People With PD Research Articles

Components of a successful community-based exercise program for individuals with Parkinson’s disease: Results from a participant survey

ObjectivesThe aim of the project was to examine the personal beliefs, motivators, and barriers in people with Parkinson’s disease (PwPD) relating to their participation in a year-round community-based cycling program, Pedaling for Parkinson’s (PFP). DesignCross-sectional survey from a 12-month pragmatic study. SettingFive community-based PFP sites. Main outcome measuresA survey was designed to capture the attitudes and beliefs of those participating in a PFP program. Survey responses were rated on a 5-point Likert scale (1–5; higher number representing a more positive response) assessing the subdomains of Personal Beliefs and Knowledge, Health and Disability, Program, and Fitness Environment following a 12-month exercise observational period. ResultsA total of 40 PwPD completed the survey. Mean subdomain scores were as follows: 4.37 (0.41) for Personal Beliefs and Knowledge, 4.25 (0.65) for Health and Disability, 4.11 (0.53) for Program, and 4.35 (0.44) for Fitness Environment. There were no significant correlations between survey subdomains and demographic variables (age, years of education, years since diagnosis, years attending the PFP program, and disease severity) or subdomains and exercise behavior (cadence, attendance, and heart rate). ConclusionsRegardless of demographic variables and disease severity, PwPD who attended a PFP program enjoyed the class, felt that their PD symptoms benefited from exercise, and were motivated to exercise by their PD diagnosis. Factors such as location of the gym, cost, and transportation were important. With the growing body of PD literature supporting the role of exercise in potentially altering the disease trajectory, it is critical that communities adopt and implement exercise programs that meet the needs of PwPD and facilitate compliance.

Dysphagia Presentation, Airway Invasion, and Gender Differences in a Clinically Based Sample of People with Parkinson's Disease.

Dysphagia in People with Parkinson's Disease (PWPD) is expected to occur in most individuals. The manifestation of dysphagia and its salient swallow dysfunction characteristics leading to decreased airway safety are not well understood. The aim of this study was to quantify dysphagia presentation and severity, examine contributors to airway invasion, and explore gender differences in dysphagia manifestation in PWPD. 60 PWPD in clinical, healthcare settings underwent a Videofluoroscopic Swallow Study (VFSS) after referral for complaints of dysphagia. VFSS records and videos were analyzed to obtain dysphagia diagnosis, Videofluoroscopic Dysphagia Scale (VDS) scores, laryngeal vestibule kinematic timings, and Penetration-Aspiration Scale scores. Frequencies of VDS component and PAS scores were examined. MANOVA and logistic regression analyses were used to identify predictors of penetration and aspiration. Pharyngeal stage dysphagia was prevalent throughout PWPD and presented more frequently than oral stage dysphagia. Pharyngeal residue was a significant predictor for aspiration events. Laryngeal vestibule closure reaction time (LVCrt) and duration time (LVCd) were significant predictors of airway invasion, as were bolus consistency and volume. LVCrt, LVCd, and pharyngeal stage VDS scores were significantly altered in men compared to women in PWPD. A broad clinical sample of PWPD displayed atypical frequencies of airway invasion and frequent atypical scores of oral and pharyngeal stage physiologies. Thicker and smaller bolus consistencies significantly reduced the odds of airway invasion. Men and women presented with significantly different swallow physiology including prolonged LVCrt, LVCd, and more frequent atypical scores of pharyngeal residue and laryngeal elevation.Journal instruction requires a country for affiliations; however, these are missing in affiliation [1, 2]. Please verify if the provided country are correct and amend if necessary.Yes, USA is correct as the provided country.

Comparison of Lingual Pressure Generation Capacity in Parkinson Disease, Amyotrophic Lateral Sclerosis, and Healthy Aging.

