Showing papers by "Bastiaan R. Bloem published in 2018"

The Parkinson Pandemic-A Call to Action

Abstract: Pandemics are usually equated with infectious diseases such as Zika, influenza, and HIV. However, an imminent noninfectious pandemic, Parkinson disease (PD), requires immediate action. Neurological disorders are now the leading cause of disability in the world.1 Among these neurological disorders, the fastest growing is PD, whose growth is surpassing that of Alzheimer disease.1 From 1990 to 2015, the prevalence of, and thus disability and deaths owing to, PD more than doubled.1 The Global Burden of Disease Study estimates that 6.2 million individuals currently have PD. Because the incidence of PD increases sharply with age and because the world’s population is aging, the number of individuals affected is poised for exponential growth (Figure). Conservatively applying worldwide prevalence data from a 2014 meta-analysis2 to projections of the world’s future population,3 the number of people with PD will double from 6.9 million in 2015 to 14.2 million in 2040. Applying this same growth rate to the lower estimate by the Global Burden of Disease study (6.2 million in 2015) projects to a staggering 12.9 million affected by 2040. All these estimates likely understate the true prevalence of PD. The future burden will probably be higher owing to underreporting (record-based studies miss many who have not been diagnosed), declining smoking rates (smoking is associated with a 50% decreased risk of PD), and increasing longevity. Regardless of the exact numbers, if PD were an infectious condition, it would rightly be called a pandemic.4 To address this pandemic, the PD community should follow the efforts of the HIV community as detailed in David France’s book How to Survive a Plague.5 In just 15 years, the affected community took what was initially an unknown and rapidly fatal illness and transformed it into one that was highly treatable, allowing millions of individuals around the world to live long, healthy lives. France outlines at least 4 efforts that should be applied to PD.

Intensive inpatient rehabilitation for persons with Parkinson's disease: last resort or pre-emptive strike?

Abstract: Parkinson’s disease (PD) is a complex neurodegenerative disorder with a wide variety of motor and non-motor symptoms. Optimal management involves a multidisciplinary approach, combining pharmacotherapy and non-pharmacological interventions. Evidence for several non-pharmacological interventions, such as physiotherapy, is growing fast.1 However, it is unclear whether combining these monodisciplinary interventions into a bundled multidisciplinary team approach offers additional benefits and at what costs. Even less is known about how such multidisciplinary care should be organised, for example, on an outpatient basis (perhaps in the community) or using intensive inpatient rehabilitation. In their JNNP paper, Ferrazzoli and colleagues2 describe their experience with the latter approach. Specifically, using a single-blind randomised controlled trial, they evaluated whether an intensive 4-week multidisciplinary and inpatient rehabilitation programme improved quality of life (QoL, measured with the PDQ-39) in persons with PD. Using a somewhat odd (pragmatically dictated) 4:1 ratio, patients were allocated to this rehabilitation programme (n=186) or a waiting list without rehabilitation (n=48). Treatment included daily sessions of physiotherapy, occupational therapy, speech-language therapy and balance/gait training. Each patient received a personalised approach, tailored to their specific …