Showing papers by "Anne M. Stiggelbout published in 2007"

Patient-reported autonomic symptoms in Parkinson disease.

Abstract: Objective: There is a wide range of autonomic symptoms (AS) in Parkinson disease (PD), but the full spectrum has never been evaluated with a validated instrument and in comparison with control subjects. In this study a reliable and valid instrument, the SCOPA–AUT, was used to evaluate the occurrence of AS in a large cohort of patients with PD and control subjects and to assess the relations with demographic, disease-related, and clinical variables. Methods: A cohort of 420 patients with PD was evaluated for the occurrence of AS, motor and nonmotor symptoms, as well as for demographic and disease-related characteristics. Results were compared with those of 150 control subjects. Associations between AS and demographic and clinical characteristics were also studied. Results: For all autonomic domains, patients with PD reported more symptoms compared to control subjects, with the greatest differences in the gastrointestinal and urinary domain. Higher age, greater disease severity, and higher doses of dopaminergic medication were related to more autonomic problems. Autonomic symptom severity was associated with more motor dysfunction, depressive symptoms, cognitive dysfunction, psychiatric complications, nighttime sleep disturbances, and excessive daytime sleepiness (all p values Conclusions: Autonomic symptoms (AS) are an important feature of Parkinson disease (PD) and increase with age, disease severity, and medication use. The prominent presence of AS warrants increased clinical awareness and highlights the need for efficacious therapies for the wide spectrum of problems related to this domain of PD.

Cognitive impairment in Parkinson’s disease

Abstract: Background: Cognitive impairment plays a role in Parkinson’s disease (PD) and has important consequences for patient management. However, many aspects of cognitive impairment in PD remain unclear because of the use of different and often invalid measurement instruments. In this study, a reliable and valid instrument, the SCales for Outcomes in PArkinson’s disease-COGnition (SCOPA-COG), was used. Aim: To evaluate cognitive functioning in a large cohort of patients with Parkinson’s disease and to assess the relations with demographic, disease related and clinical variables. Methods: A cohort of 400 patients with PD was evaluated for cognition, motor and non-motor domains, as well as for demographic and disease related characteristics. Results were compared with 150 controls matched for overall age, sex and education distribution. Results: Patients with PD scored significantly lower on all cognitive subdomains compared with controls, with the largest differences for executive functioning and memory. After correction for age and years of education, 22% of patients had impaired cognition, as measured by the total SCOPA-COG score, compared with controls. Across all patients, more severe cognitive impairment was associated with significantly more impairment in motor, autonomic, depressive and psychotic domains. Patients with the postural instability gait difficulty (PIGD) dominant phenotype showed more cognitive impairment compared with patients with the tremor dominant phenotype. Contrary to tremor scores, PIGD scores significantly worsened with increasing disease severity. Conclusions: Cognition is an important domain of the clinical spectrum of PD and poorer cognitive performance is associated with greater impairment in motor and non-motor domains in PD. The difference in cognitive scores between PIGD dominant patients and tremor dominant patients likely reflects more advanced disease.

Assessment of psychiatric complications in Parkinson's disease: The SCOPA-PC.

Abstract: The objective of this study was to develop a clinimetric sound scale that addresses both psychotic and compulsive complications in Parkinson's disease (PD). The SCales for Outcomes in PArkinson's disease-Psychiatric Complications (SCOPA-PC) was developed by modifying the items of the Parkinson Psychosis Rating Scale (PPRS) and including an item on compulsive behavior in PD. To evaluate the validity of the SCOPA-PC, 106 PD patients were assessed. A subsample of 43 patients was assessed for interrater and test-retest reliability. Construct validity was evaluated using the Neuropsychiatric Inventory (NPI) and the South Oaks Gambling Scale (SOGS). Interrater and test-retest reliability for the total score was 0.95 and 0.91 (intraclass correlation coefficient), respectively. For the items, the interrater reliability ranged from 0.62 to 0.96 (weighted kappa) and the test-retest reliability ranged from 0.54 to 0.88 (weighted kappa). Cronbach's alpha was 0.68. The correlation between the SCOPA-PC total score and the NPI was 0.41. The correlation between SCOPA-PC items and NPI items that addressed similar constructs ranged from 0.34 to 0.68, whereas the correlation between the item on compulsive behavior and the SOGS was 0.49. In conclusion, the SCOPA-PC is a reliable, valid, and easily-administered semistructured questionnaire for both psychotic and compulsive complications in PD.

Cochlear Implant Outcomes and Quality of Life in Adults with Prelingual Deafness

Abstract: Objectives: To evaluate sound and speech perception and quality of life in prelingually deafened adults implanted with state of the art devices. To investigate which patient factors influence postoperative performance. Study Design: Prospective intervention study. Methods: Eight prelingually deafened subjects (with onset of severe hearing impairment before the age of 4 years and functioning in an oral-aural setting) participated in this study. Subjects were implanted at a mean age of 36 (range, 21–55) years with a CII or 90 K cochlear implant (Advanced Bionics Corp.). All subjects completed standard speech perception tests as well as quality of life measures (Health Utility Index Mark-II, Nijmegen Cochlear Implant Questionnaire, visual analogue scale for subject's hearing and health) at different points in time. Postoperative scores were compared with each other and with the baseline preoperative scores. The relationship between nine patient variables and the postoperative consonant-vowel-consonant (CVC) phoneme score was also investigated. Results: Significant improvement was measured for CVC word and phoneme scores and several quality of life measures. Postoperative speech perception correlated with a new and promising factor named quality of a patient's own speech production (QoSP). Conclusion: With state of the art implants, speech perception and quality of life do improve in prelingually deafened adults. More importantly, the prognostic value of QoSP should be investigated further.

