Epidemiology and burden

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Epidemiology and burden

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Epidemiology and burden
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Prevalence of Parkinson’s disease
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Parkinson’s disease is a widespread public health issue
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References

Worldwide, PD is the second-most common neurodegenerative disorder, after Alzheimer’s disease. [Tanner & Goldman, 1996] It is difficult to estimate the total number of people in the world who are affected by PD, as the methods used to collect this data differ between countries.[Hirtz et al., 2007] The European Parkinson Disease Association has proposed a current estimate of approximately 6 million people with PD, worldwide.[EPDA, 2017]

The prevalence of PD is likely to increase substantially over the next few decades.[Dorsey et al., 2007] It has been predicted that, by 2030, the global prevalence of PD is expected to more than double, to between 8.7 million and 9.3 million individuals.[Dorsey et al., 2007]

The fact that PD is a prevalent disease that is costly to manage, means that it has become an important public health issue.[Dorsey et al., 2007]

Tanner CM, Goldman SM. Epidemiology of Parkinson’s disease. Neurol Clin 1996; 14 (2): 317–335.

Hirtz D, Thurman DJ, Gwinn-Hardy K, et al. How common are the “common” neurologic disorders? Neurology 2007; 68 (5): 326–337.

European Parkinson’s Disease Association website. http://www.epda.eu.com. Accessed February 2017.

Dorsey ER, Constantinescu R, Thompson JP, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 2007; 68 (5): 384–386.

Other references used on slide:
Andlin-Sobocki P, Jönsson B, Wittchen HU, Olesen J. Cost of disorders of the brain in Europe. Eur J Neurol 2005; 12 (Suppl 1): 1–27.

Bertram L, Tanzi RE. The genetic epidemiology of neurodegenerative disease. J Clin Invest 2005; 115 (6): 1449–1457.

de Lau LML, Breteler MMB. Epidemiology of Parkinson’s disease. Lancet Neurol 2006; 5: 525–535.

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388 (10053): 1545–1602.

Tysnes OB, Storstein A. Epidemiology of Parkinson’s disease. J Neural Transm 2017; 124: 901–905.

von Campenhausen S, Bornschein B, Wick R, et al. Prevalence and incidence of Parkinson’s disease in Europe. Eur Neuropsychopharmacol 2005; 15: 473–490.

Zou YM, Tan JP, Li N, et al. The prevalence of Parkinson’s disease continues to rise after 80 years of age: a cross-sectional study of Chinese veterans. Eur Rev Med Pharmacol Sci 2014; 18 (24): 3908–3915.

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Prevalence of Parkinson’s disease in the USA
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References

The Michael J. Fox Foundation for Parkinson’s Research (a leading US charity) estimates that approximately 1 million individuals in the USA, are living with PD.[Michael J. Fox Foundation for Parkinson’s Research, 2017]

A recent analysis of US Medicarea data showed an approximate 50% greater prevalence of PD in men than in women. [Wright Willis et al., 2010] In general, urban populations in the USA tend to have a higher prevalence of PD than rural populations, and data suggest that there may be a concentration of the disease in the Midwest and Northeast regions, compared to other regions.[Wright Willis et al., 2010] There is also evidence that PD is more prevalent in people of White ethnicity than in people of African-American or Asian origin.[Wright Willis et al., 2010]

Incidence data are scarce, due to the low frequency of PD and the difficulties in establishing a clear diagnosis.[Van Den Eeden et al., 2003] The incidence rate in the USA is approximately 13.4 per 100,000 people, with only 4% of new cases arising in individuals <50 years old.[Van Den Eeden et al., 2003] Furthermore, the incidence rate for men is estimated to be higher than that for women, with the male:female ratio generally increasing with age.[Van Den Eeden et al., 2003]

aMedicare is the US federal health insurance system for people aged ≥65 years, as well as for certain younger people with disabilities, and people with end-stage renal disease.

