Quality of life in Parkinson's disease: the relative importance of the symptoms.
A body of literature now exists, which demonstrates that idiopathic Parkinson's disease (PD) has a major negative impact on quality of life (QoL), and that depression and cognitive impairment are among the main predictors of poor QoL in this disorder. Relatively little work has been done to assess the differential contribution of the specific symptoms of PD to QoL, which was the aim of this study. One hundred thirty patients with PD completed a booklet of questionnaires, which included the PDQ39 as a disease-specific measure of QoL, a symptom checklist, a mobility checklist, as well as patient ratings of disease stage and disability. The results indicated that the contribution of physical, medication-related, and cognitive/psychiatric symptoms to QoL can be significant. Sudden unpredictable on/off states, difficulty in dressing, difficulty in walking, falls, depression, and confusion were PD symptoms, which significantly influenced QoL scores. Among the mobility problems associated with PD, start hesitation, shuffling gait, freezing, festination, propulsion, and difficulty in turning had a significant effect on QoL scores. In addition to depression and anxiety, the major predictors of QoL were shuffling, difficulty turning, falls, difficulty in dressing, fatigue, confusion, autonomic disturbance particularly urinary incontinence, unpredictable on/off fluctuations, and sensory symptoms such as pain. The implications of these results for the medical management of PD are discussed.
Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and the National Hospital for Neurology and Neurosurgery, University College London, Queen Square, London, United Kingdom.
Shibley
S
Rahman
Harry J
HJ
Griffin
Niall P
NP
Quinn
Marjan
M
Jahanshahi
D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000209:etiology / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology*; D004409:Dyskinesia, Drug-Induced / Q000209:etiology / Q000523:psychology; D004739:England / Q000453:epidemiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D020919:Sleep Disorders, Intrinsic / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology / Q000523:psychology
D000978:Antiparkinson Agents