scholarly journals 142 The Burden of Tardive Dyskinesia Secondary to Antipsychotic Medication Use Among Patients With Mental Disorders

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 88-89
Author(s):  
Joseph McEvoy ◽  
Tyson Park ◽  
Traci Schilling ◽  
Emi Terasawa ◽  
Rajeev Ayyagari ◽  
...  
Keyword(s):  
Tardive Dyskinesia ◽  
Healthcare Resource Utilization ◽  
Major Depressive ◽  
Additional Burden ◽  
Pharmaceutical Industries ◽  
Psychiatric Conditions ◽  
The Impact ◽  
Cohort Change ◽  
Funding Acknowledgements

AbstractIntroductionExtrapyramidal symptoms (EPS), including tardive dyskinesia (TD), may result from exposure to antipsychotics. TD is often irreversible, may be debilitating, and cause additional burden to patients with underlying psychiatric conditions.ObjectiveTo assess the impact of developing TD, both with and without other EPS, on healthcare resource utilization (HRU).MethodsData on patients receiving antipsychotics who had schizophrenia, major depressive disorder, or bipolar disorder were extracted from a Medicaid claims database. Patients from the TD cohorts (TD+EPS and TD non-EPS) were matched to those in the non-TD/EPS cohort at ∼1:5 ratio. HRU outcomes associated with TD were assessed.ResultsTD+EPS (n=289) and TD non-EPS (n=394) cohorts were matched with 1398 and 1922 control patients, respectively. The percentage of patients with all-cause and mental disorder-related inpatient admissions increased from baseline to follow-up in the TD+EPS (12.8% and 12.5%, respectively) and TD non-EPS (16.0% and 13.5%) cohorts, in contrast with slight decreases (∼3%) in matched controls. A higher percentage of patients in the TD cohorts had medical admissions/visits and claims for drugs that might be used to address TD or EPS than their matched controls at baseline and follow-up. The within-cohort change from baseline to follow-up in the use of potential drugs for TD or EPS was similar between the TD cohorts and their matched controls; however, both TD cohorts exhibited a larger increase in crisis–non-specific psychotherapy services versus matched controls.ConclusionsResults demonstrated increased HRU in TD patients with or without other pre-existing EPS, compared with matched controls.Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.Funding AcknowledgementsThis study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.

scholarly journals 186 Hospital Utilization Rates Following Antipsychotic Dose Reductions Among Patients With Schizophrenia

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 106-107
Author(s):  
Stanley N. Caroff ◽  
Fan Mu ◽  
Rajeev Ayyagari ◽  
Traci Schilling ◽  
Victor Abler ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Dose Reduction ◽  
Hospital Utilization ◽  
Medical Claims ◽  
Healthcare Burden ◽  
Increased Risk ◽  
Additional Burden ◽  
Pharmaceutical Industries ◽  
Dose Reductions ◽  
Funding Acknowledgements

AbstractIntroductionTardive dyskinesia (TD), an often-irreversible movement disorder, develops in patients treated withantipsychotics. Although antipsychotic dose reduction has been utilized in the management of TD, the benefits and risks of lowering doses have not been well studied and could cause additional burden to patients.ObjectiveTo analyze the healthcare burden of antipsychotic dose reduction in patients with schizophrenia.MethodsMedical claims from six US states spanning 6 years are retrospectively analyzed for ≥10% or ≥30% antipsychotic dosereductions and compared with those from patients receiving stable doses. Outcomes measured include inpatient admissions and emergency room (ER) visits for schizophrenia, all psychiatric disorders, and all causes.ResultsBaseline analysis revealed 17,984 patients with ≥10% and 14,029 patients with ≥30% dose reduction. Patients with≥10% dose reduction and matched controls were similar in age (mean 45.5 years), gender (51% male) and healthcare plan type. Preliminary analyses indicate that ≥10% dose reduction is associated with increased risk of admission or ER visit for schizophrenia (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.18, 1.35; P<0.001) and all psychiatric disorders (HR 1.18; 95% CI 1.11, 1.25; P<0.001) versus controls, which may be even greater with ≥30% dose reduction. Final updated results of ongoing analyses will be presented at the meeting.ConclusionsPatients with antipsychotic dose reductions may be at risk for significant increases in hospital utilization rates. This suggests that dose reductions may increase overall healthcare burden in some schizophrenia patients, and highlights the need for alternative strategies in the management of TD.Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.Funding AcknowledgementsThis study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.

