Quality of Life in Patients with Parkinson s Disease

Transcription

1 Quality of Life in Patients with Parkinson s Disease Seuk Kyung Hong, M.D., Kyung Won Park, M.D., Jae Kwan Cha, M.D., Sang Ho Kim, M.D., Dong Yeol Chun, M.D.*, Chang Kook Yang, M.D.*, Jae Woo Kim, M.D. Department of Neurology and Psychiatry*, College of Medicine, Dong-A University Background : Quality of life (QoL) has emerged as an important issue to patients with chronic illness. Parkinson s disease (PD) is a chronic neurodegenerative disorder requiring life-time treatment and supportive care, which affects not only physical activity but also cognition, mood, and daily living. The author investigated the QoL of patients with PD and aimed to find factors that have an influence on the QoL. Methods : One hundred thirty patients with PD were evaluated. The QoL was measured and assessed by the Parkinson s disease quality of life questionnaire (PDQL). The author analyzed demographic and social data and clinical profiles. The Beck Depression Inventory (BDI) and Spielburger s State-Trait Anxiety Inventory were used to evaluate depressive symptoms and anxiety levels. Results : The mean age of onset of parkinsonian symptom was years and the average duration of treatment was months. Patients with high BDI score, low Schwab and England activities of daily living scale (SEADLS) score, high bradykinesia score, progressed Hoehn and Yahr stage, high Unified Parkinson s disease rating scale score, low educational period and high economic state were all correlated with low PDQL scores. Multivariate regression analysis showed that BDI score, bradykinesia score, SEADLS score, and educational period were significantly associated with PDQL score. Conclusions : In order of magnitude, BDI, bradykinesia, SEADLS and educational period were influencing factors on PDQL. Therefore, to improve the QoL in patients with PD, we should consider not only physical disability, but also psychological factors, including depressive mood. J Korean Neurol Assoc 20(3):227~233, 2002 Key Words : Parkinson s disease, Quality of life, Parkinson s disease quality of life questionnaire, Depression Jae Woo Kim, M.D. Copyright 2002 by the Korean Neurological Association 227

2 228 J Korean Neurol Assoc / Volume 20 / May, 2002

3 Table 1. General characteristics of subjects. Table 2. Clinical data of subjects. Profiles Characteristics Number of patients(%) Mean(SD) or Age(years) Number of patients(%) (5.3) Age(years) 60.1(9.4) (7.7) Age of symptom onset(years) 55.2(10.9) (30.8) Duration of symptom(months) 59.3(50.2) (43.1) Duration of diagnosis(months) 31.7(38.9) (13.1) Duration of treatment(months) 34.7(36.9) Sex Daily levodopa dose(mg) 476.7(392.5) Man 60(46.2) Tremor score 1.8(2.1) Woman 70(53.8) Rigidity score 2.2(1.5) Marital status Bradykinesia score 5.9(2.7) Married 104(80) UPDRS score 9.9(4.5) Unmarried 1(0.8) Hoehn & Yahr stage 2.4(0.7) Divorced 1(0.8) SEADLS score 79.3(13.8) Bereaved 24(18.4) MMSE total score 26.5(3.9) Economic state Motor fluctuation 72(55.4%) Low 66(50.8) Side mostly affected Middle 53(40.8) Right 60(46.2%) High 11(8.4) Lift 61(46.9%) Educational period(years) Symmetric 9(6.9%) 0 13(10) Depression degree (26.1) Non-depressed 44(33.8%) (20) Depressive tendency 14(10.8%) (20.8) Depression 18(13.9%) (23.1) Severe depression 54(41.5%) State anxiety Non-anxiety 113(86.9%) Anxiety 17(13.1%) Trait anxiety Non-anxiety 85(65.4%) Anxiety 45(34.6%) UPDRS: Unified Parkinson s Disease Rating Scale SEADLS: Schwab and England Activities of Daily Living Scales MMSE: Korean version Mini-Mental Status Examination J Korean Neurol Assoc / Volume 20 / May,

