Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Parkinson Disease: HELP
Articles by Peter N. Schmidt
Based on 26 articles published since 2009
(Why 26 articles?)
||||

Between 2009 and 2019, P. Schmidt wrote the following 26 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review What Engineering Technology Could Do for Quality of Life in Parkinson's Disease: A Review of Current Needs and Opportunities. 2015

Stamford, Jonathan A / Schmidt, Peter N / Friedl, Karl E. · ·IEEE J Biomed Health Inform · Pubmed #26259205.

ABSTRACT: Parkinson's disease (PD) involves well-known motor symptoms such as tremor, rigidity, bradykinesia, and altered gait, but there are also nonlocomotory motor symptoms (e.g., changes in handwriting and speech) and even nonmotor symptoms (e.g., disrupted sleep, depression) that can be measured, monitored, and possibly better managed through activity-based monitoring technologies. This will enhance quality of life (QoL) in PD through improved self-monitoring and also provide information that could be shared with a healthcare provider to help better manage treatment. Until recently, nonmotor symptoms ("soft signs") had been generally overlooked in clinical management, yet these are of primary importance to patients and their QoL. Day-to-day variability of the condition, the high variability in symptoms between patients, and the isolated snapshots of a patient in periodic clinic visits make better monitoring essential to the proper management of PD. Continuously monitored patterns of activity, social interactions, and daily activities could provide a rich source of information on status changes, guiding self-correction and clinical management. The same tools can be useful in earlier detection of PD and will improve clinical studies. Remote medical communications in the form of telemedicine, sophisticated tracking of medication use, and assistive technologies that directly compensate for disease-related challenges are examples of other near-term technology solutions to PD problems. Ultimately, a sensor technology is not good if it is not used. The Parkinson's community is a sophisticated early adopter of useful technologies and a group for which engineers can provide near-term gratifying benefits.

2 Review Generic versus branded pharmacotherapy in Parkinson's disease: does it matter? A review. 2011

Go, Criscely L / Rosales, Raymond L / Schmidt, Peter / Lyons, Kelly E / Pahwa, Rajesh / Okun, Michael S. ·Department of Neurology, University of Florida, McKnight Brain Institute, Movement Disorders Center, 100 S. Newell Drive, Gainesville, FL 32611, USA. crouix_scs@yahoo.com ·Parkinsonism Relat Disord · Pubmed #21367644.

ABSTRACT: There is an ongoing debate about generic drug use for a multitude of conditions including epilepsy, psychosis, hypertension, post-organ transplantation, and several infectious diseases. Most of the concerns involve drugs with narrow therapeutic indices. There is a heightened attention to health care costs and macroeconomic policy as well as microeconomic business decisions that may impact the use of generic drugs. The issues surrounding generic substitution for chronic degenerative conditions such as in Parkinson's disease (PD) continue to be controversial subjects for physicians, pharmacists, patients, Medicare/governmental insurance programs, and for private insurance companies. The United States Food and Drug Administration (FDA) requires that generic drugs meet a standard for bioequivalence prior to market approval, but this may not translate to therapeutic efficacy or to overall patient tolerance. In this review we will address issues related to the use of generics versus branded drugs in PD, and the potential impact substitution of generics may have on patients and on clinicians. Having proper documentation may help in deciding the appropriate usage of these drugs in PD. Medicare, governmental run health care systems, and third party insurance companies should in a complex disease such as PD, allow physicians and patients the chance to properly document the superiority of brand versus generic approaches. Currently, in the U.S, and in many countries around the world, there is no obligation for payers to respect these types of patient specific bedside trials, and there has been no standardization of the process.

3 Review Management of the hospitalized patient with Parkinson's disease: current state of the field and need for guidelines. 2011

Aminoff, Michael J / Christine, Chad W / Friedman, Joseph H / Chou, Kelvin L / Lyons, Kelly E / Pahwa, Rajesh / Bloem, Bastian R / Parashos, Sotirios A / Price, Catherine C / Malaty, Irene A / Iansek, Robert / Bodis-Wollner, Ivan / Suchowersky, Oksana / Oertel, Wolfgang H / Zamudio, Jorge / Oberdorf, Joyce / Schmidt, Peter / Okun, Michael S / Anonymous4860681. ·National Parkinson Foundation Center of Excellence, University of California San Francisco, Neurology Department, CA, USA. ·Parkinsonism Relat Disord · Pubmed #21159538.

ABSTRACT: OBJECTIVE: To review the literature and to identify practice gaps in the management of the hospitalized Parkinson's disease (PD) patient. BACKGROUND: Patients with PD are admitted to hospitals at higher rates, and frequently have longer hospital stays than the general population. Little is known about outpatient interventions that might reduce the need for hospitalization and also reduce hospital-related complications. METHODS: A literature review was performed on PubMed about hospitalization and PD between 1970 and 2010. In addition, in press peer-reviewed papers or published abstracts known to the authors were included. Information was reviewed by a National Parkinson Foundation workgroup and a narrative review article was generated. RESULTS: Motor disturbances in PD are believed to be a causal factor in the higher rates of admissions and complications. However, other conditions are commonly recorded as the primary reason for hospitalization including motor complications, reduced mobility, lack of compliance, inappropriate use of neuroleptics, falls, fractures, pneumonia, and other important medical problems. There are many relevant issues related to hospitalization in PD. Medications, dosages and specific dosage schedules are critical. Staff training regarding medications and medication management may help to avoid complications, particularly those related to reduced mobility, and aspiration pneumonia. Treatment of infections and a return to early mobility is also critical to management. CONCLUSIONS: Educational programs, recommendations, and guidelines are needed to better train interdisciplinary teams in the management of the PD patient. These initiatives have the potential for both cost savings and improved outcomes from a preventative and a hospital management standpoint.

4 Article Telemedicine for Parkinson's Disease: Limited Engagement Between Local Clinicians and Remote Specialists. 2018

Elson, Molly J / Stevenson, E Anna / Feldman, Blake A / Lim, Jihoon / Beck, Christopher A / Beran, Denise B / Schmidt, Peter N / Biglan, Kevin M / Simone, Richard / Willis, Allison W / Dorsey, E Ray / Boyd, Cynthia M. ·1 Center for Health + Technology, University of Rochester Medical Center , Rochester, New York. · 2 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York. · 3 Parkinson's Foundation , Miami, Florida. · 4 Department of Neurology, University of Rochester Medical Center , Rochester, New York. · 5 Eli Lilly and Company , Indianapolis, Indiana. · 6 Simone Consulting , Sunnyvale, California. · 7 Departments of Neurology and of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania. · 8 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland. ·Telemed J E Health · Pubmed #29297769.

ABSTRACT: INTRODUCTION: The integration of remote specialists into local care teams has not been widely evaluated. METHODS: Therefore, we surveyed clinicians whose patients with Parkinson's disease had participated in a national randomized controlled trial of video visits to determine (1) whether clinicians received recommendations from remote specialists; (2) whether those recommendations were implemented; (3) what barriers to specialty care local clinicians perceived; and (4) whether they would recommend video visits. RESULTS: Of 183 clinicians surveyed, 89 (49%) responded. Less than half received the recommendations of remote specialists, but they implemented most of the recommendations they received and found them to be beneficial. CONCLUSION: The greatest perceived barrier among respondents was distance from patient to specialist, and 40% of local clinicians would recommend video visits. As telemedicine grows, improved communication between remote specialists and local clinicians is likely needed.

5 Article Sex disparities in access to caregiving in Parkinson disease. 2018

Dahodwala, Nabila / Shah, Krunal / He, Ying / Wu, Samuel S / Schmidt, Peter / Cubillos, Fernando / Willis, Allison W. ·From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia · Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY · Department of Biostatistics (S.S.W.), University of Florida, Gainesville · and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL. ·Neurology · Pubmed #29196580.

ABSTRACT: OBJECTIVE: To compare access to caregiving between men and women with Parkinson disease (PD). METHODS: This was a cross-sectional and longitudinal study among participants with PD enrolled in the National Parkinson Foundation Parkinson's Outcomes Project from 2009 to 2014 at 21 international sites. The primary outcome measures were presence of a caregiver at the baseline visit, caregiver burden as measured by the Multidimensional Caregiver Strain Index (MCSI) at baseline, and time to first paid caregiver. RESULTS: A total of 7,209 participants (63% men, 37% women) with PD were evaluated. Men had a mean age of 66.0 (SD 9.8) years, and women had a mean age of 66.9 (SD 9.7) years. More men than women had a caregiver (88.4% vs 79.4%, CONCLUSIONS: Informal caregiving resources are lower for women than men with PD, despite the finding that their caregivers report less strain than those of men. In addition, women are more likely to use formal, paid caregivers. Strategies to improve access to caregiving, particularly for women, are needed.

6 Article Patient and Physician Perceptions of Virtual Visits for Parkinson's Disease: A Qualitative Study. 2018

Mammen, Jennifer R / Elson, Molly J / Java, James J / Beck, Christopher A / Beran, Denise B / Biglan, Kevin M / Boyd, Cynthia M / Schmidt, Peter N / Simone, Richard / Willis, Allison W / Dorsey, E Ray. ·1 University of Rochester School of Nursing , Rochester, New York. · 2 The Center for Health and Technology, University of Rochester Medical Center , Rochester, New York. · 3 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York. · 4 National Parkinson Foundation , Miami, Florida. · 5 Department of Neurology, University of Rochester Medical Center , Rochester, New York. · 6 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland. · 7 Simone Consulting , Sunnyvale, California. · 8 Departments of Neurology and of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania. ·Telemed J E Health · Pubmed #28787250.

ABSTRACT: Background and Introduction: Delivering care through telemedicine directly into the patient's home is increasingly feasible, valuable, and beneficial. However, qualitative data on how patients' and physicians' perceive these virtual house calls are lacking. We conducted a qualitative analysis of perceptions of these visits for Parkinson's disease to (1) determine how patients and physicians perceive virtual visits and (2) identify components contributing to positive and negative perceptions. MATERIALS AND METHODS: Qualitative survey data were collected from patients and physicians during a 12-month randomized controlled trial of virtual house calls for Parkinson's disease. Data from 149 cases were analyzed using case-based qualitative content analysis and quantitative sentiment analysis techniques. RESULTS: Positive and negative perceptions of virtual visits were driven by three themes: (1) personal benefits of the virtual visit, (2) perceived quality of care, and (3) perceived quality of interpersonal engagement. In general, participants who identified greater personal benefit, high quality of care, and good interpersonal engagement perceived visits positively. Technical problems with the software were commonly mentioned. The sentiment analysis for patients was strongly favorable (+2.5) and moderately favorable for physicians (+0.8). Physician scores were lowest (-0.3) for the ability to perform a detailed motor examination remotely. DISCUSSION: Patients and providers generally view telemedicine favorably, but individual experiences are dependent on technical issues. CONCLUSIONS: Satisfaction with and effectiveness of remote care will likely increase as common technical problems are resolved.

7 Article National randomized controlled trial of virtual house calls for Parkinson disease. 2017

Beck, Christopher A / Beran, Denise B / Biglan, Kevin M / Boyd, Cynthia M / Dorsey, E Ray / Schmidt, Peter N / Simone, Richard / Willis, Allison W / Galifianakis, Nicholas B / Katz, Maya / Tanner, Caroline M / Dodenhoff, Kristen / Aldred, Jason / Carter, Julie / Fraser, Andrew / Jimenez-Shahed, Joohi / Hunter, Christine / Spindler, Meredith / Reichwein, Suzanne / Mari, Zoltan / Dunlop, Becky / Morgan, John C / McLane, Dedi / Hickey, Patrick / Gauger, Lisa / Richard, Irene Hegeman / Mejia, Nicte I / Bwala, Grace / Nance, Martha / Shih, Ludy C / Singer, Carlos / Vargas-Parra, Silvia / Zadikoff, Cindy / Okon, Natalia / Feigin, Andrew / Ayan, Jean / Vaughan, Christina / Pahwa, Rajesh / Dhall, Rohit / Hassan, Anhar / DeMello, Steven / Riggare, Sara S / Wicks, Paul / Achey, Meredith A / Elson, Molly J / Goldenthal, Steven / Keenan, H Tait / Korn, Ryan / Schwarz, Heidi / Sharma, Saloni / Stevenson, E Anna / Zhu, William / Anonymous471268. ·From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY · National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL · Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY · Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD · Simone Consulting (R.S.), Sunnyvale, CA · Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia · University of California San Francisco (N.B.G., M.K., C.M.T., K.D.) · Northwest Neurological, PLLC (J. Aldred), Spokane, WA · Oregon Health and Science University (J.C., A. Fraser), Portland · Baylor College of Medicine (J.J.-S., C.H.), Houston, TX · Augusta University (J.C.M., D.M.), GA · Duke Medical Center (P.H., L.G.), Durham, NC · Massachusetts General Hospital (N.I.M., G.B.), Boston · Struthers Parkinson's Center (M.N.), Minneapolis, MN · Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA · University of Miami (C.S., S.V.-P.), FL · Northwestern University (C.Z., N.O.), Evanston, IL · The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY · Medical University of South Carolina (C.V.), Charleston · University of Kansas Medical Center (R.P.), Kansas City · Parkinson's Institute (R.D.), Sunnyvale, CA · Mayo Clinic (A.H.), Rochester, MN · Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley · Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden · and PatientsLikeMe (P.W.), Derby, UK. ·Neurology · Pubmed #28814455.

