title: Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cicely Saunders Institute, King's College London, London, United Kingdom. irene.higginson@kcl.ac.uk
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Tariq Zaffer
authors.initials: TZ
authors.lastname: Saleem
authors.forename: K Ray
authors.initials: KR
authors.lastname: Chaudhuri
authors.forename: Rachel
authors.initials: R
authors.lastname: Burman
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Peter Nigel
authors.initials: PN
authors.lastname: Leigh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D011788:Quality of Life; D012737:Sex Factors