Abstract P721: Parkinson’s Disease Patients With Ischemic Stroke Have Shorter Hospital Stay Compared to Those Without Parkinson’s Disease: A National Inpatient Sample Study 1998-2017

Introduction: A paucity of studies exists about the influence of Parkinson’s Disease (PD) in the length of stay (LOS) among patients admitted with acute ischemic stroke (AIS). We seek to identify if a prior history of PD impacts the LOS of AIS patients, and to establish the factors associated it. Methodology: We analyzed data of the NIS from the Healthcare Cost and Utilization Project (HCUP) from 1998 to 2017, using a negative binomial regression to assess sociodemographic factors and hospital characteristics associated with LOS in AIS patients with PD. Results: A total of 835,380,672 hospitalizations were identified with discharge diagnosis of AIS. The cohort was divided into 2 groups based on presence of history of PD during the same admission. 12,799,437 of AIS patients had discharge records with a secondary diagnosis of PD. Non-Parkinson’s disease cohort had longer hospital stay (Incidence Rate Ratio IRR 1.02 (95% CI 1.01-1.03). An increased LOS was observed in males compared to females (IRR 1.03 (1.00-1.03)); Black (IRR 1.17 (95% CI 1.16-1.18)), Hispanics (IRR 1.13 (95% CI 1.11-1.14)) and Asians (IRR 1.22 (95% CI 1.19-1.26)) when compared to whites, Medicaid when compared to Medicare (IRR 1.37 (95% CI 1.34-1.41)). Higher Elixhauser index corresponded to longer LOS (IRR 1.14 (CI 1-14-1.14)). In terms of hospital factors, Urban teaching hospital was associated with longer LOS when compared to rural hospital (IRR 1.18 (95% CI 1.16-1.19)), Northeast compared to West region hospital areas (IRR 1.3 (95% CI 1.27-1.33)). Decreasing LOS was seen over the course of last 20 years. Conclusion: Admission for ischemic stroke tended to result in longer length of stay among non-Parkinson’s patients. Patient characteristics are a greater source of variability in length of stay than Parkinson’s disease status.

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Effects of dopaminergic depletion and brain atrophy on neuropsychiatric symptoms in de novo Parkinson’s disease

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-316075 ◽

2017 ◽

Vol 89 (2) ◽

pp. 197-204 ◽

Cited By ~ 6

Author(s):

Byoung Seok Ye ◽

Seun Jeon ◽

Sohoon Yoon ◽

Seong Woo Kang ◽

KyoungWon Baik ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Brain Atrophy ◽

Negative Binomial ◽

De Novo ◽

Neuropsychiatric Symptoms ◽

Brain Mri ◽

Negative Binomial Regression ◽

Cortical Thinning ◽

Positron Emission

BackgroundNeuropsychiatric symptoms impact the patients’ quality of life and caregivers’ burdens in Parkinson’s disease (PD). We aimed to investigate the effects of striatal dopaminergic depletion and brain atrophy on the neuropsychiatric symptoms of patients with PD.MethodsTwo hundred and seven patients with de novo drug-naïve PD underwent dopamine transporter (DAT) positron emission tomography and brain MRI scanning. In addition, the patients were assessed with caregiver-administered neuropsychiatric inventory (NPI) questionnaires. To evaluate the effects of DAT uptake, subcortical volume and cortical thinning on the patients’ neuropsychiatric symptoms, we performed logistic regression and negative binomial regression analyses on the NPI data after controlling for possible confounders.ResultsFrontal cortical thinning was associated with the presence of nighttime behaviour and irritability, and the thinning correlated with the severity of the nighttime behaviour. Temporal cortical thinning was associated with the presence of aggression/agitation, and it correlated with the severity of the aggression/agitation. Subcortical atrophy in the accumbens was associated with the presence of disinhibition and correlated with the severity of the disinhibition. Putamen atrophy and insular thinning were independently associated with the presence of apathy, but only insular thinning correlated with the severity of the apathy. Of the predictors, only frontal cortical thinning correlated with the total NPI score.ConclusionsThe results of this study suggested that accumbens atrophy and frontotemporal cortical thinning, especially frontal cortical thinning, independently contributed to neuropsychiatric symptoms in patients with PD, while DAT uptake did not affect the neuropsychiatric symptoms.

