Laurence Nègre-Pagès

Chronic pain in Parkinson's disease: The cross-sectional French DoPaMiP survey

Pain is a frequent, but poorly studied symptom of Parkinsons disease (PD). DoPaMiP survey aimed to assess the prevalence of chronic pain in PD, to describe PD patients with chronic pain, and to record analgesic consumption. About 450 parkinsonian patients underwent structured standardized clinical examination and completed self‐reported questionnaires in a cross sectional survey. Pains related or unrelated to PD were identified according to predefined criteria. About 98 patients with other chronic disorders than PD were examined to assess if pain was more frequent in PD than in this population. Two thirds parkinsonian patients (278 of 450) had chronic pain. Twenty‐five patients with non‐chronic pain (<3‐month duration) were excluded from subsequent analysis. Twenty six percent (111 of 425) parkinsonian patients had pain unrelated to PD (“non‐PD‐pain”, caused mainly by osteoarthritis), while 39.3% (167 of 425) had chronic pain related to PD (“PD‐pain”). In this last group, PD was the sole cause of pain in 103 and indirectly aggravated pain of another origin (mainly osteoarthritis) in 64. Parkinsonian patients with “PD‐pain” were younger at PD onset, had more motor complications, more severe depressive symptoms than those without pain or with “non‐PD pain.” “PD‐pain” was more intense (P = 0.03), but was less frequently reported to doctors (P = 0.02), and was associated with less frequent analgesic consumption than “non‐PD‐pain.” Pain was twice more frequent in PD patients than in patients without PD after adjustment for osteo‐articular comorbidities (OR = 1.9; 95% CI 1.2–3.2). Chronic pain is frequent but underreported in PD. Awareness of this problem should be increased and the assessment of analgesic strategies improved.

Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey

A potentially traumatic event (PTE) contributes to trauma through its frequency, conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.

Prévalence et comorbidité des troubles psychiatriques dans la population générale française : résultats de l’étude épidémiologique ESEMeD/MHEDEA 2000/ (ESEMeD)

Resume Introduction ESEMeD est la premiere etude epidemiologique internationale realisee sur des echantillons aleatoires permettant de mesurer avec precision la prevalence des troubles psychiatriques en France et de comparer directement celle-ci avec celles observees dans d’autres pays europeens. Objectifs 1) Determiner la prevalence des troubles depressifs, anxieux ou lies a l’alcool sur douze mois et au cours de la vie ; 2) estimer leur taux de comorbidite ; 3) evaluer les facteurs demographiques de risque de ces troubles. Methode - Il s’agit d’une enquete transversale realisee en 2001-2003 en population generale chez des sujets âges de plus de 18 ans et non institutionnalises, vivant en Allemagne (n = 3 555), en Belgique (n = 2 419), en Espagne (n = 5 473), en France (n = 2 894), aux Pays-Bas (n = 2 372) et en Italie (n = 4 712). En France, la base de sondage utilisee etait une liste de numeros de telephone generes aleatoirement. Les sujets ont ete interroges a leur domicile par des enqueteurs professionnels. Le questionnaire WMH-CIDI a ete utilise. Resultats Le taux de participation a ete de 46 % pour la France et de 61 % pour l’ensemble des pays. La prevalence au cours des douze derniers mois et au cours de la vie etait respectivement 6,0 % et 21,4 % pour les episodes depressifs majeurs, 1,6 % et 7,9 % pour la dysthymie, 2,1 % et 6,0 % pour l’anxiete generalisee, 1,2 % et 3,0 % pour les troubles panique, 0,6 % et 1,8 % pour l’agoraphobie, 2,2 % et 3,9 % pour l’etat de stress post-traumatique, 1,7 % et 4,7 % pour la phobie sociale, 4,7 % et 11,6 % pour la phobie specifique, 0,5 % et 4,1 % pour l’abus d’alcool, et 0,3 % et 1,6 % pour la dependance a l’alcool.Les troubles depressifs et anxieux etaient significativement plus frequents chez les femmes et les troubles lies a l’alcool plus frequents chez les hommes. La frequence des trois types de troubles est moins importante chez les sujets âges et chez ceux vivant en milieu rural. Les troubles depressifs et lies a l’alcool etaient plus frequents chez les sujets vivant sans conjoint et les troubles depressifs plus prevalents chez ceux sans emploi remunere. 38 % des sujets presentant un trouble depressif avaient egalement un trouble anxieux ou un trouble lie a l’alcool associe. La comorbidite des troubles depressifs et anxieux etait plus frequente chez les femmes, les sujets jeunes et ceux vivant sans conjoint. Le taux de comorbidite chez les sujets presentant des troubles anxieux etait de 26 % sans difference entre les sexes. En ce qui concerne les troubles lies a l’alcool, il existait une forte difference de taux de comorbidite selon le sexe, a savoir 67 % chez la femme et 26 % chez l’homme. Conclusion Cette etude souligne la prevalence elevee des troubles depressifs, anxieux et lies a l’alcool en France, ainsi qu’une importante comorbidite entre eux. En outre, elle souligne la necessite d’evaluer et de prendre en compte la presence eventuelle d’une telle comorbidite dans l’organisation des soins.

