101
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You H, Mariani LL, Mangone G, Le Febvre de Nailly D, Charbonnier-Beaupel F, Corvol JC. Molecular basis of dopamine replacement therapy and its side effects in Parkinson's disease. Cell Tissue Res 2018. [PMID: 29516217 DOI: 10.1007/s00441-018-2813-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is currently no cure for Parkinson's disease. The symptomatic therapeutic strategy essentially relies on dopamine replacement whose efficacy was demonstrated more than 50 years ago following the introduction of the dopamine precursor, levodopa. The spectacular antiparkinsonian effect of levodopa is, however, balanced by major limitations including the occurrence of motor complications related to its particular pharmacokinetic and pharmacodynamic properties. Other therapeutic strategies have thus been developed to overcome these problems such as the use of dopamine receptor agonists, dopamine metabolism inhibitors and non-dopaminergic drugs. Here we review the pharmacology and molecular mechanisms of dopamine replacement therapy in Parkinson's disease, both at the presynaptic and postsynaptic levels. The perspectives in terms of novel drug development and prediction of drug response for a more personalised medicine will be discussed.
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Affiliation(s)
- Hana You
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, Unit 1127, CIC 1422, NS-PARK/FCRIN, Hôpital Pitié-Salpêtrière, Paris, France.,CNRS, Unit 7225, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris, Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, University Hospital (Inselspital) and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Louise-Laure Mariani
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, Unit 1127, CIC 1422, NS-PARK/FCRIN, Hôpital Pitié-Salpêtrière, Paris, France.,CNRS, Unit 7225, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris, Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Graziella Mangone
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, Unit 1127, CIC 1422, NS-PARK/FCRIN, Hôpital Pitié-Salpêtrière, Paris, France.,CNRS, Unit 7225, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris, Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Delphine Le Febvre de Nailly
- INSERM, Unit 1127, CIC 1422, NS-PARK/FCRIN, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris, Department of Pharmacy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fanny Charbonnier-Beaupel
- Assistance Publique Hôpitaux de Paris, Department of Pharmacy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, ICM, Hôpital Pitié-Salpêtrière, Paris, France. .,INSERM, Unit 1127, CIC 1422, NS-PARK/FCRIN, Hôpital Pitié-Salpêtrière, Paris, France. .,CNRS, Unit 7225, Hôpital Pitié-Salpêtrière, Paris, France. .,Assistance Publique Hôpitaux de Paris, Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France. .,CIC Neurosciences, ICM building, Hôpital Pitié-Salpêtrière, 47/83 Boulevard de l'Hôpital, 75013, Paris, France.
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102
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Creese B, Bell E, Johar I, Francis P, Ballard C, Aarsland D. Glucocerebrosidase mutations and neuropsychiatric phenotypes in Parkinson's disease and Lewy body dementias: Review and meta-analyses. Am J Med Genet B Neuropsychiatr Genet 2018; 177:232-241. [PMID: 28548708 DOI: 10.1002/ajmg.b.32549] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 12/26/2022]
Abstract
Heterozygous mutations in glucocerebrosidase gene (GBA) are a major genetic risk factor for Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Recently, there has been a considerable focus on the relationship between GBA mutations and emergence of cognitive impairment and neuropsychiatric symptoms in these diseases. Here, we review the literature in this area, with a particular focus, including meta-analysis, on the key neuropsychiatric symptoms of cognitive impairment, psychosis, and depression in Parkinson's disease. Our meta-analysis demonstrated that GBA mutations are associated with a 2.4-fold increased risk of cognitive impairment. In addition, our novel meta-analyses of psychosis and depression showed a 1.8- and 2.2-fold increased risk respectively associated with GBA mutations, although due to possible bias and heterogeneity the depression findings should be interpreted with caution. While the precise mechanisms which increase susceptibility to neurodegeneration in GBA carriers are not known, evidence of greater cortical Lewy body pathology, reduced patterns of cortical activation, and hippocampal pathology in animal models are all consistent with a direct effect of GBA mutations on these symptoms. Extension of this work in DLB and individuals without neurodegeneration will be important in further characterizing how GBA mutations increase risk for PD and DLB and influence disease course.
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Affiliation(s)
- Byron Creese
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Emily Bell
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iskandar Johar
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Francis
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clive Ballard
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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103
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Patel RS, Makani R, Mansuri Z, Patel U, Desai R, Chopra A. Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study. Cureus 2017; 9:e1648. [PMID: 29142796 PMCID: PMC5669529 DOI: 10.7759/cureus.1648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Major Depressive Disorder (MDD) is a common comorbidity that significantly affects the quality of life and disease outcomes in Parkinson’s disease (PD) patients. No studies have been conducted to our knowledge to address the health care utilization and its outcomes in these patients. The aim of this study is to analyze and discern the differences in the hospitalization outcomes, comorbid conditions, and utilization of procedures in PD patients versus patients with comorbid MDD. Methods We used the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project from year’s 2010-2014. We identified PD and MDD as a primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification codes. Pearson’s chi-square test and independent sample T-test were used for categorical data and continuous data, respectively. All statistical analysis was done by SPSS 22.0 in this study. Results Extensive analysis was performed on 63,912 patients with PD and 1445 patients with PD having MDD. Patients with comorbid depression had three times greater chances of disposition to acute care hospital (3.1% vs. 1.1%, p < 0.001). Median length of hospitalization was higher in Parkinson’s patients with depression (5.85 vs. 4.08 days; p < 0.001) though the median cost of hospitalization was low ($ 31,039 vs. $ 39,464; p < 0.001). This could be because therapeutic procedures performed during the hospitalization were lower in Parkinson’s patients with depression (0.53 vs. 0.89, p < 0.001). Utilization of Deep Brain Stimulation (DBS) was lower in Parkinson’s patients with depression (9.4% vs. 25.6%, p < 0.001). In-hospital mortality was significantly higher in Parkinson’s patients with depression (1.4% vs. 1.1%; p < 0.001). Conclusion Our study establishes the negative impact of depression in PD with regards to hospitalization-related outcomes including the illness severity, comorbid conditions, risk of mortality, utilization of diagnostic and therapeutic procedures, the length of stay and disposition as compared to PD without depression.
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Affiliation(s)
| | - Ramkrishna Makani
- Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
| | | | | | - Rupak Desai
- Research Coordinator, Atlanta Veterans Affairs Medical Center
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Almeida KJ, de Macêdo LP, Lemos de Melo Lobo Jofili Lopes J, Bor-Seng-Shu E, Campos-Sousa RN, Barbosa ER. Modified Pfeffer Questionnaire for Functional Assessment in Parkinson Disease. J Geriatr Psychiatry Neurol 2017; 30:261-266. [PMID: 28747137 DOI: 10.1177/0891988717720298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION It was proposed to modify the Pfeffer questionnaire (PQ) for functional assessment in patients with Parkinson disease (PD). AIM To determine the cutoff score for diagnosis of functional impairment in patients with PD by modified PQ (mPQ). METHODS A total of 110 patients with PD were enrolled into the study, and a neuropsychological test battery was performed to assess their cognitive status. Regarding functional assessment, the mPQ has been applied, and their results were compared to the functional assessment by Informant Questionnaire on Cognitive Decline in the Elderly adapted for use in Brazil (IQCODE-BR). The statistical analysis was accomplished through receiver operating characteristic (ROC) curve with evaluation of the area under the curve, sensitivity, and specificity of the new cutoff point. RESULTS Eighty-nine patients with PD were evaluated with a mean age of 63.69 ± 9.14 years. Cognitive status categorization was 28.10% as normal, 44.94% as mild cognitive impairment, and 26.96% of patients as dementia associated with PD. The average score on PQ was 3.49 ± 4.79 and on the mPQ 2.56 ± 3.49. In IQCODE-BR, the average score was 6.75 ± 32.72. The ROC curve for the new cutoff point presented 47.4% sensitivity, 88.10% specificity, and 0.757 of area under the curve, with a standard deviation of 0.055 (95% confidence interval: 0.650-0.864). CONCLUSION 3.5 is proposed as the cutoff point to define functional impairment in patients with PD by mPQ.
