News   Research   Doctoral education   About the department  
The elderly, chronically ill and palliative care  
Peter Hagell 
Senior lecturer

Department of Nursing, Lund University
Departments of Neurology and Neurosurgery, Lund University Hospital
Section of Restorative Neurology, Division of Neurology, Department of Clinical Neuroscience, Lund University

Address: Department of Nursing, P.O. Box 157, Lund University, SE-221 00 Lund, Sweden
Phone: +46 46 222 1937
Cell phone:
Year of dissertation: 2002 
Thesis: Hagell P. Assessment of Graft Effects and Function in Cell Replacement Therapy for Parkinsonís Disease. Section of Restorative Neurology, Division of Neurology, Department of Clinical Neuroscience, Faculty of Medicine, Lund University, 2002. ISBN 91-628-5151-9.  
Current position: Senior lecturer  
Clinical speciality: Neurology (movement disorders)  
Research Field:

Outcomes Research, Measurement and Evaluation in Parkinsonís Disease and other Neurological Disorders

Parkinsonís disease (PD) is a common neurodegenerative disorder with a typical onset between 50 and 60 years of age and a prevalence of about 150/100 000. Progressive loss of nigrostriatal dopamine (DA) neurons due to unknown causes leads to a striatal dopamine deficit, believed to cause the cardinal symptoms of bradykinesia, rigidity, and tremor. DA-ergic drug therapy is successful early in the disease but most patients eventually develop a motor complications with episodes of poor drug response and increased parkinsonian disability, periods with good drug response and minimal parkinsonism, and drug-induced abnormal involuntary movements (dyskinesias). Although less well recognized and understood, PD distressing non-motor features, e.g., sleep disorders, depression and fatigue are also common. Taken together, PD causes significant consequences, from the perspective of affected patients, their families and for the society at large. Such aspects of PD and its therapy are considered among the most important and research within these areas has been identified as highly prioritized by the World Health Organization.

Current scientific efforts are focused on the measurement and understanding of the impact of PD and its therapy:

1. Development and evaluation of outcomes measures in Parkinsonís disease
This involves outcomes measures intended to reflect illness from the patientsí perspective, as well as clinical assessment tools. Ongoing work involves instruments tapping areas such as motor dysfunction (parkinsonism and motor complications), perceived health, distress, and functional status. Evaluations are performed by means of traditional as well as modern psychometric approaches, aiming at arriving with more effective, relevant, valid and objective outcome measures. Methodological issues in outcomes measurement are also addressed, e.g., regarding interpretation and clinical significance of outcomes and cross-cultural aspects of measurement and questionnaire adaptation. Initial studies have evaluated the validity of the generic and PD-specific health status questionnaires NHP and PDQ-39, respectively. It was found that while both showed promise they lacked overall measurement validity and further developmental work is now ongoing. We have also devised a clinical dyskinesia rating scale that is now recommended by international consensus for use in clinical neurosurgical PD trials. Future expansions may include development of new measures.

2. Health economy in Parkinsonís disease
This line of work involves two main branches, (i) estimating the cost-of-illness (COI) in PD, and (ii) health economic modeling for estimation of the long-term value of novel therapeutic interventions. A first, retrospective, COI study has been conducted and showed that PD causes a significant societal burden and is one of the most costly chronic diseases in Sweden. Furthermore, while most patients are elderly, the dominating costs are those due to production loss. The work on health economic modeling is ongoing and in a first application of the model, the long-term value and cost-effectiveness of a future dopamine cell replacement therapy for PD was estimated. Results indicated lower costs and better effectiveness compared to traditional drug therapy. Further developments and applications are currently being planned.

