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Quality of Life in Persons with Parkinson's Disease Appropriate for Treatment with Deep Brain Stimulation
Weaver FM, Hur K, Follett K, Stern M, Reda DJ. Quality of Life in Persons with Parkinson's Disease Appropriate for Treatment with Deep Brain Stimulation. Poster session presented at: World Parkinson Coalition Inc Annual Congress; 2006 Feb 1; Washington, DC.
Objective: To identify patient characteristics related to quality of life (QOL) in persons with Parkinsons disease (PD) appropriate for deep brain stimulation (DBS). Background:Research has shown that patient QOL deteriorates with increased disease severity in PD. Patients who undergo DBS surgery for PD usually have exhausted all alternative treatment strategies and are likely to experience poor QOL prior to surgery. Methods: An analysis of baseline data was undertaken on patient physical and cognitive functioning and QOL for 214 patients with PD enrolled in a prospective, randomized trial of DBS of the subthalamic nucleus versus globus pallidus. Results: Patients mean age was 62.9 years (std 9.2), mean duration of PD was 13.8 years (std 5.7), and mean Hoehn and Yahr stage was 3.4(std 0.9). Their UPDRS motor score off medication was 43.5, and they averaged 10 hrs/day of either off time and/or on time with troubling dyskinesia using motor diaries. Scores on the physical and mental components of the SF-36 scale were low, averages of 35.94 and 44.81, respectively; (US population norms for MCS (range 2-74) and PCS (range 4-71) are 50 with standard deviations of 10), and the Quality of Well Being score (QWB), a measure of health status, was 0.42 indicating relatively poor status/well-being (0 = death; 1 = perfect health). Patient demographics, functional capacity, and cognitive status were included in regression models for QOL measures. Baseline depression, based on the Beck Depression Inventory, was significantly related to all measures of QOL (p < 0.01 for all analyses); greater depression was related to worse QOL. Complications of therapy (UPDRS Part IV) were significantly related to the PD-specific quality measures (PDQ-39 mobility, ADL and emotional well-being subscales; p < 0.01) but not to general QOL or QWB. Lower neurocognitiive functioning (based on the Mattis Dementia Rating Scale) was related to poorer QWB (p < 0.04). Conclusions: Depression was correlated with poorer QOL in persons with PD planning to undergo DBS, and QWB was strongly correlated with cognitive functioning and mood. Follow-up of this cohort for up to 3 years after surgery will permit examination of whether site of DBS implantation may differentially affect ADL functioning, depression and QOL, and to what extent baseline parameters predict outcomes following DBS.