Nonmotor symptoms are independently associated with impaired health‐related quality of life in Chinese patients with Parkinson's disease

We performed a cross‐sectional study of 82 Chinese patients with Parkinson's disease (PD) enrolled during an 18‐month period using a clinical interview to assess the prevalence of nonmotor symptoms (NMS), the association with disease severity and motor status, and the impact on patients' health‐related quality of life (Hr‐QoL). The patients' NMS, Hr‐QoL, disease severity, and motor status were assessed by the Nonmotor Symptoms Scale (NMSS), the 39‐item Parkinson's Disease Questionnaire (PDQ‐39), the modified Hoehn and Yahr staging scale (H&Y) and the Unified Parkinson's Disease Rating Scale part III (UPDRS III), respectively. We found that 100% of patients with PD presented with NMS. The NMSS significantly correlated with disease duration (Spearman's r_S = 0.276, P = 0.012), H&Y (r_S = 0.230, P = 0.038), and UPDRS III (r_S = 0.350, P = 0.001). Similarly, the PDQ‐39 SI significantly associated with the disease duration (r_S = 0.258, P = 0.019), H&Y (r_S = 0.340, P = 0.002), and UPDRS III (r_S = 0.453, P < 0.001). NMS domains that influenced the PDQ‐39 SI were sleep/fatigue, mood, gastrointestinal, urinary, and miscellaneous symptoms. This strongly suggested that the five domains played a key role in the manifestation of Hr‐QoL. NMSS explains more of the variability in Hr‐QoL than UPDRS III, when both are the model (stepwise multiple linear regression analysis R² change, 47.8% vs. 5.87%, respectively). Therefore, these findings demonstrate that NMS are independently and negatively associated with Hr‐QoL in PD and that improving NMS should be viewed as an important part in the management of PD. © 2010 Movement Disorder Society     

The clinical impression of severity index for Parkinson's disease: International validation study

This study sought to provide further information about the psychometric properties of the Clinical Impression of Severity Index for Parkinson's Disease (CISI‐PD), in a large, international, cross‐culturally diverse sample. Six hundred and fourteen patients with PD participated in the study. Apart from the CISI‐PD, assessments were based on Hoehn & Yahr (HY) staging, the Scales for Outcomes in PD‐Motor (SCOPA‐M), ‐Cognition (SCOPA‐COG) and ‐Psychosocial (SCOPA‐PS), the Cumulative Illness Rating Scale‐Geriatrics, and the Hospital Anxiety and Depression Scale. The total CISI‐PD score displayed no floor or ceiling effects. Internal consistency was 0.81, the test–retest intraclass correlation coefficient was 0.84, and item homogeneity was 0.52. Exploratory and confirmatory factor analysis (CFI = 0.99, RMSEA = 0.07) confirmed CISI‐PD's unifactorial structure. The CISI‐PD showed adequate convergent validity with SCOPA‐COG and SCOPA‐M (r_S = 0.46–0.85, respectively) and discriminative validity for HY stages and disease duration (P < 0.0001). In a multiple regression model, main CISI‐PD predictors were SCOPA‐M, disease duration, and depression. The results obtained were not only comparable to but also extended those yielded by the preliminary validation study, thus showing that the CISI‐PD is a valid instrument to measure clinical impression of severity in PD. Its simplicity and easy application make it an attractive and useful tool for clinical practice and research. © 2008 Movement Disorder Society     

Longitudinal psychometric attributes,responsiveness, and importance of change: An approach using the SCOPA‐Psychosocial questionnaire

