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Parkinson Disease: HELP
Articles by Lisa M. Shulman
Based on 33 articles published since 2010
(Why 33 articles?)
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Between 2010 and 2020, L. Shulman wrote the following 33 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Clinical subtypes and genetic heterogeneity: of lumping and splitting in Parkinson disease. 2016

von Coelln, Rainer / Shulman, Lisa M. ·Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. ·Curr Opin Neurol · Pubmed #27749396.

ABSTRACT: PURPOSE OF REVIEW: Recent studies on clinical, genetic and pathological heterogeneity of Parkinson disease have renewed the old debate whether we should think of Parkinson disease as one disease with variations, or as a group of independent diseases that happen to present with similar phenotypes. Here, we provide an overview of where the debate is coming from, and how recent findings in clinical subtyping, genetics and clinico-pathological correlation have shaped this controversy over the last few years. RECENT FINDINGS: New and innovative clinical diagnostic criteria for Parkinson disease have been proposed and await validation. Studies using functional imaging or wearable biosensors, as well as biomarker studies, provide new support for the validity of the traditional clinical subtypes of Parkinson disease (tremor-dominant versus akinetic-rigid or postural instability/gait difficulty). A recent cluster analysis (as unbiased data-driven approach to subtyping) included a wide spectrum of nonmotor variables, and showed correlation of the proposed subtypes with disease progression in a longitudinal analysis. New genetic factors contributing to Parkinson disease susceptibility continue to be identified, including rare mutations causing monogenetic disease, common variants with small effect size and risk factors (like mutations in the gene for glucocerebrosidase) that fall in between the two other categories. Recent studies show some limited correlation between genetic factors and clinical heterogeneity. Despite some variations in patterns of pathology, Lewy bodies are still the hallmark of Parkinson disease, including the vast majority of genetic subgroups. SUMMARY: Evidence of clinical, genetic and pathological heterogeneity of Parkinson disease continues to emerge, but clearly defined subtypes that hold up in more than one of these domains remain elusive. For research to identify such subtypes, splitting is likely the way forward; until then, for clinical practice, lumping remains the more pragmatic approach.

2 Review Disability Rating Scales in Parkinson's Disease: Critique and Recommendations. 2016

Shulman, Lisa M / Armstrong, Melissa / Ellis, Terry / Gruber-Baldini, Ann / Horak, Fay / Nieuwboer, Alice / Parashos, Sotirios / Post, Bart / Rogers, Mark / Siderowf, Andrew / Goetz, Christopher G / Schrag, Anette / Stebbins, Glenn T / Martinez-Martin, Pablo. ·Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. lshulman@som.umaryland.edu. · Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Department of Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Department of Neurology, Oregon Health and Science University and Portland VA Medical System, Portland, Oregon, USA. · Department of Rehabilitation Science, KU Leuven-University of Leuven, Heverlee, Belgium. · Struthers Parkinson's Center, Golden Valley, Minnesota, USA. · Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Physical Therapy & Rehabilitation, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Avid Radiopharmaceuticals, Philadelphia, PA, USA. · Department of Neurology, Rush University Medical Center, Chicago, USA. · UCL Institute of Neurology, University College London, UK. · National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. ·Mov Disord · Pubmed #27193358.

ABSTRACT: INTRODUCTION: PD is associated with impairments that progress over time to disability. A large number of disability scales exist with little information on the best choice in PD. METHODS: Following methodology adopted by the International Parkinson and Movement Disorder Society Task Force, a review of disability scales used in PD was completed. Based on prespecified criteria, the review categorized scales into: "Recommended"; "Recommended with Further Validation in PD Required" when well-validated scales have not been specifically tested for clinimetric properties in PD; "Suggested"; and "Listed." RESULTS: Twenty-nine disability instruments were identified with nine scales fulfilling criteria for "Recommended" and 7 "Recommended with Further Validation in PD Required." Eight scales are "Suggested" and five scales are "Listed" for use in PD. The nine Recommended scales (Functional Status Questionnaire, Lawton-Brody Activities of Daily Living, Nottingham Activities of Daily Living, Schwab and England Activities of Daily Living, Self-Assessment PD Disability, Short Parkinson's Evaluation Scale/Scales for Outcomes in PD, Unified PD Rating Scale-II: Activities of Daily Living, Movement Disorders Society UPDRS Motor Experiences of Daily Living, PROMIS CONCLUSION: Many disability measures are available and recommended for application in PD. The Task Force does not recommend the development of a new scale. Selection of the most appropriate instrument for a particular objective requires consideration of the characteristics of each scale and the goals of the assessment. © 2016 International Parkinson and Movement Disorder Society.

3 Review Self-triggered assistive stimulus training improves step initiation in persons with Parkinson's disease. 2013

Creath, Robert A / Prettyman, Michelle / Shulman, Lisa / Hilliard, Marjorie / Martinez, Katherine / MacKinnon, Colum D / Mille, Marie-Laure / Simuni, Tanya / Zhang, Jane / Rogers, Mark W. ·Department of Physical Therapy & Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ·J Neuroeng Rehabil · Pubmed #23363975.

ABSTRACT: BACKGROUND: Prior studies demonstrated that hesitation-prone persons with Parkinson's disease (PDs) acutely improve step initiation using a novel self-triggered stimulus that enhances lateral weight shift prior to step onset. PDs showed reduced anticipatory postural adjustment (APA) durations, earlier step onsets, and faster 1st step speed immediately following stimulus exposure. OBJECTIVE: This study investigated the effects of long-term stimulus exposure. METHODS: Two groups of hesitation-prone subjects with Parkinson's disease (PD) participated in a 6-week step-initiation training program involving one of two stimulus conditions: 1) Drop. The stance-side support surface was lowered quickly (1.5 cm); 2) Vibration. A short vibration (100 ms) was applied beneath the stance-side support surface. Stimuli were self-triggered by a 5% reduction in vertical force under the stance foot during the APA. Testing was at baseline, immediately post-training, and 6 weeks post-training. Measurements included timing and magnitude of ground reaction forces, and step speed and length. RESULTS: Both groups improved their APA force modulation after training. Contrary to previous results, neither group showed reduced APA durations or earlier step onset times. The vibration group showed 55% increase in step speed and a 39% increase in step length which were retained 6 weeks post-training. The drop group showed no stepping-performance improvements. CONCLUSIONS: The acute sensitivity to the quickness-enhancing effects of stimulus exposure demonstrated in previous studies was supplanted by improved force modulation following prolonged stimulus exposure. The results suggest a potential approach to reduce the severity of start hesitation in PDs, but further study is needed to understand the relationship between short- and long-term effects of stimulus exposure.

4 Review Understanding disability in Parkinson's disease. 2010

Shulman, Lisa M. ·Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland 21210, USA. lshulman@som.umaryland.edu ·Mov Disord · Pubmed #20187231.

ABSTRACT: Even with optimal therapy, it is inevitable that the symptoms of Parkinson's disease (PD) progress and gradually result in disability in the performance of daily activities. Delay and prevention of disability is among the highest priorities in the clinical management of PD. Understanding the association between the diverse symptoms of PD and the emerging disability is fundamental to minimizing functional limitations. This article differentiates disability from impairment and quality of life and explores the relationship between the specific impairments of PD and resulting disability. Identifying appropriate tools for outcomes measurement and impediments to accurate assessment of disability are also reviewed.

5 Article Genetic modifiers of risk and age at onset in GBA associated Parkinson's disease and Lewy body dementia. 2020

Blauwendraat, Cornelis / Reed, Xylena / Krohn, Lynne / Heilbron, Karl / Bandres-Ciga, Sara / Tan, Manuela / Gibbs, J Raphael / Hernandez, Dena G / Kumaran, Ravindran / Langston, Rebekah / Bonet-Ponce, Luis / Alcalay, Roy N / Hassin-Baer, Sharon / Greenbaum, Lior / Iwaki, Hirotaka / Leonard, Hampton L / Grenn, Francis P / Ruskey, Jennifer A / Sabir, Marya / Ahmed, Sarah / Makarious, Mary B / Pihlstrøm, Lasse / Toft, Mathias / van Hilten, Jacobus J / Marinus, Johan / Schulte, Claudia / Brockmann, Kathrin / Sharma, Manu / Siitonen, Ari / Majamaa, Kari / Eerola-Rautio, Johanna / Tienari, Pentti J / Anonymous2731070 / Pantelyat, Alexander / Hillis, Argye E / Dawson, Ted M / Rosenthal, Liana S / Albert, Marilyn S / Resnick, Susan M / Ferrucci, Luigi / Morris, Christopher M / Pletnikova, Olga / Troncoso, Juan / Grosset, Donald / Lesage, Suzanne / Corvol, Jean-Christophe / Brice, Alexis / Noyce, Alastair J / Masliah, Eliezer / Wood, Nick / Hardy, John / Shulman, Lisa M / Jankovic, Joseph / Shulman, Joshua M / Heutink, Peter / Gasser, Thomas / Cannon, Paul / Scholz, Sonja W / Morris, Huw / Cookson, Mark R / Nalls, Mike A / Gan-Or, Ziv / Singleton, Andrew B. ·Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA. · Department of Human Genetics, McGill University, Montreal, Quebec, Canada. · Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada. · 23andMe, Inc., Mountain View, CA, USA. · Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK. · Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. · Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA. · Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel. · Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel. · The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel. · The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel. · Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA. · Department of Neurology, Oslo University Hospital, Oslo, Norway. · Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. · Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. · German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany. · Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Germany. · Institute of Clinical Medicine, Department of Neurology, University of Oulu, Oulu, Finland. · Department of Neurology and Medical Research Center, Oulu University Hospital, Oulu, Finland. · Department of Neurology, Helsinki University Hospital, and Molecular Neurology, Research Programs Unit, Biomedicum, University of Helsinki, Helsinki, Finland. · Neuroregeneration and Stem Cell Program, Institute for Cell Engineering, Johns Hopkins University Medical Center, Baltimore, MD, USA. · Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA. · Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA. · Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA. · Newcastle Brain Tissue Resource, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. · Department of Pathology (Neuropathology, Johns Hopkins University Medical Center, Baltimore, MD, USA. · Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK. · Inserm U1127, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France. · Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. · Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, London, UK. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Neurology, Baylor College of Medicine, Houston, USA. · Departments of Molecular and Human Genetics and Neuroscience, Baylor College of Medicine, Houston, USA. · Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, USA. · Data Tecnica International, Glen Echo, MD, USA. · Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada. ·Brain · Pubmed #31755958.

ABSTRACT: Parkinson's disease is a genetically complex disorder. Multiple genes have been shown to contribute to the risk of Parkinson's disease, and currently 90 independent risk variants have been identified by genome-wide association studies. Thus far, a number of genes (including SNCA, LRRK2, and GBA) have been shown to contain variability across a spectrum of frequency and effect, from rare, highly penetrant variants to common risk alleles with small effect sizes. Variants in GBA, encoding the enzyme glucocerebrosidase, are associated with Lewy body diseases such as Parkinson's disease and Lewy body dementia. These variants, which reduce or abolish enzymatic activity, confer a spectrum of disease risk, from 1.4- to >10-fold. An outstanding question in the field is what other genetic factors that influence GBA-associated risk for disease, and whether these overlap with known Parkinson's disease risk variants. Using multiple, large case-control datasets, totalling 217 165 individuals (22 757 Parkinson's disease cases, 13 431 Parkinson's disease proxy cases, 622 Lewy body dementia cases and 180 355 controls), we identified 1691 Parkinson's disease cases, 81 Lewy body dementia cases, 711 proxy cases and 7624 controls with a GBA variant (p.E326K, p.T369M or p.N370S). We performed a genome-wide association study and analysed the most recent Parkinson's disease-associated genetic risk score to detect genetic influences on GBA risk and age at onset. We attempted to replicate our findings in two independent datasets, including the personal genetics company 23andMe, Inc. and whole-genome sequencing data. Our analysis showed that the overall Parkinson's disease genetic risk score modifies risk for disease and decreases age at onset in carriers of GBA variants. Notably, this effect was consistent across all tested GBA risk variants. Dissecting this signal demonstrated that variants in close proximity to SNCA and CTSB (encoding cathepsin B) are the most significant contributors. Risk variants in the CTSB locus were identified to decrease mRNA expression of CTSB. Additional analyses suggest a possible genetic interaction between GBA and CTSB and GBA p.N370S induced pluripotent cell-derived neurons were shown to have decreased cathepsin B expression compared to controls. These data provide a genetic basis for modification of GBA-associated Parkinson's disease risk and age at onset, although the total contribution of common genetics variants is not large. We further demonstrate that common variability at genes implicated in lysosomal function exerts the largest effect on GBA associated risk for disease. Further, these results have implications for selection of GBA carriers for therapeutic interventions.

6 Article Sex differences in Parkinson's disease presentation and progression. 2019

Abraham, Danielle S / Gruber-Baldini, Ann L / Magder, Laurence S / McArdle, Patrick F / Tom, Sarah E / Barr, Erik / Schrader, Katrina / Shulman, Lisa M. ·Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: danielle.abraham@pennmedicine.upenn.edu. · Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. ·Parkinsonism Relat Disord · Pubmed #31677455.

ABSTRACT: INTRODUCTION: Females have a reduced risk of Parkinson's disease (PD). However, it is unclear if sex is a prognostic factor. We aimed to examine differences in presentation, physician- and patient-reported PD outcomes, and progression by sex in a large clinical cohort. METHODS: This study was a secondary analysis of a cohort of PD patients seen at a tertiary care center. Sociodemographic and clinical characteristics, treatment, care timing, and outcomes were examined by sex. Sex differences in progression of impairment, disability, and health-related quality of life (HRQoL) were tested with five-year piecewise linear mixed-effects models. A mediation analysis assessed drivers of sex differences. RESULTS: The study included 914 males and 549 females. Females had significantly less social support, more psychological distress, and worse self-reported (but not physician-reported) disability and HRQoL at initial PD care visits, compared to males. Addressing anxiety symptoms may attenuate this difference. PD progression sex differences were minimal. CONCLUSION: PD progression does not differ by sex, yet patient-reported measures of disease severity are worse in females than males. To attenuate this sex difference in disease experience, psychological distress screening and management, particularly targeting females, should be implemented as part of PD clinical care.

