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Parkinson’s disease: the prodromal phase and consequences with respect to working life
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.ORCID iD: 0000-0002-2924-8021
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Parkinson’s disease (PD) is a common, progressive neurodegenerative disorder, recognized by the motor symptoms of bradykinesia, tremor, rigidity, and postural impairment. At clinical onset, extensive amounts of dopaminergic neurons have already been lost. The duration of this prodromal phase is uncertain, and it is thought to include predominantly non-motor symptoms. The progressive nature and the symptoms of PD are disabling and reduces the quality of life. Among patients affected in working age, early cessation of employment is common, and such socioeconomic consequences of PD may contribute to an impaired quality of life. The aims of this thesis were to investigate the life situation for people affected by PD in working age, with attention to factors of importance for quality of life and working situation, and to evaluate long-term associations between potential prodromal signs and the later development of PD.Methods: We used a postal survey to investigate the self-perceived life situation among working-aged individuals with PD compared to matched controls, with a specific attention to socioeconomic consequences of disease (paper I). To investigate risk markers preceding the diagnosis of PD (paper II-IV), we used data from nationwide registers. Study II was performed as a cohort study, based on the Swedish Military Service Conscription Register, and study III-IV were performed as nested case-control studies based on a cohort comprising all Swedish citizens aged ≥50 years in 2005.Results: In the survey study (paper I), 38% of the PD participants and 9% of the controls were dissatisfied with life as a whole, and the working situation was an independent risk factor for dissatisfaction with life. In total, 59% of the PD participants had reduced working hours or stopped working due to PD, and many PD participants struggled to cope with their work demands. Support from employer was associated with a higher likelihood to remain employed.We found that low muscle strength in young adulthood, (paper II) and depression (paper III) were associated with an increased risk of PD over follow-up times of more than 2 decades, and that patients with PD were at increased risk of fall-related injuries, hip fractures in particular, a decade or more before the PD diagnosis (paper IV). For depression and fall-related injuries, the association with PD was clearly time-dependent, strongest in the last years before the diagnosis of PD.Conclusions: The results suggest that the prodromal phase of PD may last for more than 2 decades and include also motor symptoms. The consequences of PD include a reduced quality of life associated with the working situation. Employer’s support appear to be particularly important for a successful vocational rehabilitation.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2016. , 51 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1810
Keyword [en]
Parkinson’s disease, quality of life, employment, rehabilitation, prodromal phase, risk markers, depression, muscle strength, injurious fall, epidemiology
National Category
Geriatrics Neurology
Identifiers
URN: urn:nbn:se:umu:diva-120215ISBN: 978-91-7601-479-0 (print)OAI: oai:DiVA.org:umu-120215DiVA: diva2:928134
Public defence
2016-06-10, Vårdvetarhuset, Aulan, Umeå universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-05-18 Created: 2016-05-11 Last updated: 2016-05-26Bibliographically approved
List of papers
1. Parkinsons Disease: A population-based investigation of life satisfaction and employment
Open this publication in new window or tab >>Parkinsons Disease: A population-based investigation of life satisfaction and employment
2015 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 1, 45-51 p.Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate relationships between individuals' socioeconomic situations and quality of life in working-aged subjects with Parkinson's disease.

Methods:

A population-based cohort comprising 1,432 people with Parkinson's disease and 1,135 matched controls, who responded to a questionnaire. Logistic regression analysis was performed to identify factors associated with life satisfaction and likelihood of employment.

Results:

In multivariate analyses, Parkinson's disease was associated with an increased risk of dissatisfaction with life (odds ratio (OR) = 5.4, 95% confidence interval (95% CI) = 4.2-7.1) and reduced likelihood of employment (OR = 0.30, 95% CI = 0.25-0.37). Employers' support was associated with greater likelihood of employment (p < 0.001). Twenty-four percent of people with Parkinson's disease for ≥ 10 years remained employed and 6% worked full-time. People with Parkinson's disease also more frequently experienced work demands that exceeded their capacity; this factor and unemployment independently correlated with greater risk of dissatisfaction with life (both p < 0.05).

Conclusion:

People with Parkinson's disease have an increased risk of dissatisfaction with life. Employment situation is important for general life satisfaction among working-aged individuals. People with Parkinson's disease appear to find it difficult to meet the challenge of achieving a balanced employment situation.

Keyword
Parkinson's disease, life satisfaction, work
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-95063 (URN)10.2340/16501977-1884 (DOI)000347761600007 ()25268547 (PubMedID)
Available from: 2014-10-21 Created: 2014-10-21 Last updated: 2017-12-05Bibliographically approved
2. Low muscle strength in late adolescence and Parkinson disease later in life
Open this publication in new window or tab >>Low muscle strength in late adolescence and Parkinson disease later in life
Show others...
2015 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 84, no 18, 1862-1869 p.Article in journal (Refereed) Published
Abstract [en]