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Affiliation(s)
- Kelson James Almeida
- 1 Department of Neurology, University of São Paulo, Sao Paulo, Brazil.,2 Department of Neurology, Facid-Devry University of Medicine, Teresina, Piauí, Brazil.,3 Department of Neurology, Federal University of Piauí, Teresina, Piauí, Brazil
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105
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Titova N, Schapira AHV, Chaudhuri KR, Qamar MA, Katunina E, Jenner P. Nonmotor Symptoms in Experimental Models of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:63-89. [PMID: 28802936 DOI: 10.1016/bs.irn.2017.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nonmotor symptoms of Parkinson's disease (PD) range from neuropsychiatric, cognitive to sleep and sensory disorders and can arise from the disease process as well as from drug treatment. The clinical heterogeneity of nonmotor symptoms of PD is underpinned by a wide range of neuropathological and molecular pathology, affecting almost the entire range of neurotransmitters present in brain and the periphery. Understanding the neurobiology and pathology of nonmotor symptoms is crucial to the effective treatment of PD and currently a key unmet need. This bench-to-bedside translational concept can only be successful if robust animal models of PD charting the genesis and natural history of nonmotor symptoms can be devised. Toxin-based and transgenic rodent and primate models of PD have given us important clues to the underlying basis of motor symptomatology and in addition, can provide a snapshot of some nonmotor aspects of PD, although the data are far from complete. In this chapter, we discuss some of the nonmotor aspects of the available experimental models of PD and how the development of robust animal models to understand and treat nonmotor symptoms needs to become a research priority.
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Affiliation(s)
- Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.
| | | | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College London and King's College Hospital, London, United Kingdom; The Maurice Wohl Clinical Neuroscience Institute, King's College London, National Institute for Health Research (NIHR) South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Mubasher A Qamar
- National Parkinson Foundation International Centre of Excellence, King's College London and King's College Hospital, London, United Kingdom; The Maurice Wohl Clinical Neuroscience Institute, King's College London, National Institute for Health Research (NIHR) South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | | | - Peter Jenner
- Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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106
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Jellinger KA. Neuropathology of Nonmotor Symptoms of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:13-62. [PMID: 28802920 DOI: 10.1016/bs.irn.2017.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Parkinson's disease (PD), a multiorgan neurodegenerative disorder associated with α-synuclein deposits throughout the nervous system and many organs, is clinically characterized by motor and nonmotor features, many of the latter antedating motor dysfunctions by 20 or more years. The causes of the nonmotor manifestations such as olfactory, autonomic, sensory, neuropsychiatric, visuospatial, sleep, and other disorders are unlikely to be related to single lesions. They are mediated by the involvement of both dopaminergic and nondopaminergic systems, and diverse structures outside the nigrostriatal system that is mainly responsible for the motor features of PD. The nonmotor alterations appear in early/prodromal stages of the disease and its further progression, suggesting a topographical and chronological spread of the lesions. This lends further support for the notion that PD is a multiorgan proteinopathy, although the exact relationship between presymptomatic and later developing nonmotor features of PD and neuropathology awaits further elucidation.
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107
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Katunina E, Titova N. The Epidemiology of Nonmotor Symptoms in Parkinson's Disease (Cohort and Other Studies). INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:91-110. [PMID: 28802941 DOI: 10.1016/bs.irn.2017.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nonmotor symptoms (NMS) of Parkinson's disease (PD) were recognized by James Parkinson himself and are now considered to be an integral part of PD. While clinical assessment had focused on prevalence and severity of individual NMS such as dementia and depression, work in the last decade has concentrated on global or holistic assessment of NMS using validated tools such as the NMS questionnaire and NMS scale. These studies from cohorts of varying sizes have allowed comparison of NMS across different disease stages, duration, age, and ethnicity in PD. The data also allow exploration of the concept of the nonlinear relationship of NMS to disease duration of PD and motor stages as well as nonmotor subtypes of PD. In this chapter, these aspects of epidemiological studies of NMS in PD cohorts are described.
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Affiliation(s)
- Elena Katunina
- Federal State Budgetary Educational Institution of Higher Education, "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education, "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.
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108
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Yousaf T, Wilson H, Politis M. Imaging the Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:179-257. [PMID: 28802921 DOI: 10.1016/bs.irn.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is acknowledged to be a multisystem syndrome, manifesting as a result of multineuropeptide dysfunction, including dopaminergic, cholinergic, serotonergic, and noradrenergic deficits. This multisystem disorder ultimately leads to the presentation of a range of nonmotor symptoms, now appreciated to be an integral part of the disease-specific spectrum of symptoms, often preceding the diagnosis of motor Parkinson's disease. In this chapter, we review the dopaminergic and nondopaminergic basis of these symptoms by exploring the neuroimaging evidence based on several techniques including positron emission tomography, single-photon emission computed tomography molecular imaging, magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging. We discuss the role of these neuroimaging techniques in elucidating the underlying pathophysiology of NMS in Parkinson's disease.
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Affiliation(s)
- Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
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109
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Non-human primate models of PD to test novel therapies. J Neural Transm (Vienna) 2017; 125:291-324. [PMID: 28391443 DOI: 10.1007/s00702-017-1722-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/04/2017] [Indexed: 12/13/2022]
Abstract
Non-human primate (NHP) models of Parkinson disease show many similarities with the human disease. They are very useful to test novel pharmacotherapies as reviewed here. The various NHP models of this disease are described with their characteristics including the macaque, the marmoset, and the squirrel monkey models. Lesion-induced and genetic models are described. There is no drug to slow, delay, stop, or cure Parkinson disease; available treatments are symptomatic. The dopamine precursor, L-3,4-dihydroxyphenylalanine (L-Dopa) still remains the gold standard symptomatic treatment of Parkinson. However, involuntary movements termed L-Dopa-induced dyskinesias appear in most patients after chronic treatment and may become disabling. Dyskinesias are very difficult to manage and there is only amantadine approved providing only a modest benefit. In this respect, NHP models have been useful to seek new drug targets, since they reproduce motor complications observed in parkinsonian patients. Therapies to treat motor symptoms in NHP models are reviewed with a discussion of their translational value to humans. Disease-modifying treatments tested in NHP are reviewed as well as surgical treatments. Many biochemical changes in the brain of post-mortem Parkinson disease patients with dyskinesias are reviewed and compare well with those observed in NHP models. Non-motor symptoms can be categorized into psychiatric, autonomic, and sensory symptoms. These symptoms are present in most parkinsonian patients and are already installed many years before the pre-motor phase of the disease. The translational usefulness of NHP models of Parkinson is discussed for non-motor symptoms.
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Abstract
Nonmotor symptoms (NMS) of Parkinson's disease (PD) were recognized by the great James Parkinson himself who mentioned symptoms such as sleep dysfunction, delirium, dementia, and dysautonomia, in his seminal 1817 essay, "An Essay on the Shaking Palsy" (Parkinson, 1817). In spite of the key impact of PD NMS on quality of life, there was little holistic research and awareness till the validation and use of comprehensive tools such as the NMS questionnaire, scale, and the revised version of the unified PD rating scale. Research studies using these tools highlighted the key impact of the burden of NMS on quality of life of PD patients and the need for NMS to be routinely assessed in clinic. We now define PD as a motor and nonmotor disorder, and the natural history includes a long prodromal phase of PD dominated by a range of NMS. The prodromal phase is the subject of much research particularly in relation to neuroprotection and identifying subjects at risk. Use of NMS tools has also validated burden grading of NMS with cutoff values, which can be used as outcome measure in clinical trials. Finally, the complex multineurotransmitter dysfunction that is seen in PD has been shown to manifest clinically as nonmotor subtypes. Recognition of such subtypes is likely to lead to the emergence of personalized and precision medicine in PD.
