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Jiang JL, Lo SF, Tsai ST, Chen SY. A systematic review of the impact of subthalamic nucleus stimulation on the quality of life of patients with Parkinson's disease. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sommerauer M, Valko PO, Werth E, Poryazova R, Hauser S, Baumann CR. Revisiting the impact of REM sleep behavior disorder on motor progression in Parkinson's disease. Parkinsonism Relat Disord 2014; 20:460-2. [PMID: 24477360 DOI: 10.1016/j.parkreldis.2014.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/22/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Estimation of progression in Parkinson's disease (PD) is useful to guide clinical decisions and to enable patients to plan and manage their life with PD. Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) are recognized as early harbingers of neurodegeneration and may precede motor symptoms by years. However, their impact on motor progression remains elusive. METHODS We retrospectively analyzed polysomnographic and clinical data of 59 PD patients, grouping them into patients with RBD (n = 15), RWA (n = 22) and those with normal muscle atonia (n = 22). We compared the three groups with regard to motor progression, defined as changes in Unified Parkinson's Disease Rating Scale (UPDRS) III values per year, and selected PD specific characteristics. RESULTS Motor disability at first visit and time interval between first and last visits were similar between groups. We observed a significantly faster motor progression in PD patients with RBD and RWA than in those with preserved REM sleep atonia. CONCLUSION Our findings suggest that impaired muscle atonia during REM sleep might represent a marker of faster motor progression in PD.
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Affiliation(s)
- Michael Sommerauer
- Department of Neurology, UniversitätsSpital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland.
| | - Philipp O Valko
- Department of Neurology, UniversitätsSpital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, UniversitätsSpital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, UniversitätsSpital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Sabrina Hauser
- Department of Neurology, UniversitätsSpital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, UniversitätsSpital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
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The impact of age and disease duration on the long term outcome of neurostimulation of the subthalamic nucleus. Parkinsonism Relat Disord 2014; 20:47-52. [DOI: 10.1016/j.parkreldis.2013.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/04/2013] [Accepted: 09/11/2013] [Indexed: 01/08/2023]
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105
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Pirogovsky E, Martinez-Hannon M, Schiehser DM, Lessig SL, Song DD, Litvan I, Filoteo JV. Predictors of performance-based measures of instrumental activities of daily living in nondemented patients with Parkinson’s disease. J Clin Exp Neuropsychol 2013; 35:926-33. [DOI: 10.1080/13803395.2013.838940] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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106
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Kelly VE, Shumway-Cook A. The ability of people with Parkinson's disease to modify dual-task performance in response to instructions during simple and complex walking tasks. Exp Brain Res 2013; 232:263-71. [PMID: 24162861 DOI: 10.1007/s00221-013-3737-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/03/2013] [Indexed: 12/01/2022]
Abstract
Gait impairments are a common and consequential motor symptom in Parkinson's disease (PD). A cognitive strategy that incorporates instructions to concentrate on specific parameters of walking is an effective approach to gait rehabilitation for persons with PD during single-task and simple dual-task walking conditions. This study examined the ability to modify dual-task walking in response to instructions during a complex walking task in people with PD compared to healthy older adults (HOA). Eleven people with PD and twelve HOA performed a cognitive task while walking with either a usual base or a narrow base of support. Dual-task walking and cognitive task performance were characterized under two conditions-when participants were instructed focus on walking and when they were instructed to focus on the cognitive task. During both usual base and narrow base walking, instructions affected cognitive task response latency, with slower performance when instructed to focus on walking compared to the cognitive task. Regardless of task or instructions, cognitive task performance was slower in participants with PD compared to HOA. During usual base walking, instructions influenced gait speed for both people with PD and HOA, with faster gait speed when instructed to focus on walking compared to the cognitive task. In contrast, during the narrow base walking, instructions affected gait speed only for HOA, but not for people with PD. This suggests that among people with PD the ability to modify walking in response to instructions depends on the complexity of the walking task.
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Affiliation(s)
- Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA, 98195-6490, USA,
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Baumann CR, Held U, Valko PO, Wienecke M, Waldvogel D. Body side and predominant motor features at the onset of Parkinson's disease are linked to motor and nonmotor progression. Mov Disord 2013; 29:207-13. [PMID: 24105646 DOI: 10.1002/mds.25650] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 07/12/2013] [Accepted: 07/25/2013] [Indexed: 11/08/2022] Open
Abstract
Patients with Parkinson's disease most often have asymmetric motor features at onset, and specific motor signs (ie, tremor versus bradykinesia and rigidity) frequently characterize the first few years of disease evolution. Some previous clinical evidence has suggested that body side and a predominance of motor manifestations at disease onset are linked to long-term evolution and disease progression. We prospectively analyzed 206 patients with Parkinson's disease according to the most affected side and predominant motor signs at onset. Patients were divided into left-side rigid-akinetic (n = 71), right-side rigid-akinetic (n = 59), left-side tremor (n = 41), and right-side tremor (n = 35) subgroups. These subgroups were compared in terms of motor and cognitive functions, mean motor deterioration per year (calculated as the motor score divided by disease duration), total equivalent doses of dopaminergic drugs, and the presence of hallucinations and rapid eye movement sleep behavior disorder. Disease duration was similar in all groups. Motor fluctuations were more likely to occur in rigid-akinetic patients. In a multiple model analysis adjusted for potential confounders, faster disease progression was associated with right-side (P = 0.045) and rigid-akinetic onset (P = 0.001). With respect to nonmotor symptoms, the rigid-akinetic type was associated with increased risk of cognitive decline (P = 0.004) compared with the tremor type. A trend was noticed toward an increased risk of developing visual hallucinations in rigid-akinetic patients and toward an increased frequency of rapid eye movement sleep behavior disorder in those who had left-sided onset of symptoms. Our findings corroborate that body side and type of motor signs at the time of diagnosis affect the evolution of motor severity and may also have an impact on some nonmotor manifestations.
