Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson’s Disease Patients

Abstract

Parkinson’s disease (PD) is a chronic progressive movement disorder with severe reduction in patients’ health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients’ HR-QoL. However, the relationship of these symptoms to caregiver burden is relatively unclear. Influence of the Montreal Cognitive Assessment scale (MoCA) as a cognitive screening tool and Movement Disorders Society Unified Parkinson’s disease Rating Scale MDS-UPDRS symptoms in relation to patients’ HR-QoL and caregivers` burden was analyzed. PD patients (n = 124) completed MDS-UPDRS, MoCA, and the PD questionnaire 8 (PDQ-8) as a measure of quality of life. Caregivers (n = 78) were assessed by the PD caregiver burden inventory (PDCB). PDQ-8 and PDCB scores were regressed on MDS-UPDRS subscales and MoCA subscores. PDQ-8 correlated with attention (R2 0.1282; p<0.001) and executive (R2 0.0882; p 0.001) MoCA subscores and all parts of the MDS-UPDRS. PDCB correlated most strongly with MDS-UPDRS part III motor symptoms (R2 0.2070; p<0.001) and the MoCA attention subscore (R2 0.1815; p<0.001). While all facets of PD symptoms assessed by the MDS-UPDRS relate to PD patients’ quality of life, motor symptoms are the most relevant factor for the prediction of caregiver burden. In addition, patients’ attentional symptoms seem to affect not only them, but also their caregivers. These findings show the potential of a detailed analysis of MDS-UPDRS and MoCA performance in PD patients.

Caregiver Burden in Late-Stage Parkinsonism and Its Associations

“…One limitation of this study is that caregiver burden was assessed using the ZBI, which although being an established validated caregiver burden measure, is not a PD-specific questionnaire such as the Parkinson's Disease Caregiver Burden questionnaire (PDCB) 69,70 or an instrument relevant for patients with advanced parkinsonism such as the Parkinsonism Carers Quality of Life (PQoL Carer) 71 . It cannot be excluded that some parkinsonism-specific issues were missed through the use of the ZBI, which may account for the discrepancy with other studies 10,48 . Another limitation of the study is that only age and gender of the patient and not age and gender of the caregiver were included in the analysis.…”

Brain Morphological Alterations Are Detected in Early‐Stage Parkinson's Disease with MRI Morphometry

“…3 The brain regions showing cortical thinning reported in present study and in previous imaging studies 3,4,6 have been linked to certain dysfunctions in PD patients, eg, the orbitofrontal (bilateral medial orbitofrontal) thinning was associated with olfactory impairments thus considered as marker for early-phase PD; 30 the temporal thinning (left superior temporal and right banks sts) was associated with decline in sensory function in the PD patients; 31 and thinning of the insula (left insula) was associated with executive dysfunction in PD patients. 32,33 Of note, we only found a significant decrease of the left medial orbitofrontal cortex in early PD patients. Reasons for the lesser amount of significant cortical thinning found in our study may be attributed to the fact that most of our PD patients were in a rather early disease stage with less brain changes, besides the possible potentiation-like plasticity effect of levodopa medication.…”

Alexithymia Is Associated with Reduced Quality of Life and Increased Caregiver Burden in Parkinson’s Disease

“…Our sample included 119 PwP and related primary caregivers. Data from this patient and caregiver cohort unrelated to the current research question have already been reported elsewhere [ 27 , 28 ].…”