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111
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Bouça-Machado R, Titova N, Chaudhuri KR, Bloem BR, Ferreira JJ. Palliative Care for Patients and Families With Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:475-509. [PMID: 28554419 DOI: 10.1016/bs.irn.2017.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is the second most common neurodegenerative disease worldwide. There is widespread consensus that Parkinson patients, their carers, and clinicians involved in their care would benefit from a fully integrated, need-based provision of palliative care. However, the concept of palliative care in Parkinson's disease is still poorly defined and, consequently, poorly implemented into daily clinical practice. A particular challenge is the gradually progressive nature of Parkinson's disease-with insidiously increasing disability-making it challenging to clearly define the onset of palliative care needs for Parkinson patients. As people with Parkinson's disease are now living longer than in the past, future research needs to develop a more robust evidence-based approach to clarify the disease events associated with increased palliative care needs, and to examine these, prospectively, in an integrated palliative care service. The modern palliative care outlook, termed "simultaneous care,",is no longer restricted to the final stage of disease. It involves incorporating a continuity of care, effective management of the chronic-palliative interface, and a multidisciplinary network of professionals working both in the community and in specialized clinics, with active involvement of caregivers. Although promising, there is still a need to demonstrate the effectiveness of palliative care for patients with Parkinson's disease.
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Affiliation(s)
- Raquel Bouça-Machado
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Bas R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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112
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Bellinger D, Altenmüller E, Volkmann J. Perception of Time in Music in Patients with Parkinson's Disease-The Processing of Musical Syntax Compensates for Rhythmic Deficits. Front Neurosci 2017; 11:68. [PMID: 28280454 PMCID: PMC5322262 DOI: 10.3389/fnins.2017.00068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/30/2017] [Indexed: 11/17/2022] Open
Abstract
Objective: Perception of time as well as rhythm in musical structures rely on complex brain mechanisms and require an extended network of multiple neural sources. They are therefore sensitive to impairment. Several psychophysical studies have shown that patients with Parkinson's disease (PD) have deficits in perceiving time and rhythms due to a malfunction of the basal ganglia (BG) network. Method: In this study we investigated the time perception of PD patients during music perception by assessing their just noticeable difference (JND) in the time perception of a complex musical Gestalt. We applied a temporal discrimination task using a short melody with a clear beat-based rhythm. Among the subjects, 26 patients under L-Dopa administration and 21 age-matched controls had to detect an artificially delayed time interval in the range between 80 and 300 ms in the middle of the musical period. We analyzed the data by (a) calculating the detection threshold directly, (b) by extrapolating the JNDs, (c) relating it to musical expertise. Results: Patients differed from controls in the detection of time-intervals between 220 and 300 ms (*p = 0.0200, n = 47). Furthermore, this deficit depended on the severity of the disease (*p = 0.0452; n = 47). Surprisingly, PD patients did not show any deficit of their JND compared to healthy controls, although the results showed a trend (*p = 0.0565, n = 40). Furthermore, no significant difference of the JND was found according to the severity of the disease. Additionally, musically trained persons seemed to have lower thresholds in detecting deviations in time and syntactic structures of music (*p = 0.0343, n = 39). Conclusion: As an explanation of these results, we would like to propose the hypothesis of a time-syntax-congruency in music perception suggesting that processing of time and rhythm is a Gestalt process and that cortical areas involved in processing of musical syntax may compensate for impaired BG circuits that are responsible for time processing and rhythm perception. This mechanism may emerge more strongly as the deficits in time processing and rhythm perception progress. Furthermore, we presume that top-down-bottom-up-processes interfere additionally and interact in this context of compensation.
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Affiliation(s)
- Daniel Bellinger
- Department of Neurology, University Hospital Würzburg Würzburg, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media Hannover, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg Würzburg, Germany
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113
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Peek J. 'There was no great ceremony': patient narratives and the diagnostic encounter in the context of Parkinson's. MEDICAL HUMANITIES 2017; 43:35-40. [PMID: 27821537 PMCID: PMC5339567 DOI: 10.1136/medhum-2016-011054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 05/05/2023]
Abstract
This paper draws on stories of diagnosis that emerged from a broader narrative study exploring the lived experience of Parkinson's (n.37). Despite the life-changing nature of their diagnosis, participants' narratives highlighted considerable shortcomings in the way in which their diagnostic encounter was handled, echoing the findings of previous research in which it has been noted that 'the human significance' of diagnosis was passed over. Building on the literature, this paper provides empirical material that reveals the sensitivities involved at the moment of diagnosis. By examining both the structure and content of participants' narratives, this article discusses the diagnostic encounter in relation to three key concepts that connected many participants' stories: a 'bareness' or lack of 'ceremony', a sense of emotional and physical 'abandonment' and the impact on a person's illness story when faced with a 'hierarchy' of illness. This paper aims to raise awareness of contemporary issues related to the diagnosis of Parkinson's, and invites reflection on how diagnosis might be undertaken in a way that truly acknowledges its human significance.
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114
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Qamar MA, Sauerbier A, Politis M, Carr H, Loehrer PA, Chaudhuri KR. Presynaptic dopaminergic terminal imaging and non-motor symptoms assessment of Parkinson's disease: evidence for dopaminergic basis? NPJ Parkinsons Dis 2017; 3:5. [PMID: 28649605 PMCID: PMC5445592 DOI: 10.1038/s41531-016-0006-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/04/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is now considered to be a multisystemic disorder consequent on multineuropeptide dysfunction including dopaminergic, serotonergic, cholinergic, and noradrenergic systems. This multipeptide dysfunction leads to expression of a range of non-motor symptoms now known to be integral to the concept of PD and preceding the diagnosis of motor PD. Some non-motor symptoms in PD may have a dopaminergic basis and in this review, we investigate the evidence for this based on imaging techniques using dopamine-based radioligands. To discuss non-motor symptoms we follow the classification as outlined by the validated PD non-motor symptoms scale.
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Affiliation(s)
- MA Qamar
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - A Sauerbier
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - M Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - H Carr
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - P A Loehrer
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - K Ray Chaudhuri
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
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Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson's disease. NPJ PARKINSONS DISEASE 2017. [PMID: 28649602 PMCID: PMC5460235 DOI: 10.1038/s41531-016-0003-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The progressive nature of Parkinson’s disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson’s disease patients, making it difficult to comprehensively address non-adherence. Here we share the results from a multi-centre (seven centres) randomised controlled trial conducted in England and Scotland to assess the impact of using a smartphone-based Parkinson’s tracker app to promote patient self-management, enhance treatment adherence and quality of clinical consultation. Eligible Parkinson’s disease patients were randomised using a 1:1 ratio according to a computer-generated random sequence, stratified by centre and using blocks of variable size, to intervention Parkinson’s Tracker App or control (Treatment as Usual). Primary outcome was the self-reported score of adherence to treatment (Morisky medication adherence scale −8) at 16 weeks. Secondary outcomes were Quality of Life (Parkinson’s disease questionnaire −39), quality of consultation for Parkinson’s disease patients (Patient-centred questionnaire for Parkinson’s disease), impact on non-motor symptoms (Non-motor symptoms questionnaire), depression and anxiety (Hospital anxiety and depression scale) and beliefs about medication (Beliefs about Medication Questionnaire) at 16 weeks. Primary and secondary endpoints were analysed using a generalised linear model with treatment as the fixed effect and baseline measurement as the covariate. 158 patients completed the study (Parkinson’s tracker app = 68 and TAU = 90). At 16 weeks Parkinson’s tracker app significantly improved adherence, compared to treatment as usual (mean difference: 0.39, 95%CI 0.04–0.74; p = 0.0304) with no confounding effects of gender, number of comorbidities and age. Among secondary outcomes, Parkinson’s tracker app significantly improved patients’ perception of quality of consultation (0.15, 95% CI 0.03 to 0.27; p = 0.0110). The change in non-motor symptoms was −0.82 (95% CI −1.75 to 0.10; p = 0.0822). 72% of participants in the Parkinson’s tracker app group continued to use and engage with the application throughout the 16-week trial period. The Parkinson’s tracker app can be an effective and novel way of enhancing self-reported medication adherence and quality of clinical consultation by supporting self-management in Parkinson’s disease in patients owning smartphones. Further work is recommended to determine whether the benefits of the intervention are maintained beyond the 16 week study period. A smartphone-based application improves treatment adherence of patients with Parkinson’s disease (PD). Rashmi Lakshminarayana, from uMotif Ltd, and researchers from the UK and The Netherlands describe the results of a 16 week trial of a Parkinson’s tracker app (PTA) that randomised 215 patients from seven different health centres. Patients using the app reported significantly better adherence to their medication plan compared with control patients who continued their treatment as usual. Interestingly, using the PTA also improved the patients’ perception of the quality of their clinical care, possibly as a result of feeling more involved and in control of their care. These findings suggest that by sending medication reminders and tracking symptoms, the app can help patients with Parkinson’s self-manage their increasingly complex treatment regimen as the disease progresses.
