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Cognitive and functional changes in prediagnostic phase of Parkinson disease: A population-based study. Parkinsonism Relat Disord 2020; 79:40-46. [PMID: 32862017 DOI: 10.1016/j.parkreldis.2020.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/01/2020] [Accepted: 08/15/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Prodromal non-motor symptoms precede, often by decades, motor signs and diagnosis of Parkinson's disease. It is however still uncertain if cognitive changes belong to the spectrum of non-motor prodromal Parkinson's disease. Thanks to the very long-term follow-up of the PAQUID population-based cohort, we assessed trajectories of cognitive complaints and functioning over a 13-year period before the diagnosis of late onset Parkinson's disease. METHODS This study relies on a matched nested case-control sample selected from the cohort. Of the 3777 initial subjects of the cohort, 43 developed incident Parkinson's disease over the follow-up. The mean age at diagnosis was 78.0 (standard deviation = 5.8) years and 46.5% were men. These cases were matched to 86 elderly control subjects. Scores of different cognitive domains, daily function, and depressive symptoms were described throughout the follow-up using mixed-effects models. RESULTS No significant global cognitive decline preceded the diagnosis of late onset Parkinson's disease. However, psychomotor speed appeared significantly slower 2 years before the diagnosis and depressive symptoms 12 years before. Global score of instrumental activities of daily living became altered 2-3 years preceding the diagnosis of late onset Parkinson's disease, including the use of public transportation that was altered ten years before the diagnosis. CONCLUSION In late onset Parkinson's disease, while global cognitive functions seem preserved, psychomotor speed starts to decline 2 years before the diagnosis and activities of daily living are also impacted. Depressive symptoms appear very early in the prediagnosic phase.
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202
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Stoker V, Krack P, Tonder L, Barnett G, Durand-Zaleski I, Schnitzler A, Houeto JL, Timmermann L, Rau J, Schade-Brittinger C, Vidailhet M, Deuschl G. Deep Brain Stimulation Impact on Social and Occupational Functioning in Parkinson's Disease with Early Motor Complications. Mov Disord Clin Pract 2020; 7:672-680. [PMID: 32775513 PMCID: PMC7396868 DOI: 10.1002/mdc3.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/15/2020] [Accepted: 06/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background Deep brain stimulation (DBS) improves motor symptoms and quality of life in patients with Parkinson's disease (PD) and early motor complications, suggesting that DBS could be prescribed to the working‐age PD population. Objectives To investigate the effect of DBS compared with best medical therapy (BMT) on social, psychosocial, and occupational functioning in patients with PD ≤60 years of age with early motor complications, its correlates, and possible underlying rationale. Methods Methods included analyses of the Social and Occupational Functioning Assessment Scale, Scales for Outcomes for Parkinson's–Psychosocial, Professional Fitness, Starkstein Apathy Scale, and Schwab and England Activities of Daily Living Scale from the EARLYSTIM study. Results Compared with BMT, DBS resulted in significantly greater improvements from baseline through 24 months in social,occupational, and psychosocial functioning. Yet, work status in the 2 groups did not differ at baseline and 24 months. Physicians reported a significantly higher percentage of patients in the BMT group unable to work at 24 months relative to baseline compared with the DBS group. Apathy was significantly worse in patients for whom physicians overrated ability to work when compared with patients’ own ratings than in the group of patients who physicians' ability to work ratings were comparable to, or worse than, patients' self‐ratings of ability to work. Conclusions For patients aged ≤60 years with PD and early motor complications, DBS provided significant improvements in social, occupational, and psychosocial function, but not in the actual work engagement compared with BMT at 2 years. Apathy may impact ability to work.
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Affiliation(s)
| | - Paul Krack
- Department of Neurology University Hospital Bern and University of Bern Bern Switzerland
| | | | | | | | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology Heinrich-Heine University Duesseldorf Duesseldorf Germany
| | - Jean-Luc Houeto
- Department of Neurology, Clinical Investigational Centers-Institut National de la Sante et de la Recherche Medicale 1402, Centre Hospitalier Universitaire of Poitiers University of Poitiers Poitiers France
| | | | - Joern Rau
- The Coordinating Center for Clinical Trials Philipps University Marburg Germany
| | | | - Marie Vidailhet
- Sorbonne Université, Insitut du Cerveau et de la Moelle Epinere UMR1127, Insitut National de la Sante et de la Recherche Medicale &1127, Centre National de la Recherche Scientifique 7225, Department of Neurology Salpêtriere University Hospital Assistance Publique - Hôpitaux de Paris Paris France
| | - Günther Deuschl
- Department of Neurology, Universitätsklinikum Schleswig-Holstein Kiel Campus Christian-Albrechts-University Kiel Germany
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203
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Goldenberg MDF, Huang X, Chen H, Kong L, Postolache TT, Stiller JW, Ryan KA, Pavlovich M, Pollin TI, Shuldiner AR, Mailman RB, Mitchell BD. Parkinson's Disease-Related Motor and Nonmotor Symptoms in the Lancaster Amish. Neuroepidemiology 2020; 54:392-397. [PMID: 32739915 DOI: 10.1159/000509394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous research has suggested that the Amish may experience a relatively high prevalence of Parkinson's disease (PD) and/or parkinsonian motor signs. METHODS In a large sample from the Amish community in Lancaster County, Pennsylvania, age ≥18 years, we assessed the prevalence of self-reported PD diagnosis. For those without self-reported PD diagnosis, we assessed the frequency of PD-related motor symptoms using a 9-item questionnaire that was designed by the PD Epidemiology Research Group. Lastly, we queried study participants for the presence of 2 nonmotor symptoms that have been commonly linked to PD: bowel movement frequency and daytime sleepiness. RESULTS Among 2,025 subjects who answered the PD questionnaire, 430 were older than 60 years. Of 430 participants ≥60 years, 5 (1.2%) reported a PD diagnosis. Of those without a PD diagnosis, 10.5% reported ≥1 and 1.2% ≥ 4 motor symptoms for the 9-item PD screening questionnaire. Of the 3,789 subjects who answered the question about bowel movement frequency, 0.7% reported ≤3 bowel movements per week. Among 1,710 subjects who answered the question about daytime sleepiness, 8.1% of the participants reported "always" sleepy during the day. DISCUSSION These data neither support a markedly higher PD prevalence in the older Lancaster Amish nor do they show dramatically higher motor and/or selected nonmotor symptoms than the general population. Future studies that employ more rigorous procedures for case identification and PD-specific preclinical symptoms/tests are needed to determine the potential differences and similarities among different Amish populations and between Amish and non-Amish populations.
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Affiliation(s)
- Michael D F Goldenberg
- Department of Neurology, Penn State Health-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Xuemei Huang
- Department of Neurology, Penn State Health-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA,
| | - Honglei Chen
- Department of Epidemiology, Michigan State University, East Lansing, Michigan, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, Rocky Mountain Mental Illness, Research Education and Clinical Center, Denver, Colorado, USA.,Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado, USA.,VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, Maryland, USA
| | - John W Stiller
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, Rocky Mountain Mental Illness, Research Education and Clinical Center, Denver, Colorado, USA.,St. Elizabeth's Hospital, Neurology Consultation Service, Washington, District of Columbia, USA
| | - Katherine A Ryan
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, Maryland, USA
| | - Mary Pavlovich
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Toni I Pollin
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan R Shuldiner
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Richard B Mailman
- Department of Neurology, Penn State Health-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Braxton D Mitchell
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland, USA
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204
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Screening of Parkinsonian subtle fine-motor impairment from touchscreen typing via deep learning. Sci Rep 2020; 10:12623. [PMID: 32724210 PMCID: PMC7387517 DOI: 10.1038/s41598-020-69369-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/30/2020] [Indexed: 11/22/2022] Open
Abstract
Fine-motor impairment (FMI) is progressively expressed in early Parkinson’s Disease (PD) patients and is now known to be evident in the immediate prodromal stage of the condition. The clinical techniques for detecting FMI may not be robust enough and here, we show that the subtle FMI of early PD patients can be effectively estimated from the analysis of natural smartphone touchscreen typing via deep learning networks, trained in stages of initialization and fine-tuning. In a validation dataset of 36,000 typing sessions from 39 subjects (17 healthy/22 PD patients with medically validated UPDRS Part III single-item scores), the proposed approach achieved values of area under the receiver operating characteristic curve (AUC) of 0.89 (95% confidence interval: 0.80–0.96) with sensitivity/specificity: 0.90/0.83. The derived estimations result in statistically significant (\documentclass[12pt]{minimal}
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\begin{document}$$p<0.05$$\end{document}p<0.05) correlation of 0.66/0.73/0.58 with the clinical standard UPDRS Part III items 22/23/31, respectively. Further validation analysis on 9 de novo PD patients vs. 17 healthy controls classification resulted in AUC of 0.97 (0.93–1.00) with 0.93/0.90. For 253 remote study participants, with self-reported health status providing 252.000 typing sessions via a touchscreen typing data acquisition mobile app (iPrognosis), the proposed approach predicted 0.79 AUC (0.66–0.91) with 0.76/0.71. Remote and unobtrusive screening of subtle FMI via natural smartphone usage, may assist in consolidating early and accurate diagnosis of PD.
