Abstract
Background: There is growing interest in health-related quality of life (HRQOL) as a comprehensive view of the patient's well-being, guiding concept for the treating clinician, and therapeutic trial outcome measure for patients with PD. The key determinants of HRQOL have not been investigated in large populations of people with PD (PwPD). Our objective was to evaluate correlates of health-related quality of life (HRQOL) in a large, online cohort of PwPD.
Methods: As part of an ongoing online cohort study, we performed a cross-sectional analysis at enrollment of 23,058 PwPD. We conducted univariate and stepwise multivariate linear regression analyses of HRQOL as measured by the EQ-5D-5L tool. In addition, we performed an interaction analysis to evaluate heterogeneity of the effect of motor symptoms on HRQOL and Spearman correlation analysis to evaluate the association of non-motor symptoms with HRQOL.
Results: In the multivariate linear regression model, participants with moderate or severe depression, more severe motor symptoms, and a higher burden of medical comorbidities had the most substantially decreased HRQOL as measured by the EQ index (beta=-0.11, -0.18, -0.02, -0.01 respectively, p<0.001 for all). An interaction analysis showed that more severe motor symptoms had a higher impact on individuals of female sex, lower educational level, lower income, more severe depression, and more severe cognitive impairment (p<0.01 for interaction terms). Neuropsychiatric symptoms and falls had the most negative associations with HRQOL (rho=-0.31-0.37, p<0.0001).
Discussion: Potentially treatable motor and non-motor symptoms, particularly neuropsychiatric symptoms, account for a large amount of the variation in HRQOL in PwPD. Motor symptoms may have differential effects on HRQOL in different demographic and clinical subpopulations, highlighting important areas for future health disparities research. Our findings provide targets for clinician intervention and future research on symptom management to optimize HRQOL in PD.
Classification of evidence: This study provides Class II evidence that motor and neuropsychiatric symptoms are associated with HRQOL in PwPD.