Pablo Martinez-Martin

Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Scale Presentation and Clinimetric Testing Results

We present a clinimetric assessment of the Movement Disorder Society (MDS)‐sponsored revision of the Unified Parkinsons Disease Rating Scale (MDS‐UPDRS). The MDS‐UDPRS Task Force revised and expanded the UPDRS using recommendations from a published critique. The MDS‐UPDRS has four parts, namely, I: Non‐motor Experiences of Daily Living; II: Motor Experiences of Daily Living; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver. Item‐specific instructions and an appendix of complementary additional scales are provided. Movement disorder specialists and study coordinators administered the UPDRS (55 items) and MDS‐UPDRS (65 items) to 877 English speaking (78% non‐Latino Caucasian) patients with Parkinsons disease from 39 sites. We compared the two scales using correlative techniques and factor analysis. The MDS‐UPDRS showed high internal consistency (Cronbachs alpha = 0.79–0.93 across parts) and correlated with the original UPDRS (ρ = 0.96). MDS‐UPDRS across‐part correlations ranged from 0.22 to 0.66. Reliable factor structures for each part were obtained (comparative fit index > 0.90 for each part), which support the use of sum scores for each part in preference to a total score of all parts. The combined clinimetric results of this study support the validity of the MDS‐UPDRS for rating PD.

Assessing the non-motor symptoms of Parkinson's disease: MDS-UPDRS and NMS Scale.

Although Parkinsons disease (PD) is characterized by typical motor manifestations, non‐motor symptoms (NMS) are an outstanding part of the disease. At present, several specific instruments for assessment of NMS are available. The objective of our study was to determine the performance of the Movement Disorder Society‐Unified Parkinsons Disease Rating Scale (MDS‐UPDRS): Part I – Non‐Motor Aspects of Experiences of Daily Living (nM‐EDL) compared with the Non‐Motor Symptoms Scale (NMSS).

Relationship between the MDS-UPDRS domains and the health-related quality of life of Parkinson's disease patients.

The Movement Disorder Society sponsored version of the Unified Parkinsons Disease Rating Scale (MDS‐UPDRS) is a comprehensive instrument for assessing Parkinsons disease (PD). The present study was aimed at determining the relationships between MDS‐UPDRS components and health‐related quality of life (HRQoL) evaluations in PD patients.

Modeling depression in Parkinson disease Disease-specific and nonspecific risk factors

Objective: To construct a model for depression in Parkinson disease (PD) and to study the relative contribution of PD-specific and nonspecific risk factors to this model. Methods: Structural equation modeling of direct and indirect associations of risk factors with the latent depression outcome using a cross-sectional dataset of 342 patients with PD. Results: A model with acceptable fit was generated that explained 41% of the variance in depression. In the final model, 3 PD-specific variables (increased disease duration, more severe motor symptoms, the use of levodopa) and 6 nonspecific variables (female sex, history of anxiety and/or depression, family history of depression, worse functioning on activities of daily living, and worse cognitive status) were maintained and significantly associated with depression. Nonspecific risk factors had a 3-times-higher influence in the model than PD-specific risk factors. Conclusion: In this cross-sectional study, we showed that nonspecific factors may be more prominent markers of depression than PD-specific factors. Accordingly, research on depression in PD should focus not only on factors associated with or specific for PD, but should also examine a wider scope of factors including general risk factors for depression, not specific for PD.

Factor analysis of the Hamilton Depression Rating Scale in Parkinson's disease

INTRODUCTION Several studies have validated the Hamilton Depression Rating Scale (HAMD) in patients with Parkinsons disease (PD), and reported adequate reliability and construct validity. However, the factorial validity of the HAMD has not yet been investigated. The aim of our analysis was to explore the factor structure of the HAMD in a large sample of PD patients. METHODS A principal component analysis of the 17-item HAMD was performed on data of 341 PD patients, available from a previous cross sectional study on anxiety. An eigenvalue ≥1 was used to determine the number of factors. Factor loadings ≥0.4 in combination with oblique rotations were used to identify which variables made up the factors. Kaiser-Meyer-Olkin measure (KMO), Cronbachs alpha, Bartletts test, communality, percentage of non-redundant residuals and the component correlation matrix were computed to assess factor validity. RESULTS KMO verified the samples adequacy for factor analysis and Cronbachs alpha indicated a good internal consistency of the total scale. Six factors had eigenvalues ≥1 and together explained 59.19% of the variance. The number of items per factor varied from 1 to 6. Inter-item correlations within each component were low. There was a high percentage of non-redundant residuals and low communality. CONCLUSION This analysis demonstrates that the factorial validity of the HAMD in PD is unsatisfactory. This implies that the scale is not appropriate for studying specific symptom domains of depression based on factorial structure in a PD population.

Handbook of Non-Motor Symptoms in Parkinson's Disease

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Short-term association between road traffic noise and healthcare demand generated by Parkinson's disease in Madrid, Spain

OBJECTIVE To analyse whether there is a short-term association between road traffic noise in the city of Madrid and Parkinsons disease (PD)-related demand for healthcare. METHODS Time-series analysis (2008-2009) using variables of analysis linked to emergency and daily PD-related demand for healthcare (ICD-10: G20-G21), namely, PD-hospital admissions (HAs), PD-outpatient visits (OVs) and PD-emergency medical calls in Madrid. The noise pollution measurements used were Leqd, equivalent sound level for the daytime hours (from 8 a.m. to 10 p.m.), and Leqn, equivalent sound level for night time hours (from 10 p.m. to 8 a.m.) in dB(A). We controlled for temperature, pollution, trends and seasons, and used the Poisson regression model to calculate relative risk (RR). RESULTS The association between Leqd and HAs was found to be linear. Leqd and Leqn at lag 0.1 and temperature at lags 1 and 5 were the only environmental variables associated with increased PD-related healthcare demand. The RR (lag 0) for Leqd and HA was 1.07 (1.04-1.09), the RR (lag 0) for Leqd and OV was 1.28 (1.12-1.45), and the RR (lags 0.1) for Leqn and emergency medical calls was 1.46 (1.06-2.01). CONCLUSION The above results indicate that road traffic noise is a risk factor for PD exacerbation. Measures to reduce noise-exposure levels could result in a lower PD-related healthcare demand.

Cognition and Neuropsychiatric Symptoms

This section reviews scales that evaluate cognitive dysfunction and neuropsychiatric symptoms such as behavioural problems, psychotic complications, depression, and apathy. Behavioural problems and psychotic complications (e.g., psychomotor agitation and hallucinations), are important sources of caregiver burden, and frequently constitute a reason for institutionalization. In Parkinson’s disease (PD), depression is very prevalent and is a significant determinant of both patient’s and caregiver’s quality of life.

Scales that Evaluate Specific Non-motor Disorders

This chapter presents scales that evaluate two non-motor disorders frequently present in patients with Parkinson’s disease (PD): sleep problems and fatigue. In addition, a PD-specific scale that focuses on autonomic symptoms is reviewed.

Comprehensive Non-motor Symptoms Assessments

There are two instruments available for assessing a wide variety of non-motor symptoms (NMS) that may be present in Parkinson’s disease (PD). One is completed by the patient, and the other by the clinician. Once identified, some NMS may be assessed in more detail with specific scales, such as those described in Chapter 6.