Introduction
Parkinson’s disease is a chronic degenerative neurological disorder that adversely affects an individual’s motor functioning, which leads to disability, and impacts on quality of life. Individuals who develop Parkinson's disease are confronted not only with the physical manifestations of the disorder, but with the psychosocial issues that also impact on quality of life. Psychosocial aspects of Parkinson's disease may present as subtle changes with progression of the disease1–5.
The purpose of the present research was to assess the level of psycho-social and physical functioning impairment in patients with Parkinson’s disease.
Methods
95 patients with Parkinson’s disease have been examined (48 men and 47 women aged 65–79, average age 70,3±0,5). An interview and complete neurologic examination, including the Hoehn and Yahr scale6, were performed on the same day. Stages of Parkinson’s disease acсording to Hoehn and Yahr scale were 2–2.5.
Having the aim to assess the impact of the disease on the everyday life of patients to the fullest extent, their interviewing included the use of the tests “Functional Limitation Profile” and “Sickness Impact Profile–68”7–15.
While carrying out “Functional Limitation Profile” test, the change of patient’s behavior in cases of Parkinson’s disease was assessed in 12 categories of life activity: “walk”, “body care and motion”, “movement”, “household activity”, “leisure and entertainment”, “social interaction”, “emotions”, “clarity of mind”, “sleep and rest”, “food”, “communication”, “work”.
While carrying out “Sickness Impact Profile–68” test, functional condition of patients was assessed in 6 categories of life activity. “Somatic autonomy” category reflected the extent of help that the patient requires when performing everyday activities (dressing, standing, walking, eating etc). “Mobility control” category characterized the degree of control of motion functions, including walking and actions with hands. “Psychic autonomy and communication” category described behavior, connected with mental functions and verbal communication. ”Mobility degree” category included the ways the disease limits household and professional activity. "Social Behavior” category reflects social sphere of activity. ”Emotional stability” category reflects disease impact on the emotional sphere.
Results
While carrying out “Functional Limitation Profile” test, all patients showed functional conditions changes. Impairments in the category “walk” were present in 87 patients (92% of cases). Most patients noted a slowing down in walking speed (92%), shortening of the distance they could walk without rest (79%) and the need for outside assistance during walking (44%).
Changes in the category "body care and motion" were observed in 69 patients (72% of cases). Impairments of this category were connected with slowing of movements–bradykinesia (85%), patients’ reduced ability to maintain balance (72%) and the need for outside assistance (43%).
Limitations in the category "movement" were present in 42 patients (44% of cases) and were manifested in the inability to leave the house (15%) or room (7%), the need for support at a certain time of the day (22%).
In the category "household activity" changes were observed in 40 patients (42% of cases), and consisted of reducing the amount of housework (80%), increasing the time needed for rest (63%), and inability to perform hard work (63%).
In the category "leisure and entertainment” impairments were present in 23 patients (24% of cases). The patients showed decreased period of time spent on leisure (65%) and sports (52%).
Changes in the category "social interaction" were observed in 81 patients (85% of cases). Patients rarely participated in social activities (93%), and isolated themselves from the work team (51%).
Changes in the category "emotion" were noticed in 62 patients (65% of cases). Patients demonstrated depressed mood background (65%), talked about the future with hopelessness (85%).
Impairments in the category "clarity of mind" were noticed in 75 patients (79% of cases). Patients showed impairment of memory (85%) and concentration (85%), slowing of thought processes (80%).
In the category "sleep and rest", patients showed sleepiness in the daytime and insomnia at night (41%) and required additional time for rest because of constant fatigue (80%). Changes in this category were noted in 19 patients (38% of cases).
In the category "food", impairments were observed in 18 patients (19% of cases). The most common impairments included decreased appetite (55%), and need for outside assistance when eating (17%).
Changes in the category "communication" were observed in 21 patients (22% of cases). Patients had problems with writing (93%), and difficulties in communication because of speech dysfunction (85%).
Impairments in the category "work" were present in 53 patients (56% of cases). Some of the patients did not work at all (57%), whilst some performed some of the work at home (19%), or did less work than usual (85%), worked fewer hours (80%), performed only light work (42%), or produced lower-quality work (42%). The frequency of functional limitations is given in Table 1 and Figure 1.
