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P1.173 Validation of a home environment test battery for status assessment in patients with advanced Parkinson's disease
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
Conclusion: Our findings suggest that Echocardiography, MIBGSPECT and cardiovascular autonomic testing are useful to evaluate cardiac autonomic dysfunction in early Parkinson’s Disease. P1.171 Evolving non-motor symptoms in Parkinson disease patients. A cross-sectional study L. Vela1 , M.D. Martin Rios2 , M. Baron1 , F.J. Barriga1 , J.L. Dobato1 , J.A. Pareja1 . 1 Neurology, 2 Fundacion Hospital Alcorcon, Alcorcon, Spain Objective: The aim of this study was to determine the change concerning the type and frequency of some non-motor symptoms (NMS) in a population of Parkinson disease (PD) patients that have already been studied three years earlier. Material and Methods: This was an observational, cross-sectional, two-points-in-time study. Sixty-eight PD patients cognitively intact were assessed in 2005 and 2008. They completed a questionnaire about the presence of NMS. Twenty-nine questions were grouped in four domains: autonomic, psychiatric, cognitive and sensory symptoms. Patients answered either “yes” or “no” for each item. Demographic details, Hoehn and Yahr stage (H&Y), UPDRS III score and levodopa complications were also collected. Statistical analysis was done to compare the results in the two evaluations. Results: 32 men and 36 women completed the questionnaire. In 2008 mean age was 72±10.4 years and disease duration 10.5±5.4 years. Mean H&Y stage was 2.8±0.9 and mean UPDRS III was 31.36±10. Fifty-five percent had motor fluctuations and 50% had dyskinesia. NMS total score increased significantly from 2005 (7±5.5) to 2008 (9±5.5). Autonomic symptoms (dry mouth, dysphagia, constipation and flatulence) were significantly more frequent in 2008 (p = 0.001). There was a significant association between the presence of NMS and motor complications. Severity of disease does not linearly correlate with the number of NMS. Disease duration correlated with NMS (p = 0.001). Conclusions: NMS are very frequent in PD patients. Duration of PD correlated with NMS. Severity of disease does not correlate with NMS. Autonomic NMS increased significantly in these patients. P1.172 Prevalence of non-motor symptoms in Thai Parkinson’s disease patients K. Vongvaivanich, S. Nidhinandana. Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand Background: Although motor problems of Parkinson’s disease (PD) are as important, during the past 5 years non-motor symptoms (NMS) of PD have also been recently recognized as problematic as the cause of major disability in PD patients. PD nonmotor group developed NMS screening questionnaire (NMSQuest). Study aim to evaluate prevalence of NMS and correlation of NMS with demographic and historical factors in Thai PD patients. Methods: Data were collected from January 2008 to December 2008. 182 patients were enrolled in study, 17 patients were excluded. NMSQ-Thai were completed by 165 patients. Demographic data, duration of the disease, HY stages, levodopa dosage, numbers and types of antiparkinsonian drugs were recorded. Descriptive statistic analysis was employed to calculate prevalence of NMS, and regression analysis was used to calculate correlation. Results: The 165 patients were diagnosed to probably idiopathic PD: mean age 68.55±9.35 yr, male 56.4%, mean duration of disease 5.39±4.16 yr. Only 5 patients denied all of NMS. Mean total score of NMSQ-T was 9.54±5.51. Most prevalence of NMS was nocturia (64.2%). The most prevalence NMS domain were urinary domains (54.55%). Total NMSQ-T was significantly correlated with HY stages (p < 0.0001), levodopa doses (p < 0.0001), duration of disease (p = 0.004), and age and age at onset (p < 0.011).