ABSTRACT: OBJECTIVE: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable. METHODS: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings. RESULTS: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] -2.0 to 2.7 points; CONCLUSIONS: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience. CLINICALTRIALSGOV IDENTIFIER: NCT02038959. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.

8 Article Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence. 2017

Shahgholi, Leili / De Jesus, Sol / Wu, Samuel S / Pei, Qinglin / Hassan, Anhar / Armstrong, Melissa J / Martinez-Ramirez, Daniel / Schmidt, Peter / Okun, Michael S. ·Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America. · Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America. · Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America. · National Parkinson's Foundation, Miami, Florida, United States of America. ·PLoS One · Pubmed #28683150.

ABSTRACT: BACKGROUND: Patients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors. METHODS: We queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit. RESULTS: Of the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities. CONCLUSION: Hospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates.

9 Article Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data. 2017

Rafferty, Miriam R / Schmidt, Peter N / Luo, Sheng T / Li, Kan / Marras, Connie / Davis, Thomas L / Guttman, Mark / Cubillos, Fernando / Simuni, Tanya / Anonymous6440887. ·Center for Education in Health Sciences Northwestern University, Chicago, IL, USA. · National Parkinson Foundation, Miami, FL, USA. · Department of Biostatistics, University of Texas Health Science Center at Houston, Houston, TX, USA. · Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's disease, Toronto Western Hospital, University of Toronto, Toronto, Canada. · Thomas L. Davis, Division of Movement Disorders, Department of Neurology, Vanderbilt University, Nashville, TN, USA. · Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada. · Department of Neurology, Northwestern University, Chicago, IL, USA. ·J Parkinsons Dis · Pubmed #27858719.

ABSTRACT: BACKGROUND: Research-based exercise interventions improve health-related quality of life (HRQL) and mobility in people with Parkinson's disease (PD). OBJECTIVE: To examine whether exercise habits were associated with changes in HRQL and mobility over two years. METHODS: We identified a cohort of National Parkinson Foundation Quality Improvement Initiative (NPF-QII) participants with three visits. HRQL and mobility were measured with the Parkinson's Disease Questionnaire (PDQ-39) and Timed Up and Go (TUG). We compared self-reported regular exercisers (≥2.5 hours/week) with people who did not exercise 2.5 hours/week. Then we quantified changes in HRQL and mobility associated with 30-minute increases in exercise, across PD severity, using mixed effects regression models. RESULTS: Participants with three observational study visits (n = 3408) were younger, with milder PD, than participants with fewer visits. After 2 years, consistent exercisers and people who started to exercise regularly after their baseline visit had smaller declines in HRQL and mobility than non-exercisers (p < 0.05). Non-exercisers worsened by 1.37 points on the PDQ-39 and a 0.47 seconds on the TUG per year. Increasing exercise by 30 minutes/week was associated with slower declines in HRQL (-0.16 points) and mobility (-0.04 sec). The benefit of exercise on HRQL was greater in advanced PD (-0.41 points) than mild PD (-0.14 points; p < 0.02). CONCLUSIONS: Consistently exercising and starting regular exercise after baseline were associated with small but significant positive effects on HRQL and mobility changes over two years. The greater association of exercise with HRQL in advanced PD supports improving encouragement and facilitation of exercise in advanced PD.

10 Article Hospital care for mental health and substance abuse conditions in Parkinson's disease. 2016

Willis, Allison W / Thibault, Dylan P / Schmidt, Peter N / Dorsey, E Ray / Weintraub, Daniel. ·Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · National Parkinson's Foundation, Miami, Florida, USA. · Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA. · Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. ·Mov Disord · Pubmed #27943472.

ABSTRACT: OBJECTIVE: The objective of this study was to examine mental health conditions among hospitalized individuals with Parkinson's disease in the United States. METHODS: This was a serial cross-sectional study of hospitalizations of individuals aged ≥60 identified in the Nationwide Inpatient Sample dataset from 2000 to 2010. We identified all hospitalizations with a diagnosis of PD, alcohol abuse, anxiety, bipolar disorder, depression, impulse control disorders, mania, psychosis, substance abuse, and attempted suicide/suicidal ideation. National estimates of each mental health condition were compared between hospitalized individuals with and without PD. Hierarchical logistic regression models determined which inpatient mental health diagnoses were associated with PD, adjusting for demographic, payer, geographic, and hospital characteristics. RESULTS: We identified 3,918,703 mental health and substance abuse hospitalizations. Of these, 2.8% (n = 104, 437) involved a person also diagnosed with PD. The majority of mental health and substance abuse patients were white (86.9% of PD vs 83.3% of non-PD). Women were more common than men in both groups (male:female prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34), psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse control disorders (adjusted odds ratio 1.51, 1.31-1.75), and mania (adjusted odds ratio 1.43, 1.18-1.74) were more likely among PD patients, alcohol abuse was less likely (adjusted odds ratio 0.26, 0.25-0.27). We found no PD-associated difference in suicide-related care. CONCLUSIONS: PD patients have unique patterns of acute care for mental health and substance abuse. Research is needed to guide PD treatment in individuals with pre-existing psychiatric illnesses, determine cross provider reliability of psychiatric diagnoses in PD patients, and inform efforts to improve psychiatric outcomes. © 2016 International Parkinson and Movement Disorder Society.

11 Article Sex Differences in the Clinical Progression of Parkinson's Disease. 2016

Dahodwala, Nabila / Pei, Qinglin / Schmidt, Peter. · ·J Obstet Gynecol Neonatal Nurs · Pubmed #27444842.

ABSTRACT: OBJECTIVE: To describe characteristics of Parkinson's disease by sex and determine if differences in disease progression exist. DESIGN: Longitudinal, observational study. SETTING: Twenty-one National Parkinson Foundation Centers of Excellence. PARTICIPANTS: People (N = 4,679; 63% men and 37% women) with idiopathic Parkinson's disease. METHODS: Demographic and clinical data at enrollment and after 1 year were collected. We defined progression as a 1-year change in the following functional health outcome measures: (a) health-related quality of life (Parkinson's Disease Questionnaire-39), (b) Timed Up and Go test, (c) cognitive function, and (d) number of medications. We compared baseline characteristics between men and women. Then, linear regression models were built to assess the independent contribution of sex to progression. RESULTS: At baseline, women were significantly more likely to be older and have greater disease severity and more comorbidities than men despite similar duration of disease. This finding corresponded to worse function as assessed by the Parkinson's Disease Questionnaire-39 and Timed Up and Go test but not to number of medications and cognitive function. After 1 year, declines across all functional measures except delayed recall occurred. No significant changes in Parkinson's Disease Questionnaire-39, Timed Up and Go, number of medications, or verbal fluency between men and women occurred. Women had a more significant improvement in delayed recall than men. CONCLUSION: Numerous small baseline differences occurred between men and women with PD, although differences in markers of progression were few. Findings suggest that clinical manifestations and prognosis appear similar by sex under the same treatment conditions.

12 Article National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers. 2016

Dorsey, E Ray / Achey, Meredith A / Beck, Christopher A / Beran, Denise B / Biglan, Kevin M / Boyd, Cynthia M / Schmidt, Peter N / Simone, Richard / Willis, Allison W / Galifianakis, Nicholas B / Katz, Maya / Tanner, Caroline M / Dodenhoff, Kristen / Ziman, Nathan / Aldred, Jason / Carter, Julie / Jimenez-Shahed, Joohi / Hunter, Christine / Spindler, Meredith / Mari, Zoltan / Morgan, John C / McLane, Dedi / Hickey, Patrick / Gauger, Lisa / Richard, Irene Hegeman / Bull, Michael T / Mejia, Nicte I / Bwala, Grace / Nance, Martha / Shih, Ludy / Anderson, Lauren / Singer, Carlos / Zadikoff, Cindy / Okon, Natalia / Feigin, Andrew / Ayan, Jean / Vaughan, Christina / Pahwa, Rajesh / Cooper, Jessica / Webb, Sydney / Dhall, Rohit / Hassan, Anhar / Weis, Delana / DeMello, Steven / Riggare, Sara S / Wicks, Paul / Smith, Joseph / Keenan, H Tait / Korn, Ryan / Schwarz, Heidi / Sharma, Saloni / Stevenson, E Anna / Zhu, William. ·1 Department of Neurology, Rochester, New York. · 2 CHET, University of Rochester Medical Center , Rochester, New York. · 3 Duke University School of Medicine , Durham, North Carolina. · 4 Department of Biostatistics, University of Rochester , Rochester, New York. · 5 National Parkinson Foundation , Miami, Florida. · 6 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland. · 7 Simone Consulting , Sunnyvale, California. · 8 Department of Neurology, Philadelphia, Pennsylvania. · 9 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania. · 10 Department of Neurology, University of California San Francisco , San Francisco, California. · 11 Northwest Neurological, PLLC , Spokane, Washington. · 12 Parkinson Center and Movement Disorders Program, Oregon Health and Science University , Portland, Oregon. · 13 Department of Neurology, Baylor College of Medicine , Houston, Texas. · 14 Department of Neurology and Neurosurgery, Johns Hopkins University , Baltimore, Maryland. · 15 Department of Neurology, Georgia Regents University , Augusta, Georgia . · 16 Department of Neurology, Duke Medical Center , Durham, North Carolina. · 17 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts. · 18 Struthers Parkinson's Center , Golden Valley, Minnesota. · 19 Department of Neurology, Beth Israel Deaconess Medical Center , Boston, Massachusetts. · 20 Department of Neurology, University of Miami , Miami, Florida. · 21 Department of Neurology, Northwestern University , Evanston, Illinois. · 22 The Feinstein Institute for Medical Research, North Shore-LIJ Health System , Manhasset, New York. · 23 Department of Neurology, Medical University of South Carolina , Charleston, South Carolina. · 24 Department of Neurology, University of Kansas Medical Center , Kansas City, Kansas. · 25 Parkinson's Institute , Sunnyvale, California. · 26 Department of Neurology, Mayo Clinic , Rochester, Minnesota. · 27 Center for Information Technology Research in the Interest of Society, University of California , Berkeley, California. · 28 Health Informatics Centre, Karolinska Institute , Stockholm, Sweden . · 29 PatientsLikeMe, Cambridge, Massachusetts . · 30 West Health Institute , La Jolla, California. ·Telemed J E Health · Pubmed #26886406.

ABSTRACT: BACKGROUND: Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. MATERIALS AND METHODS: Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. RESULTS: During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. CONCLUSIONS: Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.

13 Article Capturing patients' experiences to change Parkinson's disease care delivery: a multicenter study. 2015

van der Eijk, Martijn / Faber, Marjan J / Post, Bart / Okun, Michael S / Schmidt, Peter / Munneke, Marten / Bloem, Bastiaan R. ·Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands. martijn.vandereijk@radboudumc.nl. · Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands. · Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. · McKnight Brain Institute, UF Health College of Medicine, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA. · National Parkinson Foundation, Miami, FL, USA. · Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. bas.bloem@radboudumc.nl. ·J Neurol · Pubmed #26292793.

ABSTRACT: Capturing patients' perspectives has become an essential part of a quality of care assessment. The patient centeredness questionnaire for PD (PCQ-PD) has been validated in The Netherlands as an instrument to measure patients' experiences. This study aims to assess the level of patient centeredness in North American Parkinson centers and to demonstrate the PCQ-PD's potential as a quality improvement instrument. 20 Parkinson Centers of Excellence participated in a multicenter study. Each center asked 50 consecutive patients to complete the questionnaire. Data analyses included calculating case mix-adjusted scores for overall patient centeredness (scoring range 0-3), six subscales (0-3), and quality improvement (0-9). Each center received a feedback report on their performance. The PCQ-PD was completed by 972 PD patients (median 50 per center, range 37-58). Significant differences between centers were found for all subscales, except for emotional support (p < 0.05). The information subscale (mean 1.62 SD 0.62) and collaboration subscale (mean 2.03 SD 0.58) received the lowest experience ratings. 14 centers (88 %) who returned the evaluation survey claimed that patient experience scores could help to improve the quality of care. Nine centers (56 %) utilized the feedback to change specific elements of their care delivery process. PD patients are under-informed about critical care issues and experience a lack of collaboration between healthcare professionals. Feedback on patients' experiences facilitated Parkinson centers to improve their delivery of care. These findings create a basis for collecting patients' experiences in a repetitive fashion, intertwined with existing quality of care registries.

14 Article Weight loss and impact on quality of life in Parkinson's disease. 2015

Akbar, Umer / He, Ying / Dai, Yunfeng / Hack, Nawaz / Malaty, Irene / McFarland, Nikolaus R / Hess, Christopher / Schmidt, Peter / Wu, Samuel / Okun, Michael S. ·Department of Neurology, Brown University, Providence, Rhode Island, United States of America. · Department of Mathematics, Clarkson University, Potsdam, New York, United States of America. · Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America. · Department of Neurology, University of Florida, Gainesville, Florida, United States of America. · National Parkinson Foundation, Miami, Florida, United States of America. ·PLoS One · Pubmed #25938478.

ABSTRACT: INTRODUCTION: Weight loss is common in Parkinson's Disease (PD) and sometimes may precede the diagnosis. Weight loss is associated with multiple factors but its impact on health-related quality of life (HRQL) in PD remains unknown. We sought to investigate the factors associated with weight change and to quantify its effect on HRQL. METHODS: The National Parkinson Foundation Quality Improvement Initiative (NPF-QII) data was used to analyze PD patients longitudinally between two visits, separated by 12 ± 6 months. Multiple linear regression analyses were used to assess the associations between baseline covariates and body weight change per month, and to evaluate whether, and to what degree, Parkinson's Disease Questionnaire (PDQ-39) scores were affected. RESULTS: A higher Hoehn & Yahr stage, higher number of comorbidities, older age, lower MOCA estimate, and higher rate of levodopa usage were observed in patients who lost weight. Multivariate regression analysis indicated that age and levodopa usage were significantly associated with weight loss. Furthermore, monthly body weight loss was significantly associated with HRQL decline in PD patients. Loss of 1 lb (0.45 kg) per month was associated with a decline in QOL: an increase of 0.5% in PDQ-39 Summary Index score (p=0.004), and 1.1% and 1.5% increases in the mobility and ADL dimensions, respectively. CONCLUSION: Weight loss in PD is common and seems to correlate with worsened HRQL. Awareness of factors associated with weight loss and its relation to HRQL may help practitioners improve patient management and expectations.

15 Article How Should Pushing Off or the Use of Assistive Devices Be Incorporated in the Timed Up and Go for Persons With Parkinson Disease? 2015

Stegemöller, Elizabeth L / Schmidt, Peter / Hass, Chris / Malaty, Irene / Okun, Michael S / Anonymous2030827. ·Department of Kinesiology, Iowa State University, Ames, IA; University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL. Electronic address: esteg@iastate.edu. · National Parkinson Foundation, Miami, FL. · University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL. ·Arch Phys Med Rehabil · Pubmed #25883039.

ABSTRACT: OBJECTIVES: To determine (1) the relationship between assisted timed Up and Go (TUG) performance and the Parkinson's Disease Questionnaire-39 (PDQ-39), and (2) whether adjusting the TUG score (adding time) improves the relationship between TUG performance and the PDQ-39 in persons with Parkinson disease (PD) who use assistive devices or push off, or both. DESIGN: Cross-sectional. SETTING: Twenty participating National Parkinson Foundation Centers of Excellence. PARTICIPANTS: Data were obtained from participants (N=6624) without exclusion at the 20 participating sites. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The relationship between TUG scores and PDQ-39 mobility scores was determined using the method of linear least squares. Adjusted scores were determined through minimizing the sum of the squared error. RESULTS: The correlation between assisted TUG scores and PDQ-39 mobility scores was slightly lower (R(2)=.384) compared with the correlation between nonassisted TUG scores and PDQ-39 mobility scores (R(2)=.409). Adjusting assisted TUG performance scores for push off and for use of an assistive device resulted in a modest increase in correlation (R(2)=.399). CONCLUSIONS: Applying adjustments to assisted TUG may provide clinically important information for evaluating balance, mobility, and falls, and for determining the most effective therapeutic strategies for persons with PD.

16 Article The Profile of Long-term Parkinson's Disease Survivors with 20 Years of Disease Duration and Beyond. 2015

Hassan, Anhar / Wu, Samuel S / Schmidt, Peter / Simuni, Tanya / Giladi, Nir / Miyasaki, Janis M / Bloem, Bastiaan R / Malaty, Irene A / Okun, Michael S. ·Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA. · Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Statistics, University of Florida, Gainesville, Florida, USA. · National Parkinson's Foundation, Miami, Florida, USA. · Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. · Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · The Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. · Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands. ·J Parkinsons Dis · Pubmed #25720446.

ABSTRACT: BACKGROUND: Parkinson's disease (PD) patients with 20 years or more survival (PD-20) are not well characterized. OBJECTIVE: To evaluate PD-20 patient characteristics and identify areas for improvement of their health care. METHODS: The international, multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII) study database was queried to identify PD-20 subjects. Demographic and clinical data were analyzed. RESULTS: We identified 187 PD-20 subjects (55% men) representing 4% (187/4,619) of all NPF-QII participants. Subjects were mean age 69.5 years; mean age at PD onset was 44.0 years. The majority (75% ) had 20-25 years of PD duration, the longest duration being 49 years. They were median Hoehn and Yahr stage 3, and 75% had motor fluctuations. Half (54% ) reported exercising. The majority (89% ) were living at home and required a caregiver (88% ). They were mildly cognitively impaired for age (Montreal Cognitive Assessment estimate 22.6±3.7), with most deficits in verbal fluency and delayed recall. Quality of life (Parkinson's Disease Quality of Life Questionnaire index 36±15% ) was mild to moderately impaired, with most impairment in mobility and activities of daily living. Caregiver strain measured by the Multidimensional Caregiver Strain Index (27±16% ), recorded highest subscores in social constraint. PD-20 subjects aged <70 years versus ≥70 only differed significantly by worse cognition (P <  0.0001). CONCLUSIONS: PD-20 subjects reflect an elite group of PD survivors with early-onset disease and relatively mild cognitive disability despite long disease duration. Interventions for caregivers, mobility, and activities of daily living are areas that could improve caregiver burden and patient quality of life.

17 Article Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial. 2014

Achey, Meredith A / Beck, Christopher A / Beran, Denise B / Boyd, Cynthia M / Schmidt, Peter N / Willis, Allison W / Riggare, Sara S / Simone, Richard B / Biglan, Kevin M / Dorsey, E Ray. ·Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL 7th Floor, Center Tower, Baltimore, MD 21224, USA. cyboyd@jhmi.edu. ·Trials · Pubmed #25431346.

