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Original Study| Volume 22, ISSUE 2, P440-445.e2, February 2021

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Characteristics of Patients with Late-Stage Parkinsonism Who are Nursing Home Residents Compared with those Living at Home

  • Alice Hosking
    Affiliations
    UCL Queen Square Institute of Neurology, University College London, London, UK
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  • Adrianus A.L.J. Hommel
    Affiliations
    Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands

    Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand
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  • Stefan Lorenzl
    Affiliations
    Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria

    Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany

    Department of Neurology, Agatharied Hospital, Hausham, Germany
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  • Miguel Coelho
    Affiliations
    Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany
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  • Joaquim J. Ferreira
    Affiliations
    Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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  • Wassilios G. Meissner
    Affiliations
    Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand

    Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
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  • Per Odin
    Affiliations
    Department of Neurology, Lund University Hospital, Lund, Sweden
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  • Bas R. Bloem
    Affiliations
    Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands

    Groenhuysen Organisation, Roosendaal, the Netherlands
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  • Richard Dodel
    Affiliations
    Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
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  • Anette Schrag
    Correspondence
    Address correspondence to Anette Schrag MD, PhD, UCL Queen Square Institute of Neurology, University College London, Rowland Hill St, London NW3 2PF, London, UK.
    Affiliations
    UCL Queen Square Institute of Neurology, University College London, London, UK
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  • for theCare of Late Stage Parkinsonism (CLaSP) Consortium
    Author Footnotes
    † Members of the CLaSP Consortium: Margherita Fabbri, François Tison, Alexandra Foubert-Samier, Joy Read, Marjan Meinders, Raymond Koopmans, Carmen Richinger, Kristina Rosqvist, Michael Wittenberg, Petra Neuser.
  • Author Footnotes
    † Members of the CLaSP Consortium: Margherita Fabbri, François Tison, Alexandra Foubert-Samier, Joy Read, Marjan Meinders, Raymond Koopmans, Carmen Richinger, Kristina Rosqvist, Michael Wittenberg, Petra Neuser.
Published:July 25, 2020DOI:https://doi.org/10.1016/j.jamda.2020.06.025
Characteristics of Patients with Late-Stage Parkinsonism Who are Nursing Home Residents Compared with those Living at Home
Previous ArticleAntidepressant Use and Progression of Mild to Moderate Alzheimer's Disease: Results from the European ICTUS Cohort
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      Abstract

      Objectives

      To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home.

      Design

      Cross-sectional analysis.

      Setting and Participants

      This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP).

      Measures

      Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis.

      Results

      Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement.

      Conclusions and Implications

      These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder

      Keywords

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      Article info

      Publication history

      Published online: July 25, 2020

      Footnotes

      The CLaSP study is funded by the European Commission (Joint Program–Neurodegenerative Disease Research “European research projects for the evaluation of healthcare policies, strategies, and interventions for Neurodegenerative Diseases”) through national funding bodies in all 6 countries (Economic and Social Research Council ES/L009250/1; BMBF, Marburg, Germany 01ED1403A, Munich, Germany 01ED1403B, Bordeaux, France: ANR-13-JPHC-0001-07, Lisbon, Portugal: HC/0002/2012, Lund, Sweden; HC-559-002, Nijmegen, Holland, 733051003). A. Schrag was supported by the National Institute for Health Research UCL/UCLH Biomedical Research Center. A. Hommel was supported by co-funding of Groenhuysen organization and Stichting Beroepsopleiding Huisartsen.

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2020.06.025

      Copyright

      © 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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