Abstract
Background
Insight in how impairments and disabilities related to Parkinson’s disease (PD) influence health-related quality of life (HRQoL) is required to review adequacy of current management strategies.
Methods
The Scales for Outcomes in Parkinson’s disease (SCOPA) evaluation was used to assess impairments and disabilities. HRQoL was assessed with the EuroQol-5D Visual Analogue Scale. 378 patients with PD who participated in the SCOPA/PROPARK cohort were assessed while on their usual treatment. Multiple linear regression analysis and structural equation modelling were used to construct a model of factors that influence HRQoL.
Results
A model with good fit was constructed that identified various impairments and disabilities as important contributors to HRQoL in PD. Of the disabilities, psychosocial well-being had a larger impact on HRQoL than physical functioning. Of the impairments, depression had the largest contribution to HRQoL, followed by axial motor symptoms, gastrointestinal symptoms, and urinary symptoms. In addition, pain, psychiatric and motor complications, and daytime sleepiness had small but significant influences on HRQoL.
Conclusion
Multiple factors, including disabilities, nonmotor symptoms and axial motor symptoms, affect HRQoL in patients with PD. In patients who are on symptomatic treatment aiming to alleviate mainly motor symptoms, there is a large impact on HRQoL of nonmotor and nondopaminergic symptoms. Research is warranted to develop and evaluate management strategies for the aspects that currently impact on HRQoL as psychosocial well-being, depressive symptoms, axial motor symptoms, gastrointestinal symptoms, and urinary symptoms. These findings call for a multidisciplinary approach in the care of these features.
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References
Beck AT, Ward CH, Mendelson M, Mock M, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:53–63
Bentler PM (2003) EQS 6 structural equations program manual. Encino, CA: Multivariate Software
Brazier J, Jones N, Kind P (1993) Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 2:169–180
Chapuis S, Ouchchane L, Metz O, Gerbaud L, Durif F (2005) Impact of the motor complications of Parkinson’s disease on the quality of life. Mov Disord 20:224–230
Chaudhuri KR, Yates L, Martinez- Martin P (2005) The non-motor symptom complex of Parkinson’s disease: a comprehensive assessment is essential. Curr Neurol Neurosci Rep 5:275–283
Chrischilles EA, Rubenstein LM, Voelker MD, Wallace RB, Rodnitzky RL (2002) Linking clinical variables to health-related quality of life in Parkinson’s disease. Parkinsonism Relat Disord 8:199–209
Cubo E, Rojo A, Ramos S, Quintana S, Gonzalez M, Kompoliti K, Aguilar M (2002) The importance of educational and psychological factors in Parkinson’s disease quality of life. Eur J Neurol 9:589–593
Ebrahim S (1995) Clinical and Public- Health Perspectives and Applications of Health-Related Quality-Of-Life Measurement. Soc Sci Med 41:1383–1394
Esselink RA, de Bie RM, de Haan RJ, Lenders MW, Nijssen PC, Staal MJ, Smeding HM, Schuurman PR, Bosch DA, Speelman JD (2004) Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial. Neurology 62:201–207
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Gibb WR, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752
Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP (2007) Insomnia in Parkinson’s disease: frequency and progression over time. J Neurol Neurosurg Psychiatry 78:476–479
Global Parkinson’s Disease Survey Steering Committee (2002) Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord 17:60–67
Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442
Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural equation modeling 6:1–55
Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N (1997) The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age Ageing 26:353–357
Karlsen KH, Larsen JP, Tandberg E, Maeland JG (1999) Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 66:431–435
