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O'Gorman Tuura RL, Baumann CR, Baumann-Vogel H. Beyond Dopamine: GABA, Glutamate, and the Axial Symptoms of Parkinson Disease. Front Neurol 2018; 9:806. [PMID: 30319535 PMCID: PMC6168661 DOI: 10.3389/fneur.2018.00806] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: The axial symptoms of Parkinson disease (PD) include difficulties with balance, posture, speech, swallowing, and locomotion with freezing of gait, as well as axial rigidity. These axial symptoms impact negatively on quality of life for many patients, yet remain poorly understood. Dopaminergic treatments typically have little effect on the axial symptoms of PD, suggesting that disruptions in other neurotransmitter systems beyond the dopamine system may underlie these symptoms. The purpose of the present study was to examine the relationship between the axial symptoms of PD and GABA and glutamate levels quantified with magnetic resonance spectroscopy. Methods: The participant group included 20 patients with PD and 17 healthy control participants. Water-scaled GABA and Glx (glutamate + glutamine) concentrations were derived from GABA-edited MEGA-PRESS spectra acquired from the left basal ganglia and prefrontal cortex, and additional water-scaled Glx concentrations were acquired from standard PRESS spectra acquired from the pons. Spectra were analyzed with LCModel. The axial symptoms of PD were evaluated from subscales of the Unified Parkinson's Disease rating scale (MDS-UPDRS). Results: PD patients demonstrated significantly higher GABA levels in the basal ganglia, which correlated with the degree of gait disturbance. Basal ganglia Glx levels and prefrontal GABA and Glx levels did not differ significantly between patient and control groups, but within the PD group prefrontal Glx levels correlated negatively with difficulties turning in bed. Results from an exploratory subgroup analysis indicate that the associations between GABA, Glx, and axial symptoms scores are typically more prominent in akinetic-rigid patients than in tremor-dominant patients. Conclusion: Alterations in GABAergic and glutamatergic neurotransmission may contribute to some of the axial symptoms of PD.
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Málly J, Stone TW, Sinkó G, Geisz N, Dinya E. Long term follow-up study of non-invasive brain stimulation (NBS) (rTMS and tDCS) in Parkinson’s disease (PD). Strong age-dependency in the effect of NBS. Brain Res Bull 2018; 142:78-87. [DOI: 10.1016/j.brainresbull.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/11/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
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Kauw F, Takx RAP, de Jong HWAM, Velthuis BK, Kappelle LJ, Dankbaar JW. Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2018; 45:279-287. [PMID: 29936515 DOI: 10.1159/000490422] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/24/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. METHODS A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms "ischemic stroke," "predictors/determinants," and "recurrence." Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I2) were calculated using inverse variance random effects models. RESULTS Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1-3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1-0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2-1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5-2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1-5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0-4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2-1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5-3.2). CONCLUSIONS In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Getz SJ, Levin B. Cognitive and Neuropsychiatric Features of Early Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:769-785. [PMID: 29077803 DOI: 10.1093/arclin/acx091] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
The clinical definition of Parkinson's disease (PD) is based on cardinal motor features including bradykinesia as well as an additional symptom of tremor, postural instability, or rigidity. Evidence from neuropathological, imaging, and clinical research suggests a premotor, early phase of PD pathology. Further understanding of the earliest biomarkers of PD is crucial for the development of neuroprotective, disease modifying, cognitive, and psychiatric interventions. Recent research has explored early non-motor markers of PD pathology. This issue is especially timely as the International Parkinson and Movement Disorder Society has recently provided a research definition for prodromal PD which includes combinations of prodromal markers and risk factors aimed at identifying target populations for disease-prevention trials. In this review of early PD, we will outline early non-motor symptoms, early cognitive and neuropsychiatric features, neuropsychological assessment strategies, emerging evidence for early biomarkers, and treatment recommendations.
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Affiliation(s)
- Sarah J Getz
- Department of Neurology, Division of Neuropsychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie Levin
- Department of Neurology, Division of Neuropsychology, University of Miami Miller School of Medicine, Miami, FL, USA
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55
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Wen MC, Heng HSE, Lu Z, Xu Z, Chan LL, Tan EK, Tan LCS. Differential White Matter Regional Alterations in Motor Subtypes of Early Drug-Naive Parkinson's Disease Patients. Neurorehabil Neural Repair 2018; 32:129-141. [PMID: 29347868 DOI: 10.1177/1545968317753075] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parkinson's disease (PD) can be classified into tremor dominant (TD) and postural instability and gait difficulty (PIGD) subtypes with TD considered as the benign subtype. The neural alterations of the 2 subtypes in the early stages before administration of medications remain elusive. OBJECTIVE This study assessed the subtype-related white matter (WM) microstructural features in newly diagnosed and drug-naive PD patients from the Parkinson's Progression Markers Initiative (PPMI). METHODS Sixty-five early PDs with stable subtypes (52 TD and 13 PIGD patients) and 61 controls underwent diffusion tensor imaging (DTI) scanning and clinical assessment. Tract-based special statistics (TBSS), graph-theoretical and network-based analyses were used to compare WM regional and network features between groups. RESULTS No differences in disease stages and duration were found between the 2 patient groups. TD patients showed increased fractional anisotropy (FA), but decreased radial and axial diffusivities (RD and AD) in several projection, association, and commissural tracts, compared with PIGD patients and controls. Motor severity had mild-to-moderate correlations with FA and RD of the corpus callosum (genu) in TD, but strong correlations with FA and RD of multiple association tracts in PIGD. Conversely, no significant network changes were noted. CONCLUSIONS TD patients showed regionally increased FA but decreased diffusivities, implying neural reorganization to compensate PD pathology in early stages. PIGD patients, despite having similar disease stages and duration, exhibited more WM degradation. These results demonstrate differential WM regional features between the 2 subtypes in early PD and support the notion of TD being a benign subtype.
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Affiliation(s)
| | | | - Zhonghao Lu
- 1 National Neuroscience Institute, Singapore, Singapore
| | - Zheyu Xu
- 1 National Neuroscience Institute, Singapore, Singapore
| | | | - Eng King Tan
- 1 National Neuroscience Institute, Singapore, Singapore.,3 Duke-NUS Medical School, Singapore, Singapore
| | - Louis C S Tan
- 1 National Neuroscience Institute, Singapore, Singapore.,3 Duke-NUS Medical School, Singapore, Singapore
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Konno T, Deutschländer A, Heckman MG, Ossi M, Vargas ER, Strongosky AJ, van Gerpen JA, Uitti RJ, Ross OA, Wszolek ZK. Comparison of clinical features among Parkinson's disease subtypes: A large retrospective study in a single center. J Neurol Sci 2018; 386:39-45. [PMID: 29406964 DOI: 10.1016/j.jns.2018.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tremor dominant (TD), postural instability/gait difficulty (PIGD), and akinetic-rigid (AR) subtypes are widely used in classifying patients with Parkinson's disease (PD). METHODS We compared clinical characteristics between PD subtypes in a large retrospective cohort. Between 1998 and 2016, we included a total of 1003 patients with PD in this retrospective study. Six hundred ninety-four patients had more than one visit. Data were collected regarding motor/non-motor symptoms at the initial/final visits. Based on the prominent symptom at the initial visit, we classified patients into one of the four subtypes: TD, AR, gait difficulty, and mixed. Rapid progression was defined by emergence of falls, dementia, or dependency within 5years after onset. RESULTS TD was the most prevalent subtype (44%), followed by AR (29%), mixed (18%), and gait difficulty (9%). Rapid progression was observed more frequently in gait difficulty compared to AR (OR: 3.59 P<0.001). Hallucinations at the final visit were more likely to occur in AR (OR: 2.36, P=0.005) and mixed (OR: 3.28, P<0.001) compared to TD. CONCLUSIONS Our findings provide support for a distinction of four different PD subtypes: TD, AR, gait difficulty, and mixed. The gait difficulty subtype was distinguishable from the AR subtype.
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Affiliation(s)
- Takuya Konno
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Angela Deutschländer
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Maryam Ossi
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Emily R Vargas
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Audrey J Strongosky
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Jay A van Gerpen
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Zbigniew K Wszolek
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Abstract
The aim of this study was to report the most frequent psychosocial difficulties (PSDs) in patients with Parkinson disease (PD), to explore the relationship between PSDs, disability and quality of life (QoL), and to address the predictors of PSDs. Patients with PD were interviewed using a protocol composed of a questionnaire investigating PSDs (PARADISE 24), QoL, disability, comorbidity, and social support questionnaires, scales on resilience, personality traits, and empathy in physician. Most frequent PSDs were reported. Spearman's correlation was used to address the relationship between PARADISE 24 and QoL and disability measures. Multiple linear regression was performed to investigate predictors of PARADISE 24. Eighty patients were enrolled: 40% women, mean age 61.2 years. The most frequent PSDs were related to cognitive and motor slowness, tiredness, sleeping, facing all things to do, depressive mood, and anxiety. PARADISE 24 were correlated with disability (ρ=0.831) and QoL (ρ=-0.685). Lower QoL, higher disability, early age at onset, and shorter disease duration were significant predictors of PSDs (adjusted R=0.762). PARADISE 24 is an easy to use questionnaire that could contribute toward describing the impact of PD on patients' life more extensively, thus helping to define more tailored interventions.
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Camps J, Samà A, Martín M, Rodríguez-Martín D, Pérez-López C, Moreno Arostegui JM, Cabestany J, Català A, Alcaine S, Mestre B, Prats A, Crespo-Maraver MC, Counihan TJ, Browne P, Quinlan LR, Laighin GÓ, Sweeney D, Lewy H, Vainstein G, Costa A, Annicchiarico R, Bayés À, Rodríguez-Molinero A. Deep learning for freezing of gait detection in Parkinson’s disease patients in their homes using a waist-worn inertial measurement unit. Knowl Based Syst 2018. [DOI: 10.1016/j.knosys.2017.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Paul KC, Ling C, Lee A, To TM, Cockburn M, Haan M, Ritz B. Cognitive decline, mortality, and organophosphorus exposure in aging Mexican Americans. ENVIRONMENTAL RESEARCH 2018; 160:132-139. [PMID: 28982044 PMCID: PMC5798900 DOI: 10.1016/j.envres.2017.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/28/2017] [Accepted: 09/15/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cognitive impairment is a major health concern among older Mexican Americans, associated with significant morbidity and mortality, and may be influenced by environmental exposures. OBJECTIVES To investigate whether agricultural based ambient organophosphorus (OP) exposure influences 1) the rate of cognitive decline and mortality and 2) whether these associations are mediated through metabolic or inflammatory biomarkers. METHODS In a subset of older Mexican Americans from the Sacramento Area Latino Study on Aging (n = 430), who completed modified mini-mental state exams (3MSE) up to 7 times (1998-2007), we examined the relationship between estimated ambient OP exposures and cognitive decline (linear repeated measures model) and time to dementia or being cognitively impaired but not demented (CIND) and time to mortality (cox proportional hazards model). We then explored metabolic and inflammatory biomarkers as potential mediators of these relationships (additive hazards mediation). OP exposures at residential addresses were estimated with a geographic information system (GIS) based exposure assessment tool. RESULTS Participants with high OP exposure in the five years prior to baseline experienced faster cognitive decline (β = 0.038, p = 0.02) and higher mortality over follow-up (HR = 1.91, 95% CI = 1.12, 3.26). The direct effect of OP exposure was estimated at 241 (95% CI = 27-455) additional deaths per 100,000 person-years, and the proportion mediated through the metabolic hormone adiponectin was estimated to be 4% 1.5-19.2). No other biomarkers were associated with OP exposure. CONCLUSIONS Our study provides support for the involvement of OP pesticides in cognitive decline and mortality among older Mexican Americans, possibly through biologic pathways involving adiponectin.