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205
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Abstract
The etiology of Parkinson’s disease (PD) is multifactorial, with genetics, aging, and environmental agents all a part of the PD pathogenesis. Widespread aggregation of the α-synuclein protein in the form of Lewy bodies and Lewy neurites, and degeneration of substantia nigra dopamine neurons are the pathological hallmarks of PD. Inflammatory responses manifested by glial reactions, T cell infiltration, and increased expression of inflammatory cytokines, as well as other toxic mediators derived from activated glial cells, are currently recognized as prominent features of PD. Experimental, clinical and epidemiological data suggest that intestinal inflammation contributes to the pathogenesis of PD, and the increasing number of studies suggests that the condition may start in the gastrointestinal system years before any motor symptoms develop. Patients with inflammatory bowel disease (IBD) have a higher risk of developing PD compared with non-IBD individuals. Gene association study has found a genetic link between IBD and PD, and an evidence from animal studies suggests that gut inflammation, similar to that observed in IBD, may induce loss of dopaminergic neurons. Based on preclinical models of PD, it is suggested that the enteric microbiome changes early in PD, and gut infections trigger α-synuclein release and aggregation. In this paper, the possible link between IBD and PD is reviewed based on the available literature. Given the potentially critical role of gastrointestinal pathology in PD pathogenesis, there is reason to suspect that IBD or its treatments may impact PD risk. Thus, clinicians should be aware of PD symptoms in IBD patients.
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Affiliation(s)
- Tomasz Brudek
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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206
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Marrero-González P, Iranzo A, Bedoya D, Serradell M, Niñerola-Baizán A, Perissinotti A, Gaig C, Vilaseca I, Alobid I, Santamaría J, Mullol J. Prodromal Parkinson disease in patients with idiopathic hyposmia. J Neurol 2020; 267:3673-3682. [DOI: 10.1007/s00415-020-10048-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
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207
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Siderowf A, Jennings D, Stern M, Seibyl J, Eberly S, Oakes D, Marek K. Clinical and Imaging Progression in the PARS Cohort: Long-Term Follow-up. Mov Disord 2020; 35:1550-1557. [PMID: 32657461 DOI: 10.1002/mds.28139] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The PARS (Parkinson Associated Risk Syndrome) study was designed to test whether screening for hyposmia followed by dopamine transporter imaging can identify risk for conversion to clinical PD, and to evaluate progression markers during the prodromal period. METHODS Subjects with hyposmia completed annual clinical evaluations and biennial [123 I]ß-CIT single-photon emission computed tomography scans. Subjects were categorized as normal (>80% age-expected tracer uptake; n = 134), indeterminate (>65-80%; n = 30), and dopamine transporter deficit (≤65%; n = 21) by their baseline scan, and survival analysis was used to compare risk of conversion to motor PD. Progressing to a scan with a dopamine transporter deficit was assessed for those subjects with either normal or indeterminate baseline imaging. RESULTS Over a mean of 6.3 [standard deviation: 2.2] years of follow-up, 67% (n = 14) of dopamine transporter deficit subjects, 20% (n = 6) of dopamine transporter indeterminate subjects, and 4% (n = 6) of dopamine transporter normal subjects converted to a PD diagnosis (P < 0.0001). Among subjects without dopamine transporter deficit at baseline, a reduction to ≤65% age-expected uptake occurred in 12 of 30 (40%) with indeterminate dopamine transporter and 7 of 134 (5%) with no dopamine transporter DAT deficit (P < 0.0001). Imaging conversion during follow-up was associated with subsequent clinical conversion (hazard ratio: 9.6; P = 0.0157). DISCUSSION AND CONCLUSIONS Long-term follow-up of the PARS cohort demonstrated a high rate of conversion to clinical PD in subjects who either had abnormal dopamine transporter imaging at baseline or developed abnormal imaging during follow-up. These data extend the earlier PARS findings and present new results showing the sequence of incident imaging deficit, imaging progression, and clinical changes that occur in prodromal PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Andrew Siderowf
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danna Jennings
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Matthew Stern
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
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208
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Poortvliet PC, O'Maley K, Silburn PA, Mellick GD. Perspective: Current Pitfalls in the Search for Future Treatments and Prevention of Parkinson's Disease. Front Neurol 2020; 11:686. [PMID: 32733372 PMCID: PMC7360677 DOI: 10.3389/fneur.2020.00686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
We are gradually becoming aware that there is more to Parkinson's disease (PD) than meets the eye. Accumulating evidence has unveiled a disease complexity that has not (yet) been incorporated into ongoing efforts aimed at slowing, halting or reversing the course of PD, likely underlying their lack of success. There is a substantial latency between the actual onset of PD pathology and our ability to confirm diagnosis, during which accumulating structural and functional damage might be too advanced for effective modification or protection. Identification at the earliest stages of the disease course in the absence of Parkinsonism is crucial if we are to intervene when it matters most. Prognostic and therapeutic inferences can only be successful if we are able to accurately predict who is at risk for developing PD and if we can differentiate amongst the considerable clinicopathologic diversity. Biomarkers can greatly improve our identification and differentiation abilities if we are able to disentangle cause and effect.
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Affiliation(s)
- Peter C Poortvliet
- School of Environment and Science, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
| | - Karen O'Maley
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia
| | - Peter A Silburn
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - George D Mellick
- School of Environment and Science, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
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209
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Distinctive Pathophysiology Underlying Constipation in Parkinson's Disease: Implications for Cognitive Inefficiency. J Clin Med 2020; 9:jcm9061916. [PMID: 32575365 PMCID: PMC7356098 DOI: 10.3390/jcm9061916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Depression is associated with constipation within and outside Parkinson’s disease (PD). Since inefficient cognitive-processing (bradyphrenia) features in PD and an enterokinetic agent improved cognitive performance in healthy individuals, bradyphrenia may be associated with constipation. We aim to define the archetypical bowel function of PD, and its association with cognition, mood, and motor features within and outside PD. We assessed colonic transit time (oral radio-opaque markers over 6 days), bowel function and psychometric questionnaires and measures of PD facets, including bradyphrenia, in 58 participants with diagnosed PD, and 71 without (controls). The best abdominal X-ray (day 7) predictors of PD status were total retained marker count and transverse colon segmental delay. However, Rome functional constipation status complemented segmental delay better, giving good specificity (85%) but low sensitivity (56%). Transverse colon marker count appeared to be age-associated only in PD. In PD, those correctly classified by bowel dysfunction had higher depression scores (p = 0.02) and longer cognitive-processing times than the misclassified (p = 0.05). Controls misclassified as PD by bowel dysfunction had higher depression and anxiety scores than the correctly classified (p = 0.002 and 0.003, respectively), but not slower cognitive processing. Measures of motor features were independent of sub-classification by bowel function in PD and in controls. In conclusion, constipation in PD has distinct localized pathophysiology, and is associated with bradyphrenia.