 

Michael J. Fox Foundation for Parkinson’s Research website. http://www.michaeljfox.org. Accessed February 2017.

Wright Willis A, Evanoff BA, Lian M, et al. Geographic and ethnic variation in Parkinson disease: a population-based study of US Medicare beneficiaries. Neuroepidemiology 2010; 34 (3): 143–151.

Van Den Eeden SK, Tanner CM, Bernstein AL, et al. Incidence of Parkinson’s disease: variation by age, gender and race/ethnicity. Am J Epidemiol 2003; 157 (11): 1015–1022.

Other reference used on slide:
Oxford Concise Medical Dictionary. Fourth Edition. © Oxford University Press, 2007.

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Prevalence of Parkinson’s disease in Europe
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References

A meta-analysis estimated the prevalence of PD, using data collected by various studies of Western European countries between 1961 and 2000.[von Campenhausen et al., 2015] Using the best quality evidence from these studies, the meta-analysis estimated a prevalence of approximately 108 to 257 per 100,000 people, when considering the entire age range.[von Campenhausen et al., 2015]

Estimated prevalence rates were much higher when the data from older populations were analysed.[von Campenhausen et al., 2015] In individuals aged >60 years, the prevalence of PD was between 1,280 and 1,500 per 100,000 people.[von Campenhausen et al., 2015]

The study design and methodology used to estimate the prevalence of PD can affect a study’s results.[von Campenhausen et al., 2015] For example, a study recruiting only residents from nursing homes (which are more likely to care for disabled residents) estimated a prevalence of 12,500 per 100,000 people.[von Campenhausen et al., 2015; Evers & Obladen, 1994] Different approaches to identifying cases of PD can also introduce variation between studies, particularly when non-expert clinicians are used for the initial screening of patients.[von Campenhausen et al., 2015]

von Campenhausen S, Bornschein B, Wick R, et al. Prevalence and incidence of Parkinson’s disease in Europe. Eur Neuropsychopharmacol 2015; 15 (4): 473–490.

Evers S, Obladen M. Epidemiology and therapy of Parkinson disease in inpatient nursing homes. Z Gerontol 1994; 27 (4): 270–275.

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Prevalence of Parkinson’s disease in China
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References

A multi-centre study in China reported that the prevalence of PD was 2.4% in Chinese veterans aged ≥60 years.[Zou et al., 2014] This is comparable to the burden of PD in other developed, and developing countries.[Zou et al., 2014] This observation is in contrast to an earlier study, which suggested that PD may be slightly less prevalent in Asia than in Western countries.[Muangpaisan et al., 2009] However, this may have been due to methodological differences between the studies, as well as reduced survival rates, and limited access to healthcare in Asia compared to Western countries, as opposed to reflecting any real difference in the prevalence of PD.[Muangpaisan et al., 2009]

The Chinese study also showed that the prevalence of PD significantly increases with age, a trend also observed in other studies conducted in China, Europe, and the USA.[Zou et al., 2014]

Zou YM, Tan JP, Li N, et al. The prevalence of Parkinson’s disease continues to rise after 80 years of age: a cross-sectional study of Chinese veterans. Eur Rev Med Pharmacol Sci 2014; 18 (24): 3908–3915.

Muangpaisan W, Hori H, Brayne C. Systematic review of the prevalence and incidence of Parkinson’s disease in Asia. J Epidemiol 2009; 19 (6): 281–293.

