Journal of Neurology

, Volume 255, Issue 10, pp 1580–1587 | Cite as

A comprehensive model of health-related quality of life in Parkinson’s disease

  • M. Visser
  • S. M. van Rooden
  • D. Verbaan
  • J. Marinus
  • A. M. Stiggelbout
  • J. J. van Hilten
ORIGINAL COMMUNICATION

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.

Key words

Parkinson’s disease health-related quality of life depression psychosocial well-being 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Beck AT, Ward CH, Mendelson M, Mock M, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:53–63Google Scholar
  2. 2.
    Bentler PM (2003) EQS 6 structural equations program manual. Encino, CA: Multivariate SoftwareGoogle Scholar
  3. 3.
    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 2:169–180PubMedCrossRefGoogle Scholar
  4. 4.
    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 20:224–230PubMedCrossRefGoogle Scholar
  5. 5.
    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 5:275–283PubMedCrossRefGoogle Scholar
  6. 6.
    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 8:199–209PubMedCrossRefGoogle Scholar
  7. 7.
    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 9:589–593PubMedCrossRefGoogle Scholar
  8. 8.
    Ebrahim S (1995) Clinical and Public- Health Perspectives and Applications of Health-Related Quality-Of-Life Measurement. Soc Sci Med 41:1383–1394PubMedCrossRefGoogle Scholar
  9. 9.
    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 62:201–207PubMedGoogle Scholar
  10. 10.
    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 12:189–198PubMedCrossRefGoogle Scholar
  11. 11.
    Gibb WR, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752PubMedCrossRefGoogle Scholar
  12. 12.
    Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP (2007) Insomnia in Parkinson’s disease: frequency and progression over time. J Neurol Neurosurg Psychiatry 78:476–479PubMedCrossRefGoogle Scholar
  13. 13.
    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 17:60–67Google Scholar
  14. 14.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedCrossRefGoogle Scholar
  15. 15.
    Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural equation modeling 6:1–55CrossRefGoogle Scholar
  16. 16.
    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 26:353–357PubMedCrossRefGoogle Scholar
  17. 17.
    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 66:431–435PubMedCrossRefGoogle Scholar
  18. 18.
    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 69:584–589PubMedCrossRefGoogle Scholar
  19. 19.
    Kline RB (2005) Principles and practice of structural equation modeling. 2nd ed. Guilford Press, New YorkGoogle Scholar
  20. 20.
    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–M202PubMedGoogle Scholar
  21. 21.
    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 41:202–205PubMedGoogle Scholar
  22. 22.
    Kuopio AM, Marttila RJ, Helenius H, Toivonen M, Rinne UK (2000) The quality of life in Parkinson’s disease. Mov Disord 15:216–223PubMedCrossRefGoogle Scholar
  23. 23.
    Loehlin J (1998) Latent variable models: an introduction to factor, path, and structural analysis. 3rd ed. Mahwah, N.J.: ErlbaumGoogle Scholar
  24. 24.
    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 56:61–67PubMedCrossRefGoogle Scholar
  25. 25.
    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 75:388–395PubMedCrossRefGoogle Scholar
  26. 26.
    Marinus J, Visser M, van Hilten JJ, Lammers GJ, Stiggelbout AM (2003) Assessment of Sleep and Sleepiness in Parkinson Disease. Sleep 26:1049–1054PubMedGoogle Scholar
  27. 27.
    Marinus J, Visser M, Verwey NA, Verhey FR, Middelkoop HA, Stiggelbout AM, van Hilten JJ (2003) Assessment of cognition in Parkinson’s disease. Neurology 61:1222–1228PubMedGoogle Scholar
  28. 28.
    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 19:22–28PubMedCrossRefGoogle Scholar
  29. 29.
    Martinez-Martin P (2001) Healthrelated quality of life in Parkinson’s disease: outcomes of the therapeutic interventions. Expert Rev Pharmacoeconomics Outcomes Res 1:99–108CrossRefGoogle Scholar
  30. 30.
    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 33:1518–1522PubMedGoogle Scholar
  31. 31.
    Quittenbaum BH, Grahn B (2004) Quality of life and pain in Parkinson’s disease: a controlled cross-sectional study. Parkinsonism Relat Disord 10:129–136PubMedCrossRefGoogle Scholar
  32. 32.
    Schrag A (2006) Quality of life and depression in Parkinson’s disease. J Neurol Sci 248:151–157PubMedCrossRefGoogle Scholar
  33. 33.
    Schrag A, Jahanshahi M, Quinn N (2000) What contributes to quality of life in patients with Parkinson’s disease? J Neurol Neurosurg Psychiatry 69:308–312PubMedCrossRefGoogle Scholar
  34. 34.
    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 69:67–73PubMedCrossRefGoogle Scholar
  35. 35.
    Streiner DL (2006) Building a better model: an introduction to structural equation modelling. Can J Psychiatry 51:317–324PubMedGoogle Scholar
  36. 36.
    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 21:761–766PubMedCrossRefGoogle Scholar
  37. 37.
    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 78:1182–1187PubMedCrossRefGoogle Scholar
  38. 38.
    Verbrugge LM, Jette AM (1994) The Disablement Process. Soc Sci Med 38:1–14PubMedCrossRefGoogle Scholar
  39. 39.
    Visser M, Marinus J, Stiggelbout AM, van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: The SCOPA-AUT. Mov Disord 19:1306–1312PubMedCrossRefGoogle Scholar
  40. 40.
    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 22:2221–2228PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • M. Visser
    • 1
  • S. M. van Rooden
    • 1
  • D. Verbaan
    • 1
  • J. Marinus
    • 1
  • A. M. Stiggelbout
    • 2
  • J. J. van Hilten
    • 1
  1. 1.Dept. of Neurology, K5 Q 92Leiden University Medical CenterLeidenThe Netherlands
  2. 2.Dept. of Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations