Parkinson's disease: Impact of clinical and cognitive aspects on quality of life

Tedrus, Glória Maria Almeida Souza; Fonseca, Lineu Correa; Kange, Patrícia Mencaroni

doi:10.1590/S1980-57642010DN40200010

Abstract

Parkinson's disease (PD) is a chronic disease manifested principally by motor signs and symptoms, but with frequent neuropsychological alterations.

Objectives:

To study the relationship between clinical and cognitive aspects and the perception of quality of life (QOL) in PD patients.

Methods:

Twenty consecutive patients (13 men) with idiopathic PD (mean age: 64.5y), mean disease time of 7.8 years and at stages 1-3 according to the modified Hoehn and Yahr staging scale (HYS), all outpatients from the Neurology Department of the Celso Pierro General and Maternity Hospital (PUC-Campinas), were analyzed. The following were applied: a clinical-neurological assessment, the Mini-Mental State Examination (MMSE), standard neuropsychological battery of the CERAD (Consortium to Establish a Registry for Alzheimer's Disease), Hamilton Depression Rating Scale (HAM-D) and a QOL questionnaire (Parkinson's Disease Questionnaire - PDQ-39). Statistical analysis was carried out at a significance level of p<0.05.

Results:

On the PDQ-39 under the sections total, mobility and activities of daily living, and the items motor compromise (HYS) and language of the MMSE were predictors of worse QOL. Verbal fluency was a factor for emotional well-being on the PDQ-39, whereas higher scores for HAM-D and worse performance on the item attention and calculation of the MMSE were associated with worse QOL in the social support section. Total score on the MMSE and educational level were QOL factors in cognition

Conclusions:

The findings of the present study suggest that clinical, cognitive, motor or other depression-related factors contribute differently to the domains of QOL.

Key words:
Parkinson's disease; quality of life; depression; cognition.

Resumo

Doença de Parkinson (DP) é uma doença crônica que se manifesta principalmente por sinais e sintomas motores, mas com alterações neuropsicológicas frequentes.

Objetivos:

Estudar a relação de aspectos clínicos e cognitivos com a percepção da qualidade de vida (QV) em pacientes com DP.

Métodos:

Foram analisados 20 pacientes (13 do gênero masculino) consecutivos com DP idiopática (idade média: 64,5 anos), tempo médio de doença de 7,8 anos e estágio 1-3 na escala Hoehn e Yarh modificada (HY), procedentes do ambulatório de Neurologia do Hospital e Maternidade Celso Pierro (PUC-Campinas). Foram realizados: anamnese, exame neurológico, mini-exame do estado mental (MEEM), bateria neurospicológica do CERAD, escala de depressão de Hamilton (EDH) e questionário de QV (Parkinson's Disease Questionnaire - PDQ-39). Foi feito o estudo estatístico, com nível de significância p<0.05.

Resultados:

Comprometimento motor e no item "linguagem" do MEEM foram preditores de pior QV no PDQ-39 "total", "mobilidade" e "atividades da vida diária". A fluência verbal foi fator de "bem estar emocional" do PDQ-39, enquanto maiores escores na EDH e desempenho inferior no item "atenção e calculo" do MEEM estiveram associados a pior QV em "apoio social". O escore total do MEEM e o nivel de escolaridade foram fatores de QV em "cognição".

Conclusões:

Nossos achados sugerem que diferentes fatores clínicos, cognitivos, da motricidade ou ligados a depressão contribuem de modo diferenciado para os diversos domínios da QV.

Palavras-chave:
Doença de Parkinson; qualidade de vida; depressão; cognição.

