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Armstrong MJ, Rastgardani T, Gagliardi AR, Marras C. The experience of off periods: Qualitative analysis of interviews with persons with Parkinson's and carepartners. Clin Park Relat Disord 2019; 1:31-36. [PMID: 34316596 PMCID: PMC8288715 DOI: 10.1016/j.prdoa.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/12/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Off period research in Parkinson's disease commonly relies on questionnaires. We aimed to investigate the breadth of off period experiences by interviewing persons with Parkinson's disease (PwP) and carepartners. Methods Investigators performed PwP and carepartner dyad interviews using a semi-structured questionnaire to describe off period experiences. Investigators analyzed interview transcripts using a qualitative descriptive approach to identify and compare themes between groups. Results Twenty PwP and their carepartners participated in interviews. PwP were on average 65.1 years-old (SD 8.3) and 7.8 years (SD 4.7) after their Parkinson's disease diagnosis. PwP and carepartners identified 13 motor symptoms, 5 of which (immobility, gait changes, freezing, trouble swallowing, and having to concentrate on movements) were not in the wearing off questionnaires recommended by the International Parkinson and Movement Disorders Society. PwP and carepartners identified 15 non-motor symptoms, 8 of which (behavior changes, irritability, fatigue, language difficulties, dizziness, dry mouth, urinary symptoms, and swollen feet) were not in recommended questionnaires. Certain symptoms were reported only by PwP (e.g. dizziness, urinary symptoms) or carepartners (e.g. behavioral changes), or were reported by dyad members to different degrees (e.g. fatigue, anxiety). Conclusion Wearing off questionnaires capture the presence of fluctuations and can facilitate patient-physician communication regarding off periods. However, they may miss the breadth of individual PwP experiences. PwP and carepartners also report different PwP experiences during off periods. To fully appreciate an individual's off experiences, clinicians likely need to use multiple approaches to gathering information including questionnaires and both PwP and carepartner report. Wearing off questionnaires may capture fluctuation presence but not all experiences. Persons with Parkinson's identified some motor off symptoms not in questionnaires. Six of the described non-motor wearing off symptoms were absent from questionnaires. Certain off symptoms (e.g. dizziness, urinary symptoms) were reported only by PwPs. Certain off symptoms (e.g. behavioral symptoms) were reported only by carepartners.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States of America
| | - Tara Rastgardani
- Morton and Gloria Shulman Movement Disorders Centre, the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, ON, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre, the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, ON, Canada
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Ha ULN, Tran TN, Le M, Dang THT, Vũ NA, Truong D. Validating the Vietnamese version of wearing - Off 19 questionnaire for patients with Parkinson's disease. Clin Park Relat Disord 2019; 1:37-40. [PMID: 34316597 PMCID: PMC8288827 DOI: 10.1016/j.prdoa.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One of the most common complication of the progression of Parkinson's disease (PD) is the wearing off phenomenon. A validated Vietnamese version of Wearing off 19 (WO19) questionnaire is necessary to optimize the Vietnamese PD treatment. OBJECTIVES This study was undertaken to determine the quality attribute of the questionnaire as a tool for early detection of wearing off (WO) in Vietnamese population with PD. We also sought the relationship between the WO phenomenon and factors concerning the clinical condition and course of the disease. SUBJECTS AND METHODS This is an observational, cross-sectional study. Patients diagnosed with PD under dopaminergic treatment came to University Medical Center Ho Chi Minh city for a regular appointment were sequentially asked to complete the Vietnamese WO19 questionnaire. A neurologist specialized in movement disorders assessed the patient and determined whether he had experienced wearing off or not. The questionnaire results were then compared to the clinical opinion of the expert which is considered the gold standard for diagnosing wearing off. The reliability of the questionnaire is evaluated by Cronbach'α and Cohen's kappa coefficient. The validity is measured by the sensitivity and the specificity of the instrument compared to the gold standard. The multivariate logistic regression analysis is used to learn the relations of associated factors and wearing off phenomenon. RESULTS 98 patients with the mean age 59.12 ± 10.99 have joined our study; 58.2% are male; and the mean disease duration is 6.32 years. The Vietnamese version of the WO19 questionnaire has a good reliability (Cronbach'α = 0.778) and the agreement with the expert assessment (the diagnostic accuracy) is at a substantial level (Kappa value = 0.618). The sensitivity and specificity of the questionnaire resulted 89.28% and 71.43% respectively. The multivariate logistic regression analysis revealed a long disease duration (≥6 years) (OR: 16.96; 95% CI: 2.17-132.57; p = 0.007), a high daily levodopa dosage (≥400 mg/day) (OR: 6.31; 95% CI: 1.36-29.23; p = 0.019) and high score of MDS-UPDRS part IV (≥4) (OR: 15.36; 95% CI: 2.13-110.58; p = 0.007) were independent predictive factors for wearing off in Vietnamese PD patients. CONCLUSIONS Vietnamese - WO19 is a reliable and effective tool which should be used in clinical practice for early detecting PD patients with wearing off.
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Affiliation(s)
- Uyen Le Ngoc Ha
- Neurology department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Tai Ngoc Tran
- Neurology department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Minh Le
- Neurology department, University Medical Center, Ho Chi Minh City, Vietnam
| | | | - Nhi Anh Vũ
- Neurology department, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Daniel Truong
- The Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USA
- Department of Psychiatry and Neuroscience, UC Riverside, Riverside, CA, USA
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The role of one-carbon metabolism and homocysteine in Parkinson’s disease onset, pathology and mechanisms. Nutr Res Rev 2019; 32:218-230. [DOI: 10.1017/s0954422419000106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractParkinson’s disease (PD) is the second most common neurodegenerative disorder. It is characterised by the progressive degeneration of dopaminergic (DA) neurons. The cause of degeneration is not well understood; however, both genetics and environmental factors, such as nutrition, have been implicated in the disease process. Deficiencies in one-carbon metabolism in particular have been associated with increased risk for PD onset and progression, though the precise relationship is unclear. The aim of the present review is to determine the role of one-carbon metabolism and elevated levels of homocysteine in PD onset and pathology and to identify potential mechanisms involved. A search of PubMed, Google Scholar and Web of Science was undertaken to identify relevant human and animal studies. Case–control, prospective cohort studies, meta-analyses and non-randomised trials were included in the present review. The results from human studies indicate that polymorphisms in one-carbon metabolism may increase risk for PD development. There is an unclear role for dietary B-vitamin intake on PD onset and progression. However, dietary supplementation with B-vitamins may be beneficial for PD-affected individuals, particularly those onl-DOPA (levodopa orl-3,4-dihydroxyphenylalanine) treatment. Additionally, one-carbon metabolism generates methyl groups, and methylation capacity in PD-affected individuals is reduced. This reduced capacity has an impact on expression of disease-specific genes that may be involved in PD progression. During B-vitamin deficiency, animal studies report increased vulnerability of DA cells through increased oxidative stress and altered methylation. Nutrition, especially folates and related B-vitamins, may contribute to the onset and progression of PD by making the brain more vulnerable to damage; however, further investigation is required.
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Storch A, Rosqvist K, Ebersbach G, Odin P. Disease stage dependency of motor and non-motor fluctuations in Parkinson’s disease. J Neural Transm (Vienna) 2019; 126:841-851. [DOI: 10.1007/s00702-019-02033-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022]
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Stocchi F, Coletti C, Bonassi S, Radicati FG, Vacca L. Early-morning OFF and levodopa dose failures in patients with Parkinson's disease attending a routine clinical appointment using Time-to-ON Questionnaire. Eur J Neurol 2019; 26:821-826. [PMID: 30585679 DOI: 10.1111/ene.13895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In patients with Parkinson's disease (PD) with motor fluctuations, total daily OFF time is comprised of both end-of-dose time and the time taken to turn ON with medication. However, little is known about the impact of delays in ON time. METHODS This was a single-visit pilot study of fluctuating patients with PD attending a routine appointment. During a single visit, adult patients with idiopathic PD who were treated with levodopa for at least 1 year completed a questionnaire evaluating the time waiting for ON and the symptoms experienced while waiting to turn ON. Patients then completed a 5-day home time-to-ON diary, where they documented how long it took to turn ON following their first morning dose of levodopa in 5-min increments. RESULTS A total of 151 consecutive patients completed the study survey, of whom 97 (64.2%) experienced motor fluctuations. Of the patients experiencing motor fluctuations, 54 (56%) reported delays in ON time (latency >30 min) following their first morning dose of levodopa. Half (51%) reported that they had experienced delayed ON at least once in the previous week and 21% reported having delayed ON during all seven mornings of the previous week. In addition, 10% of patients reported having dose failures on four or more mornings during the previous week. The most common symptoms experienced while waiting for ON were slowness (94.8%), fatigue (87.6%), reduced dexterity (82.5%), problems in walking (66.0%) and problems with balance (59.8%). CONCLUSION Early-morning OFF problems such as delays in time to ON and dose failures are common in levodopa-treated patients with PD.
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Affiliation(s)
- F Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - C Coletti
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - S Bonassi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - F G Radicati
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - L Vacca
- Neurology Department, Casa di Cura Privata Policlinico (CCPP), Milan, Italy
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Remigio KC, Jamora RDG. Philippine translation and validation of the Wearing-off Questionnaire-19. Clin Park Relat Disord 2019; 1:21-24. [PMID: 34316594 PMCID: PMC8288825 DOI: 10.1016/j.prdoa.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction The 19-item Wearing-Off questionnaire is used as a self-administered questionnaire assessing wearing-off (WO) in Parkinson's disease (PD) patients. Thus, we aim to translate and validate the WOQ-19 into Filipino (FWOQ-19). Methods We translated the WOQ-19 questionnaire into Filipino and used it to assess WO among Filipino PD patients. The original WOQ-19 was translated into Filipino using forward and backward translation by independent bilingual translators. WO is present if the patients checked at least 2 symptoms in the WOQ-19. Baseline demographic data, disease duration and medication use were collected. Internal consistency was measured using Cronbach's alpha. The Unified Parkinson's Disease Rating Scale (UPDRS) part IV and WOQ-32 were correlated with FWOQ-19 through Pearson's correlation coefficient to assess construct validity. Results and discussion The FWOQ-19 was answered by 46 patients. The mean age of the participants was 60.8 ± 10.0 years (range, 40–86 years). The mean duration of PD was 10.9 ± 3.1 years (range, 1–26 years). Majority (n = 38, 82%) of patients claimed that WO is predictable and only 2 of the patients claimed that WO is unpredictable. The rest of the patients (n = 6, 13%) said that they did not experience WO. The internal consistency of the FWOQ-19 is acceptable (Cronbach's alpha 0.7808). There is a high correlation between WOQ-32 and FWOQ-19 (r = 0.8191). The troublesome symptoms for the patients were tremor, insomnia, weakness and slowness. Conclusion The FWOQ-19 is a valid assessment tool for detecting wearing-off among Filipino-speaking PD patients.
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Schmitt E, Krack P, Castrioto A, Klinger H, Bichon A, Lhommée E, Pelissier P, Fraix V, Thobois S, Moro E, Martinez-Martin P. The Neuropsychiatric Fluctuations Scale for Parkinson's Disease: A Pilot Study. Mov Disord Clin Pract 2018; 5:265-272. [PMID: 30363450 DOI: 10.1002/mdc3.12607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 12/19/2022] Open
Abstract
Background Non-motor fluctuations represent a main source of disability in Parkinson's disease (PD). Among them, neuropsychiatric fluctuations are the most frequent and are often under-recognized by patients and physicians, partly because specific tools for assessment of neuropsychiatric fluctuations are lacking. Objective To develop a scale for detecting and evaluating the presence and the severity of neuropsychological symptoms during the ON and OFF phases of non-motor fluctuations. Methods Neuropsychiatric symptoms reported by PD patients in the OFF- and the ON-medication conditions were collected using different neuropsychiatric scales (BDI-II, BAI, Young, VAS, etc.). Subsequently, tree phases of a pilot study was performed for cognitive pretesting, identification of ambiguous or redundant items (item reduction), and to obtain preliminary data of acceptability of the new scale. In all the three phases, the scale was applied in both the OFF and ON condition during a levodopa challenge. Results Twenty items were selected for the final version of the neuropsychiatric fluctuation scale (NFS): ten items measured the ON neuropsychological symptoms and ten items the OFF neuropsychological manifestations. Each item rated from 0-3, providing respective subscores from 0 to 30. Conclusions Once validated, our NFS can be used to identify and quantify neuropsychiatric fluctuations during motor fluctuations. The main novelty is that it could be used in acute settings. As such, the NFS can assess the neuropsychiatric state of the patient at the time of examination. The next step will be to validate the NFS to be used in current practice.
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Affiliation(s)
- Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France.,Department of Clinical Neuroscience, Hôpitaux Universitaires de Genève University of Geneva Switzerland
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Helene Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Neurologie C Lyon France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1 Université de Lyon Lyon France.,CNRS, UMR 5229 Centre de Neurosciences Cognitives Bron France
| | - Amelie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Pierre Pelissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Valerie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Stephane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Neurologie C Lyon France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1 Université de Lyon Lyon France.,CNRS, UMR 5229 Centre de Neurosciences Cognitives Bron France
| | - Elena Moro
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation CHU Grenoble Grenoble France.,Grenoble Institut des Neurosciences Grenoble Alpes University France.,Inserm U1216 Grenoble France
| | - Pablo Martinez-Martin
- National Center of Epidemiology Carlos III Institute of Health Madrid Spain.,CIBERNED Carlos III Institute of Health Madrid Spain
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Siddiqui J, Aldaajani Z, Mehanna R, Changizi BK, Bhatti D, Al-Johani ZG, Shukla AW, Fernandez HH, Bajwa JA. Rationale and patient selection for interventional therapies in Parkinson’s disease. Expert Rev Neurother 2018; 18:811-823. [DOI: 10.1080/14737175.2018.1535902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Junaid Siddiqui
- Department of Neurology, Movement Disorders, University of Missouri, Columbia, MO, USA
| | - Zakiyah Aldaajani
- Department of Neurology, King Fahad Military Hospital, Dhahran, Saudi Arabia
| | - Raja Mehanna
- Department of Neurology, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - Barbara Kelly Changizi
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Danish Bhatti
- Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jawad A. Bajwa
- Parkinson’s, Movement Disorders and Neurorestoration Program, National Neuroscience Institute, Riyadh, Saudi Arabia
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Rastgardani T, Armstrong MJ, Gagliardi AR, Marras C. Understanding, Impact, and Communication of "Off" Periods in Parkinson's Disease: A Scoping Review. Mov Disord Clin Pract 2018; 5:461-470. [PMID: 30515435 PMCID: PMC6207105 DOI: 10.1002/mdc3.12672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Off periods are a common and disabling symptom of Parkinson's disease. We reviewed published research on understanding, impact, and communication regarding off periods to identify issues warranting further research. METHODS We performed a scoping review, searching MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsycINFO from 2006 to January 2018 for studies examining the impact of, understanding of, or communication about off periods. RESULTS Twenty-six papers met eligibility criteria. Twenty-three studies evaluated the impact or experience of off periods in patients, three evaluated the impact upon carepartners, two papers addressed understanding of off periods, one study evaluated communication about off periods, and three studies evaluated a facilitator of communication about off periods. The findings indicate that (1) off periods are among the most troublesome symptoms to patients and that their impact on activities is broad; (2) the understanding of off periods by patients, carepartners, and nurses may be suboptimal; and (3) questionnaires hold promise as a mechanism for facilitating communication given the findings that they may enhance the detection of off periods and are rated as useful by physicians. No studies evaluated interventions to promote knowledge about off periods, and no studies identified barriers of communication about off periods. CONCLUSIONS There is a paucity of knowledge regarding the lived experiences of off periods, particularly for carepartners. Additionally, little knowledge exists in the literature regarding understanding of and communication about off periods between patients or carepartners and treating physicians. Further research is required to explore these issues to ultimately improve the treatment of off periods.
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Affiliation(s)
- Tara Rastgardani
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's ResearchToronto Western HospitalTorontoONCanada
| | - Melissa J. Armstrong
- Department of NeurologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoONCanada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's ResearchToronto Western HospitalTorontoONCanada
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Pahwa R, Isaacson SH, Torres-Russotto D, Nahab FB, Lynch PM, Kotschet KE. Role of the Personal KinetiGraph in the routine clinical assessment of Parkinson’s disease: recommendations from an expert panel. Expert Rev Neurother 2018; 18:669-680. [DOI: 10.1080/14737175.2018.1503948] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | | | - Fatta B. Nahab
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | | | - Katya E. Kotschet
- Florey Neuroscience Institute, University of Melbourne, Parkville, Australia
- Department of Neurology, St Vincent’s Hospital, Fitzroy, Australia
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Validation of a simple screening tool for early diagnosis of advanced Parkinson's disease in daily practice: the CDEPA questionnaire. NPJ PARKINSONS DISEASE 2018; 4:20. [PMID: 29978014 PMCID: PMC6028449 DOI: 10.1038/s41531-018-0056-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 12/03/2022]
Abstract
Early clinical diagnosis of advanced Parkinson’s disease (APD) may be difficult. This study aimed to validate a simple screening tool, the CDEPA questionnaire (“Cuestionario De Enfermedad de Parkinson Avanzada” [Questionnaire for Advanced Parkinson’s Disease]), for the identification of APD in daily practice. The study included 173 consecutively selected patients with PD (40% were women, mean age was 68.4 ± 10.5 years), stratified according to the Hoehn and Yahr (HY) scale. The CDEPA questionnaire defined APD as the presence of severe disability requiring help for activities of daily living (ADL), motor fluctuations with limitation or inability to perform ADL, severe dysphagia, recurrent falls, or dementia. The diagnostic performance of the questionnaire was assessed against the gold standard criterion based on clinical judgment. PD was categorized as advanced in 65 (38%) patients when using the gold standard and in 109 (63%) patients when the CDEPA questionnaire was used. The CDEPA questionnaire and the gold standard agreed moderately (kappa statistic of 0.48, P < 0.001). The CDEPA classified APD with a sensitivity of 97%; specificity of 57%; total accuracy of 72.3%; and area under the curve (for a binary classifier) of 77.2%. Significant differences were found between the groups created by the CDEPA in several usual PD evaluations (HY Scale, SCOPA Motor Scale, Non-motor Symptoms Scale for PD, Clinical Impression of Severity Index for PD, Clinical Global Impression–Severity Scale, and Patient Global Impression–Severity Scale). CDEPA showed satisfactory inter-rater agreement (kappa = 0.88) and test–retest concordance (kappa 0.83). In conclusion, the CDEPA questionnaire is a valid, reliable, and useful instrument for easily screening APD. A Spanish questionnaire for advanced Parkinson’s disease, CDEPA, is a reliable tool for identifying patients with late-stage PD. Patients with advanced PD have severe motor and non-motor symptoms, and show poor response to conventional therapies. Early diagnosis is the key to determine which patients will benefit from the alternative treatment options such as deep brain stimulation. A study led by Pablo Martinez-Martin at the Carlos III Institute of Health in Madrid compared the accuracy of advanced PD diagnosis using the CDEPA questionnaire and a neurologist’s clinical judgment. The diagnostic accuracy of the questionnaire was >70% and the questionnaire results agreed with the diagnosis of advanced PD based on clinical judgment in 97% of cases. This quick and easy-to-administer questionnaire could be highly valuable for detecting advanced PD in outpatient clinics.
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Fackrell R, Carroll CB, Grosset DG, Mohamed B, Reddy P, Parry M, Chaudhuri KR, Foltynie T. Noninvasive options for 'wearing-off' in Parkinson's disease: a clinical consensus from a panel of UK Parkinson's disease specialists. Neurodegener Dis Manag 2018; 8:349-360. [PMID: 29975112 DOI: 10.2217/nmt-2018-0020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the past 4 years, two adjunctive treatment options to levodopa have been licensed for use in the UK in patients with Parkinson's disease (PD) and motor fluctuations: opicapone, a third-generation catechol-O-methyl transferase inhibitor, and safinamide, a monoamine oxidase B inhibitor. This clinical consensus outlines the practical considerations relating to motor fluctuations and managing wearing-off in patients with PD, and provides a clinical insight to adjunctive treatment options, including opicapone and safinamide. Practice-based opinion was provided from a multidisciplinary steering Group of eight UK-based movement disorder and PD specialists, including neurologists, geriatricians and a nurse specialist, from England, Scotland and Wales.
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Affiliation(s)
- Robin Fackrell
- Department of Geriatric Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Camille B Carroll
- Faculty of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Donald G Grosset
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Biju Mohamed
- Department of Medicine and Gerontology, University Hospital of Wales, Cardiff, UK
| | - Prashanth Reddy
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Miriam Parry
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kallol Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience at King's College & Parkinson Foundation International Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Foltynie
- Unit of Functional Neurosurgery at UCL Institute of Neurology and the National Hospital for Neurology & Neurosurgery, London, UK
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Clinimetrics of the 9- and 19-Item Wearing-Off Questionnaire: A Systematic Review. PARKINSONS DISEASE 2018; 2018:5308491. [PMID: 29808113 PMCID: PMC5902048 DOI: 10.1155/2018/5308491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
The treatment of Parkinson's disease (PD) with dopaminergic therapy improves functionality and quality of life. However, as the disease progresses, the wearing-off phenomenon develops, which necessitates complex posology adjustment or adjuvant therapy. This phenomenon may not be well recognized, especially if it is mild or involves nonmotor symptoms. Questionnaires were developed to improve the recognition of the wearing-off phenomenon. The questionnaires consist of a list of symptoms that patients must check if they have and if the symptoms improve with medication. A recent review by the Movement Disorder Society suggested the 19-item (WOQ-19) and 9-item (WOQ-9) questionnaires as screening tools for the wearing-off phenomenon. However, there has not been a systematic review to assess the questionnaires' clinimetric properties, such as sensitivity, specificity, test-retest reliability, and responsiveness. We conducted an extensive search for studies using these two tools. We identified 3 studies using WOQ-19 and 5 studies using WOQ-9. Both questionnaires seem to have good sensitivity (0.81–1). WOQ-19 has variable specificity (0.39–0.8), depending on the number of positive items, while WOQ-9 lacks specificity (0.1–0.69). Only one study using WOQ-19 reported test-retest, and only two studies reported responsiveness. Thus, this report describes the first independent systematic review to exam quantitatively the clinimetric properties of these two questionnaires.
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Viewpoint and practical recommendations from a movement disorder specialist panel on objective measurement in the clinical management of Parkinson's disease. NPJ PARKINSONS DISEASE 2018; 4:14. [PMID: 29761156 PMCID: PMC5945844 DOI: 10.1038/s41531-018-0051-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/02/2023]
Abstract
Motor aspects of Parkinson's disease, such as fluctuations and dyskinesia, can be reliably evaluated using a variety of "wearable" technologies, but practical guidance on objective measurement (OM) and the optimum use of these devices is lacking. Therefore, as a first step, a panel of movement disorder specialists met to provide guidance on how OM could be assessed and incorporated into clinical guidelines. A key aspect of the incorporation of OM into the management of Parkinson's disease (PD) is defining cutoff values that separate "controlled" from "uncontrolled" symptoms that can be modified by therapy and that relate to an outcome that is relevant to the person with PD (such as quality of life). Defining cutoffs by consensus, which can be subsequently tested and refined, is the first step to optimizing OM in the management of PD. OM should be used by all clinicians that treat people with PD but the least experienced may find the most value, but this requires guidance from experts to allow non-experts to apply guidelines. While evidence is gained for devices that produce OM, expert opinion is needed to supplement the evidence base.
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Chen C, Li X, Ge G, Liu J, Biju KC, Laing SD, Qian Y, Ballard C, He Z, Masliah E, Clark RA, O'Connor JC, Li S. GDNF-expressing macrophages mitigate loss of dopamine neurons and improve Parkinsonian symptoms in MitoPark mice. Sci Rep 2018; 8:5460. [PMID: 29615705 PMCID: PMC5882968 DOI: 10.1038/s41598-018-23795-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/14/2018] [Indexed: 01/12/2023] Open
Abstract
Glial cell line-derived neurotrophic factor (GDNF) is the most potent neuroprotective agent tested in cellular and animal models of Parkinson's disease (PD). However, CNS delivery of GDNF is restricted by the blood-brain barrier (BBB). Using total body irradiation as transplant preconditioning, we previously reported that hematopoietic stem cell (HSC) transplantation (HSCT)-based macrophage-mediated gene therapy could deliver GDNF to the brain to prevent degeneration of nigrostriatal dopamine (DA) neurons in an acute murine neurotoxicity model. Here, we validate this therapeutic approach in a chronic progressive PD model - the MitoPark mouse, with head shielding to avoid inducing neuroinflammation and compromising BBB integrity. Bone marrow HSCs were transduced ex vivo with a lentiviral vector expressing macrophage promoter-driven GDNF and transplanted into MitoPark mice exhibiting well developed PD-like impairments. Transgene-expressing macrophages infiltrated the midbrains of MitoPark mice, but not normal littermates, and delivered GDNF locally. Macrophage GDNF delivery markedly improved both motor and non-motor symptoms, and dramatically mitigated the loss of both DA neurons in the substantia nigra and tyrosine hydroxylase-positive axonal terminals in the striatum. Our data support further development of this HSCT-based macrophage-mediated GDNF delivery approach in order to address the unmet need for a disease-modifying therapy for PD.
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Affiliation(s)
- Cang Chen
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Xiuhua Li
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Guo Ge
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Jingwei Liu
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - K C Biju
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Suzette D Laing
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Yusheng Qian
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Cori Ballard
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
| | - Zhixu He
- Stem Cells Research Center of Guizhou Medical University and Key Laboratory of Adult Stem cell Transformation Research, Chinese Academy of Medical Science, Guiyang, Guizhou, 550025, China
| | | | - Robert A Clark
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA
- Audie L. Murphy VA Hospital, 7400 Merton Minter Boulevard, San Antonio, Texas, 78229, USA
| | - Jason C O'Connor
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA.
- Audie L. Murphy VA Hospital, 7400 Merton Minter Boulevard, San Antonio, Texas, 78229, USA.
| | - Senlin Li
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA.
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, USA.
- Audie L. Murphy VA Hospital, 7400 Merton Minter Boulevard, San Antonio, Texas, 78229, USA.
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Lee JE, Kim JS, Ryu DW, Oh YS, Yoo IR, Lee KS. Cardiac Sympathetic Denervation Can Predict the Wearing-off Phenomenon in Patients with Parkinson Disease. J Nucl Med 2018; 59:1728-1733. [DOI: 10.2967/jnumed.118.208686] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/05/2018] [Indexed: 12/26/2022] Open
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Paraskevaidi M, Martin-Hirsch PL, Martin FL. Progress and Challenges in the Diagnosis of Dementia: A Critical Review. ACS Chem Neurosci 2018; 9:446-461. [PMID: 29390184 DOI: 10.1021/acschemneuro.8b00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Longer life expectancies have led to an increased number of neurodegenerative disease cases globally. Accurate diagnosis of this devastating disorder is of crucial importance but is still feasible only by a brain biopsy after death. An enormous amount of attention and research has been in place over the years toward the better understanding of the mechanisms, as well as the early diagnosis, of neurodegeneration. However, numerous studies have been contradictory from time to time, while new diagnostic methods are constantly developed in a tireless effort to tackle the disease. Nonetheless, there is not yet a conclusive report covering a broader range of techniques for the diagnosis of different types of dementia. In this paper, we critically review current knowledge on the different hypotheses about the pathogenesis of distinct types of dementia, as well as risk factors and current diagnostic approaches in a clinical setting, including neuroimaging, cerebrospinal (CSF), and blood tests. Encouraging research results for the diagnosis and investigation of neurodegenerative disorders are also reported. Particular attention is given to the field of spectroscopy as an emerging tool to detect dementias, follow-up patients, and potentially monitor the patients' response to a therapeutic approach. Spectroscopic techniques, such as infrared and Raman spectroscopy, have facilitated numerous disease-related studies, including neurodegenerative disorders, and are currently undergoing trials for clinical implementation. This review constitutes a comprehensive report with an in-depth focus on promising imaging, molecular biomarker and spectroscopic tests in the field of dementive diseases.
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Affiliation(s)
- Maria Paraskevaidi
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
| | - Pierre L. Martin-Hirsch
- Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Francis L. Martin
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
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Chou KL, Stacy M, Simuni T, Miyasaki J, Oertel WH, Sethi K, Fernandez HH, Stocchi F. The spectrum of "off" in Parkinson's disease: What have we learned over 40 years? Parkinsonism Relat Disord 2018; 51:9-16. [PMID: 29456046 DOI: 10.1016/j.parkreldis.2018.02.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/18/2017] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
The terms "on" and "off" were used by Marsden and his contemporaries over 40 years ago to describe times when Parkinson's disease patients experienced good motor function ("on") and immobility ("off"). Yet there remains no published consensus definition of "off", leading clinicians and patients to develop individualized impressions of "off" determinations. In this paper, we first discuss the evolution of the terminology and understanding of "off" states since Marsden's time, which now include non-motor as well as motor symptoms. We then review pathophysiology and risk factors for the development of "off" states as well as tools to detect the "off" state, before proposing a practical definition of "off" for consideration. A common, practical definition of the "off" state could improve clinical recognition of "off" symptoms and lead to significant benefit for patients.
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Affiliation(s)
- Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
| | - Mark Stacy
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janis Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic, Canada
| | - Wolfgang H Oertel
- Department of Neurology, University Clinic, Philipps Universität Marburg, Marburg, Germany; Institute for Neurogenomics, Helmholtz Center for Health and Environment, Munich, Germany
| | - Kapil Sethi
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Fabrizio Stocchi
- Department of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele Roma, Roma, Italy
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Johansson D, Ericsson A, Johansson A, Medvedev A, Nyholm D, Ohlsson F, Senek M, Spira J, Thomas I, Westin J, Bergquist F. Individualization of levodopa treatment using a microtablet dispenser and ambulatory accelerometry. CNS Neurosci Ther 2018; 24:439-447. [PMID: 29652438 DOI: 10.1111/cns.12807] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 11/29/2022] Open
Abstract
AIM This 4-week open-label observational study describes the effect of introducing a microtablet dose dispenser and adjusting doses based on objective free-living motor symptom monitoring in individuals with Parkinson's disease (PD). METHODS Twenty-eight outpatients with PD on stable levodopa treatment with dose intervals of ≤4 hour had their daytime doses of levodopa replaced with levodopa/carbidopa microtablets, 5/1.25 mg (LC-5) delivered from a dose dispenser device with programmable reminders. After 2 weeks, doses were adjusted based on ambulatory accelerometry and clinical monitoring. RESULTS Twenty-four participants completed the study per protocol. The daily levodopa dose was increased by 15% (112 mg, P < 0.001) from period 1 to 2, and the dose interval was reduced by 12% (22 minutes, P = 0.003). The treatment adherence to LC-5 was high in both periods. The MDS-UPDRS parts II and III, disease-specific quality of life (PDQ-8), wearing-off symptoms (WOQ-19), and nonmotor symptoms (NMS Quest) improved after dose titration, but the generic quality-of-life measure EQ-5D-5L did not. Blinded expert evaluation of accelerometry results demonstrated improvement in 60% of subjects and worsening in 25%. CONCLUSIONS The introduction of a levodopa microtablet dispenser and accelerometry aided dose adjustments improve PD symptoms and quality of life in the short term.
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Affiliation(s)
- Dongni Johansson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Anders Johansson
- Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Medvedev
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | | | - Marina Senek
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | | | - Ilias Thomas
- Computer Engineering, Dalarna University, Falun, Sweden
| | - Jerker Westin
- Computer Engineering, Dalarna University, Falun, Sweden
| | - Filip Bergquist
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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70
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Joling M, van den Heuvel OA, Berendse HW, Booij J, Vriend C. Serotonin transporter binding and anxiety symptoms in Parkinson's disease. J Neurol Neurosurg Psychiatry 2018; 89:89-94. [PMID: 28899958 DOI: 10.1136/jnnp-2017-316193] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Anxiety is a common neuropsychiatric symptom in Parkinson's disease (PD), yet the neural mechanisms have been scarcely investigated. Disturbances in dopaminergic and serotonergic signalling may play a role in its pathophysiology. 123I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane (123I-FP-CIT) is a single-photon emission CT radiotracer, and its binding in striatal and extrastriatal subcortical brain areas represents predominant binding to the presynaptic dopamine transporter (DAT) and the serotonin transporter (SERT), respectively. Availability of DAT and SERT may thus provide an in vivo measure for the integrity of both dopamine and serotonin neurons. METHODS We studied the association between anxiety symptoms, measured with an affective subscale of the Beck Anxiety Inventory, and (extra)striatal 123I-FP-CIT binding in 127 non-demented patients with PD with a median disease duration of 2.55 (IQR 2.90) years. We conducted the analyses on patients currently on or not on dopamine replacement therapy (DRT). RESULTS Severity of anxiety symptoms showed a significant negative association with 123I-FP-CIT binding ratios in the right thalamus (β=-0.203, p=0.019; ΔR2=0.040) (multiple testing pcorr <0.020). In the subgroup of patients not on DRT (n=81), we found a significant negative association between anxiety and thalamic 123I-FP-CIT binding ratios bilaterally (right: β=-0.349, p=0.001, ΔR2=0.119; left: β=-0.269, p=0.017, ΔR2=0.071) (pcorr <0.020). CONCLUSION This study shows that higher levels of anxiety in patients with PD are associated with lower thalamic 123I-FP-CIT binding, pointing towards a contribution of serotonergic degeneration to anxiety symptoms in PD.
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Affiliation(s)
- Merijn Joling
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Research Program Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Research Program Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk W Berendse
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Research Program Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Research Program Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Chris Vriend
- Research Program Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Lees AJ, Ferreira J, Rascol O, Reichmann H, Stocchi F, Tolosa E, Poewe W. Opicapone for the management of end-of-dose motor fluctuations in patients with Parkinson's disease treated with L-DOPA. Expert Rev Neurother 2017; 17:649-659. [PMID: 28580819 DOI: 10.1080/14737175.2017.1336086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Opicapone is a third generation, highly potent and effective catechol O‑methyltransferase (COMT) inhibitor that optimizes the pharmacokinetics and bioavailability of L-DOPA therapy. Areas covered: In this review, the authors describe the preclinical and clinical development of opicapone. In PD patients with motor fluctuations, once daily opicapone administration was well-tolerated and consistently reduced OFF-time and increased ON-time without increasing the frequency of troublesome dyskinesia, and these benefits were maintained over at least a year of continued open-label therapy. Expert commentary: With its convenient once-daily regimen, adjunct opicapone should be considered as an effective option for use in L-DOPA treated PD patients experiencing motor fluctuations.
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Affiliation(s)
- Andrew J Lees
- a Reta Lila Weston Institute for Neurological Studies, UCL , London , UK
| | - Joaquim Ferreira
- b Centro de Estudos Egas Moniz , Hospital de Santa Maria , Lisbon , Portugal
| | - Olivier Rascol
- c Departments of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC 1436, NS-Park/FCRIN network and NeuroToul COEN Center , INSERM, Toulouse University Hospital and Toulouse3 University , Toulouse , France
| | - Heinz Reichmann
- d Department of Neurology , Technische Universitaet Dresden , Dresden , Germany
| | - Fabrizio Stocchi
- e Institute of Neurology , IRCCS San Raffaele Pisana , Rome , Italy
| | - Eduardo Tolosa
- f Neurology Service, Centro de Investigación Biomódica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS , Universitat de Barcelona , Barcelona , Spain
| | - Werner Poewe
- g Department of Neurology , Innsbruck Medical University , Innsbruck , Austria
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Bonomo R, Mostile G, Raciti L, Contrafatto D, Dibilio V, Luca A, Sciacca G, Cicero CE, Vasta R, Nicoletti A, Zappia M. Quantitative estimation of motor fluctuations in Parkinson's disease. Parkinsonism Relat Disord 2017. [PMID: 28624431 DOI: 10.1016/j.parkreldis.2017.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To provide a quantitative estimation of motor fluctuations in PD through a 12-h Waking-day Motor Assessment (WDMA) and to develop new WDMA-based tools, the Motor Fluctuation Indices. METHODS Two independent samples of PD patients (exploratory population N = 51, testing population N = 109) were examined. Patients underwent a WDMA using the Unified Parkinson's Disease Rating Scale (UPDRS) and were classified as either having or not having motor fluctuations. To quantify motor fluctuations, the Worsening Index (WI), the Mean Fluctuation Index (MFI) and the Coefficient of Variation (CV) were computed. The optimal cut-off for each index distinguishing patients with or without fluctuations was calculated on the exploratory population. Cut-offs' accuracy was then verified in the testing population. RESULTS Optimal cut-off scores to differentiate stable patients from fluctuating ones were 8.3 for WI, 5 for MFI and 12.9 for CV. Sensitivity and a specificity were 91.2% (95%CI: 85.9 to 96.5) and 87.8% (95%CI: 81.7 to 93.9) for WI; 75% (95%CI: 66.9 to 83.1) and 90.2% (95%CI: 84.7 to 95.8) for MFI; 69.1% (95%CI: 60.4 to 77.8) and 95.1% (95%CI: 91.1 to 99.2) for CV. Patients with a larger magnitude of fluctuation had higher values for all three indices, whereas patients with multiple daily fluctuations presented only higher WI values. CONCLUSIONS WDMA-derived Motor Fluctuation Indices may represent reliable tools for evaluating and quantifying the severity of motor fluctuations in PD patients. Even if WDMA is a time-consuming procedure, the detection of Motor Fluctuation Indices could be helpful in assessing therapeutic efficacy on motor fluctuations.
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Affiliation(s)
- Roberta Bonomo
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Giovanni Mostile
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Loredana Raciti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Donatella Contrafatto
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Valeria Dibilio
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Antonina Luca
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Giorgia Sciacca
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Rosario Vasta
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Mario Zappia
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
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A practical review of gastrointestinal manifestations in Parkinson's disease. Parkinsonism Relat Disord 2017; 39:17-26. [DOI: 10.1016/j.parkreldis.2017.02.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
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Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, Kurtis MM, Skorvanek M. Measurement of Nonmotor Symptoms in Clinical Practice. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:291-345. [PMID: 28802923 DOI: 10.1016/bs.irn.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonmotor symptoms constitute a prominent part of Parkinson's disease manifestations. They are present since the first phases of the disease, increase their number and severity with disease progression, and importantly impact on patients' health and quality of life, caregivers' burden, and social resources. Research on Parkinson's disease has traditionally focused on the motor aspects of the disease, but an increasing interest in the nonmotor manifestations has risen in the past decade. The availability of assessment instruments for detecting and measuring these symptoms has allowed understanding of their importance and course over time, as well as estimation of therapeutic effects on them. In this chapter, a review of the basic characteristics of nonmotor symptom assessments used in clinical practice and research are presented.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain.
| | | | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M Kurtis
- Movement Disorders Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Matej Skorvanek
- P.J. Safarik University, Kosice, Slovakia; University Hospital of L. Pasteur, Kosice, Slovakia
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Quantitative Analysis of Motor Status in Parkinson's Disease Using Wearable Devices: From Methodological Considerations to Problems in Clinical Applications. PARKINSONS DISEASE 2017; 2017:6139716. [PMID: 28607801 PMCID: PMC5451764 DOI: 10.1155/2017/6139716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/23/2017] [Accepted: 04/27/2017] [Indexed: 11/17/2022]
Abstract
Long-term and objective monitoring is necessary for full assessment of the condition of patients with Parkinson's disease (PD). Recent advances in biotechnology have seen the development of various types of wearable (body-worn) sensor systems. By using accelerometers and gyroscopes, these devices can quantify motor abnormalities, including decreased activity and gait disturbances, as well as nonmotor signs, such as sleep disturbances and autonomic dysfunctions in PD. This review discusses methodological problems inherent in wearable devices. Until now, analysis of the mean values of motion-induced signals on a particular day has been widely applied in the clinical management of PD patients. On the other hand, the reliability of these devices to detect various events, such as freezing of gait and dyskinesia, has been less than satisfactory. Quantification of disease-specific changes rather than nonspecific changes is necessary.
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Bhidayasiri R, Martinez-Martin P. Clinical Assessments in Parkinson's Disease: Scales and Monitoring. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:129-182. [PMID: 28554406 DOI: 10.1016/bs.irn.2017.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement of disease state is essential in both clinical practice and research in order to assess the severity and progression of a patient's disease status, effect of treatment, and alterations in other relevant factors. Parkinson's disease (PD) is a complex disorder expressed through many motor and nonmotor manifestations, which cause disabilities that can vary both gradually over time or come on suddenly. In addition, there is a wide interpatient variability making the appraisal of the many facets of this disease difficult. Two kinds of measure are used for the evaluation of PD. The first is subjective, inferential, based on rater-based interview and examination or patient self-assessment, and consist of rating scales and questionnaires. These evaluations provide estimations of conceptual, nonobservable factors (e.g., symptoms), usually scored on an ordinal scale. The second type of measure is objective, factual, based on technology-based devices capturing physical characteristics of the pathological phenomena (e.g., sensors to measure the frequency and amplitude of tremor). These instrumental evaluations furnish appraisals with real numbers on an interval scale for which a unit exists. In both categories of measures, a broad variety of tools exist. This chapter aims to present an up-to-date summary of the most relevant characteristics of the most widely used scales, questionnaires, and technological resources currently applied to the assessment of PD. The review concludes that, in our opinion: (1) no assessment methods can substitute the clinical judgment and (2) subjective and objective measures in PD complement each other, each method having strengths and weaknesses.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Juntendo University, Tokyo, Japan.
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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Rieu I, Houeto JL, Pereira B, De Chazeron I, Bichon A, Chéreau I, Ulla M, Brefel-Courbon C, Ory-Magne F, Dujardin K, Tison F, Krack P, Durif F. Impact of Mood and Behavioral Disorders on Quality of Life in Parkinson's disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:267-77. [PMID: 27003781 DOI: 10.3233/jpd-150747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mood symptoms negatively affect quality of life of Parkinson's disease (PD); however little is known about the impact of behavioral disorders such as impulse control disorders, and non-motor fluctuations on quality of life. OBJECTIVE To assess the impact of mood and behavioral disorders on quality of life in PD. METHODS 136 (84% male) PD were included (mean age: 61 ± 8y; mean duration of disease: 8.8 ± 5.4y). Mood symptoms, behavioral disorders and non-motor fluctuations were detected and quantified using the recently validated "Ardouin Scale of Behavior in Parkinson's Disease". Motor symptoms were assessed using UPDRS and quality of life with the "39-item Parkinson's Disease Questionnaire". RESULTS Both motor and non-motor factors significantly affected the quality of life of PD patients. Multivariate regression of the relationship between items of the quality of life questionnaire and the Ardouin Scale showed that alteration of patients' quality of life was strongly correlated with the presence of mood symptoms (such as depression, anxiety ...) and with non-motor fluctuations (especially in the OFF period). A significant correlation was also found between the number of symptoms and their severity, and the quality of life deterioration. Some behavioral disorders (compulsive buying / eating behavior) also negatively affected patient's quality of life to a lesser extent. Alternatively, excess in motivation and hobbyism behaviors had a positive impact on mobility and emotional well-being dimensions respectively of quality of life. CONCLUSIONS This study shows the main impact of mood symptoms and non-motor fluctuations on worsening quality of life in PD.
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Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | - Jean Luc Houeto
- Department Neurology, CIC INSERM-0802, CHU de Poitiers 86021 Poitiers cedex; INSERM U 1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Université de Poitiers, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Biostatistics Unit, Clermont-Ferrand, France
| | - Ingrid De Chazeron
- Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Department of Psychiatry B, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Amélie Bichon
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Unité 836, Grenoble Institut des Neurosciences, 38043 Grenoble, France
| | - Isabelle Chéreau
- CHU Clermont-Ferrand, Department of Psychiatry B, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Miguel Ulla
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | | | - Fabienne Ory-Magne
- University, Hospital Toulouse, Neurology department, CHU Purpan, Toulouse, France
| | - Kathy Dujardin
- Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - François Tison
- University of Bordeaux, Institut des Maladies Neurodégénératives, CNRS UMR 5293 et CHU de Bordeaux, France
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Unité 836, Grenoble Institut des Neurosciences, 38043 Grenoble, France
| | - Franck Durif
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
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Nonmotor Fluctuations in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:947-971. [DOI: 10.1016/bs.irn.2017.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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79
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Ouma S, Fukae J, Fujioka S, Yamamoto S, Hatano T, Yoritaka A, Okuma Y, Kashihara KI, Hattori N, Tsuboi Y. The Risk Factors for the Wearing-off Phenomenon in Parkinson's Disease in Japan: A Cross-sectional, Multicenter Study. Intern Med 2017; 56:1961-1966. [PMID: 28768964 PMCID: PMC5577070 DOI: 10.2169/internalmedicine.56.7667] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Parkinson's disease (PD) is a common, progressive, neurodegenerative disorder. With progression of PD, the wearing-off phenomenon occurs more frequently as a motor complication, decreasing the patient's quality of life. The aim of this study was to investigate the risk factors for the wearing-off phenomenon in Japanese PD patients. Methods All of the study participants were clinically diagnosed as having PD. Each patient was assessed for the wearing-off phenomenon based on the findings of clinical assessments and interviews that were conducted during a single visit. The risk factors for wearing-off were analyzed by univariate and multivariate logistic regression analyses. Results Wearing-off was observed in 101 of the 180 (56.1%) patients who were enrolled in this study. The multivariate logistic regression analysis revealed that the onset of PD at ≥69 years of age (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.05-0.88; p=0.032), female sex (OR, 6.49; 95% CI, 2.34-17.99; p<0.001), catechol-O-methyltransferase (COMT) inhibitor treatment (OR, 19.59; 95% CI, 3.55-108.11; p<0.001) and a high daily levodopa dosage (≥600 mg/day) (OR, 7.69; 95% CI, 1.41-41.84; p=0.018) were independent predictive factors for wearing-off in Japanese PD patients. Conclusion Age at the symptomatic disease onset, female sex, COMT inhibitor treatment, and a high daily levodopa dose were associated with the occurrence of wearing-off in Japanese PD patients. Physicians need to consider the risk factors and carefully choose medications for PD patients to postpone the occurrence of this phenomenon for as long as possible.
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Affiliation(s)
- Shinji Ouma
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Jiro Fukae
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | | | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Asako Yoritaka
- Department of Neurology, Juntendo Koshigaya Hospital, Japan
| | - Yasuyuki Okuma
- Department of Neurology, Juntendo Shizuoka Hospital, Japan
| | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University School of Medicine, Japan
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80
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Ossig C, Sippel D, Fauser M, Gandor F, Jost WH, Ebersbach G, Storch A. Assessment of Nonmotor Fluctuations Using a Diary in Advanced Parkinson’s disease. JOURNAL OF PARKINSONS DISEASE 2016; 6:597-607. [DOI: 10.3233/jpd-150764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christiana Ossig
- Department of Neurology, Division of Neurodegenerative Diseases, Technische Universität Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Daniel Sippel
- Department of Neurology, Division of Neurodegenerative Diseases, Technische Universität Dresden, Dresden, Germany
| | - Mareike Fauser
- Department of Neurology, Division of Neurodegenerative Diseases, Technische Universität Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Florin Gandor
- Movement Disorders Clinic, Beelitz-Heilstätten, Germany
| | | | | | - Alexander Storch
- Department of Neurology, Division of Neurodegenerative Diseases, Technische Universität Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Neurology, University of Rostock, Rostock, Germany
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81
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Martínez-Fernández R, Schmitt E, Martinez-Martin P, Krack P. The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations. Mov Disord 2016; 31:1080-94. [PMID: 27431515 DOI: 10.1002/mds.26731] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 12/29/2022] Open
Abstract
Only a few years after the introduction of levodopa, the first descriptions of motor fluctuations and dyskinesia related to dopaminergic therapy appeared. In PD, attention turned to their management, that had dampened the euphoria of the "levodopa miracle." It soon became clear that neuropsychiatric, autonomic, and sensory features also tend to develop fluctuations after chronic exposure to l-dopa. The diversity of fluctuating nonmotor symptoms, their largely subjective nature, coupled with a frequent lack of insight led to difficulties in identification and quantification. This may explain why, despite the high impact of nonmotor symptoms on patient autonomy and quality of life, evaluation of nonmotor fluctuations is not part of clinical routine. In view of the lack of specific validated assessment tools, detailed anamnesis should ideally be coupled with an evaluation in both ON and OFF drug conditions. The mechanisms of nonmotor fluctuations are not well understood. It is thought that they share dopaminergic presynaptic pharmacokinetic and postsynaptic pharmacodynamic mechanisms with the classical motor complications, but involve different neural pathways. Although symptoms fluctuate with dopaminergic treatment, serotonine and norepinephrine denervation, as well as interactions between neurotransmitter systems, probably contribute to their diversity. The lack of validated tools for assessment of these phenomena explains the almost complete absence of treatment studies. Management, largely resulting from expert opinion, includes psychiatric follow-up, nondopaminergic drugs, and advanced dopaminergic treatment, including drug delivery pumps and DBS. This review aims to provide a starting point for the understanding, diagnosis, and management of nonmotor fluctuations. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes and Grenoble Institut des Neurosciences, INSERM U386, Grenoble, France
| | - Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, Madrid, Spain
| | - Paul Krack
- Neurology Division, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
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Onozawa R, Tsugawa J, Tsuboi Y, Fukae J, Mishima T, Fujioka S. The impact of early morning off in Parkinson's disease on patient quality of life and caregiver burden. J Neurol Sci 2016; 364:1-5. [DOI: 10.1016/j.jns.2016.02.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/03/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
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83
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Bohlega S, Abou Al-Shaar H, Alkhairallah T, Al-Ajlan F, Hasan N, Alkahtani K. Levodopa-Carbidopa Intestinal Gel Infusion Therapy in Advanced Parkinson's Disease: Single Middle Eastern Center Experience. Eur Neurol 2015; 74:227-36. [DOI: 10.1159/000442151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
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84
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Bhidayasiri R, Hattori N, Jeon B, Chen RS, Lee MK, Bajwa JA, Mok VCT, Zhang B, Syamsudin T, Tan LCS, Jamora RDG, Pisarnpong A, Poewe W. Asian perspectives on the recognition and management of levodopa ‘wearing-off’ in Parkinson’s disease. Expert Rev Neurother 2015; 15:1285-97. [DOI: 10.1586/14737175.2015.1088783] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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85
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Matthews H, Stamford J, Saha R, Martin A. Exploring Issues Around Wearing-off and Quality of Life: The OFF-PARK Survey of People with Parkinson’s Disease and their Care Partners. JOURNAL OF PARKINSONS DISEASE 2015; 5:533-9. [DOI: 10.3233/jpd-150547] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jon Stamford
- The Cure Parkinson’s Trust (CPT), London, UK
- Parkinson’s Movement (PM), London, UK
| | - Romi Saha
- Brighton and Sussex University Hospitals NHS Trust, UK
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Tsugawa J, Onozawa R, Fukae J, Mishima T, Fujioka S, Tsuboi Y. Impact of insufficient drug efficacy of antiparkinson agents on patient's quality of life: a cross-sectional study. BMC Neurol 2015; 15:105. [PMID: 26143184 PMCID: PMC4491278 DOI: 10.1186/s12883-015-0360-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 06/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the current state of insufficient drug efficacy experienced by patients with Parkinson's disease (PD) and its effects on quality of life (QOL), we conducted a survey of patients with PD and analyzed the results from 2,630 completed questionnaires. METHODS The questionnaires inquired about age, sex, Hoehn and Yahr stage, disease duration, drugs currently being taken, and the current state of insufficient drug efficacy; it also included items of the Parkinson's Disease Questionnaire-8 (PDQ-8). Questionnaires were mailed to members of the Japan Parkinson's Disease Association. RESULTS Approximately 70% of all subjects reported some type of insufficient drug efficacy, and around half of these experienced this early in the morning or at night. The proportion of subjects who experienced insufficient drug efficacy was found to increase with greater disease severity according to the Hoehn and Yahr stage. However, even among patients with stage I severity, insufficient drug efficacy was reported by approximately 40% of the respondents. QOL was significantly lower in patients who experienced insufficient drug efficacy than in those who did not (PDQ-8 summary index; 42.0 ± 20.1 vs. 30.0 ± 19.5; p < 0.0001). CONCLUSIONS These results suggest that insufficient drug efficacy might affect the quality of life of patients in most stages PD including the early stages. Therefore, greater awareness of insufficient drug efficacy gained by questioning patients might help medical practitioners in taking appropriate actions.
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Affiliation(s)
- Jun Tsugawa
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Rieko Onozawa
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Jiro Fukae
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Takayasu Mishima
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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87
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Utility of the Japanese version of the 9-item Wearing-off Questionnaire. Clin Neurol Neurosurg 2015; 134:110-5. [DOI: 10.1016/j.clineuro.2015.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 11/21/2022]
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88
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Trenkwalder C, Chaudhuri KR, García Ruiz PJ, LeWitt P, Katzenschlager R, Sixel-Döring F, Henriksen T, Sesar Á, Poewe W, Baker M, Ceballos-Baumann A, Deuschl G, Drapier S, Ebersbach G, Evans A, Fernandez H, Isaacson S, van Laar T, Lees A, Lewis S, Martínez Castrillo JC, Martinez-Martin P, Odin P, O'Sullivan J, Tagaris G, Wenzel K. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease--Clinical practice recommendations. Parkinsonism Relat Disord 2015; 21:1023-30. [PMID: 26189414 DOI: 10.1016/j.parkreldis.2015.06.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/15/2015] [Accepted: 06/13/2015] [Indexed: 12/16/2022]
Abstract
Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuous infusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off' periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose 'off' periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation.
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Affiliation(s)
- Claudia Trenkwalder
- Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurosurgery, University Medical Centre, Goettingen, Germany.
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital, Denmark Hill Campus, London, UK
| | - Pedro J García Ruiz
- Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain
| | - Peter LeWitt
- Wayne State University School of Medicine, Parkinson's Disease and Movement Disorders Program, Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Danube Hospital, Vienna, Austria
| | - Friederike Sixel-Döring
- Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurology, Philipps-University, Marburg, Germany
| | - Tove Henriksen
- Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ángel Sesar
- Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
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90
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Rieu I, Martinez-Martin P, Pereira B, De Chazeron I, Verhagen Metman L, Jahanshahi M, Ardouin C, Chéreau I, Brefel-Courbon C, Ory-Magne F, Klinger H, Peyrol F, Schupbach M, Dujardin K, Tison F, Houeto JL, Krack P, Durif F. International validation of a behavioral scale in Parkinson's disease without dementia. Mov Disord 2015; 30:705-13. [PMID: 25809278 DOI: 10.1002/mds.26223] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 12/08/2014] [Accepted: 12/14/2014] [Indexed: 12/16/2022] Open
Abstract
The "Ardouin Scale of Behavior in Parkinson's Disease" is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview. Patients (n=260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test-retest reliability, the kappa coefficient for items was higher than 0.4. For inter-rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ=0.82); anxiety with the Hospital Anxiety and Depression Scale-anxiety (ρ=0.56); apathy with the Lille Apathy Rating Scale (ρ=0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia.
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Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Neurology Department; CHU Gabriel Montpied, Clermont-Ferrand, France; Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
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91
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Altavista M, Cassetta E, Brusa L, Viselli F, Denaro A, Ventriglia M, Pasqualetti P, Peppe A. Wearing-off detection in clinical practice: The wearing off real practice key (WORK-PD) study in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:95-100. [DOI: 10.1016/j.parkreldis.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 10/03/2014] [Accepted: 11/03/2014] [Indexed: 11/27/2022]
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92
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Gerrits NJHM, van der Werf YD, Verhoef KMW, Veltman DJ, Groenewegen HJ, Berendse HW, van den Heuvel OA. Compensatory fronto-parietal hyperactivation during set-shifting in unmedicated patients with Parkinson's disease. Neuropsychologia 2015; 68:107-16. [PMID: 25576907 DOI: 10.1016/j.neuropsychologia.2014.12.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/10/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
Patients with Parkinson's disease (PD) often suffer from impairments in executive functions, such as mental rigidity, which can be measured as impaired set-shifting. Previous studies have shown that set-shifting deficits in patients with PD result from hypo-excitation of the caudate nucleus and lateral prefrontal cortices. The results of these studies may have been influenced by the inclusion of patients on dopaminergic medication, and by choosing set-shifting paradigms in which performance also depends on other cognitive mechanisms, such as matching-to-sample. To circumvent these potential confounding factors, we tested patients with PD that were not on dopamine replacement therapy, and we developed a new feedback-based paradigm to measure the cognitive construct set-shifting more accurately. In this case-control study, 18 patients with PD and 35 well-matched healthy controls performed the set-shifting task, while task-related neural activation was recorded using functional magnetic resonance imaging. Behaviourally, PD patients, compared with healthy controls, made more errors during repeat trials, but not set-shift trials. The patients, compared with controls, showed increased task-related activation of the bilateral inferior parietal cortex, and the right superior frontal gyrus, and decreased activation of the right ventrolateral prefrontal cortex during set-shift trials. Our findings suggest that, despite decreased task-related activation of the right ventrolateral prefrontal cortex, these early-stage unmedicated patients with PD do not yet suffer from set-shifting deficits due to compensatory hyperactivation in the inferior parietal cortex and the superior frontal gyrus.
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Affiliation(s)
- Niels J H M Gerrits
- Department of Anatomy & Neurosciences, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Neuroscience Campus Amsterdam (NCA), Amsterdam, The Netherlands.
| | - Ysbrand D van der Werf
- Department of Anatomy & Neurosciences, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam (NCA), Amsterdam, The Netherlands
| | - Kim M W Verhoef
- Department of Anatomy & Neurosciences, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam (NCA), Amsterdam, The Netherlands
| | - Henk J Groenewegen
- Department of Anatomy & Neurosciences, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Neuroscience Campus Amsterdam (NCA), Amsterdam, The Netherlands
| | - Henk W Berendse
- Department of Neurology, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam (NCA), Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Anatomy & Neurosciences, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Psychiatry, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam (NCA), Amsterdam, The Netherlands
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Caillava-Santos F, Margis R, de Mello Rieder CR. Wearing-off in Parkinson's disease: neuropsychological differences between on and off periods. Neuropsychiatr Dis Treat 2015; 11:1175-80. [PMID: 25999721 PMCID: PMC4435249 DOI: 10.2147/ndt.s77060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Levodopa-associated motor fluctuations are common complications observed in Parkinson's disease (PD) patients. Although nonmotor fluctuations are a significant cause of morbidity, they frequently are not properly identified. Few studies have characterized the nonmotor emotional fluctuations and their relation to motor fluctuations. AIMS The objective of the present study is to analyze the occurrence of fluctuations in anxiety and depression symptoms, as well as in cognitive function (memory, language, executive function, and attention), and their relation to motor fluctuations in PD patients presenting wearing-off phenomenon. METHODS Twenty-four patients were assessed during the wearing on-off periods. The State-Trait Anxiety Inventory (STAI-State) and Beck Depression Inventory (BDI) were used to assess anxiety and depression, respectively, and the Wisconsin Card Sorting Test (WCST), Stroop Test, Rey Auditory Verbal Learning Test (RAVLT), Weschler Memory Scale - digits (WMS) and Controlled Oral Word Association (COWA) for assessing executive functions, verbal memory, attention and work memory and verbal fluency, respectively. RESULTS Patients presented higher depression and anxiety scores in the wearing-off period (P<0.05). Differences were also found in the semantic verbal fluency (P=0.017) and executive function (P=0.008) tests performance. CONCLUSIONS Nonmotor symptoms such as anxiety and depression, verbal fluency, and executive function performance are influenced by motor fluctuations.
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Affiliation(s)
- Fabiane Caillava-Santos
- Psychology Department, Universidade da Região da Campanha, Bagé, RS, Brazil ; Curso de Pós-Graduação em Medicina, Ciências Médicas da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Regina Margis
- Curso de Pós-Graduação em Medicina, Ciências Médicas da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carlos Roberto de Mello Rieder
- Curso de Pós-Graduação em Medicina, Ciências Médicas da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil ; Movement Disorders Center, Division of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil ; Movement Disorder Clinic, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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94
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Trefois C, Antony PMA, Goncalves J, Skupin A, Balling R. Critical transitions in chronic disease: transferring concepts from ecology to systems medicine. Curr Opin Biotechnol 2014; 34:48-55. [PMID: 25498477 DOI: 10.1016/j.copbio.2014.11.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 01/01/2023]
Abstract
Ecosystems and biological systems are known to be inherently complex and to exhibit nonlinear dynamics. Diseases such as microbiome dysregulation or depression can be seen as complex systems as well and were shown to exhibit patterns of nonlinearity in their response to perturbations. These nonlinearities can be revealed by a sudden shift in system states, for instance from health to disease. The identification and characterization of early warning signals which could predict upcoming critical transitions is of primordial interest as prevention of disease onset is a major aim in health care. In this review, we focus on recent evidence for critical transitions in diseases and discuss the potential of such studies for therapeutic applications.
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Affiliation(s)
- Christophe Trefois
- Experimental Neurobiology Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Campus Belval, 7 Avenue des Hauts-Fourneaux, L-4362 Esch-sur-Alzette, Luxembourg
| | - Paul M A Antony
- Experimental Neurobiology Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Campus Belval, 7 Avenue des Hauts-Fourneaux, L-4362 Esch-sur-Alzette, Luxembourg
| | - Jorge Goncalves
- Systems Control Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Campus Belval, 7 Avenue des Hauts-Fourneaux, L-4362 Esch-sur-Alzette, Luxembourg
| | - Alexander Skupin
- National Center for Microscopy and Imaging Research, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States; Integrative Cell Signalling Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Campus Belval, 7 Avenue des Hauts-Fourneaux, L-4362 Esch-sur-Alzette, Luxembourg
| | - Rudi Balling
- Experimental Neurobiology Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Campus Belval, 7 Avenue des Hauts-Fourneaux, L-4362 Esch-sur-Alzette, Luxembourg.
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95
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Aquino CC, Fox SH. Clinical spectrum of levodopa-induced complications. Mov Disord 2014; 30:80-9. [PMID: 25488260 DOI: 10.1002/mds.26125] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/20/2014] [Accepted: 11/24/2014] [Indexed: 12/20/2022] Open
Abstract
The first years of Parkinson disease (PD) treatment are marked by good and sustained responses to dopaminergic therapy. With disease progression and longer exposure to levodopa (l-dopa), patients develop a range of l-dopa-induced complications that include motor and non-motor symptoms. Motor complications include motor fluctuations, characterized by periods of reduced benefit from the medication, and l-dopa-induced dyskinesia, characterized by emergence of hyperkinetic involuntary movements. Dyskinesia can occur at peak effect of l-dopa, at the beginning and end of dose, or between doses. These motor complications are often associated with fluctuations in non-motor symptoms, particularly fluctuations in neuropsychiatric, autonomic, and sensory symptoms. Recognizing such complications and understanding their relationship with the timing of l-dopa doses is essential for adequate diagnosis and management. Society.
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Affiliation(s)
- Camila Catherine Aquino
- Movement Disorder Centre, Edmond J Safra Program in Parkinson Research, Toronto Western Hospital, University of Toronto, Canada
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96
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Chen W, Xiao Q, Shao M, Feng T, Liu WG, Luo XG, Chen XC, Xie AM, Liu CF, Liu ZG, Liu YM, Wang J, Chen SD. Prevalence of wearing-off and dyskinesia among the patients with Parkinson's disease on levodopa therapy: a multi-center registry survey in mainland China. Transl Neurodegener 2014; 3:26. [PMID: 25671102 PMCID: PMC4323338 DOI: 10.1186/2047-9158-3-26] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 01/19/2023] Open
Abstract
Objective Chronic levodopa (L-dopa) treatment in Parkinson’s disease (PD) is often associated with the development of motor complications, but the corresponding epidemiological data is rare in Chinese PD patients. The present survey was to investigate the prevalence rate of wearing-off (WO) and dyskinesia among the patients with PD in China. Methods From May 2012 to October 2012, a 3-step registry survey for wearing off (WO) and dyskinesia patients with PD receiving levodopa therapy was performed simultaneously at 28 movement disorders clinics in China. Results There were 1,558 PD patients fulfilling the inclusion criteria. Among them, 1,051 had at least one positive response of 9-item wearing off questionnaire (WOQ-9), 724 and 160 patients were finally diagnosed with WO and dyskinesia by movement disorders specialists, respectively. The overall prevalence rates of WO and dyskinesia were 46.5% (95% CI 44.0% - 48.9%) and 10.3% (95% CI 8.8% - 11.8%), respectively. The mean score of WOQ-9 for those with WO was 3.8 (SD = 1.8), with movement slowness being the most common motor symptoms and pain/aching being the most common non-motor symptoms. Better improvement of motor symptoms (n = 354, 87.8%) and long-term disease control and drug selection (n = 288, 71.5%) were the two most frequently considered factors when movement disorders specialists adjusted therapeutic strategies for patients with WO. Conclusions This survey provided the first multi-center epidemiological data of motor complications among PD patients on L-dopa therapy from mainland China. WO prevalence rate among Chinese PD patients was in line with, while dyskinesia prevalence rate was lower than previous reports from other Countries. Electronic supplementary material The online version of this article (doi:10.1186/2047-9158-3-26) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wei Chen
- Department of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Rui Jin 2nd Road 197, Shanghai, 200025 China
| | - Qin Xiao
- Department of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Rui Jin 2nd Road 197, Shanghai, 200025 China
| | - Ming Shao
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| | - Wei-Guo Liu
- Department of Neurology, Nanjing Brain Hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Xiao-Guang Luo
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Xiao-Chun Chen
- Department of Neurology, Union XieHe Hospital, Fujian Medical University, Fuzhou, China
| | - An-Mu Xie
- Department of Neurology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhen-Guo Liu
- Department of Neurology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Ming Liu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Jian Wang
- Department of Neurology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Sheng-Di Chen
- Department of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Rui Jin 2nd Road 197, Shanghai, 200025 China
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97
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Abstract
Although it is now generally recognized that the clinical spectrum of Parkinson disease (PD) is broader than its defining motor aspects, its various non-motor symptoms are often not routinely assessed in the clinical setting. As most of these symptoms are amenable to treatment, improved recognition would lead to more comprehensive management of the disease, and ultimately improve the quality of life for PD patients. In an attempt to increase the general awareness of physicians caring for these patients, this article focuses on the clinical manifestations and treatment of the gastrointestinal symptoms most commonly experienced by PD patients, as well as on the gastrointestinal side effects of antiparkinsonian treatments.
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98
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Brun L, Lefaucheur R, Fetter D, Derrey S, Borden A, Wallon D, Bourre B, Maltête D. Non-motor fluctuations in Parkinson's disease: Prevalence, characteristics and management in a large cohort of parkinsonian outpatients. Clin Neurol Neurosurg 2014; 127:93-6. [DOI: 10.1016/j.clineuro.2014.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 08/20/2014] [Accepted: 10/04/2014] [Indexed: 01/27/2023]
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Santos JG, Chien HF, Barbosa ER. Specificity and sensibility of 9-Itens Wearing-off Questionnaire in Brazilian Parkinson disease patient sample. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:867-73. [PMID: 25410454 DOI: 10.1590/0004-282x20140166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/12/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE (1) To evaluate whether the Nine Items Questionnaire (WOQ-9) for the detection of wearing-off (WO) in Parkinson Disease (PD), by means of its screening ability, is a helpful tool to assist neurologists in diagnosing WO; (2) To determine the sensitivity and the specificity of a free Brazilian Portuguese translation of WOQ-9. METHOD A sample obtained by convenience included 60 patients. The WOQ-9 was answered by the patients themselves before their routine consultations. The detection of the WO by the WOQ-9 was compared with the neurologist assessment. Statistical significance was 5%. RESULTS The WOQ-9 showed sensitivity of 100%, specificity of 10.3%, positive and negative predictive values of 54.4% and 100% respectively. The identification of WO by the WOQ-9 was congruent in 54.5% of cases with neurological evaluation. CONCLUSION The WOQ-9 is a convenient screening tool to aid physicians to detect WO in PD patients, and it is a quick and easy self-administered questionnaire.
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Affiliation(s)
- Jasper Guimarães Santos
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP, Brazil
| | - Hsin Fen Chien
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP, Brazil
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Rizos A, Martinez-Martin P, Odin P, Antonini A, Kessel B, Kozul TK, Todorova A, Douiri A, Martin A, Stocchi F, Dietrichs E, Chaudhuri KR. Characterizing motor and non-motor aspects of early-morning off periods in Parkinson's disease: An international multicenter study. Parkinsonism Relat Disord 2014; 20:1231-5. [DOI: 10.1016/j.parkreldis.2014.09.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/10/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
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