Parkinson's disease: disability, review, and management.

Abstract

Data from a descriptive study of idiopathic Parkinson's disease were analysed aimed at getting a clearer picture of the impact of the disease on the community and the help available to patients and capers. Altogether 267 patients aged 40-92 were identified, and the median duration of disease in those in whom this could be assessed was 7-2 years.Of the 267 patients, 204 (76-4%) were living in the community, 51 alone. A total of 201 patients were taking levodopa, 29 out of 102 had retired early, and 60 out of 84 (71-4%) had given up driving. Most patients had symptoms at the time of study, and signs such as bradykinesia, rigidity, impaired speech, and abnormal gait were often moderate or severe. Of 214 patients whose disease was assessed using the scoring system of Hoehn and Yahr, 78 (36.4%) had grade 4 and 23 (10-7%) grade 5 disability. Despite this, however, 105 of 265 patients (39.6%)were not subject to regular medical review and only 57 of 227 patients (25.1%) had been seen by an occupational therapist, 16 (7 0%) by a physiotherapist, and 10 (4.4%) by a speech therapist.

Distribution-based criteria for change in health-related quality of life in Parkinson's disease

“…As observed in other studies, PDQ-39 scores were consistently more favorable for patients with Parkinson's disease attending clinics than respondents from a community survey, suggesting possible advantages in terms of HRQoL associated with better access to clinical services [15,19,20]. Despite such overall differences in HRQoL between samples, the pattern of SEM is strikingly similar for both across time periods and between samples, for all dimensions except Social Support, suggesting that these are indeed stable, sample-independent features of the PDQ-39.…”

Aspects of speech rate and regularity in Parkinson's disease

“…Affected patients may complain about a weak voice and about difficulties to get speech started. Dysarthria can emerge at any stage of the disease and worsen in the later stages [4,5], causing a progressive loss of communication and leading to social isolation. Already James Parkinson noted in his "essay on the shaking palsy" that PD patients often became "scarcely intelligible" in the course of the disease [6].…”

Vocal Acoustic Characteristics of Patients with Parkinson’s Disease

“…Thus, clinically predicting acoustic vocal symptoms based on the comprehensive disease severity scales is difficult, and a separate assessment method is therefore necessary. Mutch et al [32] reported that although the concomitant incidence of voice and speech disorders is high in PD, only an extremely low percentage of patients were undergoing rehabilitation for these disorders. One of the reasons for this is the clinical reliance on disease severity scales such as the modified Hoehn and Yahr staging and UPDRS in the assessment of PD patients, leading to voice and speech disorders being overlooked.…”