title: Quality of life in Parkinson's disease patients with motor fluctuations and dyskinesias in five European countries.
abstract: BACKGROUND
  Little is known about the relationship between specific subtypes of treatment-associated motor complications and different domains of health-related Quality of Life (QoL) in patients with Parkinson's disease (PD). Larger studies that investigate these aspects within a cross-cultural setting are scarce.
  
  
  OBJECTIVE
  To assess QoL and its association with on-off fluctuations, peak-dose dyskinesias, biphasic dyskinesias, and off-dystonias in PD patients from five European countries.
  
  
  METHODS
  Data from 817 PD patients were collected cross-sectionally in France, Germany, Italy, Spain, and the UK. QoL was measured with the generic EuroQoL 5-Dimension questionnaire (EQ-5D) and the disease-specific Parkinson's Disease Questionnaire-39 (PDQ-39). Multivariable linear regression analyses were performed to test the associations of motor complication subtypes with QoL.
  
  
  RESULTS
  Thirty-three percent of the patients (varying from 23% in Italy to 58% in France) suffered from motor complications, either a single subtype or a combination of different subtypes. On-off fluctuations were associated with a 7.1 percentage point decrease in the EQ-5D (p < 0.001) and a 3.6 percentage point deterioration in the PDQ-39 (p = 0.01). Dyskinesias were not seen to affect global QoL scores, but had detrimental effects on the PDQ-39 dimensions activities of daily living, cognitions, stigma, and bodily discomfort. Patients from Spain, Italy, and France had lower global QoL scores in the multivariable analyses than patients from Germany and the UK.
  
  
  CONCLUSIONS
  Motor complications, primarily on-off fluctuations, may impact QoL in PD patients. This substantiates the importance of clinical strategies targeting the prevention, delay of onset, and management of motor complications in PD patients.
authors: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University Mainz, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: hechtner@uni-mainz.de.
authors: Marlene C
authors: MC
authors: Hechtner
authors: Department of Neurology, University Medical Centre, Johannes Gutenberg University Mainz, Germany.
authors: Thomas
authors: T
authors: Vogt
authors: Department of Health Sciences, Faculty of Life Sciences, Hamburg University of Applied Sciences (HAW), Germany.
authors: York
authors: Y
authors: Zöllner
authors: Department of Neurology, Skåne University Hospital, Lund, Sweden.
authors: Sabrina
authors: S
authors: Schröder
authors: Department of Psychology, University of Georgia, Athens, GA, USA.
authors: Julia B
authors: JB
authors: Sauer
authors: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University Mainz, Germany.
authors: Harald
authors: H
authors: Binder
authors: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University Mainz, Germany; Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Germany.
authors: Susanne
authors: S
authors: Singer
authors: Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
authors: Rafael
authors: R
authors: Mikolajczyk
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D020820:Dyskinesias / Q000188:drug therapy* / Q000209:etiology; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents
keywords: Dyskinesia; Europe; Motor complications; Motor fluctuations; Parkinson's disease; Quality of life