journal.pone.0046327.pdf (424.13 kB)
Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors
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posted on 2023-06-08, 14:52 authored by Irene J Higginson, Wei Gao, Tariq Zaffer Saleem, K Ray Chaudhuri, Rachel Burman, Paul McCrone, Nigel LeighNigel LeighBACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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.
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- Published
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- Published version
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PLoS ONEISSN
1932-6203Publisher
Public Library of ScienceExternal DOI
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11Volume
7Article number
e46327Department affiliated with
- Clinical and Experimental Medicine Publications
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- Yes
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- Yes
Legacy Posted Date
2013-05-14First Open Access (FOA) Date
2013-05-14First Compliant Deposit (FCD) Date
2013-05-14Usage metrics
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