7 Article Parkinson's disease age at onset genome-wide association study: Defining heritability, genetic loci, and α-synuclein mechanisms. 2019

Blauwendraat, Cornelis / Heilbron, Karl / Vallerga, Costanza L / Bandres-Ciga, Sara / von Coelln, Rainer / Pihlstrøm, Lasse / Simón-Sánchez, Javier / Schulte, Claudia / Sharma, Manu / Krohn, Lynne / Siitonen, Ari / Iwaki, Hirotaka / Leonard, Hampton / Noyce, Alastair J / Tan, Manuela / Gibbs, J Raphael / Hernandez, Dena G / Scholz, Sonja W / Jankovic, Joseph / Shulman, Lisa M / Lesage, Suzanne / Corvol, Jean-Christophe / Brice, Alexis / van Hilten, Jacobus J / Marinus, Johan / Anonymous1671060 / Eerola-Rautio, Johanna / Tienari, Pentti / Majamaa, Kari / Toft, Mathias / Grosset, Donald G / Gasser, Thomas / Heutink, Peter / Shulman, Joshua M / Wood, Nicolas / Hardy, John / Morris, Huw R / Hinds, David A / Gratten, Jacob / Visscher, Peter M / Gan-Or, Ziv / Nalls, Mike A / Singleton, Andrew B / Anonymous1681060. ·Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA. · Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA. · 23andMe, Inc., Mountain View, California, USA. · Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia. · Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Department of Neurology, Oslo University Hospital, Oslo, Norway. · Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. · German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany. · Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Germany. · Department of Human Genetics, McGill University, Montreal, Quebec, Canada. · Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada. · Institute of Clinical Medicine, Department of Neurology, University of Oulu, Oulu, Finland. · Department of Neurology and Medical Research Center, Oulu University Hospital, Oulu, Finland. · The Michael J Fox Foundation for Parkinson's Research, New York, New York, USA. · Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom. · Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom. · Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA. · Inserm U1127, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France. · Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Neurology, Helsinki University Hospital, and Molecular Neurology, Research Programs Unit, Biomedicum, University of Helsinki, Helsinki, Finland. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom. · Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, United Kingdom. · Departments of Molecular & Human Genetics and Neuroscience, Baylor College of Medicine, Houston, Texas, USA. · Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA. · Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom. · Mater Research, Translational Research Institute, Brisbane, Queensland, Australia. · Queensland Brain Institute, The University of Queensland, Brisbane, Australia. · Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada. · Data Tecnica International, Glen Echo, Maryland, USA. ·Mov Disord · Pubmed #30957308.

ABSTRACT: BACKGROUND: Increasing evidence supports an extensive and complex genetic contribution to PD. Previous genome-wide association studies (GWAS) have shed light on the genetic basis of risk for this disease. However, the genetic determinants of PD age at onset are largely unknown. OBJECTIVES: To identify the genetic determinants of PD age at onset. METHODS: Using genetic data of 28,568 PD cases, we performed a genome-wide association study based on PD age at onset. RESULTS: We estimated that the heritability of PD age at onset attributed to common genetic variation was ∼0.11, lower than the overall heritability of risk for PD (∼0.27), likely, in part, because of the subjective nature of this measure. We found two genome-wide significant association signals, one at SNCA and the other a protein-coding variant in TMEM175, both of which are known PD risk loci and a Bonferroni-corrected significant effect at other known PD risk loci, GBA, INPP5F/BAG3, FAM47E/SCARB2, and MCCC1. Notably, SNCA, TMEM175, SCARB2, BAG3, and GBA have all been shown to be implicated in α-synuclein aggregation pathways. Remarkably, other well-established PD risk loci, such as GCH1 and MAPT, did not show a significant effect on age at onset of PD. CONCLUSIONS: Overall, we have performed the largest age at onset of PD genome-wide association studies to date, and our results show that not all PD risk loci influence age at onset with significant differences between risk alleles for age at onset. This provides a compelling picture, both within the context of functional characterization of disease-linked genetic variability and in defining differences between risk alleles for age at onset, or frank risk for disease. © 2019 International Parkinson and Movement Disorder Society.

8 Article Parkinson's Disease: Patients' Knowledge, Attitudes, and Interest in Genetic Counseling. 2018

Maloney, Kristin A / Alaeddin, Dina S / von Coelln, Rainer / Dixon, Shannan / Shulman, Lisa M / Schrader, Katrina / Guan, Yue. ·Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. · Program for Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore St., MSTF 357E, Baltimore, MD, 21201, USA. · Inova Translational Medicine Institute, Falls Church, VA, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. yguan@medicine.umaryland.edu. · Program for Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore St., MSTF 357E, Baltimore, MD, 21201, USA. yguan@medicine.umaryland.edu. ·J Genet Couns · Pubmed #29500627.

ABSTRACT: The objective of this study was to assess the genetics knowledge of patients with Parkinson's disease (PD), and to explore their attitudes on genetic testing and interest in genetic counseling. We surveyed 158 patients from the University of Maryland Parkinson's Disease and Movement Disorders Center. Patients averaged a score of 63% on general genetics knowledge and 73% on PD genetics knowledge. Participants had an overall positive attitude toward genetic testing: 80% believed that the use of genetic tests among people should be promoted, and 83% would undertake genetic test for PD if it was available. Patients reported a high interest to discuss the benefits, risks, and impacts of genetic testing for PD (mean sum score = 26, range = 9-35), and 43% patients expressed interest in meeting with a genetic counselor. Multivariate regression analysis showed that patients who had more positive attitudes toward genetic testing for PD were more interested in meeting with a genetic counselor (β = 0.6, p < 0.001). This study is the first to demonstrate an interest in genetic counseling among patients with PD. Our findings demonstrate a new niche for genetic counselors to support patients in clarifying gaps or misconceptions in knowledge about PD genetics as well as the possible risks, benefits, and limitations of genetic testing.

9 Article Sex disparities in health and health care utilization after Parkinson diagnosis: Rethinking PD associated disability. 2018

Fullard, Michelle E / Thibault, Dylan P / Todaro, Veronica / Foster, Susan / Katz, Lori / Morgan, Robin / Kern, Drew S / Schwalb, Jason M / Urrea Mendoza, Enrique / Dahodwala, Nabila / Shulman, Lisa / Willis, Allison W. ·Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Electronic address: Michelle.Fullard@uphs.upenn.edu. · Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA. · Parkinson's Foundation Women in PD Initiative, New York, NY, USA. · Department of Neurology, University of Colorado, Denver, CO, USA; Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Rochester, NY, USA. · Department of Neurosurgery, Henry Ford Medical Group, Detroit, MI, USA; Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Rochester, NY, USA. · Greenville Health System University Medical Group, Greenville, SC, USA; Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Rochester, NY, USA. · Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Rochester, NY, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MA, USA; Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Rochester, NY, USA. · Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Rochester, NY, USA. ·Parkinsonism Relat Disord · Pubmed #29273434.

