The importance of educational and psychological factors in Parkinson’s disease quality of life E. Cubo a,b , A. Rojo a , S. Ramos a , S. Quintana c , M. Gonzalez d , K. Kompoliti b and M. Aguilar a a Neurology Department, Hospital Mutua de Terrassa, Terrassa (Barcelona), Spain; b Neurology Department, Rush-Presbyterian-St Luke’s Medical Center, Chicago, IL, USA; c Statistical Department, Hospital Mutua de Terrassa, Terrassa (Barcelona), Spain and d Statistical Department, University of Extremadura, Extremadura, Spain Keywords: education, Parkinson’s disease, PDQ-39, quality of life Received 13 April 2002 Accepted 8 August 2002 Objective: To define the factors correlated with quality of life (QoL) in patients with idiopathic Parkinson’s disease (PD). Background: PD has a substantial impact on QoL. Although several clinical factors have been associated with QoL in PD, the influence of patient’s education still remains controversial. Methodology: A consecutive series of patients with PD were examined using the unified Parkinson’s Disease Rating Scale (UPDRS part I, II, III), Schwab and Eng- land (SE), and Hoehn and Yahr stage (H&Y). QoL was rated with the PDQ-39, cognition with the Mini-Mental State examination (MMSE), and the presence of depressive symptoms with the geriatric depression scale (GDS). Patient’s character- istics, estimated cumulative levodopa dose (CLD), UPDRS, H&Y, MMSE and GDS were correlated with the PDQ-39 using univariate and multiple regression analysis. Results: A total of one hundred 58 patients (68 men, 90 women) with a mean age of 65.6 ± 9.3 years, PD duration of 8.1 ± 10.6 years, and education of 6.6 ± 3.9 years were included. The mean PDQ-39 was 48.8 ± 27.8, mean MMSE was 25.7 ± 4, and mean GDS was 11.7 ± 6.8. Using stepwise multiple regression analysis, the most important predictive factors were depression, UPDRS part I, UPDRS part II, and educational background, which accounted for a 61% of the variability of the PDQ-39 scores. Conclusions: In our PD sample, educational, behavioural, and psychological factors influenced life satisfaction more than physical ones. Background Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor, cognitive and behavioural dis- turbances. Its onset generally occurs between the ages of 50 and 65, and it is a leading cause of neurological dis- ability in individuals older than 60 years. Prevalence estimates are 100–200 cases per 100 000 in the general population with an annual incidence rate of approxi- mately20casesper100 000(Yahr,1989;Aminoff,1998). The goal of therapeutic interventions in PD is to manage its symptoms, thus decreasing their effects on quality of life (QoL). Several studies have shown that QoL in PD is influenced by depression, motor disability and cognitive impairment (Karlsen et al., 1999; Schrag et al., 2000a; The Global Parkinson’s Disease Survey (GPDS) Steering Committee 2002), but the impact of patient’s education, and other clinical features related to PD, such as motor and mental variables on QoL has never been systematically studied. To address these questions, we studied a consecutive sample of patients referred for an evaluation of PD in an outpatient setting. Methodology Study population We examined consecutive series of patients referred for an evaluation of PD at our tertiary care centre. Patients were self-referred or referred to our Movement Dis- order Unit by other doctors (neurologists, internists and family doctors) from 1998 to 2001. Clinical assessments The standard evaluation consisted of 1 h of diagnostic evaluation of the patient’s parkinsonian syndrome, including a complete neurological examination using the Unified Parkinson’s Disease Rating Scale (UPDRS) parts II and III (Fahn et al., 1987) and Hoehn and Yahr stage (H&Y) (Hoehn and Yahr, 1966). PD was Correspondence: Calle Maria Odiaga 64, BD, Madrid, Spain, 28025 (fax: 34-91-5250620; e-mail: cubox01@yahoo.com). Ó 2002 EFNS 589 European Journal of Neurology 2002, 9: 589–593