scholarly journals 118 Demographics and Real World Healthcare Cost and Utilization for Patients With Probable Tardive Dyskinesia

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 75-75
Author(s):  
Michael Polson ◽  
Chuck Yonan ◽  
Ted Williams
Keyword(s):  
Tardive Dyskinesia ◽  
Claims Data ◽  
Prolonged Exposure ◽  
Patient Characteristics ◽  
Major Depressive ◽  
Included Patient ◽  
Comorbidity Burden ◽  
History Of ◽  
Study Population ◽  
Funding Acknowledgements

AbstractBackgroundTardive dyskinesia (TD) is a movement disorder associated with prolonged exposure to antipsychotics. The current study was designed to describe demographics and comorbidities for patients with a dyskinesia diagnosis as probable TD (cohort 1), patients likely to have undiagnosed/uncoded TD (cohort 2), and a control population.MethodsThis retrospective study analyzed Medicaid claims data from July 2013-March 2017. For a pool of patients with a history of 3 months or more of taking an antipsychotic, three cohorts were evaluated: cohort 1 (ICD-9/10 codes for dyskinesia); cohort 2 (propensity score matching to cohort 1); and cohort 3 (patients withschizophrenia, major depressive disorder [MDD], and/or bipolar disorder [BD] and history of ≤2 antipsychotic medications). Outcomes included patient characteristics, Charlson Comorbity Index (CCI) and healthcare utilization (pre-and post [12-month] period).ResultsCohort sizes and characteristics were: cohort 1 (n=1,887; female, 68%; mean age, 42 years; MDD, 17%; BD, 48%); cohort 2 (n=1,572; female, 58%; mean age, 39 years; MDD, 22%; BD, 48%); cohort 3 (n=25,949; female, 67%; mean age, 40 years; MDD, 11%; BD, 49%). Cohorts 1 and 2 had higher comorbidity burden than cohort 3 (mean pre-index CCIs: 0.68, 0.79, and 0.47, respectively; p<0.001 for each cohort). After 12 months, mean per member per year healthcare costs were higher in cohort 1 and2 compared to cohort 3 ($21,293, $18,988, and $11,522, respectively), as were mean claims per member per year (185, 138, and 109, respectively).ConclusionIn the study population, patients likely suffering from TD, ICD-9/10 code-confirmed or unconfirmed, have a higher overall comorbidity burden and healthcareutilization than those who probably do not have TD.Funding AcknowledgementsThis study was funded by Neurocrine Biosciences, Inc.

scholarly journals 143 Effect of Tardive Dyskinesia on Quality of Life: Patient-Reported Symptom Severity Is Associated With Deficits in Physical, Mental, and Social Functioning

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 89-89
Author(s):  
Joseph McEvoy ◽  
Benjamin Carroll ◽  
Sanjay Gandhi ◽  
Avery Rizio ◽  
Stephen Maher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Tardive Dyskinesia ◽  
Social Withdrawal ◽  
Major Depressive ◽  
Health Burden ◽  
Pharmaceutical Industries

