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Elbaz A, Carcaillon L, Kab S, Moisan F. Epidemiology of Parkinson's disease. Rev Neurol (Paris) 2016; 172:14-26. [DOI: 10.1016/j.neurol.2015.09.012] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 12/25/2022]
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152
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Szeto JYY, Lewis SJG. Current Treatment Options for Alzheimer's Disease and Parkinson's Disease Dementia. Curr Neuropharmacol 2016; 14:326-38. [PMID: 26644155 PMCID: PMC4876589 DOI: 10.2174/1570159x14666151208112754] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/16/2015] [Accepted: 10/09/2015] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders encountered in clinical practice. Whilst dementia has long been synonymous with AD, it is becoming more widely accepted as part of the clinical spectrum in PD (PDD). Neuropsychiatric complications, including psychosis, mood and anxiety disorders, and sleep disorders also frequently co-exist with cognitive dysfunctions in AD and PDD patients. The incidence of such symptoms is often a significant source of disability, and may aggravate pre-existing cognitive deficits. Management of AD and PDD involves both pharmacological and non-pharmacological measures. Although research on pharmacological therapies for AD and PDD has so far had some success in terms of developing symptomatic treatments, the benefits are often marginal and non-sustained. These shortcomings have led to the investigation of non-pharmacological and novel treatments for both AD and PD. Furthermore, in light of the diverse constellation of other neuropsychiatric, physical, and behavioural symptoms that often occur in AD and PD, consideration needs to be given to the potential side effects of pharmacological treatments where improving one symptom may lead to the worsening of another, rendering the clinical management of these patients challenging. Therefore, the present article will critically review the evidence for both pharmacological and non-pharmacological treatments for cognitive impairment in AD and PD patients. Treatment options for other concomitant neuropsychiatric and behavioural symptoms, as well as novel treatment strategies will also be discussed.
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Affiliation(s)
| | - Simon J G Lewis
- Brain & Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, New South Wales, Australia.
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153
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Cash TV, Lageman SK. Randomized controlled expressive writing pilot in individuals with Parkinson's disease and their caregivers. BMC Psychol 2015; 3:44. [PMID: 26621025 PMCID: PMC4666161 DOI: 10.1186/s40359-015-0101-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Parkinson’s disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers. Methods Individuals with PD (N = 27) and their caregivers (N = 14) were randomly assigned to expressive (N = 15 patients, eight caregivers) or neutral (N = 12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention. Results Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions. Conclusions Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population. Trial registration ClinicalTrials.gov, NCT02217735, Study Start Date: August 30, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s40359-015-0101-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Therese Verkerke Cash
- Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. .,Department of Psychology, Virginia Commonwealth University, Richmond, USA.
| | - Sarah K Lageman
- Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. .,Department of Neurology, Virginia Commonwealth University, Richmond, USA.
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154
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Orgeta V, McDonald KR, Poliakoff E, Hindle JV, Clare L, Leroi I. Cognitive training interventions for dementia and mild cognitive impairment in Parkinson’s Disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vasiliki Orgeta
- University College London; Division of Psychiatry; 6th Floor, Maple House, 149 Tottenham Court Road, London UK W1T 7NF
| | - Kathryn R McDonald
- University of Manchester; Institute of Brain, Behaviour and Mental Health; 3.306, Jean McFarlane Building, Oxford Road Manchester UK M13 9PL
| | - Ellen Poliakoff
- School of Psychological Sciences; University of Manchester Manchester UK M13 9PL
| | - John Vincent Hindle
- Llandudno Hospital, Betsi Cadwaladr University Health Board; Care of the Elderly Department; Hospital Road Llandudno Conwy UK LL30 1LB
| | - Linda Clare
- University of Exeter; REACH: The Centre for Research in Ageing and Cognitive Health; Perry Road Exeter UK EX4 4QG
| | - Iracema Leroi
- University of Manchester and Manchester Mental Health and Social Care Trust; Institute of Brain, Behaviour and Mental Health; 3rd Floor, Jean McFarlane Building Oxford Road Manchester UK M13 9PL
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155
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Shakeri J, Chaghazardi M, Abdoli N, Arman F, Hoseini SD, Shakeri H. Disease-Related Variables and Depression Among Iranian Patients with Parkinson Disease. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e30246. [PMID: 26568863 PMCID: PMC4636748 DOI: 10.5812/ircmj.30246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/20/2015] [Accepted: 07/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The factors affecting the correlation between Parkinson disease (PD) and depression have remained unclear. OBJECTIVES We assessed the prevalence of depression among patients with PD and the association between PD-related variables and depression severity. PATIENTS AND METHODS This is a cross-sectional study performed in Kermanshah Province of Iran. Sampling was based on recruitment of subjects according to inclusion and exclusion criteria. Patients with confirmed Parkinson disease who were referred to clinics of Kermanshah University of Medical Sciences participated in this study. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Clinical characteristics of PD, including tremor, rigidity, impaired posture, loss of autonomic movement, changes in speech and handwriting, masked face, and hyposmia were indexed. Anhedonia was assessed with Farsi version of Snaith-Hamilton Pleasure Scale. Data were collected between April 2010 and March 2014. RESULTS A total of 350 patients (52.9% men and 47.1% women) participated in this investigation. Female gender (36.5% in women vs. 13.0% in men, P < 0.0001), impaired posture (27.2% in affected individuals vs. 18.8%, P = 0.002), masked face (39.0% vs. 5.2%, P < 0.0001), and hyposmia (48.7% vs. 21.0%, P = 0.001) were associated with higher susceptibility to profound depression. Lower scores of all domains of Farsi version of Snaith-Hamilton Pleasure Scale (including interest/pastimes, social interaction, sensory experience, and food/drink) were related to more severe depression (P < 0.0001 for all subscales). Severe and profound depression was found in 44% of the participants. CONCLUSIONS This study estimated that the prevalence of major depression among Iranian individuals with PD living in Kermanshah as 44%. Major determinants of depression were female gender, rigidity, impaired posture, masked face, hyposmia, and anhedonia.
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Affiliation(s)
- Jalal Shakeri
- Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Maryam Chaghazardi
- Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Nasrin Abdoli
- Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Farid Arman
- Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Seyed Davood Hoseini
- Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Hania Shakeri
- Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Author: Hania Shakeri, Psychiatry Department, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-8314274618, Fax: +98-8318264163, E-mail:
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156
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Pal G, Robertson E, O'Keefe J, Hall D. The Neuropsychiatric and Motor Profile of GBA-Associated Parkinson's Disease: A Review. Mov Disord Clin Pract 2015; 3:4-8. [PMID: 30363594 DOI: 10.1002/mdc3.12229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 06/25/2015] [Indexed: 01/15/2023] Open
Abstract
Background Cognitive and motor decline, along with psychiatric symptoms, have a major impact on independence, nursing home admission, caregiver burden, and mortality in Parkinson's disease (PD). The single most common genetic risk factor for developing PD is a mutation in the glucocerebrosidase (GBA) gene. Methods This work is a literature review regarding "GBA" and "Parkinson's disease" as conducted by PubMed search. Results There is a higher prevalence of cognitive decline and more rapid trajectory of disease progression in PD-GBA carriers, compared to noncarriers. PD-GBA carriers also have domain-specific cognitive impairment, particularly in visual memory tasks. PD-GBA carriers may also have a more aggressive motor phenotype than noncarriers. Conclusions Early identification of PD-GBA carriers may lead to targeted therapies and development of new treatments.
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Affiliation(s)
- Gian Pal
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Erin Robertson
- Department of Anatomy & Cell Biology Rush University Chicago Illinois USA
| | - Joan O'Keefe
- Department of Anatomy & Cell Biology Rush University Chicago Illinois USA
| | - Deborah Hall
- Department of Neurological Sciences Rush University Chicago Illinois USA
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Cummings J, Friedman JH, Garibaldi G, Jones M, Macfadden W, Marsh L, Robert PH. Apathy in Neurodegenerative Diseases: Recommendations on the Design of Clinical Trials. J Geriatr Psychiatry Neurol 2015; 28:159-73. [PMID: 25809634 DOI: 10.1177/0891988715573534] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/08/2014] [Indexed: 12/18/2022]
Abstract
Apathy is a common feature of neurodegenerative disorders but is difficult to study in a clinical trial setting due to practical and conceptual barriers. Principal challenges include a paucity of data regarding apathy in these disorders, an absence of established diagnostic criteria, the presence of confounding factors (eg, coexisting depression), use of concomitant medications, and an absence of a gold-standard apathy assessment scale. Based on a literature search and ongoing collaboration among the authors, we present recommendations for the design of future clinical trials of apathy, suggesting Alzheimer disease and Parkinson disease as models with relevance across a wider array of neuropsychiatric disorders. Recommendations address clarification of the targeted study population (apathy diagnosis and severity at baseline), confounding factors (mood/cognition, behavior, and treatment), outcome measures, study duration, use of comparators and considerations around environment, and the role of the caregiver and patient assent. This review contributes to the search for an optimal approach to study treatment of apathy in neuropsychiatric disorders.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Joseph H Friedman
- Department of Neurology, Movement Disorders Program, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - George Garibaldi
- Clinical Development, Neurosciences, F. Hoffman-La Roche AG, Basel, Switzerland
| | - Martin Jones
- Bridge Medical Consulting Ltd, London, United Kingdom
| | - Wayne Macfadden
- Clinical Development, Neurosciences, F. Hoffman-La Roche AG, Basel, Switzerland
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippe H Robert
- CoBTeK, Research Memory Center CMRR CHU, University of Sophia Antipolis, Nice, France
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158
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Informal caregivers of clients with neurological conditions: profiles, patterns and risk factors for distress from a home care prevalence study. BMC Health Serv Res 2015; 15:350. [PMID: 26315104 PMCID: PMC4552273 DOI: 10.1186/s12913-015-1010-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/18/2015] [Indexed: 12/13/2022] Open
Abstract
Background Individuals living in the community with neurological conditions receive the majority of their care from informal caregivers. The purpose of this project was to provide a profile of caregivers of home care clients with neurological conditions. The study also examined prevalence of caregiver distress and the association between neurological conditions and other client and caregiver characteristics with distress. Methods The study population included Canadian home care clients in the Winnipeg Regional Health Authority in Manitoba and in the province of Ontario. Clients with RAI-Home Care (RAI-HC) assessment data from 2003 to 2010 were examined. Neurological conditions of interest included Alzheimer’s disease and related dementias, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, Huntington disease, epilepsy, muscular dystrophy, cerebral palsy, traumatic brain injury, spinal cord injury, and stroke. Descriptive statistics were analyzed to describe home care client characteristics and caregiver characteristics for each neurological condition. Logistic regression analysis was used to identify risk factors associated with caregiver distress. Results A substantial proportion of home care clients were found to have one or more of the neurological conditions (38.8 % to 41.9 %). Caregiver distress was twice as prevalent among caregivers of clients with neurological conditions (28.0 %). The largest associations with caregiver distress were the amount of informal care hours provided in a week and the MAPLe algorithm, an indicator of a client’s level of priority for care. After adjustment for client characteristics, Huntington disease was the neurological condition most strongly associated with caregiver distress. However, clients’ clinical characteristics and informal care hours had a stronger association with caregiver distress than the presence of a neurological condition. Provision of formal home care services provided a protective effect from caregiver distress. Conclusions Neurological conditions are common among home care clients and a significant proportion of informal caregivers providing care to these clients experience distress. The complexity of clients with neurological conditions suggests the need for multicomponent support strategies for informal caregivers.
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159
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Goldman JG, Weintraub D. Advances in the treatment of cognitive impairment in Parkinson's disease. Mov Disord 2015; 30:1471-89. [DOI: 10.1002/mds.26352] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jennifer G. Goldman
- Rush University Medical Center, Department of Neurological Sciences; Section of Parkinson Disease and Movement Disorders; Chicago Illinois USA
| | - Daniel Weintraub
- Department of Psychiatry; University of Pennsylvania; Philadelphia Pennsylvania USA
- Department of Neurology; University of Pennsylvania; Philadelphia Pennsylvania USA
- Philadelphia Veterans Affairs Medical Center; Philadelphia Pennsylvania USA
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160
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Oh YS, Kim JS, Lee PH. Effect of Rivastigmine on Behavioral and Psychiatric Symptoms of Parkinson's Disease Dementia. J Mov Disord 2015; 8:98-102. [PMID: 26090082 PMCID: PMC4460546 DOI: 10.14802/jmd.15041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/04/2015] [Accepted: 02/11/2015] [Indexed: 12/22/2022] Open
Abstract
Objective A recent study showed that rivastigmine and memantin improved behavioral and psychiatric symptoms of dementia (BPSD) in Alzheimer’s dementia. Furthermore, according to recent guidelines presented by the Movement Disorder Society, rivastigmine is efficacious for the treatment of dementia in Parkinson’s disease (PD). We investigated the efficacy of rivastigmine for BPSD in patients with Parkinson’s disease dementia (PDD). Methods Twenty-three patients in whom cognitive impairment occurred at least one year after a diagnosis of PD participated in this open-label trial. Cognitive, psychiatric, and motor symptoms were assessed before and after 24 weeks of treatment with rivastigmine using unstructured clinical assessments and rating scales including the Unified Parkinson’s Disease Rating Scale, Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory. Results Age (± standard deviation) was 74.7 ± 5.9 years, average duration of PD was 3.5 ± 3.7 years, Hoehn and Yahr scores were 2.2 ± 0.8, and baseline MMSE scores were 19.1 ± 4.2. Improvements in global mental symptoms and neuropsychiatric symptoms were significant; among them, hallucination, depression and appetite changes improved. Caregiver distress significantly decreased, including distress resulting from hallucinations, depression, apathy, and appetite changes. Conclusions Although controlled trials are required, the findings suggest that rivastigmine is useful for control of several neuropsychiatric symptoms and beneficial for caregiver distress in patients with PDD.
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Affiliation(s)
- Yoon-Sang Oh
- 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
| | - Phil Hyu Lee
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
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161
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Pérez-Pérez J, Pagonabarraga J, Martínez-Horta S, Fernández-Bobadilla R, Sierra S, Pascual-Sedano B, Gironell A, Kulisevsky J. Head-to-Head Comparison of the Neuropsychiatric Effect of Dopamine Agonists in Parkinson’s Disease: A Prospective, Cross-Sectional Study in Non-demented Patients. Drugs Aging 2015; 32:401-7. [DOI: 10.1007/s40266-015-0264-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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162
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Pagonabarraga J, Kulisevsky J, Strafella AP, Krack P. Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment. Lancet Neurol 2015; 14:518-31. [PMID: 25895932 DOI: 10.1016/s1474-4422(15)00019-8] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 09/29/2014] [Accepted: 01/06/2015] [Indexed: 02/06/2023]
Abstract
Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of different networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of affected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely affect the quality of life of both patients and caregivers. Differentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain; Universitat Oberta de Catalunya, Barcelona, Spain
| | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit, E.J. Safra Parkinson Disease Program, Toronto Western Hospital and Research Institute, UHN, ON, Canada; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, ON, Canada
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France; INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France.
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163
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Santos-García D, de la Fuente-Fernández R. Factors contributing to caregivers' stress and burden in Parkinson's disease. Acta Neurol Scand 2015; 131:203-10. [PMID: 25212106 DOI: 10.1111/ane.12305] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyze the main determinants of burden and stress in caregivers of Spanish Parkinson's disease (PD) patients. METHODS One-hundred and twenty-one non-demented patients with PD (57.9% males; 70.9 ± 8.2 years old) were included in this cross-sectional, monocenter, evaluation study. Caregivers (n = 121; 71.9% females; 60.2 ± 15 years old) were assessed using the Zarit Caregiver Burden Inventory (ZCBI) and Caregiver Strain Index (CSI). Multiple linear regression methods were used to evaluate factors contributing to caregivers' stress and burden: (i) PD motor dysfunction (ON-state Hoehn & Yahr/Unified Parkinson's Disease Rating Scale [UPDRS] part III and motor complications [UPDRS part IV]); (ii) Mood (Beck Depression Inventory [BDI]); (iii) Non-motor symptoms (Non-Motor Symptoms Scale [NMSS]); (iv) Disability (Schwab & England Activities of Daily Living Scale [ADLS]); and (v) Socio-demographic and other disease-related variables. RESULTS Zarit Caregiver Burden Inventory and CSI mean scores were 16 ± 13.9 and 2.1 ± 2.3, respectively. High correlation was found between ZCBI and CSI (r = 0.819; P < 0.0001). Moderate to severe burden (ZCBI > 40) was present in 9.1% of caregivers; 5.8% had high levels of stress (CSI ≥ 7). Moderate to strong correlations were observed between patient-related variables (Hoehn&Yahr, UPDRS-III, UPDRS-IV, BDI, NMSS, and ADLS) and ZCBI and CSI (P < 0.0001). Linear regression methods showed that ADLS had the strongest influence on ZCBI and CSI, followed by BDI on ZCBI. CONCLUSIONS Disability (ADLS) and mood (BDI) of patients with PD are the main factors contributing to burden and stress in caregivers.
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Affiliation(s)
- D. Santos-García
- Section of Neurology; Complejo Hospitalario Universitario de Ferrol (CHUF); Hospital A. Marcide; Ferrol Spain
| | - R. de la Fuente-Fernández
- Section of Neurology; Complejo Hospitalario Universitario de Ferrol (CHUF); Hospital A. Marcide; Ferrol Spain
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164
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Cosgrove J, Alty JE, Jamieson S. Cognitive impairment in Parkinson's disease. Postgrad Med J 2015; 91:212-20. [PMID: 25814509 DOI: 10.1136/postgradmedj-2015-133247] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/26/2015] [Indexed: 11/03/2022]
Abstract
Cognitive impairment is a significant non-motor symptom of Parkinson's disease (PD). Longitudinal cohort studies have demonstrated that approximately 50% of those with PD develop dementia after 10 years, increasing to over 80% after 20 years. Deficits in cognition can be identified at the time of PD diagnosis in some patients and this mild cognitive impairment (PD-MCI) has been studied extensively over the last decade. Although PD-MCI is a risk factor for developing Parkinson's disease dementia there is evidence to suggest that PD-MCI might consist of distinct subtypes with different pathophysiologies and prognoses. The major pathological correlate of Parkinson's disease dementia is Lewy body deposition in the limbic system and neocortex although Alzheimer's related pathology is also an important contributor. Pathological damage causes alteration to neurotransmitter systems within the brain, producing behavioural change. Management of cognitive impairment in PD requires a multidisciplinary approach and accurate communication with patients and relatives is essential.
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Affiliation(s)
- Jeremy Cosgrove
- Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK Hull York Medical School, University of York, York, UK
| | - Jane Elizabeth Alty
- Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK Hull York Medical School, University of York, York, UK
| | - Stuart Jamieson
- Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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165
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The Natural History of Depression in Parkinson's Disease within 30-Month Follow-Up. PARKINSONS DISEASE 2015; 2015:362892. [PMID: 25722914 PMCID: PMC4333563 DOI: 10.1155/2015/362892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 11/18/2022]
Abstract
Depression is one of the most common and persistent nonmotor syndromes occurring in 35% of patients diagnosed with PD. However, little information is known about the longitudinal study of its natural history of depression in PD. In this study, we identified 110 patients who are diagnosed with idiopathic PD and recruited them for assessing information about their PD related motor and nonmotor symptoms and rating scales. A follow-up evaluation was performed in 103 patients 30 months later. About 66.7% depressed patients at baseline were still depressed at follow-up, and 24.4% had incident depression among subjects without depression at baseline. Greater decline on MMSE (P = 0.029), higher baseline UPDRS-II (P < 0.001) score, change of UPDRS-II (P = 0.026), and female (P < 0.001) were associated with the worsening of HDRS scores. Higher baseline HDRS score (P < 0.001) and greater decline on MMSE (P = 0.001) were related to the occurrence of depression. In conclusion, cognitive decline is a disease related factor of worsening and the occurrence of depression. Activities of Daily Living (ADL) symptoms in PD and female gender may be crucial factors of increasing depressive symptoms.
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166
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Pacheco CR, Morales CN, Ramírez AE, Muñoz FJ, Gallegos SS, Caviedes PA, Aguayo LG, Opazo CM. Extracellular α-synuclein alters synaptic transmission in brain neurons by perforating the neuronal plasma membrane. J Neurochem 2015; 132:731-41. [PMID: 25669123 DOI: 10.1111/jnc.13060] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 12/25/2022]
Abstract
It has been postulated that the accumulation of extracellular α-synuclein (α-syn) might alter the neuronal membrane by formation of 'pore-like structures' that will lead to alterations in ionic homeostasis. However, this has never been demonstrated to occur in brain neuronal plasma membranes. In this study, we show that α-syn oligomers rapidly associate with hippocampal membranes in a punctate fashion, resulting in increased membrane conductance (5 fold over control) and the influx of both calcium and a fluorescent glucose analogue. The enhancement in intracellular calcium (1.7 fold over control) caused a large increase in the frequency of synaptic transmission (2.5 fold over control), calcium transients (3 fold over control), and synaptic vesicle release. Both primary hippocampal and dissociated nigral neurons showed rapid increases in membrane conductance by α-syn oligomers. In addition, we show here that α-syn caused synaptotoxic failure associated with a decrease in SV2, a membrane protein of synaptic vesicles associated with neurotransmitter release. In conclusion, extracellular α-syn oligomers facilitate the perforation of the neuronal plasma membrane, thus explaining, in part, the synaptotoxicity observed in neurodegenerative diseases characterized by its extracellular accumulation. We propose that α-synuclein (α-syn) oligomers form pore-like structures in the plasma membrane of neurons from central nervous system (CNS). We believe that extracellular α-syn oligomers facilitate the formation of α-syn membrane pore-like structures, thus explaining, in part, the synaptotoxicity observed in neurodegenerative diseases characterized by its extracellular accumulation. We think that alterations in ionic homeostasis and synaptic vesicular depletion are key steps that lead to synaptotoxicity promoted by α -syn membrane pore-like structures.
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Affiliation(s)
- Carla R Pacheco
- Department of Physiology, University of Concepcion, Concepcion, Chile
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167
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The monoaminergic footprint of depression and psychosis in dementia with Lewy bodies compared to Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2015; 7:7. [PMID: 25717350 PMCID: PMC4339739 DOI: 10.1186/s13195-014-0090-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
Abstract
Introduction Depression and psychosis are two of the most severe neuropsychiatric symptoms (NPS) in dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD). Both NPS have negative effects on cognitive performance and life expectancy. The current study aimed to investigate and compare monoaminergic etiologies between both neurodegenerative conditions, given the lack of an efficient pharmacological treatment until present. Methods Eleven behaviorally relevant brain regions of the left frozen hemisphere of 10 neuropathologically confirmed AD patients with/without depression (AD + D/-D; 5 were psychotic within AD + D), 10 confirmed DLB patients, all of whom were depressed (DLB + D; 5 psychotic patients), and, finally, 10 confirmed control subjects were regionally dissected. All patients were retrospectively assessed before death using the Behavioral Pathology in Alzheimer’s Disease Rating Scale (Behave-AD) and Cornell Scale for Depression in Dementia amongst others. The concentrations of dopamine (DA), serotonin (5-HT), (nor)adrenaline and respective metabolites, i.e. 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), 5-hydroxy-3-indoleacetic acid (5-HIAA), and, 3-methoxy-4-hydroxyphenylglycol (MHPG), were determined using reversed-phase high-performance liquid chromatography with electrochemical detection. Results DLB subjects had the overall lowest monoamine and metabolite concentrations regarding 33 out of 41 significant monoaminergic group alterations. Moreover, MHPG levels were significantly decreased in almost 8 out of 11 brain regions of DLB- compared to AD patients. We also observed the lowest 5-HT and 5-HIAA levels, and 5-HIAA/5-HT turnover ratios in DLB + D compared to AD + D subjects. Additionally, a 4- and 7-fold increase of DOPAC/DA and HVA/DA turnover ratios, and, a 10-fold decrease of thalamic DA levels in DLB + D compared to AD + D patients and control subjects was noticed. Regarding psychosis, hippocampal DA levels in the overall DLB group significantly correlated with Behave-AD AB scores. In the total AD group, DA levels and HVA/DA ratios in the amygdala significantly correlated with Behave-AD AB scores instead. Conclusions Monoaminergic neurotransmitter alterations contribute differently to the pathophysiology of depression and psychosis in DLB as opposed to AD, with a severely decreased serotonergic neurotransmission as the main monoaminergic etiology of depression in DLB. Similarly, psychosis in DLB might, in part, be etiologically explained by dopaminergic alterations in the hippocampus, whereas in AD, the amygdala might be involved.
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168
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Guo X, Song W, Chen K, Chen X, Zheng Z, Cao B, Huang R, Zhao B, Wu Y, Shang HF. Associations between neuropsychiatric symptoms and cognition in Chinese idiopathic Parkinson's disease patients. J Clin Neurosci 2015; 22:578-82. [PMID: 25582976 DOI: 10.1016/j.jocn.2014.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/05/2014] [Accepted: 09/14/2014] [Indexed: 02/05/2023]
Abstract
The associations between neuropsychiatric symptoms and cognition, frontal lobe function and frontal behavioral changes in the Chinese idiopathic Parkinson's disease (PD) population are largely unknown. This study included 348 idiopathic PD patients from southwest China. Neuropsychiatric symptoms were investigated using the Neuropsychiatric Inventory Questionnaire (NPI), and cognition was assessed using Addenbrooke's Cognitive Examination-Revised (ACE-R). The Frontal Assessment Battery (FAB) was used to evaluate frontal function and the Frontal Behavior Inventory (FBI) was used to assess frontal behavioral changes. The mean (± standard deviation) age of the PD patients was 60.24 ± 12.07 years, and the mean disease duration was 3.88 ± 3.34 years. The mean NPI score was 3.49 ± 4.00. The mean score of ACE-R was 76.82 ± 16.73. The mean score of FAB was 15.27 ± 2.90, and the mean score of FBI was 3.18 ± 5.17. Weak negative correlations between the NPI and ACE-R scores as well as FAB score were found in the total sample, the male patient subgroup, the early onset PD subgroup and the late onset PD subgroup. Strong positive correlations were found between the NPI and FBI scores in the total sample (r=0.661, p<0.001), the male patient subgroup (r=0.789, p<0.001) and the late onset PD subgroup (r=0.749, p<0.001). Moderate positive correlations were found between the NPI and FBI scores in the female patient subgroup (r=0.536, p<0.001) and the early onset PD subgroup (r=0.462, p<0.001). Neuropsychiatric symptoms were closely associated with frontal behavioral changes but were not closely related with worse cognition and frontal lobe function in the Chinese idiopathic PD population.
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Affiliation(s)
- Xiaoyan Guo
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Wei Song
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Ke Chen
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - XuePing Chen
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Zhenzhen Zheng
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Bei Cao
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Rui Huang
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Ying Wu
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, SiChuan University, 610041 ChengDu, SiChuan, China.
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Bizzarri JV, Giupponi G, Maniscalco I, Schroffenegger P, Conca A, Kapfhammer HP. [Parkinson's disease and psychoses]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2015; 29:1-13. [PMID: 25586068 DOI: 10.1007/s40211-014-0132-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/28/2014] [Indexed: 06/04/2023]
Abstract
Psychotic symptoms are common in Parkinson's disease (PD) and are associated with increased disability, worsened quality of life, and poor long-term prognosis. In this article, clinical features, hypotheses on pathogenesis, and current treatment strategies for Parkinson's disease psychosis (PDP) are reviewed. According to epidemiological studies, the prevalence of PDP is between 20 to 40 %. Complex visual hallucinations are the most common psychotic symptoms and are present in 17-72 % of the patients. Other sensory disturbances encompass tactile hallucinations and minor hallucinatory phenomena, such as sense of presence and visual illusions. Hallucinations are often accompanied by delusions, whose most frequent themes are persecution and jealousy. The pathophysiology of PDP remains unclear. Different factors have been implicated, including Levo-dopa and dopaminergic medications, neurotransmitter imbalances, neuroanatomic alterations, abnormal visuospatial processes, and genetic predisposition. The first-line strategy in the treatment of persistent and problematic PDP is represented by reduction in anti-PD medications. Second-generation antipsychotics are the treatment of choice, with clozapine being demonstrated as the most effective and tolerable drug for PD patients.
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Oh YS, Lee JE, Lee PH, Kim JS. Neuropsychiatric symptoms in Parkinson's disease dementia are associated with increased caregiver burden. J Mov Disord 2015; 8:26-32. [PMID: 25614783 PMCID: PMC4298716 DOI: 10.14802/jmd.14019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/04/2014] [Accepted: 09/18/2014] [Indexed: 12/31/2022] Open
Abstract
Objective Neuropsychiatric symptoms are common in Parkinson’s disease dementia (PDD). Frequent and severe neuropsychiatric symptoms create high levels of distress for patients and caregivers, decreasing their quality of life. The aim of this study was to investigate neuropsychiatric symptoms that may contribute to increased caregiver burden in PDD patients. Methods Forty-eight PDD patients were assessed using the 12-item Neuropsychiatric Inventory (NPI) to determine the frequency and severity of mental and behavioral problems. The Burden Interview and Caregiver Burden Inventory were used to evaluate caregiver burden. Results All but one patient showed one or more neuropsychiatric symptoms. The three most frequent neuropsychiatric symptoms were apathy (70.8%) and anxiety (70.8%), followed by depression (68.7%). More severe neuropsychiatric symptoms were significantly correlated with increased caregiver burden. The domains of delusion, hallucination, agitation and aggression, anxiety, irritability and lability, and aberrant motor behavior were associated with caregiver stress. After controlling for age and other potential confounding variables, total NPI score was significantly associated with caregiver burden. Conclusions The results of this study confirm that neuropsychiatric symptoms are frequent and severe in patients with PDD and are associated with increased caregiver distress. A detailed evaluation and management of neuropsychiatric symptoms in PDD patients appears necessary to improve patient quality of life and reduce caregiver burden.
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Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji E Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bountouni I, Zis P, Chaudhuri KR, Schrag A. Psychosis in Parkinson’s Disease. NEUROPSYCHIATRIC SYMPTOMS OF MOVEMENT DISORDERS 2015. [DOI: 10.1007/978-3-319-09537-0_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Leiknes I, Lien UT, Severinsson E. The Relationship among Caregiver Burden, Demographic Variables, and the Clinical Characteristics of Patients with Parkinson’s Disease—A Systematic Review of Studies Using Various Caregiver Burden Instruments. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.510091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yarnall AJ. What are the priorities in Parkinson's disease clinical research? A focus on motor complications, gait and cognition. Neurodegener Dis Manag 2014; 4:127-36. [PMID: 24832030 DOI: 10.2217/nmt.14.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Motor complications, gait and balance disturbance, and cognitive impairment are problems frequently faced by patients with Parkinson's disease and by their treating physicians, and become more common as the disease progresses. Motor complications may be prevented or at least delayed by judicious use of levodopa, with other dopaminergic agents used for their levodopa-sparing effect. Increasingly, research has concentrated on nondopaminergic neurotransmitter systems, which may also have applicability in the management of gait and balance, and also in cognitive impairment in Parkinson's disease. This review, therefore, tackles these issues and discusses possible future treatments that may be available for the management of these challenging comorbidities.
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Affiliation(s)
- Alison J Yarnall
- * Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK;
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174
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Aarsland D, Taylor JP, Weintraub D. Psychiatric issues in cognitive impairment. Mov Disord 2014; 29:651-62. [PMID: 24757113 DOI: 10.1002/mds.25873] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/20/2014] [Accepted: 03/03/2013] [Indexed: 01/08/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) such as depression, hallucinations and apathy commonly occur in Parkinson's disease (PD) and have major clinical consequences including a negative impact on quality of life. This review discusses the epidemiology, clinical features, diagnostic procedures and treatment issues of NPS in PD and related disorders in the perspective of cognitive impairment, focusing on depression, anxiety, visual hallucinations, apathy, sleep disturbances, impulse control disorder and non-motor fluctuations. The majority of NPS are more common in PD patients with dementia, possibly related to shared underlying pathologies. Recent studies also suggest that NPS are associated with mild cognitive impairment in PD, in particular with the amnestic type. Accurate diagnosis of NPS is important but can be difficult, due to overlapping symptoms and similar appearance of symptoms of motor symptoms of parkinsonism, cognitive impairment, mood disorders and apathy. There are few systematic studies focusing on the management of NPS in PD with cognitive impairment.
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Affiliation(s)
- Dag Aarsland
- Alzheimer's Disease Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway
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Lewis CJ, Maier F, Horstkötter N, Eggers C, Visser-Vandewalle V, Moro E, Zurowski M, Kuhn J, Woopen C, Timmermann L. The impact of subthalamic deep brain stimulation on caregivers of Parkinson’s disease patients: an exploratory study. J Neurol 2014; 262:337-45. [DOI: 10.1007/s00415-014-7571-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
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Dujardin K, Langlois C, Plomhause L, Carette AS, Delliaux M, Duhamel A, Defebvre L. Apathy in untreated early-stage Parkinson disease: Relationship with other non-motor symptoms. Mov Disord 2014; 29:1796-801. [DOI: 10.1002/mds.26058] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/05/2014] [Accepted: 09/28/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kathy Dujardin
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Carole Langlois
- Department of Biostatistics; Lille University Medical Center; Lille France
| | - Lucie Plomhause
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Anne-Sophie Carette
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Marie Delliaux
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Alain Duhamel
- Department of Biostatistics; Lille University Medical Center; Lille France
| | - Luc Defebvre
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
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177
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Muller AJ, Shine JM, Halliday GM, Lewis SJG. Visual hallucinations in Parkinson's disease: theoretical models. Mov Disord 2014; 29:1591-8. [PMID: 25154807 DOI: 10.1002/mds.26004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 12/19/2022] Open
Abstract
One of the most challenging tasks in neuroscience is to be able to meaningfully connect information across the different levels of investigation, from molecular or structural biology to the resulting behavior and cognition. Visual hallucinations are a frequent occurrence in Parkinson's disease and significantly contribute to the burden of the disease. Because of the widespread pathological processes implicated in visual hallucinations in Parkinson's disease, a final common mechanism that explains their manifestation will require an integrative approach, in which consideration is taken across all complementary levels of analysis. This review considers the leading hypothetical frameworks for visual hallucinations in Parkinson's disease, summarizing the key aspects of each in an attempt to highlight the aspects of the condition that such a unifying hypothesis must explain. These competing hypotheses include implications of dream imagery intrusion, deficits in reality monitoring, and impairments in visual perception and attention.