The tongue plays a key role in bolus propulsion during swallowing, with reduced lingual pressure generation representing a risk factor for impaired swallowing safety and efficiency. We compared lingual pressure generation capacity in people with Parkinson disease (PwPD), people with amyotrophic lateral sclerosis (PwALS), and healthy older adults. We hypothesized that both patient cohorts would demonstrate reduced maximum anterior isometric pressure (MAIP) and regular effort saliva swallow (RESS) pressures compared with healthy controls, with the greatest reductions expected in the ALS cohort. We enrolled 20 PwPD, 18 PwALS, and 20 healthy adults over 60 years of age. The Iowa Oral Performance Instrument was used to measure MAIP, RESS, and lingual functional reserve (LFR, i.e., MAIP - RESS). Descriptive statistics were calculated; between-groups differences were explored using univariate analyses of variance and post hoc Sidak tests with alpha set at .05. Mean MAIPs for the PD, ALS, and heathy cohorts were 54.7, 33.5, and 47.4 kPa, respectively. Significantly lower MAIP was found in PwALS compared with PwPD and healthy controls. RESS values did not differ significantly across groups. LFR was significantly higher in PwPD versus PwALS and healthy controls. Lingual pressure generation capacity and functional reserve were reduced in PwALS, but not in PwPD, beyond changes seen with healthy aging. Both patient cohorts displayed preserved lingual pressure during saliva swallows. Future studies exploring longitudinal changes in tongue pressure generation on isometric and saliva swallowing tasks will be needed to confirm whether tongue pressure measures serve as noninvasive clinical biomarkers of swallowing impairment.

Movement disorders in COVID-19 times: impact on care in movement disorders and Parkinson disease.

The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.

Dual task effect on upper and lower extremity skills in different stages of Parkinson's disease.

Loss of automaticity and deteriorated executive function give rise to dual task deficits in Parkinson's disease (PD). This study aimed to compare single task and dual task upper and lower extremity skills in people with PD (PwPD) at different stages of PD and to examine the dual task effect (DTE) on upper and lower extremity skills in PwPD at different stages of PD. The second aim was to investigate the relationship between the DTE and the quality of life in PwPD. 30 patients divided into 2 groups as mild PD group and moderate PD group according to the Modified Hoehn & Yahr Scale. 15 age matched healthy adults were recruited as the control group. The Unified Parkinson's Disease Rating Scale (UPDRS), the Purdue Pegboard Test (PPT), the Timed Up and Go Test (TUG), the 10 Meter Walk Test (10MWT), and the Parkinson's Disease Questionnaire (PDQ-8) were used for assessments. Single task and dual task scores of all assessments of all groups were significantly different. The DTE on PPT was greater in mild and moderate PD groups than control group and significantly lower in mild PD group than moderate PD group. However, DTE on the TUG and 10MWT was not different in mild PD group than control group and DTE significantly lower in both groups than moderate PD group. Significant correlations between the DTE on PPT, TUG and 10MWT and the PDQ-8 in PwPD were observed. Dual task has a worsening effect on upper and lower extremity skills in PwPD. This effect can be observed earlier in upper extremity skills than lower extremity skills. Also, the DTE and the QoL in PwPD are related.

The Weekly Calendar Planning Activity to Assess Functional Cognition in Parkinson Disease.

The Weekly Calendar Planning Activity (WCPA) may improve understanding of functional cognition in people with Parkinson disease (PwPD) without dementia. We aimed to determine if WCPA performance (a) discriminates between PwPD with and without cognitive impairment and healthy controls and (b) correlates with other indicators of cognition and daily function. This was a cross-sectional study. Parkinson disease (PD) participants without dementia were divided into normal cognition (PD-NC, n = 25) and possible mild cognitive impairment (PD-MCI, n = 21) groups. Their WCPA performance was compared with that of a normative sample (n = 196) and correlated with neuropsychological test performance and self-reported cognition and participation. Both the PD-MCI and PD-NC groups had impaired WCPA performance. WCPA performance correlated with executive function, processing speed, and self-reported cognition and participation. The WCPA can detect functional cognitive deficits in PwPD without dementia and can inform occupational therapy interventions to support functional cognition, occupational performance, and participation in this population.