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Prevalence of Parkinson’s disease by age
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References

The prevalence of PD increases with advancing age.[Zou et al., 2014] In a meta-analysis of worldwide prevalence data, PD was found to be approximately 40 times more prevalent in populations aged ≥80 years than in those aged 40–49 years.[Pringsheim et al., 2014] Generally, PD is very rare in individuals <40 years old.[Van Den Eeden et al., 2003]

Normally, the slow and progressive nature of PD means that patients tend to live with the disease for many years.[Kulisevsky et al., 2013] Therefore, the prevalence of PD tends to be highest in the most elderly (i.e., ≥80 years of age).[Zou et al., 2014; Pringsheim et al., 2014]

In one analysis, for Asia as a whole – including South Asia, South-East Asia and the Middle East – the overall prevalence of PD was lower, in those aged 70–79 years, than in Europe, North America, and Australia (646 per 100,000 versus 1,602 per 100,000, respectively).[Pringsheim et al., 2014]

Zou YM, Tan JP, Li N, et al. The prevalence of Parkinson’s disease continues to rise after 80 years of age: a cross-sectional study of Chinese veterans. Eur Rev Med Pharmacol Sci 2014; 18 (24): 3908–3915.

Pringsheim T, Jette N, Frolkis A, Steeves TDL. The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2014; 29 (13): 1583–1590.

Van Den Eeden SK, Tanner CM, Bernstein AL, et al. Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003; 157 (11): 1015–1022.

Kulisevsky J, Luquin MR, Arbelo JM, et al. Advanced Parkinson’s disease: clinical characteristics and treatment (part I). Neurologia 2013; 28 (8): 503–521.

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Prevalence of Parkinson’s disease by sex
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References

Although there is strong evidence to indicate that a person is more likely to develop PD as they become older, the effect of gender is less clear-cut.[Pringsheim et al., 2014]

A recent analysis of worldwide data found generally higher levels of PD in male populations.[Pringsheim et al., 2014] However, the differences were only statistically significant in one age group (50–59 years), and not in any of the other age groups, geographical regions, or overall.[Pringsheim et al., 2014] Consequently, the observed differences may be a result of variations in the study designs.[Burn, 2007]

Other evidence is more supportive of a greater risk of PD in men. A review of incidence data (i.e., showing the rates at which new cases of PD occur) found that men were more likely than women to develop PD.[Wright Willis et al., 2010] In another study, the difference between sexes was relatively small between the ages of 50 to 59 years, but became much larger, and more apparent, above 80 years.[Van Den Eeden et al., 2003]

Pringsheim T, Jette N, Frolkis A, Steeves TDL. The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2014; 29 (13): 1583–1590.

Burn DJ. Sex and Parkinson’s disease: a world of difference? J Neurol Neurosurg Psychiatry 2007; 78 (8): 787.

Wright Willis A, Evanoff BA, Lian M, et al. Geographic and ethnic variation in Parkinson disease: a population-based study of US Medicare beneficiaries. Neuroepidemiology 2010; 34 (3): 143–151.

Van Den Eeden SK, Tanner CM, Bernstein AL, et al. Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003; 157 (11): 1015–1022.

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Predictions of the increase in Parkinson’s disease prevalence
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References

Life expectancy continues to grow in the world’s rapidly developing transitional countries, including in China.[United Nations, 2015] As survival rates improve, due to better economic conditions and healthcare, the prevalence of age-related chronic diseases (including PD), is expected to rise accordingly.[Yach et al., 2004]

A study that combined prevalence data for some of the world’s largest populations predicted that there will be approximately 8.7 million people living with PD by 2030, with nearly 5 million residing in China.[Dorsey et al., 2005] This increase marks a likely geographical shift in the main burden of PD, from Western countries to those in the East.[Dorsey et al., 2005]

United Nations. World population prospects: the 2015 revision. https://esa.un.org/unpd/wpp/. Accessed March 2015.

Yach D, Hawkes C, Gould CL, Hoffman KJ. The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 2004; 291 (21): 2616–2622.

Dorsey ER, Constantinescu R, Thompson JP, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 2007; 68 (5): 384–386.