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Affiliation(s)
- Alana J Muller
- Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
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Mak E, Bergsland N, Dwyer MG, Zivadinov R, Kandiah N. Subcortical atrophy is associated with cognitive impairment in mild Parkinson disease: a combined investigation of volumetric changes, cortical thickness, and vertex-based shape analysis. AJNR Am J Neuroradiol 2014; 35:2257-64. [PMID: 25082821 DOI: 10.3174/ajnr.a4055] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The involvement of subcortical deep gray matter and cortical thinning associated with mild Parkinson disease remains poorly understood. We assessed cortical thickness and subcortical volumes in patients with Parkinson disease without dementia and evaluated their associations with cognitive dysfunction. MATERIALS AND METHODS The study included 90 patients with mild Parkinson disease without dementia. Neuropsychological assessments classified the sample into patients with mild cognitive impairment (n = 25) and patients without cognitive impairment (n = 65). Volumetric data for subcortical structures were obtained by using the FMRIB Integrated Registration and Segmentation Tool while whole-brain, gray and white matter volumes were estimated by using Structural Image Evaluation, with Normalization of Atrophy. Vertex-based shape analyses were performed to investigate shape differences in subcortical structures. Vertex-wise group differences in cortical thickness were also assessed. Volumetric comparisons between Parkinson disease with mild cognitive impairment and Parkinson disease with no cognitive impairment were performed by using ANCOVA. Associations of subcortical structures with both cognitive function and disease severity were assessed by using linear regression models. RESULTS Compared with Parkinson disease with no cognitive impairment, Parkinson disease with mild cognitive impairment demonstrated reduced volumes of the thalamus (P = .03) and the nucleus accumbens (P = .04). Significant associations were found for the nucleus accumbens and putamen with performances on the attention/working memory domains (P < .05) and nucleus accumbens and language domains (P = .04). The 2 groups did not differ in measures of subcortical shape or in cortical thickness. CONCLUSIONS Patients with Parkinson disease with mild cognitive impairment demonstrated reduced subcortical volumes, which were associated with cognitive deficits. The thalamus, nucleus accumbens, and putamen may serve as potential biomarkers for Parkinson disease-mild cognitive impairment.
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Affiliation(s)
- E Mak
- From the Department of Neurology (E.M., N.B., M.G.D., R.Z.), Buffalo Neuroimaging Analysis Center Department of Neurology (E.M., N.K.), National Neuroscience Institute, Singapore
| | - N Bergsland
- From the Department of Neurology (E.M., N.B., M.G.D., R.Z.), Buffalo Neuroimaging Analysis Center Istituto de Ricovero e Cura a Carattere Scientifico "S. Maria Nascente," Don Gnocchi Foundation (N.B.), Milan, Italy
| | - M G Dwyer
- From the Department of Neurology (E.M., N.B., M.G.D., R.Z.), Buffalo Neuroimaging Analysis Center
| | - R Zivadinov
- From the Department of Neurology (E.M., N.B., M.G.D., R.Z.), Buffalo Neuroimaging Analysis Center MR Imaging Clinical Translational Research Center (R.Z.), School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - N Kandiah
- Department of Neurology (E.M., N.K.), National Neuroscience Institute, Singapore
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Abstract
ABSTRACTThe purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.
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180
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Marvanova M. Antipsychotic use in elderly patients with dementia: Efficacy and safety concerns. Ment Health Clin 2014. [DOI: 10.9740/mhc.n204371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Behavioral and psychiatric symptoms of dementia (BPSD) refer to a heterogeneous group of symptoms that represent non-cognitive complications of Alzheimer's disease (AD) and other dementias. Currently, there are no FDA-approved antipsychotic medications for management of BPSD in the United States. Second generation antipsychotics (SGAs) should only be used for appropriate and justified BPSD targets including distressing and severe physical aggression and/or disturbing hallucinations or delusions that pose a risk of harm to self or others after non-pharmacologic interventions have failed. At best, SGAs provide only modest effects and are associated with increased risk for mortality and cerebrovascular complications in addition to other agent-specific side effects. Current evidence and recommendations support use of risperidone, aripiprazole or olanzapine for Alzheimer's disease (AD) and vascular dementia (VaD), and use of quetiapine or clozapine for Lewy body dementia (LBD) and Parkinson's disease dementia (PDD). Any SGA should be initiated at low dosages with slow titration; and the lowest effective dose should be used as a maintenance dose only for a short period of time. Patients should be monitored for clinical response and adverse effects and should be periodically evaluated for continued need for medication. Appropriate use of SGAs for management of BPSD is critical to increase safety for our growing elderly population with dementia.
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Affiliation(s)
- Marketa Marvanova
- 1 Associate Professor, Pharmacy Practice, Chicago State University College of Pharmacy, Adjunct Associate Professor of Neurology, Northwestern University Feinberg School of Medicine, Department of Neurology, Clinical Pharmacy Specialist, Neurology, Rush University Medical Center, Chicago, IL
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Yao N, Shek‐Kwan Chang R, Cheung C, Pang S, Lau KK, Suckling J, Rowe JB, Yu K, Ka‐Fung Mak H, Chua S, Ho SL, McAlonan GM. The default mode network is disrupted in Parkinson's disease with visual hallucinations. Hum Brain Mapp 2014; 35:5658-66. [PMID: 24985056 PMCID: PMC4657500 DOI: 10.1002/hbm.22577] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/29/2014] [Accepted: 06/24/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Visual hallucinations (VH) are one of the most striking nonmotor symptoms in Parkinson's disease (PD), and predict dementia and mortality. Aberrant default mode network (DMN) is associated with other psychoses. Here, we tested the hypothesis that DMN dysfunction contributes to VH in PD. METHODS Resting state functional data was acquired from individuals with PD with VH (PDVH) and without VH (PDnonVH), matched for levodopa drug equivalent dose, and a healthy control group (HC). Independent component analysis was used to investigate group differences in functional connectivity within the DMN. In addition, we investigated whether the functional changes associated with hallucinations were accompanied by differences in cortical thickness. RESULTS There were no group differences in cortical thickness but functional coactivation within components of the DMN was significantly lower in both PDVH and PDnonVH groups compared to HC. Functional coactivation within the DMN was found to be greater in PDVH group relative to PDnonVH group. CONCLUSION Our study demonstrates, for the first time that, within a functionally abnormal DMN in PD, relatively higher "connectivity" is associated with VH. We postulate that aberrant connectivity in a large scale network affects sensory information processing and perception, and contributes to "positive" symptom generation in PD.
