Alice Hosking1, Adrianus A L J Hommel2, Stefan Lorenzl3, Miguel Coelho4, Joaquim J Ferreira5, Wassilios G Meissner6, Per Odin7, Bas R Bloem8, Richard Dodel9, Anette Schrag10. 1. UCL Queen Square Institute of Neurology, University College London, London, UK. 2. Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands; Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand. 3. Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany; Department of Neurology, Agatharied Hospital, Hausham, Germany. 4. Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany. 5. Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. 6. Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand; Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France. 7. Department of Neurology, Lund University Hospital, Lund, Sweden. 8. Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands; Groenhuysen Organisation, Roosendaal, the Netherlands. 9. Department of Geriatric Medicine, University Hospital Essen, Essen, Germany. 10. UCL Queen Square Institute of Neurology, University College London, London, UK. Electronic address: a.schrag@ucl.ac.uk.
Abstract
OBJECTIVES: To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP). MEASURES: Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis. RESULTS: Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement. CONCLUSIONS AND IMPLICATIONS: These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder.
OBJECTIVES: To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP). MEASURES: Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis. RESULTS: Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement. CONCLUSIONS AND IMPLICATIONS: These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder.
Authors: Daniel Oudin Åström; Jacob Simonsen; Lars Lau Raket; Simona Sgarbi; Johan Hellsten; Peter Hagell; Jenny M Norlin; Klas Kellerborg; Pablo Martinez-Martin; Per Odin Journal: Sci Rep Date: 2022-10-06 Impact factor: 4.996
Authors: Luca Vignatelli; Corrado Zenesini; Laura M B Belotti; Elisa Baldin; Giuseppe Bonavina; Giovanna Calandra-Buonaura; Pietro Cortelli; Carlo Descovich; Giovanni Fabbri; Giulia Giannini; Maria Guarino; Roberta Pantieri; Giuseppe Samoggia; Cesa Scaglione; Susanna Trombetti; Roberto D'Alessandro; Francesco Nonino Journal: Mov Disord Date: 2020-12-02 Impact factor: 9.698