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210
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Heinzel S, Aho VTE, Suenkel U, von Thaler AK, Schulte C, Deuschle C, Paulin L, Hantunen S, Brockmann K, Eschweiler GW, Maetzler W, Berg D, Auvinen P, Scheperjans F. Gut Microbiome Signatures of Risk and Prodromal Markers of Parkinson Disease. Ann Neurol 2020; 88:320-331. [PMID: 32441370 DOI: 10.1002/ana.25788] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Alterations of the gut microbiome in Parkinson disease (PD) have been repeatedly demonstrated. However, little is known about whether such alterations precede disease onset and how they relate to risk and prodromal markers of PD. We investigated associations of these features with gut microbiome composition. METHODS Established risk and prodromal markers of PD as well as factors related to diet/lifestyle, bowel function, and medication were studied in relation to bacterial α-/β-diversity, enterotypes, and differential abundance in stool samples of 666 elderly TREND (Tübingen Evaluation of Risk Factors for Early Detection of Neurodegeneration) study participants. RESULTS Among risk and prodromal markers, physical activity, occupational solvent exposure, and constipation showed associations with α-diversity. Physical activity, sex, constipation, possible rapid eye movement sleep behavior disorder (RBD), and smoking were associated with β-diversity. Subthreshold parkinsonism and physical activity showed an interaction effect. Among other factors, age and urate-lowering medication were associated with α- and β-diversity. Physical inactivity and constipation were highest in individuals with the Firmicutes-enriched enterotype. Constipation was lowest and subthreshold parkinsonism least frequent in individuals with the Prevotella-enriched enterotype. Differentially abundant taxa were linked to constipation, physical activity, possible RBD, smoking, and subthreshold parkinsonism. Substantia nigra hyperechogenicity, olfactory loss, depression, orthostatic hypotension, urinary/erectile dysfunction, PD family history, and the prodromal PD probability showed no significant microbiome associations. INTERPRETATION Several risk and prodromal markers of PD are associated with gut microbiome composition. However, the impact of the gut microbiome on PD risk and potential microbiome-dependent subtypes in the prodrome of PD need further investigation based on prospective clinical and (multi)omics data in incident PD cases. ANN NEUROL 2020;88:320-331.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Velma T E Aho
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland.,Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Christian Deuschle
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Lars Paulin
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Geriatric Center at the University Hospital Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Petri Auvinen
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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211
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Sportelli C, Urso D, Jenner P, Chaudhuri KR. Metformin as a Potential Neuroprotective Agent in Prodromal Parkinson's Disease-Viewpoint. Front Neurol 2020; 11:556. [PMID: 32595595 PMCID: PMC7304367 DOI: 10.3389/fneur.2020.00556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
To date, there are no clinically effective neuroprotective or disease-modifying treatments that can halt Parkinson's disease (PD) progression. The current clinical approach focuses on symptomatic management. This failure may relate to the complex neurobiology underpinning the development of PD and the absence of true translational animal models. In addition, clinical diagnosis of PD relies on presentation of motor symptoms which occur when the neuropathology is already established. These multiple factors could contribute to the unsuccessful development of neuroprotective treatments for PD. Prodromal symptoms develop years prior to formal diagnosis and may provide an excellent tool for early diagnosis and better trial design. Patients with idiopathic rapid eye movement behavior disorder (iRBD) have the highest risk of developing PD and could represent an excellent group to include in neuroprotective trials for PD. In addition, repurposing drugs with excellent safety profiles is an appealing strategy to accelerate drug discovery. The anti-diabetic drug metformin has been shown to target diverse cellular pathways implicated in PD progression. Multiple studies have, additionally, observed the benefits of metformin to counteract other age-related diseases. The purpose of this viewpoint is to discuss metformin's neuroprotective potential by outlining relevant mechanisms of action and the selection of iRBD patients for future clinical trials in PD.
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Affiliation(s)
- Carolina Sportelli
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Daniele Urso
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College, London, United Kingdom
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
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212
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Schrag A, Quinn N. What contributes to quality of life in Parkinson's disease: a re-evaluation. J Neurol Neurosurg Psychiatry 2020; 91:563-565. [PMID: 32139651 DOI: 10.1136/jnnp-2019-322379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Anette Schrag
- UCL Institute of Neurology, University College London, London, UK
| | - Niall Quinn
- UCL Institute of Neurology, University College London, London, UK
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213
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Han X, Wu P, Alberts I, Zhou H, Yu H, Bargiotas P, Yakushev I, Wang J, Höglinger G, Förster S, Bassetti C, Oertel W, Schwaiger M, Huang SC, Cumming P, Rominger A, Jiang J, Zuo C, Shi K. Characterizing the heterogeneous metabolic progression in idiopathic REM sleep behavior disorder. NEUROIMAGE-CLINICAL 2020; 27:102294. [PMID: 32570206 PMCID: PMC7322340 DOI: 10.1016/j.nicl.2020.102294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
Imaging biomarkers of the metabolic trajectory from HC, iRBD and PD are identified. Frontal, limbic and occipital brain regions as imaging biomarkers in PD. Frontal, limbic and occipital brain regions as imaging biomarkers of the phenoconversion from iRBD to PD.
Objective Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is a prodromal stage of synucleinopathies such as Parkinson’s disease (PD). Positron emission tomography (PET) with 18F-FDG reveals metabolic perturbations, which are scored by spatial covariance analysis. However, the resultant pattern scores do not capture the spatially heterogeneous trajectories of metabolic changes between individual brain regions. Assuming metabolic progression occurs as a continuum from the healthy control (HC) condition to iRBD and then PD, we investigated spatial dynamics of progressively perturbed glucose metabolism in a cross-sectional study. Methods 19 iRBD patients, 38 PD patients and 19 HC subjects underwent 18F-FDG PET. The images were spatially normalized, scaled to the global mean uptake, and automatically parcellated. We contrasted regional metabolism by group, and allocated the inferred progression to one of several possible trajectories. We further investigated the correlations between 18F-FDG uptake and the disease duration in the iRBD and PD groups, respectively. We also explored relationships between 18F-FDG uptake and the Unified Parkinson’s Disease Rating Scale motor (UPDRS III) scores in the PD group. Results PD patients exhibited more extensive relative hyper- and hypo-metabolism than iRBD patients. We identified three dynamic metabolic trajectories, cross-sectional hypo- or hypermetabolism, cross-sectionally unchanged hypo- or hypermetabolism, cross-sectionally late hypo- or hypermetabolism, appearing only in the contrast of PD with iRBD. No correlation was found between relative 18F-FDG metabolism and disease duration in the iRBD group. Regional hyper- and hypo-metabolism in the PD patients correlated with disease duration or clinical UPDRS III scores. Conclusion Cerebral metabolism changes heterogeneously in a continuum extending from HC to iRBD and PD groups in this preliminary study. The distinctive metabolic trajectories point towards a potential neuroimaging biomarker for conversion of iRBD to frank PD, which should be amenable to advanced pattern recognition analysis in future longitudinal studies.
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Affiliation(s)
- Xianhua Han
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Wu
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Ian Alberts
- Department of Nuclear Medicine, University of Bern, Switzerland
| | - Hucheng Zhou
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication ,Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Huan Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Panagiotis Bargiotas
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland; Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Igor Yakushev
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Jian Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Stefan Förster
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany; Department of Nuclear Medicine, Klinikum Bayreuth, Germany
| | - Claudio Bassetti
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | | | - Markus Schwaiger
- Klinikum r. d. Isar, Technische Universität München, Munich, Germany
| | - Sung-Cheng Huang
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, USA
| | - Paul Cumming
- Department of Nuclear Medicine, University of Bern, Switzerland; School of Psychology and Counselling and IHBI, Queensland University of Technology, Brisbane, Australia
| | - Axel Rominger
- Department of Nuclear Medicine, University of Bern, Switzerland
| | - Jiehui Jiang
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication ,Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China.
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai, China; Human Phenome Institute, Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
| | - Kuangyu Shi
- Department of Nuclear Medicine, University of Bern, Switzerland; Dept. Informatics, Technische Universität München, Munich, Germany
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Janitzky K. Impaired Phasic Discharge of Locus Coeruleus Neurons Based on Persistent High Tonic Discharge-A New Hypothesis With Potential Implications for Neurodegenerative Diseases. Front Neurol 2020; 11:371. [PMID: 32477246 PMCID: PMC7235306 DOI: 10.3389/fneur.2020.00371] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/14/2020] [Indexed: 12/21/2022] Open
Abstract
The locus coeruleus (LC) is a small brainstem nucleus with widely distributed noradrenergic projections to the whole brain, and loss of LC neurons is a prominent feature of age-related neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). This article discusses the hypothesis that in early stages of neurodegenerative diseases, the discharge mode of LC neurons could be changed to a persistent high tonic discharge, which in turn might impair phasic discharge. Since phasic discharge of LC neurons is required for the release of high amounts of norepinephrine (NE) in the brain to promote anti-inflammatory and neuroprotective effects, persistent high tonic discharge of LC neurons could be a key factor in the progression of neurodegenerative diseases. Transcutaneous vagal stimulation (t-VNS), a non-invasive technique that potentially increases phasic discharge of LC neurons, could therefore provide a non-pharmacological treatment approach in specific disease stages. This article focuses on LC vulnerability in neurodegenerative diseases, discusses the hypothesis that a persistent high tonic discharge of LC neurons might affect neurodegenerative processes, and finally reflects on t-VNS as a potentially useful clinical tool in specific stages of AD and PD.
