss.

Conclusion

Malnutrition remains unrecognised and untreated in this group despite unintentional weight loss and presence of nutrition impact symptoms. Improving nutritional status prior to surgery may improve surgical outcomes.     

The use of decision-analytic models in Parkinson’s disease

The aims of this review were to review decision-analytic models used to evaluate interventions in idiopathic Parkinson's disease (PD), and to consider the future directions for development of methods to model the progression of PD over time. A systematic search of the healthcare literature up to June 2010 identified model-based economic evaluations in PD. The modelling methods used in the identified studies were appraised using good practice guidelines for decision-analytic modelling. The review identified 18 model-based evaluations of interventions in PD. All models evaluated treatments targeted towards the motor symptoms of PD or the motor complications of PD treatment. There were no models identified that evaluated interventions targeted towards the non-motor symptoms of PD, such as neuropsychiatric problems or autonomic dysfunction. Consequently, models characterized disease progression in PD using clinical measures of motor functioning. Most studies (n = 13) evaluated medications, three evaluated diagnostic technologies and two examined surgical procedures. Overall, the models reported structural components and data inputs appropriately and clearly, although limited evidence was provided to support choices made on the structures used in the models or the data synthesis reported. Models did not adequately consider structural uncertainty or internal/external consistency. Modelling methods used to date do not capture the full impact of PD. The emphasis in the current literature is on the motor symptoms of PD, characterizing the clinical nature of disease progression, largely neglecting the important impacts of non-motor symptoms. Modelling methods reported for the motor symptoms of PD may not be suitable for future interventions targeted towards modifying disease progression in PD across the entire spectrum of PD. More comprehensive models of disease progression, including both motor and non-motor symptoms will be needed where it is important to capture the effects of interventions more broadly.