4 Table 3. Correlations between the clinical features and the PDQL scores. Clinical features Correlation coefficients* PD SYS ECO SOC PDQL Age Educational period Economic state Age at onset Duration of symptoms Duration of diagnosis Duration of treatment Daily Levodopa Dose Motor fluctuation Tremor score Rigidity score Bradykinesia score UPDRS score Dominent side MMSE score SEADLS score H & Y stage BDI score SAI score TAI score PD: Parkinson symptoms scores, SYS: Systemic symptoms scores, ECO; Economic functionings scores, SOC: Social functionings scores, PDQL: Parkinson s Disease Quality of Life Queationnaire total scores, UPDRS: Unified Parkinson s Disease Rating Scale, MMSE: Korean version Mini-Mental Status Examination, SEADLS: Schwab and England Activities of Daily Living Scales, H & Y stage: Hoehn and Yahr stage, BDI: Korean version Beck Depression Inventory, SAI: State Anxiety Inventory, TAI: Trait Anxiety Inventory * : Pearson correlation coefficient : p-value < 0.05 : p-value < J Korean Neurol Assoc / Volume 20 / May, 2002

5 Table 4. Results of multivariate regression analysis. Correlation of clinical factors with the PDQL total score and the PDQL subdimensions. Variable Multivariate regression coefficients P value Adjusted R-square PDQL total score Educational period Bradykinesia score SEADLS BDI score Parkinsonian symptoms Educational period Bradykinesia score SEADLS BDI score Systemic symptoms Educational period Bradykinesia score SEADLS BDI score Emotional functioning Bradykinesia score BDI score Social functioning BDI score PDQL: Parkinson s Disease Quality of Life Questionnaire SEADLS: Schwab and England Activities of Daily Living Scales BDI: Korean version Beck Depression Inventory J Korean Neurol Assoc / Volume 20 / May,

6 Table 5. Results of multivariate stepwise regression analysis. Correlation of clinical factors with PDQL total score, BDI score and SEADLS score. Variable 04. Schapira AHV. Clinical review; Parkinson s disease. BMJ P value Model R-square PDQL total score Step 1. BDI score Step 2. Bradykinesia score Step 3. SEADLS Step 4. Educational period BDI score Step 1. SEADLS score Step 2. TAI score Step 3. Economic state Step 4. Tremor score SEADLS score Step 1. H & Y stage Step 2. Bradykinesia score Step 3. Daily Levodopa dose PDQL: Parkinson s Disease Quality of Life Questionnaire SEADLS: Schwab and England Activities of Daily Living Scales BDI: Beck Depression Inventory Korean version H & Y stage: Hoehn and Yahr stage 01. Schrag A, Jahanshahi M, Quinn N. How Dose Parkinson s Disease Affect Quality of Life? A Comparison With Quality of Life in the General Population. Mov Disord 2000;15(6): Baker GA. Health-related quality of life issues: optimizing patient outcomes. Neurology 1995;45(Suppl. 3):S29-S Martinez-Martin P. An introduction to the concept of quality of life in Parkinson s disease. J Neurol 1998;245(Suppl 1):S2-S ;318: Schrag A, Ben-Shlomo Y, Quinn NP. Cross sectional prevalence survey of idiopathic Parkinson s disease and Parkinsonism in London. BMJ 2000;321: Kessler II. Epidemiologic studies of Parkinson s disease:iii. A community-based survey. Am J Epidemiol 1972;96: Rijk MC, Tzourio C, Breteler MMB, Dartigues JF, Amaducci L, Lopez-Pousa S, et al. Prevalence of Parkinsonism and Parkinson s disease in Europe: the EUROPARKINSON collaborative study. J Neurol Neurosurg Psychiatry 1997;62(1): Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, et al. Range of neuropsychiatric disturbances in patients with Parkinson s disease. J Neurol Neurosurg Psychiatry 1999;67(4): Aarsland D, Anderson K, Larsen JP, Lolk A, Nielsen H, Kragh-Sorensen P. Risk of dementia in Parkinson s disease: A community-based, prospective study. N e u r o l o g y 2001;56: Stocchi F, Barbato L, Nordera G, Berardelli A, Ruggieri S. Sleep disorders in Parkinson s disease. J Neurol 1998;245(Suppl 1):S15-S EuroQoL Group. EuroQoL: A new facility for the measurement of health-related quality of life. J Public Health Policy 1990;16: Jenkinson C, Coulter A, Wright L. Short Form 36(SF 36) Health Survey Questionnaire: normative data for adults of working age. BMJ 1993;306: J Korean Neurol Assoc / Volume 20 / May, 2002

