4 results on '"Hommel, Adrianus L.A.J."'
Search Results
2. The association of comorbidity with Parkinson's disease-related hospitalizations
- Author
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Hommel, Adrianus L.A.J. (author), Krijthe, J.H. (author), Darweesh, Sirwan (author), Bloem, Bastiaan R. (author), Hommel, Adrianus L.A.J. (author), Krijthe, J.H. (author), Darweesh, Sirwan (author), and Bloem, Bastiaan R. (author)
- Abstract
Introduction: Unplanned hospital admissions associated with Parkinson's disease could be partly attributable to comorbidities. Methods: We studied nationwide claims databases and registries. Persons with newly diagnosed Parkinson's disease were identified based on the first Parkinson's disease-related reimbursement claim by a medical specialist. Comorbidities were classified based on the Charlson Comorbidity Index. We studied hospitalization admissions because of falls, psychiatric diseases, pneumonia and urinary tract infections, PD-related hospitalizations-not otherwise specified. The association between comorbidities and time-to-hospitalization was estimated using Cox proportional hazard modelling. To better understand pathways leading to hospitalizations, we performed multiple analyses on causes for hospitalizations. Results: We identified 18 586 people with newly diagnosed Parkinson's disease. The hazard of hospitalization was increased in persons with peptic ulcer disease (HR 2.20, p = 0.009), chronic obstructive pulmonary disease (HR 1.61, p < 0.001), stroke (HR 1.37, p = 0.002) and peripheral vascular disease (HR 1.31, p = 0.02). In the secondary analyses, the hazard of PD-related hospitalizations-not otherwise specified (HR 3.24, p = 0.02) and pneumonia-related hospitalization (HR 2.90, p = 0.03) was increased for those with comorbid peptic ulcer disease. The hazard of fall-related hospitalization (HR 1.57, p = 0.003) and pneumonia-related hospitalization (HR 2.91, p < 0.001) was increased in persons with chronic obstructive pulmonary disease. The hazard of pneumonia-related hospitalization was increased in those with stroke (HR 1.54, p = 0.03) or peripheral vascular disease (HR 1.60, p = 0.02). The population attributable risk of comorbidity was 8.4%. Conclusion: Several comorbidities increase the risk of Parkinson's disease related-hospitalization indicating a need for intervention strategies targeting these comorbid disorders., Pattern Recognition and Bioinformatics
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- 2022
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3. Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial.
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Hommel, Adrianus L.A.J., Meinders, Marjan J., Weerkamp, Nico J., Richinger, Carmen, Schmotz, Christian, Lorenzl, Stefan, Dodel, Richard, Coelho, Miguel, Ferreira, Joaquim J., Tison, Francois, Boraud, Thomas, Meissner, Wassilios G., Rosqvist, Kristina, Timpka, Jonathan, Odin, Per, Wittenberg, Michael, Bloem, Bas R., Koopmans, Raymond T., and Schragand, Anette
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PARKINSONIAN disorders , *PARKINSON'S disease , *MOVEMENT disorders , *ACTIVITIES of daily living , *SYMPTOMS - Abstract
Background: Treatment of patients with late-stage parkinsonism is often sub-optimal. Objective: To test the effectiveness of recommendations by a movement disorder specialist with expertise in late-stage parkinsonism. Methods: Ninety-one patients with late-stage parkinsonism considered undertreated were included in apragmatic a pragmatic multi-center randomized-controlled trial with six-month follow-up. The intervention group received a letter with treatment recommendations to their primary clinician based on an extensive clinical assessment. Controls received care as usual. The primary outcome was the Unified Parkinson Disease Rating Scale (UPDRS)part-II (Activities of Daily Living). Other outcomes included quality-of-life (PDQ-8), mental health (UPDRS-I), motor function (UPDRS-III), treatment complications (UPDRS-IV), cognition (Mini-mental-state-examination), non-motor symptoms (Non-Motor-Symptoms-scale), health status (EQ-5D-5L) and levodopa-equivalent-daily-dose (LEDD). We also assessed adherence to recommendations. In addition to intention-to-treat analyses, a per-protocol analysis was conducted. Results: Sample size calculation required 288 patients, but only 91 patients could be included. Treating physicians followed recommendations fully in 16 (28%) and partially in 21 (36%) patients. The intention-to-treat analysis showed no difference in primary outcome (between-group difference = –1.2, p = 0.45), but there was greater improvement for PDQ-8 in the intervention group (between-group difference = –3.7, p = 0.02). The per-protocol analysis confirmed these findings, and showed less deterioration in UPDRS-part I, greater improvement on UPDRS-total score and greater increase in LEDD in the intervention group. Conclusions: The findings suggest that therapeutic gains may be reached even in this vulnerable group of patients with late-stage parkinsonism, but also emphasize that specialist recommendations need to be accompanied by better strategies to implement these to further improve outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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4. The Prevalence and Determinants of Neuropsychiatric Symptoms in Late‐Stage Parkinsonism.
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Hommel, Adrianus L.A.J., Meinders, Marjan J., Lorenzl, Stefan, Dodel, Richard, Coelho, Miguel, Ferreira, Joaquim J., Laurens, Brice, Spampinato, Umberto, Meissner, Wassilios, Rosqvist, Kristina, Timpka, Jonathan, Odin, Per, Wittenberg, Michael, Bloem PhD, Bas R., Koopmans, Raymond T., and Schrag, Anette
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APATHY , *PARKINSONIAN disorders , *PARKINSON'S disease , *COGNITION disorders , *SYMPTOMS , *DEMOGRAPHIC characteristics - Abstract
Background: Late‐stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown. Objective: To determine the prevalence and predictors of neuropsychiatric symptoms in late‐stage PD. Methods: We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms. Results: A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness. Conclusion: Neuropsychiatric symptoms are common in late‐stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late‐stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized. [ABSTRACT FROM AUTHOR]
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- 2020
- Full Text
- View/download PDF
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