Background and purpose
The Movement Disorder Society sponsored version of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) is a comprehensive instrument for assessing Parkinson's 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.
Methods
An international, multicenter, cross‐sectional study was carried out of 435 PD patients assessed with the MDS‐UPDRS, Hoehn and Yahr (HY), Clinical Impression Severity for PD, EQ‐5D and PD Questionnaire − eight items (PDQ‐8). Spearman's rank correlation coefficients, exploratory factor analysis and multiple linear regression models (dependent variables EQ‐5D and PDQ‐8) were performed.
Results
The participants’ age was 66.71 ± 10.32 years (51.5% men). PD duration was 8.52 ± 6.14, and median HY was 2 (range 1–5). The correlation between the EQ‐5D index and the MDS‐UPDRS ranged from −0.46 (Part IV) to −0.72 (Part II) and for the PDQ‐8 index from 0.47 (Part III) to 0.74 (Part II). In multiple regression models with the MDS‐UPDRS domains as independent variables, the main determinant for both the EQ‐5D index and the PDQ‐8 was Part II followed by Part I. After factorial grouping of the cardinal PD manifestations embedded in the MDS‐UPDRS Parts III and IV for inclusion into multiple regression models, a factor formed by M‐EDL, nM‐EDL and fluctuations was the main determinant for both the EQ‐5D and PDQ‐8 indexes.
Conclusions
The MDS‐UPDRS component most tightly related with the HRQoL measures was a combination of motor and non‐motor experiences of daily living.
Background and purpose
Although Parkinson's 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 Parkinson's 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).
Methods
To this purpose, 434 consecutive patients with PD were included in an international, observational, cross‐sectional study. The association between scores of both scales was determined by the Spearman rank correlation coefficient. Equations for transformation of total score of a scale to the other were constructed from weighted regression models and both, transformed and observed score, contrasted by means of the Lin's Concordance Correlation Coefficient (LCCC) and Bland–Altman plot.
Results
As a whole, the prevalence of the NMS according to each scale was quite similar, and most of the correlations between their corresponding components were high (rS > 0.60). The total score correlation of the MDS‐UPDRS Part I with the NMSS was high (rS = 0.81). Concerning the transformed scores, estimated scores only partially approach the observed ones (sharing about 60–64% of the variance) because residual variance increased with increasing magnitudes of the scores, i.e. the most severe patients (Bland–Altman plot; LCCC < 0.60 for severe patients).
Conclusions
(i) MDS‐UPDRS Part I (nM‐EDL) and NMSS showed a strong convergent validity; (ii) however, transformed scores using the equations from weighted regression models showed that for patients with the most severe NMS they are not concordant.
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Pantothenate kinase‐associated neurodegeneration (PKAN) is an autosomal recessive disorder characterized by iron accumulation in the brain, because of mutations in the PANK2 gene. Phenotypic and ...genotypic characteristics of 11 patients from five Mexican families with PKAN disease are reported. Sequencing of PANK2 confirmed the diagnosis. The 11 patients had dysarthria associated with dystonia and Parkinsonism in six. Brain magnetic resonance imaging (MRI) showed the ‘eye‐of‐the‐tiger’ sign in all patients. Three different mutations were identified, a novel one (p.A469P) and two (p.G219V and p.N404I) very rare. Homozygous sibs for the p.G219V mutation had a severe disease progression with early death. Dystonia predominated in the p.A469P/p.N404I compound heterozygous patients. Homozygous for p.N404I showed Parkinsonism, tics and personality and speech disorders. Early and late disease onset and variable expression was present in carriers of the different identified mutations. The ‘eye‐of‐the‐tiger’ is an excellent neuroimaging hallmark to predict PANK2 mutations. We detected a ‘cluster’ of patients harboring the p.N404I mutation, strongly suggesting a founder effect for this mutation. This is the first familial clinical‐genetic PKAN disease study accomplished in Mexico.
Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may ...present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease.
Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model.
98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL.
Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.
La alexitimia es un rasgo neuropsiquiátrico conceptualizado como la dificultad para identificar y describir sentimientos. Aunque está asociado con otros síntomas no motores, principalmente neuropsiquiátricos, sigue siendo una característica independiente de las personas con enfermedad de Parkinson (PcP). El objetivo del estudio es identificar los determinantes de la alexitimia y su asociación con la calidad de vida en la enfermedad de Parkinson.
Se reclutaron sujetos con enfermedad de Parkinson. Se aplicaron los siguientes instrumentos: escala unificada de la enfermedad de Parkinson de la Sociedad de Trastornos del Movimiento (MDS-UPDRS), escala de síntomas no motores (NMSS), evaluación cognitiva de Montreal (MoCA), escala de alexitimia de Toronto (TAS-20) y cuestionario de la enfermedad de Parkinson (PDQ-8). Se incluyeron controles sanos pareados, los cuales se evaluaron usando la TAS-20. Las variables clínicas y demográficas se compararon entre pacientes alexitímicos y no alexitímicos. Se utilizaron modelos de regresión para estimar los predictores de alexitimia. El impacto de este rasgo neuropsiquiátrico en la calidad de vida se estimó con un modelo de regresión lineal.
Se incluyeron 98 pacientes. El 56,1% de PcP y el 28,8% de los controles fueron alexitímicos (p < 0,001). El nivel educativo (OR 0,86) y la puntuación urinaria del NMSS (OR 1,09) determinaron la alexitimia, así como la puntuación del TAS-20. La alexitimia fue un determinante independiente de calidad de vida.
