[Impact of motor and non-motor symptoms on the direct costs of Parkinson's disease]. / Impacto de los síntomas motores y no motores en los costes directos de la enfermedad de Parkinson.

INTRODUCTION: We evaluate the health-related economic burden of patients with Parkinson's disease (PD) and identify the impact of motor and nonmotor symptoms (NMS) and health-related quality of life (HRQL) on the direct costs of PD in Spain. METHOD: A cross-sectional, multicenter, pilot study covering consecutive PD outpatients who were included during the year 2004. Cognition (MMSE, SCOPA-Cog), autonomic dysfunction (SCOPA-AUT), motor impairment, severity and complications (SCOPA-motor), depression/anxiety (HADS), sleep (PDSS), psychosis (PPRS), pain, severity/global impairment (HY staging and CISI-PD) and health-related quality of life (EuroQoL) were evaluated. PD-related cost data were obtained using a standardized questionnaire. Association of clinical variables with direct costs was analyzed using the parametric and nonparametric tests. RESULTS: Seventy-eight consecutive PD outpatients (52% female and 48% male) having a mean age of 68.2 years (SD: 11), median HY stage of 2 (1-5), and mean PD duration of 8.3 years (SD: 5.4) were included in this study. Average 3 month total direct cost of PD was euro 2,631 (SD: 4507) per person (range: euro 71.5-euro 29,159) and medical treatment was the main cost driver, accounting for 34 % (mean drug cost per person euro 669; SD: 406). PD direct costs were significantly higher among younger patients, with higher HY stage, PD duration, severity, motor impairment and motor complications (p<0.05). CONCLUSIONS: Disease severity, motor impairment and complications had a higher impact on the direct costs of PD than NMS.

Impact of fatigue in multiple sclerosis: the Fatigue Impact Scale for Daily Use (D-FIS).

OBJECTIVE: The Fatigue Impact Scale for Daily Use (D-FIS) is an eight-item instrument designed to measure subjective daily experience of fatigue. This study sought to determine the metric properties of the D-FIS in multiple sclerosis (MS) patients. METHODS: Sixty-eight patients with operationally-defined MS and fatigue (54.8% of the sample) underwent the D-FIS. Usual clinical measures for MS, the Montgomery-Asberg Depression Rating Scale (MADRS) and the Functional Assessment of Multiple Sclerosis (FAMS) were also applied. In addition, patients with fatigue completed the Fatigue Descriptive Scale, the Multidimensional Fatigue Inventory (MFI), a Visual Analogue Scale for Fatigue (VAS-F), and a Global Perception of Fatigue Scale (GPF). RESULTS: Full computable data, 95.6%; both floor and ceiling effect=1.54%; item-total correlation=0.62 (item 1) to 0.84 (item 6); Cronbach's alpha=0.91; item homogeneity =0.55; standard error of measurement=3.18; convergent validity with other fatigue measures=-0.57 (VAS-F); 0.52 (GPF); and 0.46 (MFI-general fatigue). Test-retest reliability (ICC)=0.81. There was a strong association between health-related quality of life (HRQoL) (FAMS) and D-FIS (rS=0.70). CONCLUSIONS: In this study, D-FIS proved to be a feasible and valid instrument for measuring MSrelated fatigue, a frequent symptom associated with deterioration of patients' HRQoL.

The PDQ-39 Spanish version: reliability and correlation with the short-form health survey (SF-36).

BACKGROUND AND METHODS: The Parkinson's Disease Questionnaire (PDQ-39) was the first specific instrument for evaluation of the "health-related quality of life" (QoL) in Parkinson's disease patients. The PDQ-39 has been subjected to adaptation to Spanish language and culture (PDQ-39 Spanish version, PDQ-39SV) and this version has been validated in aspects of internal consistency and construct validity. The present study assess the test-retest reliability and the convergent validity of the PDQ-39SV with a generic QoL instrument (SF-36). RESULTS: Most of the PDQ-39 dimensions showed an adequate consistency-Cronbach's alpha > 0.7 for six dimensions. As a whole, test-retest reliability resulted satisfactory. Two dimensions-activities of daily living and emotional well-being- showed a low grade significant difference (paired Student t-test, p < 0.05) due to improvement in the second survey (at 10 to 14 days from the first one) perhaps related to adjustments of the treatment at the first visit. A strong association (Spearman r, p < 0.001), indicative of convergent validity, was obtained for the PDQ-39 dimensions and the relevant SF-36 scales, as well as for the physical and mental component summary scores of the SF-36. CONCLUSIONS: Taking into account these results and previous studies, it is concluded that the PDQ-39 SV is a reliable measure that has construct validity.

A Spanish experience of DSM III in a Consultation-Liaison psychiatric service.

The authors applied the DSM III diagnosis to 500 patients seen at a Consultation-Liaison psychiatric service. Compared with similar American studies there was a lower frequency of adjustment and somatoform disorders and a higher proportion of drug abuse cases. Several possible reasons for these differences are mentioned. Although the use of DSM III has clear advantages in a General Hospital context, important difficulties were found: the use of some diagnostic criteria, the absence of a code to relate Axes I and III, the poor systemization of scores in social Axes IV and V and the lack of a specific category for attempted suicide are but a few of the difficulties encountered. Finally, some modifications of DSM III are suggested in order to improve its clinical usefulness.