Association between DATSCAN-derived dopaminergic activity and cognitive performance and quality of life in Parkinson's disease: A cross-sectional study

PC-FACS

Quality of life (QoL) in patients with inflammatory bowel disease (IBD) is influenced by several factors, many of which may also impact cognitive function. However, the extent of the interaction among these factors, QoL, and disease outcomes in IBD patients remains unknown. We thus aim to characterize the relationships among psychological disorders, coping mechanisms, cognitive function, and the overall impact on QoL and disease outcomes in patients with IBD. This cross-sectional observational study was conducted at an academic care center. QoL was evaluated using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and disease severity was evaluated using the Harvey-Bradshaw Index (HBI) for Crohn's disease (CD) and the Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). We also used the Hospital Anxiety and Depression scale (HADS). Regression models were used to test the associations among QoL, number of hospitalizations, disease severity, cognitive functioning (working memory [WM] and reaction time), and coping strategies while controlling for anxiety and depressive symptoms, age, and sex. This study included 41 patients (24 patients with CD and 17 with UC) whose mean age was 28.2 (±8.4) years (23 males) and mean SIBDQ score was 51.5 (±10.0). Patients with more WM errors had lower QoL scores (P = .041), whereas patients with higher anxiety levels had lower QoL and more active UC (P = .008 and P = .016, respectively). The use of avoidant coping mechanisms was associated with a significantly higher number of hospitalizations (P = .038), and patients who adopted more emotion-focused coping strategies had a longer illness duration (P = .021). Finally, patients with higher education levels were found to use more active coping mechanisms than others. These results confirm the impact of cognitive, psychological, and coping factors on QoL and disease outcomes in patients with IBD; however, the mechanisms by which these factors interrelate remain unclear. Therapies aimed at improving both cognitive functions and psychological conditions may thus be effective at improving QoL and disease outcomes in IBD patients, and education may play a positive role in promoting the adoption of more effective coping strategies among IBD patients.

Parkinson’s is a neurodegenerative disease characterized by motor and non-motor symptoms which are strongly associated with patients’ quality of life, affecting social skills and support. It strikes not only the motor abilities but may harm cognitive and emotional functioning. For the past 15 years, contemporary dance has been employed as an intervention to help people diagnosed with Parkinson’s disease cope physically and mentally by way of motor, vestibular, and sensory stimulation as well as social interaction. In this study we aimed to examine psychological flexibility, creative self-efficacy and quality of life of Parkinson’s patients participating in contemporary dance sessions. To obtain this goal we conducted a cross-sectional comparative study of 50 Parkinson’s patients aged 50–87 years, half of which had been participating for at least 3 months once a week, in contemporary dance classes, and the matched controls participated in a verbal support group. Study participants completed questionnaires after participating in a dance class (Intervention) or in a support group (control). Participants in the intervention group were also asked to answer three open-ended questions that examined the experience of participating in contemporary dance classes. We found that psychological flexibility and quality of life were significantly higher in the dance class participants. Participants reported positive changes that occur in their overall feeling and quality of life following their participation in dance classes. Since PD patients’ experiences are deeply embedded in the body, it is significant to explore the use of movement in treatment. The importance of the study is in its potential to highlight the relationship between psychological flexibility and quality of life and to increase awareness of clinicians treating Parkinson’s patients to the importance of incorporating dance as an inherent part of a multidisciplinary team effort.

Background/Objectives: Dystonia, traditionally regarded as a purely motor disorder, is now increasingly recognized as involving clinically significant non-motor symptoms (NMSs) that can adversely affect patients' health-related quality of life (HRQoL). This study aimed to assess HRQoL in Romanian patients with isolated dystonia and to evaluate the impact of two key NMSs, depression and cognitive impairment, on their HRQoL. We hypothesized that depression would have a greater adverse effect on HRQoL than cognitive impairment. Methods: A cross-sectional study was conducted involving 65 adult Romanian patients with isolated dystonia. HRQoL was measured using the Short Form-36 Health Survey (SF-36), including the physical component summary (PCS) and mental component summary (MCS). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA). Descriptive statistics, correlation analysis, and parametric and non-parametric tests were used. Multiple regression analysis was employed to evaluate associations between NMS and HRQoL. Results: The mean (SD) age was 56.6 (14.3) years, and 80% of participants were female. Depression and cognitive function were significantly associated with PCS (0.33 and -0.51, respectively) and MCS (0.26 and -0.78, respectively). Multiple regression analysis showed that the two NMS explained 38% of the variance in PCS and 58% of the variance in MCS. Depression had a greater impact on PCS and MCS than cognitive impairment (-0.47 vs. 0.33 and -0.72 vs. 0.16, respectively). Cognitive impairment (MoCA < 26) was present in 35.4% of patients, while 46.2% had at least mild depressive symptoms (PHQ-9 ≥ 5); 23.1% met criteria for moderate-to-severe depression (PHQ-9 ≥ 10). Depressive symptoms showed strong negative correlations with all SF-36 domains, while cognitive performance correlated modestly. Conclusions: Both depression and cognitive impairment have a significant negative impact on HRQoL in dystonia, with depression having a stronger effect, as we hypothesized. Routine screening for non-motor symptoms is essential to support better clinical outcomes and enhance patients' quality of life.