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Affiliation(s)
- Nailin Yao
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong
| | - Richard Shek‐Kwan Chang
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - Charlton Cheung
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong,State Key Laboratory for Cognitive SciencesThe University of Hong KongPokfulamHong Kong
| | - Shirley Pang
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - Kui Kai Lau
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - John Suckling
- Department of Psychiatry and Behavioural and Clinical Neuroscience InstituteUniversity of Cambridge, and Cambridge and Peterborough Foundation NHS TrustCambridgeUnited Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences and Behavioural and Clinical Neuroscience InstituteUniversity of CambridgeUnited Kingdom and Medical Research Council Cognition and Brain Sciences UnitCambridge, United Kingdom
| | - Kevin Yu
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong
| | - Henry Ka‐Fung Mak
- Department of Diagnostic RadiologyThe University of Hong KongPokfulamHong Kong
| | - Siew‐Eng Chua
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong,State Key Laboratory for Cognitive SciencesThe University of Hong KongPokfulamHong Kong
| | - Shu Leong. Ho
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - Grainne M. McAlonan
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong,Department of Forensic and Neurodevelopmental ScienceInstitute of Psychiatry, King's College LondonLondonSE5 8AZUnited Kingdom
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Creese B, Ballard C, Aarsland D, Londos E, Sharp S, Jones E. Determining the association of the 5HTTLPR polymorphism with delusions and hallucinations in Lewy body dementias. Am J Geriatr Psychiatry 2014; 22:580-6. [PMID: 23582751 DOI: 10.1016/j.jagp.2012.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 10/31/2012] [Accepted: 11/02/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine whether the 5HTTLPR serotonin transporter polymorphism is associated with delusions and hallucinations in people with dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD). DESIGN Prospective cohort study. PARTICIPANTS A total of 187 individuals, recruited from centres in Norway, Sweden, and the United Kingdom were included in this study; 97 with clinically or neuropathologically diagnosed DLB/PDD and 90 cognitively normal individuals as a comparison group. MEASUREMENTS All participants with dementia underwent serial evaluation of neuropsychiatric symptoms to assess the presence of persistent delusions and hallucinations using the Columbia University Scale for Psychopathology in Alzheimer disease, the Neuropsychiatric Inventory, or the Present Behavioural Examination. Severity of cognitive impairment was measured using the Mini Mental State Examination (MMSE). Individuals were genotyped for the 5HTTLPR polymorphism. RESULTS Logistic regression demonstrated that homozygosity for the L/L genotype and lower MMSE were associated with an increased risk for delusions (odds ratio: 11.5 and 1.16, respectively). Neither was significantly associated with hallucinations. CONCLUSIONS This study is the first to demonstrate the 5HTTLPR polymorphism is associated with delusions in Lewy body dementias, with important implications regarding the mechanisms underlying this symptom across the AD/DLB/PDD spectrum. Further studies are warranted to investigate this relationship further and examine treatment opportunities.
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Affiliation(s)
- Byron Creese
- Wolfson Centre for Age-Related Diseases, King's College London, United Kingdom
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, United Kingdom
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Medicine, Karolinska Institute, Stockholm, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sally Sharp
- Mental Health Sciences Unit, University College London, United Kingdom
| | - Emma Jones
- Wolfson Centre for Age-Related Diseases, King's College London, United Kingdom.
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183
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Nishioka K, Tanaka R, Shimura H, Hirano K, Hatano T, Miyakawa K, Arai H, Hattori N, Urabe T. Quantitative evaluation of electroconvulsive therapy for Parkinson's disease with refractory psychiatric symptoms. J Neural Transm (Vienna) 2014; 121:1405-10. [PMID: 24744048 DOI: 10.1007/s00702-014-1212-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/02/2014] [Indexed: 01/09/2023]
Abstract
Patients with advanced-stage Parkinson's disease (PD) occasionally experience refractory depression or catatonic stupor. Electroconvulsive therapy (ECT) has been reported as a successful procedure for both severe psychosis and motor symptoms in patients with PD. Four patients with PD who were receiving ECT were quantitatively evaluated using the Unified PD Rating scale part III, Hoehn and Yahr scale, Barthel index, Neuropsychiatric Inventory, mini-mental state examination, Revised Hasegawa's Dementia scale, Beck's Depression Inventory, and Hamilton Rating Scale for Depression-17. We adopted the "half-age" method, which is an age-based stimulus-dosing method. The patients showed improvement in symptoms of psychosis and motor symptoms without any adverse effects. The interval of improvement after ECT varied among patients. Of note, a decrease in psychiatric symptoms successfully alleviated the burden of caregivers. ECT may be useful to treat parkinsonism with refractory psychosis, major depression, or catatonic stupor, within the limitations of the patients enrolled.
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Affiliation(s)
- Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan,
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Utility of neuropsychiatric tools in the differential diagnosis of dementia with Lewy bodies and Alzheimer's disease: quantitative and qualitative findings. Int Psychogeriatr 2014; 26:453-61. [PMID: 24284139 DOI: 10.1017/s1041610213002068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Discerning dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is one of the most common and challenging differential diagnoses at the memory clinic. Although the neuropsychiatric manifestations have been widely reported as one of the main key points in the differential diagnosis between these two diseases, to date no neuropsychiatric questionnaire has been specifically devised for this purpose. METHODS We administered the Neuropsychiatric Inventory (NPI) and the Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD) to a memory clinic sample of 80 patients with probable DLB and 85 age- and severity-matched patients with probable AD. Diagnosis of probable DLB was supported with a positive dopamine transporter SPECT scan. We examined the usefulness of these two neuropsychiatric tools designed for AD in the differential diagnosis between DLB and AD. We also investigated the correlations between psychotic symptoms and measures of cognitive and functional decline. RESULTS Auditory hallucinations were very specific of DLB and were usually preceded by visual hallucinations. Misinterpretation of real visual stimuli (illusions) was more frequent in DLB. Delusions were both quantitatively and qualitatively different between DLB and AD: delusional misidentifications were significantly more characteristic of DLB, while paranoid delusions did not show specificity for DLB. CONCLUSIONS Neuropsychiatric tools are useful to discriminate DLB from AD. Hallucinations and delusions are not only more frequent in DLB than in AD but also have distinct qualitative characteristics and patterns of progression that can help clinicians to make a more accurate differential diagnosis.
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185
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Heller J, Dogan I, Schulz JB, Reetz K. Evidence for gender differences in cognition, emotion and quality of life in Parkinson's disease? Aging Dis 2014; 5:63-75. [PMID: 24490118 PMCID: PMC3901615 DOI: 10.14366/ad.2014.050063] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/11/2013] [Accepted: 10/16/2013] [Indexed: 11/03/2022] Open
Abstract
A number of gender differences have been documented in the incidence and symptomatology of the second most common age-related neurodegenerative disorder, idiopathic Parkinson's disease (PD). Overall, previous reports suggest a less frequent incidence and a more benign phenotype in women mainly in Western populations, which is thought to be mediated by estrogens in particular in early stages of the disease. Not only motor symptoms seem to underlie gender effects, but also non-motor symptoms such as psychiatric and cognitive impairments, which can often precede motor manifestation. However, reliable results for gender differences in PD in particular of cognitive function and emotion processing, having a major impact on quality of life, are lacking. Moreover, studies investigating gender effects in PD in these areas have revealed highly heterogeneous results. The present review summarizes findings of currently available studies on gender effects on neuropsychological tests covering major cognitive domains, emotion processing as well as quality of life in patients with PD. Overall, the occurrence of cognitive impairment in PD seems to be associated with male gender, though inconsistent results were shown in cognitive screening tests. Regarding emotion recognition, men with PD were found to be less accurate than women with PD at identifying fearful expressions, whereas vice versa results appeared in healthy subjects. Lower quality of life and greater disability were reported by women compared to men with PD, which corresponds with the results in healthy subjects. Several disease-specific mediators as well as the question of a general gender and age-related effect as observed in healthy individuals are discussed. Increased knowledge on possible gender effects in PD would provide an enhanced insight in underlying pathological mechanisms, and has potential implications for the diagnosis and treatment of PD.
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Affiliation(s)
- Julia Heller
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
- JARA – Translational Brain Medicine, Jülich and Aachen, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
- JARA – Translational Brain Medicine, Jülich and Aachen, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, Wilhelm-Johnen-Straße, Jülich, Germany
| | - Jörg B. Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
- JARA – Translational Brain Medicine, Jülich and Aachen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
- JARA – Translational Brain Medicine, Jülich and Aachen, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, Wilhelm-Johnen-Straße, Jülich, Germany
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186
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Sensi M, Preda F, Trevisani L, Contini E, Gragnaniello D, Capone JG, Sette E, Golfre-Andreasi N, Tugnoli V, Tola MR, Quatrale R. Emerging issues on selection criteria of levodopa carbidopa infusion therapy: considerations on outcome of 28 consecutive patients. J Neural Transm (Vienna) 2014; 121:633-42. [DOI: 10.1007/s00702-013-1153-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/25/2013] [Indexed: 11/28/2022]
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Hu MTM, Szewczyk-Królikowski K, Tomlinson P, Nithi K, Rolinski M, Murray C, Talbot K, Ebmeier KP, Mackay CE, Ben-Shlomo Y. Predictors of cognitive impairment in an early stage Parkinson's disease cohort. Mov Disord 2014; 29:351-9. [PMID: 24395708 PMCID: PMC4235340 DOI: 10.1002/mds.25748] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 12/22/2022] Open
Abstract
The impact of Parkinson’s disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen-month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non-motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non-motor features, suggesting that this reflects a faster progressive phenotype.
