Ingrid Estrada-Bellmann

Impact of Neuropsychiatric Symptoms on the Quality of Life of Subjects with Parkinson’s Disease

BACKGROUND Neuropsychiatric symptoms in Parkinsons disease (PD) are frequent. Impact of neuropsychiatric symptoms on quality of life has recently become a relevant topic of research due to its potential to develop targeted therapies to improve quality of life. OBJECTIVE To determine the impact of neuropsychiatric symptoms in patients with PD using the Parkinsons Disease Questionnaire Short Form (PDQ-8). METHODS Consecutive patients with PD were evaluated with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinsons disease (SEND-PD) and PDQ-8 scales separately. Association between neuropsychiatric symptoms and quality of life was explored using, means comparisons, correlation coefficients and multiple regression models. RESULTS A total of 492 patients were included for the study. Overall, 44.5% had psychotic symptoms, 76.5% had alterations on mood/apathy domains, and 27% had an impulse control disorder. All neuropsychiatric symptoms had an effect on the PDQ-8 with a moderate to large effect size. Correlation coefficients ranged from 0.17 to 0.63 between neuropsychiatric symptoms and quality of life (p <  0.001, in all cases). The regression model showed that mood/apathy alterations and impulse control disorders, along with MDS-UPDRS III accounted for 49.8% of variance in the PDQ-8 simplified index (F = 122.98; p <  0.001). Mood/apathy alterations showed the highest correlation coefficient (0.63, p <  0.001) and β (0.53, p <  0.001). CONCLUSIONS Both the presence and severity of neuropsychiatric symptoms, in particular mood/apathy alterations,had a significant impact on quality of life in subjects with PD.

Self-Perceived Pre-Motor Symptoms Load in Patients with Parkinson’s Disease: A Retrospective Study

BACKGROUND Parkinsons disease is characterized by motor and non-motor clinical features. The latter may present as pre-motor symptoms several years before the motor onset. OBJECTIVE To analyze the association between pre-motor symptoms load and its lead-time in relation to the motor onset and time to diagnosis. METHODS A cross-sectional study was carried including subjects with Parkinsons disease from five different movement disorders clinics in Mexico. A structured questionnaire was applied to assess the presence of six self-perceived pre-motor symptoms (hyposmia, depression, anxiety, constipation, pain and sleep disorders). RESULTS Overall frequency of pre-motor symptoms was 76.2% . Among the most prevalent symptoms were depression (38%), sleep disorders (37%) and anxiety (36.6%). The lead time to motor onset was greater for constipation (9.2 ± 17.89 years) and pain (8.66 ± 13.36 years). Patients with more than two pre-motor symptoms had a later age at motor onset when compared to patients without pre-motor symptoms (52.04 ± 13.11 vs 56.55 ± 12.97 years, p = 0.037). Late onset patients had a higher frequency of pre-motor symptoms (79% vs 65% in early onset, p = 0.002) and a higher load (1.75 ± 1.37 vs 1.44 ± 1.38, p = 0.033) in comparison to those with early onset. Female subjects reported a higher number of pre-motor symptoms (1.91 ± 1.43 versus 1.48 ± 1.29, p ≤ 0.001). PIGD patients reported a greater frequency of pain (8%) compared to tremor (1%, p = 0.0064) and bradykinetic-rigid (0.61%, p = 0.0061). Anxiety lead-time was greater in tremor-dominant (10.83 ± 15.77 years) compared to bradykinetic-rigid patients (3.48 ± 12.56, p = 0.014). CONCLUSIONS Pre-motor symptoms load is associated to a later motor onset of PD. Pre-motor symptoms are more frequent in subjects with late onset Parkinsons disease. Female subjects report a higher number of pre-motor symptoms, depression and anxiety being the most common.

Convergent validation of EQ-5D-5L in patients with Parkinson's disease

INTRODUCTION The European Quality of Life Questionnaire 5 level version (EQ-5D-5L) is a recently updated instrument to assess Health-Related Quality of Life (HRQoL) that has not been validated extensively. The main objective of this study was to evaluate the internal consistency and convergent validation of the EQ-5D-5L in a large sample of subjects with Parkinsons disease (PD). METHODS A cross-sectional study was carried out. Consecutive Mexican subjects with PD were included. HRQoL was assessed using the EQ-5D-5L and the PDQ-8. Validity of the EQ-5D-5L was assessed determining its association with clinical ratings of disease severity, as well as correlation with PDQ-8. Additionally, performance was evaluated along predefined groups based on clinical and demographic data of known determinants of quality of life. RESULTS A total of 585 patients were included for this study. A strong correlation was found between EQ-5D-5L index and PDQ-8 index (Spearmans correlation coefficient=-0.75; p<0.001). Correlation between EQ-5D-5L index and PDQ-8 index remained strong (-0.60 to -0.78; p values <0.001) through all predefined groups. EQ-5D-5L scored higher in those patients with dyskinesia, wearing off, freezing, postural instability, cognitive impairment or depressive mood (p values <0.001). CONCLUSION The EQ-5D-5L is a valid instrument for evaluating HRQoL in PD, performing adequately irrespective of heterogeneous clinical and demographic characteristics, and showing to be sensitive to features of advanced disease and treatment complications.

Premotor symptoms and the risk of Parkinson’s disease: A case-control study in Mexican population

OBJECTIVES To assess the prevalence of pre-motor symptoms and estimate the risk for developing Parkinsons disease in Mexican population. PATIENTS AND METHODS A case-control study was carried out with consecutive subjects with Parkinsons disease from two different referral centers in Mexico. Gender- and age-matched controls were randomly selected from the participating hospitals. All subjects were assessed using a structured questionnaire for the assessment of pre-motor symptoms (hyposmia, depression, anxiety, constipation, and sleep disorders). Odds ratios (OR) were calculated using logistic regression analysis. RESULTS A total of 430 subjects with PD and 430 healthy subjects were included. Premotor symptoms prevalence was 77.7% (n=334) for the PD group, compared to 41.3% (n=178) in the control group (p<0.001). After logistic multivariate analysis, previous history of hyposmia (OR 2.02 [95% CI 1.33-3.06]), depression (OR 2.52 [95% CI 1.67-3.84]), anxiety (OR 4.37 [95% CI 2.73-6.98]) and sleep disorders (OR 2.03 [95% CI 1.41-2.93]) were independently associated with Parkinsons disease. Overall prediction success of the model was 81.2% for controls and 61.2% for subjects with PD. CONCLUSION All five premotor symptoms assessed were more commonly reported in PD subjects than healthy controls. The presence of non-motor symptoms yield a prediction success of 71.2% to discriminate between PD subjects and healthy controls.