ABSTRACT: BACKGROUND: Interest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden. METHODS/DESIGN: We are conducting a randomized comparative effectiveness study (Connect.Parkinson) comparing usual care in the community to usual care augmented by virtual house calls with a Parkinson disease specialist. Recruitment is completed centrally using online advertisements and emails and by contacting physicians, support groups, and allied health professionals. Efforts target areas with a high proportion of individuals not receiving care from neurologists. Approximately 200 individuals with Parkinson disease and their care partners will be enrolled at 20 centers throughout the United States and followed for one year. Participants receive educational materials, then are randomized in a 1:1 ratio to continue their usual care (control arm) or usual care and specialty care delivered virtually (intervention arm). Care partners are surveyed about their time and travel burden and their perceived caregiver burden. Participants are evaluated via electronic survey forms and videoconferencing with a blinded independent rater at baseline and at 12 months. All study activities are completed remotely.The primary outcomes are: (1) feasibility, as measured by the proportion of visits completed, and (2) quality of life, as measured by the 39-item Parkinson's Disease Questionnaire. Secondary outcomes include measures of clinical benefit, quality of care, time and travel burden, and caregiver burden. DISCUSSION: Connect.Parkinson will evaluate the feasibility and effectiveness of using technology to deliver care into the homes of individuals with Parkinson disease. The trial may serve as a model for increasing access and delivering patient-centered care at home for individuals with chronic conditions. TRIAL REGISTRATION: This trial was registered on clinicaltrials.gov on January 8, 2014 [NCT02038959].

18 Article Recognition and treatment of depressive symptoms in Parkinson's disease: the NPF dataset. 2014

Bega, Danny / Wu, Sam S / Pei, Qinglin / Schmidt, Peter N / Simuni, Tanya. ·Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · Department of Biostatistics, University of Florida, Gainesville, FL, USA. · Research and Professional Programs, National Parkinson Foundation, Miami, FL, USA. ·J Parkinsons Dis · Pubmed #25035310.

ABSTRACT: Depression is a major determinant of Health Related Quality of Life in PD, but there is limited data on physician recognition of depression and treatment efficacy. We used data obtained from the QII dataset of the National Parkinson's Foundation database to determine whether there was an association between depressive symptoms and utilization of antidepressants and/or mental health services (MHS) in a large cohort of PD patients. We found that prevalence of depressive symptoms remained high in the PD population despite improved physician recognition and treatment initiation.

19 Article Mobility, mood and site of care impact health related quality of life in Parkinson's disease. 2014

Nutt, J G / Siderowf, A D / Guttman, M / Schmidt, P N / Zamudio, J I / Wu, S S / Okun, M S / Simuni, T / Parashos, S A / Dahodwala, N A / Davis, T L / Giladi, N / Gurevich, T / Hauser, R A / Jankovic, J / Lyons, K E / Marsh, L / Miyasaki, J M / Morgan, J C / Santiago, A J / Tarsy, D / Mari, Z / Malaty, I A / Nelson, E C / Anonymous990774. ·Oregon Health & Science University, USA. Electronic address: nuttj@ohsu.edu. · University of Pennsylvania, USA. · University of Toronto, USA. · National Parkinson Foundation, USA. · University of Florida, USA. · National Parkinson Foundation, USA; University of Florida, USA. · Northwestern University, USA. · Struthers Parkinson Center, USA. · Vanderbilt University, USA. · Tel Aviv Sourasky Medical Center, USA. · University of South Florida, USA. · Baylor College of Medicine, USA. · University of Kansas, USA. · DeBakey Veterans Affairs Medical Center, USA. · Toronto Western University, USA. · Georgia Regents University, USA. · Muhammad Ali Parkinson Center, USA; Barrow Neurological Institute, USA. · Beth Israel Medical Center, USA. · Johns Hopkins Medical Center, USA. · Dartmouth-Hitchcock Medical Center, USA. ·Parkinsonism Relat Disord · Pubmed #24182524.

ABSTRACT: OBJECTIVE: Examine the correlates of Health Related Quality of Life (HRQL) in a large cohort of Parkinson's disease (PD) patients from National Parkinson Foundation (NPF) Centers of Excellence (COEs). BACKGROUND: Improving outcomes for PD will depend upon uncovering disease features impacting HRQL to identify targets for intervention and variables for risk-adjustment models. Differences in HRQL outcomes between COEs could uncover modifiable aspects of care delivery. METHODS: This cross-sectional study examined the relative contribution of demographic, social, clinical and treatment features potentially related to HRQL, as measured by the PDQ-39, in 4601 consecutive subjects from 18 COEs. Stepwise linear regression was utilized to identify correlates of HRQL. RESULTS: The variability in the PDQ-39 summary index score correlated with H&Y stage (R(2) = 22%), Timed up and Go (TUG) (17%), disease duration (11%), comorbidities (8%), cognitive status (8%), antidepressant use (6%) and center at which a patient received care (5%). Stepwise regression reordered the importance of the variables, with the H&Y first and TUG and the center becoming equal and the second most important variables determining the PDQ-39 total score. All independent variables together accounted for 44% of the variability in HRQL. CONCLUSIONS: We confirmed many but not all HRQL associations found in smaller studies. A novel observation was that the site of care was an important contributor to HRQL, suggesting that comparison of outcomes and processes among centers may identify best practices.

20 Article Deep brain stimulation may improve quality of life in people with Parkinson's disease without affecting caregiver burden. 2014

Oyama, Genko / Okun, Michael S / Schmidt, Peter / Tröster, Alexander I / Nutt, John / Go, Criscely L / Foote, Kelly D / Malaty, Irene A / Anonymous2480769. · ·Neuromodulation · Pubmed #24024760.

ABSTRACT: OBJECTIVE: This study aims to investigate the influence of deep brain stimulation (DBS) on caregiver burden and quality of life in Parkinson's disease. METHODS: A cross-sectional retrospective study utilizing the National Parkinson Foundation Quality Improvement Initiative clinical study was conducted. A group of 275 patients who had undergone DBS for Parkinson's disease were extracted from 2916 subjects who were included in this data base. The data were compared to an age, sex, and disease severity matched control group. A secondary analysis was then performed on two more control groups that were matched to account for presence or absence of motor fluctuations. The multidimensional caregiver strain index and Parkinson's disease quality-of-life questionnaire 39 summary index were compared. RESULTS: The multidimensional caregiver strain index did not differ between the DBS group (16.9 ± 11.8) and a matched non-DBS group (16.1 ± 17.6, p = 0.618). The quality-of-life index was, however, significantly better in the DBS group (28.9 ± 15.6) than in the non-DBS group (32.3 ± 17.6, p = 0.034). A secondary analysis revealed that the total caregiver strain score was lower in the no motor fluctuation control group than the other two groups (p < 0.05). Regression analysis revealed significant relationships between the quality-of-life index and caregiver strain index total scores (p < 0.001), between caregiver strain index total score and age at surgery (p = 0.027), and also between the interval since surgery (p = 0.048). CONCLUSIONS: Although there were several limitations to this study, DBS seems to improve quality of life without significantly increasing caregiver burden.