Table 1. The frequency of functional limitations cases in patients with acute disseminated encephalomyelitis according to the "Functional Limitation Profile" test data.
| Behavior categories | Number of patients | % |
|---|
| Walk | 87 | 92 |
| Social interaction | 81 | 85 |
| Clarity of mind | 75 | 79 |
| Body care and motion | 69 | 72 |
| Emotions | 62 | 65 |
| Work | 53 | 56 |
| Movement | 42 | 44 |
| Household activity | 40 | 42 |
| Sleep and rest | 39 | 41 |
| Leisure and entertainments | 23 | 24 |
| Communication | 21 | 22 |
| Food | 18 | 19 |
Figure 1. The structure of functional limitations in patients with Parkinson’s disease according to the “Functional Limitation Profile” test data.
The frequency of functional limitation cases in patients with Parkinson’s disease according to “Sickness Impact profile–68” test and their assessment in points are given in Table 2, Table 3 and Figure 2, Figure 3.
Table 2. The frequency of functional limitation cases in patients with Parkinson’s disease according to "Sickness Impact profile–68" test data.
| Behavior categories | Number of patients | % |
|---|
| Social Behavior | 82 | 86 |
| Mobility Control | 78 | 50 |
| Degree of mobility | 72 | 34 |
| Somatic Autonomy | 67 | 71 |
| Psychic autonomy and communication | 55 | 58 |
| Emotional stability | 35 | 37 |
Table 3. Assessment (in points) of disease impact on functional condition of patients according to "Sickness Impact profile–68" test data.
| Behavior categories | Average
point | Total
point | Maximum possible
point | % in relation to the maximum
possible point |
|---|
| Mobility control | 6.6±0.4 | 278 | 540 | 51 |
| Social behavior | 5.9±0.4 | 70 | 270 | 26 |
| Psychic autonomy and communication | 4±0.3 | 99 | 450 | 22 |
| Degree of mobility | 5.3±0.2 | 189 | 540 | 28 |
| Somatic autonomy | 3.6±0.2 | 123 | 495 | 25 |
| Emotional stability | 2.3±0.5 | 82 | 765 | 11 |
Figure 2. The structure of functional limitations in patients with Parkinson’s disease according to the “Sickness Impact Profile–68” test data.
Figure 3. Assessment in points of functional limitations in patients with Parkinson’s disease according to the “Sickness Impact Profile–68” test data (% in relation to the maximum possible point).
Conclusion
The analysis of investigation of patients with Parkinson’s disease (duration 3–5 years) according to the tests “Functional Limitation Profile” and “Sickness Impact Profile–68” showed significant changes of their functional condition connected with the occurrence of the disease.
The patients with Parkinson's disease according to the test “Functional Limitation Profile” showed functional condition impairment most often in 3 categories: “walk", "social interaction" and "clarity of mind", while changes in the categories "body care and motion", "emotion" and "work" were less frequent. The least impaired were the categories "communication", "food" and "leisure and entertainment".
The patients with Parkinson's disease diagnosis according to the test “Sickness Impact Profile–68” showed functional condition impairment most often in the categories "mobility control", "social behavior" and "degree of mobility", less frequently in the categories "somatic autonomy" and "psychic autonomy and communication". The least impaired category was "emotional stability". The highest percent in relation to the maximum possible point was observed in the category “mobility control", and the lowest in the category “emotional stability”.
Thus, according to the results of two tests, the presence of the disease affects the motion and social sphere of life in the patients with Parkinson’s disease the most and their emotional state the least.
For the most accurate assessment of the disease impact on the functional condition of the patients diagnosed with Parkinson's disease, a secondary investigation (depending on the rate of the disease progression) should be carried out. Such interrogation of disease dynamics enables detection of possible changes in the categories of life that are most affected by the disease occurrence. Assessment of the quality of life of patients diagnosed with Parkinson's disease at different stages of the disease with the help of Hoehn and Yahr Scale is a very perspective direction of future studies.
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