Neuropsychiatric problems in Parkinson's disease: Comparisons between self and caregiver report

McKinlay, Audrey; Grace, Randolph C.; Dalrymple‐Alford, John C.; Anderson, Timothy J.; Fink, John; Roger, Derek

doi:10.1080/13607860802343225

Cited by 78 publications

(90 citation statements)

References 22 publications

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“…A similar result (45% level of agreement between self and caregiver reports) was obtained in the study by McKinlay et al (2008). Those Authors ruled out the role of the mental status of caregivers and of depression and stress in caregivers.…”

Section: Discussionsupporting

confidence: 73%

“…On the basis of our results, we believe that the main cause of discrepancy between patient and informant ratings of apathy could be a reduced perception of apathetic symptoms by caregivers. As claimed by McKinlay et al (2008), the caregiver's report may be influenced by a sense of loyalty towards the patient and therefore result in a tendency to underestimate these symptoms. Moreover, caregivers probably tend to maintain a stable representation of the patient, in which the affective relationship and the family role prevent them from perceiving the emotional changes in the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the relationships between apathy and other dimensions of PD, but little attention has been devoted to the topic of possible discrepancies between CR and SE of apathy. McKinlay et al (2008) show a low agreement (45%) between CR and SE of apathy in patients with PD, SE scores being significantly higher than those from CR. Conversely, Schiehser et al (2013) report almost comparable frequency of current apathy when comparing patients' (58.8%) and caregivers' reports (54.9%), but a significant discrepancy when considering the reported frequency of pre-diagnosis patient apathy (31.4% according to patients and 15.7% according to caregivers).…”

Section: Introductionmentioning

confidence: 99%

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Apathy in Parkinson�s disease: differences between caregiver�s report and self-evaluation

Valentino¹,

Iavarone²,

Amboni³

et al. 2018

Functional Neurology

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SummaryApathy is a state of diminished goal-directed speech, motor activity and emotions. The prevalence of apathy in Parkinson's disease (PD) ranges from 16 to 62%. Several studies have investigated the relationships between apathy and other dimensions of PD, but little is known about possible discrepancies between self-evaluation (SE) and caregiver reporting (CR) of this symptom. The aim of this study is twofold: 1) to investigate the differences in apathy evaluations according to the point of view from which apathy is reported (SE vs CR); 2) to identify the possible relationships between each of the two evaluations (SE and CR) and cognitive and affective dimensions of PD. Forty-eight patients with PD were assessed using the Apathy Evaluation Scale (AES) in its SE and CR versions (AES-SE and AES-CR); cognitive, affective and behavioral symptoms were also assessed. AES-SE scores were significantly higher than AES-CR ones. Neither AES version correlated with depression, whereas both correlated with motor impairment, disease stage and behavioral symptoms. Mini-Mental State Examination and Frontal Assessment Battery scores showed significant negative correlations only with AES-SE scores. Our findings suggest that the point of view from which apathy is seen can lead to significant discrepancies, even when using the same tool. This should be taken into account in order to obtain correct assessment of this disabling and distressing symptom.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Apathy in Parkinson�s disease: differences between caregiver�s report and self-evaluation

Valentino¹,

Iavarone²,

Amboni³

et al. 2018

Functional Neurology

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“…Moreover, non-motor symptoms pose additional burden as disease progresses. Anxiety and concern about the future were more important in the MOG group corroborating previous findings that depressive symptoms are critical determinants of lower QoL 3,6 .…”

supporting

confidence: 79%

Quality of life in Parkinson’s disease

Limongi

2017

Arq. Neuro-Psiquiatr.