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Affiliation(s)
- Kathrin Janitzky
- Department of Neurology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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215
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Alarcón F, Maldonado JC, Cañizares M, Molina J, Noyce AJ, Lees AJ. Motor Dysfunction as a Prodrome of Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:1067-1073. [PMID: 32390641 DOI: 10.3233/jpd-191851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recognition of motor signs in the prodromal stage could help identify those at risk of developing Parkinson's disease (PD). OBJECTIVE This study identified motor symptoms and signs in individuals suspected of having PD but who did not have a progressive reduction in the speed and amplitude of finger tapping or other physical signs indicative of bradykinesia. METHODS 146 patients, who had symptoms or signs suggestive of PD, were serially evaluated by a movement disorder specialist, using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and video recordings. If the patients 'converted' to PD during follow-up, they were categorized as cases and compared with those who did not meet PD criteria during follow-up (non-cases). RESULTS The 82 cases were more likely to have action dystonia or postural/action/rest tremor of a limb (OR 2.8; 95% CI 1.1-7.1; p = 0.02), a reduced blink rate at rest (OR 2.3; 95% CI 1.2-4.6; p = 0.01), anxiety (OR 8.9; 95% CI 2.6-31.1; p < 0.001), depression (OR 7.0; 95% CI 2.9-17.2; p < 0.001), or a frozen shoulder (OR 3.1; 95% CI 1.6-6.2) than the 64 'non-cases'.A reduction of the fast blink rate was common in patients who met the criteria for PD (p < 0.001). CONCLUSIONS This study emphasizes that motor dysfunction is a component of the clinical prodrome seen in some patients with PD.
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Affiliation(s)
- Fernando Alarcón
- Department of Neurology, Hospital Eugenio Espejo, Quito, Ecuador
| | | | - Miguel Cañizares
- Department of Neurology, Hospital Eugenio Espejo, Quito, Ecuador
| | - José Molina
- Department of Neurology, Hospital Eugenio Espejo, Quito, Ecuador
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Clinical and Movement Neurosciences & Reta Lila Weston, Institute of Neurology, London, UK
| | - Andrew J Lees
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Clinical and Movement Neurosciences & Reta Lila Weston, Institute of Neurology, London, UK
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216
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Hustad E, Aasly JO. Clinical and Imaging Markers of Prodromal Parkinson's Disease. Front Neurol 2020; 11:395. [PMID: 32457695 PMCID: PMC7225301 DOI: 10.3389/fneur.2020.00395] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/17/2020] [Indexed: 12/16/2022] Open
Abstract
The diagnosis of Parkinson's disease (PD) relies on the clinical effects of dopamine deficiency, including bradykinesia, rigidity and tremor, usually manifesting asymmetrically. Misdiagnosis is common, due to overlap of symptoms with other neurodegenerative disorders such as multiple system atrophy and progressive supranuclear palsy, and only autopsy can definitively confirm the disease. Motor deficits generally appear when 50–60% of dopaminergic neurons in the substantia nigra are already lost, limiting the effectiveness of potential neuroprotective therapies. Today, we consider PD to be not just a movement disorder, but rather a complex syndrome non-motor symptoms (NMS) including disorders of sleep-wake cycle regulation, cognitive impairment, disorders of mood and affect, autonomic dysfunction, sensory symptoms and pain. Symptomatic LRRK2 mutation carriers share non-motor features with individuals with sporadic PD, including hyposmia, constipation, impaired color discrimination, depression, and sleep disturbance. Following the assumption that the pre-symptomatic gene mutation carriers will eventually exhibit clinical symptoms, their neuroimaging results can be extended to the pre-symptomatic stage of PD. The long latent phase of PD, termed prodromal-PD, represents an opportunity for early recognition of incipient PD. Early recognition could allow initiation of possible neuroprotective therapies at a stage when therapies might be most effective. The number of markers with the sufficient level of evidence to be included in the MDS research criteria for prodromal PD have increased during the last 10 years. Here, we review the approach to prodromal PD, with an emphasis on clinical and imaging markers and report results from our neuroimaging study, a retrospective evaluation of a cohort of 39 participants who underwent DAT-SPECT scan as part of their follow up. The study was carried out to see if it was possible to detect subclinical signs in the preclinical (neurodegenerative processes have commenced, but there are no evident symptoms or signs) and prodromal (symptoms and signs are present, but are yet insufficient to define disease) stages of PD.
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Affiliation(s)
- Eldbjørg Hustad
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan O Aasly
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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217
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Camacho-Soto A, Gross A, Searles Nielsen S, Miller AN, Warden MN, Salter A, Racette BA. Fractures in the prodromal period of Parkinson disease. Neurology 2020; 94:e2448-e2456. [PMID: 32345729 DOI: 10.1212/wnl.0000000000009452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/02/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the association between fractures and Parkinson disease (PD) during the 5-year prodromal phase as compared to controls. METHODS We performed a population-based case-control study of Medicare beneficiaries in the United States from 2004 to 2009. We identified 89,632 incident PD cases and 117,760 comparable controls 66-90 years of age in 2009. PD case status was the outcome, and noncranial fracture the independent variable. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association between fracture and PD in yearly time intervals prior to PD diagnosis/control reference date, after adjusting for covariates. RESULTS There were 39,606 total fractures (25.4% cases, 14.3% controls) over the 5 years prior to the PD diagnosis/control reference date. PD was positively associated with fractures even after adjusting for age, sex, race/ethnicity, Charlson comorbidity index, alcohol use, tobacco use, and osteoporosis. The association between PD and fracture was evident at yearly time windows prior to PD diagnosis/control reference date. The association between PD and each type of fracture strengthened as the PD diagnosis/control reference date approached (all time interaction p values ≤0.02). Among beneficiaries with a mechanism of injury, the majority were attributed to falls (74.6% cases, 72.8% controls). CONCLUSION Fractures occur more commonly during the prodromal period of PD compared to controls, especially as diagnosis date approached, suggesting that patients with PD may experience unrecognized motor and nonmotor symptoms.
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Affiliation(s)
- Alejandra Camacho-Soto
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa
| | - Anat Gross
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Searles Nielsen
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa
| | - Anna N Miller
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa
| | - Mark N Warden
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa
| | - Amber Salter
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa
| | - Brad A Racette
- From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
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Wilke C, Santos MCT, Schulte C, Deuschle C, Scheller D, Verbelen M, Brockmann K, Thaler A, Sünkel U, Roeben B, Bujac S, Metzger FG, Maetzler W, Costa AN, Synofzik M, Berg D. Intraindividual Neurofilament Dynamics in Serum Mark the Conversion to Sporadic Parkinson's Disease. Mov Disord 2020; 35:1233-1238. [DOI: 10.1002/mds.28026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 01/02/2023] Open
Affiliation(s)
- Carlo Wilke
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | | | - Claudia Schulte
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | - Christian Deuschle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | | | - Moira Verbelen
- Exploratory StatisticsGlobal Exploratory Development, UCB Pharma Slough United Kingdom
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | - Anna‐Katharina Thaler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | - Ulrike Sünkel
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | - Benjamin Roeben
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | - Sarah Bujac
- Exploratory StatisticsGlobal Exploratory Development, UCB Pharma Slough United Kingdom
| | - Florian G. Metzger
- Department of Psychiatry and PsychotherapyUniversity Hospital Tübingen Tübingen Germany
- Geriatric CenterUniversity Hospital Tübingen Tübingen Germany
- Vitos Hospital for Psychiatry and Psychotherapy Haina Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- Department of NeurologyUniversity Hospital Schleswig‐Holstein, Kiel University Kiel Germany
| | - Andre Nogueira Costa
- Experimental Medicine and DiagnosticsGlobal Exploratory Development, UCB Biopharma Braine‐L'Alleud Belgium
- Precision MedicineOncology R&D Organisation AstraZeneca, Molndal Sweden
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- German Center for Neurodegenerative DiseasesUniversity of Tübingen Tübingen Germany
| | - Daniela Berg
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of NeurologyUniversity of Tübingen Tübingen Germany
- Department of NeurologyUniversity Hospital Schleswig‐Holstein, Kiel University Kiel Germany
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219
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Fründt O, Grashorn W, Buhmann C, Forkmann K, Mainka T, Bingel U, Schmidt K. Quantitative Sensory Testing (QST) in Drug-Naïve Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:369-378. [PMID: 30829618 DOI: 10.3233/jpd-181513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain is highly prevalent in patients with Parkinson's disease (PD), but underlying pathophysiological mechanisms are largely unclear. Alterations in somatosensory processing might contribute to sensory abnormalities in PD. OBJECTIVE This study investigated sensory processing in PD patients. METHODS We used the standardized "Quantitative Sensory Testing" (QST) protocol (German Research Network on Neuropathic Pain) to investigate 13 somatosensory parameters in 19 PD patients naïve to dopaminergic medication and 19 healthy controls matched for age, gender, and handedness. We tested for differences in sensory parameters between i) drug-naïve PD patients and healthy controls, ii) patients' more and less affected body side, and iii) for an association of somatosensory parameters with disease-specific factors. RESULTS We did not observe any significant group differences in somatosensory parameters between PD patients and healthy subjects. In PD patients, QST mean z-scores did not differ between the predominantly and the less affected body side, PD patients with and without PD-specific chronic pain or between different PD subtypes. Age, but not PD disease severity, was associated with a greater loss of function in thermal and mechanical detection thresholds. CONCLUSIONS Somatosensory processing, as assessed with the well-established QST protocol, was normal in drug-naïve PD patients. Thus, somatosensory abnormalities previously reported in medicated PD patients might rather be a result of dopaminergic medication, or may occur later in the course of the disease or with increasing age.
