Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.

<h4>Background</h4>Palliative care is increasingly offered earlier in the cancer trajectory but rarely in Idiopathic Parkinson's Disease(IPD), Progressive Supranuclear Palsy(PSP) or Multiple System Atrophy(MSA). There is little longitudinal data of people with late stage disease to...

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Autores principales:	Irene J Higginson, Wei Gao, Tariq Zaffer Saleem, K Ray Chaudhuri, Rachel Burman, Paul McCrone, Peter Nigel Leigh
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/459d3c12b72c49339c534efaf17df2c3
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spelling	oai:doaj.org-article:459d3c12b72c49339c534efaf17df2c32021-11-18T08:09:52ZSymptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.1932-620310.1371/journal.pone.0046327https://doaj.org/article/459d3c12b72c49339c534efaf17df2c32012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23144781/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Palliative care is increasingly offered earlier in the cancer trajectory but rarely in Idiopathic Parkinson's Disease(IPD), Progressive Supranuclear Palsy(PSP) or Multiple System Atrophy(MSA). There is little longitudinal data of people with late stage disease to understand levels of need. We aimed to determine how symptoms and quality of life of these patients change over time; and what demographic and clinical factors predicted changes.<h4>Methods</h4>We recruited 82 patients into a longitudinal study, consenting patients with a diagnosis of IPD, MSA or PSP, stages 3-5 Hoehn and Yahr(H&Y). At baseline and then on up to 3 occasions over one year, we collected self-reported demographic, clinical, symptom, palliative and quality of life data, using Parkinson's specific and generic validated scales, including the Palliative care Outcome Scale (POS). We tested for predictors using multivariable analysis, adjusting for confounders.<h4>Findings</h4>Over two thirds of patients had severe disability, over one third being wheelchair-bound/bedridden. Symptoms were highly prevalent in all conditions - mean (SD) of 10.6(4.0) symptoms. More than 50% of the MSA and PSP patients died over the year. Over the year, half of the patients showed either an upward (worsening, 24/60) or fluctuant (8/60) trajectory for POS and symptoms. The strongest predictors of higher levels of symptoms at the end of follow-up were initial scores on POS (AOR 1.30; 95%CI:1.05-1.60) and being male (AOR 5.18; 95% CI 1.17 to 22.92), both were more predictive than initial H&Y scores.<h4>Interpretation</h4>The findings point to profound and complex mix of non-motor and motor symptoms in patients with late stage IPD, MSA and PSP. Symptoms are not resolved and half of the patients deteriorate. Palliative problems are predictive of future symptoms, suggesting that an early palliative assessment might help screen for those in need of earlier intervention.Irene J HigginsonWei GaoTariq Zaffer SaleemK Ray ChaudhuriRachel BurmanPaul McCronePeter Nigel LeighPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 11, p e46327 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Irene J Higginson Wei Gao Tariq Zaffer Saleem K Ray Chaudhuri Rachel Burman Paul McCrone Peter Nigel Leigh Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
description	<h4>Background</h4>Palliative care is increasingly offered earlier in the cancer trajectory but rarely in Idiopathic Parkinson's Disease(IPD), Progressive Supranuclear Palsy(PSP) or Multiple System Atrophy(MSA). There is little longitudinal data of people with late stage disease to understand levels of need. We aimed to determine how symptoms and quality of life of these patients change over time; and what demographic and clinical factors predicted changes.<h4>Methods</h4>We recruited 82 patients into a longitudinal study, consenting patients with a diagnosis of IPD, MSA or PSP, stages 3-5 Hoehn and Yahr(H&Y). At baseline and then on up to 3 occasions over one year, we collected self-reported demographic, clinical, symptom, palliative and quality of life data, using Parkinson's specific and generic validated scales, including the Palliative care Outcome Scale (POS). We tested for predictors using multivariable analysis, adjusting for confounders.<h4>Findings</h4>Over two thirds of patients had severe disability, over one third being wheelchair-bound/bedridden. Symptoms were highly prevalent in all conditions - mean (SD) of 10.6(4.0) symptoms. More than 50% of the MSA and PSP patients died over the year. Over the year, half of the patients showed either an upward (worsening, 24/60) or fluctuant (8/60) trajectory for POS and symptoms. The strongest predictors of higher levels of symptoms at the end of follow-up were initial scores on POS (AOR 1.30; 95%CI:1.05-1.60) and being male (AOR 5.18; 95% CI 1.17 to 22.92), both were more predictive than initial H&Y scores.<h4>Interpretation</h4>The findings point to profound and complex mix of non-motor and motor symptoms in patients with late stage IPD, MSA and PSP. Symptoms are not resolved and half of the patients deteriorate. Palliative problems are predictive of future symptoms, suggesting that an early palliative assessment might help screen for those in need of earlier intervention.
format	article
author	Irene J Higginson Wei Gao Tariq Zaffer Saleem K Ray Chaudhuri Rachel Burman Paul McCrone Peter Nigel Leigh
author_facet	Irene J Higginson Wei Gao Tariq Zaffer Saleem K Ray Chaudhuri Rachel Burman Paul McCrone Peter Nigel Leigh
author_sort	Irene J Higginson
title	Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
title_short	Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
title_full	Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
title_fullStr	Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
title_full_unstemmed	Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
title_sort	symptoms and quality of life in late stage parkinson syndromes: a longitudinal community study of predictive factors.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/459d3c12b72c49339c534efaf17df2c3
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Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.

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