21 Article Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy--a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group. 2013

Schenck, C H / Montplaisir, J Y / Frauscher, B / Hogl, B / Gagnon, J-F / Postuma, R / Sonka, K / Jennum, P / Partinen, M / Arnulf, I / Cochen de Cock, V / Dauvilliers, Y / Luppi, P-H / Heidbreder, A / Mayer, G / Sixel-Döring, F / Trenkwalder, C / Unger, M / Young, P / Wing, Y K / Ferini-Strambi, L / Ferri, R / Plazzi, G / Zucconi, M / Inoue, Y / Iranzo, A / Santamaria, J / Bassetti, C / Möller, J C / Boeve, B F / Lai, Y Y / Pavlova, M / Saper, C / Schmidt, P / Siegel, J M / Singer, C / St Louis, E / Videnovic, A / Oertel, W. ·Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA. schen010@umn.edu ·Sleep Med · Pubmed #23886593.

ABSTRACT: OBJECTIVES: We aimed to provide a consensus statement by the International Rapid Eye Movement Sleep Behavior Disorder Study Group (IRBD-SG) on devising controlled active treatment studies in rapid eye movement sleep behavior disorder (RBD) and devising studies of neuroprotection against Parkinson disease (PD) and related neurodegeneration in RBD. METHODS: The consensus statement was generated during the fourth IRBD-SG symposium in Marburg, Germany in 2011. The IRBD-SG identified essential methodologic components for a randomized trial in RBD, including potential screening and diagnostic criteria, inclusion and exclusion criteria, primary and secondary outcomes for symptomatic therapy trials (particularly for melatonin and clonazepam), and potential primary and secondary outcomes for eventual trials with disease-modifying and neuroprotective agents. The latter trials are considered urgent, given the high conversion rate from idiopathic RBD (iRBD) to Parkinsonian disorders (i.e., PD, dementia with Lewy bodies [DLB], multiple system atrophy [MSA]). RESULTS: Six inclusion criteria were identified for symptomatic therapy and neuroprotective trials: (1) diagnosis of RBD needs to satisfy the International Classification of Sleep Disorders, second edition, (ICSD-2) criteria; (2) minimum frequency of RBD episodes should preferably be ⩾2 times weekly to allow for assessment of change; (3) if the PD-RBD target population is included, it should be in the early stages of PD defined as Hoehn and Yahr stages 1-3 in Off (untreated); (4) iRBD patients with soft neurologic dysfunction and with operational criteria established by the consensus of study investigators; (5) patients with mild cognitive impairment (MCI); and (6) optimally treated comorbid OSA. Twenty-four exclusion criteria were identified. The primary outcome measure for RBD treatment trials was determined to be the Clinical Global Impression (CGI) efficacy index, consisting of a four-point scale with a four-point side-effect scale. Assessment of video-polysomnographic (vPSG) changes holds promise but is costly and needs further elaboration. Secondary outcome measures include sleep diaries; sleepiness scales; PD sleep scale 2 (PDSS-2); serial motor examinations; cognitive indices; mood and anxiety indices; assessment of frequency of falls, gait impairment, and apathy; fatigue severity scale; and actigraphy and customized bed alarm systems. Consensus also was established for evaluating the clinical and vPSG aspects of RBD. End points for neuroprotective trials in RBD, taking lessons from research in PD, should be focused on the ultimate goal of determining the performance of disease-modifying agents. To date no compound with convincing evidence of disease-modifying or neuroprotective efficacy has been identified in PD. Nevertheless, iRBD patients are considered ideal candidates for neuroprotective studies. CONCLUSIONS: The IRBD-SG provides an important platform for developing multinational collaborative studies on RBD such as on environmental risk factors for iRBD, as recently reported in a peer-reviewed journal article, and on controlled active treatment studies for symptomatic and neuroprotective therapy that emerged during the 2011 consensus conference in Marburg, Germany, as described in our report.

22 Article High rates and the risk factors for emergency room visits and hospitalization in Parkinson's disease. 2013

Hassan, Anhar / Wu, Samuel S / Schmidt, Peter / Dai, Yunfeng / Simuni, Tanya / Giladi, Nir / Bloem, Bastiaan R / Malaty, Irene A / Okun, Michael S / Anonymous2840763. ·Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, FL, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA. Electronic address: hassan.anhar@mayo.edu. ·Parkinsonism Relat Disord · Pubmed #23835430.

ABSTRACT: BACKGROUND: Parkinson's disease (PD) patients are hospitalized more frequently than their peers as a result of falls, psychosis, infections and other medical complications. However, patient-specific risk factors for hospitalization are unclear. OBJECTIVE: To identify rates and risk factors for hospital encounters (Emergency Room [ER] visits or hospitalization) among people with PD. METHODS: 3415 PD participants (mean age 67 ± 10 years, disease duration 9 ± 6 years, H&Y 2 47%, H&Y 3 26%) enrolled in the prospective international multicenter NPF-QII Study. One-year follow-up data was available for 1030 patients. Rates and risk factors for hospital encounters were determined at baseline and after one year follow-up. RESULTS: Of 3415 PD participants at study entry, 1120 (33%) reported at least one hospital encounter. Associations were: longer timed up-and-go test (OR: 1.33), increased comorbidities (OR: 1.25), motor fluctuations (OR: 1.32), and deep brain stimulation (DBS) (OR: 2.49). Of these 1120 persons, 311 had follow-up data and 158 (51%) had a repeat encounter one year later, associated with higher H&Y stage, fluctuations, and lower health-related quality-of-life. Of 2295 participants without a hospital encounter at baseline, 719 had follow-up data and 178 (25%) had a first hospital encounter one year later. Risk factors were female gender, comorbidities, lower cognition, fluctuations, and DBS. CONCLUSIONS: One-third of people with PD had a hospital encounter each year, and one-half of those had a repeat encounter. These high rates correlated with disease severity, comorbidities and DBS. There is an urgent need to develop programs to reduce PD hospital encounters.