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Association of fall risk factors and non-motor symptoms in patients with early Parkinson’s disease

Scientific Reports ◽

10.1038/s41598-021-84720-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kyum-Yil Kwon ◽

Suyeon Park ◽

Eun Ji Lee ◽

Mina Lee ◽

Hyunjin Ju

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Freezing Of Gait ◽

Prior History ◽

Motor Symptoms ◽

Related Factors ◽

Related Risk ◽

History Of ◽

Non Motor Symptoms

AbstractThe association of non-motor symptoms (NMSs) with fall-related factors in patients with Parkinson’s disease (PD) remains to be further elucidated in the early stages of the disease. Eighty-six patients with less than 5 years of the onset of PD were retrospectively enrolled in the study. We assessed potential fall-related risk factors including (1) a history of falls during the past year (faller versus non-faller), (2) the fear of falling (FoF), and (3) the freezing of gait (FoG). Different types of NMSs were measured using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Parkinson’s disease Fatigue Scale (PFS), and the Scales for Outcomes in Parkinson’s disease—Autonomic dysfunction (SCOPA-AUT). The faller group (37.2%) showed higher scores for BDI, BAI, PFS, and SCOPA-AUT, compared to the non-faller group. From logistic regression analyses, the prior history of falls was related to the gastrointestinal domain of SCOPA-AUT, FoF was associated with BAI, and gastrointestinal and urinary domains of SCOPA-AUT, and FoG was linked to BAI and gastrointestinal domain of SCOPA-AUT. In conclusion, we found that fall-related risk factors in patients with early PD were highly connected with gastrointestinal dysautonomia.

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“Familial Parkinson's Disease” – A Case-Control Study of Families

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100021454 ◽

1997 ◽

Vol 24 (2) ◽

pp. 127-132 ◽

Cited By ~ 26

Author(s):

Ryan J. Uitti ◽

Hitoshi Shinotoh ◽

Margo Hayward ◽

Michael Schulzer ◽

Edwin Mak ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Family History ◽

General Population ◽

Prevalence Rate ◽

Positive Family History ◽

Disease Status ◽

Negative Family History ◽

History Of ◽

Second Degree

ABSTRACT:Background:Parkinson's disease (PD) patients frequently report a family history of PD and this may provide etiological clues to PD. It has also been suggested that a report of a negative family history is reliable. We studied the prevalence of PD in relatives of PD patients to assess the reliability of family history and to evaluate possible explanations of “familial PD”(fPD).Methods:81 of 650 (12.5%) PD probands (all PD patients seen at clinic in 4 years) reported a positive family history of PD. Each fPD proband was matched with non-familial PD (nfPD) proband by gender and year of birth. Screening and follow-up questionnaires were mailed to relatives to obtain information concerning pedigree and presence of neurodegenerative disease. Available family members (regardless of disease status) were examined.Results:On examination, 8 persons, said to be “normal” by probands, relatives and themselves, had definite or possible PD (5 fPD, 3 nfPD). The prevalence rate of PD among first and second degree living relatives of probands varied significantly between fPD and nfPD groups (6269/100 000 versus 1190/100 000; p < 0.001). The weighted prevalence (taking into account the proportions of fPD and nfPD within the clinic) was 1822/100 000, a value more than 5 times higher than reported prevalence rates of PD in the general population (p < 0.001). The prevalence rate was greater in first degree relatives than second degree.Conclusions:“Familial parkinsonism” cannot be explained merely by size of or advanced age within families. Significant numbers of previously unrecognized PD patients may be identified despite a “negative” family history. That is, the patient's report of an absence of familial parkinsonism is frequently inaccurate. The prevalence rate in relatives of PD patients appears to be higher than the general population – regardless of the family history reported by a PD patient. We believe our study suggests that genetic influences or early life environmental exposures are likely to be of etiological importance in PD.