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Nord M, Zsigmond P, Kullman A, Dizdar N. Levodopa Pharmacokinetics in Brain after Both Oral and Intravenous Levodopa in One Patient with Advanced Parkinson’s Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/apd.2017.62006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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117
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Nonmotor Symptoms in Parkinson's Disease: Gender and Ethnic Differences. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:417-446. [DOI: 10.1016/bs.irn.2017.05.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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118
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Titova N, Padmakumar C, Lewis SJG, Chaudhuri KR. Parkinson's: a syndrome rather than a disease? J Neural Transm (Vienna) 2016; 124:907-914. [PMID: 28028643 PMCID: PMC5514217 DOI: 10.1007/s00702-016-1667-6] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
Emerging concepts suggest that a multitude of pathology ranging from misfolding of alpha-synuclein to neuroinflammation, mitochondrial dysfunction, and neurotransmitter driven alteration of brain neuronal networks lead to a syndrome that is commonly known as Parkinson’s disease. The complex underlying pathology which may involve degeneration of non-dopaminergic pathways leads to the expression of a range of non-motor symptoms from the prodromal stage of Parkinson’s to the palliative stage. Non-motor clinical subtypes, cognitive and non-cognitive, have now been proposed paving the way for possible subtype specific and non-motor treatments, a key unmet need currently. Natural history of these subtypes remains unclear and need to be defined. In addition to in vivo biomarkers which suggest variable involvement of the cholinergic and noradrenergic patterns of the Parkinson syndrome, abnormal alpha-synuclein accumulation have now been demonstrated in the gut, pancreas, heart, salivary glands, and skin suggesting that Parkinson’s is a multi-organ disorder. The Parkinson’s phenotype is thus not just a dopaminergic motor syndrome, but a dysfunctional multi-neurotransmitter pathway driven central and peripheral nervous system disorder that possibly ought to be considered a syndrome and not a disease.
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Affiliation(s)
- Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education, N.I. Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - C Padmakumar
- Parkinson's Disease Service for the Older Person, Rankin Park Centre, John Hunter Hospital, HNELHD, Newcastle, NSW, Australia
| | | | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, UK.
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, UK.
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119
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Gastrointestinal Dysfunctions in Parkinson's Disease: Symptoms and Treatments. PARKINSONS DISEASE 2016; 2016:6762528. [PMID: 28050310 PMCID: PMC5168460 DOI: 10.1155/2016/6762528] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/16/2016] [Indexed: 12/21/2022]
Abstract
A diagnosis of Parkinson's disease is classically established after the manifestation of motor symptoms such as rigidity, bradykinesia, and tremor. However, a growing body of evidence supports the hypothesis that nonmotor symptoms, especially gastrointestinal dysfunctions, could be considered as early biomarkers since they are ubiquitously found among confirmed patients and occur much earlier than their motor manifestations. According to Braak's hypothesis, the disease is postulated to originate in the intestine and then spread to the brain via the vagus nerve, a phenomenon that would involve other neuronal types than the well-established dopaminergic population. It has therefore been proposed that peripheral nondopaminergic impairments might precede the alteration of dopaminergic neurons in the central nervous system and, ultimately, the emergence of motor symptoms. Considering the growing interest in the gut-brain axis in Parkinson's disease, this review aims at providing a comprehensive picture of the multiple gastrointestinal features of the disease, along with the therapeutic approaches used to reduce their burden. Moreover, we highlight the importance of gastrointestinal symptoms with respect to the patients' responses towards medical treatments and discuss the various possible adverse interactions that can potentially occur, which are still poorly understood.
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120
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Chaudhuri KR, Bhidayasiri R, van Laar T. Unmet needs in Parkinson's disease: New horizons in a changing landscape. Parkinsonism Relat Disord 2016; 33 Suppl 1:S2-S8. [PMID: 27932224 DOI: 10.1016/j.parkreldis.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
The success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.
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Affiliation(s)
- K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital London, UK
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Teus van Laar
- Department of Neurology, University of Groningen, Groningen, The Netherlands
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121
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Non-oral dopaminergic therapies for Parkinson's disease: current treatments and the future. NPJ PARKINSONS DISEASE 2016; 2:16023. [PMID: 28725704 PMCID: PMC5516582 DOI: 10.1038/npjparkd.2016.23] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/07/2016] [Accepted: 08/25/2016] [Indexed: 12/30/2022]
Abstract
Dysfunction of the gastrointestinal tract has now been recognized to affect all stages of Parkinson’s disease (PD). The consequences lead to problems with absorption of oral medication, erratic treatment response, as well as silent aspiration, which is one of the key risk factors in developing pneumonia. The issue is further complicated by other gut abnormalities, such as small intestinal bacterial overgrowth (SIBO) and an altered gut microbiota, which occur in PD with variable frequency. Clinically, these gastrointestinal abnormalities might be associated with symptoms such as nausea, early-morning “off”, and frequent motor and non-motor fluctuations. Therefore, non-oral therapies that avoid the gastrointestinal system seem a rational option to overcome the problems of oral therapies in PD. Hence, several non-oral strategies have now been actively investigated and developed. The transdermal rotigotine patch, infusion therapies with apomorphine, intrajejunal levodopa, and the apomorphine pen strategy are currently in clinical use with a few others in development. In this review, we discuss and summarize the most recent developments in this field with a focus on non-oral dopaminergic strategies (excluding surgical interventions such as deep brain stimulation) in development or to be licensed for management of PD.
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122
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Rana M, Varan AQ, Davoudi A, Cohen RA, Sitaram R, Ebner NC. Real-Time fMRI in Neuroscience Research and Its Use in Studying the Aging Brain. Front Aging Neurosci 2016; 8:239. [PMID: 27803662 PMCID: PMC5067937 DOI: 10.3389/fnagi.2016.00239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/27/2016] [Indexed: 02/05/2023] Open
Abstract
Cognitive decline is a major concern in the aging population. It is normative to experience some deterioration in cognitive abilities with advanced age such as related to memory performance, attention distraction to interference, task switching, and processing speed. However, intact cognitive functioning in old age is important for leading an independent day-to-day life. Thus, studying ways to counteract or delay the onset of cognitive decline in aging is crucial. The literature offers various explanations for the decline in cognitive performance in aging; among those are age-related gray and white matter atrophy, synaptic degeneration, blood flow reduction, neurochemical alterations, and change in connectivity patterns with advanced age. An emerging literature on neurofeedback and Brain Computer Interface (BCI) reports exciting results supporting the benefits of volitional modulation of brain activity on cognition and behavior. Neurofeedback studies based on real-time functional magnetic resonance imaging (rtfMRI) have shown behavioral changes in schizophrenia and behavioral benefits in nicotine addiction. This article integrates research on cognitive and brain aging with evidence of brain and behavioral modification due to rtfMRI neurofeedback. We offer a state-of-the-art description of the rtfMRI technique with an eye towards its application in aging. We present preliminary results of a feasibility study exploring the possibility of using rtfMRI to train older adults to volitionally control brain activity. Based on these first findings, we discuss possible implementations of rtfMRI neurofeedback as a novel technique to study and alleviate cognitive decline in healthy and pathological aging.