Sleep disorders are common non-motor symptoms in patients with Parkinson’s disease (PD). The characteristics and impact of multiple comorbid sleep disorders remain to be elucidated. Our goal was to investigate the characteristics of various sleep disorder comorbidities, and their association with motor complications and the impact on the quality of life in PD patients. In this multicenter, observational, cross-sectional study, data concerning the clinical characteristics of complicated sleep disorders were collected from PD patients treated at 40 different hospitals in Shanghai. Sleep disorders were evaluated using the PD Sleep Scale-2, Epworth Sleepiness Scale, Rapid Eye Movement Sleep Behavior Disorder Questionnaire-Hong Kong, and the International Restless Legs Scale. Among the 1006 subjects evaluated, 77.53% exhibited signs of sleep disorders, and most had multiple sleep disorders (n = 502, 49.9%). A smaller percentage of patients with sleep disorders had a single disorder (n = 278, 27.6%). Furthermore, an increased number of sleep disorders, including nighttime problems, excessive daytime sleepiness, rapid eye movement sleep behavior disorder, and restless legs syndrome was a significant contributor to a poor quality of life (β = 4.33, CI: 3.33–5.33, P for trend <0.001), even when controlling for multiple factors. Moreover, motor complications partially mediated this relationship (indirect effect: β = 0.355, 95% boot CI: 0.134, 0.652).Our study showed that a large proportion of PD patients suffer from multiple comorbid sleep disorders, which greatly decreases the quality of life in PD patients and is partially mediated by motor complications.

Multiple sclerosis is an inflammatory and neurodegenerative disease that leads to motor, cognitive, and sensory impairments, significantly affecting walking and quality of life. This study aimed to analyze the relationship between quality of life and kinematic walking parameters in individuals with multiple sclerosis, as well as to evaluate the influence of fatigue, balance, and cognitive performance on different aspects of quality of life. A cross-sectional observational study was conducted with 32 patients diagnosed with multiple sclerosis with Expanded Disability Status Scale scores of ≤5.5. Quality of life was assessed using the MusiQoL questionnaire, and clinical variables included fatigue (Fatigue Scale for Motor and Cognitive Functions, Borg scale), balance (Berg Balance Scale), and cognitive performance (Trail Making Test). Walking kinematics were analyzed using the Vicon motion capture system to obtain walking speed, step frequency, and joint asymmetry indices. Spearman correlations and linear regression models were applied. Results showed significant correlations between quality of life and walking speed (rho = 0.506), step frequency (rho = 0.508), and knee asymmetry (rho = −0.525), as well as strong associations with cognitive fatigue (rho = −0.796) and balance (rho = 0.635). Regression models explained up to 58.4% of the variance in the Activities of Daily Living dimension. These findings indicate that quality of life in multiple sclerosis is influenced by both clinical and biomechanical factors, highlighting the importance of comprehensive assessments to guide physiotherapeutic interventions.