AbstractIntroductionTardive dyskinesia (TD), an often-irreversible movement disorder typically caused by exposure to antipsychotics, most commonly affects the face, mouth, and tongue and may be debilitatingObjectiveTo investigate TD burden on patients’ quality of life and functionalityMethodsAdults with clinician-confirmed schizophrenia, bipolar disorder, or major depressive disorder participated in an observational study. Approximately half (47%) ofparticipants had a clinician-confirmed TD diagnosis. Participants completed the SF-12v2 Health Survey® (SF-12v2), Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF), social withdrawal subscale of the Internalized Stigma of Mental Illness scale (SW-ISMI), and rated the severity of their TD symptoms. Group differences in SF-12v2 physical and mental component summaries (PCS and MCS), Q-LES-Q-SF, and SW-ISMI scores were analyzed.ResultsTD (n=79) and non-TD (n=90) groups were similar in age, gender, and number of patients with schizophrenia, bipolar disorder, and major depressive disorder. TD patients reported significantly worse scores on PCS (P=0.003), Q-LES-Q-SF (P<0.001) and SW-ISMI (P<0.001) than non-TD patients. The difference in PCS exceeded the established minimal clinically important difference (MCID) of 3 points. When stratified by TD severity, those with more severe symptoms had significantly worse Q-LES-Q-SF (P<0.001) and SW-ISMI (P=0.006) scores than those with less severe symptoms. Differences in PCS (P=0.12) and MCS (P=0.89) were in the expected direction and exceeded the MCID.ConclusionsAmong patients with psychiatric disorders, TD is associated with significant physical health burden and incremental mental health burden. TD severity is also associated with lower overall quality of life and greater social withdrawal.Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.Funding AcknowledgementsThis study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.

Abstract 125: Fewer Hospitalizations And Emergency Room Visits With Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor Or Angiotensin-Receptor Blocker In A Retrospective Claims-Based Study Of Patients With Heart Failure

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Nancy M Albert ◽  
Jason P Swindle ◽  
Erin K Buysman ◽  
Chunlan Chang
Keyword(s):  
Failure Probability ◽  
Real World ◽  
Variance Estimation ◽  
Proportional Hazards ◽  
Enzyme Inhibitor ◽  
Healthcare Resource Utilization ◽  
Hospital Facility ◽  
Patients With Heart Failure ◽  
The Impact

Introduction: Among patients with HFrEF, treatment with sacubitril/valsartan (SAC/VAL) was shown in PARADIGM-HF to reduce risks of CV death and HF hospitalization compared with enalapril; however, scarce data exist regarding the impact of SAC/VAL on real-world healthcare resource utilization (HCRU) compared to ACEI or ARB. Objective: To compare HCRU among patients with HFrEF treated with SAC/VAL vs. ACEI or ARB. Methods: Using managed care claims data, we identified stable adults with claims-based proxy for HFrEF and ≥1 claim for SAC/VAL (identified first), ACEI or ARB during Oct 2015 to Jun 2016. We required ≥80% proportion of days covered with SAC/VAL or ACE/ARB for first 3 months post index claim. SAC/VAL and ACEI/ARB cohorts were propensity score matched on demographics, baseline characteristics and length of follow-up. Per patient per month (PPPM) HCRU (ambulatory visit, ER visit and hospitalization) and timing of first hospitalization (including estimated failure probabilities) were calculated during a variable follow-up period (3-12 months). HF hospitalization was identified based on first-listed diagnosis code of HF on a hospital facility claim. Robust variance estimation was used to compare PPPM HCRU between matched cohorts and proportional hazards models (no covariate adjustment) were used to evaluate risk of first hospitalization. Results: With mean (SD) follow-up of 185.0 (70.1) days, 279 patients were identified in each of the SAC/VAL cohort and matched ACEI/ARB cohort (mean [SD] age, 67.9 [12.6] years; 73.5% Medicare Advantage enrollee; 26.5% commercial enrollee; 68.1% male; 56.1% diabetes; 46.1% AF; 46.6% hospitalization in 1 year pre index claim). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, experienced lower mean (SD) PPPM all-cause ER visits (0.10 vs. 0.19, p<.001), all-cause hospitalizations (0.05 vs. 0.11, p<.001) and HF hospitalizations (0.01 vs. 0.03, p=.003), and no difference in all-cause ambulatory visits (3.13 vs. 3.24, p=.608). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, had reduced risk of first all-cause hospitalization (hazard ratio [HR]: 0.57, 95% CI: 0.42-0.77, p<.001; estimated failure probability: 1.8% and 6.5% at 1 month, 11.1% and 21.9% at 3 months, 20.7% and 33.1% at 6 months) and first HF hospitalization (HR: 0.56, 95% CI: 0.33-0.94, p=.030; estimated failure probability: 0.7% and 2.2% at 1 month, 3.2% and 8.6% at 3 months, 9.2% and 13.3% at 6 months). Conclusions: Based on a real-world sample of patients with HFrEF, those initiated with SAC/VAL ≤12 months following US market approval experienced fewer monthly hospitalizations and ER visits compared to ACEI/ARB, and no difference in ambulatory visits. Lower risk of hospitalization after initiating SAC/VAL, rather than using ACEI/ARB, is important since HF hospitalization was previously associated with higher 30-60 day mortality and readmission rate.

