Quality of life in patients with Parkinson's disease

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Abstract

We evaluated the quality of life (QoL) in 278 Indian patients with Parkinson's disease (PD) using PDQL questionnaire, with measures various aspects of health status in PD patients including parkinsonian symptoms, systemic symptoms, social and emotional functions. Apart from demographic and treatment details parkinsonian disability and stage was assessed by Hoehn and Yahr stage, Schwab and England scale and UPDRS scores. We conclude that female gender, presence of depression, low degree of independence, higher levodopa dose (>400 mg/day) and higher UPDRS activity of daily living score have the most detrimental impact on QoL in patients with Parkinson's disease. Depression was the most significant factor impairing the QoL and it needs to be treated.

Section snippets

Subjects

The study included 278 PD patients attending Movement Disorder Clinic of All India Institute of Medical Sciences (AIIMS), New Delhi, India, from September 1996 to September 1999. AIIMS is a tertiary care center in northern India, which caters to a large population of all strata of society. All incident as well as prevalent cases were recruited in the study. The diagnosis of PD was based on the United Kingdom Parkinson's disease Society Brain Bank Clinical Diagnostic Criteria [25].

All the cases

Data collection

Information from subjects was obtained regarding the following demographic data and treatment details—age, gender, age at disease onset, marital status (living with spouse/no spouse), working status (retired/working/unable to work), and treatment status (levodopa alone/levodopa) and other anti parkinsonian drug (APD)/APD other than levodopa/no treatment and levodopa dose if taken.

Parkinsonian disability and stage was assessed by Hoehn and Yahr stage, [26] Schwab and England scale [27] and

Statistical methods

Data was managed on Excel spreadsheet. All the entries were checked for any keyboard errors. Total scores as well as the sub-scale scores of PDQL were calculated by adding the items of the scale. Age was divided into two categories (up to 55 years and more than 55 years). Age at onset of disease was divided into two categories (up to 45 years and more than 45 years). We performed bivariate analysis to examine the correlation of the factors—age, gender, age at onset, working status, treatment,

Result

The study included 278 patients all of whom completed the QoL questionnaire (Table 1). There were 218 males and 60 females with mean age of 57.2±10.8 years (range 24–86 years). Median age at disease onset was 52 years (mean±SD 52.6±11.5 years). Details of clinical profile and variables presumed to affect health related quality of life and which were included in the analyses as independent variables are shown in Table 1.

Hoehn and Yahr staging was done in 262 patients. UPDRS staging was done in

Discussion

Our study revealed female gender, presence of depression, low degree of independence in activities of daily living (low Schwab and England score), high levodopa dose and higher UPDRS activity of daily living (ADL) score to have the most detrimental effect on QoL measurement in patients with Parkinson's disease. The mean age of PD patients recruited in the study was younger as compared to reported series from other countries despite comparable mean age at disease onset, but it was similar to our

Conclusion

We conclude that female gender, presence of depression, low degree of independence (low England and Schwab Score), higher levodopa dose (>400 mg/day) and higher UPDRS activity of daily living score have the most detrimental impact on QoL in patients with PD. While managing female patients with PD, treatment should be aimed to improve overall features including social and emotional functions. PD patients should be encouraged to live with family (children and grand children) to improve their

Acknowledgements

Authors acknowledge the help of Dr AGEM de Boer for allowing us to use the questionnaire developed by her.

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