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Risk factors associated with Parkinson’s disease
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References

Approximately 90% of PD cases are ‘sporadic’ or ‘idiopathic’, meaning that the cause is unknown.[Thomas & Beal, 2007] However, the disease is known to cluster in families, with <10% of patients reporting a family history of PD.[Thomas & Beal, 2007] Only five single genes have been discovered thus far that, by themselves, produce the clinical symptoms of PD.[Thomas & Beal, 2007; Nalls et al., 2014] Other PD-related genes tend to have little effect by themselves, but may contribute to a substantial increase in overall risk when found together.[Nalls et al., 2014] At present, genetic screening can predict an individual case no better than knowing a person’s age, sex, smoking history, or parental history.[Darweesh et al., 2016]

Smokers tend to have a markedly lower risk of PD than non-smokers, and evidence exists to suggest that nicotine may be the component responsible for this protective effect.[Ascherio & Schwarzschild, 2016] While this finding has led to nicotine being tested in clinical trials as a potential therapy for PD,[Ascherio & Schwarzschild, 2016] smoking itself should never be considered as a useful preventive measure, since it remains the world’s leading cause of avoidable premature death.[Samet, 2013]

Urate is a biochemical end product of the metabolism of purines, that is normally present in the blood.[Ascherio & Schwarzschild, 2016] There is convincing evidence to indicate that naturally higher levels of urate may protect against PD.[Ascherio & Schwarzschild, 2016] While substances known to raise plasma urate levels (e.g., dietary fructose) have been associated with a reduced PD risk, those known to lower urate levels (e.g., dairy intake) have been associated with an increased risk of PD.[Ascherio & Schwarzschild, 2016]

Thomas B, Beal MF. Parkinson’s disease. Hum Mol Genet 2007; 16 (R2): R183–R194.

Nalls MA, Pankratz N, Lill CM, et al. Large-scale meta-analysis of genome-wide association data identifies six new risk loci for Parkinson’s disease. Nat Genet 2014; 46 (9): 989–993.

Darweesh SKL, Verlinden VJA, Adams HHH, et al. Genetic risk of Parkinson’s disease in the general population. Parkinsonism Relat Disord 2016; 29: 54–59.

Ascherio A, Schwarzschild MA. The epidemiology of Parkinson’s disease: risk factors and prevention. Lancet Neurol 2016; 15 (12): 1257–1272.

Samet JM. Tobacco smoking: the leading cause of preventable disease worldwide. Thorac Surg Clin 2013; 23 (2): 103–112.

Other reference used on slide:
Lee A, Gilbert RM. Epidemiology of Parkinson disease. Neurol Clin 2016; 34 (4): 955–965.

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The burden of Parkinson’s disease
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The economic burden of Parkinson’s disease
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References

The economic impact of PD to a healthcare system, and to society, can be considerable.[Huse et al., 2005]

A study in the USA estimated the costs associated with PD over approximately 4 years, using data from more than 20,000 patients who were diagnosed with the disease.[Huse et al., 2005] The slide shows that the cost of inpatient/outpatient care, including prescription drugs (known as the ‘direct’ costs), accounted for 32% of the economic burden of PD.[Huse et al., 2005] The major contributor to the economic burden of PD, was the combined costs associated with lost productivity,a and those associated with caring for someone with PD (known as the ‘indirect’ costs).[Huse et al., 2005] These indirect costs reflect the nature of PD as a progressively disabling disease, rather than an acute illness.[Huse et al., 2005]

By extrapolating the total costs per patient to reflect the number of people in the USA with PD, the study revealed that caring for patients with PD costs approximately $23 billion USD per year.[Huse et al., 2005] This economic burden is predicted to increase even further over the coming decades, as the proportion of older adults in the population increases.[Huse et al., 2005]

 

aLost productivity can be a result of absenteeism or reduced productivity in the workplace, and applies not only to the patient, but also to their caregiver who may have had to give up work to care for the person with PD.

Huse DM, Schulman K, Orsini L, et al. Burden of illness in Parkinson’s disease. Mov Disord 2005; 20 (11): 1449–1454.

