Abstract
Objectives Health-related quality of life (HRQoL) is considered a very important outcome indicator in patients with Parkinson’s disease (PD). A broad list of motor and non-motor features have been shown to affect HRQoL in PD, however, there is a dearth of information about the complexity of interrelationships between determinants of HRQoL in different PD phenotypes. We aimed to find independent determinates and the best structural model for HRQoL, also to investigate the heterogeneity in HRQoL between PD patients with different phenotypes regarding onset-age, progression rate and dominant symptom. Methods A broad spectrum of demographic, motor and non-motor characteristics were collected in 157 idiopathic PD patients, namely comorbidity profile, nutritional status, UPDRS (total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial functioning through physical examination, validated questionnaires and scales. Structural equation model (SEM) and multivariate regressions were applied to find determinants of Parkinson’s disease summary index (PDSI) and different domains of HRQoL (PDQ-39). Results Female sex, anxiety, depression and UPDRS-part II scores were the significant independent determinants of PDSI. A structural model consisting of global motor, global non-motor and co-morbidity indicator as three main components was able to predict 89% of the variance in HRQoL. In older-onset and slow-progression phenotypes, the motor domain showed smaller contribution on HRQoL and the majority of its effects were mediated through non-motor features. Comorbidity component was a significant determinant of HRQoL only among older-onset and non-tremor-dominant PD patients. Fatigue was not a significant indicator of non-motor component to affect HRQoL in rapid-progression PD. Conclusions Our findings showed outstanding heterogeneities in the pattern and determinants of HRQoL among PD phenotypes. These factors should be considered during the assessments and developing personalized interventions to improve HRQOL in PD patients with different phenotypes or prominent feature.
Highlights
Both the chronic nature and the wide spectrum of Parkinson’s disease (PD) manifestations affect several aspects of patients’ daily life
Comorbidity component was a significant determinant of health-related quality of life (HRQoL) only among older-onset and non-tremor-dominant PD patients
Our findings showed outstanding heterogeneities in the pattern and determinants of HRQoL among PD phenotypes
Summary
Both the chronic nature and the wide spectrum of Parkinson’s disease (PD) manifestations affect several aspects of patients’ daily life. Health-related quality of life (HRQoL) has been considered as an important outcome indicator for management, care and progression of PD[1]. Many studies have investigated the impact of different variables on HRQoL in PD patients including disease severity, motor symptoms, non-motor symptoms, nutritional status, demographic and socioeconomic characteristics[1,2,3,4,5,6,7,8,9]. A few of them have included the broad range of parkinsonian features all together and compare their independent role and strength of their affect on HRQoL. Patients with PD show significant heterogeneity in their motor and non-motor features[10], which is a great obstacle in generalizability of the pattern of HRQoL for PD patients with different phenotypes. While the National Institutes of Health has recently delineated subtype-identification as one of the top priorities in the field of PD clinical research[11], there is a dearth of information about determinants of QoL in different PD subtypes
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