Karlsen KH, Tandberg E, Arsland D, Larsen JP (2000) Health related quality of life in Parkinson’s disease: a prospective longitudinal study. J Neurol Neurosurg Psychiatry 69:584–589
Kline RB (2005) Principles and practice of structural equation modeling. 2nd ed. Guilford Press, New York
Koplas PA, Gans HB, Wisely MP, Kuchibhatla M, Cutson TM, Gold DT, Taylor CT, Schenkman M (1999) Quality of life and Parkinson’s disease. J Gerontol A Biol Sci Med Sci 54:M197–M202
Kostic V, Przedborski S, Flaster E, Sternic N (1991) Early development of levodopa-induced dyskinesias and response fluctuations in young-onset Parkinson’s disease. Neurology 41:202–205
Kuopio AM, Marttila RJ, Helenius H, Toivonen M, Rinne UK (2000) The quality of life in Parkinson’s disease. Mov Disord 15:216–223
Loehlin J (1998) Latent variable models: an introduction to factor, path, and structural analysis. 3rd ed. Mahwah, N.J.: Erlbaum
Marinus J, Visser M, Martinez-Martin P, van Hilten JJ, Stiggelbout AM (2003) A short psychosocial questionnaire for patients with Parkinson’s disease. the SCOPA-PS. J Clin Epidemiol 56:61–67
Marinus J, Visser M, Stiggelbout AM, Rabey JM, Martinez-Martin P, Bonuccelli U, Kraus PH, van Hilten JJ (2004) A short scale for the assessment of motor impairments and disabilities in Parkinson’s disease: the SPES/SCOPA. J Neurol Neurosurg Psychiatry 75:388–395
Marinus J, Visser M, van Hilten JJ, Lammers GJ, Stiggelbout AM (2003) Assessment of Sleep and Sleepiness in Parkinson Disease. Sleep 26:1049–1054
Marinus J, Visser M, Verwey NA, Verhey FR, Middelkoop HA, Stiggelbout AM, van Hilten JJ (2003) Assessment of cognition in Parkinson’s disease. Neurology 61:1222–1228
Marras C, Lang A, Krahn M, Tomlinson G, Naglie G (2004) Quality of life in early Parkinson’s disease: Impact of dyskinesias and motor fluctuations. Mov Disord 19:22–28
Martinez-Martin P (2001) Healthrelated quality of life in Parkinson’s disease: outcomes of the therapeutic interventions. Expert Rev Pharmacoeconomics Outcomes Res 1:99–108
Pederzoli M, Girotti F, Scigliano G, Aiello G, Carella F, Caraceni T (1983) L-dopa long-term treatment in Parkinson’s disease: age-related side effects. Neurology 33:1518–1522
Quittenbaum BH, Grahn B (2004) Quality of life and pain in Parkinson’s disease: a controlled cross-sectional study. Parkinsonism Relat Disord 10:129–136
Schrag A (2006) Quality of life and depression in Parkinson’s disease. J Neurol Sci 248:151–157
Schrag A, Jahanshahi M, Quinn N (2000) What contributes to quality of life in patients with Parkinson’s disease? J Neurol Neurosurg Psychiatry 69:308–312
Schrag A, Selai C, Jahanshahi M, Quinn NP (2000) The EQ-5D-a generic quality of life measure-is a useful instrument to measure quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 69:67–73
Streiner DL (2006) Building a better model: an introduction to structural equation modelling. Can J Psychiatry 51:317–324
Suzukamo Y, Ohbu S, Kondo T, Kohmoto J, Fukuhara S (2006) Psychological adjustment has a greater effect on health-related quality of life than on severity of disease in Parkinson’s disease. Mov Disord 21:761–766
Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, Middelkoop HA, van Hilten JJ (2007) Cognitive impairment in Parkinson’s disease. J Neurol Neurosurg Psychiatry 78:1182–1187
Verbrugge LM, Jette AM (1994) The Disablement Process. Soc Sci Med 38:1–14
Visser M, Marinus J, Stiggelbout AM, van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: The SCOPA-AUT. Mov Disord 19:1306–1312
Visser M, Verbaan D, van Rooden SM, Stiggelbout AM, Marinus J, van Hilten JJ (2007) Assessment of psychiatric complications in Parkinson’s disease: The SCOPA-PC. Mov Disord 22:2221–2228
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A. M. Stiggelbout and J. J. van Hilten contributed equally to this study.
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Visser, M., van Rooden, S.M., Verbaan, D. et al. A comprehensive model of health-related quality of life in Parkinson’s disease. J Neurol 255, 1580–1587 (2008). https://doi.org/10.1007/s00415-008-0994-4
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DOI: https://doi.org/10.1007/s00415-008-0994-4