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References

¹
de Boer AG, Wijker W, Speelman JD, et al. Quality of life in patients with Parkinson's disease: development of a questionnaire. J Neurol Neurosurg Psychiatry 1996;61:70-74.
²
Hobson P, Holden A, Meara J. Measuring the impact of Parkinson's disease with the Parkinson's disease quality of life questionnaire. Age ageing 1999;28:341-346.
³
Karlsen KH, Larsen JP, Tandberg E, Maland JG. Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease. J Neurol Neurosurg Psiquiatry 1999;66:431-435.
⁴
Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry 2000;69:308-312.
⁵
Keränen T, Kaakkola S, Sotaniemi K, et al. Economic burden and quality of life impairment increase with severity of PD. Parkinsonism Relat Disord 2003;9:163-168.
⁶
Barone P, Antoniani A, Colosimo C, et al. The priamo study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson disease. Mov Disord 2009;24:1641-1649.
⁷
Martinez-Martin P, Arroyo S, Rojo-Albuin JM, Rodriguez-Blazquez C, Frades B, de Pedro Cuesta J. Burden, perceived healthy status, and moon among caregivers of Parkinson's disease patients. Mov Disord 2008;23:1673-1680.
⁸
Peto V, Jenkinson C, Fitzpatrick R. Determining minimally important differences for the P-39 Parkinson's disease a review of the development, validation and application of a Parkinson disease questionnaire. Age ageing 2001;30:299-302.
⁹
Peto V, Jenkinson C, Fitzpatrick R. PDQ-39: a review of the development, validation and application of a Parkinson disease quality of life questionnaire and its associated measures. J Neurol 1998;245(Suppl 1):S10-14.
¹⁰
Carod-Artal FJ, Martinez-Martin P, Vargas AP. Independent validation of SCOPA-Psychosocial and metric properties of the PDQ-39 Brazilian version. Mov Disord 2007;22:91-98.
¹¹
Lana RC, Alvares LMRS, Nasciutti-Prudente C, Goulart FRP, Teixeira-Salmela LF, Cardoso FE. Percepção da qualidade de vida de indivíduos com doença de Parkinson através do PDQ-39. Rev Bras Fisioter 2007;11:397-402.
¹²
Souza RG, Borges V, Silva SMCA, Ferraz HB. Quality of life scale in de Parkinson - PDQ-39 (versão do Português falado no Brasil) como instrumento para avaliação de pacientes com e sem flutuação motora decorrente da levodopa. Arq Neuropsiquiatr 2007;65:787-791.
¹³
Scalzo P, Kummer A, Cardoso F, Teixeira AL. Depressive symptoms and perception of quality of life in Parkinson's disease. Arq Neuropsiquiatr 2009;67:203-208.
¹⁴
Global Parkinson's disease survey steering committee. Factors impacting quality of life in Parkinson's disease: results from an international survey. Mov Disord 2002;17:60-67.
¹⁵
Slawek J, Derejko M, Lass P. Factors affecting the quality of life of patients with idiopathic Parkinson's disease: an cross-section study in an outpatient clinic attendees. Parkinsonism Relat Disod 2005;11:465-468.
¹⁶
Kuopio AM, Marttila RJ, Helenius H, et al. The quality of life in Parkinson's disease. Mov Disord 2000;2:216-223.
¹⁷
Schrag A. Quality of life and depression in Parkinson's disease. J Neurol Sci 2006;248:151-157.
¹⁸
Forsaa EB, Larsen JP, Wentzel-Larsen T, Herlofson K, Alves G. Predictors and course of health-related quality of life in Parkinson's disease. Mov Disord 2008;23:1420-1427.
¹⁹
