Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Parkinsonism Relat Disord. 2023 Mar;108:105292. doi: 10.1016/j.parkreldis.2023.105292. Epub 2023 Jan 23.
We aimed to identify caregiver characteristics associated with the trajectory of quality of life (QoL) in Parkinson's disease (PD). We fit a growth mixture model to longitudinal data from the Parkinson Foundation Parkinson's Outcomes Project (POP) to identify the heterogeneity of QOL trajectories in PD. We then used multinomial logistic regression to model baseline factors that predicted class membership. Baseline growth models were fit to QOL scores measured over 4 disease duration time points. A random intercept and slope model was determined to best fit the data. Next, growth mixture models (1, 2, 3, 4, and 5-class) were fit with covariates (Hoehn & Yahr, sex, and depression) and a three-class model was found to provide the best fit. Class 1 (problematic class (10.0%)) represented individuals with poor QOL at baseline and minor improvement over time. Class 2 (moderate class (32.6%)) represented individuals with moderate QOL at baseline with slight worsening over time. Class 3 (favorable class (56.9%)) represented individuals with good QOL at baseline and slight worsening over time. Multinomial regression revealed that lower caregiver strain, better mobility, and better verbal fluency at baseline predicted membership in the favorable compared to the moderate class. Worse mobility and younger age predicted membership in the problematic compared to the moderate class. While previous studies have reported on the association between mobility and cognition, the novel finding of an association between caregiver strain and PD QOL trajectory suggests caregiver strain is important to measure and address in future research and practice.
我们旨在确定与帕金森病（PD）患者生活质量（QoL）轨迹相关的照顾者特征。我们使用帕金森基金会帕金森病结果项目（POP）的纵向数据拟合增长混合模型，以确定 PD 患者 QoL 轨迹的异质性。然后，我们使用多项逻辑回归来模拟预测类别成员身份的基线因素。对跨越 4 个疾病持续时间点测量的 QOL 评分拟合基线增长模型。随机截距和斜率模型被确定为最适合数据。接下来，拟合增长混合模型（1、2、3、4 和 5 类），并加入协变量（Hoehn 和 Yahr、性别和抑郁），发现 3 类模型提供了最佳拟合。第 1 类（问题类（10.0%））代表基线 QOL 较差且随时间略有改善的个体。第 2 类（中等类（32.6%））代表基线时 QOL 中等且随时间略有恶化的个体。第 3 类（良好类（56.9%））代表基线时 QOL 良好且随时间略有恶化的个体。多项回归显示，基线时较低的照顾者压力、更好的移动能力和更好的语言流畅性预示着与中等组相比，属于有利组。较差的移动能力和较年轻的年龄预示着与中等组相比，属于问题组。虽然之前的研究报告了移动能力和认知之间的关联，但照顾者压力与 PD QoL 轨迹之间关联的新发现表明，照顾者压力是未来研究和实践中需要测量和解决的重要因素。