scholarly journals The Impact of an Online Psychiatric Assessment on the Mental Health and Wellbeing of Participants Presenting with Depressive Symptoms: Longitudinal Observational Study (Preprint)

2020 ◽  
Author(s):  
Dan-Mircea Mirea ◽  
Nayra A Martin-Key ◽  
Giles Barton-Owen ◽  
Tony Olmert ◽  
Jason D Cooper ◽  
...  
Keyword(s):  
Mental Health ◽  
Subjective Wellbeing ◽  
Health Assessment ◽  
Mental Wellbeing ◽  
Health And Wellbeing ◽  
Mental Health Assessment ◽  
Psychiatric Conditions ◽  
Study Participants ◽  
The Impact

BACKGROUND Online assessments of mental health concerns hold great potential for earlier, more cost-effective and more accurate diagnosis of psychiatric conditions compared to traditional interview-based methods. OBJECTIVE To assess the impact of a comprehensive online mental health assessment on mental health and wellbeing in over 2000 individuals presenting with symptoms of depression. METHODS Participants presenting with depressive symptoms at baseline completed an online assessment which screened for mood and other psychiatric conditions. After completing the assessment, participants received a report containing their assessment results and personalised psychoeducation. After 6 and 12 months, participants were asked to rate the usefulness of the online assessment on different mental health-related outcomes, as well as to self-report on their recent help-seeking behaviour, diagnosis, medication and lifestyle changes. Additionally, general mental wellbeing was assessed at baseline and both follow-ups using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). RESULTS Data from all participants who completed either the 6-months or the 12-months follow-up (N=2064) were analysed. The majority of study participants rated the study as useful for their subjective mental wellbeing. This included talking more openly (68%) and understanding one’s mental health problems better (56%). While most participants (76%) found their assessment results useful, only a small proportion (15%) subsequently discussed them with a mental health professional, leading to only a small number of study participants receiving a new diagnosis (5%). Among those who were reviewed, new mood disorder diagnoses were predicted by the digital algorithm with high sensitivity (above 70%), and nearly half of the newly-diagnosed participants also had a corresponding change in medication. Furthermore, participants’ subjective wellbeing significantly improved over 12 months (baseline WEMWBS score: M=35.24, SD=8.11; 12-months WEMWBS score: M=41.19, SD=10.59). Significant positive predictors of follow-up subjective wellbeing included talking more openly, exercising more and having been reviewed by a psychiatrist. CONCLUSIONS Our results suggest that completing an online mental health assessment and receiving personalised psychoeducation is associated with subjective mental health improvements, facilitated by increased self-awareness and subsequent utilisation of self-help interventions. Integrating online mental health assessments within primary and/or secondary care services could benefit patients further and expedite earlier diagnosis and effective treatment. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT RR2-10.2196/18453

In the Shadow of Adversity: the Evolution and Resolution of Anxiety and Depressive Disorder

1995 ◽  
Vol 166 (5) ◽  
pp. 583-594 ◽  
Author(s):  
P. G. Surtees
Keyword(s):  
Anxiety Disorder ◽  
Depressive Disorder ◽  
Major Depressive ◽  
Initial Interview ◽  
Marital Partner ◽  
Psychiatric Status ◽  
Adverse Experiences ◽  
Psychiatric Conditions ◽  
Advance Knowledge

