Elsevier

Parkinsonism & Related Disorders

Volume 66, September 2019, Pages 151-157
Parkinsonism & Related Disorders

Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson's disease patients: Results from the COPPADIS Study Cohort

https://doi.org/10.1016/j.parkreldis.2019.07.031Get rights and content

Highlights

  • Non-motor symptoms (NMS) are frequent in Parkinson's disease (PD) patients during the first steps of the disease.

  • Health-related and global perceived quality of life (QoL) are worse in PD patients than controls.

  • Strong correlation was observed between PQ-10 and EUROHIS-QOL8, both scales to provide global QoL.

  • NMS burden, mood, and gait problems are the most significant factors contributing to a worse QoL.

  • In practice, it is necessary to ask about NMS, mood, and gait problems in PD patients during their first years of evolution.

Abstract

Objective

To identify factors related to a poor health-related and global quality of life (QoL) in a cohort of non-demented Parkinson's disease (PD) patients and compare to a control group.

Methods

The data correspond to the baseline evaluation of the COPPADIS-2015 Study, an observational, 5-year follow-up, multicenter, evaluation study. Three instruments were used to assess QoL: (1) the 39-item Parkinson's disease Questionnaire (PDQ-39), (2) a subjective rating of global QoL (PQ-10), and (3) the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Multiple linear regression methods were used to evaluate the direct impact of different variables on these QoL measures.

Results

QoL was worse in PD patients (n = 692; 62.6 ± 8.9 years old, 60.3% males) than controls (n = 206; 61 ± 8.3 years old, 49.5% males): PDQ-39, 17.1 ± 13.5 vs 4.4 ± 6.3 (p < 0.0001); PQ-10, 7.3 ± 1.6 vs 8.1 ± 1.2 (p < 0.0001); EUROHIS-QOL8, 3.8 ± 0.6 vs 4.2 ± 0.5 (p < 0.0001). A high correlation was observed between PDQ-39 and Non-Motor Symptoms Scale (NMSS) (r = 0.72; p < 0.0001), and PDQ-39 and Beck Depression Inventory-II (BDI-II) (r = 0.65; p < 0.0001). For health-related QoL (PDQ-39), non-motor symptoms burden (NMSS), mood (BDI-II), and gait problems (Freezing Of Gait Questionnaire [FOGQ]) provided the highest contribution to the model (β = 0.32, 0.28, and 0.27, respectively; p < 0.0001); whereas mood and gait problems contributed the most to global QoL (PQ-10, β = -0.46 and −0.21, respectively; EUROHIS-QOL8, β = -0.44 and −0.23, respectively).

Conclusions

QoL is worse in PD patients than in controls. Mood, non-motor symptoms burden, and gait problems seem to be the most relevant factors affecting health-related and global perceived QoL in non-demented PD patients.

Introduction

Parkinson's disease (PD) is characterized by motor and non-motor manifestations. In contrast to motor dysfunction, non-motor symptoms (NMS) remain frequently unreported unless specifically investigated [1]. However, their identification is important because NMS are frequent and negatively impact the quality of life (QoL) of PD patients [2,3]. Improving or keeping QoL is very important in chronic diseases, such as PD, for which a cure does not exist [4]. So, currently the aim of PD management is, as a whole, to improve QoL and autonomy of the patient for activities of daily living. To achieve this objective, it is necessary to know which factors are contributing to QoL, deterioration, and disability, in order to revert or neutralize those susceptible of intervention [5]. Different studies have analyzed factors contributing to a poor QoL in PD patients [[2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]]. However, limitations in some studies about this topic are the sample size, differences between scales used for assessing QoL, different types of QoL assessed, development in only one center, and/or the lack of a global evaluation including different aspects that could impact on QoL. For example, mood is frequently included in studies assessing QoL in PD, but an important problem like freezing of gait (FOG) is not.

The aim of the present study is to identify factors that influence health-related QoL (HRQoL) and global QoL (GQoL) in a population of PD patients from the COPPADIS-2015 Study Cohort, a comprehensive observational, 5-year follow-up, nationwide, multicenter study [17].

Section snippets

Methods

Non-demented PD patients and controls (subjects without PD and any other disabling concomitant neurological or non neurological disease) from the COPPADIS-2015 Study Cohort [17] were included in this study. The recruitment period was from January 1, 2016 to October 31, 2017. The data correspond to the baseline evaluation of the cited study (cross-sectional study). All patients were diagnosed according to UK PD Brain Bank criteria [18]. Exclusion criteria were: parkinsonism other than PD,

Results

A total of 694 PD patients and 207 controls were recruited and considered valid after a monitoring process in the COPPADIS-2015 Study (Fig. 1 – Supplementary Material). Of them, 2 patients and 1 control were excluded due to lack of key data for the analysis, so finally 692 PD patients (62.6 ± 8.9 years old, 60.3% males) and 206 controls (61 ± 8.3 years old, 49.5% males) were included for analysis. Data about sociodemographic variables, comorbid conditions, and therapies in PD patients and in

Discussion

The present study demonstrates that in non-demented PD patients the most relevant factors contributing to a worse QoL are NMS burden, mood, and gait problems. These factors had the strongest impact on both specific HRQoL (PDQ-39) and GQoL (EUROHIS-QOL8). Considered together, the contribution of NMS burden (NMSS), plus mood (BDI-II), plus gait problems (FOGQ) to HRQoL and GQoL was significant.

The clinical characteristics and assessment results of our PD sample were similar to those of

Conflicts of interest

None.

Funding sources

Fundación Curemos el Parkinson (www.curemoselparkinson.org).

Authors' roles

Diego Santos-García, MD, PhD: conception, organization, and execution of the project; statistical analysis; writing of the first draft of the manuscript; recruitment and/or evaluation of participants.

De Deus Fonticoba T: review and critique; evaluation of participants.

Suárez Castro E: review and critique; evaluation of participants.

Borrué C: review and critique; recruitment and/or evaluation of participants.

Mata M: review and critique; recruitment and/or evaluation of participants.

Solano Vila

Financial disclosures

Santos García D. has received honoraria for educational presentations and advice service by Abbvie, UCB Pharma, Lundbeck, KRKA, Zambon, Bial and Teva.

De Deus Fonticoba T: None.

Suárez Castro E:

Borrué C: None.

Mata M. has recived speaking honoraria from Abbvie, Italfarmaco, Zambon, Bial, Alter, and has participated in Advisory Board of Zambon, Italfarmaco and Abbvie.

Solano Vila B. has received honoraria for educational presentations by UCB Pharma, Zambon, Teva, Abbvie and Bial.

Cots Foraster A. has

Acknowledgements

We would like to thank all patients, caregivers and all persons, companies or institutions collaborating in this project. We especially want to thank all the work of the Curemos el Parkinson Foundation (www.curemoselparkinson.org), which is working very hardly to develop the COPPADIS project (https://curemoselparkinson.org/proyectos-en-desarrollo/coppadis/).

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