Objective: To determine predictors of a clinically meaningful change of HRQL of patients with PD.

Background: There is limited literature on the baseline and longitudinal predictors of changes in health-related quality of life (HRQL) in Parkinson’s disease (PD).

Methods: Data was collected from PD patients enrolled in the NPF-QII registry, a longitudinal observational study. Dataset includes demographics, disease characteristics, and health care utilization. HRQL was measured by PDQ-39. Subjects were separated into two groups, worse vs no worse based on the PDQ-39 change> 1.6 (minimal clinically meaningful change)2 between two consecutive annual visits. Chi-squared tests were used for discrete and t-test for continuous variables for baseline characteristics comparison, and generalized mixed models with repeated measures were used for the longitudinal analysis.

Results: 5250 of 8041 QII participants had at least one longitudinal visit and were included into the analysis. Average (SD) follow up was 16 + 7 months. 48% had worsening PDQ-39 over the first year of observation. Changes were largest in the mobility subscore. Baseline characteristics associated with first-year worsening PDQ-39 were older age of PD onset (P<0.001), lack of tremor (p=0.003), presence of motor fluctuations (p=0.011), higher H&Y stage (p=0.007 but not worse timed up and go (p=0.8), use of cognitive enhancing medication (p=0.014), worse immediate recall (p=0.04), better baseline PDQ-39 scores (p<0.0001) and less social worker/counseling (p=0.046). The annualized PDQ-39 change was not linear: 1.6 + 10.7 in the first year to 2.6 + 9.9 in year 4. All baseline variables associated with year 1 change also were top predictors of worsening of the PDQ-39 over all visits. The only interventions that were associated with the slower rate of decline of PDQ-39 (bottom vs top quartile) were use of MAO-Bs (p=0.017) and use of social worker/ counseling (p=0.01) but not other allied health care services.

Conclusions: Decline in PD HRQL is largely driven by mobility subscore. Majority of predictors of worsening HRQL reflect demographic and baseline disease characteristics that are difficult to modify. The positive effect of social service/counseling is intriguing and important to further explore in controlled interventional studies.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/predictors-of-clinically-meaningful-change-in-pdq-39-in-parkinsons-disease/