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108
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Ivey FM, Katzel LI, Sorkin JD, Macko RF, Shulman LM. The Unified Parkinson's Disease Rating Scale as a predictor of peak aerobic capacity and ambulatory function. ACTA ACUST UNITED AC 2013; 49:1269-76. [PMID: 23341319 DOI: 10.1682/jrrd.2011.06.0103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Unified Parkinson's Disease Rating Scale (UPDRS) is a widely applied index of disease severity. Our objective was to assess the utility of UPDRS for predicting peak aerobic capacity (VO2 peak) and ambulatory function. Participants (n = 70) underwent evaluation for UPDRS (Total and Motor ratings), VO2 peak, 6-minute walk distance (6MW), and 30-foot self-selected walking speed (SSWS). Using regression, we determined the extent to which the Total and Motor UPDRS scores predicted each functional capacity measure after adjusting for age and sex. We also tested whether adding the Hoehn and Yahr scale (H-Y) to the model changed predictive power of the UPDRS. Adjusted for age and sex, both the Total UPDRS and Motor UPDRS subscale failed to predict VO2 peak. The Total UPDRS did weakly predict 6MW and SSWS (both p < 0.05), but the Motor UPDRS subscale did not predict these ambulatory function tests. After adding H-Y to the model, Total UPDRS was no longer an independent predictor of 6MW but remained a predictor of SSWS. We conclude that Total and Motor UPDRS rating scales do not predict VO2 peak, but that a weak relationship exists between Total UPDRS and measures of ambulatory function.
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Affiliation(s)
- Frederick M Ivey
- Department of Neurology, University of Maryland School of Medicine, Baltimore VA Medical Center Geriatrics Service/GRECC, BT(18) GR, 10 North Greene St, Baltimore, MD 21201-1524, USA.
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Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013; 74:546-57. [PMID: 23354249 DOI: 10.1097/ta.0b013e31827d5e3a] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or without angiography and embolization. METHODS MEDLINE, Embase, and the Cochrane Library databases were searched. Prospective or retrospective cohort studies addressing failure of nonoperative treatment, with and/or without angiography and embolization, of blunt abdominal injuries were included. Methodological quality of the studies was assessed. RESULTS A total of 335 titles and abstracts were screened, of which 31 fulfilled the inclusion criteria. No randomized controlled trials were found. Ten articles were qualified as high-quality articles and used for data extraction (best-evidence synthesis). A total of 25 prognostic factors were investigated, of which 14 were statistically significant in one or more studies. Strong evidence exists that age of 40 years or above, Injury Severity Score (ISS) of 25 or greater, and splenic injury grade of 3 or greater are prognostic factors for failure of NOM. Moderate evidence was found for a splenic Abbreviated Injury Scale score of 3 or greater, trauma and ISS of less than 0.80, the presence of an intraparenchymal contrast blush, as well as transfusion of 1 unit of packed red blood cells or more. Limited evidence was found for large hemoperitoneum, lower Revised Trauma Score, lower Glasgow Coma Scale score, lower systolic blood pressure, male sex, the presence of traumatic brain injury, and splenic embolization as protective factor for failure of NOM. CONCLUSION Awareness for failure of NOM is required in patients aged 40 years or older, in patients with an ISS of 25 or higher or those with splenic injury grade 3 or higher. The prognostic factors for failure that we identified should be confirmed in future prospective cohort studies or meta-analyses using individual patient data. LEVEL OF EVIDENCE Systematic review, level III.
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110
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Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK. Markers of disease severity are associated with malnutrition in Parkinson's disease. PLoS One 2013; 8:e57986. [PMID: 23544041 PMCID: PMC3609752 DOI: 10.1371/journal.pone.0057986] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/30/2013] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE In Parkinson's disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson's disease (PWP). METHODS Community-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck's Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke's Cognitive Examination (ACE-R), Unified Parkinson's Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA). RESULTS Nineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight (mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score. CONCLUSIONS In this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.
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Affiliation(s)
- Jamie M Sheard
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
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111
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Klucken J, Barth J, Kugler P, Schlachetzki J, Henze T, Marxreiter F, Kohl Z, Steidl R, Hornegger J, Eskofier B, Winkler J. Unbiased and mobile gait analysis detects motor impairment in Parkinson's disease. PLoS One 2013; 8:e56956. [PMID: 23431395 PMCID: PMC3576377 DOI: 10.1371/journal.pone.0056956] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/16/2013] [Indexed: 11/29/2022] Open
Abstract
Motor impairments are the prerequisite for the diagnosis in Parkinson's disease (PD). The cardinal symptoms (bradykinesia, rigor, tremor, and postural instability) are used for disease staging and assessment of progression. They serve as primary outcome measures for clinical studies aiming at symptomatic and disease modifying interventions. One major caveat of clinical scores such as the Unified Parkinson Disease Rating Scale (UPDRS) or Hoehn&Yahr (H&Y) staging is its rater and time-of-assessment dependency. Thus, we aimed to objectively and automatically classify specific stages and motor signs in PD using a mobile, biosensor based Embedded Gait Analysis using Intelligent Technology (eGaIT). eGaIT consist of accelerometers and gyroscopes attached to shoes that record motion signals during standardized gait and leg function. From sensor signals 694 features were calculated and pattern recognition algorithms were applied to classify PD, H&Y stages, and motor signs correlating to the UPDRS-III motor score in a training cohort of 50 PD patients and 42 age matched controls. Classification results were confirmed in a second independent validation cohort (42 patients, 39 controls). eGaIT was able to successfully distinguish PD patients from controls with an overall classification rate of 81%. Classification accuracy increased with higher levels of motor impairment (91% for more severely affected patients) or more advanced stages of PD (91% for H&Y III patients compared to controls), supporting the PD-specific type of analysis by eGaIT. In addition, eGaIT was able to classify different H&Y stages, or different levels of motor impairment (UPDRS-III). In conclusion, eGaIT as an unbiased, mobile, and automated assessment tool is able to identify PD patients and characterize their motor impairment. It may serve as a complementary mean for the daily clinical workup and support therapeutic decisions throughout the course of the disease.
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Affiliation(s)
- Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany.
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112
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de Rooij NK, Rinkel GJ, Dankbaar JW, Frijns CJ. Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Stroke 2013; 44:43-54. [DOI: 10.1161/strokeaha.112.674291] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Established predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage are large amounts of extravasated blood and poor clinical condition on admission. The predictive value of other factors is uncertain.
Methods—
We searched MEDLINE (1960–2012) for clinical, laboratory, and radiological predictors routinely available within 72 hours after subarachnoid hemorrhage. The studies were categorized according to methodological quality. Crude data and effect estimates (odds ratio [OR], hazard ratios, and risk ratio) with 95% CI were extracted, (re-)calculated and pooled if possible. For every potential predictor we assessed all effect estimates on consistency (point estimates in equal direction) and clinical relevance (size and 95% CI).
Results—
Fifty-two studies on 33 potential predictors were included. There was strong evidence (≥3 high-quality studies) for a higher risk of delayed cerebral ischemia in smokers (pooled OR, 1.2; 95% CI, 1.1–1.4), and moderate evidence (2 high-quality studies) for an increased risk in patients with hyperglycemia (OR, 3.2; 1.8–5.8 and hazard ratios, 1.7; 1.1–2.5), hydrocephalus (OR, 1.3; 1.1–1.5 and OR, 2.6; 1.2–5.5), history of diabetes mellitus (pooled OR, 6.7; 1.7–26), and early systemic inflammatory response syndrome (pooled OR, 2.1; 1.4–3.3). Evidence was limited for increased risk in women (pooled OR, 1.3; 1.1–1.6) and in patients with history of hypertension (pooled OR, 1.5; 1.3–1.7). The evidence on initial loss of consciousness, history of migraine, previous use of selective serotonin reuptake inhibitors, hypomagnesemia, low hemoglobin, or high blood flow on early transcranial Doppler was also limited.
Conclusions—
There is strong evidence that smoking is a predictor of delayed cerebral ischemia. For several other potential predictions the evidence is moderate, limited, or inconsistent.
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Affiliation(s)
- Nicolien K. de Rooij
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands (N.K.d.R., G.J.E.R., C.J.M.F.); and the Department of Radiology, University Medical Center Utrecht, the Netherlands (J.W.D.)
| | - Gabriel J.E. Rinkel
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands (N.K.d.R., G.J.E.R., C.J.M.F.); and the Department of Radiology, University Medical Center Utrecht, the Netherlands (J.W.D.)
| | - Jan Willem Dankbaar
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands (N.K.d.R., G.J.E.R., C.J.M.F.); and the Department of Radiology, University Medical Center Utrecht, the Netherlands (J.W.D.)
| | - Catharina J.M. Frijns
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands (N.K.d.R., G.J.E.R., C.J.M.F.); and the Department of Radiology, University Medical Center Utrecht, the Netherlands (J.W.D.)
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Duncan GW, Yarnall AJ, Marrinan S, Burn DJ. New horizons in the pathogenesis, assessment and management of movement disorders. Age Ageing 2013; 42:2-10. [PMID: 22908205 DOI: 10.1093/ageing/afs103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this review, we shall outline recent advances in our understanding of the movement disorders which geriatricians encounter in their clinical practice. Many of these diseases are no longer simply considered disorders of movement: carefully conducted longitudinal studies have shown that concomitant cognitive dysfunction, neuropsychiatric disturbance and behavioural issues are frequent and exert a heavy burden on the individual and their carers. Great progress has been made in understanding the molecular and cellular processes that drive the pathological changes in these conditions, as have advances in neuroimaging and preclinical drug discovery programmes. Unfortunately, this is yet to translate into disease-modifying therapies for these progressive disorders. Advances have been also made in non-pharmacological interventions such as tailored physiotherapy and speech therapy programmes. The important contribution of palliative care has been recognised and increasingly incorporated into the multidisciplinary approach. The UK is at the forefront of research into these conditions and geriatricians are well placed to contribute to research through recruiting patients to observational studies or therapeutic trials, particularly with the support of agencies such as the National Institute for Health Research-Dementias & Neurodegenerative Diseases Research Network (NIHR-DeNDRoN).
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Affiliation(s)
- Gordon W Duncan
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
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114
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The effects of instructions on dual-task walking and cognitive task performance in people with Parkinson's disease. PARKINSONS DISEASE 2012; 2012:671261. [PMID: 23326758 PMCID: PMC3544310 DOI: 10.1155/2012/671261] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/18/2012] [Accepted: 11/26/2012] [Indexed: 11/17/2022]
Abstract
Gait impairments are prevalent among people with Parkinson's disease (PD). Instructions to focus on walking can improve walking in PD, but the use of such a cognitive strategy may be limited under dual-task walking conditions, when walking is performed simultaneously with concurrent cognitive or motor tasks. This study examined how dual-task performance of walking and a concurrent cognitive task was affected by instructions in people with PD compared to healthy young and older individuals. Dual-task walking and cognitive task performance was characterized under two sets of instructions as follows: (1) focus on walking and (2) focus on the cognitive task. People with PD and healthy adults walked faster when instructed to focus on walking. However, when focused on walking, people with PD and young adults demonstrated declines in the cognitive task. This suggests that dual-task performance is flexible and can be modified by instructions in people with PD, but walking improvements may come at a cost to cognitive task performance. The ability to modify dual-task performance in response to instructions or other task and environmental factors is critical to mobility in daily life. Future research should continue to examine factors that influence dual-task performance among people with PD.
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115
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Müller MLTM, Frey KA, Petrou M, Kotagal V, Koeppe RA, Albin RL, Bohnen NI. β-Amyloid and postural instability and gait difficulty in Parkinson's disease at risk for dementia. Mov Disord 2012; 28:296-301. [PMID: 23239424 DOI: 10.1002/mds.25213] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/03/2012] [Accepted: 08/30/2012] [Indexed: 11/07/2022] Open
Abstract
Although motor impairments in Parkinson's disease (PD) are attributed to nigrostriatal dopaminergic denervation, postural instability and gait difficulty (PIGD) features are less responsive to dopaminergic medications. PIGD features are a risk factor also for the development of dementia in PD (PDD). These observations suggest that nondopaminergic mechanisms may contribute to axial motor impairments. The aim was to perform a correlative PET study to examine the relationship between neocortical β-amyloid deposition ([(11)C]-Pittsburgh Compound B), nigrostriatal dopaminergic denervation ([(11)C]-dihydrotetrabenazine), and PIGD feature severity in PD patients at risk for dementia. This was a cross-sectional study of 44 PD patients (11 female and 33 male; 69.5 ± 6.6 years of age; 7.0 ± 4.8 years motor disease duration; mean H & Y stage: 2.7 ± 0.5) who underwent PET, motor feature severity assessment using the Movement Disorder Society revised UPDRS, and the Dementia Rating Scale (DRS). Linear regression (R(2)(adj) = 0.147; F(4,39) = 2.85; P = 0.036) showed that increased PIGD feature severity was associated with increased neocortical [(11)C]-Pittsburgh Compound B binding (β = 0.346; t(39) = 2.13; P = 0.039) while controlling for striatal [(11)C]-dihydrotetrabenazine binding, age, and DRS total score. Increased neocortical β-amyloid deposition, even at low-range levels, is associated with higher PIGD feature severity in PD patients at risk for dementia. This finding may explain why the PIGD motor phenotype is a risk factor for the development of PDD.