La alexitimia es un síntoma independiente no motor prevalente con impacto en la calidad de vida. El bajo nivel educativo y los síntomas urinarios son determinantes importantes de esta condición.
Micelles are good devices for use as controlled drug delivery systems because they exhibit the ability to protect the encapsulated substance from the routes of degradation until they reach the site ...of action. The present work assesses loading kinetics of a hydrophobic drug, pilocarpine, in polymeric micellar nanoparticles (NPs) and its pH-dependent release in hydrophilic environments. The trigger pH stimulus, pH 5.5, was the value encountered in damaged tissues in solid tumors. The new nanoparticles were prepared from an amphiphilic block copolymer, (HEMA19%-DMA31%)-(FMA5%-DEA45%). For the present research, three systems were validated, two of them with cross-linked cores and the other without chemical stabilization. A comparison of their loading kinetics and release profiles is discussed, with the support of additional data obtained by scanning electron microscopy and dynamic light scattering. The drug was loaded into the NPs within the first minutes; the load was dependent on the degree of cross-linking. All of the systems experienced a boost in drug release at acidic pH, ranging from 50 to 80% within the first 48 h. NPs with the highest degree (20%) of core cross-linking delivered the highest percentage of drug at fixed times. The studied systems exhibited fine-tuned sustained release features, which may provide a continuous delivery of the drug at specific acidic locations, thereby diminishing side effects and increasing therapeutic rates. Hence, the studied NPs proved to behave as smart controlled drug delivery systems capable of responding to changes in pH.
Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may ...present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease.
Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model.
98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL.
Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.
La alexitimia es un rasgo neuropsiquiátrico conceptualizado como la dificultad para identificar y describir sentimientos. Aunque está asociado con otros síntomas no motores, principalmente neuropsiquiátricos, sigue siendo una característica independiente de las personas con enfermedad de Parkinson (PcP). El objetivo del estudio es identificar los determinantes de la alexitimia y su asociación con la calidad de vida en la enfermedad de Parkinson.
Se reclutaron sujetos con enfermedad de Parkinson. Se aplicaron los siguientes instrumentos: escala unificada de la enfermedad de Parkinson de la Sociedad de Trastornos del Movimiento (MDS-UPDRS), escala de síntomas no motores (NMSS), evaluación cognitiva de Montreal (MoCA), escala de alexitimia de Toronto (TAS-20) y cuestionario de la enfermedad de Parkinson (PDQ-8). Se incluyeron controles sanos pareados, los cuales se evaluaron usando la TAS-20. Las variables clínicas y demográficas se compararon entre pacientes alexitímicos y no alexitímicos. Se utilizaron modelos de regresión para estimar los predictores de alexitimia. El impacto de este rasgo neuropsiquiátrico en la calidad de vida se estimó con un modelo de regresión lineal.
Se incluyeron 98 pacientes. El 56,1% de PcP y el 28,8% de los controles fueron alexitímicos (p < 0,001). El nivel educativo (OR 0,86) y la puntuación urinaria del NMSS (OR 1,09) determinaron la alexitimia, así como la puntuación del TAS-20. La alexitimia fue un determinante independiente de calidad de vida.
La alexitimia es un síntoma independiente no motor prevalente con impacto en la calidad de vida. El bajo nivel educativo y los síntomas urinarios son determinantes importantes de esta condición.
Parkinson's disease affects the quality of life of the individual with the disease in addition to creating a burden on the caregiver. Factors related to these effects include motor and non-motor ...aspects of the disease, as well as traits inherent to the caregiver.
We evaluated subjects with Parkinson's disease using the following instruments: Quality of Life Questionnaire PDQ-8, Movement Disorders Society Unified Parkinson's disease Rating Scale part i to iv (MDS-UPDRS), and Hoehn and Yahr staging. The Zarit Burden Inventory was used to assess all primary caregivers. Major demographic and clinical variables were also recorded.
A total of 250 subjects with Parkinson's disease were included, of whom 201 had a primary caregiver. In the multivariate analysis, predictors of poor quality of life for a subject with Parkinson's disease were the MDS-UPDRS I score (β=.39, P<.001), MDS-UPDRS II score (β=.21, P<.001), and MDS-UPDRS III score (β=.07, P=.004). Regarding caregiver burden, the MDS-UPDRS II score (β=.54, P=.007) was the most influential factor.
The present study shows a relationship between quality of life for the subject with Parkinson's disease and the caregiver's perceived burden. However, the factors that determine each situation appear to be distinct.
In people with Parkinson's disease, neuropsychiatric signs and symptoms are common throughout the disease course. These symptoms can be disabling and as clinically relevant as motor symptoms, and ...their presentation can be similar to, or distinct from, their counterparts in the general population. Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics. The underlying neurobiology of these presentations is complex and not well understood, with the strongest evidence for neuropathological changes associated with Parkinson's disease, mechanisms linked to dopaminergic therapy, and effects not specific to Parkinson's disease. Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice. Mounting evidence supports a range of pharmacological and non-pharmacological interventions, but relatively few efficacious treatment options exist. Optimising the management of neuropsychiatric presentations in people with Parkinson's disease will require additional research, raised awareness, specialised training, and development of innovative models of care.
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