Adherence to Antiparkinson medication in a Multicenter European study

Two small studies reported suboptimal therapy adherence in Parkinsons disease. We conducted a larger multicenter European study to assess medicine‐taking behavior. Parkinsons disease patients taking dopaminergic therapy were enrolled in 8 centers in 5 countries, and disease severity and demographics recorded. Antiparkinson drug adherence was measured for 4 weeks using electronic monitoring bottles which record the date and time of cap opening (Aardex®, Switzerland). One hundred twelve patients, mean age 65 years (standard deviation (SD) 10), with Parkinsons disease for 7.7 (SD 8.2) years completed the study. Total median adherence (doses taken/doses prescribed) was 97.7% (interquartile range [IQ] 90.6–100), days adherence (correct dose days) was 86.2% (IQ 61.1–96.2) and timing adherence (doses taken at correct time intervals) was 24.4% (IQ 5.3–56.5). Fourteen patients (12.5%) took less than 80% of prescribed doses, which was defined as suboptimal adherence. Patients with satisfactory adherence took a median of 8 mg/day (IQ 0–33) less than their prescribed dose of levodopa (P = NS), while suboptimal adherence patients took a median of 481 mg/day (IQ 205–670) less than their prescribed dose (P = 0.0006). The Parkinson motor score was significantly higher in patients with suboptimal adherence at 29 (IQ 20–40), versus those with satisfactory adherence at 19 (IQ 13–26), P = 0.005. Once daily drugs had significantly better adherence when compared with drugs prescribed more frequently (P < 0.0001). Suboptimal therapy adherence is associated with significant deviation from prescribed levodopa doses, despite greater Parkinsons motor severity. Optimizing oral medication intake has a potential role in maximizing the therapy response in Parkinsons disease.

Anxious and Depressive Symptoms in Parkinson's Disease: The French Cross-Sectionnal DoPAMiP Study

Anxiety has been less extensively studied than depression in Parkinsons disease (PD). The DoPaMiP survey allowed assessing simultaneously anxiety and depressive symptoms in PD and comparing correlations of both symptoms with clinical and therapeutic features of the disease. Cross sectional survey conducted prospectively in 450 ambulatory nondemented PD patients and 98 patients with other disorders than PD. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), parkinsonism using the Unified Parkinsons Disease Rating Scale (UPDRS). Other clinical factors were measured using a structured standardized examination/questionnaire. The mean HADS‐A (anxiety) subscore was higher in PD patients than in the others (8.2 ± 3.9 vs. 6.5 ± 3.2, P < 10−4) as was the HADS‐D (depressive) subscore (6.6 ± 3.8 vs. 3.9 ± 3.2, P < 10−4). Patients with possible/probable anxious signs (HADS‐A ≥ 8) were more prevalent in PD (51% vs. 29%, P < 10−4) as were those with depressive symptoms (40% vs. 10%, P < 10−4). Conversely, anxiolytic and antidepressant medications consumption was not different between the 2 groups. Patients with anxious symptoms were more frequently female and younger than those without such symptoms, while those with depressive symptoms had more severe indices of parkinsonism, more comorbidities and lower cognitive function (Mini Mental State Exam). The logistic regression model revealed that patients with depressive symptoms received more frequently levodopa and less frequently a dopamine agonist. Anxiety and depressive symptoms were more frequent in PD patients than in medical control group. Both symptoms were commonly associated in the same PD patients, but were correlated with different clinical/therapeutic features, suggesting different underlying pathophysiological mechanisms.

