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In late stage Parkinson’s disease (PD) (i.e., Hoehn and Yahr (HY) stages IV-V), both motor and nonmotor symptoms (NMS) are pronounced, and the patients become increasingly dependent on help in their daily life. Consequently, there is an increasing demand on health-care and social care resources for these patients and support for their informal caregivers. The aim of this study was to assess satisfaction with care in late stage PD patients and to identify factors associated with satisfaction with care. Moreover, to assess their informal caregivers’ satisfaction with support and to identify factors associated with caregivers’ satisfaction with support. Factors potentially associated with satisfaction with care/support were assessed in 107 late stage PD patients and their informal caregivers () and entered into multivariable logistic regression analyses. Fifty-eight (59%) of the patients and 45 (59%) of the informal caregivers reported satisfaction with their overall care/support. Patients satisfied with their care reported higher independence in activities of daily living (ADL) (Katz ADL index; ), less depressive symptoms (Geriatric Depression Scale, GDS-30; ), and higher individual quality of life (QoL) (Schedule for the Evaluation of Individual Quality of Life Questionnaire, SEIQoL-Q; ). Multivariable logistic regression analyses identified depressive symptoms () and independence in ADL () as independently associated with satisfaction with care. For informal caregivers, the analyses identified patients’ HY stage () and caregivers’ QoL (Alzheimer’s Carers Quality of Life Inventory, ACQLI; ) as independently associated with satisfaction with caregiver support. The results indicate that an effective both pharmacological and nonpharmacological PD therapy is important, to adequately treat motor and NMS (e.g., depressive symptoms) in order to improve depressive symptoms and patient independence in ADL. This may benefit not only the patients, but also their informal caregi

BACKGROUND: Non-motor symptoms (NMS) are common in late stage Parkinson's disease (PD), as the frequency and severity of most of these symptoms increase with advancing disease. OBJECTIVE: To assess effect of dopaminergic therapy on NMS in late stage PD and to investigate relationships between dopaminergic effect on NMS and on motor function. METHOD: Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. Dopaminergic effect on non-motor symptomatology was assessed by the modified version of the Non-Motor Symptoms Scale (NMSS) in the "off" and the "on" state during a standardized L-dopa test, in parallel also assessing motor function. RESULTS: NMS were common and many of the symptoms occurred in >80% of the individuals. The highest NMSS scores were seen within the NMSS domains 3: mood/apathy and 7: urinary in both the "off" and the "on" state. There was a statistically significant (p < 0.001) improvement in the modified NMSS total score (median) from 79 in "off" to 64 in "on". There were statistically significant differences between the "off" and the "on" state for domains 2: sleep/fatigue, 3: mood/apathy, 5: attention/memory, 6: gastrointestinal and 7: urinary. The differences in the NMSS score between the "off" and the "on" state were in general larger for motor responders than for motor non-responders. In motor non-responders, differences of the NMSS score between the "off" and the "on" state were found for the total score, domain 3: mood/apathy and its item 11-flat moods. CONCLUSION: There is an effect of dopaminergic medication on NMS in late stage PD, to some extent also for those with a non-significant response on motor function during L-dopa test. It is therefore of importance to optimize dopaminergic therapy in order to give the most effective symptomatic treatment possible.

BACKGROUND: It is unclear to which degree Levodopa (L-dopa) remains effective also in the late stage of Parkinson's disease (PD) and to which degree motor fluctuations and dyskinesias remain a problem. OBJECTIVE: To assess responsiveness of motor symptomatology to L-dopa in a group of patients with late stage PD. Moreover, to investigate the extent to which motor fluctuations and dyskinesias occur. METHODS: Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. L-dopa responsiveness was assessed with a standardized L-dopa test in the defined "off" and defined "on" states. Motor function was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests. Motor fluctuations and dyskinesias were assessed by the UPDRS IV. The participants were further monitored for 10 days with a mobile movement-analyses-system, the Parkinson's Kinetigraph (PKG). The median (q1-q3) L-dopa equivalent daily dose (LEDD) was 799 (536-973) mg. RESULTS: The UPDRS III score improved with ≥15% in 15 (50%) and with ≥30% in six (20%) participants during the L-dopa test. The median (q1-q3) UPDRS III score in "off" was 46 (37-53) and in "on" 36 (28-46). Twenty-one (70%) of the participants reported either predictable or unpredictable "off" fluctuations (items 36-37). The prevalence of dyskinesias (item 32, duration of dyskinesias ≥1) was 47%. The PKG indicated that dyskinesias primarily were mild and that a majority had a pronounced "off" symptomatology, spending a large proportion of the day either asleep or very inactive. CONCLUSIONS: Half of a group of patients with late stage PD had an L-dopa response of ≥15% on the UPDRS III. According to the UPDRS IV, a majority of the patients had motor fluctuations and about half had dyskinesias, although the PKG results suggested that these were not very severe.