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Affiliation(s)
- Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48105, USA.
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116
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Marras C, Oakes D. Piecing together the puzzle of progression and mortality in Parkinson's disease. Br J Clin Pharmacol 2012; 74:264-6. [PMID: 22554391 DOI: 10.1111/j.1365-2125.2012.04315.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Connie Marras
- Toronto Western Hospital Movement Disorders Centre, University of Toronto and the Edmond J. Safra Program in Parkinson's Research, Toronto, Ontario, Canada.
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117
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Vu TC, Nutt JG, Holford NHG. Disease progress and response to treatment as predictors of survival, disability, cognitive impairment and depression in Parkinson's disease. Br J Clin Pharmacol 2012; 74:284-95. [PMID: 22300470 PMCID: PMC3630748 DOI: 10.1111/j.1365-2125.2012.04208.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 01/25/2012] [Indexed: 11/28/2022] Open
Abstract
AIM To describe the time to clinical events (death, disability, cognitive impairment and depression) in Parkinson's disease using the time course of disease status and treatment as explanatory variables. METHODS Disease status based on the Unified Parkinson's Disease Rating Scale (UPDRS) and the time to clinical outcome events were obtained from 800 patients who initially had early Parkinson's disease. Parametric hazard models were used to describe the time to the events of interest. RESULTS Time course of disease status (severity) was an important predictor of clinical outcome events. There was an increased hazard ratio for death 1.4 (95% CI 1.31, 149), disability 2.75 (95% CI 2.30, 3.28), cognitive impairment 4.35 (95% CI 1.94, 9.74), and depressive state 1.43 (95% CI 1.26, 1.63) with each 10 unit increase of UPDRS. Age at study entry increased the hazard with hazard ratios of 49.1 (95% CI 8.7, 278) for death, 4.76 (95% CI 1.10, 20.6) for disability and 90.0 (95% CI 63.3-128) for cognitive impairment at age 60 years. Selegiline treatment had independent effects as a predictor of death at 8 year follow-up with a hazard ratio of 2.54 (95% CI 1.51, 4.25) but had beneficial effects on disability with a hazard ratio of 0.363 (95% CI 0.132, 0.533) and depression with a hazard ratio of 0.372 (95% CI 0.12, 0.552). CONCLUSIONS Our findings show that the time course of disease status based on UPDRS is a much better predictor of future clinical events than any baseline disease characteristic. Continued selegiline treatment appears to increase the hazard of death.
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Affiliation(s)
- Thuy C Vu
- Department of Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, CA, USA
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Ritz B, Rhodes SL, Bordelon Y, Bronstein J. α-Synuclein genetic variants predict faster motor symptom progression in idiopathic Parkinson disease. PLoS One 2012; 7:e36199. [PMID: 22615757 PMCID: PMC3352914 DOI: 10.1371/journal.pone.0036199] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/03/2012] [Indexed: 11/19/2022] Open
Abstract
Currently, there are no reported genetic predictors of motor symptom progression in Parkinson's disease (PD). In familial PD, disease severity is associated with higher α-synuclein (SNCA) expression levels, and in postmortem studies expression varies with SNCA genetic variants. Furthermore, SNCA is a well-known risk factor for PD occurrence. We recruited Parkinson's patients from the communities of three central California counties to investigate the influence of SNCA genetic variants on motor symptom progression in idiopathic PD. We repeatedly assessed this cohort of patients over an average of 5.1 years for motor symptom changes employing the Unified Parkinson's Disease Rating Scale (UPDRS). Of 363 population-based incident PD cases diagnosed less than 3 years from baseline assessment, 242 cases were successfully re-contacted and 233 were re-examined at least once. Of subjects lost to follow-up, 69% were due to death. Adjusting for covariates, risk of faster decline of motor function as measured by annual increase in motor UPDRS exam score was increased 4-fold in carriers of the REP1 263bp promoter variant (OR 4.03, 95%CI:1.57-10.4). Our data also suggest a contribution to increased risk by the G-allele for rs356165 (OR 1.66; 95%CI:0.96-2.88), and we observed a strong trend across categories when both genetic variants were considered (p for trend = 0.002). Our population-based study has demonstrated that SNCA variants are strong predictors of faster motor decline in idiopathic PD. SNCA may be a promising target for therapies and may help identify patients who will benefit most from early interventions. This is the first study to link SNCA to motor symptom decline in a longitudinal progression study.
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Affiliation(s)
- Beate Ritz
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America.
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Leonardi M, Raggi A, Pagani M, Carella F, Soliveri P, Albanese A, Romito L. Relationships between disability, quality of life and prevalence of nonmotor symptoms in Parkinson’s disease. Parkinsonism Relat Disord 2012; 18:35-9. [DOI: 10.1016/j.parkreldis.2011.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/20/2011] [Accepted: 08/12/2011] [Indexed: 01/15/2023]
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A review of dual-task walking deficits in people with Parkinson's disease: motor and cognitive contributions, mechanisms, and clinical implications. PARKINSONS DISEASE 2011; 2012:918719. [PMID: 22135764 PMCID: PMC3205740 DOI: 10.1155/2012/918719] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/29/2011] [Accepted: 09/04/2011] [Indexed: 12/20/2022]
Abstract
Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or carrying an object. The consequences of gait impairments in PD are significant and include increased disability, increased fall risk, and reduced quality of life. However, effective therapeutic interventions for dual-task walking deficits are limited. The goals of this narrative review are to describe dual-task walking deficits in people with PD, to discuss motor and cognitive factors that may contribute to these deficits, to review potential mechanisms underlying dual-task deficits, and to discuss the effect of therapeutic interventions on dual-task walking deficits in persons with PD.