Rabinstein AA, Shulman LM. Management of behavioral and psychiatric problems in Parkinson's disease. Parkinsonism Relat Disord 2000;7:41-50.
²⁰
Klepac N, Trkulja V, Relja M, Babic T. Is quality of life in non-demented Parkinson's disease related to cognitive performance? A clinic-based cross-section study. Eur J Neurol 2008;15:128-133.
²¹
Calne DB, Snow BJ, Lee C. Criteria for diagnosing Parkinson's disease. Ann Neurol 1992;32:S125-S127.
²²
Hoehn MM, Yarh MD. Parkinsonism: onset, progression and mortally. Neurology 1967;17:427-442.
²³
Goetz CG, Poewe W, Rascol O, et al. Movement Disorder Society Task Force Report on the Hoehn and Yahr Staging Scale: status and recommendations. Mov Disord 2004;19:1020-1028.
²⁴
Morris JC, Heyman A, Mohs RC. The Consortium to establish a registry for Alzheimer's disease (CERAD): part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.
²⁵
Bertolucci PHF, Okamoto IH, Brucki SMD, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.
²⁶
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatr 1960;23:56-62.
²⁷
Blacker D. Psychiatric rating scales. In: Sadock B, Sadock V, Editors. Comprehensive textbook of psychiatry. 7th Ed. Philadelphia: Lippincott Williams & Wilkins, 2000;1:755-783.
²⁸
Carod-Artal FJ, Vargas AP, Martinez-Martin P. Determinants of quality of life in brazilian patients with Parkinson's disease. Mov Disord 2007;22:1408-1415.
²⁹
Chapuis S, Ouchchane L, Metz O, Gerbaud L, Durif F. Impact of the motor complications of Parkinson disease on quality of life Mov Disord 2005;20: 224-230.
³⁰
Karlsen KH, Tandberg E, Arsland D, Larsen JP. Health related quality of life in Parkinson's disease: a prospective longitudinal study 2000;69:584-589.
³¹
Lyons KE, Pahwa R, Troester AE. A comparison of Parkinson disease symptoms and self-reported functioning and well being. Parkinsonism Relat Disord 1998;3:207-209.
³²
Dubois B, Burn D, Goetz C, Aarsland D, Brown RG, Broe GA, Dickson D, Duyckaerts C, Cummings J, Gauthier S, Korczyn A, Lees A, Levy R, Litvan I, Mizuno Y, McKeith IG, Olanow CW, Poew W, Sampaio C, Tolosa E, Emre M. Diagnostic procedures for Parkinson's disease dementia: recommendations from the Movement Disorder Society Task Force. Mov Disord 2007;22:2314-2324.
³³
Miyasaki JM, Shannon K, Voon V, et al. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson's disease. (an evidence-based review) Neurology 2006;66:996-1002.
³⁴
Verbaan D, Marinus J, Visser M, et al. Cognitive impairment in Parkinson disease. J Neurol Neurosurg Psychiatr 2007;78: 1182-1187.
³⁵
Tedrus GMAS, Fonseca LC, Letro GH, Bossoni AS. Dementia and mild cognitive impairment in Parkinson's disease. Arq Neuropsiquiatr 2009;67:423-427.
³⁶
Muslimovic D, Post B, Speelman JD, Schmand B. Cognitive profile of patients with newly diagnosed Parkinson's disease. Neurology 2005;65:1239-1245.
³⁷
Uc EY, Rizzo M, Anderson SW, Qian MS, Rodnitzky RL, Dawson JD. Visual dysfunction in Parkinson disease without dementia. Neurology 2005;65:1907-1913.
³⁸
Muslimovic D, Post B, Speelman JD, Scmand B, Haan RJ. Determinants of disability and quality of life in mild to moderate Parkinson's disease. Neurology 2008;70:22419-2247.
³⁹
Bronnick K, Emre M, Lane R, Tekin S, Aarsland D. Profile of cognitive impairment in dementia associates with Parkinson's disease compared with Alzheimer disease. J Neurol Neurosurg Psychiatry 2007;78:1064-1068.

Publication Dates

Publication in this collection
Apr-Jun 2010

History

Received
07 Nov 2009
Accepted
14 Apr 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
de Boer AG, Wijker W, Speelman JD, et al. Quality of life in patients with Parkinson's disease: development of a questionnaire. J Neurol Neurosurg Psychiatry 1996;61:70-74.

[2] ²
Hobson P, Holden A, Meara J. Measuring the impact of Parkinson's disease with the Parkinson's disease quality of life questionnaire. Age ageing 1999;28:341-346.

[3] ³
Karlsen KH, Larsen JP, Tandberg E, Maland JG. Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease. J Neurol Neurosurg Psiquiatry 1999;66:431-435.

[4] ⁴
Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry 2000;69:308-312.

[5] ⁵
Keränen T, Kaakkola S, Sotaniemi K, et al. Economic burden and quality of life impairment increase with severity of PD. Parkinsonism Relat Disord 2003;9:163-168.

[6] ⁶
Barone P, Antoniani A, Colosimo C, et al. The priamo study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson disease. Mov Disord 2009;24:1641-1649.

[7] ⁷
Martinez-Martin P, Arroyo S, Rojo-Albuin JM, Rodriguez-Blazquez C, Frades B, de Pedro Cuesta J. Burden, perceived healthy status, and moon among caregivers of Parkinson's disease patients. Mov Disord 2008;23:1673-1680.

[8] ⁸
Peto V, Jenkinson C, Fitzpatrick R. Determining minimally important differences for the P-39 Parkinson's disease a review of the development, validation and application of a Parkinson disease questionnaire. Age ageing 2001;30:299-302.

[9] ⁹
Peto V, Jenkinson C, Fitzpatrick R. PDQ-39: a review of the development, validation and application of a Parkinson disease quality of life questionnaire and its associated measures. J Neurol 1998;245(Suppl 1):S10-14.

[10] ¹⁰
Carod-Artal FJ, Martinez-Martin P, Vargas AP. Independent validation of SCOPA-Psychosocial and metric properties of the PDQ-39 Brazilian version. Mov Disord 2007;22:91-98.

[11] ¹¹
Lana RC, Alvares LMRS, Nasciutti-Prudente C, Goulart FRP, Teixeira-Salmela LF, Cardoso FE. Percepção da qualidade de vida de indivíduos com doença de Parkinson através do PDQ-39. Rev Bras Fisioter 2007;11:397-402.

[12] ¹²
Souza RG, Borges V, Silva SMCA, Ferraz HB. Quality of life scale in de Parkinson - PDQ-39 (versão do Português falado no Brasil) como instrumento para avaliação de pacientes com e sem flutuação motora decorrente da levodopa. Arq Neuropsiquiatr 2007;65:787-791.

[13] ¹³
Scalzo P, Kummer A, Cardoso F, Teixeira AL. Depressive symptoms and perception of quality of life in Parkinson's disease. Arq Neuropsiquiatr 2009;67:203-208.

[14] ¹⁴
Global Parkinson's disease survey steering committee. Factors impacting quality of life in Parkinson's disease: results from an international survey. Mov Disord 2002;17:60-67.

[15] ¹⁵
Slawek J, Derejko M, Lass P. Factors affecting the quality of life of patients with idiopathic Parkinson's disease: an cross-section study in an outpatient clinic attendees. Parkinsonism Relat Disod 2005;11:465-468.

[16] ¹⁶
Kuopio AM, Marttila RJ, Helenius H, et al. The quality of life in Parkinson's disease. Mov Disord 2000;2:216-223.

[17] ¹⁷
Schrag A. Quality of life and depression in Parkinson's disease. J Neurol Sci 2006;248:151-157.

[18] ¹⁸
Forsaa EB, Larsen JP, Wentzel-Larsen T, Herlofson K, Alves G. Predictors and course of health-related quality of life in Parkinson's disease. Mov Disord 2008;23:1420-1427.

[19] ¹⁹
Rabinstein AA, Shulman LM. Management of behavioral and psychiatric problems in Parkinson's disease. Parkinsonism Relat Disord 2000;7:41-50.

[20] ²⁰
Klepac N, Trkulja V, Relja M, Babic T. Is quality of life in non-demented Parkinson's disease related to cognitive performance? A clinic-based cross-section study. Eur J Neurol 2008;15:128-133.

[21] ²¹
Calne DB, Snow BJ, Lee C. Criteria for diagnosing Parkinson's disease. Ann Neurol 1992;32:S125-S127.

[22] ²²
Hoehn MM, Yarh MD. Parkinsonism: onset, progression and mortally. Neurology 1967;17:427-442.

[23] ²³
Goetz CG, Poewe W, Rascol O, et al. Movement Disorder Society Task Force Report on the Hoehn and Yahr Staging Scale: status and recommendations. Mov Disord 2004;19:1020-1028.

[24] ²⁴
Morris JC, Heyman A, Mohs RC. The Consortium to establish a registry for Alzheimer's disease (CERAD): part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.

[25] ²⁵
Bertolucci PHF, Okamoto IH, Brucki SMD, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.

[26] ²⁶
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatr 1960;23:56-62.

[27] ²⁷
Blacker D. Psychiatric rating scales. In: Sadock B, Sadock V, Editors. Comprehensive textbook of psychiatry. 7th Ed. Philadelphia: Lippincott Williams & Wilkins, 2000;1:755-783.

[28] ²⁸
Carod-Artal FJ, Vargas AP, Martinez-Martin P. Determinants of quality of life in brazilian patients with Parkinson's disease. Mov Disord 2007;22:1408-1415.

[29] ²⁹
Chapuis S, Ouchchane L, Metz O, Gerbaud L, Durif F. Impact of the motor complications of Parkinson disease on quality of life Mov Disord 2005;20: 224-230.

[30] ³⁰
Karlsen KH, Tandberg E, Arsland D, Larsen JP. Health related quality of life in Parkinson's disease: a prospective longitudinal study 2000;69:584-589.

[31] ³¹
Lyons KE, Pahwa R, Troester AE. A comparison of Parkinson disease symptoms and self-reported functioning and well being. Parkinsonism Relat Disord 1998;3:207-209.

[32] ³²
Dubois B, Burn D, Goetz C, Aarsland D, Brown RG, Broe GA, Dickson D, Duyckaerts C, Cummings J, Gauthier S, Korczyn A, Lees A, Levy R, Litvan I, Mizuno Y, McKeith IG, Olanow CW, Poew W, Sampaio C, Tolosa E, Emre M. Diagnostic procedures for Parkinson's disease dementia: recommendations from the Movement Disorder Society Task Force. Mov Disord 2007;22:2314-2324.

[33] ³³
Miyasaki JM, Shannon K, Voon V, et al. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson's disease. (an evidence-based review) Neurology 2006;66:996-1002.

[34] ³⁴
Verbaan D, Marinus J, Visser M, et al. Cognitive impairment in Parkinson disease. J Neurol Neurosurg Psychiatr 2007;78: 1182-1187.

[35] ³⁵
Tedrus GMAS, Fonseca LC, Letro GH, Bossoni AS. Dementia and mild cognitive impairment in Parkinson's disease. Arq Neuropsiquiatr 2009;67:423-427.

[36] ³⁶
Muslimovic D, Post B, Speelman JD, Schmand B. Cognitive profile of patients with newly diagnosed Parkinson's disease. Neurology 2005;65:1239-1245.

[37] ³⁷
Uc EY, Rizzo M, Anderson SW, Qian MS, Rodnitzky RL, Dawson JD. Visual dysfunction in Parkinson disease without dementia. Neurology 2005;65:1907-1913.

[38] ³⁸
Muslimovic D, Post B, Speelman JD, Scmand B, Haan RJ. Determinants of disability and quality of life in mild to moderate Parkinson's disease. Neurology 2008;70:22419-2247.

[39] ³⁹
Bronnick K, Emre M, Lane R, Tekin S, Aarsland D. Profile of cognitive impairment in dementia associates with Parkinson's disease compared with Alzheimer disease. J Neurol Neurosurg Psychiatry 2007;78:1064-1068.

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