Quality of life with Parkinson's: A two-decade follow-up
A follow-up to a prominent study first published 20 years ago looks to discover which Parkinson's symptom is most affecting quality of life.
The study was conducted in a community-based, unselected sample of patients whose condition severity ranged from mild to severe.
As opposed to the study two decades ago, the severity of motor symptoms is no longer the main contributor to the quality of living, as evaluated by people with Parkinson's.
The importance of addressing depression
While overall disability was an important factor, the key and overwhelmingly determining feature associated with poorer quality of life scores was the severity of factors like depression. Depression has been associated with Parkinson's, owing to brain dysfunction rising from dopamine deficiency.
Modern research shows how depression is an integral feature of Parkinson's and is commonly seen years before a diagnosis is made.
Some researchers suggest that Parkinson's associated with depression could be considered a possible subtype of the condition.
The Shift to the Symptoms You Can't See
Beyond depression, the other key elements found by the study were the degree of disability and the presence of postural impairment. These factors reflect the increased risk of injuries and consequent fear of falling.
Another symptom unrelated to movement, cognitive impairment, was seen as a key determining factor for reduced quality of life scores.
Perhaps most importantly, the recognition that non-motor symptoms, such as depression and cognitive impairment, may be more important to how people with Parkinson's evaluate their experience, rather than pure motor impairment.
These findings may begin to shift the focus in both research and clinical practice from improving motor scores towards a broader view of the motor and non-motor symptoms.
Other Wellbeing Factors
Other studies have found a range of specific factors that affect the quality of living, including impulse control disorders, fatigue, and hallucinations.
Interestingly, personal factors, such as optimism, and healthcare experiences such as how the diagnosis was communicated, have also been recognised as essential.
"Ultimately, it is the improvement of patients' wellbeing from their point of view that is the aim of any symptomatic treatment," the researchers concluded.
Understanding Depression in Parkinson's
- Depression and anxiety can arise in response to life with Parkinson’s but can also be a symptom of the condition itself.
- Parkinson’s decreases brain chemicals that impact mood.
- Mood changes can worsen movement and non-movement symptoms — anxiety could bring out tremors or freezing, and depression can interfere with your sleep.
- The symptoms of depression include a decreased interest in activities, sleeping too much or too little, changes in appetite, feelings of worthlessness, and suicide.
- The symptoms of anxiety include worry that is difficult to reign in, restlessness, irritability, sudden-onset panic attacks, and difficulty concentrating.
- Loved ones often are the first to see personality or behaviour changes, so consider checking in regularly.
- Depression and anxiety are medical conditions, just like diabetes or heart disease. Ask for help and treat them as you would any other serious health concern.
- Options for improving your mood include prescription medication, talk therapy, support groups or other social connections, physical exercise, and meditation.
Source: Schrag, Anette, and Niall Quinn. "What contributes to quality of life in Parkinson's disease: a re-evaluation." Journal of Neurology, Neurosurgery & Psychiatry