ABSTRACT: OBJECTIVE: To examine sex differences and trends in comorbid disease and health care utilization in individuals with newly diagnosed Parkinson disease (PD). DESIGN: Retrospective cohort study. PARTICIPANTS: Over 133,000 Medicare beneficiaries with a new PD diagnosis in 2002 followed through 2008. METHODS: We compared the prevalence and cumulative incidence of common medical conditions, trends in survival and health care utilization between men and women with PD. RESULTS: Female PD patients had higher adjusted incidence rate ratio (IRR) of depression (IRR: 1.28, 1.25-1.31), hip fracture (IRR: 1.51, 1.45-1.56), osteoporosis (3.01, 2.92-3.1), and rheumatoid/osteoarthritis (IRR: 1.47, 1.43-1.51) than men. In spite of greater survival, women with PD used home health and skilled nursing facility care more often, and had less outpatient physician contact than men throughout the study period. CONCLUSIONS: Women experience a unique health trajectory after PD diagnosis as suggested by differing comorbid disease burden and health care utilization compared to men. Future studies of sex differences in care needs, care quality, comorbidity related disability, PD progression, and non-clinical factors associated with disability are needed to inform research agendas and clinical guidelines that may improve quality survival for women with PD.

10 Article Utilization of rehabilitation therapy services in Parkinson disease in the United States. 2017

Fullard, Michelle E / Thibault, Dylan P / Hill, Andrew / Fox, Joellyn / Bhatti, Danish E / Burack, Michelle A / Dahodwala, Nabila / Haberfeld, Elizabeth / Kern, Drew S / Klepitskava, Olga S / Urrea-Mendoza, Enrique / Myers, Phillip / Nutt, Jay / Rafferty, Miriam R / Schwalb, Jason M / Shulman, Lisa M / Willis, Allison W / Anonymous330917. ·From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine · Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia · Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha · Department of Neurology (M.A.B.), University of Rochester, NY · Department of Neurology (E.H.), Temple University, Philadelphia, PA · Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora · Greenville Health System (E.-U.M.), SC · Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA · Department of Neurology (J.N.), Oregon Health Sciences University, Portland · Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL · Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI · Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore. ·Neurology · Pubmed #28835397.

ABSTRACT: OBJECTIVE: To examine rehabilitation therapy utilization for Parkinson disease (PD). METHODS: We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST). RESULTS: Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization. CONCLUSIONS: This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.

11 Article The factor structure of the Brief Symptom Inventory-18 (BSI-18) in Parkinson disease patients. 2017

Abraham, Danielle S / Gruber-Baldini, Ann L / Harrington, Donna / Shulman, Lisa M. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: dabraham@umaryland.edu. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. · University of Maryland School of Social Work, Baltimore, MD, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. ·J Psychosom Res · Pubmed #28545788.

ABSTRACT: OBJECTIVE: Psychological distress is common among Parkinson disease (PD) patients. Screening tools, such as the Brief Symptom Inventory-18 (BSI-18), help clinicians to identify and manage PD patients with psychiatric symptoms. The objective of this study is to test the factor structure of the BSI-18 in PD patients. METHODS: Analysis was conducted on PD patients who had initial visits at a movement disorders center from 2004 to 2015. Univariate analysis was used to describe the distribution of socio-demographic and clinical characteristics. The BSI-18 was used to determine the prevalence of clinically significant psychological distress. Confirmatory factor analyses (CFA) treating BSI-18 items as ordered categorical data were conducted. Five competing models were tested. Multiple fit indices, parsimony, and past theory were used to select the final model. RESULTS: In the study sample (n=1067), 18.7%, 22.5%, 15.4%, and 15.0% of patients had BSI-18 T-scores indicative of clinically significant global psychological distress, somatization, depression, and anxiety, respectively. Of the competing models, the final model chosen was the second-order three-factor structure with somatization, depression, and anxiety loaded on psychological distress. CONCLUSION: The original proposed factor structure of the BSI-18 was validated in this patient population. Consequently, this study confirms the construct validity of the BSI-18 for screening of psychological distress in PD patients. Findings highlight somatization as a particularly important component of psychological distress in PD patients.

12 Article Discordance Between Physician Assessment and Patient-Reported Depressive Symptoms in Parkinson Disease. 2017

Lachner, Christian / Armstrong, Melissa J / Gruber-Baldini, Ann L / Rezvani, Zahra / Reich, Stephen G / Fishman, Paul S / Salazar, Richard / Shulman, Lisa M. ·1 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. · 2 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. · 3 Division of Psychiatry, Mayo Clinic, Jacksonville, FL, USA. · 4 Department of Neurology, University of Florida, Gainesville, FL, USA. · 5 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. · 6 Jackson Hospital, Montgomery, AL, USA. ·J Geriatr Psychiatry Neurol · Pubmed #28535723.

ABSTRACT: OBJECTIVE: To assess concordance between physician assessment and patient-reported symptoms when screening for depression in Parkinson disease (dPD). BACKGROUND: Depression in Parkinson disease is highly prevalent (∼40%) and has a significant impact on quality of life and disability, yet physician recognition and treatment remain inadequate. METHODS: One thousand seventy-six patients with PD completed the Brief Symptom Inventory-18 (BSI-18), a screening questionnaire for psychiatric symptoms, which was compared to item #3 (depression) on the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: The mean BSI-18 depression score was 51.4 (9.7). Of the 170 (16%) patients screening positive for dPD on the BSI-18, 104 (61%) were not recognized as depressed by neurologists on the UPDRS. Factors associated with lower neurologist recognition included male gender, better mental health quality of life, and lack of antidepressant use. CONCLUSION: More than 60% of patients screening positive for depression on self-report were not recognized by neurologists on the UPDRS. A patient-reported screening tool for depression may improve recognition and management of dPD.

13 Article Response shift - The experience of disease progression in Parkinson disease. 2017

Yang, Jessica / Hanna-Pladdy, Brenda / Gruber-Baldini, Ann L / Barr, Erik / von Coelln, Rainer / Armstrong, Melissa J / Reich, Stephen G / Shulman, Lisa M. ·Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street, 3rd Floor, Baltimore, MD 21201, United States. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood Street, Howard Hall Suite 200, Baltimore, MD 21201, United States. · Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street, 3rd Floor, Baltimore, MD 21201, United States. Electronic address: shulman@som.umaryland.edu. ·Parkinsonism Relat Disord · Pubmed #28082015.