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The indirect costs of Parkinson’s disease
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References

Indirect costs were introduced on the previous slide and, in the study discussed, they were the main contributors to the overall economic burden of PD.[Huse et al., 2005]

The slide presents a general definition for the indirect costs of human disease and illness, further broken down into specific components.[Boccuzzi, 2003; Johnson et al., 2013]

It is important to estimate indirect costs to provide an insight into the additional economic impact of a disease – beyond the more obvious costs associated with healthcare utilisation. In PD, indirect costs make up a considerable proportion of the overall cost, and can be greater than the direct costs.[Huse et al., 2005; Johnson et al., 2013; Martinez-Martín et al., 2015]

Given the progressively debilitating nature of PD, individuals may experience a gradual reduction in productivity in the workplace as their symptoms worsen, until they can no longer maintain a position of employment. In this instance, there is a cost to the individual through lost wages/income, but also to the employer resulting from reduced productivity/absenteeism.[Boccuzzi, 2003] Mortality is also associated with indirect costs in terms of lost future earnings by those who die prematurely, and the cost to the employer to replace staff.[Boccuzzi, 2003] Another aspect to consider is that, as a long-term illness, PD may have wider ‘indirect’ economic implications, such as work disability benefits, cost of caregiving, and loss of taxes to society.[Boccuzzi, 2003]

 

Huse DM, Schulman K, Orsini L, et al. Burden of illness in Parkinson’s disease. Mov Disord 2005; 20 (11): 1449–1454.

Boccuzzi SJ. Indirect health care costs: an overview. In: Weintraub WS (ed). Contemporary Cardiology: Cardiovascular Health Care Economics. New York: Humana Press, 2003.

Johnson SJ, Kaltenboeck A, Diener MD, et al. Cost of Parkinson’s disease in a privately insured population. Pharmacoeconomics 2013; 31 (9): 779–806.

Martinez-Martín P, Rodriguez-Blazquez C, Paz S, et al. Parkinson symptoms and health related quality of life as predictors of costs: a longitudinal observational study with linear mixed model analysis. PLoS One 2015; 10 (12): e0145310.

Other reference used on slide:
Boland DF, Stacy M. The economic and quality of life burden associated with Parkinson’s disease: a focus on symptoms. Am J Manag Care 2012; 18 (7 Suppl): S168–S175.

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The costs of hospitalisation
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References

Direct costs include those associated with the use of healthcare resources, such as inpatient/outpatient care, and drugs.[Huse et al., 2005; Findley, 2007]

A UK survey evaluated the costs associated with the use of healthcare services in 432 patients diagnosed with PD.[Findley, 2007; Findley et al., 2003] Overall, the direct costs of PD care increased with advancing age, driven mainly by the worsening severity of symptoms.[Findley, 2007; Findley et al., 2003] As PD progresses, patients may develop co-morbidities, requiring the use of additional healthcare resources.[Findley, 2007] Many patients eventually enter residential/nursing home care, particularly those patients with advanced disease.[Findley, 2007; Findley et al., 2003]

Inpatient care is a major component of the direct costs of PD.[Huse et al., 2005] These are mostly emergency admissions, leading to longer hospital stays when compared with age-matched individuals without PD.[Low et al., 2015]

Huse DM, Schulman K, Orsini L, et al. Burden of illness in Parkinson’s disease. Mov Disord 2005; 20 (11): 1449–1454.

Findley LJ. The economic impact of Parkinson’s disease. Parkinsonism Relat Disord 2007; 13: S8–S12.

Findley L, Aujla M, Bain PG, et al. Direct economic impact of Parkinson’s disease: a research survey in the United Kingdom. Mov Disord 2003; 18 (10): 1139–1145.

Low V, Ben-Shlomo Y, Coward E, et al. Measuring the burden and mortality of hospitalisation in Parkinson’s disease: a cross-sectional analysis of the English Hospital Episodes Statistics database 2009–2013. Parkinsonism Relat Disord 2015; 21 (5): 449–454.