The objective of this study was to illustrate the analysis of longitudinal validity, responsiveness, and importance of change, using the SCOPA‐Psychosocial Questionnaire (SCOPA‐PS) as a source of empirical data. Sixty‐seven patients with PD in Hoehn and Yahr (HY) stage 2 were followed up for 1 year and assessed by means of the Schwab and England Scale, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS), PDQ‐39, and SCOPA‐PS. A range of methods was applied to enable each of the target attributes to be analyzed from different conceptual stances. The SCOPA‐PS displayed satisfactory acceptability (no floor or ceiling effect), internal consistency (α = 0.80–0.84), convergent validity (r_S = 0.70–0.82 with PDQ‐39), and precision (SEM = 8.80), both at baseline and at the end of follow‐up. The threshold value for significant change ranged from 17.25 (1.96 SEM) to 24.39 (Smallest real difference and Reliable change index). Threshold values for a clinically meaningful change were 0.73–1.26 (effect size, standardized response mean, responsiveness statistic). Change in SCOPA‐PS scores correlated strongly with change in total UPDRS, HADS, and PDQ‐39 scores, and reliably detected 70% of cases that worsened according to the PDQ‐39. The minimally important change (MIC) for “minimally impaired” patients as per the PDQ39 was 8.30–9.10 points. Indices such as 1.96 SEM, effect size, and correlation with the change in other measures provide useful information about different concepts of responsiveness. The MIC should be determined for each specific setting, using distribution‐ and anchor‐based methods. The SCOPA‐PS showed satisfactory longitudinal attributes and responsiveness in stage‐2 Brazilian patients with PD across 1 year of follow‐up. © 2008 Movement Disorder Society     

Independent validation of the scales for outcomes in Parkinson’s disease‐autonomic (SCOPA‐AUT)

Background and purpose: Autonomic dysfunction is common in Parkinson’s disease (PD) and causes a great impact in health‐related quality of life (HRQL) and functional status of patients. This study is the first independent validation of the Scales for Outcomes in PD‐Autonomic (SCOPA‐AUT). Methods: In an observational, cross‐sectional study (ELEP Study), 387 PD patients were assessed using, in addition to the SCOPA‐AUT, the Hoehn and Yahr staging, SCOPA‐Motor, SCOPA‐Cognition, Cumulative Illness Rating Scale‐Geriatrics, modified Parkinson Psychosis Rating Scale, Clinical Impression of Severity Index for PD, Hospital Anxiety and Depression Scale, SCOPA‐Sleep, SCOPA‐Psychosocial, pain and fatigue visual analogue scales, and EQ‐5D. SCOPA‐AUT acceptability, internal consistency, construct validity, and precision were explored. Results: Data quality was satisfactory (97%). SCOPA‐AUT total score did not show floor or ceiling effect, and skewness was 0.40. Cronbach’s alpha coefficients ranged from 0.64 (Cardiovascular and Thermorregulatory subscales) to 0.95 (Sexual dysfunction, women). Item homogeneity index was low (0.24) for Gastrointestinal subscale. Factor analysis identified eight factors for men (68% of the variance) and seven factors for women (65% of the variance). SCOPA‐AUT correlated at a high level with specific HRQL and functional measures (r_S = 0.52–0.56). SCOPA‐AUT scores were higher for older patients, for more advanced disease, and for patients treated only with levodopa (Kruskal–Wallis test, P < 0.01). Standard error of measurement for SCOPA‐AUT subscales was 0.81 (sexual, men) – 2.26 (gastrointestinal). Conclusions: Despite its heterogeneous content, which determines some weaknesses in the psychometric attributes of its subscales, SCOPA‐AUT is an acceptable, consistent, valid and precise scale.     

Metric properties of the mini‐mental Parkinson and SCOPA‐COG scales for rating cognitive deterioration in Parkinson's disease

Parkinson's disease (PD) is a chronic neurodegenerative disorder that causes cognitive impairment and dementia in ～30% of patients. Objective: Compare metric qualities of Mini‐Mental Parkinson (MMP) and scales for outcomes in Parkinson's disease‐cognition (SCOPA‐COG) with respect to their relative reliability, validity and ability to predict symptoms (mobility, quality of life, social repercussions, and mood) in PD patients. Outpatients (n=123, 78 males/45 females) diagnosed with PD were included in the study. A multilevel (hierarchical) modeling analysis was performed along with tests of reliability and validity to ascertain which of the two models better predicts symptoms related to PD. Results: The MMP differed significantly between patients with Hoehn and Yahr (H&Y) stages 1, 2 or versus 4/5 (grouped together). The SCOPA‐COG showed differences only between patients in H&Y stages 2 versus 4/5. Both scales were dependent on educational background and age. The SCOPA‐COG had a higher coefficient of variation (0.303) than the MMP (0.184), indicating that it was the more discriminative of the two. Conclusions: The SCOPA‐COG has some advantages over the MMP, the most important being a greater discriminative ability. Multilevel hierarchical analysis clarified the necessity of stratifying the PD population according to educational background, years of illness, and H&Y stage when using these scales. © 2010 Movement Disorder Society     

