title: The impact of early morning off in Parkinson's disease on patient quality of life and caregiver burden.
abstract: BACKGROUND
  Early morning off (EMO) is a symptom experienced by patients with Parkinson's disease (PD) in any stage of the illness; however, few studies have explored its prevalence. Thus, the impact of EMO on patient Quality of Life (QOL) and caregiver burden is unclear.
  
  
  METHODS
  A QOL questionnaire was administered to members of the Japan Parkinson's Disease Association and their caregivers via mail using the PD questionnaire - 8 (PDQ-8), which measures the appearance of EMO. The analysis assessed the responses from 2205 completed surveys.
  
  
  RESULTS
  Patients who felt they had EMO amounted to 79.8%, with 37.8% of respondents stating that EMO was a daily occurrence. The prevalence of EMO increased as the Hoehn and Yahr stage increased, but was observed at a rate of 52.4% even in patients at Stage 1. The QOL of those with EMO was significantly reduced (p<0.0001), and the odds of caregivers feeling a sense of burden was higher for the group that experienced EMO even after adjusting for age of patient, age of caregivers, disease duration, relationship to patient, and Hoehn and Yahr stage.
  
  
  CONCLUSIONS
  The prevalence of EMO in the survey results was high, significantly lowering the patients' QOL. Interestingly, EMO was also observed in the early stage of the disease. Since the presence of EMO impacts patients' QOL and caregiver burden, medical intervention and appropriate gathering of information for such intervention should be considered.
authors.affiliation: Department of Neurology, Fukuoka University School of Medicine, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Onozawa
authors.affiliation: Department of Neurology, Fukuoka University School of Medicine, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tsugawa
authors.affiliation: Department of Neurology, Fukuoka University School of Medicine, Japan. Electronic address: tsuboi@cis.fukuoka-u.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tsuboi
authors.affiliation: Department of Neurology, Fukuoka University School of Medicine, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Fukae
authors.affiliation: Department of Neurology, Fukuoka University School of Medicine, Japan.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Mishima
authors.affiliation: Department of Neurology, Fukuoka University School of Medicine, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Fujioka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D010300:Parkinson Disease / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Caregiver burden; Early morning off; Parkinson's disease; Quality of life