The asymmetry of motor manifestations present in Parkinson's disease (PD) suggests the existence of differences between both hemispheres. As a consequence, this asymmetry might contribute to different PD clinical phenotypes. To study the relationship between motor symptom laterality with motor, non-motor symptoms (NMS), freezing of gait (FOG), and quality of life (QoL) impairment in PD. In this cross-sectional study, we measured motor symptoms severity and complications with the Unified Parkinsons' disease Rating Scale (UPDRS), FOG with the FOG questionnaire, QoL with the 39-item PD Quality of Life Questionnaire Summary Index, and NMS with the NMS, Visual Analogue Scales for Pain and Fatigue, Beck Depression Inventory-II, Impulsive-Compulsive Disorders, and PD Sleep and Cognitive Rating scales. We defined left and right motor laterality using the UPDRS part III. We used comparative, regression, and effect size analyses to evaluate the impact of asymmetry on motor and NMS, FOG, and QoL. 342 left (LPD) and 310 right (RPD) patients, with a mean age of 62.0±8.8 years, were included. In multivariate regression analysis, LPD was associated with a greater motor (OR = 1,50, 95% CI 1.02-2.21), FOG (OR = 1.56, 95% CI 1.01-2.41), and overall NMS impairment (OR = 1.43, 95% CI 1.001-2.06), and better QoL (OR = 0.52 95% CI 0.32-0.85). Overall, only a mild effect size was found for all comparisons in which significant differences were present. In this large multicenter study, motor symptom laterality seems to carry a mild but significant impact on PD clinical manifestations, and QoL.

This study aimed to evaluate motor and non-motor symptoms in idiopathic Parkinson's disease (IPD) patients and to determine the self-reported influence of all existing symptoms on their quality of life (QoL). The sociodemographic and clinical characteristics, medical treatments, and Modified Hoehn and Yahr (mH&Y) scores of IPD patients without cognitive impairment were recorded. A survey questioning different motor and non-motor symptoms was administered to the patients. The patients were asked to rate their symptoms by number from the greatest influence to the least influence on their QoL. Subjects were divided into two groups: those suffering from IPD for ≤5 years (Group 1) and those suffering from IPD for >5 years (Group 2). These groups were compared in terms of sociodemographic and clinical characteristics, existing symptoms, and influences of these symptoms on their QoL. There were 63 patients in Group 1 and 37 patients in Group 2. No statistically significant differences were detected between the groups with respect to sociodemographic characteristics or mH&Y scores. The most common motor symptoms in both of these groups were tremor and bradykinesia; meanwhile, the non-motor symptoms most frequently encountered in these groups were pain-cramps, constipation, and excessive daytime sleepiness (EDS). Again, while the symptoms that most greatly disturbed QoL in all patients were reported to be tremor and bradykinesia, the most disturbing non-motor symptom was frequent voiding/incontinence, which was a less common symptom. Pain-cramp, constipation, and EDS, which were the most frequent non-motor symptoms, were the symptoms that least disturbed QoL. It is widely accepted that motor symptoms determine QoL in IPD. However, non-motor symptoms are seen during all phases of the disease. The impact of non-motor symptoms on the QoL of IPD patients remains substantial. Therefore, in addition to the well-known motor symptoms, non-motor symptoms, which may be overlooked during physical examination yet may profoundly impact QoL, should be questioned and treated appropriately to improve QoL in PD patients as much as possible.

Determinants of the quality of life in Parkinson's disease: Results of a cohort study from Southwest China

Non-motor symptoms have a more significant impact on the quality of life in Parkinson's disease than motor symptoms. To evaluate the frequency of non-motor symptoms in Parkinson's disease and study their impact on quality of life. A cross-sectional study was conducted on 100 patients with idiopathic Parkinson's disease. All patients underwent a detailed history and neurological examination, Hoehn and Yahr staging, MDS UPDRS scoring, NMSS scoring, and PDQ-39 scoring to assess their quality of life. All patients presented with at least one non-motor symptom. The most frequently affected non-motor symptom was sleep/fatigue (95%), followed by urinary (79%) and gastrointestinal dysfunction (76%). The total NMSS score significantly correlated with disease severity and quality of life. Non-motor symptoms are quite prevalent in patients with Parkinson's disease and significantly impact their quality of life.

Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

Levodopa-carbidopa intestinal gel (LCIG) has shown to be efficacious in motor and non-motor symptoms (NMS). Nevertheless, studies with patient Quality of Life (QoL) as a primary endpoint are scarce. To assess the effect of LCIG on Advanced Parkinson’s Disease (APD) patients QoL. Secondarily, the impact on motor symptoms and NMS, emotional well-being, treatment satisfaction, and caregiver QoL, stress, disease burden, anxiety, depression, and work impairment were also investigated. In this prospective, 6-month multicenter postmarketing observational study, LCIG was administered to 59 patients with APD. Endpoints were assessed using validated scales and questionnaires. LCIG significantly improved patient QoL (PDQ-39 mean change ± standard deviation from baseline, −12.8 ± 14.6; P < 0.0001), motor symptoms (UPDRS-III in “On,” −6.5 ± 11.8; P = 0.0002), NMS (NMSS, −35.7 ± 31.1; P < 0.0001), mood (Norris/Bond-Lader VAS, −6.6 ± 21.1; P = 0.0297), fatigue (PFS-16, −0.6 ± 1.0; P = 0.0003), depression (BDI-II, −5.1 ± 9.4; P = 0.0002), anxiety (BAI, −6.2 ± 9.6; P < 0.0001), and patient treatment satisfaction (SATMED-Q, 16.1 ± 16.8; P < 0.0001). There were significant correlations between the change from baseline to 6 months between PDQ-39 and UPDRS-IV, NMSS, BAI, BDI-II, AS, and PFS-16 scores, and Norris/Bond-Lader alertness/sedation factor. Caregiver anxiety also improved (Goldberg anxiety scale, −1.1 ± 1.0; P = 0.0234), but the clinical relevance of this finding is questionable. The serious adverse events reported were similar to those previously described for LCIG. In patients with APD, LCIG improves QoL, motor symptoms and NMS, emotional well-being, and satisfaction with the treatment. Improvement in patient QoL is associated with improvements in motor complications, NMS, anxiety, depression, apathy and fatigue. Improvements in patients’ QoL does not correspond with improvements in caregivers’ QoL or burden.

Myasthenia gravis: do not forget the patient perspective

Safinamide is a highly selective, reversible MAO B-inhibitor recently marketed in European and North American countries. To better define clinical indications regarding motor and non-motor symptoms, targeted population and safety of this compound, ten movement disorders specialists, experts in their field, convened and developed a panel of statements on: the role of glutamate in Parkinson’s disease, introduction to fluctuations, efficacy of safinamide on motor symptoms, motor complications and non-motor symptoms, quality of life, safety of safinamide and target population for use. Strong consensus was reached for all the statements on the efficacy of safinamide on motor symptoms, motor fluctuations, quality of life and safety. Among non-motor symptoms, a positive consensus was reached for the symptoms sleep/fatigue, mood, and pain while there was a lack of consensus for the statements regarding the efficacy of safinamide in improving cognition, urinary and sexual functions. The statement on orthostatic hypotension obtained a negative consensus. The consistent and large agreement reached in this Delphi panel perfectly reflects the perception of efficacy, safety and tolerability of safinamide as evident from pivotal trials and clinical practice and shows how these findings may guide movement disorders specialists in their clinical therapeutic approach. The impact of non-motor symptoms in PD is considerable, and management remains an unmet need. In this context, the ability of safinamide to impact some non-motor symptoms may represent the most promising and distinctive feature of this compound and deserves further investigations.

Context:Parkinson's disease (PD) is a neurodegenerative disease characterized by traditional motor features. Non-motor symptoms (NMS) are also seen in PD, which inevitably emerge through the disease progression and are often under-recognized and untargeted.Aims:We studied the prevalence of NMS in PD and their impact on health-related quality of life (HRQoL).Materials and Methods:A cross-sectional observational study from January 2017 to July 2017 of PD patients (n = 100) was done. NMS and HRQoL are measured using NMS scoring scale; PD questionnaire-39 and Hoehn and Yahr scale, respectively. Motor symptoms were assessed using scales for outcome in Parkinson's disease (SCoPA) - motor scoring scale.Statistical Analysis:Descriptive statistics calculated for NMS' prevalence. Continuous variables were assessed by two-tailed t-test and discrete and categorical variables by chi-square test. Multiple linear regression analysis was done among scoring scales to identify the influence on 39-item Parkinson's disease questionnaire (PDQ-39) scoring scale. All statistical data collected are analyzed with SSPS software version- 20 for windows.Results:In 100 study population, 66 were males and 34 females. The mean age was 68.35 years and median onset of duration of PD was 3.49 with 64.6% on treatment. Fatigue, pain, and lightheadedness were more prevalent NMS with 78%, 75%, and 69%, respectively. With regression analysis, strongest predictor was NMSS score (P = 0.000), with each unit increase, it is associated with nearly 0.65 increase in PDQ-39 score.Conclusion:Though motor symptoms define the disease, NMS have a larger impact on HRQoL in PD and on caregiver's life. Understanding the pattern and effect of NMS is needed for targeted treatment strategies.