Burden,perceived health status,and mood among caregivers of Parkinson's disease patients

The objective of this study is to describe the characteristics of the caregivers of patients with Parkinson's disease (PD) and to analyze the association between these characteristics and caregiver burden, perceived health and mood status, and identify their predictors. A multicenter, nationwide, observational, cross‐sectional study that included 289 patient–caregiver pairs was conducted. Caregiver self‐assessments were the Hospital Anxiety and Depression Scale (HADS), EuroQol (EQ), and Zarit Caregiver Burden Inventory (ZCBI). Most caregivers in the study were women aged 60 years or thereabouts. Over two thirds were gainfully employed or housewives, 75% were patients' spouses, and the majority (96.5%) had been permanently taking care of the patient for 6 ± 5.4 years. Less than 5% of patients were in the most advanced stages of disease, and direct costs were 6,350 euros per patient per year. Caregivers had more mood disorders and worse health‐related quality of life (HRQol; EQ‐Tariff) than did the general population. Caregiver HADS and EuroQol scores displayed a weak correlation (r_S = 0.01–0.28) with patient‐related variables (disease duration, HY, SCOPA‐Motor, SCOPA‐AUT, HADS, PPRS, and CISI‐PD) whereas the ZCBI correlated moderately (r_S = 0.27–0.47). Among caregivers, the EQ‐Tariff was significantly lower and the HADS‐Anxiety scores significantly higher for women. ZCBI and HADS‐depression, though not EuroQol and HADS‐anxiety, scores significantly increased with increasing PD severity levels. Caregivers' affective status proved the most important factor influencing their burden and perceived health, whereas patient‐related variables influenced caregiver burden and mood but not health status. In PD, prevalence of affective disorders among patients' caregivers is high and influences both burden and HRQoL. © 2008 Movement Disorder Society     

Independent validation of the Non motor Symptoms Scale for Parkinson's disease in Brazilian patients

ObjectiveIndependent validation of the Non motor Symptoms Scale in Parkinson's disease (NMSS) based on a cross-culturally adapted Brazilian version.MethodsParkinson's disease (PD) patients were evaluated by means of the Scales for Outcomes in Parkinson's disease-Motor (SCOPA-M), Autonomic, Cognition, and Psychosis; Hoehn and Yahr staging (H&Y); Berg Balance Scale; PD Sleep Scale; Clinical Impression of Severity Index for PD (CISI-PD); PDQ-39; and EQ-5D. The following clinimetric attributes were explored for the NMSS: acceptability, scaling assumptions, reliability, construct validity, and precision.Results150 patients were assessed (mean age 63.1 years; 56.7% males; mean duration of illness 8.7 years; HY median: 2). Mean NMSS was 48.9 (SD 36.3; median 42; skewness 1.3). Neither floor nor ceiling effect was observed on the NMSS total score. For domains, the Cronbach's alpha coefficient ranged from 0.40 to 0.82. The NMSS total score correlated significantly with SCOPA-AUT (r_S = 0.65) and with those scales measuring related constructs (r_S = 0.46–0.57). NMSS significantly increased as the H&Y stage increased (Kruskal–Wallis, p < 0.0001). These values were quite close to those from the original validation studies.ConclusionsThe NMSS is a reliable and valid measure to evaluate non motor symptoms in Brazilian PD patients.     