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Abstract
Parkinson's disease is caused by the premature death of neurons in the midbrain. By contrast, cancer spawns from cells that refuse to die. We would therefore expect their pathogenic mechanisms to be very different. However, recent genetic studies and emerging functional work show that strikingly similar and overlapping pathways are involved in both diseases. We consider these areas of convergence and discuss how insights from one disease can inform us about, and possibly help us to treat, the other.
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Affiliation(s)
- Michael J Devine
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Jasinska-Myga B, Heckman MG, Wider C, Putzke JD, Wszolek ZK, Uitti RJ. Loss of ability to work and ability to live independently in Parkinson's disease. Parkinsonism Relat Disord 2011; 18:130-5. [PMID: 21975262 DOI: 10.1016/j.parkreldis.2011.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/22/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Ability to work and live independently is of particular concern for patients with Parkinson's disease (PD). We studied a series of PD patients able to work or live independently at baseline, and evaluated potential risk factors for two separate outcomes: loss of ability to work and loss of ability to live independently. METHODS The series comprised 495 PD patients followed prospectively. Ability to work and ability to live independently were based on clinical interview and examination. Cox regression models adjusted for age and disease duration were used to evaluate associations of baseline characteristics with loss of ability to work and loss of ability to live independently. RESULTS Higher UPDRS dyskinesia score, UPDRS instability score, UPDRS total score, Hoehn and Yahr stage, and presence of intellectual impairment at baseline were all associated with increased risk of future loss of ability to work and loss of ability to live independently (P ≤ 0.0033). Five years after initial visit, for patients ≤70 years of age with a disease duration ≤4 years at initial visit, 88% were still able to work and 90% to live independently. These estimates worsened as age and disease duration at initial visit increased; for patients >70 years of age with a disease duration >4 years, estimates at 5 years were 43% able to work and 57% able to live independently. CONCLUSIONS The information provided in this study can offer useful information for PD patients in preparing for future ability to perform activities of daily living.
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Ohye C, Higuchi Y, Shibazaki T, Hashimoto T, Koyama T, Hirai T, Matsuda S, Serizawa T, Hori T, Hayashi M, Ochiai T, Samura H, Yamashiro K. Gamma Knife Thalamotomy for Parkinson Disease and Essential Tremor: A Prospective Multicenter Study. Neurosurgery 2011; 70:526-35; discussion 535-6. [DOI: 10.1227/neu.0b013e3182350893] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
No prospective study of gamma knife thalamotomy for intractable tremor has previously been reported.
Objective:
To clarify the safety and optimally effective conditions for performing unilateral gamma knife (GK) thalamotomy for tremors of Parkinson disease (PD) and essential tremor (ET), a systematic postirradiation 24-month follow-up study was conducted at 6 institutions. We present the results of this multicenter collaborative trial.
Methods:
In total, 72 patients (PD characterized by tremor, n = 59; ET, n = 13) were registered at 6 Japanese institutions. Following our selective thalamotomy procedure, the lateral part of the ventralis intermedius nucleus, 45% of the thalamic length from the anterior tip, was selected as the GK isocenter. A single 130-Gy shot was applied using a 4-mm collimator. Evaluation included neurological examination, magnetic resonance imaging and/or computerized tomography, the unified Parkinson's disease rating scale (UPDRS), electromyography, medication change, and video observations.
Results:
Final clinical effects were favorable. Of 53 patients who completed 24 months of follow-up, 43 were evaluated as having excellent or good results (81.1%). UPDRS scores showed tremor improvement (parts II and III). Thalamic lesion size fluctuated but converged to either an almost spherical shape (65.6%), a sphere with streaking (23.4%), or an extended high-signal zone (10.9%). No permanent clinical complications were observed.
Conclusion:
GK thalamotomy is an alternative treatment for intractable tremors of PD as well as for ET. Less invasive intervention may be beneficial to patients.
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Affiliation(s)
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toru Shibazaki
- Functional and Gamma Knife Surgery Center, Hidaka Hospital, Takasaki, Japan
| | - Takao Hashimoto
- Center for Neurological Diseases, Aizawa Hospital, Matsumoto, Japan
| | - Toru Koyama
- Center for Neurological Diseases, Aizawa Hospital, Matsumoto, Japan
| | - Tatsuo Hirai
- Gamma Knife Center, Heisei Memorial Hospital, Fujieda, Japan
| | - Shinji Matsuda
- Gamma Knife House, Chiba Cardiovascular Center, Ichihara, Japan
| | - Toru Serizawa
- Gamma Knife House, Chiba Cardiovascular Center, Ichihara, Japan
| | - Tomokatsu Hori
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Ochiai
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirofumi Samura
- Department of Neurosurgery, Okinawa Central Hospital, Naha, Japan
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Sheard JM, Ash S, Silburn PA, Kerr GK. Prevalence of malnutrition in Parkinson's disease: a systematic review. Nutr Rev 2011; 69:520-32. [DOI: 10.1111/j.1753-4887.2011.00413.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Silver DE, Buck PO. Determining the Efficacy of Rasagiline in Reducing Bradykinesia Among Parkinson's Disease Patients: A Review. Int J Neurosci 2011; 121:485-9. [DOI: 10.3109/00207454.2011.582240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kuhle J, Petzold A. What makes a prognostic biomarker in CNS diseases: strategies for targeted biomarker discovery? Part 2: chronic progressive and relapsing disease. ACTA ACUST UNITED AC 2011; 5:393-410. [DOI: 10.1517/17530059.2011.592184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Merola A, Zibetti M, Angrisano S, Rizzi L, Ricchi V, Artusi CA, Lanotte M, Rizzone MG, Lopiano L. Parkinson's disease progression at 30 years: a study of subthalamic deep brain-stimulated patients. Brain 2011; 134:2074-84. [PMID: 21666262 DOI: 10.1093/brain/awr121] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Clinical findings in Parkinson's disease suggest that most patients progressively develop disabling non-levodopa-responsive symptoms during the course of the disease. Nevertheless, several heterogeneous factors, such as clinical phenotype, age at onset and genetic aspects may influence the long-term clinical picture. In order to investigate the main features of long-term Parkinson's disease progression, we studied a cohort of 19 subjects treated with subthalamic nucleus deep brain stimulation after >20 years of disease, reporting clinical and neuropsychological data up to a mean of 30 years from disease onset. This group of patients was characterized by an early onset of disease, with a mean age of 38.63 years at Parkinson's disease onset, which was significantly lower than in the other long-term subthalamic nucleus deep brain stimulation follow-up cohorts reported in the literature. All subjects were regularly evaluated by a complete Unified Parkinson's Disease Rating Scale, a battery of neuropsychological tests and a clinical interview, intended to assess the rate of non-levodopa-responsive symptom progression. Clinical data were available for all patients at presurgical baseline and at 1, 3 and 5 years from the subthalamic nucleus deep brain stimulation surgical procedure, while follow-up data after >7 years were additionally reported in a subgroup of 14 patients. The clinical and neuropsychological performance progressively worsened during the course of follow-up; 64% of patients gradually developed falls, 86% dysphagia, 57% urinary incontinence and 43% dementia. A progressive worsening of motor symptoms was observed both in 'medication-ON' condition and in 'stimulation-ON' condition, with a parallel reduction in the synergistic effect of 'medication-ON/stimulation-ON' condition. Neuropsychological data also showed a gradual decline in the performances of all main cognitive domains, with an initial involvement of executive functions, followed by the impairment of language, reasoning and memory. Thirty years after the disease onset, most patients presented non-levodopa-responsive symptoms, although the effect of both subthalamic nucleus deep brain stimulation and dopaminergic therapies still showed significant efficacy on the main disease cardinal features. Nevertheless, compared with other subthalamic nucleus deep brain stimulation follow-up studies, which included patients with a shorter disease duration at the time of surgery, a higher prevalence of axial and non-levodopa-responsive symptoms was observed in the long-term evaluations, confirming that several complex aspects underlie the development of non-motor symptoms and other features of Parkinson's disease progression, even in patients with an early disease onset and a prior long-lasting response to dopaminergic therapies.