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Affiliation(s)
- Michele T M Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, United Kingdom; Department of Clinical Neurology, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Parkinson's Disease Centre, Oxford, United Kingdom
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188
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Lebedev AV, Beyer MK, Fritze F, Westman E, Ballard C, Aarsland D. Cortical changes associated with depression and antidepressant use in Alzheimer and Lewy body dementia: an MRI surface-based morphometric study. Am J Geriatr Psychiatry 2014; 22:4-13.e1. [PMID: 23880336 DOI: 10.1016/j.jagp.2013.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 10/19/2012] [Accepted: 12/10/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT Depression is common in dementia, especially in the early stages, with important clinical implications, but the etiology is unknown and most likely heterogeneous. Antidepressant use in the elderly without dementia has previously been shown to be associated with high risks of adverse events and with structural brain alterations. OBJECTIVE To investigate cortical changes associated with depression and antidepressant use in patients with mild Alzheimer's disease (AD) and Lewy body dementia (LBD). METHODS 74 subjects with mild AD and LBD from geriatric and psychiatry outpatient clinics in Western Norway were included. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess depression. Automatic preprocessing using Freesurfer included steps for white and grey matter surface reconstruction. The resulting cortical thickness was analyzed using linear modeling. RESULTS Clusters of depression-associated thinning were found in prefrontal and temporal areas. Treatment-associated thinning was observed in the parahippocampal region and was significant even after correction for age, sex, AD/LBD diagnosis, and MADRS scores. CONCLUSION Depression in mild AD and LBD is associated with cortical thinning in prefrontal and temporal areas. The findings suggest that depressive symptoms in mild dementia could develop due to neurodegeneration in the same neural circuits that are critical for depression across different brain disorders. Antidepressant use in patients with mild AD and LBD is associated with parahippocampal thinning. Taken together with low efficacy of antidepressants in cognitively impaired patients and high risks of adverse events, our results suggest a need to re-evaluate the treatment approaches for depression and the role of antidepressants in patients with dementia.
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Affiliation(s)
- Alexander V Lebedev
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
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189
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Sindhi A, Leroi I. Nonpharmacological therapies for cognitive enhancement in Parkinson’s disease: applying old interventions in a new setting? Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
SUMMARY Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and non-motor features. Among non-motor features, cognitive impairment and the development of dementia is common. Current pharmacological treatment for cognitive impairment is limited and is only licensed for established dementia. Furthermore, pharmacological treatment may not be tolerated by some patients. Therefore, alternative treatment strategies such as nondrug cognition-enhancing therapies may have a role in PD. This article outlines therapies that have been widely used in non-PD dementia and makes recommendations for how they can be adapted to the PD setting.
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Affiliation(s)
- Amit Sindhi
- Institute of Brain, Behaviour & Mental Health, University of Manchester, Jean McFarlane Building, 3rd floor, Oxford Road, Manchester, M19 9PL, UK
| | - Iracema Leroi
- Manchester Mental Health & Social Care Trust, Jean McFarlane Building, 3rd Floor, Oxford Road, Manchester, M13 9PL, UK
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190
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Abstract
Introduction Disease interactions can alter functional decline near the end of life (EOL). Parkinson's disease (PD) is characterized by frequent occurrences of co-morbidities but data challenges have limited studies investigating co-morbidities across a broad range of diseases. The goal of this study was to describe disease associations with PD. Methods We conducted an analysis of death certificate data from 1998 to 2005 in Nova Scotia. All death causes were utilized to select individuals dying of PD and compare with the general population and an age–sex-matched sample without PD. We calculated the mean number of death causes and frequency of disease co-occurrence. To account for the chance occurrence of co-morbidities and measure the strength of association, observed to expected ratios were calculated. Results PD decedents had a higher mean number of death causes (3.37) than the general population (2.77) and age–sex-matched sample (2.88). Cancer was the most common cause in the population and matched sample but fifth for those with PD. Cancer was one of nine diseases that occurred less often than what would be expected by chance while four were not correlated with PD. Dementia and pneumonia occurred with PD 2.53 ([CI] 2.21–2.85) and 1.83 (CI 1.58–2.08) times more often than expected. The strength of association for both is reduced but remains statistically significant when controlling for age and sex. Discussion Those with PD have a higher number of co-morbidities even after controlling for age and sex. Individuals dying with PD are more likely to have dementia and pneumonia, which has implications for the provision of care at EOL.
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Affiliation(s)
- Lynn Lethbridge
- School of Health Administration, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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191
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Abstract
BACKGROUND Visual hallucination (VH) is a common psychotic symptom in patients with Parkinson's disease (PD) and may be a significant predictor of cognitive impairment (CI) in such patients. OBJECTIVE This study aimed to investigate the pattern of glucose metabolism of VH and the relationship between VH and CI in PD. METHODS We studied 28 PD patients, including 15 with VH (PD-VH) and 13 without VH (PD-NVH). Of the 15 PD-VH patients, 8 patients had cognitive impairment (PD-VHCI) whereas 7 did not (PD-VHNCI). All patients underwent [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) followed by statistical parametric mapping (SPM) analyses. RESULTS Compared to the patients with PDNVH, PD-VHNCI patients showed glucose hypometabolism in the inferior and middle temporal cortices, fusiform gyri, and frontal areas, suggesting the involvement of the ventral visual pathway. Compared to the patients with PDNVH, PD-VHCI patients showed glucose hypometabolism in the temporoparietal association cortices with scattered frontal areas. CONCLUSION Dysfunction of ventral visual pathway involving the temporal lobe may play a key role in VH development in PD patients. The evolving distribution from the ventral visual pathway to more extensive posterior cortices in PD-VHCI patients suggests that VH may be a prodromal symptom occurring prior to CI in PD patients.
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192
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Oguh O, Kwasny M, Carter J, Stell B, Simuni T. Caregiver strain in Parkinson's disease: National Parkinson Foundation Quality Initiative Study. Parkinsonism Relat Disord 2013; 19:975-9. [DOI: 10.1016/j.parkreldis.2013.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 05/28/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
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193
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Huang C, Ravdin LD, Nirenberg MJ, Piboolnurak P, Severt L, Maniscalco JS, Solnes L, Dorfman BJ, Henchcliffe C. Neuroimaging markers of motor and nonmotor features of Parkinson's disease: an 18f fluorodeoxyglucose positron emission computed tomography study. Dement Geriatr Cogn Disord 2013; 35:183-96. [PMID: 23445555 DOI: 10.1159/000345987] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2012] [Indexed: 01/21/2023] Open
Abstract
AIM We sought to identify markers of motor and nonmotor function in Parkinson's disease (PD) using advanced neuroimaging techniques in subjects with PD. METHODS We enrolled 26 nondemented PD subjects and 12 control subjects. All subjects underwent [(18)F]fluorodeoxyglucose positron emission computed tomography (FDG-PET) and magnetic resonance imaging, and a complete neuropsychological battery. RESULTS FDG-PET of subjects with PD revealed significant metabolic elevations in the bilateral posterior lentiform nucleus, posterior cingulate, and parahippocampus, and metabolic reductions in the bilateral temporoparietal association cortex and occipital lobe versus controls. PD subjects had significant reductions in executive/attention function, memory/verbal learning, and speed of thinking, and significantly increased depression, anxiety and apathy scores compared with controls. Motor dysfunction correlated with increased metabolism in the posterior lentiform nucleus, pons, and cerebellum, and decreased metabolism in the temporoparietal lobe. Cognitive dysfunction correlated with increased posterior cingulate metabolism and decreased temporoparietal lobe metabolism. Depressive symptoms correlated with increased amygdala metabolism; anxiety scores correlated with decreased caudate metabolism, and apathy scores correlated with increased metabolism in the anterior cingulate and orbitofrontal lobe and decreased metabolism in the temporoparietal association cortex. CONCLUSIONS Our findings showed that motor, cognitive, and emotional dysfunction in PD are associated with distinct patterns of cerebral metabolic changes.