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Affiliation(s)
- Odette Fründt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Grashorn
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katarina Forkmann
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tina Mainka
- Department of Neurology, Charité Berlin, Berlin
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for magnetic resonance imaging, Essen, Germany
| | - Katharina Schmidt
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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220
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Moradi SZ, Momtaz S, Bayrami Z, Farzaei MH, Abdollahi M. Nanoformulations of Herbal Extracts in Treatment of Neurodegenerative Disorders. Front Bioeng Biotechnol 2020; 8:238. [PMID: 32318551 PMCID: PMC7154137 DOI: 10.3389/fbioe.2020.00238] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
Nanotechnology is one of the methods that influenced human life in different ways and is a substantial approach that assists to overcome the multiple limitations of various diseases, particularly neurodegenerative disorders (NDs). Diverse nanostructures such as polymer nanoparticles, lipid nanoparticles, nanoliposomes, nano-micelles, and carbon nanotubes (CNTs); as well as different vehicle systems including poly lactic-co-glycolic acid, lactoferrin, and polybutylcyanoacrylate could significantly increase the effectiveness, reduce the side effects, enhance the stability, and improve the pharmacokinetics of many drugs. NDs belong to a group of annoying and debilitating diseases that involve millions of people worldwide. Previous studies revealed that several nanoformulations from a number of natural products such as curcumin (Cur), quercetin (QC), resveratrol (RSV), piperine (PIP), Ginkgo biloba, and Nigella sativa significantly improved the condition of patients diagnosed with NDs. Drug delivery to the central nervous system (CNS) has several limitations, in which the blood brain barrier (BBB) is the main drawback for treatment of NDs. This review discusses the effects of herbal-based nanoformulations, their advantages and disadvantages, to manage NDs. In summary, we conclude that herbal-based nano systems have promising proficiency in treatment of NDs, either alone or in combination with other drugs.
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Affiliation(s)
- Seyed Zachariah Moradi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeideh Momtaz
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Bayrami
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
- Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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221
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Ahn JH, Kim M, Mun JK, Cho Y, Kim JS, Youn J, Kim JS, Cho JW. The Dysfunctional Autonomic Function and “Dysfunctional” Fatigue in Drug Naïve Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:605-612. [DOI: 10.3233/jpd-201919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Jun Kyu Mun
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Yoonsu Cho
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
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222
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Carroll CB, Wyse RKH, Grosset DG. Statins and Parkinson's: A complex interaction. Mov Disord 2020; 34:934-935. [PMID: 31322771 DOI: 10.1002/mds.27721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Camille B Carroll
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, United Kingdom
| | | | - Donald G Grosset
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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223
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Palma JA. Renal dysfunction might be a marker of cardiovascular dysautonomia in prodromal α-synucleinopathies. Mov Disord 2020; 35:374. [PMID: 32056310 DOI: 10.1002/mds.27840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
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Seritan AL, Rienas C, Duong T, Delucchi K, Ostrem JL. Ages at Onset of Anxiety and Depressive Disorders in Parkinson's Disease. J Neuropsychiatry Clin Neurosci 2020; 31:346-352. [PMID: 31117906 DOI: 10.1176/appi.neuropsych.18090201] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) is a quintessential neuropsychiatric condition in which anxiety and depressive symptoms are common and may precede motor manifestations. The authors explored the ages at onset of anxiety and depressive disorders among patients with PD evaluated by psychiatrists at a deep brain stimulation center. METHODS Psychiatric diagnoses and ages at onset were collected via clinical interviews. The ages at PD diagnosis were ascertained by chart review. Onset ages for anxiety and depressive disorders (overall and for specific disorders) were compared with patients' ages at PD diagnosis by using t tests. Onset ages for major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder were compared with typical onset ages in the general population by using the sign test. A total of 108 patients (66.7% men; age 63.7 years [SD=8.9]) were included in the analysis. RESULTS Anxiety and depressive disorders occurred significantly earlier than PD diagnoses. Among patients whose anxiety and depression predated motor symptoms, the mean age at onset of anxiety disorders was 25.6 years earlier, and the mean age at onset of depressive disorders was 17.6 years earlier compared with the mean age at PD diagnosis (both p values <0.0001). Median onset ages for MDD (p<0.0001), GAD (p=0.0002), and panic disorder (p=0.0005) were significantly higher than typical median onset ages in the general population. CONCLUSIONS These results may indicate that neurodegenerative changes are present in parts of the brainstem reticular core and limbic system before motor circuits are affected to a degree that causes motor symptoms. Psychiatrists should be mindful that onset of MDD, GAD, and panic disorder after age 45 might signal a neurodegenerative movement disorder such as PD.
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Affiliation(s)
- Andreea L Seritan
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Christopher Rienas
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Tammy Duong
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Kevin Delucchi
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Jill L Ostrem
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
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225
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Incidence of muscle relaxant use in relation to diagnosis of Parkinson's disease. Int J Clin Pharm 2020; 42:336-340. [PMID: 32144610 DOI: 10.1007/s11096-020-01002-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Background Parkinson's disease is the second most common neurodegenerative disorder. Motor and non-motor symptoms seem to precede the diagnosis of Parkinson's disease. Objective To evaluate the incidence of muscle relaxant use in community-dwelling persons with and without Parkinson's disease from 4 years before to 4 years after the diagnosis of Parkinson's disease. Method Nationwide register-based cohort included all community-dwelling Finnish persons who received reimbursement of Parkinson's disease drugs between 2000 and 2015 (N = 17,450) and comparison persons without Parkinson's disease who were matched for age, gender and region of residence (N = 122,694). Data on muscle relaxant use during 1995-2016 were collected from the Prescription Register. Results The incidence of muscle relaxant use was higher among persons with Parkinson's disease in comparison to persons without Parkinson's disease from 3 years before the diagnosis until 6 months after the diagnosis. The largest difference in incidence rates was observed at the time of the diagnosis (incidence rate ratio = 2.04, 95% confidence interval = 1.81-2.30). Tizanidine was the most frequently initiated muscle relaxant. Conclusions The incidence of muscle relaxant use starts increasing years before the diagnosis of Parkinson's disease but declines after that. It is important to identify the causes of muscle symptoms to avoid unnecessary muscle relaxant use and consequent adverse effects and events.
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Kwon KY, Park S, Lee M, Ju H, Im K, Joo BE, Lee KB, Roh H, Ahn MY. Dizziness in patients with early stages of Parkinson's disease: Prevalence, clinical characteristics and implications. Geriatr Gerontol Int 2020; 20:443-447. [PMID: 32092783 DOI: 10.1111/ggi.13894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
AIM The clinical features and implications of dizziness in patients with Parkinson's disease (PD) remain little known. This study aimed to investigate the clinical characteristics of dizziness, and the association of dizziness with motor and non-motor symptoms in early stages of PD. METHODS Demographics and clinical characteristics of patients with early PD (disease duration ≤5 years) were retrospectively assessed. The characteristics of dizziness were surveyed in each parkinsonian patient according to existence, frequency, duration and nature. Not only motor symptoms, but also non-motor scales for global cognition, anxiety, depression and fatigue were evaluated to identify risk factors of dizziness. RESULTS Of a total of 80 patients with early PD, 37 (46.3%) had dizziness. The characteristics of dizziness included short duration (seconds to minutes) and frequent occurrence (several times in a day or a week). The most common type of dizziness was orthostatic (40.5%), followed by non-specific and disequilibrium type. Among many scales for motor and non-motor symptoms, dizzy patients with early PD showed lower scores of Montreal Cognitive representing global cognition than non-dizzy people. A lower Montreal Cognitive Assessment score was the only factor significantly related to dizziness in patients with early PD. CONCLUSIONS We found that dizziness frequently occurs in early parkinsonian patients. It is highly linked to low Montreal Cognitive Assessment scores in patients with early PD, inferring that dizziness might be a potential non-motor symptom associated with cognitive decline in PD. Geriatr Gerontol Int 2020; 20: 443-447.
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Affiliation(s)
- Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Mina Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Hyunjin Ju
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Kayeong Im
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Hakjae Roh
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Moo-Young Ahn
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
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Faust IM, Racette BA, Searles Nielsen S. Validation of a Parkinson Disease Predictive Model in a Population-Based Study. PARKINSON'S DISEASE 2020; 2020:2857608. [PMID: 32148753 PMCID: PMC7054801 DOI: 10.1155/2020/2857608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/18/2022]
Abstract
Parkinson disease (PD) has a relatively long prodromal period that may permit early identification to reduce diagnostic testing for other conditions when patients are simply presenting with early PD symptoms, as well as to reduce morbidity from fall-related trauma. Earlier identification also could prove critical to the development of neuroprotective therapies. We previously developed a PD predictive model using demographic and Medicare claims data in a population-based case-control study. The area under the receiver-operating characteristic curve (AUC) indicated good performance. We sought to further validate this PD predictive model. In a randomly selected, population-based cohort of 115,492 Medicare beneficiaries aged 66-90 and without PD in 2009, we applied the predictive model to claims data from the prior five years to estimate the probability of future PD diagnosis. During five years of follow-up, we used 2010-2014 Medicare data to determine PD and vital status and then Cox regression to investigate whether PD probability at baseline was associated with time to PD diagnosis. Within a nested case-control sample, we calculated the AUC, sensitivity, and specificity. A total of 2,326 beneficiaries developed PD. Probability of PD was associated with time to PD diagnosis (p < 0.001, hazard ratio = 13.5, 95% confidence interval (CI) 10.6-17.3 for the highest vs. lowest decile of probability). The AUC was 83.3% (95% CI 82.5%-84.1%). At the cut point that balanced sensitivity and specificity, sensitivity was 76.7% and specificity was 76.2%. In an independent sample of additional Medicare beneficiaries, we again applied the model and observed good performance (AUC = 82.2%, 95% CI 81.1%-83.3%). Administrative claims data can facilitate PD identification within Medicare and Medicare-aged samples.
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Affiliation(s)
- Irene M. Faust
- Washington University School of Medicine, Department of Neurology, St. Louis, Missouri, USA
| | - Brad A. Racette
- Washington University School of Medicine, Department of Neurology, St. Louis, Missouri, USA
- University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Susan Searles Nielsen
- Washington University School of Medicine, Department of Neurology, St. Louis, Missouri, USA
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Schaeffer E, Postuma RB, Berg D. Prodromal PD: A new nosological entity. PROGRESS IN BRAIN RESEARCH 2020; 252:331-356. [PMID: 32247370 DOI: 10.1016/bs.pbr.2020.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Recent years have brought a rapid growth in knowledge of the prodromal phase of Parkinson's disease (PD). It is now clear that the clinical phase of PD is preceded by a phase of progressing neurodegeneration lasting many years. This involves not only central nervous system structures outside the substantia nigra and neurotransmitter systems other than the dopaminergic system, but also the peripheral nervous systems. Different ways of alpha-synuclein spreading are presumed, corresponding to typical prodromal non-motor symptoms like constipation, REM sleep behavior disorder (RBD) and hyposmia. Moreover, many risk and prodromal markers have been identified and combined in the prodromal research criteria, which can be used to calculate an individual's probability of being in the prodromal phase of PD. Apart from specific genetic risk markers, including most importantly GBA- and LRRK2 mutations, RBD is currently the most important prodromal marker, predicting PD with a very high likelihood. This makes individuals with RBD a promising cohort for future clinical trials to detect and treat PD in its prodromal phase. New markers, especially those derived from tissue biopsies, quantitative motor assessment and imaging, appear very promising; these are paving the way for a better understanding of the prodromal phase and its potential clinicopathological subtypes, and a more precise probability calculation.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany.
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, QC, Canada
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
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229
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β-adrenoreceptors and the risk of Parkinson's disease. Lancet Neurol 2020; 19:247-254. [PMID: 31999942 DOI: 10.1016/s1474-4422(19)30400-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND β-adrenoceptors are widely expressed in different human organs, mediate important body functions and are targeted by medications for various diseases (such as coronary heart disease and heart attack) and many β-adrenoceptor acting drugs are listed on the WHO Model List of Essential Medicines. β-adrenoceptor antagonists are used by billions of patients with neurological disorders, primarily for the treatment of migraine and action tremor (mainly essential tremor), worldwide. RECENT DEVELOPMENTS An observational study reported a link between the chronic use of the β-adrenoceptor antagonist propranolol and an increased risk of Parkinson's disease, while the chronic use of the β-adrenoceptor agonists was associated with a decreased risk. Further support of this association was provided by a dose-dependent decrease in the risk of Parkinson's disease with chronic β-adrenoceptor agonist (eg, salbutamol) use, and by functional data indicating a possible underlying molecular mechanism. Five additional epidemiological studies have examined the modulation of the risk of Parkinson's disease as a result of the use of β-adrenoceptor-acting drugs in different populations. Overall, similar estimates but different interpretations of the associations were provided. Several findings suggest that the increase in risk of Parkinson's disease associated with β-adrenoceptor antagonists use can be explained by reverse causation because prodromal Parkinson's disease is often associated with non-specific action tremor, which is usually treated with propranolol. The lower risk of Parkinson's disease seen in patients receiving β-adrenoceptor agonists is likely to be indirectly mediated by smoking because smoking has a strong inverse association with Parkinson's disease (people that smoke have a reduced risk of developing Parkinson's disease). Smoking also causes chronic obstructive pulmonary disease, which is treated with β-adrenoceptor-agonist medications. Even if causal, the effect of β-adrenoceptor antagonists on the risk of Parkinson's disease would be small compared with other Parkinson's disease risk factors and would be similar to the risk evoked by pesticide exposure. The estimated risk of Parkinson's disease because of β-adrenoceptor antagonists use corresponds to one case in 10 000 patients after 5 years of propranolol use, and would be considered a very rare adverse effect. Thus, not using β-adrenoceptor antagonists would severely harm patients with recommended indications, such as heart disease or migraine. Similarly, 50 000 people would have to be treated for 5 years with salbutamol to prevent Parkinson's disease in one patient, suggesting that primary preventive therapy studies on disease modification are not warranted. WHERE NEXT?: Epidemiological evidence for a causal relationship between use of β2-adrenoceptor antagonists and the increased risk of Parkinson's disease is weak, with other explanations for the association being more probable. Future observational studies are warranted to clarify this association. However, given the very low risk associated with propranolol, most clinicians are unlikely to change their treatment approach.
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231
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Lill CM. WITHDRAWN: Genetics of Parkinson's disease. Mol Cell Probes 2020:101471. [PMID: 31978549 DOI: 10.1016/j.mcp.2019.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 11/25/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, DOI of original article: https://doi.org/10.1016/j.mcp.2016.11.001. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Christina M Lill
- Genetic and Molecular Epidemiology Group, Institute of Neurogenetics, University of Lübeck, Maria-Goeppert-Str. 1, 23562, Lübeck, Germany
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232
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Ren J, Hua P, Pan C, Li Y, Zhang L, Zhang W, Xu P, Zhang M, Liu W. Non-Motor Symptoms of the Postural Instability and Gait Difficulty Subtype in De Novo Parkinson's Disease Patients: A Cross-Sectional Study in a Single Center. Neuropsychiatr Dis Treat 2020; 16:2605-2612. [PMID: 33173298 PMCID: PMC7646450 DOI: 10.2147/ndt.s280960] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known about non-motor symptoms (NMSs) associated with the postural instability and gait difficulty (PIGD) phenotype, especially in de novo Parkinson's disease (PD) patients. The aims of this study were to compare NMSs between the tremor dominant (TD) and PIGD phenotypes in de novo PD patients and to determine factors that are associated with the PIGD subtype. PATIENTS AND METHODS In a cross-sectional study conducted at our single center, 226 de novo PD patients with a median disease duration of 2 years were recruited. Data, including comprehensive demographics, motor subtypes and NMSs were obtained. Motor subtypes were classified as PIGD and non-PIGD (TD and indeterminate) by Jankovic's method. NMSs were evaluated by the non-motor symptoms questionnaire (NMSQuest). RESULTS We identified 73 (32.3%), 34 (15.0%) and 119 (52.7%) patients with TD, intermediate and PIGD subtypes, respectively. Patients with the PIGD subtype had poorer ADL, motor, depression, anxiety, sleep, and non-motor scores compared with those with the TD subtype. In the NMSQuest, the prevalence of cardiovascular, sleep, mood/cognitive and miscellaneous domains was increased in patients with the PIGD subtype compared with patients with the TD subtype. Multivariable forward stepwise logistic regression revealed that the Hamilton Depression Scale (HAMD) [odds ratio (OR), 1.059; 95% confidence interval (CI), 1.016-1.104, p = 0.007] and pain (OR, 3.175; 95% CI, 1.695-5.947, p < 0.001) exhibit significant discriminative power in differentiating PIGD and non-PIGD groups. CONCLUSION The PIGD group had more severe cardiovascular symptoms, sleep impairments, mood disturbances and pain. We demonstrated for the first time that pain was associated with the PIGD phenotype. Prompt detection and early treatment of NMSs related to the PIGD phenotype may improve patient outcomes.
