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Progression, Prognostic Factors, and...

Lee, Tsung-Ying,

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Progression, Prognostic Factors, and Economic Costs of Loss of Independence in Parkinson Disease /

Record Type:	Electronic resources : Monograph/item
Title/Author:	Progression, Prognostic Factors, and Economic Costs of Loss of Independence in Parkinson Disease // Tsung-Ying Lee.
Author:	Lee, Tsung-Ying,
Description:	1 electronic resource (132 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 85-12, Section: B.
Contained By:	Dissertations Abstracts International85-12B.
Subject:	Pharmaceutical sciences. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30991594
ISBN:	9798383177532

Progression, Prognostic Factors, and Economic Costs of Loss of Independence in Parkinson Disease /
Lee, Tsung-Ying,

Progression, Prognostic Factors, and Economic Costs of Loss of Independence in Parkinson Disease /Tsung-Ying Lee. - 1 electronic resource (132 pages)

Source: Dissertations Abstracts International, Volume: 85-12, Section: B.

Introduction: Parkinson disease (PD) is a neurodegenerative disorder causing disability and loss of independence (LOI), impacting patients and families. The longitudinal patterns of LOI in PD, prognostic factors predicting LOI in different types of activities of daily living (ADLs), and costs associated with functional dependency (FD) in PD remain unclear.Methods: We used 2003-2020 data from a prospective PD cohort at a tertiary neurologic center. Disability with LOI was assessed using the modified Older Americans Resource and Services Daily Function Questionnaire at baseline and follow-up. Patterns of LOI were summarized using EventFlow data visualization software. Cox proportional hazards models identified prognostic factors for LOI on different types of ADLs. Costs borne by patients with PD (PWP) and their families were analyzed using 2018-2019 Financial and Social Impact of Parkinson's Disease Survey data. We estimated the incremental costs comparing families of PWP with and without FD using generalized linear models.Results: Among 270 early-stage PD patients, 133 (45%) developed LOI on one or more ADL, where 57 regained independence at least once. Housework was the most frequent first ADL requiring help (mean time 4.6 years post-first visit). Longitudinal patterns of loss included transient and persistent loss. Strongest associations were dyskinesia (adjusted hazard ratios [aHR], 1.82; 95% CI, 1.12-2.96) for LOI on any ADL; falls (aHR, 1.72; 95% CI, 1.16-2.55) for basic ADLs (BADLs); gait impairment (aHR, 2.04; 95% CI, 1.43-2.91) and dyskinesia (aHR, 2.09; 95% CI, 1.29-3.37) for instrumental ADLs (IADLs); and dyskinesia (aHR, 1.68; 95% CI, 1.05-2.68) for walking. Compared to families of PWP without FD (n=882), families of PWP with FD (n=476) faced higher direct non-medical costs (adjusted average marginal effect [aAME], $3,438; 95% CI, $1,719-$5,157) and indirect costs (aAME, $11,479; 95% CI, $1,545-$21,413).Conclusion: This study provides novel information about LOI patterns in PD and the fluctuations in patients' functioning in daily tasks. We identified factors (e.g., dyskinesia and gait impairment) with varying impacts on BADLs and IADLs. The study quantifies the financial strain on families of PWP with FD, underscoring the need for interventions to delay or prevent LOI in PD.

English

ISBN: 9798383177532Subjects--Topical Terms:

3173021
Pharmaceutical sciences.
Subjects--Index Terms:

Clinical outcome assessments

Progression, Prognostic Factors, and Economic Costs of Loss of Independence in Parkinson Disease /
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245 1 0 $a Progression, Prognostic Factors, and Economic Costs of Loss of Independence in Parkinson Disease / $c Tsung-Ying Lee.
264 1 $a Ann Arbor : $b ProQuest Dissertations & Theses, $c 2024
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500 $a Source: Dissertations Abstracts International, Volume: 85-12, Section: B.
500 $a Advisors: Onukwugha, Eberechukwu Committee members: Slejko, Julia; Gopalakrishnan, Mathangi; Shulman, Lisa; Gruber-Baldini, Ann.
502 $b Ph.D. $c University of Maryland, Baltimore $d 2024.
520 $a Introduction: Parkinson disease (PD) is a neurodegenerative disorder causing disability and loss of independence (LOI), impacting patients and families. The longitudinal patterns of LOI in PD, prognostic factors predicting LOI in different types of activities of daily living (ADLs), and costs associated with functional dependency (FD) in PD remain unclear.Methods: We used 2003-2020 data from a prospective PD cohort at a tertiary neurologic center. Disability with LOI was assessed using the modified Older Americans Resource and Services Daily Function Questionnaire at baseline and follow-up. Patterns of LOI were summarized using EventFlow data visualization software. Cox proportional hazards models identified prognostic factors for LOI on different types of ADLs. Costs borne by patients with PD (PWP) and their families were analyzed using 2018-2019 Financial and Social Impact of Parkinson's Disease Survey data. We estimated the incremental costs comparing families of PWP with and without FD using generalized linear models.Results: Among 270 early-stage PD patients, 133 (45%) developed LOI on one or more ADL, where 57 regained independence at least once. Housework was the most frequent first ADL requiring help (mean time 4.6 years post-first visit). Longitudinal patterns of loss included transient and persistent loss. Strongest associations were dyskinesia (adjusted hazard ratios [aHR], 1.82; 95% CI, 1.12-2.96) for LOI on any ADL; falls (aHR, 1.72; 95% CI, 1.16-2.55) for basic ADLs (BADLs); gait impairment (aHR, 2.04; 95% CI, 1.43-2.91) and dyskinesia (aHR, 2.09; 95% CI, 1.29-3.37) for instrumental ADLs (IADLs); and dyskinesia (aHR, 1.68; 95% CI, 1.05-2.68) for walking. Compared to families of PWP without FD (n=882), families of PWP with FD (n=476) faced higher direct non-medical costs (adjusted average marginal effect [aAME], $3,438; 95% CI, $1,719-$5,157) and indirect costs (aAME, $11,479; 95% CI, $1,545-$21,413).Conclusion: This study provides novel information about LOI patterns in PD and the fluctuations in patients' functioning in daily tasks. We identified factors (e.g., dyskinesia and gait impairment) with varying impacts on BADLs and IADLs. The study quantifies the financial strain on families of PWP with FD, underscoring the need for interventions to delay or prevent LOI in PD.
546 $a English
590 $a School code: 0373
650 4 $a Pharmaceutical sciences. $3 3173021
650 4 $a Neurosciences. $3 588700
653 $a Clinical outcome assessments
653 $a Data visualization
653 $a Economic impact on families
653 $a Loss of independence
653 $a Parkinson disease
653 $a Prognostic factors
690 $a 0572
690 $a 0317
690 $a 0769
710 2 $a University of Maryland, Baltimore. $b Pharmaceutical Health Services Research. $e degree granting institution. $3 3829419
720 1 $a Onukwugha, Eberechukwu $e degree supervisor.
773 0 $t Dissertations Abstracts International $g 85-12B.
790 $a 0373
791 $a Ph.D.
792 $a 2024
856 4 0 $u https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30991594