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Affiliation(s)
- Kimberly C Paul
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Chenxiao Ling
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Anne Lee
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Tu My To
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, USA
| | - Mary Haan
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.
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He L, Lee EY, Sterling NW, Kong L, Lewis MM, Du G, Eslinger PJ, Huang X. The Key Determinants to Quality of Life in Parkinson's Disease Patients: Results from the Parkinson's Disease Biomarker Program (PDBP). JOURNAL OF PARKINSONS DISEASE 2017; 6:523-32. [PMID: 27258700 DOI: 10.3233/jpd-160851] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of motor- and non-motor symptoms on health-related quality of life (HRQOL) in Parkinson's disease (PD) has received increasing attention. OBJECTIVES To address this, the study explored a large cohort of patients enrolled in the PD Biomarker Program. METHODS The PD Questionnaire-39 (PDQ-39) measured HRQOL, whereas the Unified PD Rating Scale (UPDRS) assessed motor and non-motor symptoms. Determinants of HRQOL in PD patients were identified by stepwise linear regression analysis. The relationship between the PDQ-39 and UPDRS subscale scores then was explored through structural equation modeling. RESULTS The mean disease duration was 6.8 years and the mean PDQ-39 summary index (PDQ-39SI) was 18.4. UPDRS-I (non-motor function) and UPDRS-II (motor questionnaire) scores demonstrated the strongest correlations with PDQ-39SI (r Ϡ 0.4, P < 0.05), whereas UPDRS-III (motor exam) and UPDRS-IV (motor complications) scores were correlated moderately with PDQ-39SI (0.3 < r < 0.4, P < 0.05). Multiple linear stepwise regression analyses showed that age (β= -0.13, P < 0.001), education (β= -0.07, P = 0.008), UPDRS-I (β= 0.32, P = 0.000), and UPDRS-II (β= 0.44, P < 0.001) significantly contributed to HRQOL, and cumulatively accounted for 69.1% of the PDQ-39SI variance. UPDRS-II score was the primary predictor of PDQ-39SI, accounting for 57.3% of the variance, whereas UPDRS-I score accounted for 7.5%. UPDRS-III and -IV and other factors measured did not survive stepwise regression. Structural equation modeling confirmed the association of UPDRS-II (β= 0.67, P < 0.001) and UPDRS-I (β= 0.35, P < 0.001) with the PDQ-39SI. CONCLUSION Both motor and non-motor function scores impacted significantly HRQOL in PD. UPDRS-III, however, has limited contributions to HRQOL although it is used as a main outcome in many clinical trials.
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Affiliation(s)
- Lu He
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA.,School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Eun-Young Lee
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA
| | - Nicholas W Sterling
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA
| | - Lan Kong
- Department of Public School Health, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA.,Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Guangwei Du
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA
| | - Paul J Eslinger
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey PA, USA.,Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center Hershey, PA, USA.,Department of Kinesiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
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Guan X, Zeng Q, Guo T, Wang J, Xuan M, Gu Q, Wang T, Huang P, Xu X, Zhang M. Disrupted Functional Connectivity of Basal Ganglia across Tremor-Dominant and Akinetic/Rigid-Dominant Parkinson's Disease. Front Aging Neurosci 2017; 9:360. [PMID: 29163141 PMCID: PMC5673841 DOI: 10.3389/fnagi.2017.00360] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/20/2017] [Indexed: 11/23/2022] Open
Abstract
It is well known that disruption of basal ganglia function generates the motor symptoms in PD, however, these are presented in a heterogeneous manner; patients can be divided into tremor-dominant and akinesia/rigidity-dominant subtypes. To date, it is unknown if these differences in the motor symptoms could be explained by differences on the functional connectivity of basal ganglia with specific brain regions. In this study, we aimed to explore the alterations of the network-based and global functional connectivity linking to basal ganglia between the PD-TD and PD-AR patients. One hundred and six PD patients and 52 normal controls were recruited. According to the subscales of UPDRS motor scale, PD patients were divided into the PD-TD (n = 57) and PD-AR (n = 49) subtypes. We performed independent component analysis to identify basal ganglia network (BGN) involving connected brain regions having coactivation with basal ganglia. Eigenvector centrality mapping were processed and the eigenvector centrality in the subcortical component of BGN including the bilateral caudate nuclei, putamen, thalami and pallidum were extracted to measure the global connectivity. Compared with controls, whole PD patients or PD subtypes showed decreases of functional connectivity within the subcortical component of BGN, e.g., thalamus, pallidum and putamen. Compared with controls, decreased functional connectivity of precuneus and amygdala with basal ganglia was observed in the PD-TD while that of occipital lobule and precuneus was observed in the PD-AR. Compared with the PD-TD, significantly decreased functional connectivity between occipital lobule and cerebellum posterior lobule and basal ganglia was observed in the PD-AR, and such connectivity had positive correlations with tremor and negative correlations with akinesia/rigidity. We also observed enhanced global connectivity in the caudate nucleus and thalamus in the PD subtypes compared with controls. In conclusion, PD patients independent of motor subtypes consistently express similar alterations of functional connectivity within the subcortical component of BGN including network-based connectivity and global connectivity. Functional connectivity of cerebellum posterior lobule and occipital lobule with basal ganglia play important roles in the modulation of parkinsonian motor symptoms.
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Affiliation(s)
- Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiaoling Zeng
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqiu Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Xuan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Paul KC, Sinsheimer JS, Cockburn M, Bronstein JM, Bordelon Y, Ritz B. Organophosphate pesticides and PON1 L55M in Parkinson's disease progression. ENVIRONMENT INTERNATIONAL 2017; 107:75-81. [PMID: 28689109 PMCID: PMC5600289 DOI: 10.1016/j.envint.2017.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/08/2017] [Accepted: 06/22/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Parkinson's disease (PD) has motor and non-motor features that contribute to its phenotype and functional decline. Organophosphate (OP) pesticides and PON1 L55M, which influences OP metabolism, have been implicated in multiple mechanisms related to neuronal cell death and may influence PD symptom progression. OBJECTIVE To investigate whether ambient agricultural OP exposure and PON1 L55M influence the rate of motor, cognitive, and mood-related symptom progression in PD. METHODS We followed a longitudinal cohort of 246 incident PD patients on average over 5years (7.5years after diagnosis), repeatedly measuring symptom progression with the Mini-Mental State Exam (MMSE), Unified Parkinson's Disease Rating Scale (UPDRS), and Geriatric Depressive Scale (GDS). OP exposures were generated with a geographic information system (GIS) based exposure assessment tool. We employed repeated-measures regression to assess associations between OP exposure and/or PON1 L55M genotype and progression. RESULTS High OP exposures were associated with faster progression of motor (UPDRS β=0.24, 95% CI=-0.01, 0.49) and cognitive scores (MMSE β=-0.06, 95% CI=-0.11, -0.01). PON1 55MM was associated with faster progression of motor (UPDRS β=0.28, 95% CI=0.08, 0.48) and depressive symptoms (GDS β=0.07; 95% CI=0.01, 0.13). We also found the PON1 L55M variant to interact with OP exposures in influencing MMSE cognitive scores (β=-1.26, 95% CI=-2.43, -0.09). CONCLUSION Our study provides preliminary support for the involvement of OP pesticides and PON1 in PD-related motor, cognitive, or depressive symptom progression. Future studies are needed to replicate findings and examine whether elderly populations generally are similarly impacted by pesticides or PON1 55M genotypes.
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Affiliation(s)
- Kimberly C Paul
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Janet S Sinsheimer
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA; Departments of Human Genetics and Biomathematics, David Geffen School of Medicine, Los Angeles, California, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, USA
| | - Jeff M Bronstein
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Yvette Bordelon
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA; Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA.
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Latourelle JC, Beste MT, Hadzi TC, Miller RE, Oppenheim JN, Valko MP, Wuest DM, Church BW, Khalil IG, Hayete B, Venuto CS. Large-scale identification of clinical and genetic predictors of motor progression in patients with newly diagnosed Parkinson's disease: a longitudinal cohort study and validation. Lancet Neurol 2017; 16:908-916. [PMID: 28958801 PMCID: PMC5693218 DOI: 10.1016/s1474-4422(17)30328-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 01/21/2023]
Abstract
Background Better understanding and prediction of PD progression could improve disease management and clinical trial design. We aimed to use longitudinal clinical, molecular, and genetic data to develop predictive models, compare potential biomarkers, and identify novel predictors for motor progression in PD. We also sought to assess the use of these models in the design of treatment trials in PD. Methods A Bayesian multivariate predictive inference platform was applied to data from the Parkinson’s Progression Markers Initiative (PPMI) study (NCT01141023). We used genetic data and baseline molecular and clinical variables from PD patients and healthy controls to construct an ensemble of models to predict the annualised rate of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale parts II and III combined. We tested our overall explanatory power, as assessed by the coefficient of determination (R2), and replicated novel findings in an independent clinical cohort of PD patients from the Longitudinal and Biomarker Study in PD (LABS-PD; NCT00605163). The potential utility of these models for clinical trial design was quantified by comparing simulated randomized placebo-controlled trials within the out-of sample LABS-PD cohort. Findings A total of 117 controls and 312 PD cases were available for analysis. Our model ensemble exhibited strong performance in-cohort (5-fold cross-validated R2=41%, 95% CI: 35% – 47%) and significant, though reduced, performance out-of-cohort (R2=9%, 95% CI: 4% – 16%). Individual predictive features identified from PPMI data were confirmed in the LABS-PD cohort of 317 PD patients. These included significant replication of higher baseline motor score, male sex, and increased age, as well as a novel PD-specific epistatic interaction all indicative of faster motor progression. Genetic variation was the most useful predictive marker of motor progression (2.9%, 95%CI: 1.5–4.3%). CSF biomarkers at baseline showed a more modest (0.3%; 95%CI: 0.1–0.5%), but still significant effect on motor progression prediction. The simulations (n=5000) showed that incorporating the predicted rates of motor progression into the final models of treatment effect reduced the variability in the study outcome allowing significant differences to be detected at sample sizes up to 20% smaller than in naïve trials. Interpretation Our model ensemble confirmed established and identified novel predictors of PD motor progression. Improving existing prognostic models through machine learning approaches should benefit trial design and evaluation, as well as clinical disease monitoring and treatment. Funding Michael J. Fox Foundation for Parkinson’s Research and National Institute of Neurological Disorders and Stroke (1P20NS092529-01).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Charles S Venuto
- Center for Health and Technology and Department of Neurology, University of Rochester, Rochester, NY, USA
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Contribution of language studies to the understanding of cognitive impairment and its progression over time in Parkinson’s disease. Neurosci Biobehav Rev 2017; 80:657-672. [DOI: 10.1016/j.neubiorev.2017.07.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/28/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022]
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De Pablo-Fernandez E, Tur C, Revesz T, Lees AJ, Holton JL, Warner TT. Association of Autonomic Dysfunction With Disease Progression and Survival in Parkinson Disease. JAMA Neurol 2017; 74:970-976. [PMID: 28655059 DOI: 10.1001/jamaneurol.2017.1125] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Evidence suggests that development of autonomic dysfunction (AutD) may negatively affect disease course and survival in patients with synucleinopathies. However, the few available studies on Parkinson disease (PD) have conflicting results, comprise a small number of patients, have short follow-up periods, and lack pathologic confirmation of the diagnosis. Objective To examine the association of time of onset of AutD with disease progression and survival in PD. Design, Setting, and Participants This retrospective review of clinical data from 100 consecutive patients with an autopsy-confirmed diagnosis of PD from the archives of the Queen Square Brain Bank in London, United Kingdom, from January 1, 2006, to June 3, 2016, included patients with PD regularly seen by hospital specialists (neurologists or geriatricians) in the United Kingdom throughout their disease until death. Patients with dementia before or within 1 year after onset of motor symptoms, monogenic forms of PD, comorbidities that affect autonomic function, a coexisting neuropathologic diagnosis, or insufficient clinical information were excluded. Main Outcomes and Measures Survival and time from diagnosis to specific disease milestones were calculated to assess disease progression. Autonomic dysfunction was defined as autonomic failure at autonomic function testing or 2 of the following symptoms: urinary symptoms, constipation, upper gastrointestinal tract dysfunction, orthostatic hypotension, sweating abnormalities, or erectile dysfunction. Multivariable Cox proportional hazards regression models on the risk of a disease milestone and death were used. Results A total of 100 patients (60 [60.0%] male; mean [SD] age at diagnosis, 63.9 [10.3] years; mean [SD] disease duration, 14.6 [7.7] years) were studied. Autonomic dysfunction developed in 85 patients (mean [SD] time from diagnosis, 6.7 [7.7] years) and was associated with older age at diagnosis, male sex, poor initial levodopa treatment response, and postural instability and gait difficulty motor PD subtype in linear regression analysis, but staging of α-synuclein pathologic changes was unrelated. Earlier AutD increased the risk of reaching the first milestone (hazard ratio, 0.86; 95% CI, 0.83-0.89; P < .001) and shortened survival (hazard ratio, 0.92; 95% CI, 0.88-0.96; P < .001). Older age at diagnosis and poorer levodopa treatment response were the other factors associated with shorter survival in adjusted multivariate analysis. Conclusions and Relevance Earlier AutD is associated with a more rapid development of disease milestones and shorter survival in patients with PD.
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Affiliation(s)
- Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom.,Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Carmen Tur
- Department of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom.,Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom.,Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, United Kingdom
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Amara AW, Chahine LM, Caspell-Garcia C, Long JD, Coffey C, Högl B, Videnovic A, Iranzo A, Mayer G, Foldvary-Schaefer N, Postuma R, Oertel W, Lasch S, Marek K, Simuni T. Longitudinal assessment of excessive daytime sleepiness in early Parkinson's disease. J Neurol Neurosurg Psychiatry 2017; 88:653-662. [PMID: 28554959 PMCID: PMC7282477 DOI: 10.1136/jnnp-2016-315023] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/30/2017] [Accepted: 04/19/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is common and disabling in Parkinson's disease (PD). Predictors of EDS are unclear, and data on biological correlates of EDS in PD are limited. We investigated clinical, imaging and biological variables associated with longitudinal changes in sleepiness in early PD. METHODS The Parkinson's Progression Markers Initiative is a prospective cohort study evaluating progression markers in participants with PD who are unmedicated at baseline (n=423) and healthy controls (HC; n=196). EDS was measured with the Epworth Sleepiness Scale (ESS). Clinical, biological and imaging variables were assessed for associations with EDS for up to 3 years. A machine learning approach (random survival forests) was used to investigate baseline predictors of incident EDS. RESULTS ESS increased in PD from baseline to year 3 (mean±SD 5.8±3.5 to 7.55±4.6, p<0.0001), with no change in HC. Longitudinally, EDS in PD was associated with non-tremor dominant phenotype, autonomic dysfunction, depression, anxiety and probable behaviour disorder, but not cognitive dysfunction or motor severity. Dopaminergic therapy was associated with EDS at years 2 and 3, as dose increased. EDS was also associated with presynaptic dopaminergic dysfunction, whereas biofluid markers at year 1 showed no significant associations with EDS. A predictive index for EDS was generated, which included seven baseline characteristics, including non-motor symptoms and cerebrospinal fluid phosphorylated-tau/total-tau ratio. CONCLUSIONS In early PD, EDS increases significantly over time and is associated with several clinical variables. The influence of dopaminergic therapy on EDS is dose dependent. Further longitudinal analyses will better characterise associations with imaging and biomarkers.
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Affiliation(s)
- Amy W Amara
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lama M Chahine
- Department of Neurology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey D Long
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Geert Mayer
- Department of Neurology, Hephata-Klinik,Hephata Hessisches Diakoniezentrum, e.V., Schwalmstadt-Treysa, Germany
| | | | - Ron Postuma
- Division of Neurology, McGill University, Montreal, Québec, Canada
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
- Charitable Hertie Foundation, Frankfurt, Germany
| | - Shirley Lasch
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Ken Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Tu XJ, Hwang WJ, Ma HI, Chang LH, Hsu SP. Determinants of generic and specific health-related quality of life in patients with Parkinson's disease. PLoS One 2017. [PMID: 28650957 PMCID: PMC5484474 DOI: 10.1371/journal.pone.0178896] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives Generic and disease-specific health-related quality of life (HRQoL) instruments may reflect different aspects of lives in patients with Parkinson’s disease (PD) and thus be associated with different determinants. We used the same cluster of predictors for the generic and disease-specific HRQoL instruments to examine and compare the determinants of HRQoL. Method HRQoL was measured in 92 patients with PD by the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson’s Disease Questionnaire (PDQ-39). The predictors included demographic and disease characteristics, and motor and non-motor symptoms. Multiple regression analyses were used to identify HRQoL determinants. Results Depressive symptoms and motor difficulties of daily living were the first two significant determinants for both instruments. The other significant determinant for the SF-36 was fatigue and non-motor difficulties of daily living, and for the PDQ-39 was motor signs of PD. Conclusions The results suggest the importance of the evaluation and intervention focused on depressive symptoms and motor difficulties of daily living in patients with PD. In addition, the SF-36 seems more related to non-motor symptoms, while the PDQ-39 appears more associated with motor symptoms. This information is important for understanding results from these two instruments and for choosing which to use.
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Affiliation(s)
- Xiao-Jing Tu
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Juh Hwang
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ing Ma
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (SPH); (HIM)
| | - Ling-Hui Chang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- * E-mail: (SPH); (HIM)
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Development and validation of the Korea Dementia Comorbidity Index (KDCI): A nationwide population-based cohort study from 2002 to 2013. Arch Gerontol Geriatr 2017; 72:195-200. [PMID: 28709115 DOI: 10.1016/j.archger.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/10/2017] [Accepted: 06/04/2017] [Indexed: 11/21/2022]
Abstract
This study develop and validate a simple and accessible measure of comorbidity, named the Korean Dementia Comorbidity index (KDCI), to assist in predicting the onset of dementia. This study used the National Health Insurance Service-Cohort Sample Database from 2002 to 2013 (n=23,856). Cox proportional hazard model was used to estimate incident dementia (International Classification of Disease, 10th edition (ICD-10) codes: F00-F03, G30, G311), with a hazard ratio higher than 1.05 for each comorbid condition being assigned a score. Scores ranging from 1 to 4 were assigned based on the magnitude of the hazard ratio (HR): 1 (1.050≤HR≤1.099), 2 (1.100≤HR≤1.149), 3 (1.150≤HR≤1.199), and 4 (HR≥1.200) Summated scores of comorbidities for each individual constituted the Korean Dementia Comorbidity Index (KDCI). Five patterns were extracted: (1) disease of the eye and adnexa; (2) endocrine and metabolic disease, and disease of circulatory system; (3) disease of the musculoskeletal system and connective tissue; (4) disease of the respiratory system; and (5) disease of the nervous system, and mental and behavioral disorders through factor analysis. Fitting performance by Akaike information criterion (AIC) of CCI by Charlson, CCI by Quan and KDCI adjusting for age and sex was 29,486, 29,488 and 29,444, respectively. Our analysis results on discriminatory abilities provided evidence that KDCI is superior to other comorbidity indices on incident dementia in terms of comorbidity adjustment. Therefore, KDCI can be a useful tool to identify incident dementia. This has implications for clinical management of patients with multimorbidity as well as risk adjustment for database studies.
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69
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Ramani L, Malek N, Patterson J, Nissen T, Newman EJ. Relationship between [ 123 I]-FP-CIT SPECT and clinical progression in Parkinson's disease. Acta Neurol Scand 2017; 135:400-406. [PMID: 27255673 DOI: 10.1111/ane.12613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The demonstration of presynaptic dopaminergic deficiency on [123 I]-FP-CIT SPECT imaging is a useful ancillary tool in the diagnosis of Parkinson's disease (PD). Whilst there is evidence of a cross-sectional relationship between the degree of dopaminergic deficiency and severity of bradykinesia and rigidity, longitudinal studies are rare. Moreover, the relationship between motor subtypes and their dopaminergic deficient state is not well characterized. AIM Our primary aim was to assess the correlations between dopaminergic deficiency on baseline [123 I]-FP-CIT SPECT imaging with the progression of motor severity in patients classified by motor subtype, and the development of motor complications. Our secondary aim was to assess the correlation between UPDRS-III subscores and the time to onset of motor complications. METHODS 42 PD patients with abnormal baseline [123 I]-FP-CIT SPECT scans and at least 3 years of clinical follow-up were classified by motor subtype: akinetic-rigid, tremor-dominant or mixed. UPDRS-III scores at baseline and at 3-year follow-up, and time to onset of motor complications were recorded. RESULTS [123 I]-FP-CIT uptake ratios were inversely correlated with UPDRS-III scores at 3 years only in akinetic-rigid patients (r=-.51, P=.04). Time to onset of motor complications was inversely correlated with UPDRS-III subscores for bradykinesia and rigidity at baseline (r=-.52, P=.02) and at 3 years (r=-.54, P=.01). CONCLUSION The degree of dopaminergic deficiency on baseline [123 I]-FP-CIT SPECT inversely correlates with motor severity at 3-year follow-up in akinetic-rigid patients only. Furthermore, UPDRS-III subscores for bradykinesia and rigidity at baseline show an inverse correlation with time to onset of motor complications across all PD subtypes.
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Affiliation(s)
- L. Ramani
- University of Glasgow School of Medicine; Glasgow UK
| | - N. Malek
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - J. Patterson
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - T. Nissen
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - E. J. Newman
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
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Pérez-López C, Samà A, Rodríguez-Martín D, Català A, Cabestany J, Moreno-Arostegui JM, de Mingo E, Rodríguez-Molinero A. Assessing Motor Fluctuations in Parkinson's Disease Patients Based on a Single Inertial Sensor. SENSORS (BASEL, SWITZERLAND) 2016; 16:E2132. [PMID: 27983675 PMCID: PMC5191112 DOI: 10.3390/s16122132] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/27/2016] [Accepted: 12/10/2016] [Indexed: 01/23/2023]
Abstract
Altered movement control is typically the first noticeable symptom manifested by Parkinson's disease (PD) patients. Once under treatment, the effect of the medication is very patent and patients often recover correct movement control over several hours. Nonetheless, as the disease advances, patients present motor complications. Obtaining precise information on the long-term evolution of these motor complications and their short-term fluctuations is crucial to provide optimal therapy to PD patients and to properly measure the outcome of clinical trials. This paper presents an algorithm based on the accelerometer signals provided by a waist sensor that has been validated in the automatic assessment of patient's motor fluctuations (ON and OFF motor states) during their activities of daily living. A total of 15 patients have participated in the experiments in ambulatory conditions during 1 to 3 days. The state recognised by the algorithm and the motor state annotated by patients in standard diaries are contrasted. Results show that the average specificity and sensitivity are higher than 90%, while their values are higher than 80% of all patients, thereby showing that PD motor status is able to be monitored through a single sensor during daily life of patients in a precise and objective way.
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Affiliation(s)
- Carlos Pérez-López
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Albert Samà
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Daniel Rodríguez-Martín
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Andreu Català
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Joan Cabestany
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Juan Manuel Moreno-Arostegui
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Eva de Mingo
- Clinical Research Unit, Consorci Sanitari del Garraf (Fundación Sant Antoni Abat ), Carrer de Sant Josep, 21-23, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Alejandro Rodríguez-Molinero
- Clinical Research Unit, Consorci Sanitari del Garraf (Fundación Sant Antoni Abat ), Carrer de Sant Josep, 21-23, Vilanova i la Geltrú 08800, Barcelona, Spain.
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Czechowicz B, Siuda J, Bednar M, Nowakowska I, Rudzińska-Bar M. Assessment of the correlation between gait and balance disorders, and the severity of motor symptoms in Parkinson’s disease, depression and cognitive impairment. REHABILITACJA MEDYCZNA 2016. [DOI: 10.5604/01.3001.0009.4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Postural instability in patients with Parkinson’s disease (PD) is one of the major factors contributing to an increasing
number of falls and fall related complications. Diagnosis of balance disorder is based on assessment of postural control
by the biomechanical assessment of the musculoskeletal system, coordinating speed and precision of movements. The condition
for the performance of precise and smooth movement is coordination of motor activity and sensory signals fl owing to
the motor system.
Study aim: The aim of the study is to assess the impact of non-motor symptoms (depression and cognitive impairment) and the
impact of the severity of motor symptoms on the process of course of movement planning and control in Parkinson’s disease.
Material and methods: The study involved 40 patients with idiopathic Parkinson’s disease, diagnosed according to the criteria
adopted by the United Kingdom Parkinson’s Disease Society Brain Bank (UKPDSBB), with stage II or III severity of symptoms
of the disease according to the Hoehn-Yahr sclae. All the patients underwent physical examination with an evaluation
using the UPDRS (Unifi ed Parkinson’s Disease Rating Scale) and screening clinical trials were performed, evaluating cognitive
functions (Montreal Cognitive Assessment, MoCA) and depressive disorders (Beck Depression Inventory, BDI). Evaluation of
mobility, stability and motor control was done using the Berg Balance Scale (BBS), the Tinetti test, the Up and Go test (TUG)
and the Dynamic Gait Index (DGI).
Results: There was a signifi cant correlation between the level of severity of movement disorders (according to UPRDS ON
part III) and the parameters defi ning motor skills in the DGI (R= -0.49, p<0.001), the TUG test evaluating mobility (R=0.4,
p<0.01), and static and dynamic balance disorder using BBS (R=-0.44, p<0.004). The level of cognitive functioning had signifi
cant impact on the mobility and stability of patients, and the occurrence of depressive disorder did not affect the deterioration
of basic postural reactions in the group of patients with PD.
Cite this article as: Czechowicz B., Siuda J., Bednar M., Nowakowska I., Rudzińska-Bar M. Assessment of the correlation between gait and balance disorders, and the severity of motor symptoms in Parkinson’s disease, depression and cognitive impairment. Med Rehabil 2016; 20(2): 13-19.
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Affiliation(s)
- Bartłomiej Czechowicz
- Medical University of Silesia, Katowice, Poland Central University Hospital Department of Neurology
| | - Joanna Siuda
- Medical University of Silesia, Katowice School of Medicine in Katowice Department of Neurology,
| | - Magdalena Bednar
- Medical University of Silesia, Katowice, Poland Central University Hospital Department of Neurology
| | - Iwona Nowakowska
- School of Health Sciences in Katowice, Medical University of Silesia, Katowice Department of Balneoclimatology and Biological Regeneration
| | - Monika Rudzińska-Bar
- Medical University of Silesia, Katowice, Poland Central University Hospital Department of Neurology
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Bellucci A, Mercuri NB, Venneri A, Faustini G, Longhena F, Pizzi M, Missale C, Spano P. Review: Parkinson's disease: from synaptic loss to connectome dysfunction. Neuropathol Appl Neurobiol 2016; 42:77-94. [PMID: 26613567 DOI: 10.1111/nan.12297] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/06/2015] [Accepted: 11/14/2015] [Indexed: 12/12/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder with prominent loss of nigro-striatal dopaminergic neurons. The resultant dopamine (DA) deficiency underlies the onset of typical motor symptoms (MS). Nonetheless, individuals affected by PD usually show a plethora of nonmotor symptoms (NMS), part of which may precede the onset of motor signs. Besides DA neuron degeneration, a key neuropathological alteration in the PD brain is Lewy pathology. This is characterized by abnormal intraneuronal (Lewy bodies) and intraneuritic (Lewy neurites) deposits of fibrillary aggregates mainly composed of α-synuclein. Lewy pathology has been hypothesized to progress in a stereotypical pattern over the course of PD and α-synuclein mutations and multiplications have been found to cause monogenic forms of the disease, thus raising the question as to whether this protein is pathogenic in this disorder. Findings showing that the majority of α-synuclein aggregates in PD are located at presynapses and this underlies the onset of synaptic and axonal degeneration, coupled to the fact that functional connectivity changes correlate with disease progression, strengthen this idea. Indeed, by altering the proper action of key molecules involved in the control of neurotransmitter release and re-cycling as well as synaptic and structural plasticity, α-synuclein deposition may crucially impair axonal trafficking, resulting in a series of noxious events, whose pressure may inevitably degenerate into neuronal damage and death. Here, we provide a timely overview of the molecular features of synaptic loss in PD and disclose their possible translation into clinical symptoms through functional disconnection.
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Affiliation(s)
- Arianna Bellucci
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Annalena Venneri
- IRCCS Fondazione Ospedale San Camillo (NHS-Italy), Venice Lido, Italy.,Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Gaia Faustini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Longhena
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marina Pizzi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,IRCCS Fondazione Ospedale San Camillo (NHS-Italy), Venice Lido, Italy
| | - Cristina Missale
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - PierFranco Spano
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,IRCCS Fondazione Ospedale San Camillo (NHS-Italy), Venice Lido, Italy
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Chaudhuri KR, Bhidayasiri R, van Laar T. Unmet needs in Parkinson's disease: New horizons in a changing landscape. Parkinsonism Relat Disord 2016; 33 Suppl 1:S2-S8. [PMID: 27932224 DOI: 10.1016/j.parkreldis.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
The success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.
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Affiliation(s)
- K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital London, UK
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Teus van Laar
- Department of Neurology, University of Groningen, Groningen, The Netherlands
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Mendes A, Gonçalves A, Vila-Chã N, Calejo M, Moreira I, Fernandes J, Damásio J, Teixeira-Pinto A, Krack P, Lima AB, Cavaco S. Statistical Models of Parkinson’s Disease Progression: Predictive Validity in a 3-Year Follow-up. JOURNAL OF PARKINSONS DISEASE 2016; 6:793-804. [DOI: 10.3233/jpd-160877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandre Mendes
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Vila-Chã
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Margarida Calejo
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Moreira
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Fernandes
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Damásio
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Armando Teixeira-Pinto
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Krack
- Department of Clinical Neurosciences, Clinic of Neurology, Geneva University Hospital, Geneva, Switzerland
- Department of Basic Neurosciences, Medical Faculty, University of Geneva, Geneva, Switzerland
| | | | - Sara Cavaco
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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75
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Bega D, Kim S, Zhang Y, Elm J, Schneider J, Hauser R, Fraser A, Simuni T. Predictors of Functional Decline in Early Parkinson's Disease: NET-PD LS1 Cohort. JOURNAL OF PARKINSONS DISEASE 2016; 5:773-82. [PMID: 26639661 DOI: 10.3233/jpd-150668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on predictors of decline in PD are largely based on de-novo populations and limited to the use of motor outcomes that fail to capture the full scope of disease. OBJECTIVE Determine the clinical predictors of decline in early treated PD using a novel multi-domain measure. METHODS Data from NINDS Exploratory Trials in PD Long-Term Study 1 (NET-PD LS1), a multicenter Phase 3 study of creatine in early treated PD, were analyzed. Functional decline was defined by a global outcome metric (GO) that consisted of: Schwab and England ADL scale, PD 39-item Questionnaire, Unified PD Rating Scale, Ambulatory Capacity Score, Symbol Digit Modalities Test, and Modified Rankin Scale. Univariate and multivariate models were used to test the association of predictors of interest with a standardized rank-sum of the GO. RESULTS 765 of 1741 participants completed five-year assessments and were included. Older age at disease onset (p < 0.0001), higher baseline levodopa equivalent dose (p = 0.01), and worse Scales for Outcomes of Parkinson's Disease Cognition score (p = 0.001) at baseline were the strongest predictors of functional decline in multivariate analysis. PD symptom subtype was not a significant predictor of outcome (p = 0.42). The full model was only a modest predictor of change in GO (R2 = 0.186). CONCLUSIONS This is the largest study to systematically assess predictors of functional decline in early treated PD over several years, and the first to use a multi-domain outcome measure of decline. Older age at disease onset and worse cognition, and not PD subtype, were predictors of decline.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, IL, USA
| | - Soeun Kim
- University of Texas Health Science Center, Houston, TX, USA
| | - Yunxi Zhang
- University of Texas Health Science Center, Houston, TX, USA
| | - Jordan Elm
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Andy Fraser
- Oregon Health Sciences University, Portland, OR, USA
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76
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Contribution of Axial Motor Impairment to Physical Inactivity in Parkinson Disease. Am J Phys Med Rehabil 2016; 95:348-54. [PMID: 26368837 DOI: 10.1097/phm.0000000000000384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the relationships between motor symptoms of Parkinson disease (PD) and activity limitations in persons with PD. DESIGN/METHODS This is a cross-sectional study of persons with mild to moderate PD (N = 90). Associations among axial motor features, limb motor signs, the Physical Activity Scale for the Elderly, the ability to perform Activities of Daily Living (ADLs), and level of ADL dependency were studied. A composite score of axial motor features included the following Unified Parkinson Disease Rating Scale items: speech, rigidity of the neck, arising from chair, posture, gait, and postural stability. A composite score of limb motor signs included the following Unified Parkinson Disease Rating Scale items: tremor at rest of all extremities, action tremor, rigidity of all extremities, finger taps, hand movement, rapid alternating hand movements, and foot tapping. RESULTS Axial motor features of PD were significantly correlated with physical inactivity (P < 0.001), decreased ADL (P < 0.001), and increase in ADL dependency (P < 0.001). Limb motor signs significantly correlated with decreased ADL (P < 0.001) and level of ADL dependency (P = 0.035) but did not correlate with physical inactivity. After controlling for age, sex, disease duration, and comorbidity, axial motor features contributed significantly to physical inactivity, decreased ADL, and increase in ADL dependency, whereas the limb motor signs did not. CONCLUSIONS Axial motor impairment contributed to physical inactivity and decreased ability to perform ADLs in persons with PD.
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Takahashi K, Ohsawa I, Shirasawa T, Takahashi M. Early-onset motor impairment and increased accumulation of phosphorylated α-synuclein in the motor cortex of normal aging mice are ameliorated by coenzyme Q. Exp Gerontol 2016; 81:65-75. [DOI: 10.1016/j.exger.2016.04.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/15/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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78
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How stable are Parkinson's disease subtypes in de novo patients: Analysis of the PPMI cohort? Parkinsonism Relat Disord 2016; 28:62-7. [DOI: 10.1016/j.parkreldis.2016.04.027] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/15/2016] [Accepted: 04/22/2016] [Indexed: 11/19/2022]
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79
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Shi C, Zheng Z, Wang Q, Wang C, Zhang D, Zhang M, Chan P, Wang X. Exploring the Effects of Genetic Variants on Clinical Profiles of Parkinson's Disease Assessed by the Unified Parkinson's Disease Rating Scale and the Hoehn-Yahr Stage. PLoS One 2016; 11:e0155758. [PMID: 27299523 PMCID: PMC4907455 DOI: 10.1371/journal.pone.0155758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
Many genetic variants have been linked to familial or sporadic Parkinson’s disease (PD), among which those identified in PARK16, BST1, SNCA, LRRK2, GBA and MAPT genes have been demonstrated to be the most common risk factors worldwide. Moreover, complex gene-gene and gene-environment interactions have been highlighted in PD pathogenesis. Compared to studies focusing on the predisposing effects of genes, there is a relative lack of research investigating how these genes and their interactions influence the clinical profiles of PD. In a cohort consisting of 2,011 Chinese Han PD patients, we selected 9 representative variants from the 6 above-mentioned common PD genes to analyze their main and epistatic effects on the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr (H-Y) stage of PD. With multiple linear regression models adjusting for medication status, disease duration, gender and age at onset, none of the variants displayed significant main effects on UPDRS or the H-Y scores. However, for gene-gene interaction analyses, 7 out of 37 pairs of variants showed significant or marginally significant associations with these scores. Among these, the GBA rs421016 (L444P)×LRRK2 rs33949390 (R1628P) interaction was consistently significant in relation to UPDRS III and UPDRS total (I+II+III), even after controlling for the family-wise error rate using False Discovery Rate (FDR-corrected p values are 0.0481 and 0.0070, respectively). Although the effects of the remaining pairs of variants did not survive the FDR correction, they showed marginally significant associations with either UPDRS or the H-Y stage (raw p<0.05). Our results highlight the importance of epistatic effects of multiple genes on the determination of PD clinical profiles and may have implications for molecular classification and personalized intervention of the disease.
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Affiliation(s)
- Chen Shi
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
- Bioinformatics Center, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Zheng Zheng
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Qi Wang
- Department of Statistics, Purdue University, West Lafayette, Indiana, United States of America
| | - Chaodong Wang
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurology, The Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China
| | - Dabao Zhang
- Bioinformatics Center, School of Biomedical Engineering, Capital Medical University, Beijing, China
- Department of Statistics, Purdue University, West Lafayette, Indiana, United States of America
| | - Min Zhang
- Bioinformatics Center, School of Biomedical Engineering, Capital Medical University, Beijing, China
- Department of Statistics, Purdue University, West Lafayette, Indiana, United States of America
- Alzheimer Disease Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- * E-mail: (MZ); (PC); (XMW)
| | - Piu Chan
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
- Key Laboratory on Neurodegenerative Disease of Ministry of Education and Key Laboratory on Parkinson’s Disease of Beijing, Beijing, China
- Parkinson Disease Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- * E-mail: (MZ); (PC); (XMW)
| | - Xiaomin Wang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
- Parkinson Disease Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- * E-mail: (MZ); (PC); (XMW)
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Maetzler W, Klucken J, Horne M. A clinical view on the development of technology-based tools in managing Parkinson's disease. Mov Disord 2016; 31:1263-71. [PMID: 27273651 DOI: 10.1002/mds.26673] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 12/22/2022] Open
Abstract
Recently, quantitative, objective, and easy-to-use technology-based tools that can assess PD features over long time periods have been developed and generate clinically relevant and comparable patient information. Herein, we present a clinician's view on technological developments that have the potential to revolutionize clinical management concepts in PD. According to prominent examples in clinical medicine (e.g., blood glycosylated hemoglobin and blood pressure), we argue that the consideration of technology-based assessment in the clinical management of PD must be based on specific assumptions: (1) It provides a valid and accurate parameter of a clinically relevant feature of the disease; (2) there is confirmed evidence that the parameter has an ecologically relevant effect on the specific clinical application; (3) a target range can be defined wherein the parameter reflects the adequate treatment response; and (4) implementation is simple to allow repetitive use. Currently, there are no technology-based tools available that fulfil all these assumptions; however, assessments of akinesia, dyskinesia, motor fluctuations, physical inactivity, gait impairment, and postural instability seem relatively close to the specifications described. An iterative process of integration is recommended to bring technology-based tools into clinical practice. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany.
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Malcolm Horne
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- St. Vincent's, Neurology Department, Fitzroy, Victoria, Australia
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81
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Diabetes, Gray Matter Loss, and Cognition in the Setting of Parkinson Disease. Acad Radiol 2016; 23:577-81. [PMID: 26874576 DOI: 10.1016/j.acra.2015.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/25/2015] [Accepted: 07/21/2015] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES Parkinson disease (PD) is a progressive neurodegenerative disorder affecting motor and cognitive functions. Prior studies showed that patients with PD and diabetes (DM) demonstrate worse clinical outcomes compared to nondiabetic subjects with PD. Our study aimed at defining the relationship between DM, gray matter volume, and cognition in patients with PD. MATERIALS AND METHODS This study included 36 subjects with PD (12 with DM, 24 without DM, mean age = 66). Subjects underwent high-resolution T1-weighted brain magnetic resonance imaging, [(11)C]dihydrotetrabenazine positron emission tomography imaging to quantify nigrostriatal dopaminergic denervation, clinical, and cognitive assessments. Magnetic resonance images were postprocessed to determine total and lobar cortical gray matter volumes. Cognitive testing scores were converted to z-scores for specific cognitive domains and a composite global cognitive z-score based on normative data computed. Analysis of covariance, accounting for effects of age, gender, intracranial volume, and striatal [(11)C]dihydrotetrabenazine binding, was used to test the relationship between DM and gray matter volumes. RESULTS Impact of DM on total gray matter volume was significant (P = 0.02). Post hoc analyses of lobar cortical gray matter volumes revealed that DM was more selectively associated with lower gray matter volumes in the frontal regions (P = 0.01). Cognitive post hoc analyses showed that interaction of total gray matter volume and DM status was significantly associated with composite (P = 0.007), executive (P = 0.02), and visuospatial domain cognitive z-scores (P = 0.005). These associations were also significant for the frontal cortical gray matter. CONCLUSION DM may exacerbate brain atrophy and cognitive functions in PD with greater vulnerability in the frontal lobes. Given the high prevalence of DM in the elderly, delineating its effects on patient outcomes in the PD population is of importance.
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Marras C, Alcalay RN, Caspell-Garcia C, Coffey C, Chan P, Duda JE, Facheris MF, Fernández-Santiago R, Ruíz-Martínez J, Mestre T, Saunders-Pullman R, Pont-Sunyer C, Tolosa E, Waro B. Motor and nonmotor heterogeneity of LRRK2-related and idiopathic Parkinson's disease. Mov Disord 2016; 31:1192-202. [PMID: 27091104 DOI: 10.1002/mds.26614] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) associated with LRRK2 mutations has been described as similar to idiopathic PD with minor clinical differences. No study has compared the clinical features of LRRK2-associated PD due to different mutations. The objective of this study was to compare LRRK2-associated PD due to G2019S and G2385R mutations and to compare each to idiopathic PD. METHODS Sites within the international LRRK2 Cohort Consortium undertook family-based, community-based, or clinic-based studies to gather clinical data on manifesting carriers and patients with idiopathic PD. RESULTS Five hundred sixteen PD patients with the G2019S mutation, 199 with the G2385R mutation, and 790 patients with idiopathic PD were included in the data set. Adjusted for age, sex, disease duration, and levodopa-equivalent daily dose, mean MDS-UPDRS part II or III scores and the frequency of motor fluctuations were higher in the G2385R mutation carriers than in either the G2019S mutation carriers or idiopathic PD patients. G2019S mutation carriers had significantly lower UPDRS part III scores than idiopathic PD patients. Both G2019S and G2385R mutation carriers had a higher proportion of the postural instability gait disorder phenotype compared with idiopathic PD patients. LRRK2 G2019S PD patients had better UPSIT scores and lower Geriatric Depression Scale scores than idiopathic PD patients in adjusted analyses. CONCLUSIONS G2385R and G2019S PD appear to have motor differences that may be explained by contrasting local treatment or measurement practices or differences in the biology of the disease. Longitudinal studies should evaluate whether progression is faster in G2385R mutation carriers compared with G2019S PD or idiopathic PD. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Connie Marras
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University of Toronto, Toronto, Ontario, Canada
| | - Roy N Alcalay
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Piu Chan
- Departments of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, China
| | - John E Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz VA Medical Center and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurizio F Facheris
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Rubén Fernández-Santiago
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, and the Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Javier Ruíz-Martínez
- Department of Neurology (Movement Disorders Unit), Hospital Universitario Donostia. Biodonostia Research Institute, Neurosciences area. San Sebastián, Guipúzcoa, Spain, and CIBERNED, Carlos III Health Institute, Madrid, Spain
| | - Tiago Mestre
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University of Toronto, Toronto, Ontario, Canada.,Parkinson's Disease and Movement Disorder Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claustre Pont-Sunyer
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institutd'InvestigacionsBiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institutd'InvestigacionsBiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Bjorg Waro
- Department of Neurology, Norwegian University of Science and Technology, Trondheim, Norway
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Velseboer DC, de Bie RMA, Wieske L, Evans JR, Mason SL, Foltynie T, Schmand B, de Haan RJ, Post B, Barker RA, Williams-Gray CH. Development and external validation of a prognostic model in newly diagnosed Parkinson disease. Neurology 2016; 86:986-93. [PMID: 26888991 DOI: 10.1212/wnl.0000000000002437] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/21/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop a prognostic model to predict disease outcomes in individual patients with Parkinson disease (PD) and perform an external validation study in an independent cohort. METHODS Model development was done in the Comorbidity and Aging in Rehabilitation Patients: The Influence on Activities (CARPA) cohort (Netherlands). External validation was performed using the Cambridgeshire Parkinson's Incidence from GP to Neurologist (CamPaIGN) cohort (UK). Both are longitudinal incident cohort studies that prospectively followed up patients with PD from the time of diagnosis. A composite outcome measure was made in which patients were classified as having an unfavorable prognosis when they had postural instability or dementia at the 5-year assessment (or at the last assessment before loss to follow-up), or had died before this time. The final model was derived with a backward selection strategy from candidate predictor variables that were measured at baseline. RESULTS In the resulting model, higher patient age, higher Unified Parkinson's Disease Rating Scale motor examination axial score, and a lower animal fluency score were all associated with a higher probability of an unfavorable outcome. External validation confirmed good discriminative ability between favorable and unfavorable outcomes with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval 0.77-0.93) and a well-calibrated model with a calibration slope of 1.13 and no significant lack of fit (Hosmer-Lemeshow test: p = 0.39). CONCLUSION We constructed a model that allows individual patient prognostication at 5 years from diagnosis, using a small set of predictor variables that can easily be obtained by clinicians or research nurses.
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Affiliation(s)
- Daan C Velseboer
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Rob M A de Bie
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luuk Wieske
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jonathan R Evans
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sarah L Mason
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Foltynie
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ben Schmand
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rob J de Haan
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart Post
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roger A Barker
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Caroline H Williams-Gray
- From the Department of Neurology (D.C.V., R.M.A.d.B., L.W.), Department of Medical Psychology (B.S.), and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam, the Netherlands; John Van Geest Centre for Brain Repair (J.R.E., S.L.M., R.A.B., C.H.W.-G.), Department of Clinical Neurosciences, University of Cambridge; Institute of Neurology (T.F.), University College London, UK; Department of Brain and Cognition (B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
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85
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Lafo JA, Jones JD, Okun MS, Bauer RM, Price CC, Bowers D. Memory Similarities Between Essential Tremor and Parkinson's Disease: A Final Common Pathway? Clin Neuropsychol 2015; 29:985-1001. [PMID: 26689342 DOI: 10.1080/13854046.2015.1118553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A growing body of literature supports the view that essential tremor (ET) involves alteration of cerebellar-thalamo-cortical networks which can result in working memory and executive deficits. In this study, we tested the hypothesis that individuals with ET would exhibit worse performance on memory tasks requiring more intrinsic organization and structuring (i.e., word lists) relative to those with fewer 'executive' demands (i.e., stories), similar to that previously observed in individuals with Parkinson's disease (PD). METHOD Participants included a convenience sample of 68 ET patients and 68 idiopathic PD patients, retrospectively matched based on age, education, and sex. All patients underwent routine neuropsychological evaluation assessing recent memory, auditory attention/working memory, language, and executive function. Memory measures included the Hopkins Verbal Learning Test-R and WMS-III Logical Memory. RESULTS Both ET and PD patients performed significantly worse on word list than story memory recall tasks. The magnitude of the difference between these two memory tasks was similar for ET and PD patients. In both patient groups, performance on measures of executive function and auditory attention/working memory was not distinctly correlated with word list vs. story recall. CONCLUSIONS These findings suggest that frontal-executive dysfunction in both ET and PD may negatively influence performance on memory tests that are not inherently organized. Although the pathophysiology of these two 'movement disorders' are quite distinct, both have downstream effects on thalamo-frontal circuitry which may provide a common pathway for a similar memory phenotype. Findings are discussed in terms of neuroimaging evidence, conceptual models, and best practice.
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Affiliation(s)
- Jacob A Lafo
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Jacob D Jones
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Michael S Okun
- b Department of Neurology , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Russell M Bauer
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Catherine C Price
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Dawn Bowers
- b Department of Neurology , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
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86
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Wee N, Kandiah N, Acharyya S, Chander RJ, Ng A, Au WL, Tan LCS. Depression and anxiety are co-morbid but dissociable in mild Parkinson's disease: A prospective longitudinal study of patterns and predictors. Parkinsonism Relat Disord 2015; 23:50-6. [PMID: 26711668 DOI: 10.1016/j.parkreldis.2015.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/26/2015] [Accepted: 12/01/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety are common in Parkinson's disease (PD) and contribute significantly to a reduced quality of life in PD patients. Though they often co-exist, it is unclear whether depression and anxiety result from a shared pathological process. We studied the longitudinal course and determinants of depression and anxiety in PD in order to understand which factors contribute to the development of these symptoms. METHODS We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring depressive and anxiety symptoms at 6 monthly intervals using the Geriatric Depression Scale and Hospital Anxiety and Depression Scale--'Anxiety' subscale. Univariate and multivariate Generalised Estimating Equations were used to investigate the course of depression and anxiety and their association with demographic factors, motor measures, non-motor symptoms, and pharmacological factors. RESULTS Depression and anxiety were co-morbid in 13.5% of the sample. Depressive symptoms remained relatively stable while anxiety symptoms improved over the course of 18 months. Severity of depressive symptoms was associated with female gender, motor fluctuations, apathy, and anxiety, while severity of anxiety was associated with older age, higher educational attainment, shorter disease duration, younger age of disease onset, and excessive daytime sleepiness. CONCLUSIONS Although depression and anxiety are frequently co-morbid in PD, they were dissociable from each other. They had distinct trajectories and different longitudinal relationships with demographic, motor, and non-motor factors that were unique to each disorder.
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Affiliation(s)
- Natalie Wee
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Sanchalika Acharyya
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Russell J Chander
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Aloysius Ng
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Wing Lok Au
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
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Health-Related Quality of Life in patients with Parkinson's disease--A systematic review based on the ICF model. Neurosci Biobehav Rev 2015; 61:26-34. [PMID: 26645499 DOI: 10.1016/j.neubiorev.2015.11.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 01/16/2023]
Abstract
We analyzed features associated with a reduction in Health-Related Quality of Life (HRQoL) in people with idiopathic Parkinson's disease (PD). As a new approach, features were embedded in the WHO framework for measuring health and disability, the ICF model. From 609 articles screened, 114 articles were included. Features aligned with the ICF's body functions and structures domain (BFS) were investigated more often than personal features, activities of daily living, environmental factors, and participation in societal roles (95, 42, 35, 29 and 14 times, respectively). The strongest associations were found for the relationships between HRQoL and "psychosocial functioning" from the participation domain and HRQoL, and "mobility limitations" from the activities domain. For the BFS, non-motor symptoms were more closely associated with reduced HRQoL than motor symptoms. In conclusion, this systematic review (i) provides entirely new insights in the association of HRQoL with PD features, (ii) shows an imbalance between most extensively investigated and most relevant features for HRQoL, and (iii) demonstrates the usefulness of the ICF model for such an approach.
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88
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Jiang JL, Tsai ST, Chen SY. Effects of subthalamic nucleus deep brain stimulation on quality of life and motor and depressive symptoms in Parkinson's disease. Tzu Chi Med J 2015. [DOI: 10.1016/j.tcmj.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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The role of prefrontal cortex during postural control in Parkinsonian syndromes a functional near-infrared spectroscopy study. Brain Res 2015; 1633:126-138. [PMID: 26551767 DOI: 10.1016/j.brainres.2015.10.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 12/28/2022]
Abstract
Postural instability represents a main source of disability in Parkinsonian syndromes and its pathophysiology is poorly understood. Indirect probes (i.e., mental imagery) of brain involvement support the role of prefrontal cortex as a key cortical region for postural control in older adults with and without Parkinsonian syndromes. Using functional near infrared spectroscopy (fNIRs) as a direct online cortical probe, this study aimed to compare neural activation patterns in prefrontal cortex, postural stability, and their respective interactions, in (1) patients with Parkinsonian syndromes; (2) those with mild parkinsonian signs; (3) and healthy older adults. Among 269 non-demented older adults (76.41 ± 6.70 years, 56% women), 26 individuals presented with Parkinsonian syndromes (Unified Parkinson's disease rating scale (UPDRS): 11.08 ± 3.60), 117 had mild parkinsonian signs (UPDRS: 3.21 ± 2.49), and 126 individuals were included as a healthy control group. Participants were asked to stand upright and count silently for ten seconds while changes in oxygenated hemoglobin levels over prefrontal cortex were measured using fNIRs. We simultaneously evaluated postural stability with center of pressure velocity data recorded on an instrumented walkway. Compared to healthy controls and patients with mild parkinsonian signs, patients with Parkinsonian syndromes demonstrated significantly higher prefrontal oxygenation levels to maintain postural stability. The pattern of brain activation and postural control of participants with mild parkinsonian signs were similar to that of normal controls. These findings highlight the online role of the prefrontal cortex in postural control in patients with Parkinsonian syndromes and afford the opportunity to improve therapeutic options for postural instability.
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90
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Cilia R, Cereda E, Klersy C, Canesi M, Zecchinelli AL, Mariani CB, Tesei S, Sacilotto G, Meucci N, Zini M, Ruffmann C, Isaias IU, Goldwurm S, Pezzoli G. Parkinson's disease beyond 20 years. J Neurol Neurosurg Psychiatry 2015; 86:849-55. [PMID: 25280915 DOI: 10.1136/jnnp-2014-308786] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/08/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND A very limited number of studies report data on the clinical features of Parkinson's disease (PD) 20 years after onset and beyond. OBJECTIVE To characterise PD 20 years after onset, investigating the impact of age at onset and disease duration on the clinical picture and the predictors of outcomes in patients reaching the 20-year time point. METHODS We conducted a retrospective, cross-sectional study and a longitudinal study. All case visits of patients with a disease duration ≥20 years (N=401) were stratified by disease duration (20-22, 23-25, ≥26 years) and by age at onset (cut-off, 50 years). Patients with a disease duration of 20-22 years (N=320) were prospectively followed up for a median of 45 months (IQR 23-89) for the new occurrence of fracture, percutaneous endoscopic gastrostomy, institutionalisation, confinement to a wheelchair or bed and death. RESULTS Older age at onset and longer disease duration were independently associated with a higher prevalence of major motor and non-motor milestones of disease disability (no interaction observed). In the longitudinal study, the most frequent outcomes were death (N=92), confinement to a wheelchair or bed (N=67) and fracture (N=52). Mortality was associated with the gender: male, older age, dysphagia, orthostatic hypotension, postural instability, fractures and institutionalisation. Fracture was associated with postural instability. Predictors of permanent confinement to a wheelchair or bed were older age, postural instability and institutionalisation. Comorbid dementia at the 20-year examination did not predict any of the outcomes. CONCLUSIONS Age at onset and disease duration are independent determinants of the clinical features of PD beyond 20 years. Non-motor symptoms depend more on age at onset rather than the disease duration itself. Non-levodopa-responsive axial symptoms are the main predictors of all relevant outcomes.
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Affiliation(s)
- Roberto Cilia
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Canesi
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | | | - Claudio B Mariani
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Silvana Tesei
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Giorgio Sacilotto
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Nicoletta Meucci
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Michela Zini
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Claudio Ruffmann
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Ioannis U Isaias
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Stefano Goldwurm
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Gianni Pezzoli
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
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Macleod AD, Grieve JWK, Counsell CE. A systematic review of loss of independence in Parkinson's disease. J Neurol 2015; 263:1-10. [PMID: 26174653 DOI: 10.1007/s00415-015-7847-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 11/29/2022]
Abstract
Functional dependency (needing help with basic ADLs) is an important outcome in Parkinson's disease (PD). "Death or dependency", as opposed to being alive and independent, is a useful dichotomous indicator of poor outcome. We aimed to systematically review the progression to dependency in PD and what factors predicted development of dependency. Comprehensive searches were performed to identify observational studies of dependency in PD with follow-up of at least 3 years. Other forms of parkinsonism and highly selected cohorts were excluded. Descriptive analysis of included studies was performed and outcomes over time were plotted by type of cohort (inception/non-inception). Independent prognostic factors were identified. There were insufficient data for meta-analysis. Of 15,154 unique references identified, 14 studies were included. Most studies were of low quality. There was heterogeneity in definitions of dependency and the measured risk of dependency at similar time-points. Risk of dependency in inception studies was about 10-25 % at 5 years and about 20-50 % at 10 years; and risk of "death or dependency" in the inception studies was about 15-40 % at 5 years and about 35-70 % at ten years. More bradykinesia and older age were associated with more dependency, but there was little evidence for other prognostic factors. Few high-quality data on dependency are available. Heterogeneity in study populations, methodology and outcome reporting made data synthesis difficult. Few prognostic factors have been identified. Further data from representative inception studies are necessary to better understand the progression of dependency in PD.
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Affiliation(s)
- Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - J W Kerr Grieve
- Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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92
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Bega D, Luo S, Fernandez H, Chou K, Aminoff M, Parashos S, Walker H, Russell DS, Christine CW, Dhall R, Singer C, Bodis-Wollner I, Hamill R, Truong D, Mari Z, Glazmann S, Huang M, Houston E, Simuni T. Impact of Depression on Progression of Impairment and Disability in Early Parkinson's Disease. Mov Disord Clin Pract 2015; 2:371-378. [PMID: 28393083 DOI: 10.1002/mdc3.12205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Depression is one of the most common nonmotor symptoms associated with Parkinson's disease (PD), yet the impact of depression on progression of disease is unclear. OBJECTIVE The aim of this study was to prospectively characterize the relationship between depressive symptoms and measures of disease progression in a large sample of patients with early, medically treated PD. METHODS Baseline and longitudinal Beck Depression Inventory (BDI) scores from participants in the NINDS Exploratory Trials in PD Long Term Study 1 were correlated with changes in multiple measures of disease severity over 5 years. Multivariate analysis of predictors of change in BDI was performed. RESULTS Of 1,741 participants, 746 completed 5-year assessments and were included. Mean age was 62.00 years (standard deviation [SD]: 9.22) and mean disease duration was 1.69 years (SD, 1.16). Mean BDI score was 6.24 (SD, 5.02) at baseline and 8.57 (SD, 6.60) at 5 years. Baseline BDI score was strongly associated with rate of change in all examined measures of disease severity. In multivariate analysis, BDI 5-year change was associated with change in UPDRS Part I (excluding depression item; P < 0.01), 33-item Parkinson's Disease Questionnaire (P < 0.01), EuroQOL Five Dimensional Questionnaire (P = 0.02), and Total Functional Capacity (P < 0.01), but was not associated with motor or cognitive measures. This model explained 68.8% of the variance 5-year change of the BDI score. CONCLUSIONS Worse baseline BDI scores are associated with a decline in multiple measures of disease severity in PD. Worsening of BDI at 5 years was associated with worsening in UPDRS Part I and quality-of-life measures, but not with motor or cognitive measures.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, Illinois, USA
| | - Sheng Luo
- University of Texas Health Science Center, Houston, Texas, USA
| | | | - Kelvin Chou
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Aminoff
- University of California San Francisco, San Francisco, California, USA
| | | | - Harrison Walker
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Russell
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | | | - Rohit Dhall
- Muhammad Ali Parkinson Center, Phoenix, Arizona, USA
| | | | | | | | - Daniel Truong
- Parkinson and Movement Disorders Institute, Fountain Valley, California, USA
| | - Zoltan Mari
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Meilin Huang
- University of Texas Health Science Center, Houston, Texas, USA
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Erro R, Picillo M, Amboni M, Moccia M, Vitale C, Longo K, Pellecchia MT, Santangelo G, Martinez‐Martin P, Ray Chaudhuri K, Barone P. Nonmotor predictors for levodopa requirement in de novo patients with Parkinson's disease. Mov Disord 2015; 30:373-8. [DOI: 10.1002/mds.26076] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 09/01/2014] [Accepted: 09/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of Neurology London United Kingdom
- Dipartimento di Scienze Neurologiche e del MovimentoUniversità di VeronaPoliclinico Borgo Roma Verona Italy
| | - Marina Picillo
- University of Naples “Federico II”Department of Neurological Science Naples Italy
| | | | - Marcello Moccia
- University of Naples “Federico II”Department of Neurological Science Naples Italy
| | - Carmine Vitale
- IDC Hermitage–Capodimonte Naples Italy
- University of Naples “Parthenope”Department of Motor Sciences Naples Italy
| | | | | | - Gabriella Santangelo
- IDC Hermitage–Capodimonte Naples Italy
- Neuropsychology Laboratory, Department of PsychologySecond University of Naples Caserta Italy
| | - Pablo Martinez‐Martin
- Alzheimer Center Reina Sofia Foundation Madrid Spain
- CIBERNED, Carlos III Institute of Health Madrid Spain
| | - K. Ray Chaudhuri
- National Parkinson Foundation International Center of ExcellenceKings College Hospital, Kings College London United Kingdom
| | - Paolo Barone
- University of Salerno, Center for Neurodegenerative Diseases–CEMAND Salerno Italy
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Sakar BE, Isenkul ME, Sakar CO, Sertbas A, Gurgen F, Delil S, Apaydin H, Kursun O. Collection and analysis of a Parkinson speech dataset with multiple types of sound recordings. IEEE J Biomed Health Inform 2015; 17:828-34. [PMID: 25055311 DOI: 10.1109/jbhi.2013.2245674] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There has been an increased interest in speech pattern analysis applications of Parkinsonism for building predictive telediagnosis and telemonitoring models. For this purpose, we have collected a wide variety of voice samples, including sustained vowels, words, and sentences compiled from a set of speaking exercises for people with Parkinson's disease. There are two main issues in learning from such a dataset that consists of multiple speech recordings per subject: 1) How predictive these various types, e.g., sustained vowels versus words, of voice samples are in Parkinson's disease (PD) diagnosis? 2) How well the central tendency and dispersion metrics serve as representatives of all sample recordings of a subject? In this paper, investigating our Parkinson dataset using well-known machine learning tools, as reported in the literature, sustained vowels are found to carry more PD-discriminative information. We have also found that rather than using each voice recording of each subject as an independent data sample, representing the samples of a subject with central tendency and dispersion metrics improves generalization of the predictive model.
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Liepelt-Scarfone I, Lerche S, Behnke S, Godau J, Gaenslen A, Pausch C, Fassbender K, Brockmann K, Srulijes K, Huber H, Wurster I, Berg D. Clinical characteristics related to worsening of motor function assessed by the Unified Parkinson's Disease Rating Scale in the elderly population. J Neurol 2014; 262:451-8. [PMID: 25451854 DOI: 10.1007/s00415-014-7584-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
There is evidence that nigrostriatal pathology may at least partly underlie mild Parkinsonian signs. We evaluated whether an increase in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) could be predicted by the presence of risk and prodromal markers for neurodegenerative diseases in elderly individuals without those diseases. Therefore, we analyzed the UPDRS-III score and various risk and prodromal markers known to antecede neurodegenerative diseases in a population-based cohort comprising 807 individuals free of neurodegenerative diseases at baseline. After 5 years, eight persons (1.0 %) were diagnosed with Parkinson's Disease (PD). Of those, seven (87.5 %) had motor worsening ≥3 points on the UPDRS-III from baseline to follow-up, one had two points increase. Of the 788 people without PD, 568 (72.1 %) showed no increase in the UPDRS-III scale, 220 (27.9 %) had ≥1 point increase and out of these 104 (13.2 %) had an increase of ≥3 points in the UPDRS-III score after 5 years. We identified an age >60 years (relative risk, RR = 1.7; confidence interval, CI 1.3-2.1) and the occurrence of ≥2 risk factors (RR = 1.5; CI 1.2-1.9) as possible predictors of motor progression. After 5 years, individuals with an increase in the UPDRS-III score had more often a one-sided reduced arm swing (p < 0.001) and identified less odors in the Sniffin' sticks test (p < 0.041) than persons with stable motor performance. Our data support the assumption that progression of Parkinsonian signs assessed by the UPDRS-III parallels the development of prodromal markers for neurodegenerative diseases in the elderly population.
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Affiliation(s)
- Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany,
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96
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Chiou SM, Lin YC, Lu MK, Tsai CH. Bilateral subthalamic stimulation for advanced Parkinson disease: early experience at an Eastern center. Neurol Sci 2014; 36:515-20. [PMID: 25394741 DOI: 10.1007/s10072-014-2008-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/08/2014] [Indexed: 11/29/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve the life quality of patients with advanced Parkinson disease (PD). However, previous studies have stemmed mainly from Western centers. Present study analyzed the 6-month outcomes of bilateral STN-DBS therapy that were observed during a 9-year period at a Taiwanese institute. We retrospectively reviewed 72 consecutive patients, whose mean disease history was 8 years when they underwent surgery. The median "drug-off" Hoehn and Yahr stage was 3. The STN was targeted using T2-weighted magnetic resonance imaging and electrophysiological guidance. The over-time mean differences in the Unified PD Rating Scale (UPDRS) scores and daily levodopa-equivalent dose (LED) were assessed using the repeated measurements ANOVA at 3 and 6 months relative to those of presurgical drug-off baseline. At 6 months postsurgery, the mean UPDRS total, Part II and Part III subscores significantly decreased by 27, 30 and 25 %, respectively, with clinically high effect size. Tremors were markedly (66 %) ameliorated. Moreover, problems of akinesia, rigidity, and locomotion were significantly improved by 20 %. The mean daily LED needs decreased by 25 %; thus, drug-induced dyskinesia was markedly (80 %) diminished. STN-DBS therapy could provide similarly effective impacts to Eastern and Western PD patients. Preoperative optimal selection of patients and postoperative delicate programming ensure a better surgical improvement.
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Affiliation(s)
- Shang-Ming Chiou
- Department of Neurosurgery, China Medical University Hospital, 2, Yuh-Der Road, Taichung, Taiwan,
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Rigby HB, Dugger BN, Hentz JG, Adler CH, Beach TG, Shill HA, Driver-Dunckley E, Sabbagh MN, Sue LI, Caviness JN. Clinical Features of Patients with Concomitant Parkinson's Disease and Progressive Supranuclear Palsy Pathology. Mov Disord Clin Pract 2014; 2:33-38. [PMID: 30363831 DOI: 10.1002/mdc3.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/16/2014] [Accepted: 09/23/2014] [Indexed: 11/06/2022] Open
Abstract
The pathologic changes of Parkinson's disease (PD) and Progressive Supranuclear Palsy (PSP) have been reported to coexist, but whether PSP pathology modifies the clinical course of those individuals is unknown. The aim of this study was to determine whether clinical features of pathologically confirmed PD subjects with concomitant PSP pathology differ from those with PD alone. Subjects enrolled in the Arizona Study of Aging and Neurodegenerative Disorders had annual movement and cognitive evaluations from enrollment until death/autopsy. All cases between 1997 and 2014 with a final clinicopathological diagnosis of PD with or without PSP at autopsy were analyzed. Overall, 12 of the 125 cases with pathologically confirmed PD had coexisting PSP pathology (9.6%). Those with PD-PSP had more-prominent postural instability, body bradykinesia, difficulty arising from a chair, and falls; asymmetric onset was less common in this group. Downgaze palsy and square wave jerks were infrequent in both groups. Gender, age at death, disease duration, rate of dementia, and presence of rest tremor did not differ between groups. Only 58% of subjects in the PD-PSP group were correctly given a final diagnosis in life of PD, compared to 91% of those with PD alone. The combination of PD and PSP pathology yields a heterogeneous clinical syndrome that often resembles PD, but may be more symmetric at onset and have more-prominent postural instability and falls. Our observations suggest that coexisting PSP pathology may be an important factor contributing to the clinical heterogeneity in PD and a potential confounder in diagnosis.
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Affiliation(s)
- Heather B Rigby
- Parkinson's Disease and Movement Disorders Center Department of Neurology Mayo Clinic Scottsdale Arizona USA
| | - Brittany N Dugger
- Civin Laboratory for Neuropathology Banner Sun Health Research Institute Sun City Arizona USA
| | - Joseph G Hentz
- Department of Biostatistics Mayo Clinic Scottsdale Arizona USA
| | - Charles H Adler
- Parkinson's Disease and Movement Disorders Center Department of Neurology Mayo Clinic Scottsdale Arizona USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology Banner Sun Health Research Institute Sun City Arizona USA
| | - Holly A Shill
- Cleo Roberts Center Banner Sun Health Research Institute Sun City Arizona USA.,University of Arizona College of Medicine Phoenix Arizona USA
| | - Erika Driver-Dunckley
- Parkinson's Disease and Movement Disorders Center Department of Neurology Mayo Clinic Scottsdale Arizona USA
| | - Marwan N Sabbagh
- Cleo Roberts Center Banner Sun Health Research Institute Sun City Arizona USA.,University of Arizona College of Medicine Phoenix Arizona USA
| | - Lucia I Sue
- Civin Laboratory for Neuropathology Banner Sun Health Research Institute Sun City Arizona USA
| | - John N Caviness
- Parkinson's Disease and Movement Disorders Center Department of Neurology Mayo Clinic Scottsdale Arizona USA
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98
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Reinoso G, Allen JC, Au WL, Seah SH, Tay KY, Tan LCS. Clinical evolution of Parkinson's disease and prognostic factors affecting motor progression: 9-year follow-up study. Eur J Neurol 2014; 22:457-63. [PMID: 24888502 DOI: 10.1111/ene.12476] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/07/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE There have been few long-term studies that have characterized and charted the clinical progression of Parkinson's disease (PD). This study was therefore undertaken to understand the natural clinical evolution of treated PD patients and to identify the variables that predict greater progression in these patients. METHODS A longitudinal linear mixed model analysis of motor score progression was performed on 576 PD patients derived from the National Neuroscience Institute Movement Disorders Database. Clinical and demographic variables were taken at baseline and formed the subgroups for comparison (gender, age at diagnosis, subtype, Mini-Mental State Examination score and baseline motor score). Motor score progression was calculated at each patient follow-up time point as the difference between Unified Parkinson's Disease Rating Scale (UPDRS) motor score at baseline and follow-up scores. RESULTS The overall annual motor score progression as measured by the change of UPDRS motor scores from baseline ranged from 0.62% to 3.67%. There are three distinct phases: improvement, stability, and steady progression. Patients returned to baseline score 2-2.5 years after diagnosis, with stability lasting to 7 years, followed by a period of steady progression. When analyzed longitudinally, male gender (P < 0.03), older age at diagnosis (P < 0.05), akinetic-rigid subtype (P < 0.04), cognitive impairment (P < 0.005) and lower baseline motor score (P < 0.04) were associated with greater progression of motor scores. CONCLUSIONS Our results show that, when measured clinically, motor progression was non-linear and that it occurred in distinct phases, all of which were affected by baseline demographic and clinical variables such as gender, age at diagnosis, disease subtype, cognitive status and baseline motor score.
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Affiliation(s)
- G Reinoso
- Duke - NUS Graduate Medical School, Singapore
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99
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Berg D, Postuma RB, Bloem B, Chan P, Dubois B, Gasser T, Goetz CG, Halliday GM, Hardy J, Lang AE, Litvan I, Marek K, Obeso J, Oertel W, Olanow CW, Poewe W, Stern M, Deuschl G. Time to redefine PD? Introductory statement of the MDS Task Force on the definition of Parkinson's disease. Mov Disord 2014; 29:454-62. [PMID: 24619848 PMCID: PMC4204150 DOI: 10.1002/mds.25844] [Citation(s) in RCA: 314] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 12/12/2022] Open
Abstract
With advances in knowledge disease, boundaries may change. Occasionally, these changes are of such a magnitude that they require redefinition of the disease. In recognition of the profound changes in our understanding of Parkinson's disease (PD), the International Parkinson and Movement Disorders Society (MDS) commissioned a task force to consider a redefinition of PD. This review is a discussion article, intended as the introductory statement of the task force. Several critical issues were identified that challenge current PD definitions. First, new findings challenge the central role of the classical pathologic criteria as the arbiter of diagnosis, notably genetic cases without synuclein deposition, the high prevalence of incidental Lewy body (LB) deposition, and the nonmotor prodrome of PD. It remains unclear, however, whether these challenges merit a change in the pathologic gold standard, especially considering the limitations of alternate gold standards. Second, the increasing recognition of dementia in PD challenges the distinction between diffuse LB disease and PD. Consideration might be given to removing dementia as an exclusion criterion for PD diagnosis. Third, there is increasing recognition of disease heterogeneity, suggesting that PD subtypes should be formally identified; however, current subtype classifications may not be sufficiently robust to warrant formal delineation. Fourth, the recognition of a nonmotor prodrome of PD requires that new diagnostic criteria for early-stage and prodromal PD should be created; here, essential features of these criteria are proposed. Finally, there is a need to create new MDS diagnostic criteria that take these changes in disease definition into consideration.
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Affiliation(s)
- Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative DiseasesTuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General HospitalMontreal, Quebec, Canada
| | - Bastiaan Bloem
- Department of Neurology, Radboud University Nijmegen Medical CenterNijmegen, the Netherlands
| | - Piu Chan
- Xuanwu Hospital of Capital Medical UniversityBeijing, People's Republic of China
| | - Bruno Dubois
- Department of neurology, Salpêtrière Hospital, APHP, University Paris 6UPMC, Paris, France
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative DiseasesTuebingen, Germany
| | | | - Glenda M Halliday
- Neuroscience Research, Randwick, Australia and the University of New South WalesSydney, Australia
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of NeurologyLondon, UK
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital and the University of TorontoToronto, Canada
| | - Irene Litvan
- Department of Neurosciences, University of California San DiegoLa Jolla, California, USA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew Haven, Connecticut, USA
| | - José Obeso
- University of Navarra-FIMAPamplona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University of MarburgMarburg, Germany
| | - C Warren Olanow
- Department of Neurology, The Mount Sinai HospitalNew York, New York, USA
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical UniversityInnsbruck, Austria
| | - Matthew Stern
- Penn Neurological InstitutePhiladelphia, Pennsylvania, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts UniversityKiel, Germany
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100
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