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The increasing economic burden of Parkinson’s disease
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References

The previous slide showed that the direct costs of PD care increased over decades with advancing age, mainly due to worsening disease severity.[Findley, 2007; Findley et al., 2003]

Evidence from a study conducted within the Spanish healthcare system suggests that the increase in costs (direct and indirect) can be considerable, even in the earlier stages of PD.[Martinez-Martín et al., 2015] An association of increased cost with disease progression was reported; motor symptoms, cognitive impairment, and pain had a direct impact on cost.[Martinez-Martín et al., 2015]

Findley LJ. The economic impact of Parkinson’s disease. Parkinsonism Relat Disord 2007; 13: S8–S12.

Findley L, Aujla M, Bain PG, et al. Direct economic impact of Parkinson’s disease: a research survey in the United Kingdom. Mov Disord 2003; 18 (10): 1139–1145.

Martinez-Martín P, Rodriguez-Blazquez C, Paz S, et al. Parkinson symptoms and health related quality of life as predictors of costs: a longitudinal observational study with linear mixed model analysis. PLoS One 2015; 10 (12): e0145310.

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The predicted burden of Parkinson’s disease in the future
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References

To help healthcare systems plan for the future, it is important to forecast the requirement for resources.

The number of people diagnosed with PD in the USA is predicted to more than double in the 30-year period from 2010 to 2040, as are the associated costs.[Kowal et al., 2013] These increases reflect the growing numbers of elderly citizens in the US population,[Huse et al., 2005] and also highlight the substantial increase in resources needed to manage the care of patients with PD in the coming years.[Huse et al., 2005]

 

Kowal SL, Dall TM, Chakrabarti R, et al. The current and projected economic burden of Parkinson’s disease in the United States. Mov Disord 2013; 28 (3): 311–318.

Huse DM, Schulman K, Orsini L, et al. Burden of illness in Parkinson’s disease. Mov Disord 2005; 20 (11): 1449–1454.

Other reference used on slide:
Medicare website. https://www.medicare.gov/glossary/m.html. Accessed March 2017.

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The burden of Parkinson’s disease on the patient
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References

The burden of PD is not confined to its economic impact; the disease also has a considerable detrimental effect on a patient’s quality of life (i.e., their general well-being).

In patients with PD, quality of life can be affected from both a physical and mental health perspective by the classic motor symptoms of the disease, and by certain non-motor symptoms such as depression.[Boland & Stacy, 2012; Gage et al., 2003]

There is evidence to suggest that quality of life is reduced with worsening disease severity, as patients gradually lose their independence and the ability to perform daily tasks.[Kleiner-Fisman et al., 2010]

Boland DF, Stacy M. The economic and quality of life burden associated with Parkinson’s disease: a focus on symptoms. Am J Manag Care 2012; 18 (7 Suppl): S168–S175.

Gage H, Hendricks A, Zhang S, Kazis L. The relative health related quality of life of veterans with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2003; 74 (2): 163–169.

Kleiner-Fisman G, Stern MB, Fisman DN. Health-related quality of life in Parkinson disease: correlation between Health Utilities Index III and Unified Parkinson’s Disease Rating Scale (UPDRS) in U.S. male veterans. Health Qual Life Outcomes 2010; 8: 91.

Other references used on slide:
Chapuis S, Ouchchane L, Metz O, et al. Impact of the motor complications of Parkinson’s disease on the quality of life. Mov Disord 2005; 20 (2): 224–230.

Jankovic J, Aguilar LG. Current approaches to the treatment of Parkinson’s disease. Neuropsychiatr Dis Treat 2008; 4 (4): 743–757.

