Rate of clinical progression in Parkinson's disease. A prospective study.

Few prospective data on the clinical progression of Parkinson's disease (PD) in patient groups outside treatment trials in selected patients are available, and controversy exists on the rate of clinical disease progression with advancing disease. In this study, we investigated the rate of clinical progression of PD in a clinic-based sample of 145 patients over 1 year and in a community-based sample of 124 patients over 4 years. Depending on the sample and clinical scale used, mean deterioration of motor and disability scores ranged from 2.4 to 7.4% of the maximum possible score per year, and standard deviations indicated that there was considerable variability of progression rates between individuals. The progression of motor scores decreased with follow-up over 4 years and significantly decreased in more advanced disease stages. Deterioration of disability scores did not differ between disease stages; this may reflect the increasing rate of disease complications, which contribute to increasing disability in addition to motor impairment alone, in more advanced disease. Thus, motor fluctuations, hallucinations, depression, memory problems, and bladder symptoms were all reported more often at follow-up in the community-based sample (all P < 0.01), and dyskinesias, motor fluctuations, falls, and hallucinations were more common and cognitive and depression scores worse in higher disease stages in the clinic-based sample (all P < 0.001). We conclude that progression of motor scores in PD decreases with advancing disease in PD. However, disability continues to deteriorate with advancing disease and with the development of disease complications that are likely to be related to additional extrastriatal pathology.     

Frequency of dementia, depression, and other neuropsychiatric symptoms in 1,449 outpatients with Parkinson’s disease

Neuropsychiatric symptoms (NPS) of Parkinson’s disease (PD) are of growing diagnostic and therapeutic importance. Data on their prevalence and characteristics have been primarily derived from highly selective clinical populations. We have conducted a national study in the outpatient care sector to provide a fuller characterization of the frequency of dementia, depression, and other NPS in PD outpatients. We also examined associations with biosocial and neurological variables. A nationwide representative sample of 1,449 PD outpatients was examined with a standardized clinical interview. PD severity was rated with the Hoehn and Yahr (HY) scale and the Unified Parkinson’s Disease Rating Scale. Depression was measured with the Montgomery-Asberg Depression Rating Scale. Cognitive impairment and dementia were assessed with the Mini-Mental State Exam and according to diagnostic criteria. Logistic regression analyses were used to investigate associations. At least one NPS occurred in 71% of all patients with PD. The estimated prevalences (ranges) by age group and HY-stage were: depression, 25% (13.2–47.9%), dementia, 29% (12.2–59.4%), and psychotic syndromes, 12.7% (3.1–40.9%). Other frequent complications were sleep disturbances (49%) and anxiety (20%). Depression was associated with gender but not with age. Dementia was associated with age. The rates and comorbidity of depression and dementia were driven by PD severity. NPS were highly prevalent in our comprehensive patient sample, largely representative of management problems occurring in an outpatient setting. PD outpatients are at an increased risk for all neuropsychiatric conditions, increasing with PD severity but not with age or age of onset (except dementia), revealing challenging symptom patterns.     

Safety and efficacy of perampanel in advanced Parkinson's disease: A randomized,placebo‐controlled study

Perampanel, a novel, noncompetitive, selective AMPA‐receptor antagonist demonstrated evidence of efficacy in reducing motor symptoms in animal models of Parkinson's disease (PD). We assessed the safety and efficacy of perampanel for treatment of “wearing off” motor fluctuations in patients with PD. Patients (N = 263) were randomly assigned to once‐daily add‐on 0.5, 1, or 2 mg of perampanel or placebo. The primary objective was to determine whether there was a dose‐response relationship for efficacy among the 3 perampanel doses and placebo. The primary efficacy endpoint for each treatment was measured as the least‐squares (LS) mean change from baseline to week 12 in percent “off” time reduction during the waking day, as recorded by patient diaries. The primary efficacy analysis was a 1‐sided Williams test for dose‐response trend at the 0.025 level of significance. At week 12, dose‐response trends, as determined by the Williams test, were not statistically significant for LS mean reduction in percent “off” time during the waking day (P = 0.061, with significance defined as P ≤ 0.025). The 2 higher perampanel doses (ITT population; n = 258) produced nonsignificant reductions from baseline to week 12 in percent “off” time during the waking day versus placebo (7.59%, P= 0.421 [1 mg], 8.60%, P = 0.257 [2 mg] versus 5.05% [placebo]; significance for pairwise comparisons defined as P ≤ 0.05). There were no significant changes in dyskinesia or cognitive function in any perampanel group versus placebo. Adverse events were similar across treatment groups. Perampanel treatment was well tolerated and safe, but failed to achieve statistical significance in primary and secondary endpoints. © 2010 Movement Disorder Society     

