Die Entwicklung der gesundheitsbezogenen Lebensqualität von Patienten und Patientinnen mit Morbus Parkinson und deren Einflussfaktoren – die DEMPARK/LANDSCAPE-Studie

Due to an highly populated aging society, a significant increase in chronic diseases will be observed in the healthcare system in future, which will require an adequate care. There will also be an associated increase in neurological and neurodegenerative diseases, such as Parkinson’s disease. Parkinson’s disease is the most common form of neurodegenera-tive diseases, which requires good care and treatment. This includes the very important area of quality of life. The DEMPARK/LANDSCAPE-study is a multi-center, prospective study which has data collection in nine centers, which revolve around specializations in movement disorders, within Germany. The study has the aim of characterizing the natural course of cognitive function in patients with idiopathic Parkinson's syndrome and factors that influ-ence and determine this development. In addition, this study was designed to provide a quality of life assessment of a large cohort during a lengthy period of time. In the DEMPARK/LANDSCAPE study, at a baseline, the 711 participants who were suf-fering from idiopathic Parkinson's syndrome were recruited and accompanied in annual visits over a total period of 72 months. During these visits, data was collected in the re-spective centers using standardized questionnaires. Subsequently, a neuropsychological, neurological and physical examination was performed and then the demographic status was assessed. Throughout the evaluation of the disease many things were tracked. For describing the patient’s characteristics and the psychological status, the Mini Mental Sta-tus Examination, the Parkinson Neuropsychometric Dementia Assessment, the Geriatric Depression Scale and the Apathy Evaluation Scale as well as the Neuropsychiatric Inven-tory Score were used. The ADCS-MCI-ADL-Scale was used to measure the participants' ability to perform activities of daily living as well as the Unified Parkinson Disease Rating Scale. The EuroQol instruments EQ-5D-3L and EQ-VAS were used to assess the general quality of life. The PDQ-39-Score was also used to assess the quality of life of patients who are suffering from Parkinson’s disease. Of the 711 initially starting participants in the study, 67.4% were men and 32.6% women. The mean age of the total cohort was 67.75 years, the mean duration of the dis-ease was 6.78 years. The majority of the participants were classified as Hoehn & Yahr stage 2, followed by stage 3, with only a comparatively small number of patients in Hoehn & Yahr stage 4 and 5. Depressive symptoms of different severity were reported in 28.7% of the baseline participants in the DEMPARK/LANDSCAPE study, with an increase in depression and apathy behavior as signs of cognitive impairment that has progressed. With regard to possible impairments of daily life, the overall cohort reported problems in motor skills and in general activities of their daily lives. Restrictions in cognitive perfor-mance, behavior and mood were also expressed. In comparison to the general population, a significantly reduced quality of life was shown for the Parkinson‘s cohort at baseline and at 36-month follow-up in EQ-5D-3L and EQ-VAS-Score across all age groups. Compared to other chronic diseases, neurological diseases often show lower quality of life scores. In particular cognitive limitations like what is seen in dementia and Alzheimer's patients show a massive reduction in quality of life. The relatively high EQ-5D-3L scores from the DEMPARK/LANDSCAPE study with 0,78 ± 0,23 and 0,77 ± 0,25 (Index for german population at baseline and 36-month-follow-up), which can be set in the upper third in the ranking list, is striking. Compared to other publi-cations on quality of life in Parkinson's disease the quality of life in this study was ex-pected to be in the midrange. However, in this study, the quality of life decreases as the cognitive impairment progresses. At baseline the EQ-5D-3L-Indices (Germany-Index) are 0,83 ± 0,19 and 0,82 ± 0,19 (36-Monats-Follow-up) for participants without cognitive im-pairment and 0,65 ± 0,19 (Baseline) and 0,57 ± 0,27 (36-month-follow-up) for participants with dementia. The same developement was shown in EQ-VAS-scores of the population in this study. Psychiatric symptoms in particular - and most importantly – can lead to a signifi-cant reduction in quality of life to a large extent. It is observable in the univariate and mul-tiple regression analyses in this study. In addition, significant influences of the Hoehn & Yahr stage and gender on the Parkinson-specific quality of life are found, but also the effect of dyskinesia, effect fluctuations and vegetativum on certain areas of the Parkin-son-specific quality of life can be determined. Overall, it can be said that the quality of life of patients with Parkinson's disease is greatly reduced compared to the quality of life of the general population, but in this study it is rather in the upper third compared to the quality of life of other chronic diseases. A number of factors may play a significant role of the quality of life of patients with Parkin-son's disease. These conditions should be known when treating these patients. A com-prehensive multimodal approach is needed to cover the different components of patients suffering from this disease. It is necessary to understand and improve the complex di-mensions of disease-specific quality of life.