OBJECTIVES: To identify factors associated with life satisfaction (LS) in people with Parkinson's disease (PD), including a specific focus on those with late-stage PD. MATERIAL AND METHODS: The study included 251 persons with PD (median age 70 years; PD duration 8 years). Analyses involved the total sample and a subsample with late-stage PD, that is Hoehn and Yahr stages IV and V (n=62). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Simple logistic regression analyses were performed for both the total sample and for the subsample with late-stage PD. For the total sample, a multivariable logistic regression analysis was also performed. RESULTS: In the total sample, 12 of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; motor symptoms; pain; PD severity; freezing episodes; gender (woman); and fluctuations. When controlling for age and gender in the multivariable logistic regression model, depressive symptoms were negatively associated with high LS and general self-efficacy was positively associated with high LS. In late-stage PD, simple logistic regression analyses (controlling for age and gender) identified the following factors as associated with LS: number of NMS, general self-efficacy, walking difficulties and fatigue. CONCLUSIONS: This study provides new knowledge on factors associated with LS in a PD sample, including those with late-stage PD. As the ultimate goal for PD care should be improvement in LS, the results have direct clinical implication.

Objective: To assess responsiveness to Levodopa (L-dopa) in patients with late stage Parkinson’s disease (PD). Moreover, to investigate if the L-dopa effect is stable or whether motor fluctuations and dyskinesias are present. Background: A majority of PD patients treated with L-dopa develop motor complications, in many cases within a few years of treatment. It is unclear to which degree L-dopa remains effective also in the last stages and whether motor fluctuations and dyskinesias remain a problem. Methods: The study included 30 patients with PD in Hoehn and Yahr (HY) stages IV and V in “on” and/or having a substantial need of help with ADL (<50% Schwab and England Scale) and having been diagnosed with PD for =7 years. Nineteen were men, median age 83 and median PD duration 12 years. Nineteen were in HY stage IV and 11 in V. L-dopa responsiveness was assessed with an L-dopa test and motor evaluation according to a standardized protocol in the defined “off” and defined “on” state. Motor performance was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests for gait and hand-arm. The participants were further evaluated with a mobile movement-analyses-system, the Parkinson’s Kinetigraph (PKG) for 10 days. Results: The number of participants with an improvement in UPDRS III during L-dopa test of =15% were 15 (50%) and of =30% were 6 (20%). The median UPDRS III score in “off” was 46 (q1-q3, 37-53) and in “on” 36 (28-46), with a median improvement of 15.5% (8-27%), p<0.001. There was a statistically significant effect in almost all variables; UPDRS III total score; speech (item 18); resting tremor (item 20); tremor (items 20, 21); rigidity (item 22); bradykinesia (items 23-26, 31); gait (item 29); axial signs (items 18, 19, 22, 27-30); dyskinesias (Clinical Dyskinesia Rating Scale); hand-arm movement; gait test and blood pressure. According to the UPDRS IV, 67% experienced predictable off-fluctuations, while 30% had unpredictable off-fluctuations. The p

Objective: To identify factors associated with life satisfaction (LS) in people with Parkinson’s disease (PD), including a specific focus on those with late stage PD. Background: Despite that patients with PD have an increased risk of reduced LS, there is limited knowledge regarding which factors are associated with LS. Such knowledge could serve as an important base for optimizing treatment and care. Concerning patients with late stage PD, i e Hoehn and Yahr (HY) IV-V, no published study has specifically addressed LS for this group. Methods: Data from 251 persons with PD (median age 70 years and duration 8 years) was analyzed statistically; the total sample was assessed and a subsample with late stage PD was further evaluated separately. LS was assessed by item 1 of the Life Satisfaction Questionnaire (LiSat-11). A large number of independent variables were described in relation to HY for groups HY I-III and IV-V, differences between the groups were tested. Sample characteristics in relation to LS were tested with simple logistic regression analyses. Independent variables with a p-value < 0.3 in the simple logistic regressions were entered into a multiple logistic regression model. For the subsample with late stage PD, simple logistic regression analyses were calculated. Results: The simple logistic regression analyses showed that 11 out of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; pain; PD severity; freezing episodes; gender (women) and fluctuations. When controlling for age and gender in the multiple logistic regression model, two independent variables were found to be independently associated with LS; depressive symptoms (negatively associated with high LS) and general self-efficacy (positively associated with high LS). For late stage PD, when controlling for age and gender in simple logistic regressio