ABSTRACT: OBJECTIVE: To investigate response shift, the recalibration of perceived quality of life (QoL) relative to symptomatic changes in Parkinson disease (PD). BACKGROUND: Health-related QoL in PD is influenced by improvement vs. decline in disease severity. However, it is unclear how disease course changes internal standards of QoL over time. METHODS: 124 PD patients were subdivided based on Total UPDRS change over 1 year (stable, improved, declined). The EuroQol Visual Analog Scale assessed QoL at baseline (T1) and 1 year later (T2). At T2, patients rated current QoL (T2-current) and reappraised their T1 QoL (T2-retrospective). Recalibration response shifts were represented by the difference between T1 and T2-retrospective QoL ratings. RESULTS: At follow-up (T2), the total patient sample reported no difference between current (T2 current mean (M) = 76.3) and retrospective (T2-R M = 77.8) QoL ratings. While there was no significant difference between T1 (M = 79.2) and T2-R ratings 1 year later (M = 77.8) for the total sample, there was a change by group interaction (p < 0.005) which showed that retrospectively, decliners reduced ratings (M Δ = -9.0) and improvers increased ratings (M Δ = +6.4) while stable patients did not change. CONCLUSIONS: When PD patients consider their health status one year ago, decliners recalibrate and downgrade last year's health assessment, while improvers upgrade last year's assessment. Changes in internal calibrations cushion periods of decline or improvement in PD such that patients tend to "stabilize" their general disease course when recalling symptom trajectory, providing insight into the process of adaptation to the effects of disease progression and treatment over time.

14 Article Asymmetric responsiveness of disability and health-related quality of life to improvement versus decline in Parkinson's disease. 2016

Lamichhane, Dronacharya / Gruber-Baldini, Ann L / Reich, Stephen G / Shulman, Lisa M. ·Illinois Neurological Institute, University of Illinois College of Medicine-Peoria, 100 NE Randolph Avenue, Peoria, IL, 61606, USA. dlamich@uicomp.uic.edu. · Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. · University of Maryland PD and Movement Disorders Center, University of Maryland School of Medicine, Baltimore, MD, USA. ·Qual Life Res · Pubmed #27363693.

ABSTRACT: PURPOSE: Clinical trials in Parkinson's disease commonly employ outcome measures of disability and quality of life. Responsiveness of these outcomes measures to symptomatic decline versus improvement has not been studied. We wanted to study the responsiveness of Schwab & England Activities of Daily Living Scale (SE) and Short Form-12 (SF-12) to symptomatic decline versus improvement in Parkinson's disease over a 4-year period among a naturalistic cohort of patients. METHODS: Parkinson's disease patients (N = 228, disease duration 6.1 years) were followed for 4 years with assessments of disease severity, Unified Parkinson's Disease Rating Scale (UPDRS), health-related quality of life (SF-12 physical/mental health), and disability (SE). The sample was subdivided into those who declined (N = 118) or improved (N = 102) on total-UPDRS. Responsiveness was assessed with Cohen's effect size and standardized response mean. RESULTS: At baseline, patients who improved over 4 years had greater disease severity and worse quality of life than decliners (p < .05). Decliners had a 13.5-point worsening on total-UPDRS, 26.3-39.8; p < .001) associated with concomitant decline on the SF-12 (physical health 42.9-39.2, mental health 50.0-46.6; both p < .001) and the SE (85-74 %; p < .001). Improvers had a 13.0-point improvement on total-UPDRS (39.8-26.8; p < .001) associated with minimal change on the SF-12 (physical health 40.8-39.5, mental health 47.1-46.3) and SE (79-79 %). Based on effect size, the rank order of responsiveness of measures for decliners from high to low was SE (-0.78), Short Form-12 mental health (-0.45), and SF-12 physical health (-0.34). Rank order of responsiveness for improvers was Short Form-12 physical health (-0.11), SF-12 mental health (-0.10), and SE (-0.03). CONCLUSIONS: Among decliners, measures of disability and quality of life were moderate to highly responsive to change in disease severity. Among improvers, both disability and quality of life were poorly responsive despite UPDRS improvement of comparable magnitude.

15 Article Sex Differences in Clinical Features of Early, Treated Parkinson's Disease. 2015

Augustine, Erika F / Pérez, Adriana / Dhall, Rohit / Umeh, Chizoba C / Videnovic, Aleksandar / Cambi, Franca / Wills, Anne-Marie A / Elm, Jordan J / Zweig, Richard M / Shulman, Lisa M / Nance, Martha A / Bainbridge, Jacquelyn / Suchowersky, Oksana. ·Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States of America. · The University of Texas School of Public Health, Austin, TX, United States of America. · Barrow Neurological Institute, Phoenix, AZ, United States of America. · Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America. · Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, United States of America. · Department of Neurology, University of Kentucky, Lexington, KY, United States of America. · Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America. · Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America. · Louisiana State University Health Sciences Center, Shreveport, LA, United States of America. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States of America. · Struthers Parkinson's Center, Minneapolis, MN, United States of America. · University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United States of America. · Department of Medicine, University of Alberta‎, Edmonton, AB, Canada; Department of Medical Genetics, University of Alberta‎, Edmonton, AB, Canada; Department of Pediatrics, University of Alberta‎, Edmonton, AB, Canada. ·PLoS One · Pubmed #26171861.

ABSTRACT: INTRODUCTION: To improve our understanding of sex differences in the clinical characteristics of Parkinson's Disease, we sought to examine differences in the clinical features and disease severity of men and women with early treated Parkinson's Disease (PD) enrolled in a large-scale clinical trial. METHODS: Analysis was performed of baseline data from the National Institutes of Health Exploratory Trials in Parkinson's Disease (NET-PD) Long-term Study-1, a randomized, multi-center, double-blind, placebo-controlled study of 10 grams of oral creatine/day in individuals with early, treated PD. We compared mean age at symptom onset, age at PD diagnosis, and age at randomization between men and women using t-test statistics. Sex differences in clinical features were evaluated, including: symptoms at diagnosis (motor) and symptoms at randomization (motor, non-motor, and daily functioning). RESULTS: 1,741 participants were enrolled (62.5% male). No differences were detected in mean age at PD onset, age at PD diagnosis, age at randomization, motor symptoms, or daily functioning between men and women. Differences in non-motor symptoms were observed, with women demonstrating better performance compared to men on SCOPA-COG (Z = 5.064, p<0.0001) and Symbol Digit Modality measures (Z = 5.221, p<0.0001). CONCLUSIONS: Overall, men and women did not demonstrate differences in clinical motor features early in the course of PD. However, the differences observed in non-motor cognitive symptoms suggests further assessment of the influence of sex on non-motor symptoms in later stages of PD is warranted.

16 Article Relationships between antiparkinson medication nonadherence, regimen modifications, and healthcare utilization and expenditures. 2015

Wei, Yu-Jung / Palumbo, Francis B / Simoni-Wastila, Linda / Shulman, Lisa M / Stuart, Bruce / Beardsley, Robert / Brown, Clayton. ·Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: ywei001@umaryland.edu. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: fpalumbo@rx.umaryland.edu. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: lsimoniw@rx.umaryland.edu. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: lshulman@som.umaryland.edu. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: bstuart@rx.umaryland.edu. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: rbeardsl@rx.umaryland.edu. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: cbrown@epi.umaryland.edu. ·Parkinsonism Relat Disord · Pubmed #25465748.

ABSTRACT: OBJECTIVES: To examine 1) the effect of prior antiparkinson drug (APD) nonadherence on subsequent APD regimen modifications; and 2) the influence of modifications on healthcare utilization and costs by patients with Parkinson's disease (PD). METHODS: This retrospective cohort study included 7052 PD patients with ≥2 APD prescriptions who initiated a modification of APD regimens in 2007. Modification was assessed as changing from one APD to another and/or adding a new APD to an existing regimen. Nonadherence was measured using Medication Possession Ratio <0.8. Discrete-time survival analyses were used to estimate the effect of prior nonadherent behavior on initiating APD modifications. Generalized linear models were used to estimate the effect of initiating medication modifications on subsequent 3-month medical use and costs. RESULTS: Initiation of APD modifications in any given month was higher among patients who were nonadherent to APDs in the preceding month (adjusted hazard ratio [HR] = 1.23), compared to their adherent counterparts. Modifications significantly predicted higher risk of all-cause and PD-related hospitalizations (adjusted relative risk [RR] = 1.22 and 1.83, respectively), home health agency utilization (RR = 1.18 and 1.52), and use of physician services (RR = 1.14 and 1.41), as well as higher total all-cause healthcare expenditures (mean = $1064) in any given 3-month interval. CONCLUSIONS: Prior nonadherence to APDs might influence initiation of APD modification. APD modifications were associated with increased health care utilization and expenditures, with the caveats that indications of modifications and disease severity may still play roles. Prescribers should consider patients' medication adherence when changing APD regimens to lower the costs of medical services.

17 Article Does spouse participation influence quality of life reporting in patients with Parkinson's disease? 2015

Morrow, Chelsea D / Smentkowski, Katherine / Schwartz, Stacy / Armstrong, Melissa J / Gruber-Baldini, Ann L / Anderson, Karen E / Reich, Stephen G / Weiner, William J / Shulman, Lisa M. ·Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA, chelseadmorrow@gmail.com. ·Qual Life Res · Pubmed #24972974.

ABSTRACT: PURPOSE: To investigate whether patient-spouse co-reporting (patient reporting with assistance from their spouse) results in the same ratings of health-related quality of life (HRQoL) as patient ratings without co-reporting, and to assess whether mutuality of the marital relationship is a determinant of co-reported ratings. Patients are the best source of HRQoL; however, co-reporting is common in clinical settings, but has not been compared to independent patient reporting of HRQoL. METHODS: Fifty-nine Parkinson's disease (PD) patient-spouse pairs completed the Short Form Health Status Survey (SF-12), measuring mental and physical HRQoL. Initially, the patient and spouse completed the SF-12 independently (about the patient). Then, patient-spouse pairs completed the SF-12 together assessing the patient's HRQoL. Patients and spouses independently completed the Mutuality Scale rating the intimacy of their relationship. RESULTS: Patients rated physical HRQoL higher (M = 46.6) than spouses alone (M = 43.4, p < 0.01) and co-reporting (M = 44.8, p < 0.05). Co-reporting rated physical HRQoL in between that of patients and spouses, (p < 0.05). Spouses who reported greater mutuality showed greater concordance with the patient regarding the patient's mental HRQoL (B = -0.43, p < 0.05). CONCLUSION: Consistency of the mode of completion of HRQoL instruments is important since co-reporting may alter HRQoL ratings in PD and lead to inaccurate conclusions. Mutuality is a mediator of mental HRQoL.

18 Article Which features of Parkinson's disease predict earlier exit from the workforce? 2014

Armstrong, Melissa J / Gruber-Baldini, Ann L / Reich, Stephen G / Fishman, Paul S / Lachner, Christian / Shulman, Lisa M. ·Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: marmstrong@som.umaryland.edu. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. ·Parkinsonism Relat Disord · Pubmed #25179494.

ABSTRACT: INTRODUCTION: Few objective data exist regarding predictors of leaving the workforce (LWF) in Parkinson's disease (PD). METHODS: Employed PD patients were followed prospectively. Baseline demographics, disease duration, and measures of disease severity, cognition, disability, and mental health were compared between patients working at last follow-up versus those who left the workforce using student's t-tests and multivariate analyses controlling for age, gender, and PD duration. RESULTS: Of 419 employed patients, 224 had left the workforce by last follow-up. Patients who left the workforce were more likely to be older, female, have lower-income, and have longer PD duration. LWF patients had greater baseline depression, anxiety, and overall psychiatric distress. PD severity did not differ between groups. CONCLUSION: Demographics, disease duration, and mental health contribute to LWF, but not motor severity. Age, gender and income contributions are difficult to modify but important to recognize. Worse baseline mental health is associated with LWF, suggesting a potential target for intervention.

19 Article Measuring disease progression in early Parkinson disease: the National Institutes of Health Exploratory Trials in Parkinson Disease (NET-PD) experience. 2014

Parashos, Sotirios A / Luo, Sheng / Biglan, Kevin M / Bodis-Wollner, Ivan / He, Bo / Liang, Grace S / Ross, G Webster / Tilley, Barbara C / Shulman, Lisa M / Anonymous4510790. ·Struthers Parkinson's Center, Golden Valley, Minnesota. · Division of Biostatistics, University of Texas at Houston. · Department of Neurology, University of Rochester, Rochester, New York. · State University of New York, Downstate Medical Center, Brooklyn. · The Parkinson's Institute and Clinical Center, Sunnyvale, California. · VA Pacific Islands Health Care System, Honolulu, Hawaii. · Department of Neurology, University of Maryland School of Medicine, Baltimore. ·JAMA Neurol · Pubmed #24711047.

ABSTRACT: IMPORTANCE: Optimizing assessments of rate of progression in Parkinson disease (PD) is important in designing clinical trials, especially of potential disease-modifying agents. OBJECTIVE: To examine the value of measures of impairment, disability, and quality of life in assessing progression in early PD. DESIGN, SETTING, AND PARTICIPANTS: Inception cohort analysis of data from 413 patients with early, untreated PD who were enrolled in 2 multicenter, randomized, double-blind clinical trials. INTERVENTIONS: Participants were randomly assigned to 1 of 5 treatments (67 received creatine, 66 received minocycline, 71 received coenzyme Q10, 71 received GPI-1485, and 138 received placebo). We assessed the association between the rates of change in measures of impairment, disability, and quality of life and time to initiation of symptomatic treatment. MAIN OUTCOMES AND MEASURES: Time between baseline assessment and need for the initiation of symptomatic pharmaceutical treatment for PD was the primary indicator of disease progression. RESULTS: After adjusting for baseline confounding variables with regard to the Unified Parkinson's Disease Rating Scale (UPDRS) Part II score, the UPDRS Part III score, the modified Rankin Scale score, level of education, and treatment group, we assessed the rate of change for the following measurements: the UPDRS Part II score; the UPDRS Part III score; the Schwab and England Independence Scale score (which measures activities of daily living); the Total Functional Capacity scale; the 39-item Parkinson's Disease Questionnaire, summary index, and activities of daily living subscale; and version 2 of the 12-item Short Form Health Survey Physical Summary and Mental Summary. Variables reaching the statistical threshold in univariate analysis were entered into a multivariable Cox proportional hazards model using time to symptomatic treatment as the dependent variable. More rapid change (ie, worsening) in the UPDRS Part II score (hazard ratio, 1.15 [95% CI, 1.08-1.22] for 1 scale unit change per 6 months), the UPDRS Part III score (hazard ratio, 1.09 [95% CI, 1.06-1.13] for 1 scale unit change per 6 months), and the Schwab and England Independence Scale score (hazard ratio, 1.29 [95% CI, 1.12-1.48] for 5 percentage point change per 6 months) was associated with earlier need for symptomatic therapy. CONCLUSIONS: AND RELEVANCE In early PD, the UPDRS Part II score and Part III score and the Schwab and England Independence Scale score can be used to measure disease progression, whereas the 39-item Parkinson's Disease Questionnaire and summary index, Total Functional Capacity scale, and the 12-item Short Form Health Survey Physical Summary and Mental Summary are not sensitive to change. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00063193 and NCT00076492.