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Affiliation(s)
- Mohit Rana
- Department of Psychiatry and Division of Neuroscience, School of Medicine, Pontificia Universidad Católica de ChileSantiago, Chile; Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Andrew Q Varan
- Department of Psychology, University of Florida Gainesville, FL, USA
| | - Anis Davoudi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida Gainesville, FL, USA
| | - Ronald A Cohen
- Center for Cognitive Aging and Memory, Institute on Aging, University of FloridaGainesville, FL, USA; Department of Aging and Geriatric Research, College of Medicine, University of FloridaGainesville, FL, USA
| | - Ranganatha Sitaram
- Department of Psychiatry and Division of Neuroscience, School of Medicine, Pontificia Universidad Católica de ChileSantiago, Chile; Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de ChileSantiago, Chile; Institute for Biological and Medical Engineering, Schools of Engineering, Biology and Medicine, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Natalie C Ebner
- Department of Psychology, University of FloridaGainesville, FL, USA; Center for Cognitive Aging and Memory, Institute on Aging, University of FloridaGainesville, FL, USA; Department of Aging and Geriatric Research, College of Medicine, University of FloridaGainesville, FL, USA
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123
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Fereshtehnejad SM. Strategies to maintain quality of life among people with Parkinson's disease: what works? Neurodegener Dis Manag 2016; 6:399-415. [PMID: 27600287 DOI: 10.2217/nmt-2016-0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Among chronic neurodegenerative disorders, Parkinson's disease (PD) is one of the most difficult and challenging to tackle as several motor and nonmotor features influence the patients' quality of life (QoL) and daily activities. Assessing patients QoL with valid instruments and gathering knowledge about the determinants that affect QoL in individuals with PD are the basis of an efficient caring strategy. In addition to the known motor symptoms, nonmotor disorders must also be comprehensively tracked and targeted for treatment to enhance QoL. A holistic strategy to maintain QoL in people with PD should consist of a multidisciplinary, personalized and patient-centered approach with timely administration of palliative care and efficient involvement of caregivers and family members.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences & Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal General Hospital, Montreal, Québec, Canada
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124
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Martinez-Ramirez D, Okun MS, Jaffee MS. Parkinson's disease psychosis: therapy tips and the importance of communication between neurologists and psychiatrists. Neurodegener Dis Manag 2016; 6:319-30. [PMID: 27408981 PMCID: PMC5066136 DOI: 10.2217/nmt-2016-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/03/2016] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a chronic and complex neurodegenerative disorder resulting in a mixture of motor and nonmotor symptoms. Psychosis develops in around 60% of PD patients during and can be one of the most challenging nonmotor symptoms. PD psychosis is considered the single greatest precipitant for nursing home placement. PD psychosis is an independent predictor of increased mortality, and there is no 'ideal' or universal treatment strategy. The treatment approach to PD psychosis should be tailored and individualized for each patient. In this review, we will discuss PD psychosis and provide practical treatment considerations for neurologists, psychiatrists and other healthcare professionals. We stress the importance of real-time communication between members of the healthcare team.
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Affiliation(s)
- Daniel Martinez-Ramirez
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA
| | - Michael S Okun
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA
| | - Michael S Jaffee
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA
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125
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Schrag A, Sauerbier A, Chaudhuri KR. New clinical trials for nonmotor manifestations of Parkinson's disease. Mov Disord 2016; 30:1490-504. [PMID: 26371623 DOI: 10.1002/mds.26415] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/22/2015] [Accepted: 08/03/2015] [Indexed: 11/07/2022] Open
Abstract
Nonmotor manifestations in Parkinson's disease (PD) encompass a range of clinical features, including neuropsychiatric problems, autonomic dysfunction, sleep disorders, fatigue, and pain. Despite their importance for patients' quality of life, the evidence base for their treatment is relatively sparse. Nevertheless, the last few years have seen a number of new trials starting that specifically address nonmotor features as an outcome measure in clinical trials. Large randomized, controlled trials in the last 3 years reported improvement of psychosis with the new selective serotonin 5-HT2A inverse agonist pimavanserin and of postural hypotension with the oral norepinephrine precursor droxidopa. Smaller new randomized, controlled trials support the effectiveness of Deep Brain Stimulation and opiates for pain, of rivastigmine for apathy and piribedil for apathy post-DBS, group cognitive behavioral therapy for depression and/or anxiety, continuous positive airway pressure for sleep apnea in PD and doxepin for insomnia, and of solifenacin succinate and transcutaneous tibial nerve stimulation for urinary symptoms. A number of new smaller or open trials as well as post-hoc analyses of randomized, controlled trials have suggested usefulness of other treatments, and new randomized, controlled trials are currently ongoing.
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Affiliation(s)
- Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, United Kingdom
| | - Anna Sauerbier
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
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126
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Arnhold M, Dening Y, Chopin M, Arévalo E, Schwarz M, Reichmann H, Gille G, Funk RHW, Pan-Montojo F. Changes in the sympathetic innervation of the gut in rotenone treated mice as possible early biomarker for Parkinson's disease. Clin Auton Res 2016; 26:211-22. [PMID: 27178445 PMCID: PMC4877429 DOI: 10.1007/s10286-016-0358-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/02/2016] [Indexed: 12/21/2022]
Abstract
Introduction Involvement of the peripheral nervous system (PNS) is relatively common in Parkinson’s disease (PD) patients. PNS alterations appear early in the course of the disease and are responsible for some of the non-motor symptoms observed in PD patients. In previous studies, we have shown that environmental toxins can trigger the disease by acting on the enteric nervous system. Material and methods Here, we analyzed the effect of mitochondrial Complex I inhibition on sympathetic neuritis in vivo and sympathetic neurons in vitro. Combining in vivo imaging and protein expression profiling. Results we found that rotenone, a widely used mitochondrial Complex I inhibitor decreases the density of sympathetic neurites innervating the gut in vivo, while in vitro, it induces the redistribution of intracellular alpha-synuclein and neurite degeneration. Interestingly, sympathetic neurons are much more resistant to rotenone exposure than mesencephalic dopaminergic neurons. Conclusion Altogether, these results suggest that enteric sympathetic denervation could be an initial pre-motor alteration in PD progression that could be used as an early biomarker of the disease. Electronic supplementary material The online version of this article (doi:10.1007/s10286-016-0358-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mike Arnhold
- Klinik und Poliklinik für Neurologie, Uniklinikum Carl-Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Yanina Dening
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Munich Cluster for Systems Neurology, Munich, Germany
| | - Michaël Chopin
- The Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Esteban Arévalo
- Institut für Anatomie, TU-Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Mathias Schwarz
- Institut für Anatomie, TU-Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Heinz Reichmann
- Klinik und Poliklinik für Neurologie, Uniklinikum Carl-Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
- Center for Regenerative Therapies Dresden, Tatzberg 47/49, 01307, Dresden, Germany
| | - Gabriele Gille
- Klinik und Poliklinik für Neurologie, Uniklinikum Carl-Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Richard H W Funk
- Institut für Anatomie, TU-Dresden, Fetscherstr. 74, 01307, Dresden, Germany
- Center for Regenerative Therapies Dresden, Tatzberg 47/49, 01307, Dresden, Germany
| | - Francisco Pan-Montojo
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
- Munich Cluster for Systems Neurology, Munich, Germany.
