Klietz Martin, Tulke Amelie, Müschen Lars H, Paracka Lejla, Schrader Christoph, Dressler Dirk W, Wegner Florian
Department of Neurology, Hannover Medical School, Hannover, Germany.
Front Neurol. 2018 Mar 6;9:120. doi: 10.3389/fneur.2018.00120. eCollection 2018.
Parkinson's disease (PD) is the second most frequent neurodegenerative disease of the elderly. Patients suffer from various motor and non-motor symptoms leading to reduced health-related quality of life (HRQOL) and an increased mortality. Their loss of autonomy due to dementia, psychosis, depression, motor impairments, falls, and swallowing deficits defines a phase when palliative care interventions might help to sustain or even improve quality of life.
The aim of this study was to investigate the current status of palliative care implementation and quality of life in a local cohort of advanced PD patients in order to frame and improve future care.
76 geriatric patients with advanced idiopathic PD meeting the inclusion criteria for palliative care interventions were clinically evaluated by neurological examination using Movement Disorders Society Unified Parkinson's Disease Rating Scale, Barthel Index, Montreal Cognitive Assessment Test, and a structured interview concerning palliative care implementation.
HRQOL is severely reduced in our cohort of geriatric advanced PD patients. We found motor deficits, impairment of activities of daily living, depression, and cognitive decline as most relevant factors determining decreased HRQOL. Only 2.6% of our patients reported present implementation of palliative care. By contrast, 72% of the patients indicated an unmet need for palliative care.
Quality of life is dramatically affected in advanced PD patients. However, we found palliative care to be implemented extremely rare in their treatment concept. Therefore, geriatric patients suffering from advanced PD should be enrolled for palliative care to provide adequate and holistic treatment which may improve or sustain their quality of life.
帕金森病（PD）是老年人中第二常见的神经退行性疾病。患者会出现各种运动和非运动症状，导致健康相关生活质量（HRQOL）下降和死亡率增加。由于痴呆、精神病、抑郁、运动障碍、跌倒和吞咽障碍导致的自主能力丧失定义了一个阶段，此时姑息治疗干预可能有助于维持甚至改善生活质量。
本研究的目的是调查当地晚期帕金森病患者队列中姑息治疗的实施现状和生活质量，以便规划和改善未来的护理。
对76例符合姑息治疗干预纳入标准的老年特发性帕金森病患者进行临床评估，采用运动障碍协会统一帕金森病评定量表、巴氏指数、蒙特利尔认知评估测试进行神经学检查，并进行关于姑息治疗实施的结构化访谈。
在我们的老年晚期帕金森病患者队列中，HRQOL严重降低。我们发现运动功能障碍、日常生活活动受损、抑郁和认知下降是决定HRQOL降低的最相关因素。我们的患者中只有2.6%报告目前正在实施姑息治疗。相比之下，72%的患者表示对姑息治疗有未满足的需求。
晚期帕金森病患者的生活质量受到极大影响。然而，我们发现姑息治疗在他们的治疗理念中极少实施。因此，患有晚期帕金森病的老年患者应纳入姑息治疗，以提供充分和全面的治疗，这可能会改善或维持他们的生活质量。