Self-perceived affective, behavioral, and cognitive reactions associated with voice use in people with Parkinson’s disease: a pilot study

Purpose This study aimed to compare the affective, behavioral, and cognitive reactions related to vocal function in people with Parkinson’s disease (PWPD) and healthy controls using the Behavior Assessment Battery – Voice (BAB-Voice). The test’s internal consistency was also described. Methods 31 PWPD and 19 healthy controls were recruited from September 2020 to March 2021. Participants completed four BAB-Voice subtests: Speech Situation Checklist – Emotional Reaction (SSC-ER), the Speech Situation Checklist – Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT), describing the experienced negative emotional reaction, voice disruptions, coping behaviors, and negative attitude regarding communication respectively. Subtest scores were calculated and analyzed. Results The scores of the PWPD were significantly different from those of the controls (Pillai’s Trace = 0.344, F[4] = 5.508, p = .001, ηp 2 = .344): PWPD showed more negative emotions and voice problems, more coping behaviors, and more negative speech-related attitude compared to healthy controls. All subtests showed excellent internal consistency. Conclusions The BAB-Voice proved a tool with a good internal consistency that measured different psychosocial reactions in PWPD versus controls. PWPD exhibited significantly more negative emotions and voice problems in specific speech situations, more coping behaviors, and a more negative speech-related attitude. The specificity of information obtained from the BAB-Voice may aid in improving the treatment planning of voice disorders in PWPD.

A study of turn bias in people with idiopathic Parkinson's disease.

The objective of the study is to explore whether people with Parkinson's disease (PwPD) display a preferential turn bias dependent upon disease asymmetry, and whether specific disease features predict turn bias. PwPD and age-matched controls were instructed to walk on an instrumented gait mat making "normal" turns. Trials were analyzed using Proto Kinetics Movement Analysis Software (PKMAS) and time-locked video recordings to obtain turn directionality and spatiotemporal turn measures. Turn bias was estimated using previously defined formulas. Seventy-two PwPD and 28 controls were included. One hundred percent of controls and 85% of PwPD had left turn bias. Turn bias was not significantly associated with age, gender, handedness, disease asymmetry, cognition, or disease severity. The Freezing of Gait Questionnaire (FOGQ) questions 5 and 6 showed linear-by-linear association with turn bias. In binary logistic and ordinal regression models, FOGQ question 6 (average duration of turn freezing) and turn width were predictive of turn bias. Rightward turns had greater frequency of freezing episodes. Turn bias in our PwPD cohort does not appear related to disease asymmetry or other disease features, except gait freezing. Whether freezing severity on turning leads to non-left turn bias or vice versa requires more focused studies. Physical therapy interventions targeting turning direction in PwPD could reduce freezing severity.

The burden of face masks on speech in Parkinson's disease: Impact of clear and loud speech styles

Face masks, now ubiquitous as a means of reducing COVID-19 transmission, have been shown to act as a low pass acoustic filter on speech. People with Parkinson’s disease (PwPD) and dysarthria may be especially vulnerable to the detrimental effects of masks, which may have negative consequences on spoken communication. The speech of PwPD has been shown to have lower concentrations of high frequency spectral energy and is perceptually characterized by a low speech volume and a breathy-hoarse voice quality. Increased vocal effort may aid in overcoming the filtering effects of masks. The purpose of this study was to quantify the effects of three masks (none, surgical, KN95) and three speech styles (habitual, clear, and loud) on the spectral characteristics of speech in PD. Fifteen PwPD and fifteen controls read aloud sentences with and without masks in three speech conditions. Measures of spectral tilt were taken from the long-term average spectra and modelled as a function of group, mask, and style. While both masks were associated with overall attenuation (steeper spectral tilt), a greater decrease was found for the PwPD (group by mask interaction). Loud speech, followed by clear speech, was effective in overcoming these effects for both groups.