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127
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van Vliet LM, Gao W, DiFrancesco D, Crosby V, Wilcock A, Byrne A, Al-Chalabi A, Chaudhuri KR, Evans C, Silber E, Young C, Malik F, Quibell R, Higginson IJ. How integrated are neurology and palliative care services? Results of a multicentre mapping exercise. BMC Neurol 2016; 16:63. [PMID: 27165157 PMCID: PMC4862117 DOI: 10.1186/s12883-016-0583-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients affected by progressive long-term neurological conditions might benefit from specialist palliative care involvement. However, little is known on how neurology and specialist palliative care services interact. This study aimed to map the current level of connections and integration between these services. METHODS The mapping exercise was conducted in eight centres with neurology and palliative care services in the United Kingdom. The data were provided by the respective neurology and specialist palliative care teams. Questions focused on: i) catchment and population served; ii) service provision and staffing; iii) integration and relationships. RESULTS Centres varied in size of catchment areas (39-5,840 square miles) and population served (142,000-3,500,000). Neurology and specialist palliative care were often not co-terminus. Service provisions for neurology and specialist palliative care were also varied. For example, neurology services varied in the number and type of provided clinics and palliative care services in the settings they work in. Integration was most developed in Motor Neuron Disease (MND), e.g., joint meetings were often held, followed by Parkinsonism (made up of Parkinson's Disease (PD), Multiple-System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP), with integration being more developed for MSA and PSP) and least in Multiple Sclerosis (MS), e.g., most sites had no formal links. The number of neurology patients per annum receiving specialist palliative care reflected these differences in integration (range: 9-88 MND, 3-25 Parkinsonism, and 0-5 MS). CONCLUSIONS This mapping exercise showed heterogeneity in service provision and integration between neurology and specialist palliative care services, which varied not only between sites but also between diseases. This highlights the need and opportunities for improved models of integration, which should be rigorously tested for effectiveness.
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Affiliation(s)
- Liesbeth M van Vliet
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Daniel DiFrancesco
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Anthony Byrne
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, Institute of Psychiatry, Psychology & Neuroscience London, London, UK
| | - K Ray Chaudhuri
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,King's College London, National Parkinson Foundation International Centre of Excellence, London, UK
| | - Catherine Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Trust, Brighton, UK
| | - Eli Silber
- King's College Hospital NHS Foundation Trust, London, UK
| | - Carolyn Young
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Farida Malik
- St Wilfrids Hospice, Eastbourne, UK.,East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Rachel Quibell
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, UK.
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Bostantjopoulou S, Katsarou Z, Danglis I, Karakasis H, Milioni D, Falup-Pecurariu C. Self-reported autonomic symptoms in Parkinson's disease: properties of the SCOPA-AUT scale. Hippokratia 2016; 20:115-120. [PMID: 28416907 PMCID: PMC5388511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIM Autonomic symptoms in Parkinson's disease (PD) are very common and contribute to the severity of patient's disability. We evaluated the occurrence of autonomic symptoms in Greek patients with PD utilizing the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire (SCOPA-AUT), a specific 23-item self-completed questionnaire for the assessment of autonomic dysfunction in patients with PD. SUBJECTS AND METHODS One hundred and sixty-one PD patients and forty matched controls were enrolled in the study. Clinical assessment was performed with the Hoehn and Yahr scale. Patients completed a demographic questionnaire, the Non-Motor Symptoms Questionnaire (NMSQuest), the Parkinson's Disease Questionnaire (PDQ-39) and the SCOPA-AUT scale which was properly translated into Greek and validated for the study. RESULTS SCOPA-AUT scale showed a good reliability profile and correlated well with other measures for non-motor symptoms and health-related quality measures in PD patients. PD patients scored higher than controls in the total SCOPA -AUT score (mean score 11.9 versus 6.4). Patients reported problems in many items of the SCOPA-AUT, but the most common autonomic symptoms emerged in the Urinary and the Gastrointestinal domains. Especially sialorrhea, constipation, straining for defecation, incontinence and nocturia differentiated patients from controls. Furthermore, mean total SCOPA-AUT score correlated with duration and severity of the disease. CONCLUSION Autonomic symptoms in PD are too important to remain undetected. By incorporating into everyday practice the use of suitable and reliable questionnaires, physicians will be able to adequately detect and manage these symptoms. Hippokratia 2016, 20(2):115-120.
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Affiliation(s)
- S Bostantjopoulou
- 3 Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Z Katsarou
- Department of Neurology, Hippokration Hospital, Thessaloniki, Greece
| | - I Danglis
- 3 Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Karakasis
- 3 Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Milioni
- 3 Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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129
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Rana AQ, Ahmed US, Chaudry ZM, Vasan S. Parkinson's disease: a review of non-motor symptoms. Expert Rev Neurother 2016; 15:549-62. [PMID: 25936847 DOI: 10.1586/14737175.2015.1038244] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder resulting from degeneration of the substantia nigra and the dopaminergic nigrostriatal pathway. Most treatments are geared toward the management and relief of motor symptoms in Parkinson's patients; however, as the disease progresses, various complications can be observed. Non-motor symptoms (NMS) may arise simply from the disease itself and are highly destructive to quality of life. These symptoms include mood disorders, cognitive dysfunction, pain, sensory dysfunction, and dysautonomia. Though it is undisputed that many NMS may appear years or even decades prior to the clinical diagnosis of PD, the focus of this review will be the overt motor phase of the condition. As such, the focus of this paper is to review the major NMS found in PD patients status post-diagnosis, their etiology, as well as treatment options available for the individual NMS.
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Affiliation(s)
- Abdul Qayyum Rana
- Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre, Toronto, Ontario, Canada
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130
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Akhtar RS, Xie SX, Brennan L, Pontecorvo MJ, Hurtig HI, Trojanowski JQ, Weintraub D, Siderowf AD. Amyloid-Beta Positron Emission Tomography Imaging of Alzheimer's Pathology in Parkinson's Disease Dementia. Mov Disord Clin Pract 2016; 3:367-375. [PMID: 27500181 DOI: 10.1002/mdc3.12290] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neuronal loss and α-synuclein (α-syn) pathology are diagnostic of PD in the appropriate clinical context. However, some PD patients have co-morbid Alzheimer's disease (AD) pathology on autopsy, including amyloid-β (Aβ) plaques and neurofibrillary tangles. Florbetapir(18F) is a PET ligand that detects Aβ pathology. We hypothesized that florbetapir(18F) imaging could detect Aβ pathology in Parkinson disease dementia (PDD) patients prior to death. OBJECTIVE To determine the utility of florbetapir(18F) PET imaging in detecting Aβ pathology in patients with autopsy-confirmed PDD. METHODS Five participants with PDD had florbetapir(18F) PET imaging prior to death as a part of a longitudinal research study of cognitive decline in PD. PET scans were evaluated by expert raters blinded to clinical and neuropathological information. At autopsy, all five participants underwent semi-quantitative assessments of regional Aβ and tau immunohistochemistry. RESULTS All participants met neuropathological criteria for PD. Two had both positive florbetapir(18F) scans and Aβ-positive plaques in multiple brain regions. Regional florbetapir(18F) binding correlated with regional semi-quantitative Aβ pathology in these cases. Three cases had negative florbetapir(18F) scans. Two of these had significant tau pathology without Aβ pathology, consistent with progressive supranuclear palsy (PSP) in one case and argyrophilic grain disease (AGD) in the other. The last case had a low level of AD neuropathological change. CONCLUSIONS Florbetapir(18F) Aβ imaging can detect the presence of Aβ neuropathology in patients with PDD. This imaging technique may aid the clinical evaluation of PDD patients to determine if cognitive decline is occurring in the setting of Aβ accumulation.
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Affiliation(s)
- Rizwan S Akhtar
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA; Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA
| | - Laura Brennan
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA; Department of Psychiatry, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA
| | | | - Howard I Hurtig
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA; Department of Psychiatry, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA
| | - Andrew D Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-3339, USA; Avid Radiopharmaceuticals, Philadelphia, PA 19104, USA
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131
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Sauerbier A, Jenner P, Todorova A, Chaudhuri KR. Non motor subtypes and Parkinson's disease. Parkinsonism Relat Disord 2016; 22 Suppl 1:S41-6. [DOI: 10.1016/j.parkreldis.2015.09.027] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
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132
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Kwon DY, Koh SB, Lee JH, Park HK, Kim HJ, Shin HW, Youn J, Park KW, Choi SA, Kim SJ, Choi SM, Park JY, Jeon BS, Kim JY, Chung SJ, Lee CS, Park JH, Ahn TB, Kim WC, Kim HS, Cheon SM, Kim HT, Lee JY, Kim JS, Kim EJ, Kim JM, Lee KS, Kim JS, Kim MJ, Baik JS, Park KJ, Kim HJ, Park MY, Kang JH, Song SK, Kim YD, Yun JY, Lee HW, Oh HG, Cho J, Song IU, Sohn YH, Lee PH, Kim JW. The KMDS-NATION Study: Korean Movement Disorders Society Multicenter Assessment of Non-Motor Symptoms and Quality of Life in Parkinson's Disease NATION Study Group. J Clin Neurol 2016; 12:393-402. [PMID: 27819413 PMCID: PMC5063863 DOI: 10.3988/jcn.2016.12.4.393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 02/03/2023] Open
Abstract
Background and Purpose Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. Methods We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. Results In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. Conclusions The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.
