Quality of life in Parkinson’s disease patients: progression markers of mild to moderate stages

Moreira, Raissa Carla; Zonta, Marise Bueno; Araújo, Ana Paula Serra de; Israel, Vera Lúcia; Teive, Hélio A. G.

doi:10.1590/0004-282X20170091

Brasil

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ARTICLES • Arq. Neuro-Psiquiatr. 75 (8) • Aug 2017 • https://doi.org/10.1590/0004-282X20170091 linkcopy

Quality of life in Parkinson’s disease patients: progression markers of mild to moderate stages

Qualidade de vida de indivíduos com doença de Parkinson: marcadores da progressão da fase leve para moderada

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective To investigate which factors are associated with the quality of life decline in Parkinson’s disease patients from mild to moderate stages.

Methods The Unified Parkinson’s Disease Rating Scale and Parkinson’s Disease Questionnaire-39 were used to evaluate clinical/functional data and the quality of life.

Results The markers of clinical/functional worsening were drooling (p < 0.004), need for assistance with hygiene (p = 0.02), greater freezing frequency (p = 0.042), bradykinesia (p = 0.031), greater intensity of the resting tremor (p = 0.035) and “pill rolling” (p = 0.001). The decline in quality of life was related to stigma (p = 0.043), greater impairment in cognition (p = 0.002), mobility (p = 0.013) and for daily living activities (p = 0.05), and was considered more significant in men, married, older individuals, and those with a longer time of disease.

Conclusions The quality of life worsening markers at the moderate stage were related to stigma, worsening of cognition, and to greater impairment in mobility and daily living activities.

Parkinson disease; quality of life; surveys and questionnaires

Variable	Mild	Moderate	p-value*

	n (%)	n (%)
Gender
Female	28 (56)	22 (44)
Male	22 (44)	28 (56)	0.317
Age (years)
60-65	11 (22)	13 (26)
66-70	16 (32)	8 (16)
71-75	10 (20)	17 (34)
76-80	13 (26)	12 (24)	0.196
Race
White	45 (90)	46 (92)
Yellow/Black	5 (10)	4 (8)	1
Marital status
Married	32 (64)	38 (76)
Separated/widow(er)/single	18 (36)	12 (24)	0.275
Level of education
Primary education (incomplete)	9 (18)	11 (22)
Primary education (complete)	27 (54)	19 (38)
High school (complete or incomplete)	5 (10)	8 (16)
Third-level education (complete or incomplete)	9 (18)	12 (24)	0.438

UPDRS – ADLs	Stage	Number of individuals and % for each answer				p-value*

		0	1	2	3 or 4
Drooling	Mild	24 (48)	15 (30)	11 (22)	0 (0)
Drooling	Moderate	9 (18)	18 (36)	19 (38)	4 (8)	0.004*
Personal hygiene	Mild	5 (10)	34 (68)	10 (20)	1 (2)
Personal hygiene	Moderate	0 (0)	38 (76)	6 (12)	6 (12)	0.020*
Freezing	Mild	7 (14)	23 (46)	12 (24)	8 (16)
Freezing	Moderate	8 (16)	11 (22)	13 (26)	18 (36)	0.042*
UPDRS - Motor examination
Resting tremor	Mild	5 (10)	30 (60)	12 (24)	3 (6)
Resting tremor	Moderate	1 (2)	33 (66)	6 (12)	10 (20)	0.035*
Pill-rolling	Mild	25 (50)	23 (46)	2 (4)	0 (0)
Pill-rolling	Moderate	7 (14)	39 (78)	3 (6)	1 (2)	0.001**
Bradykinesia	Mild	3 (6)	21 (42)	1 (2)	25 (50)
Bradykinesia	Moderate	1 (2)	32 (64)	4 (8)	13 (26)	0.031*

Domain	Stage	n	Mean	Median	Minimum	Maximum	Standard deviation	p-value*
Mobility	Mild	50	19.2	20.0	1.0	37.0	7.5
Mobility	Moderate	50	23.4	23.0	10.0	38.0	7.1	0.013*
ADLs	Mild	50	9.4	9.0	0.0	19.0	4.6
ADLs	Moderate	50	11.6	11.0	2.0	24.0	4.8	0.050
Well-being	Mild	50	10.0	12.0	0.0	26.0	5.1
Well-being	Moderate	50	10.5	11.0	1.0	18.0	4.4	0.724
Stigma	Mild	50	2.7	1.5	0.0	12.0	3.1
Stigma	Moderate	50	3.9	2.0	0.0	18.0	3.8	0.043*
Support	Mild	50	6.7	8.0	1.0	12.0	2.3
Support	Moderate	50	7.4	8.0	2.0	11.0	2.1	0.089
Cognition	Mild	50	5.8	7.0	0.0	12.0	2.6
Cognition	Moderate	49	7.3	8.0	2.0	12.0	2.4	0.002*
Communication	Mild	50	3.3	3.5	0.0	8.0	2.6
Communication	Moderate	50	3.6	4.0	0.0	8.0	2.4	0.614
Bodily discomfort	Mild	50	6.3	7.0	0.0	11.0	2.3
Bodily discomfort	Moderate	50	6.2	6.0	2.0	10.0	1.8	0.525

PDQ-39 domains	Difference between the MIG and MOG groups
Mobility
Q1. Have you had difficulty doing the leisure activities you like?	p = 0.041
Q10. Have you been confined to the house more than you would like?	p = 0.052
ADLs domain
Q5. Have you had difficulty cutting up your food?	p = 0.048
Q6. Have you had difficulty holding a drink without spilling it?	p = 0.043
Emotional well-being domain
Q5. Have you felt anxious?	p = 0.01
Q6. Have you felt worried about your future? (p=0.054)	p = 0.054
Stigma domain
Q2. Have you avoided situations which involve eating or drinking in public?	p = 0.045
Cognition domain
Q2. Have you had problems with your concentration?	p = 0.018
Q3. Have you felt your memory was bad?	p = 0.027
Bodily discomfort domain
Q1. Have you had painful muscle cramps or spasms?	p = 0.04

Variable	Mild		Moderate

	r	p-value	r	p-value
ADLs	0.14	0.328	0.17	0.230
UPDRS
Motor examination	-0.03	0.811	0.17	0.232
Mobility	-0.05	0.742	0.19	0.188
ADLs	0.30	0.035*	0.11	0.459
Well-being	0.01	0.948	0.34	0.017*
PDQ-39
Stigma	0.12	0.414	-0.05	0.729
Support	-0.13	0.387	0.01	0.972
Cognition	0.15	0.311	0.27	0.060
Communication	0.06	0.681	0.24	0.087
Bodily discomfort	0.16	0.275	0.07	0.629

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[TFN1] p* < 0.05.