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Affiliation(s)
- Aristide Merola
- Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Turin, Italy.
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128
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Klotsche J, Reese JP, Winter Y, Oertel WH, Irving H, Wittchen HU, Rehm J, Dodel R. Trajectory classes of decline in health-related quality of life in Parkinson's disease: a pilot study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:329-338. [PMID: 21402301 DOI: 10.1016/j.jval.2010.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To analyze the change in health-related quality-of-life (HRQoL) in patients with Parkinson's disease (PD) and to identify different classes of HRQoL decline. METHODS A longitudinal cohort study was performed to assess clinical parameters (unified PD rating scale, Beck Depression Inventory) and HRQoL data (EuroQol, Parkinson's Disease Questionnaire [PDQ]-39) at baseline, 3, 6, 12, 24, and 36 months. A total of 145 patients with PD were consecutively recruited in the county of Northern Hessia, Germany, between January and June 2000. A latent growth mixture model was applied to analyse the heterogeneity in HRQoL trajectories. RESULTS We successfully applied latent mixture growth modeling in order to identify different classes of HRQoL trajectories in PD. Three growth models were developed and each resulted in a four-class model of distinct patterns using the generic EuroQol instruments' outcomes (EuroQol-5 Dimensions and visual analogue scale) and the disease-specific PDQ-39. The four classes were defined by individual trajectory characteristics. Classes one and two represented trajectories with moderate declines over 36 months, but with different initial intercepts. Class three consisted mainly of patients who passed away during the observation period and therefore had a large HRQoL decline. Class four was characterized by a low level of HRQoL at baseline and a significant subsequent decline. CONCLUSIONS The findings provide a more elaborate understanding of the variability in HRQoL reduction in PD over time. The classification of different HRQoL subgroups may help to explain the response of PD patients to the natural history of the disease. Future research will enable the identification of HRQoL responder subgroups on different treatment regimens.
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Affiliation(s)
- Jens Klotsche
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
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129
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Post B, Muslimovic D, van Geloven N, Speelman JD, Schmand B, de Haan RJ. Progression and prognostic factors of motor impairment, disability and quality of life in newly diagnosed Parkinson's disease. Mov Disord 2011; 26:449-56. [PMID: 21312273 DOI: 10.1002/mds.23467] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/19/2010] [Accepted: 09/10/2010] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine progression and prognostic factors of progression rate of motor impairment, disability, and quality of life (QoL) in patients with newly diagnosed Parkinson's disease. METHODS A group of 126 patients with newly diagnosed PD recruited from outpatient clinics participated in this 3-year prospective cohort study. Motor impairment was rated with the Unified Parkinson Disease Rating Scale Motor-Examination. Disability was rated using the Schwab and England Activities of Daily Living Scale, the AMC Linear Disability Score. QoL was assessed with the Parkinson's Disease Quality of Life questionnaire. Linear mixed model analyses were conducted to identify determinants of progression rate of motor impairment, disability, and poor QoL. RESULTS Motor impairment progressed with 3 points per year. There was a slight progression of disability and QoL during 3 years of follow-up. Female sex was a prognostic factor for slower progression of motor impairment and QoL. Older age at onset showed to prognosticate faster progression of disability and impaired QoL. Furthermore, independent of follow-up time, older age at onset was associated with worse motor impairment; nondopaminergic reactive symptoms (Axial impairment) were associated with more disability and poorer QoL; comorbidity showed relation with disability and QoL but to a lesser extent; self-reported mood symptoms were associated with poorer QoL; and disease duration correlated with motor impairment. CONCLUSIONS Motor impairment, disability, and QoL of newly diagnosed Parkinson patients show progression in the first 3 years. Older age at onset predicts worse progression rate of disability and impaired QoL over time. Female sex predicts slower progression of motor impairment and less decline of QoL.