BackgroundIt was proposed to explore the longitudinal relationship between adverse experience and mental health; in particular, whether particular adverse experiences influence the form of subsequent expression of morbidity.MethodThree groups of women were selected: 64 whose marital partner had recently died, 143 whose husbands had recently experienced a myocardial infarction and a third group of 32 women who had sought protection in a Women's Aid refuge. An initial interview assessed psychiatric status according to the RDC for the six months before the event and up to the time of interview, and a second interview was completed four months after the event had occurred. The course was assessed using the Longitudinal Interval Follow-up Evaluation.ResultsFor the coronary group, the prevalence of psychiatric disorder doubled following the experience of the event, and was most pronounced for anxiety disorder. For the bereaved, rates increased over eight times for major depressive disorder and more than twice for anxiety disorder, following the loss; for the refuge group, prevalence rates were lower after entering the refuge than those before. Analyses that took account of the timing of the onset of disorders showed that in almost half of those experienced by the coronary group, and about 40% of the bereaved group, onset pre-dated the timing of the event.ConclusionsThe results further advance knowledge of the evolution and form of psychiatric conditions following the experience of severe adversity.

Evaluating the impact of survivorship models on health system resources and costs.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 1-1
Author(s):  
Nicole Mittmann ◽  
Hasmik Beglaryan ◽  
Ning Liu ◽  
Soo Jin Seung ◽  
Farah Rahman ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Healthcare Resource Utilization ◽  
Primary Study ◽  
X Rays ◽  
Health Care Environment ◽  
System Utilization ◽  
System Resources ◽  
The Impact

1 Background: The provincial cancer agency in Ontario developed and implemented a model of care (MOC) for breast cancer (BC) survivors to transition from oncology-lead care to primary care in a publically funded health care environment (2010-2013). Transition options included direct to primary care and stepped transition. The objective of our study was to examine the health system resources used by the women in the MOC group and compare them to those used by women who did not transition. Methods: A propensity score matched, quasi-experimental approach was used to compare the healthcare resource utilization and costs between BC survivors in the MOC program (case) and those receiving usual care (control). All MOC cases were linked using unique identifiers and linked into the provincial health system databases. Cases and controls were matched 1:1 on year of diagnosis and location of care and were followed from an index date to the earliest of her death date, date of last contact in the database, one day before another cancer diagnosis or the end of study available databases. The primary study outcome was overall health system utilization and mean cost during the follow-up period. Results: There were 2324 women in the MOC program. Demographic information (age, region, stage) were well balanced between cases and controls. Transitioned cases had lower hospitalizations (20.1% vs. 24.4%, p<0.05), fewer cancer clinic visits (6.0% vs. 15.1%, p<0.05), fewer medical oncologist visits (0.39 vs. 1.29, p<0.05) and fewer diagnostics (CT, MRI, ultrasound, x-rays) over an average of 25 months of follow-up. There was a trend for fewer family practice (7.35 vs. 7.91, p=0.08) and internal medical and hematology visits (0.81 vs. 1.03, p=0.08). Annual emergency visits were similar between the two groups (0.76 vs. 0.82, p=0.2). There was a $4300 (2012 $CAN) difference in the mean annual cost between cases and controls. Conclusions: Survivors in the MOC transition program used fewer health system resources and had lower health system costs when compared to controls. These findings provide real world evidence to inform transition policies for cancer survivors.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Coexistent Osteoarthritis and Parkinson’s Disease: Data from the Parkinson’s Foundation Outcomes Project

2020 ◽  
Vol 10 (4) ◽  
pp. 1601-1610
Author(s):  
Jaimie A. Roper ◽  
Abigail C. Schmitt ◽  
Hanzhi Gao ◽  
Ying He ◽  
Samuel Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Study Data ◽  
Functional Mobility ◽  
Quality Improvement Initiative ◽  
Timed Up And Go ◽  
Mobility Performance ◽  
Risk Of Mortality ◽  
The Impact

Background: The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson’s disease is unknown. Objective: We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson’s disease. Methods: In a retrospective observational longitudinal study, data from the Parkinson’s Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson’s disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. Results: More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson’s disease seem to additively increase the risk of mortality (p = 0.007). Conclusion: Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson’s disease.

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