Usage des psychotropes et troubles psychiatriques en France : résultats de l’étude épidémiologique ESEMeD/MHEDEA 2000/ (ESEMeD) en population générale

Resume Introduction L’usage de psychotropes est important en France et augmente depuis deux decennies. A ce jour, aucune etude nationale confrontant cet usage au diagnostic des troubles psychiatriques n’a ete realisee. L’etude ESEMeD/MHEDEA 2000 permet d’avoir une idee precise des conditions d’usage des psychotropes et de mettre en perspective la France par rapport a cinq autres pays europeens (Allemagne, Belgique, Espagne, Hollande et Italie). Les objectifs etaient (1) decrire l’usage des psychotropes declares (globalement et par classe therapeutique) afin d’en evaluer la prevalence annuelle, les durees de traitement et les facteurs demographiques associes a leur utilisation. (2) estimer la proportion des sujets presentant un trouble anxieux, depressif ou lie a l’alcool (abus ou dependance) qui sont effectivement traites par un antidepresseur (AD) ou un anxiolytique-hypnotique (AX-HY). (3) evaluer la proportion des usagers de psychotropes repondant aux criteres diagnostiques de troubles depressif, anxieux, ou lie a l’alcool. Methode Il s’agit d’une enquete transversale realisee en 2001-2003, en population generale, chez des sujets âges de plus de 18 ans et non institutionnalises, vivant en Allemagne (n = 3 555), en Belgique (n = 2 419), en Espagne (n = 5 473), en France (n = 2 894), aux Pays-Bas (n = 2 372) et en Italie (n = 4 712). En France, la base de sondage utilisee etait une liste de numeros de telephone generes aleatoirement. Les sujets ont ete interroges a leur domicile par des enqueteurs professionnels. Le questionnaire WMH-CIDI a ete utilise. Resultats En France, 21 % des sujets interroges (n = 590) avait pris au moins une fois un psychotrope dans l’annee. Il s’agissait d’un anxiolytique-hypnotique (AX-HY) pour 19 %, d’un antidepresseur (AD) pour 6,0 %, d’un antipsychotique (AP) pour 0,8 % et d’un thymoregulateur (TY) pour 0,4 %.La repartition des usagers d’AX-HY selon le nombre de jours de traitement etait la suivante : 44 % (1-15 jours), 13 % (16-30 jours), 14 % (1-3 mois), 6,7 % (3-6 mois) et 23 % (> 6 mois). Pour les AD, la repartition etait : 21 % (1-15 jours), 7,8 % (16-30 jours), 18 % (1-3 mois), 12 % (3-6 mois) et 42 % (> 6 mois). Parmi les personnes qui repondaient aux criteres de trouble depressif dans l’annee ou au cours de la vie, 43 % et 29 % respectivement avaient pris un AX-HY dans les douze derniers mois, 29 % et 16 % un AD. Pour ceux qui repondaient au diagnostic de trouble anxieux dans l’annee ou au cours de la vie, l’usage d’AX-HY, dans les douze derniers mois, a concerne 43 % et 30 % des sujets tandis que celui des AD concernait 16 % et 14 %. En cas de trouble lie a l’alcool dans l’annee ou sur la vie, l’usage d’AX-HY, dans les douze derniers mois, a concerne respectivement 63 % et 22 % de ces sujets et l’usage des AD, 9,3 % et 7,2 %.Chez les usagers d’AX-HY au cours des douze derniers mois, un diagnostic de trouble depressif a ete retrouve parmi 16 % sur l’annee et 39 % au cours de la vie. Chez les usagers d’AD, les prevalences respectives etaient de 31 % et 64 %. Un diagnostic de trouble anxieux sur l’annee et au cours de la vie a ete retrouve parmi 22 % et 37 % des usagers d’AX-HY et parmi 27 % et 50 % des usagers d’AD respectivement. Un diagnostic de trouble lie a l’alcool sur l’annee et au cours de la vie a ete retrouve parmi 2,5 % et 6,6 % des usagers d’AX-HY et parmi 1,1 % et 7,8 % des usagers d’AD respectivement.Le taux d’usagers d’AX-HY ne repondant a aucun des diagnostics precedents etait de 68 % sur l’annee et de 46 % au cours de la vie. En ce qui concerne les usagers d’AD ne repondant a aucun des diagnostics precedents, ce taux s’etablissait a 56 % sur l’annee et a 20 % au cours de la vie.La comparaison des donnees francaises a celles de l’echantillon europeen montre que la prevalence annuelle de l’usage des AX-HY et des AD est plus elevee en France avec des durees moyennes d’usage plus courtes. Pour les AP et les TY, il n’existe pas de difference nette entre la France et l’ensemble des six pays de l’etude. Discussion Depuis deux decennies, l’usage des AX-HY semble avoir diminue en France, meme s’il reste plus eleve que celui observe dans les autres pays de l’etude. Cet usage plus important peut, en partie, s’expliquer par le fait qu’il correspond, dans la moitie des cas, a un usage ponctuel. En revanche, l’usage des AD a augmente. Chez les sujets presentant des troubles depressifs ou anxieux recents, l’usage des AX-HY reste plus important que celui des AD. Enfin, parmi les usagers des AX-HY, seulement la moitie a presente un episode anxieux, depressif ou lie a l’alcool au cours de leur vie, alors que cette proportion s’eleve a 80 % chez les usagers des AD. Remerciements Ce projet a ete soutenu financierement par la Commission Europeenne (Contrat QLG5-1999-01042) et a ete developpe grâce au soutien humain et financier du Laboratoire GlaxoSmithKline que nous remercions chaleureusement. L’etude ESEMeD/ MHEDEA 2000 (The European Study of Epidemiology of Mental Disorders/Mental Health Disability : a European Assessment in the year 2000) a ete menee conjointement avec l’Organisation Mondiale de la Sante : World Mental Health Survey Initiative ( http://www.hcp.med.harvard.edu/wmh/ ). Nous remercions l’equipe coordinatrice World Mental Health (WMH) pour leur aide concernant les outils de mesure et pour leur conseil en matiere de procedures operationnelles.

Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease.

IMPORTANCE Freezing of gait (FOG) is a common axial symptom of Parkinson disease (PD). OBJECTIVE To determine the prevalence of FOG in a large group of PD patients, assess its relationship with quality of life and clinical and pharmacological factors, and explore its changes from the off to on conditions in patients with motor fluctuations. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey of 683 patients with idiopathic PD. Scores for FOG were missing in 11 patients who were not included in the analysis. Patients were recruited from referral centers and general neurology clinics in public or private institutions in France. EXPOSURE Patients with FOG were identified as those with a score of 1 or greater on item 14 of the Unified Parkinsons Disease Rating Scale (UPDRS) in the on condition. Item 14 scores for FOG in the off condition were also collected in patients with fluctuating motor symptoms. MAIN OUTCOMES AND MEASURES Quality of life (measured by the 39-item Parkinsons Disease Questionnaire and 36-Item Short Form Health Survey), anxiety and depression (Hospital Anxiety and Depression Scale), clinical features (UPDRS), and drug consumption. RESULTS Of 672 PD patients, 257 reported FOG during the onstate (38.2%), which was significantly related to lower quality of life scores (P < .01). Freezing of gait was also correlated with longer PD duration (odds ratio, 1.92 [95% CI, 1.28-2.86]), higher UPDRS parts II and III scores (4.67 [3.21-6.78]), the presence of apathy (UPDRS item 4) (1.94 [1.33-2.82]), a higher levodopa equivalent daily dose (1.63 [1.09-2.43]), and more frequent exposure to antimuscarinics (3.07 [1.35-6.97]) (logistic regression). The FOG score improved from the off to on states in 148 of 174 patients with motor fluctuations (85.1%) and showed no change in 13.8%. The FOG score improved by more than 50% in 43.7% of patients. Greater improvement in the on state was observed in younger patients (r = -0.25; P < .01) with lower UPDRS II and III scores (r = -0.50; P < .01) and no antimuscarinic use (r = -0.21; P < .01). CONCLUSIONS AND RELEVANCE Freezing of gait in PD patients correlates with poor quality of life, disease severity, apathy, and exposure to antimuscarinics. Dopaminergic therapy improved FOG in most patients with motor fluctuations, especially younger ones with less severe disease and no antimuscarinic use. This finding suggests that quality of life is impaired in PD patients with FOG and that optimizing dopaminergic therapy and avoiding antimuscarinics should be considered.

Oro-buccal symptoms (dysphagia, dysarthria, and sialorrhea) in patients with Parkinson’s disease: preliminary analysis from the French COPARK cohort

Introduction:  Abnormal oro‐buccal functions including dysarthria, sialorrhea and dysphagia commonly affect patients with Parkinson’s disease (PD).

L‐DOPA‐induced dyskinesias, motor fluctuations and Health‐related Quality of Life: the COPARK survey

Studies assessing the correlations between L‐DOPA‐induced dyskinesias (LIDs) and motor fluctuations with health‐related quality of life (HRQoL) in Parkinsons disease (PD) have yielded conflicting results. This study aimed to assess the relationship between LIDs and motor fluctuations with HRQoL in patients with PD, and to assess the relative contribution of their severity and duration in a large sample of patients with PD.