Benefit from preoperative radiotherapy in rectal cancer treatment: disease-free patients' and oncologists' preferences.

Abstract: Preoperative radiotherapy (PRT) in resectable rectal cancer improves local control but increases probability of faecal incontinence and sexual dysfunction. Consensus was reached in 2001 in the Netherlands on a guideline advising PRT to new patients. Purpose was to assess at what benefit oncologists and rectal cancer patients prefer PRT followed by surgery to surgery alone, and how oncologists and patients value various treatment outcomes. Sixty-six disease-free patients and 60 oncologists (surgical, radiation, medical) were interviewed. Minimally desired benefit from PRT (local control) was assessed using the Treatment Tradeoff Method. Importance of survival, local control, faecal incontinence, and sexual dysfunction in determining treatment outcome preferences was assessed using Adaptive Conjoint Analysis. The range of required benefit from PRT varied widely within participant groups. Seventeen percent of patients would choose PRT at a 0% benefit; 11% would not choose PRT for the maximum benefit of 11%. Mean minimally desired benefit excluding these two groups was 4%. For oncologists, the required benefit was 5%. Also, how strongly participants valued treatment outcomes varied widely within groups. Of the four outcomes, participants considered incontinence most often as most important. Relative treatment outcome importance differed between specialties. Patients considered sexual functioning more important than oncologists. Large differences in treatment preferences exist between individual patients and oncologists. Oncologists should adequately inform their patients about the risks and benefits of PRT, and elicit patient preferences regarding treatment outcomes.

How important is the opinion of significant others to cancer patients’ adjuvant chemotherapy decision-making?

Abstract: Decisions regarding adjuvant chemotherapy are difficult, since value tradeoffs are involved. Little is known about the importance of the significant others in patients’ decision-making regarding adjuvant treatment. We surveyed patients with breast and colorectal cancer about the importance they assigned to the opinions of their significant others and assessed correlates of these importance scores. One hundred and twenty-three patients rated on a five-point scale how much they cared about the opinion of six significant others. Most important was the opinion of their treating specialist, followed by that of their partner, children, other family, friends, and colleagues. Women assigned higher scores to the opinion of their children, younger patients to that of their specialist, and patients who were about to undergo chemotherapy to that of their family. Patients with breast cancer and patients without paid employment assigned slightly more importance to the opinion of their partner. Information on the influence of significant others may help clinicians when involving patients in treatment decision-making and discussing patients’ treatment preferences.

Development and Validation of the Pelvic Floor Inventories Leiden (PelFIs)

Abstract: AIMS To evaluate the validity and reliability in Dutch of the Pelvic Floor Inventories Leiden (PelFIs) for men and women, an administered questionnaire, developed to create a condition-specific pelvic floor questionnaire addressing all symptoms of micturition, defecation and sexual dysfunction related to pelvic floor dysfunction. METHODS The PelFIs is an 83-item instrument for women and 76-item instrument for men measuring the degree of pelvic floor dysfunction, containing nine different domains. Questions have been selected which, from a clinical point of view, should configure a domain. The PelFIs was administered to healthy volunteers (N = 120), and to patients (N = 100). Reliability of the PelFIs was assessed by internal consistency and test-retest reliability. Construct validity was established comparing healthy volunteers and patients by intercorrelating the domains. RESULTS A total of 220 questionnaires were completed; by 147 women and 73 men. Some domains in the men's questionnaire had a low alpha (alpha) although the overall alpha was good. The overall of the domains for men ranged from 0.53 to 0.90. The internal consistency for the total scale of men's questionnaire was 0.84. The overall of the domains in women ranged from 0.60 to 0.85. The internal consistency of the women's questionnaire was 0.88 for the total scale. Intraclass correlation ranged from 0.65 to 0.88. Differences between healthy volunteers and patients were statistically significant for all domains. CONCLUSION The PelFIs is a new, practical and conceptually clear questionnaire, which focus on micturition, defecation and/or sexual dysfunction related to pelvic floor dysfunction.

Stability of preferences with regard to adjuvant chemotherapy: impact of treatment decision, experience and the passing of time.

Abstract: Research has shown that patients' preferences for adjuvant chemotherapy do not change as a result of experience. However, the preferences of experienced patients are usually more favourable than those of inexperienced patients. These results indicate a shift in preferences after the decision to proceed with adjuvant chemotherapy has been made, but before actual experience. We tested this assumption in early-stage breast and colorectal cancer patients. We asked patients to provide their preferences for chemotherapy before surgery and thus before they knew whether chemotherapy would be advised (T(1)), after surgery but before the start of chemotherapy (T(2)) and about 1 month after chemotherapy (T(3)). Patients who did not undergo chemotherapy co-operated at similar points in time. Preferences were measured on a nine-point scale, ranging from (1) 'very strong preference for no chemotherapy' to (9) 'very strong preference for chemotherapy'. As hypothesized, the preferences of patients who would be treated with chemotherapy became more favourable after the treatment decision had been made (n = 7, P = 0.06). The preferences of patients for whom chemotherapy was not part of the treatment plan showed the opposite effect (n = 38, P = 0.03). We did not find any effect of experiencing treatment (n = 22, P = 0.62) or the passing of time (n = 81, P = 0.25) on the stability of preferences. We conclude that the frequently observed discrepancy in treatment preferences between experienced and inexperienced patients seems to be an effect of the treatment decision and not of experience of the treatment.