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The burden of non-motor symptoms on the patient
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References

Non-motor symptoms of PD can be present for many years before the characteristic motor symptoms appear.[Duncan et al., 2014] These non-motor symptoms may affect an individual’s quality of life well before a formal diagnosis has been made.[Duncan et al., 2014] A study conducted in patients who were newly diagnosed with PD, found that their quality of life was reduced as the number of non-motor symptoms that were present increased.[Duncan et al., 2014]

Screening for non-motor symptoms at the time of diagnosis may prompt appropriate intervention, and reduce their negative impact on the patient’s quality of life.[Duncan et al., 2014]

Duncan GW, Khoo TK, Yarnall AJ, et al. Health-related quality of life in early Parkinson’s disease: the impact of nonmotor symptoms. Mov Disord 2014; 29 (2): 195–202.

Other reference used on slide:
Aarsland D, Marsh L, Schrag A. Neuropsychiatric symptoms in Parkinson’s disease. Mov Disord 2009; 24 (15): 2175–2186.

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The burden of Parkinson’s disease on caregivers
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References

The progressive disabling effect of PD on an individual means that they will inevitably require some form of care, usually provided by a relative or friend.[Peters, 2014; Martinez-Martin et al., 2012] The caregiving role is all-encompassing as carers provide wide-ranging physical, emotional, and social support to people living with PD.[Peters, 2014; Martinez-Martin et al., 2012] As the disease progresses and patients gradually lose their ability to perform everyday tasks, such care becomes increasingly burdensome, and impacts greatly on a caregiver’s quality of life.[Peters, 2014; Martinez-Martin et al., 2012]

Caregivers may suffer from stress and other health problems, experience financial difficulties, and feel that they are neglecting other areas of responsibility.[Peters, 2014; Martinez-Martin et al., 2012] In some cases, caregivers may feel that they can no longer look after a person with PD, and so the patient is placed in residential care.[Martinez-Martin et al, 2012]

It is important to provide support and education to caregivers, so that they can maximise their own quality of life, and that of the patient for whom they care.[Peters, 2014; Martinez-Martin et al., 2012]

Peters M. Quality of life and burden in caregivers for patients with PD. Focus on PD 2014; 24 (1): 44–48.

Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ. Quality of life and burden in caregivers for patients with Parkinson’s disease: concepts, assessment and related factors. Expert Rev Pharmacoecon Outcomes Res 2012; 12 (2): 221–230.

Other reference used on slide:
Aarsland D, Brønnick K, Ehrt U, et al. Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated caregiver stress. J Neurol Neurosurg Psychiatry 2007; 78 (1): 36–42.

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The burden of the cognitive symptoms of Parkinson’s disease on caregivers
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References

There are many aspects of PD that can intensify the caregiver burden (e.g., impaired movement, sleep disorders, pain, cognitive impairment, etc.).[Martinez-Martin et al., 2012]

Attentional deficits may have a negative impact on the ability of people with PD to perform basic everyday tasks, including physical and social activities.[Lawson et al., 2017] Consequently, caregivers may take on these responsibilities, further increasing the burden of care and reducing quality of life (which may already be considerably affected).[Lawson et al., 2017]

Researchers are hoping to determine the effects of caring for a person with PD on the cognitive function of the caregiver, as well as the potential impact that any such impairment might have on both parties.[Lawson et al., 2017]

Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ. Quality of life and burden in caregivers for patients with Parkinson’s disease: concepts, assessment and related factors. Expert Rev Pharmacoecon Outcomes Res 2012; 12 (2): 221–230.

Lawson RA, Yarnall AJ, Johnston F, et al. Cognitive impairment in Parkinson’s disease: impact on quality of life of carers. Int J Geriatr Psychiatry 2017; 32 (12): 1362–1370.

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Parkinson’s disease is a disease with growing prevalence and negative effects on quality of life
References

Boland DF, Stacy M. The economic and quality of life burden associated with Parkinson’s disease: a focus on symptoms. Am J Manag Care 2012; 18 (7 Suppl): S168–S175.

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