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Affiliation(s)
- Jingru Ren
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ping Hua
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Chenxi Pan
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yuqian Li
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Li Zhang
- Department of Geriatrics, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wenbin Zhang
- Department of Neurosurgery, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Pingyi Xu
- Department of Neurology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Weiguo Liu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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Diederich NJ, Sauvageot N, Pieri V, Hipp G, Vaillant M. The Clinical Non-Motor Connectome in Early Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1797-1806. [PMID: 32925095 PMCID: PMC7683075 DOI: 10.3233/jpd-202102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Non-motor symptoms (NMS) of various anatomical origins are seen in early stage idiopathic Parkinson's disease (IPD). OBJECTIVE To analyse when and how NMS are linked together at this stage of the disease. METHODS Prospective study recruiting 64 IPD patients with ≤3 years of disease duration and 71 age-matched healthy controls (HC). NMS were clustered in 7 non-motor domains (NMD): general cognition, executive function, visuospatial function, autonomic function, olfaction, mood, and sleep. Correlation coefficients ≥|0.3| were considered as significant. Bootstrapped correlation coefficients between the scores were generated in both groups. Fourteen IPD patients and 19 HC were available for a follow-up study two years later. RESULTS The mean age of both groups was similar. 58% of IPD patients and 37% of HC were male (p = 0.01). At baseline IPD patients performed less well than HC on all NMD (p value between 0.0001 and 0.02). Out of 91 possible correlations between NMD, 21 were significant in IPD patients and 14 in HC at the level of ≥|0.3|. The mean correlation level was higher in IPD patients than in HC, as evidenced by the higher box plot of correlation coefficients. Visuospatial scores at baseline were predictive of the motor deterioration at the follow-up exam. CONCLUSION At early IPD stage various NMS are linked together, although not connected by anatomical networks. Such a clinical NMD connectome suggests almost synchronous disease initiation at different sites as also supported by fMRI findings. Alternatively, there may be compensation-driven interconnectivity of NMD.
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Affiliation(s)
- Nico J. Diederich
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Nicolas Sauvageot
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Vannina Pieri
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Géraldine Hipp
- Luxembourg Centre of Systems Biomedicine, University of Luxembourg, University of Luxembourg, Belvaux, Luxembourg
| | - Michel Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
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Kilzheimer A, Hentrich T, Burkhardt S, Schulze-Hentrich JM. The Challenge and Opportunity to Diagnose Parkinson's Disease in Midlife. Front Neurol 2019; 10:1328. [PMID: 31920948 PMCID: PMC6928126 DOI: 10.3389/fneur.2019.01328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease (PD) is the most common neurodegenerative movement disorder that affects extensive regions of the nervous system. Its current clinical diagnosis is based on motor symptoms that appear late during disease progression when substantial proportions of the nigrostriatal dopaminergic neuron population are lost already. Although disturbances in sleep and other biofunctions often surface years prior to motor impairments and point to a long prodromal phase, these phenotypic signs in a person's midlife lack predictive power. They do, however, signal the unfolding of the disease and suggest molecular correlates that begin deviating early on. Revealing such trajectories, hence, promises not only a better understanding of prodromal PD but may also enable a much-needed earlier diagnosis. A nexus that may harbor such molecular trajectories is the epigenome as key etiological factors of PD-genetics, age, and environment-influence this substrate. An earlier diagnosis would also allow earlier interventions and lifestyle adjustments to improve brain function and reduce symptoms. In this review, we describe the challenges of diagnosing PD early on and highlight the opportunities that may arise from steering research efforts towards comprehensive interrogations of molecular layers during the long-time neglected midlife phase. In particular, we emphasize how existing cohorts of at-risk individuals, available animal models, and suitable markers may come together and aid in revealing molecular trajectories that offer diagnostic utility for PD in its prodromal stage.
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Simonet C, Schrag A, Lees AJ, Noyce AJ. The motor prodromes of parkinson's disease: from bedside observation to large-scale application. J Neurol 2019; 268:2099-2108. [PMID: 31802219 PMCID: PMC8179909 DOI: 10.1007/s00415-019-09642-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022]
Abstract
There is sufficient evidence that the pathological process that causes Parkinson's disease begins years before the clinical diagnosis is made. Over the last 15 years, there has been much interest in the existence of a prodrome in some patients, with a particular focus on non-motor symptoms such as reduced sense of smell, REM-sleep disorder, depression, and constipation. Given that the diagnostic criteria for Parkinson's disease depends on the presence of bradykinesia, it is somewhat surprising that there has been much less research into the possibility of subtle motor dysfunction as a pre-diagnostic pointer. This review will focus on early motor features and provide some advice on how to detect and measure them.
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Affiliation(s)
- C Simonet
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - A Schrag
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - A J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
| | - A J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. .,Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK.
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Chen Z, Li G, Liu J. Autonomic dysfunction in Parkinson's disease: Implications for pathophysiology, diagnosis, and treatment. Neurobiol Dis 2019; 134:104700. [PMID: 31809788 DOI: 10.1016/j.nbd.2019.104700] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/13/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disease with a 200 year-long research history. Our understanding about its clinical phenotype and pathogenesis remains limited, although dopaminergic replacement therapy has significantly improved patient outcomes. Autonomic dysfunction is an essential category of non-motor phenotypes that has recently become a cutting edge field that directs frontier research in PD. In this review, we initially describe the epidemiology of dysautonomic symptoms in PD. Then, we perform a meticulous analysis of the pathophysiology of autonomic dysfunction in PD and propose that the peripheral autonomic nervous system may be a key route for α-synuclein pathology propagation from the periphery to the central nervous system. In addition, we recommend that constipation, orthostatic hypotension, urinary dysfunction, erectile dysfunction, and pure autonomic failure should be viewed as prodromal dysautonomic markers in PD prediction and diagnosis. Finally, we summarize the strategies currently available for the treatment of autonomic dysfunction in PD and suggest that high-quality, better-designed, randomized clinical trials should be conducted in the future.
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Affiliation(s)
- Zhichun Chen
- Department of Neurology, Institute of Neurology, Ruijin Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guanglu Li
- Department of Neurology, Institute of Neurology, Ruijin Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Abstract
Parkinson disease (PD) is associated with a variety of motor and non-motor clinical manifestations, including cardiovascular autonomic dysfunction. Neurogenic orthostatic hypotension (nOH) is a potentially serious manifestation of cardiovascular sympathetic failure that occurs in approximately 30% of patients with PD. Here we review the pathophysiology and effects of the condition as well as treatment considerations for patients with PD and nOH. Screening for nOH using orthostatic symptom questionnaires, orthostatic blood pressure measurements, and specialized autonomic testing is beneficial for the identification of symptomatic and asymptomatic cases because cardiac sympathetic denervation and nOH can occur even at early (premotor) stages of PD. Symptoms of nOH, such as orthostatic lightheadedness, in patients with PD, have been shown to adversely affect patient safety (with increased risk of falls) and quality of life and should prompt treatment with non-pharmacologic and, occasionally, pharmacologic measures. Patients with nOH are also at increased risk of supine hypertension, which requires balancing various management strategies. FUNDING: Lundbeck (Deerfield, IL).