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Affiliation(s)
- Bart Post
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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130
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Baba T, Takeda A, Kikuchi A, Nishio Y, Hosokai Y, Hirayama K, Hasegawa T, Sugeno N, Suzuki K, Mori E, Takahashi S, Fukuda H, Itoyama Y. Association of olfactory dysfunction and brain. Metabolism in Parkinson's disease. Mov Disord 2011; 26:621-8. [DOI: 10.1002/mds.23602] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 11/06/2022] Open
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Determinants of health-related quality of life in Parkinson's disease: a systematic review. Parkinsonism Relat Disord 2010; 17:1-9. [PMID: 20833572 DOI: 10.1016/j.parkreldis.2010.08.012] [Citation(s) in RCA: 256] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 11/22/2022]
Abstract
This systematic review critically evaluates the literature to identify the demographic and clinical factors that predict the health-related quality of life (HRQOL) of people with Parkinson's disease (PD). Understanding how these factors relate to HRQOL in people with PD may assist clinicians minimise the functional and social impact of the disease by optimising their assessment and clinical decision making processes. A tailored search strategy in six databases identified 29 full-text reports that fulfilled the pre-defined inclusion and exclusion criteria. The quality of included studies was assessed by two independent reviewers using a customized assessment form. A best-evidence synthesis was used to summarise the demographic and clinical factors that were examined in relation to HRQOL. Depression was the most frequently identified determinant of HRQOL in people with idiopathic PD. Disease severity and disease disability were also found to be predictive of poor HRQOL outcomes in many studies. The motor symptoms that contributed most often to overall life quality were gait impairments and complications arising from medication therapy. To minimise the impact of PD on HRQOL, it may be necessary to consider the extent to which demographic factors and motor and non-motor symptoms contribute to life quality.
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132
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Raggi A, Leonardi M, Ajovalasit D, Carella F, Soliveri P, Albanese A, Romito L. Functioning and disability in Parkinson's disease. Disabil Rehabil 2010; 32 Suppl 1:S33-41. [DOI: 10.3109/09638288.2010.511688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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133
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Bliwise DL, Trotti LM, Greer SA, Juncos JJ, Rye DB. Phasic muscle activity in sleep and clinical features of Parkinson disease. Ann Neurol 2010; 68:353-9. [PMID: 20626046 PMCID: PMC3666956 DOI: 10.1002/ana.22076] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The absence of atonia during rapid eye movement (REM) sleep and dream-enactment behavior (REM sleep behavior disorder [RBD]) are common features of sleep in the alpha-synucleinopathies. This study examined this phenomenon quantitatively, using the phasic electromyographic metric (PEM), in relation to clinical features of idiopathic Parkinson disease (PD). Based on previous studies suggesting that RBD may be prognostic for the development of later parkinsonism, we hypothesized that clinical indicators of disease severity and more rapid progression would be related to PEM. METHODS A cross-sectional convenience sample of 55 idiopathic PD patients from a movement disorders clinic in a tertiary care medical center underwent overnight polysomnography. PEM, the percentage of 2.5-second intervals containing phasic muscle activity, was quantified separately for REM and non-REM (NREM) sleep from 5 different electrode sites. RESULTS Higher PEM rates were seen in patients with symmetric disease, as well as in akinetic-rigid versus tremor-predominant patients. Men had higher PEM relative to women. Results occurred in all muscle groups in both REM and NREM sleep. INTERPRETATION Although our data were cross-sectional, phasic muscle activity during sleep suggests disinhibition of descending motor projections in PD broadly reflective of more advanced and/or progressive disease. Elevated PEM during sleep may represent a functional window into brainstem modulation of spinal cord activity and is broadly consistent with the early pathologic involvement of non-nigral brainstem regions in PD, as described by Braak.
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Affiliation(s)
- Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30329, USA.
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134
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Abstract
Given the rising costs of health care, the rational use of resources is a necessity. Evidence-based medicine assists physicians in providing the right care to the right patient at the right time. Familiarity with scientific literature and clinical experience are also important in decision making. This article covers the basics of critical appraisal and an introduction to statistics that will help clinicians, patients, and policymakers make sense of scientific evidence.
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135
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Abstract
Parkinson's disease is a neurodegenerative process characterized by numerous motor and nonmotor clinical manifestations for which effective, mechanism-based treatments remain elusive. Here we discuss a series of critical issues that we think researchers need to address to stand a better chance of solving the different challenges posed by this pathology.
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136
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Gray WK, Wood BH, Walker RW. Do autonomic function tests in people with Parkinson's disease predict survival rates at 7 years follow-up? Mov Disord 2010; 24:2432-4. [PMID: 19890986 DOI: 10.1002/mds.22834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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137
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Alcalay RN, Mejia-Santana H, Tang MX, Rosado L, Verbitsky M, Kisselev S, Ross BM, Louis ED, Comella CL, Colcher A, Jennings D, Nance MA, Bressman S, Scott WK, Tanner C, Mickel SF, Andrews HF, Waters CH, Fahn S, Cote LJ, Frucht SJ, Ford B, Rezak M, Novak K, Friedman JH, Pfeiffer R, Marsh L, Hiner B, Siderowf A, Caccappolo E, Ottman R, Clark LN, Marder KS. Motor phenotype of LRRK2 G2019S carriers in early-onset Parkinson disease. ACTA ACUST UNITED AC 2010; 66:1517-22. [PMID: 20008657 DOI: 10.1001/archneurol.2009.267] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the motor phenotype of LRRK2 G2019S mutation carriers. LRRK2 mutation carriers were previously reported to manifest the tremor dominant motor phenotype, which has been associated with slower motor progression and less cognitive impairment compared with the postural instability and gait difficulty (PIGD) phenotype. DESIGN Cross-sectional observational study. SETTING Thirteen movement disorders centers. PARTICIPANTS Nine hundred twenty-five early-onset Parkinson disease cases defined as age at onset younger than 51 years. MAIN OUTCOME MEASURES LRRK2 mutation status and Parkinson disease motor phenotype: tremor dominant or PIGD. Demographic information, family history of Parkinson disease, and the Unified Parkinson's Disease Rating Scale score were collected on all participants. DNA samples were genotyped for LRRK2 mutations (G2019S, I2020T, R1441C, and Y1699C). Logistic regression was used to examine associations of G2019S mutation status with motor phenotype adjusting for disease duration, Ashkenazi Jewish ancestry, levodopa dose, and family history of Parkinson disease. RESULTS Thirty-four cases (3.7%) (14 previously reported) were G2019S carriers. No other mutations were found. Carriers were more likely to be Ashkenazi Jewish (55.9% vs 11.9%; P < .001) but did not significantly differ in any other demographic or disease characteristics. Carriers had a lower tremor score (P = .03) and were more likely to have a PIGD phenotype (92.3% vs 58.9%; P = .003). The association of the G2019S mutation with PIGD phenotype remained after controlling for disease duration and Ashkenazi Jewish ancestry (odds ratio, 17.7; P < .001). CONCLUSION Early-onset Parkinson disease G2019S LRRK2 carriers are more likely to manifest the PIGD phenotype, which may have implications for disease course.