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Affiliation(s)
- Chaorui Huang
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10021, USA. chh2019 @ med.cornell.edu
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194
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Ballard C, Aarsland D, Francis P, Corbett A. Neuropsychiatric symptoms in patients with dementias associated with cortical Lewy bodies: pathophysiology, clinical features, and pharmacological management. Drugs Aging 2013; 30:603-11. [PMID: 23681401 DOI: 10.1007/s40266-013-0092-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are synucleinopathies that lead to neurodegeneration and dementia. Although they result in symptoms common to Alzheimer's disease, they are associated with early emergence of parkinsonism and high frequency of neuropsychiatric symptoms, most commonly hallucinations and delusions. This review summarizes the current understanding of the underlying biology of neuropsychiatric symptoms in DLB and PDD and the evidence base for treatment to address them. Disruption to cholinergic and serotonergic neurotransmission and synapse activity are highlighted as primary pathological factors in neuropsychiatric symptoms, particularly loss of key neurotransmitter functions, alterations to neuronal receptors in the serotonergic pathway, and regionally specific structural changes that are linked to specific symptoms. Review of options for pharmacological treatment of neuropsychiatric symptoms suggests that the best evidence for the value of treatment is for cholinesterase inhibitors, with an indication that people with visual hallucinations are particularly likely to benefit. Evidence for the benefits of antipsychotics other than clozapine is limited, and there are serious safety concerns about the use of antipsychotics in these patients. Evidence to support other pharmacological interventions is very preliminary. Nonpharmacological approaches based on person-centered care and cholinesterase inhibitors should be considered as the first-line treatment for neuropsychiatric symptoms except in extreme cases.
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Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, Wolfson Building, Guy's Campus, London, SE1 1UL, UK.
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195
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Weerkamp NJ, Tissingh G, Poels PJ, Zuidema SU, Munneke M, Koopmans RT, Bloem BR. Nonmotor Symptoms in Nursing Home Residents with Parkinson's Disease: Prevalence and Effect on Quality of Life. J Am Geriatr Soc 2013; 61:1714-21. [DOI: 10.1111/jgs.12458] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nico J. Weerkamp
- Department of Neurology; Atrium Medical Center; Heerlen the Netherlands
- Department of Neurology; Nijmegen Center for Evidence Based Practice; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Gerrit Tissingh
- Department of Neurology; Atrium Medical Center; Heerlen the Netherlands
| | - Petra J.E. Poels
- Department of Neurology; Nijmegen Center for Evidence Based Practice; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Systse U. Zuidema
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
| | - Marten Munneke
- Department of Neurology; Nijmegen Center for Evidence Based Practice; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community Care; Center for Family Medicine, Geriatric Care and Public Health; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology; Donders Institute for Brain, Cognition and Behavior; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
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196
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Abstract
The concept of mild cognitive impairment (MCI) in the general population has received increased attention over recent years, and is associated with risk of progression to Alzheimer's disease. Within Parkinson's disease (PD), MCI (PD-MCI) is also now recognised to be relatively common, with certain subtypes predicting progression to Parkinson's disease dementia (PDD). Recently, criteria to better characterise PD-MCI and its subtypes have been produced by the Movement Disorder Society. In contrast to the population as a whole, where amnestic MCI is the most common subtype, non-amnestic PD-MCI dominates, with prominent executive and attention dysfunction. Although the pathophysiology of PD-MCI is poorly understood and encompasses both PD and non-PD pathology, it is most likely the result of a complex interaction between neurotransmitter dysfunction, synaptic pathology, protein aggregation and neuronal damage. Determining the factors that influence the progression of these pathologies in PD and the individuals at risk of ultimately developing PDD is critical for targeted intervention and drug discovery studies. Further work is required, however, to determine the significance of PD-MCI and also to validate the diagnostic criteria. This would be best delivered in the form of longitudinal studies in homogenous cohorts of PD participants, to allow prognostication and generalisation among the PD population. At the present time, no drug therapies are available for PD-MCI. Management includes screening for the disorder, excluding treatable causes of cognitive decline and cautious use of dopamine agonists and medications such as anticholinergics.
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Affiliation(s)
- Alison Jane Yarnall
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Tyne and Wear NE4 5PL, UK
| | - Lynn Rochester
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - David John Burn
- Clinical Ageing Research Unit, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Watson GS, Cholerton BA, Gross RG, Weintraub D, Zabetian CP, Trojanowski JQ, Montine TJ, Siderowf A, Leverenz JB. Neuropsychologic assessment in collaborative Parkinson's disease research: a proposal from the National Institute of Neurological Disorders and Stroke Morris K. Udall Centers of Excellence for Parkinson's Disease Research at the University of Pennsylvania and the University of Washington. Alzheimers Dement 2013; 9:609-14. [PMID: 23164549 PMCID: PMC3612566 DOI: 10.1016/j.jalz.2012.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/23/2022]
Abstract
Cognitive impairment (CI) and behavioral disturbances can be the earliest symptoms of Parkinson's disease (PD), ultimately afflict the vast majority of PD patients, and increase caregiver burden. Our two Morris K. Udall Centers of Excellence for Parkinson's Disease Research were supported by the National Institute of Neurological Disorders and Stroke (NINDS) in an effort to recommend a comprehensive yet practical approach to cognitive and behavioral assessment to further collaborative research. We recommend a stepwise approach with two levels of standardized evaluation to establish a common battery, as well as an alternative testing recommendation for severely impaired subjects, and review supplemental tests that may be useful in specific research settings. Our flexible approach may be applied to studies with varying emphasis on cognition and behavior, does not place undue burden on participants or resources, and has a high degree of compatibility with existing test batteries to promote collaboration.
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Affiliation(s)
- G. Stennis Watson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Brenna A. Cholerton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel G. Gross
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Cyrus P. Zabetian
- Geriatric, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Neurology, University of Washington, Seattle, WA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
- Institute on Aging, University of Pennsylvania, Philadelphia, PA
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA
| | | | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - James B. Leverenz
- Mental Illness, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Department of Neurology, University of Washington, Seattle, WA
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Bee TS, Allison W. The Effects of Parkinson's Disease on Caregivers and People with Parkinson's Disease: A Literature Review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parkinson's disease (PD) is a complex, slowly progressive, neurodegenerative, neurological condition characterised by a wide range of motor problems such as movement disorders, issues with gait and balance, and difficulty with swallowing and speech. In addition, sufferers also experience non-motor symptoms such as disorder of sleep, postural hypotension, mood alterations, lethargy, and cognitive dysfunction. As PD progresses to an advanced stage, people experience periods of debilitating physical and neurological problems and their caregivers face increasing complexity of care. Many people with PD require the support of a caregiver to attend to activities of daily living. This paper will review the literature on the effects of Parkinson's disease on both the patient and caregiver. Findings highlight the progressive nature of the disease affecting both functional and affective domains, and the need for caregiver support to enable the delivery of quality of care to this group throughout the disease trajectory.
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Affiliation(s)
- Tan Siok Bee
- Nursing Division, Singapore General Hospital, Singapore
| | - Williams Allison
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Oyama G, Okun MS, Schmidt P, Tröster AI, Nutt J, Go CL, Foote KD, Malaty IA. Deep Brain Stimulation May Improve Quality of Life in People With Parkinson's Disease Without Affecting Caregiver Burden. Neuromodulation 2013; 17:126-32. [DOI: 10.1111/ner.12097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 04/30/2013] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Genko Oyama
- Department of Neurology; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
| | - Michael S. Okun
- Department of Neurology; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
- Department of Neurosurgery; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
| | | | - Alexander I. Tröster
- Department of Neurology; University of North Carolina School of Medicine; Chapel Hill NC USA
| | - John Nutt
- Department of Neurology; Oregon Health & Science University; Portland OR USA
| | - Criscely L. Go
- Department of Neurology; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
| | - Kelly D. Foote
- Department of Neurology; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
- Department of Neurosurgery; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
| | - Irene A. Malaty
- Department of Neurology; University of Florida Center for Movement Disorders and Neurorestoration; Gainesville FL USA
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Dujardin K, Sockeel P, Carette AS, Delliaux M, Defebvre L. Assessing apathy in everyday clinical practice with the short-form Lille Apathy Rating Scale. Mov Disord 2013; 28:2014-9. [DOI: 10.1002/mds.25584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/20/2013] [Accepted: 06/06/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kathy Dujardin
- Laboratoire de Neurosciences Fonctionnelles et Pathologies; EA 4559; Université Lille; Lille France
- Neurologie et Pathologie du Mouvement; Neurologie A; Hôpital Salengro; Centre Hospitalier Universitaire; Lille France
| | - Pascal Sockeel
- Laboratoire PSITEC; EA 4072; UDL3; Université Lille Nord de France; Lille France
| | - Anne-Sophie Carette
- Neurologie et Pathologie du Mouvement; Neurologie A; Hôpital Salengro; Centre Hospitalier Universitaire; Lille France
| | - Marie Delliaux
- Neurologie et Pathologie du Mouvement; Neurologie A; Hôpital Salengro; Centre Hospitalier Universitaire; Lille France
| | - Luc Defebvre
- Laboratoire de Neurosciences Fonctionnelles et Pathologies; EA 4559; Université Lille; Lille France
- Neurologie et Pathologie du Mouvement; Neurologie A; Hôpital Salengro; Centre Hospitalier Universitaire; Lille France
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