Langzeitkrankheitskosten 4 Jahre nach Schlaganfall oder TIA in Deutschland

BACKGROUND: The economic burden of stroke is considerable. While studies on the costs of acute stroke treatment have been undertaken in Germany, thorough analysis of direct and indirect long-term costs is lacking. PATIENTS AND METHODS: A hospital-based cohort of 151 consecutive patients with stroke or transient ischemic attacks (TIA) was followed up (medical examination and interview) at the end of the 4th year following the cerebrovascular event. Costs were calculated using a bottom-up approach and classified into direct medical and nonmedical costs, indirect costs, and patients' costs. RESULTS: Non-stroke-related costs (mean +/- standard deviation 4,610+/-9,310 Euros/person) were separated from total costs. Total stroke-related costs of the 4th year after stroke/TIA amounted to 7,670+/-10,250 Euros per person. The cost components were as follows: direct costs 56% (4,320+/-5,740 Euros), indirect costs 31% (2,350+/-2,710 Euros), and patients' payments 13% (1,000+/-4,100 Euros). The annual nationwide costs for the 4th year following stroke or TIA amounted to approximately 3 billion Euros. CONCLUSION: The considerable size of long-term costs after stroke/TIA is mainly due to direct costs and poses an economic challenge to the German health care system. Patients contribute in a relevant way by their own payments.     

Assessing health-related quality of life in patients with Parkinson's disease in a prospective longitudinal study

OBJECTIVE: To prospectively assess the health-related quality of life (HrQoL) in Parkinson's disease (PD) during 12 months. METHODS: HrQoL was assessed in 145 PD patients using the PD-specific PDQ-39, PDQL and the generic EQ-5D. In addition, clinical rating-scales were used. RESULTS: All scales showed a pronounced effect of PD. In comparison to an age-matched population the EQ-5D was considerably affected. In comparison to baseline, however, there was no significant change in the generic scale but a significant change in the sum-score of disease-specific HrQoL-scales. CONCLUSIONS: Only disease-specific scales were sensitive to change. Further studies are necessary to evaluate the time-dependent change in HrQoL.     

Social and clinical determinants of quality of life in Parkinson’s disease in Austria: a cohort study

Parkinson’s disease (PD) is associated with a reduction of health-related quality of life (HrQoL). Demographic and clinical determinants of HrQoL in PD have been previously investigated, but less is known about its social determinants. Data on HrQoL in Austrian patients with PD are not available. The objective of this cross-sectional survey was to evaluate HrQoL of Austrian patients with PD and to provide a comprehensive analysis of its social and clinical determinants. Outpatients (n = 100) with idiopathic PD were recruited in the Department of Neurology of the University Innsbruck. Clinical status was estimated using the Unified Parkison’s Disease Rating Scale (UPDRS). HrQoL was evaluated using a generic instrument, the EuroQol (EQ5D and EQ-VAS). Independent determinants of HrQoL were assessed in multivariate regression analysis. The proportion of PD patients with moderate or severe problems in at least one dimension of the EQ5D was significantly higher than in the general population (90.1 vs. 35.1%, P < 0.001). The mean EQ-VAS score in PD was lower than in the general population (48.9 ± 19.6 vs. 77.0 ± 20.8, P < 0.001). Social support (number of household members) was identified as an independent social determinant of HrQoL. Demographic and clinical determinants were age, depression, UPDRS and motor fluctuations. The analysis of determinants of HrQoL showed that a greater attention should be paid to social support and home care. Our data on HrQoL in PD should be considered in the development of new health care programs.     

Direkte und indirekte Kosten der Epilepsie

Limited financial resources in the healthcare system are contrasted by an increased utilization of medical services. In order to maintain medical care at a high standard in the future it is becoming increasingly necessary to consider economical factors in medical decision-making. The aim of cost-of-illness studies is to ascertain the complete costs related to the illness. Cost-of-illness studies are primarily implemented to elucidate the financial impact of diseases on society. They, therefore, serve as reference measures for economical analyses and provide important information for resource allocation by decision-makers in the healthcare system. Direct medical and non-medical costs contribute to the total costs attributable to treatment and care of patients whereas indirect costs include, for example those arising from premature pensioning or work loss. This article summarizes the available data on the direct and indirect costs of epilepsy.