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      Seeing ophthalmologic problems in Parkinson disease : Results of a visual impairment questionnaire

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          Abstract

          Objective

          To determine the prevalence and clinical effect of ophthalmologic symptoms in patients with Parkinson disease (PD), compared with controls, using a standardized questionnaire.

          Methods

          In this observational, cross-sectional, multicenter study, 848 patients with PD and 250 healthy controls completed the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q). The VIPD-Q addressed 4 domains according to structures: (1) ocular surface; (2) intraocular; (3) oculomotor; and (4) optic nerve. The questionnaire also assessed the effect of ophthalmologic symptoms on daily activities.

          Results

          One or more ophthalmologic symptoms were reported by 82% (95% confidence interval [CI], 80–85) of patients, compared with 48% (95% CI, 42–54) of controls ( p < 0.001). Patients with PD experienced more ophthalmologic symptoms across all domains than controls ( p < 0.001), as reflected by a higher VIPD-Q total score among patients (median 10 [interquartile range (IQR) 13]) than controls (median 2 [IQR 5]; p < 0.001). Ophthalmologic symptoms interfered with daily activities in 68% (95% CI, 65–71) of patients, compared with 35% (95% CI, 29–41) of controls ( p < 0.001).

          Conclusion

          Patients with PD have a higher prevalence of ophthalmologic symptoms than controls. Moreover, these frequently interfere with daily activities. A screening questionnaire such as the VIPD-Q may help with identifying ophthalmologic symptoms in PD, thereby enabling more timely treatment.

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          Most cited references44

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          Predictors of nursing home placement in Parkinson's disease: a population-based, prospective study.

          To examine the rate and predictors of nursing home placement in patients with Parkinson's disease. Four-year prospective study. A population-based study in western Norway 178 community-dwelling subjects with Parkinson's disease. Main outcome measure was the time from baseline to nursing home admission. Baseline evaluation of motor symptoms (Unified Parkinson's Disease Rating Scale, UPDRS), cognition (clinical dementia interview, Gottfries, Brane & Steen dementia scale, and Mini-Mental State Examination), depression (clinical interview and the Montgomery & Asberg Depression Rating Scale), and psychotic symptoms (UPDRS Thought Disorder item) were performed. Forty-seven patients (26.4%) were admitted to a nursing home during the 4-year study period. Institutionalized patients were older, had more advanced Parkinson's disease with more severe motor symptoms and impairment of activities of daily living, were cognitively more impaired, were more often living alone, and had more hallucinations than those who continued to live at home. Duration of disease, levodopa dose, and gender distribution did not differ between the two groups. A Cox proportional hazards linear regression analysis showed that old age, functional impairment, dementia, and hallucinations were independent predictors of nursing home admission. Both motor and neuropsychiatric symptoms contributed to institutionalization, but the presence of hallucinations was the strongest predictor. This finding indicates it is possible that effective treatment of hallucinations may reduce the need for institutionalization in patients with Parkinson's disease.
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            Visual dysfunction in Parkinson’s disease

            Visual symptoms are frequently reported in Parkinson’s disease. Weil et al.. relate visual changes to underlying brain regions, and consider mechanisms for visual hallucinations. They examine links between visual changes and other features of Parkinson’s disease and discuss the role of visual dysfunction as a marker of dementia.
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              Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study.

              To accurately establish the incidence of falls in Parkinson's disease (PD) and to investigate predictive risk factors for fallers from baseline data. 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data, disease specific rating scales, physiotherapy assessment, tests of visual, cardiovascular and autonomic function, and bone densitometry. Patients were then prospectively followed up for one year using weekly prepaid postcards along with telephone follow up. Falls occurred in 68.3% of the subjects. Previous falls, disease duration, dementia, and loss of arm swing were independent predictors of falling. There were also significant associations between disease severity, balance impairment, depression, and falling. Falls are a common problem in PD and some of the major risk factors are potentially modifiable. There is a need for future studies to look at interventions to prevent falls in PD.
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                Author and article information

                Journal
                Neurology
                Neurology
                neurology
                neur
                neurology
                NEUROLOGY
                Neurology
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0028-3878
                1526-632X
                07 April 2020
                07 April 2020
                : 94
                : 14
                : e1539-e1547
                Affiliations
                From Parkinson Centre Nijmegen (ParC), Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (C.D.J.M.B., D.d.G., B.R.B., N.M.d.V.), and Department of Ophthalmology (C.H., T.T.), Radboud University Medical Centre, Nijmegen; Department of Neurology (F.V., A.M.M.V.), Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands; and Departments of Neurology (M.W., K.S., W.P.) and Ophthalmology (D.P.), Medical University Innsbruck, Austria.
                Author notes
                Correspondence Dr. Borm carlijn.borm@ 123456radboudumc.nl

                Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

                [*]

                These authors contributed equally to this work.

                The Article Processing Charge was funded by the authors.

                Article
                NEUROLOGY2019014126 00015
                10.1212/WNL.0000000000009214
                7251522
                32161030
                fb8c6b0a-29d6-4bda-a655-3b9e0ea00b5d
                Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 18 July 2019
                : 15 October 2019
                Funding
                Funded by: Stichting Parkinson Fonds
                Award ID: 38000
                Categories
                56
                165
                186
                Article
                Custom metadata
                TRUE
                ONLINE-ONLY

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