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Affiliation(s)
- Roy N Alcalay
- Department of Neurology, Columbia University, New York, NY 10032, USA
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Gray WK, Hildreth A, Bilclough JA, Wood BH, Baker K, Walker RW. Physical assessment as a predictor of mortality in people with Parkinson's disease: a study over 7 years. Mov Disord 2010; 24:1934-40. [PMID: 19672988 DOI: 10.1002/mds.22610] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The primary aim of this study was to ascertain whether a battery of physical function measures in a Parkinson's disease (PD) patient cohort predicted mortality status at 7-year follow-up. Secondary aims were establishing which specific tests were the most useful, and whether PD phenotype was a predictor. A retrospective correlation design was used in this study. A cohort of 109 PD patients underwent baseline physiotherapy assessment of gait, balance, posture, muscle strength, and ability to change postural set. We compared mortality status at 7-year follow-up and baseline physical assessment tests. Tinetti gait and balance scores, UPDRS score, 10-m walk test (time, velocity, and number of strides), posture in standing, lying to sitting, sitting to standing, getting up from floor assessments, and time to ascend and descend four steps were found to be statistically significant physical predictors of mortality at 7-year follow-up. In addition, age, sex, and mini-mental state examination were significant nonphysical predictors of mortality. Using Cox regression, a survival model was constructed with age, sex, and Tinetti gait score as independent predictors of mortality. The results of this study suggest that there is a link between reduced physical function and an increased mortality risk in PD populations.
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Affiliation(s)
- William K Gray
- School of Health, Community and Education Studies, University of Northumbria, Coach Lane Campus, Newcastle-upon-Tyne NE29 8NH , United Kingdom
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Morelli M, Carta AR, Kachroo A, Schwarzschild MA. Pathophysiological roles for purines: adenosine, caffeine and urate. PROGRESS IN BRAIN RESEARCH 2010; 183:183-208. [PMID: 20696321 PMCID: PMC3102301 DOI: 10.1016/s0079-6123(10)83010-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The motor symptoms of Parkinson's disease (PD) are primarily due to the degeneration of the dopaminergic neurons in the nigrostriatal pathway. However, several other brain areas and neurotransmitters other than dopamine such as noradrenaline, 5-hydroxytryptamine and acetylcholine are affected in the disease. Moreover, adenosine because of the extensive interaction of its receptors with the dopaminergic system has been implicated in the pathophysiology of the disease. Based on the involvement of these non-dopaminergic neurotransmitters in PD and the sometimes severe adverse effects that limit the mainstay use of dopamine-based anti-parkinsonian treatments, recent assessments have called for a broadening of therapeutic options beyond the traditional dopaminergic drug arsenal. In this review we describe the interactions between dopamine and adenosine receptors that underpin the pre-clinical and clinical rationale for pursuing adenosine A(2A) receptor antagonists as symptomatic and potentially neuroprotective treatment of PD. The review will pay particular attention to recent results regarding specific A(2A) receptor-receptor interactions and recent findings identifying urate, the end product of purine metabolism, as a novel prognostic biomarker and candidate neuroprotectant in PD.
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Affiliation(s)
- Micaela Morelli
- Department of Toxicology, University of Cagliari, Cagliari, Italy.
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Nation DA, Katzen HL, Papapetropoulos S, Scanlon BK, Levin BE. Subthreshold depression in Parkinson's disease. Int J Geriatr Psychiatry 2009; 24:937-43. [PMID: 19212967 PMCID: PMC2729808 DOI: 10.1002/gps.2199] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It is estimated that 40% of patients with Parkinson's disease (PD) are clinically depressed, however, little is known about the frequency and associated features of subthreshold depression in PD. The current study sought to determine the prevalence of subthreshold depression (sD) and to further characterize the associated features in a sample of 111 nondemented patients with moderate to severe PD. METHODS Patients were classified into the following groups: diagnostic depression (DD), subthreshold depression (sD), or nondepressed (ND) by applying the Diagnostic and Statistical Manual, 4th edn criteria for depression and previously reported criteria for sD to items from the Beck Depression Inventory, 2nd edn. These groups were compared on clinical and demographic variables. The symptom profile of the sD group is also described. RESULTS Fifty participants (45.0%) were classified as ND, 32 (28.8%) as sD, and 29 (26.1%) as DD. Patients with sD were younger (approximately 5 yrs) than nondepressed patients, but did not differ in disease stage or any other demographic variables. Patients with sD tended to endorse mood symptoms that overlap with PD, including fatigue, sleep difficulties, appetite dysfunction, and concentration difficulties. These symptoms were also endorsed with high frequency by the other groups. CONCLUSIONS These findings suggest that sD is not uncommon in PD and may be more prevalent among younger patients. The finding that sD patients report mood symptoms that overlap with the PD symptomatology suggests that these two entities share common features and may be difficult to disentangle.
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Affiliation(s)
- Daniel A. Nation
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | | | - Blake K. Scanlon
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Department of Neurology, University of Miami, Coral Gables, FL, USA
| | - Bonnie E. Levin
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Department of Neurology, University of Miami, Coral Gables, FL, USA,Correspondence to: Dr B. E. Levin, Clinical Research Building, 1120 NW, 14th Street, rm 1337, Miami, FL 33136, USA. E-mail:
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Can focusing on UPDRS Part II make assessments of Parkinson disease progression more efficient? Nat Rev Neurol 2009; 5:130-1. [DOI: 10.1038/ncpneuro1049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 01/14/2009] [Indexed: 11/08/2022]
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Ishihara-Paul L, Wainwright NWJ, Khaw KT, Luben RN, Welch AA, Day NE, Brayne C, Surtees PG. Prospective association between emotional health and clinical evidence of Parkinson’s disease. Eur J Neurol 2008; 15:1148-54. [DOI: 10.1111/j.1468-1331.2008.02299.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Post B, Speelman JD, de Haan RJ. Clinical heterogeneity in newly diagnosed Parkinson’s disease. J Neurol 2008; 255:716-22. [PMID: 18344057 DOI: 10.1007/s00415-008-0782-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 10/10/2007] [Accepted: 10/16/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Bart Post
- Dept. of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands.
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