S73
Conclusion: NMS in Thai PD patients were found in high prevalence; almost all patients had NMS. Screening all PD patients in outpatient setting should be done with NMSQ-T to recognize NMS and early treat appropriately. P1.173 Validation of a home environment test battery for status assessment in patients with advanced Parkinson’s disease J. Westin1,2 , M. Schiavella3 , M. Memedi2 , D. Nyholm4 , M. Dougherty2 , T. Groth1 , A. Antonini3 . 1 Medical Informatics, Medical Sciences, Uppsala University, Uppsala, 2 Computer Science, Dalarna University, Borl¨ ange, Sweden; 3 Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy; 4 Neurology, Neuroscience, Uppsala University, Uppsala, Sweden Introduction: A test battery, consisting of self-assessments (modified PDQ-8) and motor tests (tapping and spiral drawing), was developed for a hand computer with touch screen in a telemedicine setting. Assessments and tests are carried out four times per day during one week’s test periods and summarised in an ‘overall score’. Objective: To assess patient compliance, test-retest reliability, correlations to other assessment methods and ability to detect differences between patient groups at different disease stages. Methods: Data from 30 patients (26m, 4f; 64.7±6.8 y), both in stable (H&Y 1.8±0.4) and fluctuating (H&Y 2.2±0.4) conditions, in age and gender matched pairs were analysed. Patients used the test battery for one week, and were assessed with UPDRS and PDQ-39 at the end of the test period. This procedure was repeated one week later without allowing treatment changes. Reliability and validity were assessed by Spearman rank correlations. The Mann-Whitney statistical test was used to test if the overall score’s median was different between stable and fluctuating groups. Results: Median compliance was 93%. The test–retest reliability of the overall score was 0.71 in the stable group and 0.84 in the fluctuating group. The correlation (combined group) to UPDRS was −0.60 and to PDQ-39, −0.66. Median overall score differed 18% between the two groups (p < 0.0001). Conclusions: Compliance and reliability of the test battery were good overall, with better reliability in fluctuating patients. Correlations to UPDRS and PDQ-39 were adequate and difference in test score between stable and fluctuating patient groups was detected. P1.174 A successful computer method for assessing drawing impairment in Parkinson’s disease J. Westin1,2 , S. Ghiamati2 , M. Memedi2 , D. Nyholm3 , A. Johansson3 , M. Dougherty2 , T. Groth1 . 1 Medical Informatics, Medical Sciences, Uppsala University, Uppsala, 2 Computer Science, Dalarna University, Borl¨ ange, 3 Neurology, Neuroscience, Uppsala University, Uppsala, Sweden Introduction: A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing) was developed for a hand computer with touch screen in a telemedicine setting. Methods: This test battery was used on 8062 test occasions by 62 patients with advanced Parkinson’s disease (PD). On each test occasion, 3 spirals were drawn. A computer method, using wavelet transforms and principal component analysis processed the spirals to generate a ‘spiral score’. Two PD specialists (AJ, DN) rated drawing impairment in the 3 spiral drawings from 3 random test occasions per patient, using a modification of the Bain & Findley 10-category scale. Gold standard rating was defined as the mean of the two PD specialists’ assessments. Results: The 95% confidence interval for prediction errors was below ±2, which is similar to the differences of opinion between human raters. Spearman rank correlations were as follows:
Conclusion: Our findings suggest that Echocardiography, MIBGSPECT and cardiovascular autonomic testing are useful to evaluate cardiac autonomic dysfunction in early Parkinson’s Disease. P1.171 Evolving non-motor symptoms in Parkinson disease patients. A cross-sectional study L. Vela1 , M.D. Martin Rios2 , M. Baron1 , F.J. Barriga1 , J.L. Dobato1 , J.A. Pareja1 . 1 Neurology, 2 Fundacion Hospital Alcorcon, Alcorcon, Spain Objective: The aim of this study was to determine the change concerning the type and frequency of some non-motor symptoms (NMS) in a population of Parkinson disease (PD) patients that have already been studied three years earlier. Material and Methods: This was an observational, cross-sectional, two-points-in-time study. Sixty-eight PD patients cognitively intact were assessed in 2005 and 2008. They completed a questionnaire about the presence of NMS. Twenty-nine questions were grouped in four domains: autonomic, psychiatric, cognitive and sensory symptoms. Patients answered either “yes” or “no” for each item. Demographic details, Hoehn and Yahr stage (H&Y), UPDRS III score and levodopa complications were also collected. Statistical analysis was done to compare the results in the two evaluations. Results: 32 men and 36 women completed the questionnaire. In 2008 mean age was 72±10.4 years and disease duration 10.5±5.4 years. Mean H&Y stage was 2.8±0.9 and mean UPDRS III was 31.36±10. Fifty-five percent had motor fluctuations and 50% had dyskinesia. NMS total score increased significantly from 2005 (7±5.5) to 2008 (9±5.5). Autonomic symptoms (dry mouth, dysphagia, constipation and flatulence) were significantly more frequent in 2008 (p = 0.001). There was a significant association between the presence of NMS and motor complications. Severity of disease does not linearly correlate with the number of NMS. Disease duration correlated with NMS (p = 0.001). Conclusions: NMS are very frequent in PD patients. Duration of PD correlated with NMS. Severity of disease does not correlate with NMS. Autonomic NMS increased significantly in these patients. P1.172 Prevalence of non-motor symptoms in Thai Parkinson’s disease patients K. Vongvaivanich, S. Nidhinandana. Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand Background: Although motor problems of Parkinson’s disease (PD) are as important, during the past 5 years non-motor symptoms (NMS) of PD have also been recently recognized as problematic as the cause of major disability in PD patients. PD nonmotor group developed NMS screening questionnaire (NMSQuest). Study aim to evaluate prevalence of NMS and correlation of NMS with demographic and historical factors in Thai PD patients. Methods: Data were collected from January 2008 to December 2008. 182 patients were enrolled in study, 17 patients were excluded. NMSQ-Thai were completed by 165 patients. Demographic data, duration of the disease, HY stages, levodopa dosage, numbers and types of antiparkinsonian drugs were recorded. Descriptive statistic analysis was employed to calculate prevalence of NMS, and regression analysis was used to calculate correlation. Results: The 165 patients were diagnosed to probably idiopathic PD: mean age 68.55±9.35 yr, male 56.4%, mean duration of disease 5.39±4.16 yr. Only 5 patients denied all of NMS. Mean total score of NMSQ-T was 9.54±5.51. Most prevalence of NMS was nocturia (64.2%). The most prevalence NMS domain were urinary domains (54.55%). Total NMSQ-T was significantly correlated with HY stages (p < 0.0001), levodopa doses (p < 0.0001), duration of disease (p = 0.004), and age and age at onset (p < 0.011).