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Q uality of life (QoL) can be defined as a general sense of well being which is determined by multidimensional factors related to the individual, social interactions and the environment in the context of a given culture and value system. It also relates to the individuals own perception of their position in life in relation to their goals, expectations and concerns, and therefore should be truly judged by the individuals themselves 1,2 . Although health status has been considered to be a key factor in determining QoL, several authors have found low level of agreement between reports from individuals with chronic diseases and their caregivers regarding health-related QoL (HRQoL) estimations. This is particularly true with respect to Parkinson's disease (PD), which is a multifaceted and symptomatically complex neurodegenerative condition 3 . PD is the second most common neurodegenerative disorder and is characterized by the classical motor symptoms (resting tremor, bradykinesia, rigidity, postural instability) and nonmotor symptoms, some of which may precede clinical diagnosis by several years. Non-motor symptoms include autonomic dysfunction (constipation, urinary), cognitive decline (memory and attention), psychiatric disorders (depression, anxiety), sleep disturbances (vivid dreams, REM behavior disorder) and fatigue, among others. HRQoL in PD is determined by motor and non-motor symptoms and by the effects of treatment as well (efficacy and side effects) 4 . As the disease progresses, patients with PD are particularly prone to deterioration of HRQoL as a result of both increased motor disability and the burden of non-motor symptoms. Among motor symptoms, the main determinants are disease severity, motor complications of treatment, postural instability, and gait disturbances 5. Among non-motor symptoms, depression has been recognized as the main HRQoL determinant but other symptoms such as anxiety, cognitive impairment, fatigue, sleep disorders, pain and dysautonomia are also major contributors to low HRQoL in PD 6 . Several rating scales have been used to assess disease severity and HRQoL in PD. The most widely used include: Hoehn and Yahr staging (HY), Non-MotorSymptoms Scale (NMSS), MDS-UPDRS, Parkinson's Disease Questionnaire (PDQ-39) and its eight item-short version (PDQ-8).The NMSS include the following domains:cardiovascular, sleep/fatigue, mood, perceptual, attention/memory, gastrointestinal, urinary and sexual function. The MDS-UPDRS is composed of four subscales:Part I,non-motor experiences of daily living; Part II, motor experiences of daily living; Part III, motor examination; and Part IV, motor complications. Items are scored on a five-point scale, ranging from 0 (normal)to 4 (severe), and the total score is obtained for each section.The PDQ-8 has eight items scoring from 0 (never) to 4 (always) and provides judgments about the impact of PD on physical, mental and social domains. The summary index (SI) is expressed as the percentage of the sum of item scores on the maximum possible score (32points)...

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“…This means that some symptoms (mood and anxiety disorders) do not lead to as much stress in caregivers of geriatric PD patients as behavioural symptoms do. Although some other studies failed to identify stress in caregivers derived from neuropsychiatric symptoms (37), more extensive studies also found this association, specially for those patients with dementia (38). An interesting study examined the level of agreement between caregiver and PD patient reports of neuropsychiatric problems reporting a low level of agreement (39).…”

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

2015

neurol neurosci

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Objectives: In Parkinson´s disease, researchers are becoming increasingly aware of the need to include the assessment of behavioural and psychological symptoms as important outcome measures in clinical trials. Besides, clinicians are starting to recognise the need to identify and manage these symptoms in addition to the motor ones. Our objective is to explore the presence of neuropsychiatric symptoms in geriatric patients with Parkinson and the associated distress in their caregivers.Methods: 100 patients with PD ageing 75 years old or more (50 PD without dementia and 50 PD Dementia (PDD) were assessed using the 10-item Neuropsychiatric Inventory-questionnaire (NPI-Q), and the NPI Caregiver Distress Scale (NPI-D). Results:The mean total NPI score was 12.9. At least one neuropsychiatric symptom was present in more than 80% of participants. Within PDD patients about 89% suffered at least one NPI symptom, 70% suffered at least 2 symptoms and one of those symptoms had an intensity scoring 4 of higher in more than 50%. Numbers in PD patients without dementia were significantly lower, though more than 50% of patients had at least 2 symptoms. The most frequent symptom was depression, followed by apathy, anxiety, depression and hallucinations. Antiparkinsonian agents can exacerbate psychotic symptoms. Nearly 60% of caregivers reported suffering a moderate to severe level of stress due to these symptoms. Symptoms causing more stress were agitation/aggression followed by hallucinations and irritability/lability. Conclusions:Neuropsychiatric symptoms are frequent in geriatric patients with PD -specially in patients with PDD-and lead to moderate to severe caregiver distress.

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Neuropsychiatric problems in Parkinson's disease: Comparisons between self and caregiver report

Abstract: Given this low level of agreement between self and other report, these two methods of assessment cannot be considered interchangeable.

Cited by 78 publications

References 22 publications

Apathy in Parkinson�s disease: differences between caregiver�s report and self-evaluation

Apathy in Parkinson�s disease: differences between caregiver�s report and self-evaluation

Quality of life in Parkinson’s disease

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

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