20 Article Severity of depression and anxiety are predictors of response to antidepressant treatment in Parkinson's disease. 2014

Moonen, A J H / Wijers, A / Leentjens, A F G / Christine, C W / Factor, S A / Juncos, J / Lyness, J M / Marsh, L / Panisset, M / Pfeiffer, R / Rottenberg, D / Serrano Ramos, C / Shulman, L / Singer, C / Slevin, J / McDonald, W / Auinger, P / Richard, I H. ·Department of Psychiatry, Maastricht University, Maastricht, The Netherlands. Electronic address: anja.moonen@maastrichtuniversity.nl. · Department of Psychiatry, Maastricht University, Maastricht, The Netherlands. · Department of Neurology, University of California, San Francisco, San Francisco, CA, USA. · Department of Neurology, Emory University, Atlanta, GA, USA. · University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. · Mental Health Care Line, Michael E. DeBakey Veterans Administration Medical Center, Houston, USA; Department of Psychiatry, Baylor College of Medicine, Houston, USA; Department of Neurology, Baylor College of Medicine, Houston, USA. · Department of Neurology, University of Montreal, Montreal, Canada. · Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA. · Department of Neurology, University of Minnesota, Minneapolis, MN, USA; Department of Radiology, University of Minnesota, Minneapolis, MN, USA. · University of Puerto Rico School of Medicine, Puerto Rico. · Department of Neurology, University of Maryland School of Medicine, Baltimore, USA. · Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA. · Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA. · Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA. ·Parkinsonism Relat Disord · Pubmed #24679737.

ABSTRACT: BACKGROUND: Antidepressants have appeared to be more effective than placebo treatment in treating depressive syndromes in patients with Parkinson's disease (PD). OBJECTIVE: To identify factors that predict improvement in depressive symptoms during antidepressant treatment in depressed PD patients. METHODS: A secondary analysis was performed on the dataset of the Randomized Placebo-controlled Study of Antidepressants in PD (SAD-PD), in which 76 patients received active treatment with either paroxetine or venlafaxine extended release (XR), and 39 patients received placebo treatment. Backward stepwise regression analyses were conducted with change in 24-item Hamilton Depression Rating Scale (HAMD-24) score between assessments at baseline and week 12 as the main outcome measure, and sex, age, baseline HAMD-24 score, Unified Parkinson's Disease Rating Scale section III (UPDRS-III) score, Mini-Mental State Examination (MMSE), and the Clinical Anxiety Scale (CAS) as independent variables. RESULTS: In both the active treatment and placebo groups, higher baseline HAMD-24 score and lower UPDRS-III score were associated with greater reduction in HAMD-24 score. Higher anxiety scores predicted less response in the active treatment group. Higher MMSE scores predicted greater response only in the placebo-treated group. Sex and age were no predictors of response. CONCLUSIONS: Higher pre-treatment depression scores and lower pre-treatment anxiety scores are the two most important predictors for improvement during antidepressant treatment in depressed PD patients, which is in line with those found in treatment studies of depressed non-PD patients. Furthermore, our results indicate the requirement for different or more intensive treatment for depressed PD patients with more severe anxiety symptoms.

21 Article Antiparkinson drug adherence and its association with health care utilization and economic outcomes in a Medicare Part D population. 2014

Wei, Yu-Jung / Palumbo, Francis B / Simoni-Wastila, Linda / Shulman, Lisa M / Stuart, Bruce / Beardsley, Robert / Brown, Clayton H. ·Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: ywei@rx.umaryland.edu. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD, USA. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA. · Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. ·Value Health · Pubmed #24636377.

ABSTRACT: OBJECTIVES: We examine the associations of adherence to antiparkinson drugs (APDs) with health care utilization and economic outcomes among patients with Parkinson's disease (PD). METHODS: By using 2006-2007 Medicare administrative data, we examined 7583 beneficiaries with PD who filled two or more APD prescriptions during 19 months (June 1, 2006, to December 31, 2007) in the Part D program. Two adherence measures--duration of therapy (DOT) and medication possession ratio (MPR)--were assessed. Negative binomial and gamma generalized linear models were used to estimate the rate ratios (RRs) of all-cause health care utilization and expenditures, respectively, conditional upon adherence, adjusting for survival risk, sample selection, and health-seeking behavior. RESULTS: Approximately one-fourth of patients with PD had low adherence (MPR < 0.80, 28.7%) or had a short DOT (≤ 400 days, 23.9%). Increasing adherence to APD therapy was associated with decreased health care utilization and expenditures. For example, compared with patients with low adherence, those with high adherence (MPR = 0.90-1.00) had significantly lower rates of hospitalization (RR = 0.86), emergency room visits (RR = 0.91), skilled nursing facility episodes (RR = 0.67), home health agency episodes (RR = 0.83), physician visits (RR = 0.93), as well as lower total health care expenditures (-$2242), measured over 19 months. Similarly, lower total expenditure (-$6308) was observed in patients with a long DOT versus those with a short DOT. CONCLUSIONS: In this nationally representative sample, higher adherence to APDs and longer duration of use of APDs were associated with lower all-cause health care utilization and total health care expenditures. Our findings suggest the need for improving medication-taking behaviors among patients with PD to reduce the use of and expenditures for medical resources.

22 Article Antiparkinson drug use and adherence in medicare part D beneficiaries with Parkinson's disease. 2013

Wei, Yu-Jung / Palumbo, Francis B / Simoni-Wastila, Linda / Shulman, Lisa M / Stuart, Bruce / Beardsley, Robert / Brown, Clayton. ·Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland. Electronic address: ywei@rx.umaryland.edu. ·Clin Ther · Pubmed #24139423.