Psychometric attributes of the SCOPA‐COG Brazilian version

Cross‐cultural adaptation and independent psychometric assessment of the Scales for Outcomes in Parkinson's disease‐Cognition (SCOPA‐COG), Brazilian version was performed. Parkinson's disease (PD) patients were evaluated by means of the SCOPA‐Motor scale, Hoehn and Yahr staging (HY), Clinical Impression of Severity Index‐PD (CISI‐PD), Parkinson Psychosis Rating Scale, and Hospital Anxiety and Depression Scale. Cognition was evaluated using the Mini‐Mental State Examination (MMSE), Short Portable Mental Status Questionnaire (SPMSQ), and SCOPA‐COG. The following attributes were explored: acceptability, scaling assumptions, reliability, precision, and construct validity. One hundred fifty‐two patients were assessed (mean age, 63.2 years; disease duration, 7.8 years; median HY stage, 3). Mean SCOPA‐COG and MMSE were 18.2 and 25.7, respectively. The internal consistency of the SCOPA‐COG (Cronbach's alpha = 0.81; item‐total correlation, 0.38–0.62) was satisfactory. While the intraclass correlation coefficient value was 0.80, weighted kappa ranged from 0.30 (dice task) to 0.72 (animal fluency task). The standard error of measurement value for the SCOPA‐COG was 3.2, whereas the smallest real difference was 8.9. SCOPA‐COG total scores significantly decreased as the HY stage increased (Kruskal‐Wallis, P < 0.0001). Age, years of education, and PD duration (all, P < 0.001) were observed to have an independent, significant effect on the SCOPA‐COG. The SCOPA‐COG is a short, reliable, valid instrument that is sensitive to cognitive deficits specific to PD. © 2007 Movement Disorder Society     

Addenbrooke's Cognitive Examination validation in Parkinson's disease

Background: There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson’s disease (PD). Objectives: To study Addenbrooke’s Cognitive Examination (ACE) validity for cognitive assessment of PD patient’s using the Mattis Dementia Rating Scale (MDRS) as reference method. A specific scale for cognitive evaluation in PD, in this instance the Scales for Outcomes of Parkinson’s disease – Cognition (SCOPA‐COG), as well as a general use scale the Mini‐mental state examination (MMSE) were also studied for further correlation. Methods: Forty‐four PD patients were studied, of these 27 were males (61%), with a mean (SD) age of 69.5 (11.8) years, mean (SD) disease duration of 7.6 (6.4) years (range 1–25), mean (SD) total Unified Parkinson’s Disease Rating Scale (UPDRS) score 37 (24) points, UPDRS III 16.5 (11.3) points. MDRS, ACE and SCOPA‐COG scales were administered in random order. All patients remained in on‐state during the study. Results: Addenbrooke’s Cognitive Examination correlated with SCOPA‐COG (r = 0.93, P < 0.0001), and MDRS (r = 0.91 P < 0.0001) and also with MMSE (r = 0.84, P < 0.001). Area under the receiver‐operating curve, taking MDRS as the reference test, was 0.97 [95% confidence interval (CI): 0.92–1.00] for ACE, 0.92 (95% CI: 0.83–1.00) for SCOPA‐COG and 0.91 (95% CI: 0.83–1.00) for MMSE. Best cut‐off value for ACE was 83 points [Sensitivity (Se) = 92%; Specificity (Sp) = 91%; Kappa concordance (K) = 0.79], 20 points for the SCOPA‐COG (Se = 92%; Sp = 87%; K = 0.74) and 26 points for MMSE (Se = 61%; Sp = 100%; K = 0.69). Conclusion: Addenbrooke’s Cognitive Examination appears to be a valid tool for dementia evaluation in PD, with a cut‐off point which should probably be set at 83 points, displaying good correlation with both the scale specifically designed for cognitive deficits in PD namely SCOPA‐COG, as well as with less specific tests such as MMSE.     

