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a Department of
Neurology, Central Hospital of Rogaland, Postbox 8100, N-4003
Stavanger, Norway, b Department of Psychiatry
Correspondence to: Professor Jan P Larsen
Received 26 April 1999 and in revised form 24 May 2000;
Accepted 2 June 2000
OBJECTIVES
To examine
the change over time in health related quality of life (HRQL) in a
community based cohort of patients with Parkinson's disease.
METHODSOne hundred
and eleven patients were evaluated for HRQL in 1993 and then again in a
follow up study 4 years later. The patients included in the study in
1993 were derived from a prevalence study of patients with Parkinson's
disease in the county of Rogaland, Norway. The HRQL was measured by the
Nottingham health profile (NHP). At both evaluations clinical and
demographic variables were determined during semistructured interviews
and by clinical examinations by a neurologist.
RESULTSDuring the 4 year follow up period there was a significant increase in NHP scores,
reflecting a decreased HRQL, in the dimensions of physical mobility,
emotional reactions, pain, and social isolation. In the same time
period mean total NHP score increased from 120.0 (SD 102.6) to 176.0 (SD 119.4) (p<0.01). There were no clinical or demographic factors
found in 1993 that identified patients at higher risk for developing
decreased HRQL. Increased UPDRS score (unified Parkinson's disease
rating scale) and Hoehn and Yahr stage during the 4 year study period
correlated with increased NHP scores. Even though there was no increase
in depressive symptoms or self reported insomnia, these symptoms,
together with lower Schwab and England score, were the most important
factors for a poor HRQL in 1997.
CONCLUSIONSParkinson's
disease has a substantial impact on HRQL. Despite modern care, we found
a significantly increased distress during the 4 year follow up period.
Increased parkinsonism, measured by UPDRS and Hoehn and Yahr stage,
correlated with increased stress, not only in the dimension of physical
mobility, but also in the areas of pain, social isolation, and
emotional reactions. In addition to the clinical examination, HRQL
scoring provides valuable information on the total health burden of
Parkinson's disease in both cross sectional and longitudinal
evaluations, and contributes to a more comprehensive picture of the
total disease impact.
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