| Objective Parkinson’s disease(PD)is a chronic progressive neurodegenerative movement disorder characterized by motor and non-motor symptoms.The medication adherence affects the quality of life of patients and the caregiver burden.The purpose of our study was to explore the influencing factors of medication adherence and caregiver burden in PD patients.Methods A total of 179 PD patients and their caregivers from the Northern Jiangsu People’s Hospital were included from October 2017 to June 2019.All PD patients met the diagnostic criteria of Parkinson’s disease published by The Movement Disorder Society in 2015.The general demographic data of PD patients and caregivers were collected,the Montreal Cognitive Assessment Scale(Mo CA),Cognition-12(Cog-12),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HDRS),Non-motor symptoms questionnaire(NMSQ),Fatigue severity scale(FSS),The scale for outcomes in PD for autonomic symptoms(SCOPA-AUT),and Pittsburgh Sleep Quality Index(PSQI)scale were used to evaluate the non-motor symptoms of patients.Patients were assessed for quality of life using the Unified Parkinson’s Disease Assessment Scale Part II(UPDRS II)and the Parkinson’s Disease Questionnaire-39(PDQ-39).UPDRS Part III(UPDRS III),and revised Hoehn-Yahr(H-Y)stage were evaluated for the motor function and the severity of the disease.The Morisky Medication Adherence Scale(MMAS-8)was used to assess the patient’s medication adherence.All patients completed the scale assessment during the " ON " phase.The Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HDRS)were used to assess caregiver’s anxiety and depression,the Caregiver Burden Inventory(CBI)was used to assess caregiver burden,and the Social Support Rating Scale(SSRS)was used to evaluate the social support of caregivers.Results 1.A total of 179 PD patients and caregivers were enrolled in the study.And 6 patients with Parkinson’s syndrome,2 patients with deep brain stimulation surgery,7 patients without medication,5 patients without caregivers,and 3 patients with incomplete data collection were excluded.156 patients and caregivers were actually enrolled.There were 122 cases in the good adherence group and 34 cases in the poor adherence group according to the total score of MMAS-8.There were statistically significant differences in the course of disease,panic gait,freezing,difficulty in turning over,medication categories,levodopa equivalent dose,H-Y stage,total score of UPDRS II,total score of UPDRS III,total score of Cog-12,total score of HDRS,total score of SCOPA-AUT and total score of PDQ-39 between the two groups(P<0.05).There were no significant differences between the two groups in age,onset age,gender,constipation,hyposmia,pesticide exposure history,history of hypertension and diabetes,years of education,total score of Mo CA,total score of FSS,total score of HAMA,total score of NMSQ and total score of PSQI(P> 0.05).2.Multivariate logistic regression analysis showed the levodopa equivalent dose(LED)(OR: 1.003,95% CI: 1.001-1.005,P = 0.004)and panic gait(OR: 8.091,95% CI: 3.328-19.671,P<0.001)were independently related to medication adherence.3.The order of the caregiver burden of PD patients is developmental burden,timedependent burden,physical burden,emotional burden and social burden.4.Caregiver burden was positively correlated with the age of caregivers,total duration of care,daily duration of care,total score of HAMA and total score of HDRS of caregivers(P<0.05),and negatively correlated with years of education and total score of SSRS of caregivers(P<0.05).In addition,the caregiver burden was positively correlated with the age of patients,course of the disease,medication categories,levodopa equivalent dose,H-Y stage,total score of UPDRS II,total score of UPDRS III,total score of Cog-12,total score of HDRS,total score of HAMA,total score of NMSQ,total score of SCOPA-AUT,total score of PDQ-39,total score of FSS and total score of PSQI(P < 0.05),and was negatively correlated with years of education,total score of Mo CA and medication adherence of patients(P < 0.05),and was not correlated with the onset age of the patients(P > 0.05).5.Multiple linear regression analysis showed that total score of UPDRS III,total score of PDQ-39,total score of HDRS of caregivers and daily duration of care were independently related to caregiver burden.Conclusion 1.Compared to the good adherence group,patients in the poor adherence group have a longer course of disease and are more possible to have motor symptoms such as panic gait,freezing,and difficulty turning over.Patients in the poor adherence group take a larger equivalent dose of levodopa and their quality of life is worse.The H-Y stage,motor symptoms and non-motor symptoms including cognitive impairment,depression and autonomic symptoms in the poor adherence group are more severe than good adherence group.2.The increase of Levodopa equivalent dose and panic gait are risk factors for medication adherence.3.The most common burden of caregivers in the PD patients is developmental burden.4.Caregiver burden is heavier if the caregivers with older age,longer total duration of care and daily duration of care.Caregivers who are with anxiety and depression will increase the caregiver burden,meanwhile caregivers who have the higher years of education and social support will reduce the caregiver burden.In addition,Caregiver burden is related to the patients who are with older age,longer course of the disease,more medication categories,larger equivalent dose of levodopa and worse quality of life.And caregiver burden is related to patients who are with severe H-Y stage,motor symptoms and non-motor symptoms including cognitive impairment,depression,anxiety,autonomic symptoms,fatigue and sleep disorders.Patients with higher years of education and better medication adherence can reduce the caregiver burden.5.Exacerbation of motor symptoms,worsening of quality of life,depression of caregivers,and increased daily duration of care are risk factors for the caregiver burden. |
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