Duodenal levodopa/carbidopa infusion therapy in patients with advanced Parkinson’s disease leads to improvement in caregivers’ stress and burden

Background: Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson’s disease (PD). However, the impact of DLI on caregivers’ stress and burden has not been reported. Methods: We evaluated prospectively open‐label seven advanced PD patients (65.7 ± 9.6 years, 71.4% men) treated with DLI. Schwab & England Activities of Daily Living Scale (ADLS), 39‐item Parkinson’s disease QoL Questionnaire Summary Index score (PDQ‐39SI), Zarit Caregiver Burden Interview (ZCBI), and Caregiver Strain Index (CSI) were used. Comparisons were made between scores obtained at baseline and those at a mean follow‐up of 31.4 ± 7.9 months (range, 23–42). Results: In patients, mean ± SD ADLS was increased from 50 ± 8.2 to 80 ± 11.6 (P = 0.014), and mean ± SD PDQ‐39SI was decreased from 53.7 ± 11.9 to 33.6 ± 12.8 (P = 0.018). In caregivers, ZCBI decreased from 43 ± 13.3 to 20.7 ± 12.1 (P = 0.018) and CSI from 6.3 ± 2.5 to 1.6 ± 0.9 (P = 0.018). At baseline, 57.1% of caregivers reported moderate to severe burden (ZCBI 41–88) compared to 28.6% at the end of the follow‐up (P = 0.015); at that time, no caregiver reported high level of stress (CSI ≥ 7) compared to 57.1% at baseline (P = 0.046). There were significant correlations between ZCBI and CSI improvement (r = 0.813, P = 0.026), ZCBI and PDQ‐39SI (r = 0.875, P = 0.01), and ZCBI and ADLS (r = 0.813, P = 0.026). Conclusions: Duodenal levodopa infusion‐related clinical improvement in patients with advanced PD leads to substantial reductions in caregivers’ stress and burden.     

Cross‐cultural evaluation of the modified Parkinson Psychosis Rating Scale across disease stages

This study assessed the psychometric attributes of the modified Parkinson Psychosis Rating Scale (mPPRS). In an attempt to improve scale's scaling assumptions and content validity, all types of hallucinations were rated and all items were scored based on intensity. The scale was cross‐culturally adapted to four Latin American countries (Argentina, Brazil, Ecuador, and Paraguay). Acceptability, internal consistency, factor structure, convergent and known‐groups validity, and precision (standard error of measurement, SEM) were explored. A total of 388 patients with PD were included in the study (age, 64.5 ± 10.7 years; 59.8% males; PD duration, 8.2 ± 4.9 years). The mPPRS was highly usable in terms of missing values generated and scores distribution (total computable scores, 99.7%, ceiling effect, <15%). Scaling assumptions were acceptable as noted by the range of item‐total correlations (0.14–0.55, only one coefficient below 0.2). Internal consistency was adequate for research use (Cronbach alpha, 0.7). Factor analysis identified two factors that accounted for 58.5% of the variance. Low correlation coefficients were found with cognitive function (SCOPA‐Cog) and disease severity (CISI‐PD) (r_S ≤ 0.30), whereas correlation with psychosis were high (r_S = 0.56). Known‐groups validity analyses indicated a significant increase in mPPRS scores by Hoehn and Yahr stage (P < 0.001). The SEM value was 1.06. Overall, the results suggest that the mPPRS is a useful tool for evaluation of psychosis in PD. The results show that some psychometric properties of the mPPRS are satisfactory albeit there is room for the improvement of scale's content validity and internal consistency. © 2010 Movement Disorder Society     

Assessing autonomic symptoms of Parkinson’s disease with the SCOPA‐AUT: a new perspective from Rasch analysis