Mindfulness-based Cognitive Therapy for People with Parkinson's Disease during the COVID-19 Pandemic

IntroductionAnxiety and depression are among the most common non-motor PD symptoms. People with PD have experienced additional stress and social isolation during the COVID-19 pandemic. Caregivers of people with PD may experience significant caregiver burden. MBCT can prevent the relapse of depression and improve anxiety symptoms. Few studies have explored its benefits for people with PD; none have included caregivers. This study aimed to investigate the feasibility and effectiveness of a mindfulness-based cognitive therapy (MBCT) intervention in reducing anxiety and/or depression in people with Parkinson's disease (PD) and their caregivers. The study was registered on ClinicalTrials.gov (NCT04469049) and it was conducted entirely online.MethodsPeoplewith PD or parkinsonism and mild-to-moderate anxiety and/or depressive symptoms and caregivers of people with PD were recruited from neurology clinics, support groups, and online. 3 MBCT groups were conducted in Zoom from November 2020 to June 2021, using a previously adapted MBCT protocol, further modified for online delivery during the pandemic. Caregivers could also enter MBCT groups or complete pre- and post- surveys without joining groups. Data collected included demographic and clinical variables, pre- and post-MBCT behavioral measures (GAD-7, PHQ-9, Five Facet Mindfulness Questionnaire: FFMQ-15), home practice time, and satisfaction surveys. Descriptive statistics were used to summarize participant characteristics, home practice time, and satisfaction survey responses. Pre- and post-MBCT behavioral measure scores were compared using mixed-effect models.ResultsSee attached tables. All 27 participants who entered MBCT groups completed the intervention, except for one man with PD (n = 22 people with PD/parkinsonism, n = 4 caregivers). Attendance and participant satisfaction were high. MBCT completers had significant anxiety (GAD-7) and depression (PHQ-9) score reductions and FFMQ-15 total and Observing and Non-reactivity subscale score increases (all p’s < 0.05). Completers with PD/parkinsonism and anxiety (n = 14) had a significant GAD-7 score reduction; those with PD/parkinsonism and depression (n = 13) had a significant PHQ-9 score reduction (both p’s < 0.05). Completers with PD/parkinsonism also had a significant FFMQ-15 Observing subscale score increase (p < 0.05). The caregiver sample was too small to be analyzed.ConclusionsOnline MBCT is feasible and may be effective in reducing anxiety and/or depression in people with PD. Results should be replicated in studies with larger samples and control groups.Please note, this study built on the previous pilot trial presented in poster #1101 at the 2021 AAGP Virtual Annual Meeting. This was a different study and it also included caregivers.This research was funded byThis study was supported by the Mount Zion Health Fund.

The coin rotation test: a reliable and valid test in people with Parkinson's disease

Purpose To investigate: (1) the interrater, and test–retest reliability of the coin rotation test (CRT) in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the CRT; (3) the concurrent and known-groups validity of the CRT; and (4) the cut-off times that best discriminate PwPD from healthy people and functionally dependent PwPD from functionally independent PwPD. Method Forty-eight PwPD and 33 healthy people were included. The CRT was administered with the nine-hole peg test, Movement Disorders Society Sponsored Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-8, and Schwab and England Scale. Results The CRT had excellent interrater and test–retest reliability. Minimal detectable changes were 5.96 and 8.23 s for the dominant and non-dominant hand, respectively. The CRT correlated with other outcome measures. Significant differences in the CRT times were found between PwPD and healthy people, and between functionally dependent PwPD and functionally independent PwPD. The cut-off times of 12.66 s on the dominant hand and 15.76 s on the non-dominant best discriminated PwPD from healthy people, while 22.99 s on the dominant hand and 23.48 s on the non-dominant best discriminated functionally dependent PwPD from functionally independent PwPD. Conclusions The CRT is a reliable, and clinically available tool for assessing manual dexterity in PwPD. Implications for rehabilitation The coin rotation test is a reliable, valid, and clinically available tool for assessing manual dexterity in Parkinson's Disease. The minimal detectable changes of the coin rotation test are 5.96 s for dominant hand and 8.23 s for the non-dominant hand, which may useful for clinicians and researchers to detect in any true change in manual dexterity after any intervention. The coin rotation test correlated with Parkinson's Disease-specific measurement tools. The coin rotation test times may detect impaired manual dexterity between people with Parkinson's Disease and healthy people, and between functionally dependent and functionally independent in Parkinson's Disease population.

Infographic: Four training modalities to improve functional mobility in people with Parkinson’s disease

Impairment of functional mobility is one of the most disabling symptoms in people with Parkinson’s disease (PwPD). Limitations in mobility lead to sedentarism, which may decrease the quality of life in PwPD. Several studies demonstrated that the combination of exercise with the traditional pharmacological treatment (i.e., levodopa) is effective to improve mobility in PwPD 1-5. Although the effects of traditional modalities (e.g., walking overground and cycling) are well documented, other stimuli may also induce positive responses on mobility in PwPD. However, such studies demonstrated trivial results or effectiveness in terms of functional mobility, indicating that the exercise – mainly using non-traditional stimuli – should be carefully prescribed. To avoid practical mistakes and ensure a high probability of success in mobility rehabilitation in PwPD, rehabilitation professionals must apply up-to-date and high-quality knowledge about mobility. Also, they must recognize the effects of different exercise modalities to improve functional mobility and the motivators and barriers to exercise in PwPD 1. This infographic aims to present (1) the motiving factors and barriers of training in PwPD, (2) the main effects of four exercise modalities on functional mobility (considering its underlining mechanisms), and (3) demonstrate the training evidence to improve the functional mobility. The exercise modalities were selected from the four recent meta-analyses (searched on PUBMED) that tested the exercise effects on functional mobility and presented data related to exercise prescription for PwPD. The encouragement of other persons is the most motivating factor for PwPD during exercise. The lacking of encouragement, fatigue and depression are related to exercise barriers in PwPD 1. Suárez-Iglesias et al. 2 demonstrated that Pilates was effective to improve functional mobility, improving Timed Up and Go (TUG) performances. Interventions using hydrotherapy, with or without land-based therapy, also showed positive effects on TUG values 3. Dance modality, associated with auditory cues, promoted positive effects on gait velocity, TUG, and freezing of gait 4. Finally, Robinson et al. 5 observed that treadmill training, when compared to no-exercise ones, improved the gait velocity and step length in PwPD regardless of use or not body weight support. Overall these results were observed in patients with early to moderate stages of disease (Hoehn and Yahr &lt; 3). These main effects and the mechanism related to the positive responses were presented in the infographic. Despite the noteworthy positive effects of exercise using these modalities in PwPD, recommendations for training prescriptions are still debatable. The characteristics of the modalities were poorly described in most of the studies. For example, even with the availability of acceptable and practical tools, the exercise intensity or its increment throughout the training was not properly reported. Therefore, it is difficult to determine a specific guideline to improve functional mobility in PwPD. The discussion about prescriptions (hydrotherapy) and the program with the highest weight in the meta-analysis (dance, pilates and treadmill) were presented in the infographic. Future studies should detail, as many as, possible training characteristics, increasing the reproducibility and applicability of the results.

Impact of Isolation During the COVID-19 Pandemic on the Patient Burden of Parkinson's Disease: A PMD Alliance Survey.

PurposeAs the COVID-19 pandemic resulted in social restrictions around the globe, this cross-sectional survey aimed to assess the impact of social isolation on self- or proxy-reported symptoms of Parkinson’s disease (PD) during the pandemic.Patients and MethodsThe survey was distributed among 7109 subscribers of the Parkinson and Movement Disorders Alliance (PMD Alliance) News and Information list and was open only to people with PD (PwP) and care partners (CP, defined as main caregivers of PwP and serving as proxy respondents). No attempt was made to identify PwP and CP pairs. The survey was distributed online using Survey Monkey between 01/06/2021 and 02/27/2021. Respondents were grouped by level of social support from outside of their household during the pandemic (decreased or maintained [ie, the same as pre-pandemic or increased]).ResultsOf 7109 invited participants, 718 responded to the survey (response rate 10.1%). PwP (self-reports) accounted for 70.6% of respondents and CP (proxy reports) for 29.4%. Decreased social support from outside of the household during the COVID-19 pandemic (58.5% of all responses) was significantly associated with increases in sadness/depression and anxiety, compared with maintained levels of social support (p < 0.0001 for both comparisons). It was also associated with increased burden of several non-motor (decline in memory, problem solving, or communication, p = 0.0009; new or worsening confusion, p < 0.0001; new or worsening delusions, p = 0.018) and motor PD symptoms.ConclusionDecline in social support from outside of the household during the COVID-19 pandemic showed a statistically significant and negative association with the burden of mood and non-motor symptoms of PD. These results call for increased vigilance towards non-motor symptoms in PwP experiencing social isolation and highlight the need for stronger provider focus on encouraging PwP and their CPs to build and maintain social connections and engagements.