7 13. Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a stroke-specific quality of life scale. Stroke 1999;30: 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 Psychiatry 1999;66: Schrag A, Selai C, Jahanshahi M, Quinn NP. The EQ-5D-a generic quality of life measure-is a useful instrument to measure quality of life in patients with Parkinson s disease. J Neurol Neurosurg Psychiatry 2000;69: Kuopio AM, Marttila RJ, Helenius H, Toivonen M, Rinne UK. The quality of life in Parkinson s disease. M o v Disord 2000;15(2): Boer AGEM, Wijker W, Speelman JD, Haes JCJM. Quality of life in patients with Parkinson s disease: development of a questionnaire. J Neurol Neurosurg Psychiatry 1996;61: Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N. The Parkinson s disease questionnaire(pdq-39): development and validation of a Parkinson s disease summary index score. Age Ageing 1997;26: Schrag A, Jahanshahi M, Quinn NP. What contributes to quality of life in patients with Parkinson s disease? J Neurol Neurosurg Psychiatry 2000;69: Peto V, Jenkinson C, Fitzpatrick R, Greenhall R. The development of a short measure of functioning and well being for individuals with Parkinson s disease. Q u a l i t y Life Res 1995;4: Hanson 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: Gibb WRG, Lee AJ. The relavance of the Lewy body to the pathogenesis of idiopathic Parkinson s disease. J Neurol Neurosurg Psychiatry 1988;51: Hahn HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A Standardization Study of Beck Depression Inventory in Korea. J Korean Neuropsychiatr Asso 1986;25: Rhee MK, Lee YH, Park SH, Sohn CH, Chung YC, Hong SK, et al. A Standardization Study of Beck Depression Inventory I - Korean Version(K-BDI): Reliability and Factor Analysis. The Korean Journal of Psychopathology 1995;4: ,,. Spielburger ; Patrick HT, Levy DM. Parkinson s disease: a clinical study of 146 cases. Arch Neurol Psychiatry 1922 ; 7 : Mindham RHS. Psychiatric symptoms in Parkinsonism. J Neurol Neurosurg Psychiatry 1970;33: Gotham AM, Brown RG, Marsden CD. Depression in Parkinson s disease: a quantitative and quantitative analysis. J Neurol Neurosurg Psychiatry 1986;49: Ring AH, Bench CJ, Trimble MR, Brooks DJ, Frackowiak RS, Dolan RJ. Depression in Parkinson s disease. A positron emission study. British J Psychiatry 1994;165: Charlton CG. Depletion of nigrostriatal and forebrain tyrosine hydroxylase by S-adenosylmethionine: a model that may explain the occurrence of depression in Parkinson s disease. Life Sci 1997;61: Schrag A, Jahanshahi M, Quinn NP. What contributes to depression in Parkinson s disease? Psychol Med 2001;31(1): Karlsen KH, Tandberg E, Arsland D, Larsen JP. Health related quality of life in Parkinson s disease: a prospective longitudinal study. J Neurol Neurosurg Psychiatry 2000;69(5): J Korean Neurol Assoc / Volume 20 / May,