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Affiliation(s)
- Do Young Kwon
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Seong Beom Koh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Kyung Park
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Han Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kun Woo Park
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Sun Ah Choi
- Department of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Sang Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Seong Min Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Yun Park
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Beom S Jeon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Neurology, College of Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, University of Ulsan College of Medicine, Asan Hospital, Seoul, Korea
| | - Chong Sik Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Hospital, Seoul, Korea
| | - Jeong Ho Park
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Tae Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Won Chan Kim
- Department of Neurology, CHA University College of Medicine, Seongnam, Korea
| | - Hyun Sook Kim
- Department of Neurology, CHA University College of Medicine, Seongnam, Korea
| | - Sang Myung Cheon
- Department of Neurology, Dong-A University Medical Centre, Busan, Korea
| | - Hee Tae Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jee Young Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Ji Sun Kim
- Department of Neurology, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Daejeon, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Jong Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Jeong Kim
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Jong Sam Baik
- Department of Neurology, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Ki Jong Park
- Department of Neurology, Gyeongsang National University School of Medicine, Busan, Korea
| | - Hee Jin Kim
- Department of Neurology, Konkuk University School of Medicine, Daejeon, Korea
| | - Mee Young Park
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji Hoon Kang
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Sook Kun Song
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Yong Duk Kim
- Department of Neurology, Konyang University Hospital, Daejeon, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ho Won Lee
- Department of Neurology, School of Medicine, Kyungpook National Univeristy, Daegu, Korea
| | - Hyung Geun Oh
- Department of Neurology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Jinwhan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Uk Song
- Department of Neurology, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University Medical Centre, Busan, Korea.
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Băjenaru O, Ene A, Popescu BO, Szász JA, Sabău M, Mureşan DF, Perju-Dumbrava L, Popescu CD, Constantinescu A, Buraga I, Simu M. The effect of levodopa-carbidopa intestinal gel infusion long-term therapy on motor complications in advanced Parkinson's disease: a multicenter Romanian experience. J Neural Transm (Vienna) 2015; 123:407-14. [PMID: 26699635 PMCID: PMC4805768 DOI: 10.1007/s00702-015-1496-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
Chronic treatment with oral levodopa is associated with an increased frequency of motor complications in the late stages of Parkinson’s disease (PD). Continuous administration of levodopa–carbidopa intestinal gel (LCIG—Duodopa®, Abbott Laboratories), which has been available in Romania since 2009, represents an option for treating patients with advanced PD. Our primary objective was to report changes in motor complications after initiation of LCIG therapy. The secondary objectives were as follows: to determine the impact of LCIG therapy on the daily levodopa dose variation before/and after LCIG, to collect patient self-assessments of quality of life (QoL), and to study the overall tolerability and safety of LCIG administration. A retrospective analysis (2009–2013) of LCIG therapy and the experience in nine neurology centers in Romania was performed. The impact of LCIG therapy was evaluated by analyzing changes in motor fluctuations, dyskinesia and the patients’ QoL after initiating therapy. The safety of LCIG therapy was estimated by noting agent-related adverse events (AEs) and medical device-related AEs. In the 113 patients included, we observed a significant improvement in PD symptoms after initiation of LCIG therapy. The “on” period increased, with a mean value of 6.14 h, and the dyskinesia period was reduced, with a mean value of 29.4 %. The quantified non-motor symptoms subsided. The patients exhibited significant improvements in QoL scores. There were few AEs and few cases of LCIG therapy discontinuation. LCIG is an important and available therapeutic option for managing patients with advanced PD.
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Affiliation(s)
- O Băjenaru
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, University Emergency Hospital Bucharest, 169 Splaiul Independentei, Sector 5, Bucharest, Romania
| | - A Ene
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, University Emergency Hospital Bucharest, 169 Splaiul Independentei, Sector 5, Bucharest, Romania
| | - B O Popescu
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Colentina Hospital, 19-21 Stefan cel Mare Street, Sector 2, 020125, Bucharest, Romania
| | - J A Szász
- Department of Neurology, University of Medicine and Pharmacy Targu Mures, 38 Gh Marinescu Street, 540139, Targu Mures, Mures, Romania
| | - M Sabău
- Department of Neurology, Emergency Clinical Hospital Oradea, 65 Gh Doja Street, 410169, Oradea, Bihor, Romania
| | - D F Mureşan
- Department of Neurology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj County Hospital, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - L Perju-Dumbrava
- Department of Neurology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj County Hospital, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - C D Popescu
- Neurology Rehabilitation Department, University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661, Iasi, Romania
| | - A Constantinescu
- Neurology Rehabilitation Department, University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661, Iasi, Romania
| | - I Buraga
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Colentina Hospital, 19-21 Stefan cel Mare Street, Sector 2, 020125, Bucharest, Romania
| | - M Simu
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes," Timisoara County Hospital, 10 Iosif Bulbuca Street, 300736, Timisoara, Timis, Romania.
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134
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Robinson SJ, Petzer JP, Terre'Blanche G, Petzer A, van der Walt MM, Bergh JJ, Lourens ACU. 2-Aminopyrimidines as dual adenosine A1/A2A antagonists. Eur J Med Chem 2015; 104:177-88. [PMID: 26462195 DOI: 10.1016/j.ejmech.2015.09.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022]
Abstract
In this study thirteen 2-aminopyrimidine derivatives were synthesised and screened as potential antagonists of adenosine A1 and A2A receptors in order to further investigate the structure activity relationships of this class of compounds. 4-(5-Methylfuran-2-yl)-6-[3-(piperidine-1-carbonyl)phenyl]pyrimidin-2-amine (8m) was identified as a compound with high affinities for both receptors, with an A2AKi value of 6.34 nM and an A1Ki value of 9.54 nM. The effect of selected compounds on the viability of cultured cells was assessed and preliminary results indicate low cytotoxicity. In vivo efficacy at A2A receptors was illustrated for compounds 8k and 8m since these compounds attenuated haloperidol-induced catalepsy in rats. A molecular docking study revealed that the interactions between the synthesised compounds and the adenosine A2A binding site most likely involve Phe168 and Asn253, interactions which are similar for structurally related adenosine A2A receptor antagonists.
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Affiliation(s)
- Sarel J Robinson
- Pharmaceutical Chemistry, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa; Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Jacobus P Petzer
- Pharmaceutical Chemistry, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa; Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Gisella Terre'Blanche
- Pharmaceutical Chemistry, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa; Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Anél Petzer
- Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Mietha M van der Walt
- Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Jacobus J Bergh
- Pharmaceutical Chemistry, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa; Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Anna C U Lourens
- Pharmaceutical Chemistry, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa; Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
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135
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Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease. Brain Stimul 2015; 9:78-85. [PMID: 26385442 DOI: 10.1016/j.brs.2015.08.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design so far. However, these are only a part of the non-motor symptoms spectrum. HYPOTHESIS We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. METHODS In this multicenter, open, prospective, international study (EuroInf-study, UKCRN10084/DRKS00006735) we investigated non-motor effects of STN-DBS in "real-life" use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.6 ± 7.8 years, mean disease duration: 10.4 ± 4.2 years). RESULTS All outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p = 0.006; activities of daily living, p = 0.012; all others, p < 0.001; Wilcoxon signed-rank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Non-motor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p ≤ 0.001), perceptual problems/hallucinations (p = 0.036), and urinary (p = 0.018) scores. Effect sizes were "moderate" for Non-motor Symptom Scale, and motor complications, "large" for motor examination, and "small" for other outcomes. CONCLUSIONS This study provides evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other invasive therapies of advanced PD.