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Medication Management Performance in Parkinson’s Disease: Examination of Process Errors

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab004 ◽

2021 ◽

Author(s):

Catherine A Sumida ◽

Francesca V Lopez ◽

Emily J Van Etten ◽

Nicole Whiteley ◽

Raeanne C Moore ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Negative Binomial ◽

Memory Performance ◽

Medication Management ◽

Negative Binomial Regression ◽

Healthy Adults ◽

Neuropsychological Battery ◽

Management Ability ◽

Normal Cognition

Abstract Objective Individuals with Parkinson’s disease (PD) are at risk for increased medication mismanagement, which can lead to worse clinical outcomes. However, the nature of the errors (i.e., undertaking or overtaking medications) contributing to mismanagement and their relationship to cognition in PD is unknown. Therefore, this study sought to examine errors committed on the Medication Management Ability Assessment (MMAA) between PD participants with normal cognition (PD-NC) or mild cognitive impairment (PD-MCI) relative to healthy adults (HA). Method HA (n = 74), PD-NC (n = 102), and PD-MCI (n = 45) participants were administered the MMAA to assess undertaking, overtaking, and overall errors as well as overall performance (total score). Additionally, participants were administered a comprehensive neuropsychological battery from which cognitive composites of Attention, Learning, Memory, Language, Visuospatial, and Executive Functioning were derived. Results Separate negative binomial regression analyses indicated the PD-MCI group performed significantly worse overall on the MMAA (total score) and committed more undertaking and overall errors relative to HA and PD-NC. In the PD-MCI group, poorer MMAA performance was associated with worse delayed memory performance, whereas cognitive performance was not related to MMAA in HA or PC-NC. Conclusion Compared to PD and healthy adults with normal cognition, PD-MCI patients exhibited greater difficulty with medication management, particularly with undertaking medications. Poorer medication management in PD-MCI was associated with worse delayed recall. Thus, PD-MCI patients experiencing memory problems may require additional assistance with their medications. Findings have clinical relevance suggesting that objective measures of medication errors may assist clinicians in identifying PD patients needing adherence strategies.

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Prior history of head trauma in Parkinson's disease

Movement Disorders ◽

10.1002/mds.870060306 ◽

1991 ◽

Vol 6 (3) ◽

pp. 225-229 ◽

Cited By ~ 38

Author(s):

Stewart A. Factor ◽

William J. Weiner

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Head Trauma ◽

Prior History ◽

History Of

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Clinical and Economic Outcomes Associated with Dysphagia in Hospitalized Patients with Parkinson’s Disease

Journal of Parkinson s Disease ◽

10.3233/jpd-212798 ◽

2021 ◽

pp. 1-7

Author(s):

Daniel G. Di Luca ◽

Eric W. McArthur ◽

Allison Willis ◽

Rosemary Martino ◽

Connie Marras

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Length Of Stay ◽

Negative Binomial ◽

Early Recognition ◽

Strong Predictor ◽

Hospitalized Patients ◽

Healthcare Outcomes ◽

Prolonged Length ◽

Rate Ratios

Background: Dysphagia is a frequent complication that may increase morbidity and mortality in Parkinson’s disease (PD). Nevertheless, there is limited data on its objective impact on healthcare outcomes. Objective: To investigate the outcomes associated with dysphagia in hospitalized patients with PD and associated healthcare costs and utilization. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) data from 2004 to 2014. A multivariable regression analysis was adjusted for demographic, and comorbidity variables to examine the association between dysphagia and associated outcomes. Logistic and negative binomial regressions were used to estimate odds or incidence rate ratios for binary and continuous outcomes, respectively. Results: We identified 334,395 non-elective hospitalizations of individuals with PD, being 21,288 (6.36%) associated with dysphagia. Patients with dysphagia had significantly higher odds of negative outcomes, including aspiration pneumonia (AOR 7.55, 95%CI 7.29–7.82), sepsis (AOR 1.91, 95%CI 1.82–2.01), and mechanical ventilation (AOR 2.00, 95%CI 1.86–2.15). For hospitalizations with a dysphagia code, the length of stay was 44%(95%CI 1.43–1.45) longer and inpatient costs 46%higher (95%CI 1.44–1.47) compared to those without dysphagia. Mortality was also substantially increased in individuals with PD and dysphagia (AOR 1.37, 95%CI 1.29–1.46). Conclusion: In hospitalized patients with PD, dysphagia was a strong predictor of adverse clinical outcomes, and associated with substantially prolonged length of stay, higher mortality, and care costs. These results highlight the need for interventions focused on early recognition and prevention of dysphagia to avoid complications and lower costs in PD patients.