Determinants of 6-minute walk test in people with Parkinson's disease.

Most of the previous studies, investigating determinants of 6-minute walk test (6MWT), were conducted on small sample sizes and/or have not explored different aspects such as freezing of gait, physical activity, gender, dual-task cost, and/or have not been able to explain large portion of variation in 6MWTin people withParkinson's disease. This study aimed to investigate the determinants of 6MWT, including aspects that previous studies have not explored. In this descriptive cross-sectional study, 6MWT determinants were investigated upon 42 people with Parkinson's disease. After recording participants' demographic data, walking capacity, disease stage, severity of motor symptoms, freezing of gait, balance, physical activity, fear of falling, functional balance, and dual-task cost values were evaluated and grouped into modifiable and unmodifiable variables to investigate possible therapeutic benefits aiming improvement in walking capacity. The mean distance for 6MWT was 401.7 ± 92.7m. Significant differences between women and men were found for height, walking capacityand speed, fear of falling, andfunctional balance(p<0.05). Hierarchical regression analysis showed that gender, age, and time since diagnosis significantly explained 52.4% of the variance in 6MWT and disease stage, freezing of gait, dual-task cost, and functional balance added an extra 35.6% to the explained variance. These results showed that gender, age, disease stage, freezing of gait, dual-task cost, and functional balance values are significant contributors to the variance in 6MWT. Therefore, while planning rehabilitation strategies to improve walking capacity, one should focus on these aspects in people with Parkinson's disease.

The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease

Purpose To investigate: (1) the interrater, and test–retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD. Methods This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale. Results The F8WT showed good interrater and test–retest reliability (ICC = 0.964–0.978 and ICC = 0.905–0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD. Conclusions The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD. Implications for rehabilitation The figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD). The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention. The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD. The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD.

Neuropsychiatric Symptoms in Parkinson's Disease Patients Are Associated with Reduced Health-Related Quality of Life and Increased Caregiver Burden.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder resulting in reduced health-related quality of life (HR-QoL) of people with PD (PwP) and their caregivers. Furthermore, there is an accumulating burden on caregivers of patients in advanced stages of the disease. In previous studies, motor- and non-motor-symptoms of PwP have been identified to contribute to reduced HR-QoL and an increased caregiver burden. This cross-sectional observational study aimed to study the influence of neuropsychiatric symptoms measured with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson’s Disease (SEND-PD) questionnaire on the HR-QoL of PwP, as well as the caregiver burden. Analyses revealed a significant association between SEND-PD subscale mood/apathy and reduced HR-QoL in PwP, measured by the Parkinson’s disease quality of life questionnaire (PDQ-8) (p < 0.001). Furthermore, mood/apathy was significantly correlated with caregiver burden (p = 0.001) in the multiple linear regression analysis. Hence, neuropsychiatric symptoms were found to have a profound impact on the HR-QoL of PwP, as well as on caregiver burden. Since neuropsychiatric symptoms were one of the main predictors for caregiver burden, physicians of PwP should treat these symptoms to stabilize caregiver burden, as well as HR-QoL in PwP and their caregivers.