Background: The Scale for Outcomes in Parkinson’s disease (PD) for Autonomic Symptoms (SCOPA‐AUT) is a specific scale to assess autonomic dysfunction in PD patients. It was developed and validated under the classic test theory approach. This study sought to test whether the SCOPA‐AUT meets item response theory standards for reliability, internal construct validity, response category ordering, and differential item functioning by gender and age group. Method: The Rasch measurement model was applied to a sample of 385 PD patients. Results: Model fit was obtained after the response categories were rescored and item 10‐Incomplete emptying deleted because of redundancy. Person separation index, a reliability measure, was 0.82. All but two items (2‐Sialorrhea and 13‐Nocturia) were free of gender‐ and age‐related bias. The strict tests of unidimensionality were met, indicating the validity of the total sumscore. Scale targeting suggested the need for items representing milder autonomic symptoms. Conclusions: Suggestions for improving the SCOPA‐AUT include a shorter scale with a simpler response scheme and a combination of sexual items for men and women. The resulting SCOPA‐AUT is a reliable scale, with good internal construct validity, providing Rasch transformed results on a linear metric scale.     

Validation of the Italian version of the Non Motor Symptoms Scale for Parkinson's disease

ObjectiveTo validate the adapted Italian version of the Non-Motor Symptoms Scale (NMSS), a tool to assess non-motor symptoms (NMS) in Parkinson's disease (PD).MethodsA cross cultural adaptation of the NMSS into Italian and a psychometric analysis of the translated version of the NMSS was carried out in patients with PD from two university centres–affiliated hospitals. The quality of data and the acceptability, reliability and construct validity of NMSS were analyzed. The following standard scales were also applied: Hoehn and Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) part III, Montreal Cognitive Assessment, Beck Depression Inventory, Neuropsychiatric Inventory, Epworth Sleepiness Scale, Autonomic Scale for Outcomes in Parkinson's disease-Motor, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part I and Modified Cumulative Illness Rating Scale (CIRS). Levodopa equivalent daily dose (LEDD) was calculated.ResultsSeventy-one patients with PD were assessed (mean age years 69.8 ± 9.6 SD; 31% women; mean length of disease 6.3 ± 4.6 years; H&Y median: 2). Mean NMSS was 39.76 (SD 31.9; skewness 0.95). The total score of NMSS was free of floor or ceiling effects and showed a satisfactory reliability (Cronbach's alpha coefficient on total score was 0.72 [range for domains: 0.64–0.73], SEM value was 3.88 [½ SD = 31.90]). Significant positive correlations were found among total NMSS and other NMS standard tests, but no significant correlation appeared with UPDRS part III, CIRS and LEDD.ConclusionsThe Italian NMSS is a comprehensive and helpful measure for NMS in native Italian patients with PD.     

Sleep problems affect quality of life in Parkinson's disease along disease progression

ObjectivesNon-motor symptoms (NMS) frequently impact health-related quality of life (HRQoL) in patients with Parkinson's Disease (PD). Sleep problems represent one of the main NMS complained by PD patients. In this observation study, sleep problems measured by Parkinson's Disease Sleep Scale - 2nd version (PDSS-2), and HRQoL measured by Parkinson's Disease Questionnaire-39 (PDQ39) were quantified in patients with PD ranging from mild to moderate-advanced disease stages, and correlated to motor impairment and anti-PD therapy.MethodsWe included idiopathic PD patients who underwent PDSS-2 and PDQ39. Moreover, we assessed patients' motor symptoms by rating the Unified Parkinson's Disease Rating Scale (UPDRS) - III section (motor examination), patients' PD status following H&Y stage, and levodopa equivalent daily dose (LEDD).ResultsOne-hundred and fifty-four patients with PD were included and distributed for H&Y stage. PDSS-2 and PDQ39 total and sub-items scores significantly increased with the H&Y stage. PDSS-2 total score significantly correlated with PDQ39 total score (γ = 0.63, P < 0.01). Finally, distributing PD patients according to the PDSS-2 cut-off for detecting sleep disturbances, we found in poor sleepers (n = 58) higher PDQ39 scores than good sleepers (n = 89).ConclusionsSleep problems are very common in patients with PD and severely impact on HRQoL. Sleep impairment and low HRQoL occur from the early stages of the disease and deteriorate along disease progression. Further studies investigating sleep and quality of life should be planned for targeting sleep improvement to increase HRQoL and possibly reduce motor impairment.     

Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life

Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society     

Should the SCOPA‐COG be modified?: a Rasch analysis perspective

Background and purpose: The SCales for Outcomes in PArkinson’s disease‐Cognition (SCOPA‐COG) is a specific measure of cognitive function for Parkinson’s disease (PD) patients. Previous studies, under the frame of the classic test theory, indicate satisfactory psychometric properties. The Rasch model, an item response theory approach, provides new information about the scale, as well as results in a linear scale. This study aims at analysing the SCOPA‐COG according to the Rasch model and, on the basis of results, suggesting modification to the SCOPA‐COG. Method: Fit to the Rasch model was analysed using a sample of 384 PD patients. Results: A good fit was obtained after rescoring for disordered thresholds. The person separation index, a reliability measure, was 0.83. Differential item functioning was observed by age for three items and by gender for one item. Conclusions: The SCOPA‐COG is a unidimensional measure of global cognitive function in PD patients, with good scale targeting and no empirical evidence for use of the subscale scores. Its adequate reliability and internal construct validity were supported. The SCOPA‐COG, with the proposed scoring scheme, generates true linear interval scores.     

Effectiveness of multidisciplinary care for Parkinson's disease: A randomized,controlled trial

Multidisciplinary care is considered an optimal model to manage Parkinson's disease (PD), but supporting evidence is limited. We performed a randomized, controlled trial (RCT) to establish whether a multidisciplinary/specialist team offers better outcomes, compared to stand‐alone care from a general neurologist. Patients with PD were randomly allocated to an intervention group (care from a movement disorders specialist, PD nurses, and social worker) or a control group (care from general neurologists). Both interventions lasted 8 months. Clinicians and researchers were blinded for group allocation. The primary outcome was the change in quality of life (Parkinson's Disease Questionnaire; PDQ‐39) from baseline to 8 months. Other outcomes were the UPDRS, depression (Montgomery‐Asberg Depression Scale; MADRS), psychosocial functioning (Scales for Outcomes in Parkinson's disease‐Psychosocial; SCOPA‐PS), and caregiver strain (Caregiver Strain Index; CSI). Group differences were analyzed using analysis of covariance adjusted for baseline values and presence of response fluctuations. A total of 122 patients were randomized and 100 completed the study (intervention, n = 51; control, n = 49). Compared to controls, the intervention group improved significantly on PDQ‐39 (difference, 3.4; 95% confidence interval [CI]: 0.5–6.2) and UPDRS motor scores (4.1; 95% CI: 0.8–7.3). UPDRS total score (5.6; 95% CI: 0.9–10.3), MADRS (3.7; 95% CI: 1.4–5.9), and SCOPA‐PS (2.1; 95% CI: 0.5–3.7) also improved significantly. This RCT gives credence to a multidisciplinary/specialist team approach. We interpret these positive findings cautiously because of the limitations in study design. Further research is required to assess teams involving additional disciplines and to evaluate cost‐effectiveness of integrated approaches. © 2012 Movement Disorder Society     

The impact of non-motor symptoms on the Health-Related Quality of Life of Parkinson's disease patients from Southwest China

BackgroundThe impact of non-motor symptoms (NMS) on the Health-Related Quality of Life (HRQoL) of patients with Parkinson's disease (PD) in the Chinese population are largely unknown.ObjectivesTo study the impact of NMS on the HRQoL in Chinese PD patients.MethodsA total of 693 PD patients from Southwest China were included in the study. NMS of patients were evaluated by non-motor symptoms scale (NMSS) and Parkinson's disease questionnaire-39 item version (PDQ-39) was used to evaluate the HRQoL of PD.ResultsThe mean total score of NMSS was 37.2 ± 33.0 and the most prevalent NMS domain was sleep/fatigue (79.8%). There was a significant strong positive correlation between total NMSS score (r_s = 0.71, P < 0.01), sleep/fatigue domain (r_s = 0.60, P < 0.01) and PDQ-39 SI. Mood/apathy (r_s = 0.55, P < 0.01), attention/memory (r_s = 0.42, P < 0.01), gastrointestinal (r_s = 0.44, P < 0.01) and Miscellany domains (r_s = 0.46, P < 0.01) moderately correlated with PDQ-39 SI. A strong correlation was found between PDQ-39 SI (r_s = 0.71, P < 0.01), emotional well-being (r_s = 0.62, P < 0.01), cognitions (r_s = 0.62, P < 0.01), and the total score of NMSS. Moderate correlation was found between mobility (r_s = 0.45, P < 0.01), activities of daily living (r_s = 0.43, P < 0.01), stigma (r_s = 0.42, P < 0.01), communication (r_s = 0.47, P < 0.01), bodily discomfort (r_s = 0.46, P < 0.01) and the total score of NMSS. Female, H–Y stage, UPDRS-III and NMSS total score were the potential determinants of worse HRQoL of PD patients.ConclusionsNMS have close association with various aspects of the HRQoL. Severe NMS may be related to dramatic decline of the HRQoL of PD patients.     