23 Article What are the issues facing Parkinson's disease patients at ten years of disease and beyond? Data from the NPF-QII study. 2012

Hassan, Anhar / Wu, Samuel S / Schmidt, Peter / Malaty, Irene A / Dai, Yun Feng / Miyasaki, Janis M / Okun, Michael S. ·Department of Neurology and Neurosurgery, University of Florida, 3450 Hull Rd., Gainesville, FL 32607, USA. ·Parkinsonism Relat Disord · Pubmed #22776044.

ABSTRACT: BACKGROUND: Parkinson's disease (PD) is the second most common neurodegenerative syndrome, classically characterized by levodopa-responsive motor features accompanied by non-motor mood, cognitive, sensory and autonomic issues. Over time, disease burden slowly accumulates resulting in diminished health status. Many clinicians consider the 10 year disease duration mark as significant, however the clinical status and health-related quality of life of patients reaching this milestone have not been well documented. METHODS: A cross-sectional study was performed on PD patients with ≥ 10 years disease duration (PD-10) (n = 1835) included in the multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII). Demographic, clinical and health-related quality of life data was analyzed. RESULTS: PD-10 patients (62.2% male) had a mean age of 67.8 years (± 9.5) with a mean age of PD onset of 52.7 years (± 10.6), and median disease duration 14.3 years (interquartile range 11.5-18.1). Many were minimally disabled with Hoehn and Yahr stage 1 or 2 (44.0%) or experiencing postural instability (HY stage 3, 40.3%). Most (88.2%) were able to stand unaided, but falls were common (54.8%). Almost all were living at home (93.1%) with a family member as a regular caregiver (83.8%). PD-10 patients had an average of 1.9 (± 1.4) co-morbidities, with arthritis (48.9%) and heart problems (31.7%) most commonly encountered. The majority (86.7%) took at least 2 medications: levodopa (95.7%), dopamine agonists (45.6%) and antidepressants (37.3%) were most commonly recorded. Most PD-10 patients were not currently utilizing physical, occupational or speech therapy, although two-thirds reported engaging in physical activity. Deep brain stimulation was documented in 22.4%. Overall the mean health-related quality of life and caregiver burden was impaired in all domains. CONCLUSIONS: Our data on PD patients with at least 10 years disease duration confirmed the younger age of onset of PD, but not the higher proportion of females or rest tremor, or the lower proportion of Caucasians seen in other aged PD cohorts. PD-10 patients had increased disease burden, increased caregiver burden, and impaired health-related quality of life. Although subjects mostly remained independently mobile, balance could be impaired with frequent falls identified. The prevalence of PD-10 patients living at home (93%) was very high in our sample which was drawn from specialty clinics, compared to prior studies reporting up to 27% PD patients institutionalized at 10 years duration. Thus policies to improve in-home support and caregiver support will be crucial in efforts aimed at maintaining patients in a home setting.

24 Article Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers. 2011

Chou, Kelvin L / Zamudio, Jorge / Schmidt, Peter / Price, Catherine C / Parashos, Sotirios A / Bloem, Bastiaan R / Lyons, Kelly E / Christine, Chadwick W / Pahwa, Rajesh / Bodis-Wollner, Ivan / Oertel, Wolfgang H / Suchowersky, Oksana / Aminoff, Michael J / Malaty, Irene A / Friedman, Joseph H / Okun, Michael S. ·Department of Neurology, University of Michigan, Ann Arbor, MI 48109-5316, USA. klchou@med.umich.edu ·Parkinsonism Relat Disord · Pubmed #21458353.

ABSTRACT: OBJECTIVES: To explore current practices and opinions regarding hospital management of Parkinson disease (PD) patients in specialized PD Centers. METHODS: Fifty-one out of 54 National Parkinson Foundation (NPF) Centers worldwide completed an online survey regarding hospitalization of PD patients. RESULTS: Many Centers were concerned about the quality of PD-specific care provided to their patients when hospitalized. Primary concerns were adherence to the outpatient medication schedule and poor understanding by hospital staff of medications that worsen PD. Few Centers had a policy with their primary hospital that notified them when their patients were admitted. Rather, notification of hospitalization came often from the patient or a family member. Several Centers (29%) reported not finding out about a hospitalization until a routine clinic visit after discharge. Quick access to outpatient PD care following discharge was a problem in many Centers. Elective surgery, fall/fracture, infection, and mental status changes, were identified as common reasons for hospitalization. CONCLUSIONS: There is a perceived need for PD specialists to be involved during hospitalization of their patients. Improvement in communication between hospitals and PD Centers is necessary so that hospital clinicians can take advantage of PD specialists' expertise. Education of hospital staff and clinicians regarding management of PD, complications of PD, and medications to avoid in PD is critical. Most importantly, outpatient access to PD specialists needs to be improved, which may prevent unnecessary hospitalizations in these patients.

25 Article Piloting the NPF data-driven quality improvement initiative. 2010

Okun, Michael S / Siderowf, Andrew / Nutt, John G / O'Conner, Gerald T / Bloem, Bastiaan R / Olmstead, Elaine M / Guttman, Mark / Simuni, Tanya / Cheng, Eric / Cohen, Elaine V / Parashos, Sotirios / Marsh, Laura / Malaty, Irene A / Giladi, Nir / Schmidt, Peter / Oberdorf, Joyce. ·National Parkinson Foundation Center of Excellence, University of Florida, Movement Disorders Center, McKnight Brain Institute, Department of Neurology, Gainesville, FL 32611, USA. okun@neurology.ufl.edu ·Parkinsonism Relat Disord · Pubmed #20609611.

ABSTRACT: OBJECTIVE: To pilot a data-driven quality care program in National Parkinson Foundation (NPF) Centers of Excellence. BACKGROUND: Evidence from comparative effectiveness research (CER) can be used to guide decisions regarding health care and to improve quality and efficiency of care. We propose to develop the infrastructure required to conduct CER across an extensive network of NPF Centers of Excellence. METHODS: We present the staged planning for a pilot study which will demonstrate the development and implementation of the infrastructure that will be needed for a large standardized patient-centered, clinical practice database for PD. This database will support CER and drive quality improvement studies. RESULTS: We describe the infrastructure for the ongoing pilot feasibility testing in a subset of six NPF Centers of Excellence, and we discuss the impact that the data (available in 2010) could have in guiding PD management. CONCLUSION: This preliminary experience will facilitate the longitudinal tracking of therapies and of outcomes in PD clinical practice. Further, we are hopeful that the information will provide insight into PD that will extend beyond the clinical trials population (the population included in most available PD databases). This prospective standardized real-world multi-center clinical practice database will aim to identify positive health outcomes associated with treatment approaches, and to identify variations in clinical outcomes that may suggest improvements in best clinical practice patterns.

Next