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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Hunting for Familial Parkinson’s Disease Mutations in the Post Genome Era

Genes ◽

10.3390/genes12030430 ◽

2021 ◽

Vol 12 (3) ◽

pp. 430

Author(s):

Steven R. Bentley ◽

Ilaria Guella ◽

Holly E. Sherman ◽

Hannah M. Neuendorf ◽

Alex M. Sykes ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Family History ◽

Rare Variants ◽

Strong Family History ◽

Disease Mutations ◽

Whole Exome ◽

History Of ◽

Functional Consequences ◽

Multiplex Families

Parkinson’s disease (PD) is typically sporadic; however, multi-incident families provide a powerful platform to discover novel genetic forms of disease. Their identification supports deciphering molecular processes leading to disease and may inform of new therapeutic targets. The LRRK2 p.G2019S mutation causes PD in 42.5–68% of carriers by the age of 80 years. We hypothesise similarly intermediately penetrant mutations may present in multi-incident families with a generally strong family history of disease. We have analysed six multiplex families for missense variants using whole exome sequencing to find 32 rare heterozygous mutations shared amongst affected members. Included in these mutations was the KCNJ15 p.R28C variant, identified in five affected members of the same family, two elderly unaffected members of the same family, and two unrelated PD cases. Additionally, the SIPA1L1 p.R236Q variant was identified in three related affected members and an unrelated familial case. While the evidence presented here is not sufficient to assign causality to these rare variants, it does provide novel candidates for hypothesis testing in other modestly sized families with a strong family history. Future analysis will include characterisation of functional consequences and assessment of carriers in other familial cases.

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Statistical models for analyzing count data: predictors of length of stay among HIV patients in Portugal using a multilevel model

BMC Health Services Research ◽

10.1186/s12913-021-06389-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmed Nabil Shaaban ◽

Bárbara Peleteiro ◽

Maria Rosario O. Martins

Keyword(s):

Length Of Stay ◽

Regression Model ◽

Random Effects ◽

Count Data ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Comprehensive Approach ◽

Negative Binomial Regression Model ◽

Hiv Patients ◽

Binomial Regression

Abstract Background This study offers a comprehensive approach to precisely analyze the complexly distributed length of stay among HIV admissions in Portugal. Objective To provide an illustration of statistical techniques for analysing count data using longitudinal predictors of length of stay among HIV hospitalizations in Portugal. Method Registered discharges in the Portuguese National Health Service (NHS) facilities Between January 2009 and December 2017, a total of 26,505 classified under Major Diagnostic Category (MDC) created for patients with HIV infection, with HIV/AIDS as a main or secondary cause of admission, were used to predict length of stay among HIV hospitalizations in Portugal. Several strategies were applied to select the best count fit model that includes the Poisson regression model, zero-inflated Poisson, the negative binomial regression model, and zero-inflated negative binomial regression model. A random hospital effects term has been incorporated into the negative binomial model to examine the dependence between observations within the same hospital. A multivariable analysis has been performed to assess the effect of covariates on length of stay. Results The median length of stay in our study was 11 days (interquartile range: 6–22). Statistical comparisons among the count models revealed that the random-effects negative binomial models provided the best fit with observed data. Admissions among males or admissions associated with TB infection, pneumocystis, cytomegalovirus, candidiasis, toxoplasmosis, or mycobacterium disease exhibit a highly significant increase in length of stay. Perfect trends were observed in which a higher number of diagnoses or procedures lead to significantly higher length of stay. The random-effects term included in our model and refers to unexplained factors specific to each hospital revealed obvious differences in quality among the hospitals included in our study. Conclusions This study provides a comprehensive approach to address unique problems associated with the prediction of length of stay among HIV patients in Portugal.

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