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Functional movement disorders in neurogeriatric inpatients

Underdiagnosed, often comorbid to neurodegenerative disorders and treatable

Funktionelle Bewegungsstörungen in der Geriatrie

Unterdiagnostiziert, oft mit neurodegenerativen Erkrankungen assoziiert und behandelbar

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Abstract

Background

The proportion of patients with functional movement disorders (FMD) is particularly high in neurology clinics. Treatment options have not been consistently developed, not well evaluated and not validated. This article presents the preliminary data on the prevalence and treatment response of patients with FMD who were treated within the framework of an early rehabilitative geriatric complex treatment at a university hospital for neurology.

Methods

From July 2017 to November 2018 the prevalence, demographic and clinical parameters, and response to treatment of FMD patients were documented and compared to non-FMD patients treated at the neurogeriatric ward of the University Hospital Schleswig-Holstein, in Kiel. Clinical endpoints were the Short Physical Performance Battery (SPPB) for mobility and the Barthel index for instrumented activity of daily life (iADL).

Results

The prevalence of FMD was 11% (19/175) and predominantly observed in women (74%). Of the FMD patients nine also had a diagnosis of either idiopathic Parkinson’s disease (N = 7), dementia with Lewy bodies (N = 1) or progressive supranuclear palsy (N = 1). At admission, neither the SPPB nor the iADL differed significantly between FMD and non-FMD patients. The treatment response was comparable between the groups: SPPB change was +0.3±1.8 (mean, standard deviation) in FMD and +0.4±1.9 in non-FMD patients (p = 0.83). The iADL change was +19±15 in FMD and +18±17 in non-FMD (p = 0.83).

Conclusion

The prevalence of FMD was unexpectedly high in the neurogeriatric ward of a German university hospital. There were comparable impairments and responses to multidisciplinary treatment in mobility and iADL between FMD and non-FMD geriatric patients, suggesting that specific and informed treatment provided by a multidisciplinary geriatric team is effective in geriatric FMD patients. Further studies of this underdiagnosed disorder in older age are warranted.

Zusammenfassung

Hintergrund

Der Anteil von Patienten mit funktionellen Bewegungsstörungen (FBS) ist vor allem im neurologischen Fachgebiet relativ hoch. Therapeutische Optionen sind nicht konsequent entwickelt, nicht gut evaluiert und nicht validiert. Die hier vorgestellte Analyse präsentiert erste Daten zu Prävalenz und Therapieansprechen von Patienten mit FBS, die im Rahmen der frührehabilitativen geriatrischen Komplexbehandlung an einer neurologischen Universitätsklinik behandelt wurden.

Methoden

Auf der neurogeriatrischen Station des Universitätsklinikums Schleswig-Holstein Campus Kiel wurde über den Zeitraum von Juli 2017 bis November 2018 der prozentuale Anteil von Patienten mit FBS bestimmt. Danach wurde in diesen FBS-Patienten die Mobilität („short physical performance battery“, SPPB) sowie die Schwere der Beeinträchtigung der instrumentellen Aktivität des täglichen Lebens (Barthel-Index) bestimmt und mit den Daten der Nicht-FBS-Patienten verglichen.

Ergebnisse

Der Anteil von Patienten mit FBS (N = 19) am Gesamtkollektiv (N = 175) lag bei 11 %. Der Anteil von Frauen lag bei 74 %. Neun der FBS-Patienten hatten zusätzlich die Diagnose einer neurodegenerativen Bewegungsstörung (7 idiopathisches Parkinson-Syndrom, 1 Demenz mit Lewy-Körpern, 1 progressive supranukleäre Blickparese). Bei Aufnahme zeigten sich keine signifikanten Unterschiede in der SPPB oder im Barthel-Index zwischen FBS- und Nicht-FBS-Patienten. Mit Delta SPPB von +0,3 (1,8) versus +0,4 (1,9; M [SD]; p = 0,83) und Delta Barthel-Index von +19 (15) vs. +18 (17) Punkten (p = 0,83) zeigten sich keine relevanten Unterschiede hinsichtlich Therapieerfolg zwischen FBS und Nicht-FBS.

Schlussfolgerung

Der Anteil von Patienten mit FBS auf einer neurogeriatrischen Station an einer deutschen Universitätsklinik zeigt sich überraschend hoch. Erste Analysen deuten darauf hin, dass FBS-Patienten bei Zuweisung ähnlich schwer betroffen sind wie Nicht-FBS-Patienten und sie von der angebotenen Struktur und Behandlung durch das multidisziplinäre geriatrische Team auch ähnlich effektiv profitieren. Dies ist aufgrund der bestehenden Literatur nicht selbsterklärend und bedarf weiterer wissenschaftlicher Aufarbeitung.

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Authors and Affiliations

  1. Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany

    Sara Mätzold, Johanna Geritz,  Kirsten E. Zeuner,  Daniela Berg,  Steffen Paschen,  Johanne Hieke,  Simone Sablowsky, Christian Ortlieb &  Walter Maetzler

  2. Department of Internal Medicine I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany

    Philipp Bergmann

  3. Institute of Family Medicine, Center of Geriatrics, University Hospital Schleswig-Holstein, Campus Lübeck, Neumünster and Bad Bramstedt, Germany

    Werner Hofmann

  4. James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA

    Alberto J. Espay

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  1. Sara Mätzold
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Correspondence to Walter Maetzler.

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Conflict of interest

S. Mätzold, J. Geritz, K.E. Zeuner, D. Berg, S. Paschen, J. Hieke, S. Sablowsky, C. Ortlieb, P. Bergmann, W. Hofmann, A.J. Espay and W. Maetzler declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the Faculty of Medicine, Christian-Albrechts-Universität zu Kiel [No D427/17]) and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

S. Mätzold and J. Geritz contributed equally.

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Mätzold, S., Geritz, J., Zeuner, K.E. et al. Functional movement disorders in neurogeriatric inpatients. Z Gerontol Geriat 52, 324–329 (2019). https://doi.org/10.1007/s00391-019-01562-y

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