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Travel distance, growing disability, and uneven distribution of doctors limit access to care for most Parkinson's disease (PD) patients worldwide. Telemedicine, the use of telecommunications technology to deliver care at a distance, can help overcome these barriers. In this report, we describe the past, present, and likely future applications of telemedicine to PD. Historically, telemedicine has relied on expensive equipment to connect single patients to a specialist in pilot programs in wealthy nations. As the cost of video conferencing has plummeted, these efforts have expanded in scale and scope, now reaching larger parts of the world and extending the focus from care to training of remote providers. Policy, especially limited reimbursement, currently hinders the growth and adoption of these new care models. As these policies change and technology advances and spreads, the following will likely develop: integrated care networks that connect patients to a wide range of providers; education programs that support patients and health care providers; and new research applications that include remote monitoring and remote visits. Together, these developments will enable more individuals with PD to connect to care, increase access to expertise for patients and providers, and allow more-extensive, less-expensive participation in research.

The incidence of hip fracture and outcomes from hip surgery for people with Parkinson's disease (PD) are thought to be poorer than for people without PD. The aim of this audit of a prospective hip-fracture database was to establish the incidence of, and outcomes from, hip fracture in people with and without PD living in North East England. The number of people with PD living in the study area was estimated using data from two previous prevalence studies in the same geographical area. Using data collected prospectively for the National Hip Fracture Database for Northumbria Healthcare National Health Service Foundation Trust in the UK, the annual incidence of hip fracture in people with and without PD was calculated. Type of fracture, time to surgery, time to discharge, and 30-day outcomes from surgery were compared. Annual incidence of hip fracture was significantly higher in people with PD across all age bands. In those 60 years of age and over, it was 2,171 (95% confidence interval [CI]: 2,082–2,264) per 100,000 in people with PD and 551 (95% CI: 506–598) in people without PD. The experience of PD and non-PD patients within hospital was remarkably similar. However, PD patients had poorer mobility before hip fracture, took longer to be discharged to the community, and were less mobile postsurgery. Specific guidelines for managing people with PD who sustain a hip fracture may help to improve awareness of the potential complications of the condition and improve outcomes. © 2012 Movement Disorder Society

The incidence of Parkinson's disease (PD) in sub-Saharan Africa (SSA) is greater than thought however, is largely undiagnosed and untreated. This study aimed to evaluate a nonpharmacological approach using cueing therapy to improve gait in drug-naïve PD and the feasibility of delivering rehabilitation in northern Tanzania. In this study, twenty-one people with PD aged 76.4 years (12.9 SD) with varying disease severity participated. They received 9 x 30 min sessions of cueing therapy for gait problems over 3 weeks from a trained therapist delivered in their home environment. Cueing therapy consisted of walking in time to a metronome beat to correct step amplitude and step frequency during a range of functional activities. Gait was recorded on video before and after therapy, and videos were analyzed in the UK by an assessor not involved in data collection. Disease severity (UPDRS) and balance were also measured. Patients were assessed in their nearest clinic. Data were analyzed in Minitab and a P value of 0.05 was considered significant. Cueing therapy significantly improved single and dual task walking speed, step amplitude, and single task step frequency. There was also a significant improvement in motor impairment (UPDRS III) and activities of daily living (UPDRS II). The results provide promising evidence for the role of cueing therapy in PD for symptom management to reduce or delay medication onset. This study also supports the feasibility of rehabilitation in PD in community environments in SSA, which may be applicable to other developing regions.

The primary aim of this study was to ascertain whether a battery of physical function measures in a Parkinson's disease (PD) patient cohort predicted mortality status at 7-year follow-up. Secondary aims were establishing which specific tests were the most useful, and whether PD phenotype was a predictor. A retrospective correlation design was used in this study. A cohort of 109 PD patients underwent baseline physiotherapy assessment of gait, balance, posture, muscle strength, and ability to change postural set. We compared mortality status at 7-year follow-up and baseline physical assessment tests. Tinetti gait and balance scores, UPDRS score, 10-m walk test (time, velocity, and number of strides), posture in standing, lying to sitting, sitting to standing, getting up from floor assessments, and time to ascend and descend four steps were found to be statistically significant physical predictors of mortality at 7-year follow-up. In addition, age, sex, and mini-mental state examination were significant nonphysical predictors of mortality. Using Cox regression, a survival model was constructed with age, sex, and Tinetti gait score as independent predictors of mortality. The results of this study suggest that there is a link between reduced physical function and an increased mortality risk in PD populations.

The prevalence of Parkinson's disease (PD) varies worldwide from 7 to 450 per 100,000, and appears low in sub-Saharan Africa (SSA) but few data exist. We conducted a prevalence study of PD in rural Tanzania. A door-to-door study was conducted in the Hai district project area (population 161,071), using a screening questionnaire followed by structured history and examination of positive responders. Diagnosis was based on the UK PD Society Brain Bank Criteria. 33 (23 men) cases of PD were detected, with mean age 74 years (range 38-94). One patient died before the prevalence date. 78% were previously undiagnosed and untreated. Mean duration of symptoms was 5 years, and median Hoehn and Yahr stage 3. Crude prevalence rates were 30/100,000 (men), 11/100,000 (women) and 20/100,000 (combined). The direct age-standardized prevalence rates compared with the UK population were 64/100,000 (men), 20/100,000 (women) and 40/100,000 (combined). These rates are higher than previously reported from SSA, but still lower than the developed world. Many PD patients in SSA may never be diagnosed or treated, with consequent reduction in their life expectancy and quality of life. With the world population ageing PD is predicted to become an increasing problem.

The purpose of this study was to assess quality of life (QoL) of patients with idiopathic Parkinson's disease (IPD). The Parkinson's Disease Questionnaire (PDQ-39) was compared with an individualized QoL tool: the Schedule for Evaluation of Individual Quality of Life Direct Weighting (SEIQoL-DW). One hundred twenty-three patients underwent interviews using these tools, together with the Mini Mental State examination, Beck Depression Inventory, a qualitative pain assessment, and the Palliative Care Assessment tool (for symptoms). The SEIQoL-DW was well tolerated and demonstrated that QoL not only was broad and highly individualistic but also was determined more by psychosocial than physical issues. Of the 87 domains nominated by patients, the most common were family (87.8%), health (52.8%), leisure activities (36.6%), marriage (35%), and friends (30.9%). The SEIQoL index score was predicted by depression but not by disease stage. However, the PDQ-39 was predicted by disease stage, the number of symptoms, and depression. Direct comparison of the tools confirmed that the SEIQoL index score was predicted by the PDQ-39 domains of social support, cognitive impairment, and emotion. The use of the SEIQoL-DW challenges current thinking within IPD research regarding QoL and its assessment using the PDQ-39.