Objective:To evaluate maximal isometric muscle force at 18 years of age in relation to Parkinson disease (PD) later in life.Methods:The cohort consisted of 1,317,713 men who had their muscle strength measured during conscription (1969-1996). Associations between participants' muscle strength at conscription and PD diagnoses, also in their parents, were examined using multivariate statistical models.Results:After adjustment for confounders, the lowest compared to the highest fifth of handgrip strength (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.06-1.79), elbow flexion strength (HR 1.34, 95% CI 1.02-1.76), but not knee extension strength (HR 1.24, 95% CI 0.94-1.62) was associated with an increased risk of PD during follow-up. Furthermore, men whose parents were diagnosed with PD had reduced handgrip (fathers: mean difference [MD] -5.7 N [95% CI -7.3 to -4.0]; mothers: MD -5.0 N [95% CI -7.0 to -2.9]) and elbow flexion (fathers: MD -4.3 N [95% CI -5.7 to -2.9]; mothers: MD -3.9 N [95% CI -5.7 to -2.2]) strength, but not knee extension strength (fathers: MD -1.1 N [95% CI -2.9 to 0.8]; mothers: MD -0.7 N [95% CI -3.1 to 1.6]), than those with no such familial history.Conclusions:Maximal upper extremity voluntary muscle force was reduced in late adolescence in men diagnosed with PD 30 years later. The findings suggest the presence of subclinical motor deficits 3 decades before the clinical onset of PD.

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-106274 (URN)10.1212/WNL.0000000000001534 (DOI)000354104100011 ()25841033 (PubMedID)
Available from: 2015-07-10 Created: 2015-07-09 Last updated: 2017-12-04Bibliographically approved
3. Depression and subsequent risk of Parkinson disease: A nationwide cohort study
Open this publication in new window or tab >>Depression and subsequent risk of Parkinson disease: A nationwide cohort study
2015 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 84, no 24, 2422-2429 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the long-term risk of Parkinson disease (PD) after depression and evaluate potential confounding by shared susceptibility to the 2 diagnoses.

METHODS: The nationwide study cohort included 140,688 cases of depression, matched 1:3 using a nested case-control design to evaluate temporal aspects of study parameters (total, n = 562,631). Potential familial coaggregation of the 2 diagnoses was investigated in a subcohort of 540,811 sibling pairs. Associations were investigated using multivariable adjusted statistical models.

RESULTS: During a median follow-up period of 6.8 (range, 0-26.0) years, 3,260 individuals in the cohort were diagnosed with PD. The multivariable adjusted odds ratio (OR) for PD was 3.2 (95% confidence interval [CI], 2.5-4.1) within the first year of depression, decreasing to 1.5 (95% CI, 1.1-2.0) after 15 to 25 years. Among participants with depression, recurrent hospitalization was an independent risk factor for PD (OR, 1.4; 95% CI, 1.1-1.9 for ≥5 vs 1 hospitalization). In family analyses, siblings' depression was not significantly associated with PD risk in index persons (OR, 1.1; 95% CI, 0.9-1.4).

CONCLUSIONS: The time-dependent effect, dose-response pattern for recurrent depression, and lack of evidence for coaggregation among siblings all indicate a direct association between depression and subsequent PD. Given that the association was significant for a follow-up period of more than 2 decades, depression may be a very early prodromal symptom of PD, or a causal risk factor.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-111892 (URN)10.1212/WNL.0000000000001684 (DOI)000369077700011 ()25995056 (PubMedID)
Available from: 2015-11-25 Created: 2015-11-25 Last updated: 2017-12-01Bibliographically approved
4. Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort
Open this publication in new window or tab >>Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort
2016 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 13, no 2, e1001954Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Low muscle strength has been found in late adolescence in individuals diagnosed with Parkinson disease (PD) 30 y later. This study investigated whether this lower muscle strength also may translate into increased risks of falling and fracture before the diagnosis of PD.

METHODS AND FINDINGS: Among all Swedish citizens aged ≥50 y in 2005, two nested case-control cohorts were compiled. In cohort I, individuals diagnosed with PD during 1988-2012 (n = 24,412) were matched with up to ten controls (n = 243,363), and the risk of fall-related injuries before diagnosis of PD was evaluated. In cohort II, individuals with an injurious fall in need of emergency care during 1988-2012 (n = 622,333) were matched with one control (n = 622,333), and the risk of PD after the injurious fall was evaluated. In cohort I, 18.0% of cases and 11.5% of controls had at least one injurious fall (p < 0.001) prior to PD diagnosis in the case. Assessed by conditional logistic regression analysis adjusted for comorbid diagnoses and education level, PD was associated with increased risks of injurious fall up to 10 y before diagnosis (odds ratio [OR] 1.19, 95% CI 1.08-1.31; 7 to <10 y before diagnosis) and hip fracture ≥15 y before diagnosis (OR 1.36, 95% CI 1.10-1.69; 15-26 y before diagnosis). In cohort II, 0.7% of individuals with an injurious fall and 0.5% of controls were diagnosed with PD during follow-up (p < 0.001). The risk of PD was increased for up to 10 y after an injurious fall (OR 1.18, 95% CI 1.02-1.37; 7 to <10 y after diagnosis). An important limitation is that the diagnoses were obtained from registers and could not be clinically confirmed for the study.

CONCLUSIONS: The increased risks of falling and hip fracture prior to the diagnosis of PD may suggest the presence of clinically relevant neurodegenerative impairment many years before the diagnosis of this disease.

Place, publisher, year, edition, pages
Public library science, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-116133 (URN)10.1371/journal.pmed.1001954 (DOI)000373038600005 ()26836965 (PubMedID)
Available from: 2016-02-08 Created: 2016-02-08 Last updated: 2017-11-30Bibliographically approved

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