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136
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Dagur G, Warren K, Schwamb R, Dalpiaz A, Gandhi J, Khan S. Neuro-urological manifestations of Parkinson's disease. Int J Neurosci 2015; 126:481-487. [DOI: 10.3109/00207454.2015.1048548] [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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137
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Zis P, Martinez-Martin P, Sauerbier A, Rizos A, Sharma JC, Worth PF, Sophia R, Silverdale M, Chaudhuri KR. Non-motor symptoms burden in treated and untreated early Parkinson's disease patients: argument for non-motor subtypes. Eur J Neurol 2015; 22:1145-50. [DOI: 10.1111/ene.12733] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Zis
- National Parkinson Foundation International Centre of Excellence; King's College Hospital NHS Foundation Trust; London UK
| | - P. Martinez-Martin
- National Centre of Epidemiology and Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED); Carlos III Institute of Health; Madrid Spain
| | - A. Sauerbier
- National Parkinson Foundation International Centre of Excellence; King's College Hospital NHS Foundation Trust; London UK
- King's College London; London
| | - A. Rizos
- National Parkinson Foundation International Centre of Excellence; King's College Hospital NHS Foundation Trust; London UK
| | - J. C. Sharma
- United Lincolnshire Hospitals NHS Trust; Lincoln UK
| | | | - R. Sophia
- Yeovil Hospital NHS Foundation Trust; Somerset UK
| | | | - K. Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence; King's College Hospital NHS Foundation Trust; London UK
- King's College London; London
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138
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Joutsa J, Johansson J, Seppänen M, Noponen T, Kaasinen V. Dorsal-to-Ventral Shift in Midbrain Dopaminergic Projections and Increased Thalamic/Raphe Serotonergic Function in Early Parkinson Disease. J Nucl Med 2015; 56:1036-41. [PMID: 25952735 DOI: 10.2967/jnumed.115.153734] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/25/2015] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED Loss of nigrostriatal neurons leading to dopamine depletion in the dorsal striatum is the pathologic hallmark of Parkinson disease contributing to the primary motor symptoms of the disease. However, Parkinson pathology is more widespread in the brain, affecting also other dopaminergic pathways and neurotransmitter systems, but these changes are less well characterized. This study aimed to investigate the mesencephalic striatal and extrastriatal dopaminergic projections together with extrastriatal serotonin transporter binding in Parkinson disease. METHODS Two hundred sixteen patients with Parkinson disease and 204 control patients (patients without neurodegenerative parkinsonism syndromes and normal SPECT imaging) were investigated with SPECT using the dopamine/serotonin transporter ligand (123)I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane ((123)I-FP-CIT) in the clinical setting. The group differences and midbrain correlations were analyzed voxel by voxel over the entire brain. RESULTS We found that Parkinson patients had lower (123)I-FP-CIT uptake in the striatum and ventral midbrain but higher uptake in the thalamus and raphe nuclei than control patients. In patients with Parkinson disease, the correlation of the midbrain tracer uptake was shifted from the putamen to widespread corticolimbic areas. All findings were highly significant at the voxel level familywise error-corrected P value of less than 0.05. CONCLUSION Our findings show that Parkinson disease is associated not only with the degeneration of the nigrostriatal dopamine neurotransmission, but also with a parallel shift toward mesolimbic and mesocortical function. Furthermore, Parkinson disease patients seem to have upregulation of brain serotonin transporter function at the early phase of the disease.
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Affiliation(s)
- Juho Joutsa
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland; and
| | - Jarkko Johansson
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tommi Noponen
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Valtteri Kaasinen
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
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139
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140
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Jenner P. Treatment of the later stages of Parkinson's disease - pharmacological approaches now and in the future. Transl Neurodegener 2015; 4:3. [PMID: 25973178 PMCID: PMC4429454 DOI: 10.1186/2047-9158-4-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/01/2015] [Indexed: 11/10/2022] Open
Abstract
The problems associated with the pharmacological treatment of the later stages of Parkinson's disease (PD) remain those seen over many years. These centre on a loss of drug effect ('wearing off') with disease progression, the occurrence of dyskinesia, notably with L-dopa use and the appearance of non-motor symptoms that are largely refractory to dopaminergic medication. Treatment strategies in late PD have been dominated by the use of drug combinations and the subtle manipulation of drug dosage. However, change is occurring as the understanding of the basis of motor complications and fluctuations and non-motor symptoms improves. New pharmacological options are expanding with the advent of longer acting versions of existing dopaminergic drugs, new drug delivery systems and the introduction of non-dopaminergic agents able to manipulate motor function both within the basal ganglia and in other brain regions. Non-dopaminergic agents are also being investigated for the treatment of dyskinesia and for the relief of non-motor symptoms. However, while therapy continues to improve, the treatment of late stage PD remains problematic with non-motor symptoms dominating the unmet need in this patient group.
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Affiliation(s)
- Peter Jenner
- Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Sciences, Faculty of Health Sciences and Medicine, King's College, London, SE1 1UL UK
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Erro R, Picillo M, Amboni M, Moccia M, Vitale C, Longo K, Pellecchia MT, Santangelo G, Martinez‐Martin P, Ray Chaudhuri K, Barone P. Nonmotor predictors for levodopa requirement in de novo patients with Parkinson's disease. Mov Disord 2015; 30:373-8. [DOI: 10.1002/mds.26076] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 09/01/2014] [Accepted: 09/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of Neurology London United Kingdom
- Dipartimento di Scienze Neurologiche e del MovimentoUniversità di VeronaPoliclinico Borgo Roma Verona Italy
| | - Marina Picillo
- University of Naples “Federico II”Department of Neurological Science Naples Italy
| | | | - Marcello Moccia
- University of Naples “Federico II”Department of Neurological Science Naples Italy
| | - Carmine Vitale
- IDC Hermitage–Capodimonte Naples Italy
- University of Naples “Parthenope”Department of Motor Sciences Naples Italy
| | | | | | - Gabriella Santangelo
- IDC Hermitage–Capodimonte Naples Italy
- Neuropsychology Laboratory, Department of PsychologySecond University of Naples Caserta Italy
| | - Pablo Martinez‐Martin
- Alzheimer Center Reina Sofia Foundation Madrid Spain
- CIBERNED, Carlos III Institute of Health Madrid Spain
| | - K. Ray Chaudhuri
- National Parkinson Foundation International Center of ExcellenceKings College Hospital, Kings College London United Kingdom
| | - Paolo Barone
- University of Salerno, Center for Neurodegenerative Diseases–CEMAND Salerno Italy
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Aquino CC, Fox SH. Clinical spectrum of levodopa-induced complications. Mov Disord 2014; 30:80-9. [PMID: 25488260 DOI: 10.1002/mds.26125] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/20/2014] [Accepted: 11/24/2014] [Indexed: 12/20/2022] Open
Abstract
The first years of Parkinson disease (PD) treatment are marked by good and sustained responses to dopaminergic therapy. With disease progression and longer exposure to levodopa (l-dopa), patients develop a range of l-dopa-induced complications that include motor and non-motor symptoms. Motor complications include motor fluctuations, characterized by periods of reduced benefit from the medication, and l-dopa-induced dyskinesia, characterized by emergence of hyperkinetic involuntary movements. Dyskinesia can occur at peak effect of l-dopa, at the beginning and end of dose, or between doses. These motor complications are often associated with fluctuations in non-motor symptoms, particularly fluctuations in neuropsychiatric, autonomic, and sensory symptoms. Recognizing such complications and understanding their relationship with the timing of l-dopa doses is essential for adequate diagnosis and management. Society.
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Affiliation(s)
- Camila Catherine Aquino
- Movement Disorder Centre, Edmond J Safra Program in Parkinson Research, Toronto Western Hospital, University of Toronto, Canada
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