Diet Quality and Nutrition Concerns of People with Parkinson’s Disease and Their Informal Caregivers: A Mixed Methods Study

Limited research exists regarding the diet quality and nutritional concerns of people with Parkinson’s disease (PwPD) and their informal caregivers. The study’s purpose was to assess diet quality via the Healthy Eating Index-2015 (HEI-2015) and self-reported nutrition concerns via semi-structured, dyadic interviews of 20 PwPD (69.7 ± 9.2 yrs) and their caregivers (66.7 ± 13.0 yrs). HEI-2015 scores were 58.3 ± 12.4 and 58.1 ± 10.6 for PwPD and caregivers, respectively. Reported dietary concerns related to PD included: change in appetite or amount eaten, gastrointestinal issues, food-medication management, chewing/swallowing issues, and change in taste/smell. The poor diet quality and nutrition concerns identified suggest nutrition professionals and caregivers are critical on the healthcare team to promote optimal health among PwPD. Future research should address overall and specific aspects of diet quality, and nutritional concerns identified by dyads in this study, such as gastrointestinal issues and food-medication management.

Feasibility of telemedicine research visits in people with Parkinson's disease residing in medically underserved areas.

Gait, balance, and cognitive impairment make travel cumbersome for People with Parkinson's disease (PwPD). About 75% of PwPD cared for at the University of Arkansas for Medical Sciences' Movement Disorders Clinic reside in medically underserved areas (MUAs). Validated remote evaluations could help improve their access to care. Our goal was to explore the feasibility of telemedicine research visits for the evaluation of multi-modal function in PwPD in a rural state. In-home telemedicine research visits were performed in PwPD. Motor and non-motor disease features were evaluated and quantified by trained personnel, digital survey instruments for self-assessments, digital voice recordings, and scanned and digitized Archimedes spiral drawings. Participant's MUA residence was determined after evaluations were completed. Twenty of the fifty PwPD enrolled resided in MUAs. The groups were well matched for disease duration, modified motor UPDRS, and Montreal Cognitive assessment scores but MUA participants were younger. Ninety-two percent were satisfied with their visit, and 61% were more likely to participate in future telemedicine research. MUA participants traveled longer distances, with higher travel costs, lower income, and education level. While 50% of MUA participants reported self-reliance for in-person visits, 85% reported self-reliance for the telemedicine visit. We rated audio-video quality highly in approximately 60% of visits in both groups. There was good correlation with prior in-person research assessments in a subset of participants. In-home research visits for PwPD in MUAs are feasible and could help improve access to care and research participation in these traditionally underrepresented populations.

Covid-19 and Parkinson's disease: Nursing care, vaccination and impact on advanced therapies.

The Coronavirus Disease 2019 (Covid-19) pandemic has created many challenges for the Parkinson's Disease (PD) care service delivery, which has been established over the past decades. The need for rapid adjustments to the new conditions has highlighted the role of technology, which can act as an enabler both in patient-facing aspects of care, such as clinical consultations, as well as in professional development and training. The Parkinson's Disease Nurse Specialists (PNSs) play a vital role in the effective management of people with PD (PwP). Maintaining optimum functionality and availability of device aided therapies is essential in order to ensure patients’ quality of life. PwP are particularly recommended to use vaccination as a basic protection from the virus. The long-term consequences of this pandemic on PwP are highly uncertain, and education, support and reassurance of patients and their families may help ease their burden.

Real-life consequences of cognitive dysfunction in Parkinson's disease.

While motor symptoms are the most recognized features of Parkinson's disease (PD), cognitive dysfunction is a key determinant of consequences of PD in real-life. In this chapter we review important domains where cognitive dysfunction negatively impacts the lives of people with PD (PwPD), such as difficulties in occupational and social life, and instrumental ADLs such as driving. Early loss of employment has important effects for PwPD, their families, and society. PwPD experience higher rates of family and social discord as well as important changes in their social roles. These processes are largely mediated through cognitive dysfunction, particularly difficulties processing and understanding emotions, decreased attention, and executive dysfunction. Cognitive dysfunction is also an important mediator of driving impairments, which contributes to decreased independence in PwPD. Finally, we briefly review the costs associated with cognitive impairment in PD. Both indirect and direct costs for PwPD with cognitive impairment are substantially higher than for PwPD with normal cognition.