The relationship between quality of life and swallowing in Parkinson's disease

Few studies exist in the literature investigating the impact of idiopathic Parkinson's Disease (IPD) on swallow‐related quality of life. We therefore aimed in this project to: (1) evaluate swallow‐specific quality of life in IPD; (2) delineate potential relationships between IPD duration and severity with swallow‐specific quality of life; (3) investigate relationships between swallow‐specific quality of life and general health‐related quality of life; and (4) investigate relationships between swallow‐specific quality of life and depression. Thirty‐six patients diagnosed with IPD with and without dysphagia filled out self‐report assessments of the SWAL‐QOL, Parkinson's Disease Questionnaire‐39 (PDQ‐39), and Beck Depression Inventory (BDI). A series of Mann Whitney U tests were performed between non‐dysphagic and dysphagic groups for the total SWAL‐QOL score and the 10 SWAL‐QOL domains. Spearman's Rho correlation analyses were performed between the SWAL‐QOL and (1) PDQ‐39; (2) Hoehn and Yahr stage; (3) PD disease duration; (4) UPDRS “on” score; and (5) the BDI. The dysphagia swallowing group reported significant reductions compared to the non‐dysphagic group for the total SWAL‐QOL score (P = 0.02), mental health domain score (P = 0.002) and social domain score (P = 0.002). No relationships existed between swallow‐specific quality of life and disease duration or severity. Significant relationships existed between swallow‐specific quality of life and general health‐related quality of life (r_s =?0.56, P = 0.000) and depression (r_s = ?0.48, P = 0.003). These exploratory data highlight the psychosocial sequelae that swallowing impairment can have in those with IPD and suggest a possible association between swallowing, social function, and depression. © 2009 Movement Disorder Society     

Long-term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well-being

Santos‐García D, Sanjurjo LF, Macías M, Llaneza M, Carpintero P, de la Fuente‐Fernández R. Long‐term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well‐being.
Acta Neurol Scand: 2012: 125: 187–191.
© 2011 John Wiley & Sons A/S. Background – Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson′s disease (PD). However, in which aspects improve the patients their QoL has been poorly documented. Methods – We evaluated 39‐item Parkinson′s disease Quality of Life Questionnaire Summary Index score (PDQ‐39SI) changes analyzing its different domains in nine patients with advanced PD treated with DLI. Results – All the patients (64.7 ± 11.1 years, 55.5% men) improved PDQ‐39SI 6 months after beginning with DLI (29.7 ± 8.6, P = 0.008) and after median duration infusion of 25.3 ± 8.8 months (34.8 ± 11.2, P = 0.008) compared with baseline (55.6 ± 11.5). All domains except social support improved significantly at 6 months. Mobility (P = 0.012), activities of daily living (P = 0.015), and emotional well‐being (P = 0.008) improved significantly at the end of the follow‐up. Conclusions– DLI improves QoL in patients with advanced PD after short‐ and long‐term exposure. Whereas all domains except social support improve after 6 months under DLI, only mobility, activities of daily living and emotional well‐being improve significantly after long‐term exposure to DLI.