3. Non-motor symptoms in Parkinsonís disease
Although common, our understanding of non-motor features of PD in relation to its motor features or the underlying neurobiological alterations is very limited. This study, which is in its start-up phase, initially focuses on fatigue and involves application and validation of a fatigue-specific measure in PD, and explorative analyses of the construct of fatigue and the relationship between fatigue and other aspects of PD, in order to gain a better understanding of this symptom and formulate more solid hypotheses regarding its underlying mechanisms. The study is performed in collaboration with leading Swedish PD-centers. Future phases of the study are being planned.

In addition to the studies outlined above, I am also involved in other research projects, particularly in the development toward a future cell replacement therapy for PD. There are also single projects ongoing regarding, e.g., perceived health effects of structured patient information in PD, and the implementation of PD nurse specialists in Sweden.

Co-workers, postdoc
level and above:
  • Stephen P. McKenna, PhD, Director of Research (Galen Research, Manchester, UK)
  • Ulf Persson, PhD, Research Director (The Swedish Institute for Health Economics, Lund)
  • Olle Lindvall, MD, PhD, Professor (Section of Restorative Neurology, Division of Neurology, Department of Clinical Neuroscience, Lund University)
  • HŚkan Widner, MD, PhD, Associate Professor (Department of Neurology, Lund University Hospital)
  • Martin Grabowski, MD, PhD (Department of Neurology, Lund University Hospital)

Original Research Articles

  • Wenning G, Odin P, Morrish P, Rehncrona S, Widner H, Brundin P, Rothwell JC, Brown R, Gustavii B, Hagell P, Jahanshahi M, Sawle G, BjŲrklund A, Brooks DJ, Marsden CD, Quinn NP, Lindvall O. Short- and long-term survival and function of unilateral intrastriatal dopaminergic grafts in Parkinsonís disease. Annals of Neurology 1997; 42: 95-107. [abstract]
  • Pietz K, Hagell P, Odin P. Subcutaneous apomorphine in late stage Parkinsonís disease: A long-term follow-up. Journal of Neurology Neurosurgery and Psychiatry 1998; 65: 709-716. [full-text]
  • Hagell P, Widner H. Clinical rating of dyskinesias in Parkinsonís disease: Use and reliability of a new rating scale. Movement Disorders 1999; 14: 448-455. [abstract]
  • Hagell P, Schrag A, Piccini P, Jahanshahi M, Brown R, Rehncrona S, Widner H, Brundin P, Rothwell JC, Odin P, Wenning GK, Morrish P, Gustavii B, BjŲrklund A, Brooks DJ, Marsden CD, Quinn NP, Lindvall O. Sequential bilateral transplantation in Parkinsonís disease: Effects of the second graft. Brain 1999; 122: 1121-1132. [full-text]
  • Piccini P, Brooks D, BjŲrklund A, Gunn RN, Grasby PM, Rimoldi O, Brundin P, Hagell P, Rehncrona S, Widner H, Lindvall O. Dopamine release from nigral transplants visualized in vivo in a Parkinsonís patient. Nature Neuroscience 1999; 2: 1137-1140. [abstract]
  • Hagell P, Crabb L, Pogarell O, Schrag A, Widner H, Brooks DJ, Oertel WH, Quinn NP, Lindvall O. Health-related quality of life following bilateral intrastriatal transplantation in Parkinsonís disease. Movement Disorders 2000; 15: 224-229. [abstract]
  • Brundin P, Pogarell O, Hagell P, Piccini P, Widner H, Schrag A, Kupsch A, Crabb L, Odin P, Gustavii B, BjŲrklund A, Brooks DJ, Marsden CD, Oertel WH, Quinn NP, Rehncrona S, Lindvall O. Bilateral caudate and putamen grafts of lazaroid-treated embryonic mesencephalic tissue in Parkinsonís disease. Brain 2000; 123: 1380-1390. [full-text]
  • Piccini P, Lindvall O, BjŲrklund A, Brundin P, Hagell P, Cerevalo R, Oertel W, Quinn N, Samuel M, Rehncrona S, Widner H, Brooks D. Delayed recovery of movement-related cortical function in Parkinsonís disease after striatal dopaminergic grafts. Annals of Neurology 2000; 48: 689-695. [abstract]
  • Hagell P, Piccini P, BjŲrklund A, Brundin P, Rehncrona S, Widner H, Crabb L, Oertel WH, Quinn N, Brooks DJ, Lindvall O. Dyskinesias following neural transplantation in Parkinsonís disease. Nature Neuroscience 2002; 5: 627-628. [abstract]
  • Hagell P, Nordling S, Reimer J, Grabowski M, Persson U. Resource use and costs in a Swedish cohort of patients with Parkinsonís disease. Movement Disorders 2002; 17: 1213-1220. [abstract]
  • Masferrer R, Prendergast V, Hagell P. Colored pain drawings: Preliminary observations in a neurosurgical practice. European Journal of Pain 2003; 7: 213-217. [full-text]
  • Hagell P, Whalley D, McKenna SP, Lindvall O. Health status measurement in Parkinsonís disease: Validity of the PDQ-39 and Nottingham Health Profile. Movement Disorders 2003; 18: 773-783. [abstract]
  • Hagell P, McKenna SP. International use of health status questionnaires in Parkinsonís disease: Translation is not enough. Parkinsonism & Related Disorders 2003; 10: 89-92. [full-text]
  • Reimer J, Grabowski M, Lindvall O, Hagell P. Use and interpretation of on/off-diaries in Parkinsonís disease. Journal of Neurology Neurosurgery & Psychiatry 2004; 75: 396-400. [abstract]

Review Articles, Book Chapters, Editorials, etc. (selected)

  • Hagell P, Odin P, Freccero-Rosman K, Tršskman-Bendz L, Lindvall O. Depression vanlig vid Parkinsons sjukdom - Begršnsade studier kring symtom och behandling. Lškartidningen 1994; 91: 4270-4276. 
  • Hagell P, Odin P, Vinge E. Pregnancy in Parkinsonís disease: A review of the literature and a case report. Movement Disorders 1998; 13: 34-38. [abstract]
  • Hagell P and the International Steering Committee of Movement Disorder Nursing Societies. An introduction to movement disorders for the neuroscience nurse. International Brain Waves 1998; 6: 5-7+insert.
  • Hagell P. Restorative neurology in movement disorders. Journal of Neuroscience Nursing 2000; 32: 256-262. [abstract]
  • Hagell P. Timed tests in clinical assessment of motor function in Parkinsonís disease. Journal of Neuroscience Nursing 2000; 32: 331-336. [abstract]
  • Lindvall O, Hagell P. Clinical observations after neural transplantation in Parkinsonís disease. Progress in Brain Research 2000; 127: 299-320.
  • Hagell P, Odin P. Apomorphine in the treatment of Parkinsonís disease. Journal of Neuroscience Nursing 2001; 33: 21-38. [abstract]
  • Hagell P, Brundin P. Cell survival and clinical outcome following intrastriatal transplantation in Parkinson's disease. Journal of Neuropathology and Experimental Neurology 2001; 60: 741-752. [abstract]
  • Brundin P, Hagell P. The neurobiology of cell transplantation in Parkinsonís disease. Clinical Neuroscience Research 2001; 1: 507-520. [full-text]
  • Lindvall O, Hagell P. Neural and stem cell transplantation. In: Jankovic J, Tolosa E (eds.). Parkinsonís disease and movement disorders, Fourth Edn. Philadelphia: Lippincott Williams and Wilkins, 2002. pp 663-673.
  • Lindvall O, Hagell P. Role of cell therapy in Parkinsonís disease. Neurosurgical Focus 2002; 13(5): article 2. [full-text]

Abstracts/conference presentations (selected; unpublished studies/reviews only)

  • Hagell P. Symptoms and signs during the immediate post-operative phase after embryonic transplantations in Parkinsonís disease. 7th World Federation of Neuroscience Nurses Congress. Amsterdam, the Netherlands, 1997.
  • Hagell P. Clinical rating scales: Rationale, principles and methodology with examples from Parkinson's disease. 31st Annual Meeting of the American Association of Neuroscience Nurses. Philadelphia, USA, 1999.
  • Piccini P, Pavese N, Lindvall O, Hagell P, Gunn RN, Brooks D. Endogenous dopamine release correlates with dopamine storage in patients with Parkinsonís disease: An 11C-raclopride and 18F-dopa PET study. 52nd Annual Meeting of the American Academy of Neurology. San Diego, USA, 2000. Neurology 2000; 54(Suppl 3): A329-330.
  • Hagell P, Sandlund B. Patientsí self-assessment of disease and symptom severity in Parkinsonís disease. The 7th Annual Conference of the International Society for Quality of Life Research. Vancouver, Canada, 2000. Quality of Life Research 2000; 9(3): 285.
  • Hagell P, Sandlund B, Reimer J, Grabowski M, Lindvall O. The NHP index of distress in Parkinsonís disease. The 8th Annual Conference of the International Society for Quality of Life Research. Amsterdam, Netherlands, 2001. Quality of Life Research 2001; 10(3): 237. [abstract]
  • Hagell P. Quality of life in Parkinsonís disease [expanded abstract]. 2nd Scandinavian Congress of Neurological Nursing, Reykjavik, Iceland, 2002. Icelandic Medical Journal 2002; 88(43): 20-21. 
  • Hagell P. Quality of life in Parkinsonís disease: What do we measure and how does it affect our results? The 7th International Congress of Parkinsonís Disease and Movement Disorders. Miami, Florida, USA, 2002. Movement Disorders 2002; 17(Suppl 5): S240.
  • Hjelmgren J, Reimer J, Persson U, Ghatnekar O, Grabowski M, Lindvall O, Hagell P. Early decision-making modeling in Parkinsonís disease Ė The case of neural transplantation in patients with advanced Parkinsonís disease. International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 6th Annual European Congress. Barcelona, Spain, 2003. Value in Health 2003; 6(6): 765-766.
Accepted for publication:

Review Articles, Book Chapters, etc.

  • Hagell P. Future developments in the treatment of Parkinsonís disease. In: Swinn L (ed.). Parkinson's disease: Theory and practice for nurses. London: Whurr Publishers Ltd.
  • Hagell P, Swinn L. Diagnosing Parkinsonís disease. In: Swinn L (ed.). Parkinson's disease: Theory and practice for nurses. London: Whurr Publishers Ltd.
  • Cenci MA, Hagell P. Dyskinesias and neural grafting in Parkinson's disease. In: Olanow CW, Brundin P (eds.). Restorative therapies in Parkinson's disease. New York: Kluwer Academic/Plenum Publishers.
  • Lindvall O, Hagell P. Status of neural repair clinical trials in brain diseases. In: Selzer ME, Cohen L, Gage FH, Clarke S, Duncan PW (eds.). Textbook of neural repair and rehabilitation. Cambridge University Press.
  • Tennant A, McKenna SP, Hagell P. Application of Rasch analysis in the development and application of quality of life instruments. Value in Health.
  • Swaine-Verdier A, Doward LC, Hagell P, Thorsen H, McKenna SP. Adapting quality of life instruments. Value in Health.
Financing: The Skane County Council Research and Development Foundation, the Parkinson Foundation, the Rut och Erik Hardebo Foundation, the Elsa Schmitz Foundation, RŚdet fŲr hšlso- och sjukvŚrdsforskning (HSF), Lund University Hospital, Inge & Elsa Andersson's Foundation.  
 Division of Nursing Baravšgen 3  Box 157  221 00  Lund Sweden

About the department | Research | Research areas | Elderly and chronically ill | Researchers | Peter Hagell

Faculty of Medicine   Lund University         (The pages are optimized for Internet Explorer v. 5.5+)