S73
Conclusion: NMS in Thai PD patients were found in high prevalence; almost all patients had NMS. Screening all PD patients in outpatient setting should be done with NMSQ-T to recognize NMS and early treat appropriately. P1.173 Validation of a home environment test battery for status assessment in patients with advanced Parkinson’s disease J. Westin1,2 , M. Schiavella3 , M. Memedi2 , D. Nyholm4 , M. Dougherty2 , T. Groth1 , A. Antonini3 . 1 Medical Informatics, Medical Sciences, Uppsala University, Uppsala, 2 Computer Science, Dalarna University, Borl¨ ange, Sweden; 3 Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy; 4 Neurology, Neuroscience, Uppsala University, Uppsala, Sweden Introduction: A test battery, consisting of self-assessments (modified PDQ-8) and motor tests (tapping and spiral drawing), was developed for a hand computer with touch screen in a telemedicine setting. Assessments and tests are carried out four times per day during one week’s test periods and summarised in an ‘overall score’. Objective: To assess patient compliance, test-retest reliability, correlations to other assessment methods and ability to detect differences between patient groups at different disease stages. Methods: Data from 30 patients (26m, 4f; 64.7±6.8 y), both in stable (H&Y 1.8±0.4) and fluctuating (H&Y 2.2±0.4) conditions, in age and gender matched pairs were analysed. Patients used the test battery for one week, and were assessed with UPDRS and PDQ-39 at the end of the test period. This procedure was repeated one week later without allowing treatment changes. Reliability and validity were assessed by Spearman rank correlations. The Mann-Whitney statistical test was used to test if the overall score’s median was different between stable and fluctuating groups. Results: Median compliance was 93%. The test–retest reliability of the overall score was 0.71 in the stable group and 0.84 in the fluctuating group. The correlation (combined group) to UPDRS was −0.60 and to PDQ-39, −0.66. Median overall score differed 18% between the two groups (p < 0.0001). Conclusions: Compliance and reliability of the test battery were good overall, with better reliability in fluctuating patients. Correlations to UPDRS and PDQ-39 were adequate and difference in test score between stable and fluctuating patient groups was detected. P1.174 A successful computer method for assessing drawing impairment in Parkinson’s disease J. Westin1,2 , S. Ghiamati2 , M. Memedi2 , D. Nyholm3 , A. Johansson3 , M. Dougherty2 , T. Groth1 . 1 Medical Informatics, Medical Sciences, Uppsala University, Uppsala, 2 Computer Science, Dalarna University, Borl¨ ange, 3 Neurology, Neuroscience, Uppsala University, Uppsala, Sweden Introduction: A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing) was developed for a hand computer with touch screen in a telemedicine setting. Methods: This test battery was used on 8062 test occasions by 62 patients with advanced Parkinson’s disease (PD). On each test occasion, 3 spirals were drawn. A computer method, using wavelet transforms and principal component analysis processed the spirals to generate a ‘spiral score’. Two PD specialists (AJ, DN) rated drawing impairment in the 3 spiral drawings from 3 random test occasions per patient, using a modification of the Bain & Findley 10-category scale. Gold standard rating was defined as the mean of the two PD specialists’ assessments. Results: The 95% confidence interval for prediction errors was below ±2, which is similar to the differences of opinion between human raters. Spearman rank correlations were as follows: