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Pont-Sunyer C, Hotter A, Gaig C, Seppi K, Compta Y, Katzenschlager R, Mas N, Hofeneder D, Brücke T, Bayés A, Wenzel K, Infante J, Zach H, Pirker W, Posada IJ, Álvarez R, Ispierto L, De Fàbregues O, Callén A, Palasí A, Aguilar M, Martí MJ, Valldeoriola F, Salamero M, Poewe W, Tolosa E. The Onset of Nonmotor Symptoms in Parkinson's disease (The ONSET PDStudy). Mov Disord 2014; 30:229-37. [DOI: 10.1002/mds.26077] [Citation(s) in RCA: 339] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/27/2014] [Accepted: 10/03/2014] [Indexed: 12/21/2022] Open
Affiliation(s)
- Claustre Pont-Sunyer
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Anna Hotter
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
- Austrian PD Study Group
| | - Carles Gaig
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Klaus Seppi
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
- Austrian PD Study Group
| | - Yaroslau Compta
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Regina Katzenschlager
- Austrian PD Study Group
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders; Sozialmedizinisches Zentrum Ost; Vienna Austria
| | - Natalia Mas
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Dominik Hofeneder
- Austrian PD Study Group
- Department of Neurology; Wilhelminenspital; Vienna Austria
| | - Thomas Brücke
- Austrian PD Study Group
- Department of Neurology; Wilhelminenspital; Vienna Austria
| | | | - Karoline Wenzel
- Austrian PD Study Group
- Department of Neurology; Medical University of Graz; Graz Austria
| | - Jon Infante
- Neurology Service; Hospital Universitario Marqués de Valdecilla, University of Cantabria (UC); Santander Spain
| | - Heidemarie Zach
- Austrian PD Study Group
- Department of Neurology; Allgemeines Krankenhaus der Stadt Wien; Wien Vienna
| | - Walter Pirker
- Austrian PD Study Group
- Department of Neurology; Allgemeines Krankenhaus der Stadt Wien; Wien Vienna
| | - Ignacio J. Posada
- Neurology Service; Hospital Universitario “12 de Octubre”, Universidad Complutense; Madrid Spain
| | - Ramiro Álvarez
- Neurology Service; Department of Neuroscience; Hospital Germans Trias i Pujol; Badalona Spain
| | - Lourdes Ispierto
- Neurology Service; Department of Neuroscience; Hospital Germans Trias i Pujol; Badalona Spain
| | - Oriol De Fàbregues
- Movement Disorders Unit; Department of Neurology; Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona; Barcelona Spain
| | - Antoni Callén
- Movement Disorders Unit; Department of Neurology; Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona; Barcelona Spain
| | - Antoni Palasí
- Movement Disorders Unit; Department of Neurology; Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona; Barcelona Spain
| | - Miquel Aguilar
- Neurology Service; Hospital Mútua de Terrassa; Terrassa Spain
| | - Maria José Martí
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Francesc Valldeoriola
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Manel Salamero
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
| | - Werner Poewe
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
- Austrian PD Study Group
| | - Eduardo Tolosa
- Neurology Service; Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Catalonia Spain
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Gigante AF, Bruno G, Iliceto G, Guido M, Liuzzi D, Mancino PV, De Caro MF, Livrea P, Defazio G. Action tremor in Parkinson's disease: frequency and relationship to motor and non-motor signs. Eur J Neurol 2014; 22:223-8. [PMID: 25363380 DOI: 10.1111/ene.12583] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 08/29/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Action tremor may occur in patients with Parkinson's disease and cause misdiagnosis with other movement disorders such as essential tremor and dystonia. Data on the frequency of action tremor in Parkinson's disease and on the relationships with other motor and non-motor signs are limited. METHODS A cross-sectional study of 237 patients with Parkinson's disease staging 1-2 on the Hoehn-Yahr scale was conducted. Data on action tremor and other motor and non-motor signs were collected using the Unified Parkinson's Disease Rating Scale part III and the Non-Motor Symptoms Scale. RESULTS Action tremor was found in 46% of patients and was associated with both severity of rest tremor (adjusted odds ratio 3.0, P < 0.001) and severity of rigidity (adjusted odds ratio 1.5, P = 0.004). No association was found between action tremor and severity of bradykinesia (adjusted odds ratio 0.97, P = 0.4) or axial symptoms (adjusted odds ratio 0.9, P = 0.3). Moreover, patients who had action tremor reported a significant lower mean number of non-motor symptoms than those who had not (2.1 ± 1.3 vs. 2.4 ± 1.3; P = 0.04). CONCLUSIONS Action tremor is a relatively frequent motor sign in patients with Parkinson's disease staging 1-2 on the Hoehn-Yahr scale. Action tremor correlates with rest tremor and rigidity and may be associated with a lower burden of non-motor symptoms. These findings suggest a contribution of non-dopaminergic mechanisms to action tremor pathophysiology.
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Affiliation(s)
- A F Gigante
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, 'Aldo Moro' University of Bari, Bari, Italy
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53
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Drooling in Parkinson's disease: a review. Parkinsonism Relat Disord 2014; 20:1109-18. [PMID: 25200111 DOI: 10.1016/j.parkreldis.2014.08.013] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 12/13/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease causing both motor and non-motor symptoms. Drooling, an excessive pooling and spillover of saliva out of the oral cavity, is one of the non-motor symptoms in PD patients that produces various negative physical and psychosocial consequences for patients and their caregivers. At present, the pathophysiology of drooling in PD is not completely certain; however, impaired intra-oral salivary clearance is likely the major contributor. There are neither standard diagnostic criteria nor standard severity assessment tools for evaluating drooling in PD. In accordance with the possible pathophysiology, dopaminergic agents have been used to improve salivary clearance; however, these agents are not completely effective in controlling drooling. Various pharmacological and non-pharmacological treatment options have been studied. Local injection with botulinum toxin serotypes A and B into major salivary glands is most effective to reduce drooling. Future research to explore the exact pathophysiology and develop standard diagnostic criteria and standard severity assessment tools are needed to formulate specific treatment options and improve patient care.
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54
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Iranzo A. Parkinson disease and sleep: sleep-wake changes in the premotor stage of Parkinson disease; impaired olfaction and other prodromal features. Curr Neurol Neurosci Rep 2014; 13:373. [PMID: 23881622 DOI: 10.1007/s11910-013-0373-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Parkinson disease (PD) has a premotor stage where neurodegeneration occurs before parkinsonism becomes apparent. Identification of individuals at this stage provides an opportunity to study early disease progression and test disease-modifying interventions. Hyposmia, constipation, depression and hypersomnia are part of this premotor phase and predictive of future development of PD. However, these features are common in the general population, and they are most often the result of causes other than incipient PD. In contrast, most individuals with idiopathic REM sleep behavior disorder (IRBD) eventually develop PD and other synucleinopathies. IRBD individuals with hyposmia, substantia nigra hyperechogenicity, and abnormal striatal dopamine transporter imaging findings have increased short-term risk of developing a synucleinopathy. IRBD is an optimal target to test disease-modifying agents in the PD prodromal phase. Serial dopamine transporter imaging, but not olfactory tests, may serve to monitor the disease process in future disease-modifying trials in IRBD.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, C/Villarroel 170, 08036, Barcelona, Spain.
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55
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Gaenslen A, Wurster I, Brockmann K, Huber H, Godau J, Faust B, Lerche S, Eschweiler GW, Maetzler W, Berg D. Prodromal features for Parkinson's disease--baseline data from the TREND study. Eur J Neurol 2014; 21:766-72. [PMID: 24612314 DOI: 10.1111/ene.12382] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 01/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE A number of non-motor features are known to precede motor manifestations of Parkinson's disease (PD). They are supposed to already represent the prodromal neurodegenerative state in those who later develop PD and are thus called prodromal markers. In this study, three prodromal markers, depression, rapid eye movement behaviour disorder (RBD) and hyposmia, were selected and were related to other prodromal features in elderly individuals without PD. METHODS From the Tübinger Evaluation of Risk Factors for Early Detection of Neurodegeneration (TREND) study, 698 healthy individuals aged 50-80 years reporting one or more of the selected prodromal markers (SPMs), but without neurodegenerative disorders, were evaluated and classified according to the status of prodromal markers. Other prodromal PD-related features were assessed with a 23-item questionnaire and compared between participants with and without the three SPMs. RESULTS Individuals with the SPMs for PD endorsed more of the additional possible prodromal features of PD than those without; of 23 possible prodromal features, the median number identified amongst participants with no SPMs was two, compared with four with one marker, five with two and seven with three (P < 0.001). Regarding individual SPMs, participants with depression and RBD endorsed five of 23 markers, compared with three for those with hyposmia (P = 0.001). There was no significant increase in the number of prodromal features amongst those with two SPMs compared with those with only one marker. CONCLUSIONS Individuals with the SPMs for PD report a higher prevalence of other prodromal PD symptoms. This may indicate that these markers can identify individuals at risk for PD.
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Affiliation(s)
- A Gaenslen
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
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56
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Martinez-Martin P. Nonmotor symptoms and health-related quality of life in early Parkinson's disease. Mov Disord 2013; 29:166-8. [DOI: 10.1002/mds.25799] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/13/2013] [Accepted: 12/09/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- Pablo Martinez-Martin
- Research Unit, Alzheimer Center Reina Sofía Foundation; Section of Neuroepidemiology; National Center for Epidemiology; and Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health; Madrid Spain
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Müller B, Assmus J, Herlofson K, Larsen JP, Tysnes OB. Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson's disease. Parkinsonism Relat Disord 2013; 19:1027-32. [DOI: 10.1016/j.parkreldis.2013.07.010] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/28/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
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Duncan GW, Khoo TK, Yarnall AJ, O'Brien JT, Coleman SY, Brooks DJ, Barker RA, Burn DJ. Health-related quality of life in early Parkinson's disease: The impact of nonmotor symptoms. Mov Disord 2013; 29:195-202. [DOI: 10.1002/mds.25664] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/18/2013] [Accepted: 08/12/2013] [Indexed: 12/20/2022] Open
Affiliation(s)
- Gordon W. Duncan
- Institute for Ageing and Health, Newcastle University; Newcastle UK
| | - Tien K. Khoo
- School of Medicine; Griffith University; Queensland Australia
| | | | - John T. O'Brien
- Department of Psychiatry; University of Cambridge; Cambridge UK
| | | | | | - Roger A. Barker
- Cambridge Centre for Brain Repair; Cambridge University; Cambridge UK
| | - David J. Burn
- Institute for Ageing and Health, Newcastle University; Newcastle UK
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Potential impact of self-perceived prodromal symptoms on the early diagnosis of Parkinson’s disease. J Neurol 2013; 260:3077-85. [DOI: 10.1007/s00415-013-7125-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
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Zhou MZ, Gan J, Wei YR, Ren XY, Chen W, Liu ZG. The association between non-motor symptoms in Parkinson's disease and age at onset. Clin Neurol Neurosurg 2013; 115:2103-7. [PMID: 23962754 DOI: 10.1016/j.clineuro.2013.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Age at onset is likely to be related to a wide range of problems in Parkinson's disease (PD), including cardinal motor features, motor complications and non-motor symptoms (NMS). This study investigated the effect of the age at onset on NMS. METHODS Two hundred and thirty patients were examined and classified into one of three groups based on age at onset: early onset PD (EOPD) group (<45 years), middle-age onset group (45-64 years) and old-age onset group (≥65 years). The trends relating to NMS were compared across the three groups. The EOPD and old-age onset groups were separately studied to determine their association to the appearance of non-motor features using logistic regression analysis. RESULTS There were upward trends in the occurrence of dribbling (P=0.009; all P values are stated for trend), impaired taste/smelling (P=0.016), constipation (P=0.006), urinary urgency (P=0.002), nocturia (P=0.018), hallucinations (P=0.016) and acting out during dreams (P=0.011) with the increase of age at onset. Older age at onset is an independent risk factor for dementia (OR=8.42, CI 3.16-22.44), dribbling (OR=4.14, CI 1.93-8.87), impaired taste/smelling (OR=2.23, CI 1.20-4.13), constipation (OR=3.42, CI 1.88-6.24), incomplete bowel emptying (OR=2.23, CI 1.19-4.20), urinary urgency (OR=2.58 CI 1.46-4.57), nocturia (OR=2.65, CI 1.49-4.71), hallucinations (OR=5.32, CI 1.78-15.97), dizziness (OR=3.03, CI 1.59-5.79), falling (OR=3.60, CI 1.67-7.77), insomnia (OR=2.29, CI 1.28-4.11), intense vivid dreaming (OR=2.10, CI 1.21-3.66) and acting out during dreams (OR=2.23, CI 1.24-4.01). CONCLUSIONS PD patients with different ages at onset present clinically different symptoms in terms of NMS. Old-age onset PD is characterized by more olfactory and sensory symptoms, autonomic symptoms, sleep disorders, dementia and psychosis compared to EOPD.
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Affiliation(s)
- Ming-Zhu Zhou
- Department of Neurology, Xinhua Hospital, Shanghai Jiaotong, University, School of Medicine, Shanghai, China
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Behavioral characterization of A53T mice reveals early and late stage deficits related to Parkinson's disease. PLoS One 2013; 8:e70274. [PMID: 23936403 PMCID: PMC3731353 DOI: 10.1371/journal.pone.0070274] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/17/2013] [Indexed: 11/19/2022] Open
Abstract
Parkinson's disease (PD) pathology is characterized by the formation of intra-neuronal inclusions called Lewy bodies, which are comprised of alpha-synuclein (α-syn). Duplication, triplication or genetic mutations in α-syn (A53T, A30P and E46K) are linked to autosomal dominant PD; thus implicating its role in the pathogenesis of PD. In both PD patients and mouse models, there is increasing evidence that neuronal dysfunction occurs before the accumulation of protein aggregates (i.e., α-syn) and neurodegeneration. Characterization of the timing and nature of symptomatic dysfunction is important for understanding the impact of α-syn on disease progression. Furthermore, this knowledge is essential for identifying pathways and molecular targets for therapeutic intervention. To this end, we examined various functional and morphological endpoints in the transgenic mouse model expressing the human A53T α-syn variant directed by the mouse prion promoter at specific ages relating to disease progression (2, 6 and 12 months of age). Our findings indicate A53T mice develop fine, sensorimotor, and synaptic deficits before the onset of age-related gross motor and cognitive dysfunction. Results from open field and rotarod tests show A53T mice develop age-dependent changes in locomotor activity and reduced anxiety-like behavior. Additionally, digigait analysis shows these mice develop an abnormal gait by 12 months of age. A53T mice also exhibit spatial memory deficits at 6 and 12 months, as demonstrated by Y-maze performance. In contrast to gross motor and cognitive changes, A53T mice display significant impairments in fine- and sensorimotor tasks such as grooming, nest building and acoustic startle as early as 1-2 months of age. These mice also show significant abnormalities in basal synaptic transmission, paired-pulse facilitation and long-term depression (LTD). Combined, these data indicate the A53T model exhibits early- and late-onset behavioral and synaptic impairments similar to PD patients and may provide useful endpoints for assessing novel therapeutic interventions for PD.
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Sánchez-Ferro A, Benito-León J, Gómez-Esteban JC. The management of orthostatic hypotension in Parkinson's disease. Front Neurol 2013; 4:64. [PMID: 23772219 PMCID: PMC3677136 DOI: 10.3389/fneur.2013.00064] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/19/2013] [Indexed: 12/23/2022] Open
Abstract
Orthostatic hypotension (OH) is a common and disabling symptom affecting Parkinson's disease (PD) patients. We present the effect of the different therapies commonly used to manage PD on this clinical manifestation. For this purpose, we describe the relationship between OH and the current treatments employed in PD, such as L-DOPA, dopaminergic agonists, and continuous dopaminergic stimulation therapies. Additionally, we review the therapeutic measures that could be used to ameliorate OH. There are different approaches to deal with this manifestation, including pharmacological and non-pharmacological treatments, although none of them is specifically aimed for treating OH in PD.
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Affiliation(s)
- Alvaro Sánchez-Ferro
- Department of Neurology, University Hospital "12 de Octubre," Madrid , Spain ; Department of Medicine, Faculty of Medicine, Complutense University , Madrid , Spain ; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas , Madrid , Spain ; Instituto de Salud Carlos III , Madrid , Spain
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Stuebner E, Vichayanrat E, Low DA, Mathias CJ, Isenmann S, Haensch CA. Twenty-four hour non-invasive ambulatory blood pressure and heart rate monitoring in Parkinson's disease. Front Neurol 2013; 4:49. [PMID: 23720648 PMCID: PMC3654335 DOI: 10.3389/fneur.2013.00049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/23/2013] [Indexed: 11/18/2022] Open
Abstract
Non-motor symptoms are now commonly recognized in Parkinson's disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., "dipper" vs. non-"dipper"). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM.
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Affiliation(s)
- Eva Stuebner
- Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, HELIOS-Klinikum Wuppertal, University of Witten/HerdeckeWuppertal, Germany
| | - Ekawat Vichayanrat
- Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary’s HospitalLondon, UK
- Autonomic Unit, Queen Square/Division of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College LondonLondon, UK
| | - David A. Low
- Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary’s HospitalLondon, UK
- Autonomic Unit, Queen Square/Division of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College LondonLondon, UK
| | - Christopher J. Mathias
- Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary’s HospitalLondon, UK
- Autonomic Unit, Queen Square/Division of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College LondonLondon, UK
| | - Stefan Isenmann
- Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, HELIOS-Klinikum Wuppertal, University of Witten/HerdeckeWuppertal, Germany
| | - Carl-Albrecht Haensch
- Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, HELIOS-Klinikum Wuppertal, University of Witten/HerdeckeWuppertal, Germany
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Müller B, Assmus J, Larsen JP, Haugarvoll K, Skeie GO, Tysnes OB. Autonomic symptoms and dopaminergic treatment in de novo Parkinson's disease. Acta Neurol Scand 2013; 127:290-4. [PMID: 22998158 DOI: 10.1111/ane.12010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Autonomic symptoms are present in early stages of Parkinson's disease (PD), but evidence on how they are influenced by dopaminergic treatment remains unclear. The aim of this study was to investigate the impact of dopaminergic treatment on autonomic symptoms in early PD in a population-based cohort. METHODS A total of 171 drug-naive patients with PD were investigated at diagnosis and 12 months later. Orthostatic blood pressure was measured, and autonomic symptoms were assessed by a preliminary version of the Movement Disorders Society-sponsored new version of the Unified Parkinson's Disease Rating Scale (range 0-4). RESULTS In the 82% using dopaminergic treatment after 1 year, constipation and orthostatic blood pressure drop increased. There was a tendency towards increased orthostatic dizziness and urinary dysfunction. Dysphagia scores were reduced, and this was associated with higher levodopa-equivalent daily dose. CONCLUSIONS Dopaminergic treatment during the first year after initiation seems to have only a minor impact on autonomic symptoms in early PD. It may increase constipation and orthostatic dizziness, while dysphagia can improve. Autonomic symptoms remained mild after 1 year of dopaminergic treatment.
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Affiliation(s)
| | - J. Assmus
- Centre for Clinical Research; Haukeland University Hospital; Bergen; Norway
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Abstract
Growing recognition of the non-motor features of Parkinson's disease (PD) has led to increased awareness of autonomic dysfunction as part of the disease process, not only in advanced disease but also early in its course, sometimes even preceding the development of the classic motor features of PD. Virtually all aspects of autonomic function can become impaired in PD, including cardiovascular, gastrointestinal, urological, sexual and thermoregulatory function. Recognition of the various autonomic abnormalities of PD is important because effective treatment may be available and may measurably improve quality of life for individuals with PD.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, University of Tennessee Health Science Center, 855 Monroe Avenue, Memphis, TN 38163, USA.
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Khoo TK, Yarnall AJ, Duncan GW, Coleman S, O'Brien JT, Brooks DJ, Barker RA, Burn DJ. The spectrum of nonmotor symptoms in early Parkinson disease. Neurology 2013; 80:276-81. [PMID: 23319473 DOI: 10.1212/wnl.0b013e31827deb74] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Nonmotor symptoms (NMS) are common in patients with established Parkinson disease (PD) but their frequency in early PD has not been extensively studied. Our aim was to determine the frequency of NMS in a cohort of patients with newly diagnosed PD. METHODS A total of 159 patients with early PD and 99 healthy controls participated in this study. NMS were screened for using the nonmotor symptom questionnaire. Other assessments included measures of motor disability (Movement Disorders Society-revised unified Parkinson's disease rating scale [MDS-UPDRS]), disease severity (Hoehn & Yahr staging), depression (geriatric depression scale), and global cognitive function (Mini-mental state examination and Montreal cognitive assessment). RESULTS The PD group reported a significantly greater number of NMS compared with controls (8.4 [4.3] vs. 2.8 [2.6]). In the PD group, the most commonly experienced NMS were excessive saliva, forgetfulness, urinary urgency, hyposmia, and constipation. Patients with higher MDS-UPDRS III scores and those with the postural instability gait subtype experienced a greater number of NMS. CONCLUSION NMS are common in early PD and reflect the multisystem nature of the disorder. Even in the earliest stages of PD, NMS may be detrimental to patients' functional status and sense of well-being.
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Affiliation(s)
- Tien K Khoo
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Ray Chaudhuri K, Rojo JM, Schapira AHV, Brooks DJ, Stocchi F, Odin P, Antonini A, Brown RJ, Martinez-Martin P. A proposal for a comprehensive grading of Parkinson's disease severity combining motor and non-motor assessments: meeting an unmet need. PLoS One 2013; 8:e57221. [PMID: 23468940 PMCID: PMC3584126 DOI: 10.1371/journal.pone.0057221] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/18/2013] [Indexed: 01/25/2023] Open
Abstract
Background Non-motor symptoms are present in Parkinson's disease (PD) and a key determinant of quality of life. The Non-motor Symptoms Scale (NMSS) is a validated scale that allows quantifying frequency and severity (burden) of NMS. We report a proposal for using NMSS scores to determine levels of NMS burden (NMSB) and to complete PD patient classification. Methods This was an observational, cross-sectional international study of 935 consecutive patients. Using a distribution of NMSS scores by quartiles, a classification based on levels from 0 (no NMSB at all) to 4 (very severe NMSB) was obtained and its relation with Hoehn and Yahr (HY) staging, motor and health-related quality of life scales was analyzed. Concordance between NMSB levels and grouping based on clinician's global impression of severity, using categorical regression, was determined. Disability and HRQoL predictors were identified by multiple regression models. Results The distribution of motor and QoL scales scores by HY and NMSB levels was significantly discriminative. The difference in the classification of cases for both methods, HY and NMSB, was significant (gamma = 0.45; ASE = 0.032). Concordance between NMSB and global severity-based levels from categorical regression was 91.8%, (kappaw = 0.97). NMS score was predictor of disability and QoL. Conclusions Current clinical practice does not address a need for inclusion of non-motor scores in routine assessment of PD in spite of the overwhelming influence of NMS on disability and quality of life. Our data overcome the problems of “pure motor assessment” and we propose a combined approach with addition of NMSB levels to standard motor assessments.
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Affiliation(s)
- Kallol Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital and Kings College, and University Hospital Lewisham, London, United Kingdom
| | - Jose Manuel Rojo
- Department of Statistics, Centre of Human and Social Sciences, Spanish Council for Scientific Research, Madrid, Spain
| | | | - David J. Brooks
- Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Per Odin
- Department of Neurology, Lund University Hospital, Lund, Sweden
| | - Angelo Antonini
- Department for Parkinson's Disease, IRCCS San Camillo, Venice, Italy
| | - Richard J. Brown
- Department of Psychology, Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Pablo Martinez-Martin
- Alzheimer Disease Research Unit and CIBERNED, CIEN Foundation, Carlos III Institute of Health, Alzheimer Centre Reina Sofia Foundation, Madrid, Spain
- * E-mail:
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Ferrer I, López-Gonzalez I, Carmona M, Dalfó E, Pujol A, Martínez A. Neurochemistry and the non-motor aspects of PD. Neurobiol Dis 2012; 46:508-26. [PMID: 22737710 DOI: 10.1016/j.nbd.2011.10.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Parkinson disease (PD) is a systemic disease with variegated non-motor deficits and neurological symptoms, including impaired olfaction, autonomic failure, cognitive impairment and psychiatric symptoms, in addition to the classical motor symptoms. Many non-motor symptoms appear before or in parallel with motor deficits and then worsen with disease progression. Although there is a relationship, albeit not causal, between motor symptoms and the presence of Lewy bodies (LBs) and neurites filled with abnormal α-synuclein, other neurological alterations are independent of the amount of α-synuclein inclusions in neurons and neurites, thereby indicating that different mechanisms probably converge in the degenerative process. This may apply to complex alterations interfering with olfactory and autonomic nervous systemfunctions, emotions, sleep regulation, and behavioral, cognitive and mental performance. Involvement of the cerebral cortex leading to impaired behavior and cognition is related to several convergent altered factors including: a. dopaminergic, noradrenergic, serotoninergic and cholinergic cortical innervation; b. synapses; c. cortical metabolism; d. mitochondrial function and energy production; e. oxidative damage; f. transcription; g. protein expression; h. lipid composition; and i. ubiquitin–proteasome system and autophagy, among others. This complex situation indicates that multiple subcellular failure in selected cell populations is difficult to reconcilewith a reductionistic scenario of a single causative cascade of events leading to non-motor symptoms in PD. Furthermore, these alterationsmay appear at early stages of the disease and may precede the appearance of substantial irreversible cell loss by years. These observations have important implications in the design of therapeutic approaches geared to prevention and treatment of PD.
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Affiliation(s)
- I Ferrer
- Institute of Neuropathology, Service of Pathology, University Hospital of Bellvitge, Spain.
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Erro R, Santangelo G, Picillo M, Vitale C, Amboni M, Longo K, Costagliola A, Pellecchia MT, Allocca R, De Rosa A, De Michele G, Santoro L, Barone P. Link between non-motor symptoms and cognitive dysfunctions in de novo, drug-naive PD patients. J Neurol 2012; 259:1808-13. [PMID: 22310940 DOI: 10.1007/s00415-011-6407-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 12/29/2011] [Accepted: 12/30/2011] [Indexed: 11/25/2022]
Abstract
Little is known about the relationship between cognitive dysfunctions and the non-motor complex in subjects with newly diagnosed untreated Parkinson's disease (PD). The aim of this study was to explore the association between non-motor symptoms (NMS) and cognitive dysfunctions in an incident cohort of de novo, drug-naive, PD patients. Sixty-six non-demented, early, untreated PD patients completed a semi-structured interview on NMS and a battery of neuropsychological tests that assess verbal memory, visuospatial abilities, and attention/executive functions. Scores were age- and education-corrected. Patients who failed at least two tests for each cognitive domain were diagnosed as having mild cognitive impairment (MCI). All but three (95.4%) PD patients complained of at least one NMS. A total of 37.8% was diagnosed with MCI. There was a relationship between sleep-NMS and cognitive dysfunctions. Specifically, both REM behavioral sleep disorders (RBD) and insomnia were associated with lower scores on several cognitive tests. Moreover, RBD was closely related to MCI. NMS and MCI are very common even in the early phase of PD, before patients are treated. Given the correlation between sleep disturbances and cognitive impairment, it is possible that sleep symptoms in PD patients might be considered as an early marker of dementia.
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Affiliation(s)
- Roberto Erro
- Department of Neurological Science, University of Naples Federico II, Naples, Italy
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Pathological correlates of gastrointestinal dysfunction in Parkinson's disease. Neurobiol Dis 2011; 46:559-64. [PMID: 22048068 DOI: 10.1016/j.nbd.2011.10.014] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/11/2011] [Accepted: 10/16/2011] [Indexed: 12/11/2022] Open
Abstract
Gastrointestinal dysfunction is a prominent manifestation of Parkinson's disease (PD). Gastrointestinal symptoms in PD include reduced salivation, dysphagia, impaired gastric emptying, constipation, and defecatory dysfunction. Constipation may precede the development of somatic motor symptoms of PD for several years. Neuropathological studies show early accumulation of abnormal alpha-synuclein (α-SYN) containing inclusions (Lewy neurites) in the enteric nervous system (ENS) and dorsal motor nucleus of the vagus (DMV) both in PD and in incidental Lewy body disease (ILBD). These findings provided the basis for the hypothesis that α-SYN pathology progresses in a centripetal, prion-like fashion, from the ENS to the DMV and then to more rostral areas of the central nervous system. Colonic biopsies may show accumulation α-SYN immunoreactive Lewy neurites in the submucosal plexus of PD patients. Salivary gland involvement is prominent in PD and α-SYN pathology can be detected both at autopsy and in minor salivary gland biopsies.
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Cersosimo MG, Benarroch EE. Autonomic involvement in Parkinson's disease: pathology, pathophysiology, clinical features and possible peripheral biomarkers. J Neurol Sci 2011; 313:57-63. [PMID: 22001247 DOI: 10.1016/j.jns.2011.09.030] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 12/14/2022]
Abstract
Autonomic nervous system involvement occurs at early stages in both Parkinson's disease (PD) and incidental Lewy body disease (ILBD), and affects the sympathetic, parasympathetic, and enteric nervous systems (ENS). It has been proposed that alpha-synuclein (α-SYN) pathology in PD has a distal to proximal progression along autonomic pathways. The ENS is affected before the dorsal motor nucleus of the vagus (DMV), and distal axons of cardiac sympathetic nerves degenerate before there is loss of paravertebral sympathetic ganglion neurons. Consistent with neuropathological findings, some autonomic manifestations such as constipation or impaired cardiac uptake of norepinephrine precursors, occur at early stages of the disease even before the onset of motor symptoms. Biopsy of peripheral tissues may constitute a promising approach to detect α-SYN neuropathology in autonomic nerves and a useful early biomarker of PD.
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Affiliation(s)
- Maria G Cersosimo
- Parkinson's Disease and Movement Disorder Unit, Hospital de Clínicas, University of Buenos Aires, Argentina
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