ABSTRACT: BACKGROUND: Antiparkinson drugs (APDs) are the mainstay of managing Parkinson's disease (PD). However, there is paucity of evidence documenting patterns of APD use and examining factors associated with adherence to APDs. OBJECTIVES: Our goal was to provide updated, comprehensive population-based data on APD use and adherence and to examine characteristics associated with adherence behaviors. METHODS: We analyzed data from 7583 beneficiaries with PD who had ≥ 2 APD prescription fills and were continuously enrolled in Medicare Parts A, B, and D for up to 19 months (from June 1, 2006, through December 31, 2007) or until death in 2007. We assessed 5 patterns of APD use: (1) concurrent use of ≥ 2 APD classes for ≥ 30 days; (2) switching of APDs from 1 to another; (3) augmentation of the existing regimen with a new APD; (4) duration of therapy, defined as days of APD treatment; and (5) adherence measured by using the medication possession ratio (MPR). We corrected for sample selection bias inherent in patients' self-selection into either a Part D plan or a Medicare Advantage Prescription Plan by using Heckman's 2-stage procedures. RESULTS: APD users were pre-dominantly aged ≥ 65 years (93.6%), female (59.9%), and white (89.3%). Almost one half (43.2%) of APD users concurrently used ≥ 2 APD classes. One in 4 APD users experienced changes in their APD regimen, with 16.4% switching medications and 21.1% augmenting their current regimen. Three quarters of APD users had therapy lasting ≥ 436 days (75.3%) and an MPR ≥ 0.8 (72.7%). Multivariate analyses revealed that patients aged ≥ 65 years, of non-white race, non-low-income subsidy recipients, late Part D enrollees, cognitively impaired, highly comorbid, and who experienced multiple changes in APD therapy were less likely to adhere to APD therapy. We were able to generalize our findings to all Part D enrollees by correcting for sample selection bias using the Heckman approach. These population-level, generalizable observations provide better understanding of APD use and adherence and assist in the design of interventions for poor adherence. Limitations include cross-sectional study design and constraints in administrative data that preclude measurement of other potential factors related to adherence. CONCLUSIONS: A substantial proportion of these Medicare beneficiaries with PD used multiple APDs concurrently, experienced switching and/or augmentation of APDs, and had poor adherence to APDs. Patient characteristics and clinical and drug-related factors were important predictors of APD adherence.

23 Article Comparison of caregiver strain in Parkinson's disease between Yamagata, Japan, and Maryland, The United States. 2013

Tanji, Haruko / Koyama, Shingo / Wada, Manabu / Kawanami, Toru / Kurita, Keiji / Tamiya, Gen / Saito, Naohiro / Suzuki, Kyoko / Kato, Takeo / Anderson, Karen E / Gruber-Baldini, Ann L / Fishman, Paul S / Reich, Stephen G / Weiner, William J / Shulman, Lisa M. ·Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, Japan. t.haruko@med.id.yamagata-u.ac.jp ·Parkinsonism Relat Disord · Pubmed #23514630.

ABSTRACT: BACKGROUND: Japan and the United States (US) have different cultures of caregiving including differences in family structure and social programs that may influence caregiver strain. Differences in caregiver strain between regions in Japan and in the US have not been investigated in patient-spouse dyads in PD. OBJECTIVES: To compare caregiver strain in spouses of PD patients between Yamagata, Japan and Maryland, US. Correlations between caregiver strain and patient/spousal variables are also examined. METHODS: In Yamagata and Maryland, spouses of patients with PD completed questionnaires assessing caregiver strain. Patients and spouses completed scales assessing mental health, and medical co-morbidity. PD severity and disability were assessed with the Unified Parkinson's Disease Rating Scale and the Schwab and England Activities of Daily Living Scale. Results in the two regions were compared with Chi-square and Student's t-tests. Relationships between caregiver strain and patient/spousal variables were analyzed with univariate correlations and multivariate regression. RESULTS: 178 Spouse-patient pairs were assessed. The level of caregiver strain in PD did not differ between Yamagata, Japan and Maryland, US despite differences in demographics and social support programs in the two regions. Yamagata spouses reported physical, time and financial constraints, while Maryland spouses reported more emotional distress. In both regions, spousal depression was a significant contributor to caregiver strain. CONCLUSION: Different approaches to reduce caregiver strain will likely be necessary in Yamagata and Maryland since the contributing factors to caregiver strain are influenced by differences in culture and social supports in each country.

24 Article Dual task performance in Parkinson's disease: a sensitive predictor of impairment and disability. 2013

Fuller, Rebecca L / Van Winkle, Elizabeth P / Anderson, Karen E / Gruber-Baldini, Ann L / Hill, Terra / Zampieri, Cris / Weiner, William J / Shulman, Lisa M. ·Department of Psychology, The Catholic University of America, Washington DC 20064, USA. fuller@cua.edu ·Parkinsonism Relat Disord · Pubmed #23265679.

ABSTRACT: BACKGROUND: Dual task (DT) performance assesses the ability to perform two tasks simultaneously. Difficulty with DT performance may be a sensitive indicator of early Parkinson's disease (PD) impairment. The objective of this study was to assess what elements of a DT performance (cognition or gait) are most associated with impairment and disability in PD. METHODS: Performance in single and DT conditions was examined in 154 PD patients. The single task assessments included the time required to walk 50 feet (gait speed) and the number of words generated in a verbal fluency task (word generation). The DT comprised simultaneous performance of the single tasks. Impairment and disability were measured with the Unified Parkinson's Disease Rating Scale, Hoehn &Yahr, Berg Balance Scale, and Older Americans Resource and Services Scale. Age, education, and gender were control variables. Standardized residuals from regressions of DT upon single task performance were computed separately for word and gait, indicating the extent that the individual performed proportionally better/worse than predicted in DT considering their single task performance. RESULTS: Multiple regressions revealed that individuals who performed worse than expected in DT-word had greater impairment and disability. Dual task-gait was not significant in any model. Verbal fluency during DT performance is more closely associated with PD-related impairment and disability than gait speed during DT. CONCLUSION: This suggests that subjects prioritize gait performance at the expense of cognitive performance, and that DT word generation may be a sensitive indicator of early PD impairment and disability.

25 Article Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. 2013

Shulman, Lisa M / Katzel, Leslie I / Ivey, Frederick M / Sorkin, John D / Favors, Knachelle / Anderson, Karen E / Smith, Barbara A / Reich, Stephen G / Weiner, William J / Macko, Richard F. ·University of Maryland School of Medicine, Department of Neurology, Baltimore,MD21201, USA. lshulman@som.umaryland.edu ·JAMA Neurol · Pubmed #23128427.

ABSTRACT: OBJECTIVE: To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease. DESIGN: A comparative, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise. SETTING: The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center. PATIENTS: A total of 67 patients with Parkinson disease who had gait impairment were randomly assigned to 1 of 3 arms of the trial. INTERVENTIONS; (1) A higher-intensity treadmill exercise (30 minutes at 70%-80% of heart rate reserve), (2) a lower-intensity treadmill exercise (50 minutes at 40%-50% of heart rate reserve), and (3) stretching and resistance exercises (2 sets of 10 repetitions on each leg on 3 resistance machines [leg press, leg extension, and curl]). These exercises were performed 3 times a week for 3 months. MAIN OUTCOME MEASURES: The primary outcome measures were gait speed (6-minute walk), cardiovascular fitness (peak oxygen consumption per unit time [$$ VO2], and muscle strength (1-repetition maximum strength). RESULTS: All 3 types of physical exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12% increase; P=.001), stretching and resistance exercises (9% increase; P<.02), and higher-intensity treadmill exercise (6% increase; P=.07), with no between-group differences. Both treadmill exercises improved peak $$ VO2 (7%-8% increase; P<.05) more than did the stretching and resistance exercises. Only stretching and resistance improved muscle strength (16% increase; P<.001). CONCLUSIONS: The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.

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