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Affiliation(s)
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Gumber A, Ramaswamy B, Thongchundee O. Effects of Parkinson's on employment, cost of care, and quality of life of people with condition and family caregivers in the UK: a systematic literature review. Patient Relat Outcome Meas 2019; 10:321-333. [PMID: 31695537 PMCID: PMC6816078 DOI: 10.2147/prom.s160843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background Parkinson’s is an incurable, neuro-degenerative condition with multiple symptoms substantially impacting on living conditions and quality of life (QoL) for people with Parkinson’s (PwP), most whom are older adults, and their families. The study aimed to undertake a literature review of studies conducted in the UK that quantify the direct or indirect impact of Parkinson’s on people with the condition, their families, and society in terms of out-of-pocket payments and financial consequences. Methods Literature was searched for Parkinson’s-related terms plus condition impact (eg, financial, employment, pension, housing, health care costs, and QoL) in the UK setting. The strategy probed several electronic databases with all retrieved papers screened for relevancy. The instruments used to measure patient-related outcomes were then examined for their relevancy in justifying the results. Results The initial search retrieved 2,143 papers of which 79 were shortlisted through title and abstract screening. A full-text reading indicated 38 papers met the inclusion and quality criteria. Summary data extracted from the articles on focus, design, sample size, and questionnaires/instruments used were presented in four themes: (a) QoL and wellbeing of PwP, (b) QoL and wellbeing of caregivers and family members, (c) employment and living conditions, and (d) direct and indirect health care and societal cost. Conclusion UK results substantiated global evidence regarding the deterioration of QoL of PwP as the condition progressed, utilizing numerous measures to demonstrate change. Many spouses and family accept care responsibilities, affecting their QoL and finances too. The review highlighted increased health care and privately borne costs with condition progression, although UK evidence was limited on societal costs of Parkinson’s in terms of loss of employment, reduced work hours, premature retirement of PwP and caregivers that directly affected their household budget.
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Affiliation(s)
- Anil Gumber
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Bhanu Ramaswamy
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Oranuch Thongchundee
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
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239
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Kim YJ, Lee CM, Kim S, Jang JW, Lee SY, Lee SH. Risk of Parkinson’s disease after colectomy: longitudinal follow-up study using a national sample cohort. J Neurol 2019; 267:513-521. [DOI: 10.1007/s00415-019-09617-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 11/02/2019] [Indexed: 12/20/2022]
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240
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Peeters MC, Dirven L, Koekkoek JA, Numans ME, Taphoorn MJ. Prediagnostic presentations of glioma in primary care: a case-control study. CNS Oncol 2019; 8:CNS44. [PMID: 31674205 PMCID: PMC6880303 DOI: 10.2217/cns-2019-0015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study aimed to assess the prevalence of symptoms glioma patients may present with to the general practitioner, and whether these can be distinguished from patients with other CNS disorders or any other condition. Methods: Glioma patients were matched to CNS patients and ‘other controls’ using anonymized general practitioner registries. Prevalences were evaluated in the 5 years prior to diagnosis. Result: CNS patients reported significantly more motor symptoms in the period 60–24 months, (p = 0.039). Moreover, <6 months before diagnosis CNS patients differed significantly in mood disorders/fear compared with ‘other controls’ (p = 0.012) but not glioma patients (p = 0.816). Conclusion: Glioma patients could not be distinguished from both control groups with respect to the number or type of prediagnostic symptoms.
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Affiliation(s)
- Marthe Cm Peeters
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, Burg. Banninglaan, 2262 BA Leidschendam, The Netherlands
| | - Johan Af Koekkoek
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, Burg. Banninglaan, 2262 BA Leidschendam, The Netherlands
| | - Mattijs E Numans
- Department of Public Health & Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Martin Jb Taphoorn
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, Burg. Banninglaan, 2262 BA Leidschendam, The Netherlands
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241
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Machine-learning-derived rules set excludes risk of Parkinson's disease in patients with olfactory or gustatory symptoms with high accuracy. J Neurol 2019; 267:469-478. [PMID: 31676975 DOI: 10.1007/s00415-019-09604-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chemosensory loss is a symptom of Parkinson's disease starting already at preclinical stages. Their appearance without an identifiable etiology therefore indicates a possible early symptom of Parkinson's disease. Supervised machine-learning was used to identify parameters that predict Parkinson's disease among patients having sought medical advice for chemosensory symptoms. METHODS Olfactory, gustatory and demographic parameters were analyzed in 247 patients who had reported for chemosensory symptoms. Unsupervised machine-learning, implanted as so-called fast and frugal decision trees, was applied to map these parameters to a diagnosis of Parkinson's disease queried for in median 9 years after the first interview. RESULTS A symbolic hierarchical decision rule-based classifier was created that comprised d = 5 parameters, including scores in tests of odor discrimination, odor identification and olfactory thresholds, the age at which the chemosensory loss has been noticed, and a familial history of Parkinson's disease. The rule set provided a cross-validated negative predictive performance of Parkinson's disease of 94.1%; however, its balanced accuracy to predict the disease was only 58.9% while robustly above guessing. CONCLUSIONS Applying machine-learning techniques, a classifier was developed that took the shape of a set of six hierarchical rules with binary decisions about olfaction-related features or a familial burden of Parkinson's disease. Its main clinical strength lies in the exclusion of the possibility of developing Parkinson's disease in a patient with olfactory or gustatory loss.
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242
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Berg D, Postuma RB. From Prodromal to Overt Parkinson's Disease: Towards a New Definition in the Year 2040. JOURNAL OF PARKINSONS DISEASE 2019; 8:S19-S23. [PMID: 30584153 PMCID: PMC6311373 DOI: 10.3233/jpd-181457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The field of prodromal PD is still in its infancy, and at the cusp of major advances. This article summarizes where we are, and most importantly where we need to go in order for the promise of prodromal PD to be realized. In the immediate future, the criteria need to be updated with additional markers and disseminated broadly. In the near future, they need to better incorporate changes in likelihood ratio with age and sex, combine markers in novel ways using big data approaches, identify subtypes, and incorporate better higher-specificity markers as they are discovered. Integration of smartphone/wearable markers and biomarkers of progression from the prodromal phase will allow development of neuroprotective trials in early stages. By 2040, it is hoped that prodromal criteria will be incorporated into active neuroprotective treatment programs, allowing a program of population-based screening followed by early treatment and ultimately the prevention of clinical PD from ever becoming manifest.
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Affiliation(s)
- Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research Tuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
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243
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Palma JA, Norcliffe-Kaufmann L, Kaufmann H. Orthostatic Hypotension as a Prodromal Marker of α-Synucleinopathies. JAMA Neurol 2019; 75:1154. [PMID: 30105358 DOI: 10.1001/jamaneurol.2018.2248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
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244
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Weintraub D, Mamikonyan E. The Neuropsychiatry of Parkinson Disease: A Perfect Storm. Am J Geriatr Psychiatry 2019; 27:998-1018. [PMID: 31006550 PMCID: PMC7015280 DOI: 10.1016/j.jagp.2019.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and interindividual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, although psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and undertreated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well-tolerated treatment strategies.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (DW), Philadelphia Veterans Affairs Medical Center, Philadelphia.
| | - Eugenia Mamikonyan
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia
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245
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Houghton R, Boess F, Verselis L, Ding Y, Freitas R, Constantinovici N, Ong R. Treatment Patterns in Patients with Incident Parkinson's Disease in the United States. JOURNAL OF PARKINSONS DISEASE 2019; 9:749-759. [PMID: 31424419 PMCID: PMC6839607 DOI: 10.3233/jpd-191636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treatment patterns in Parkinson's disease (PD) have not been extensively studied for nearly two decades. Insurance claims are appropriate for such analysis. OBJECTIVE To understand the standard of care use of symptomatic treatments in new cases of PD and factors associated with treatment choice. METHODS Retrospective cohort study using claims data from the United States between 2008 and 2016. We used Kaplan-Meier methodology to estimate time to treatment start and switch or add-on therapy and Cox proportional hazards models to identify predictors. RESULTS We identified 68,532 patients eligible for treatment pattern analyses. Median time from diagnosis until first treatment was 37 days (95% confidence interval: 36-38). Two distinct patterns of treatment initiation were identified: fast initiators and patients with delayed treatment start (or no recorded treatment). Levodopa therapies were the most commonly prescribed treatment class (52.6%). Increased age was associated with shorter time to start of treatment with levodopa. Younger age was associated with shorter time to initiation of dopamine agonists and other symptomatic treatments. Patients that initiated treatment with levodopa/combinations had the fewest switches/add-ons [30.4%; median time 7.29 (6.71, 8.13) years]. Older patients had fewer switch/add-on therapies, but only in the group that started with levodopa/combination therapy. CONCLUSIONS Time from diagnosis to treatment start was relatively short, suggesting that PD diagnosis, as reflected in the database, is closely linked to start of symptomatic treatment. Levodopa treatment remains the most common treatment, especially for older patients. Delayed treatment start was associated with increased age and comorbidity.
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Affiliation(s)
- Richard Houghton
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Frank Boess
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Lynne Verselis
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases Discovery and Translational Area, Roche Innovation Center New York, F. Hoffmann-La Roche Ltd., New York NY, USA
| | | | - Rita Freitas
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Rose Ong
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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246
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de Rooy FBB, Buhmann C, Schönwald B, Martinez-Martin P, Rodriguez-Blazquez C, Putter H, Elzevier HW, van der Plas AA. Discussing sexuality with Parkinson's disease patients: a multinational survey among neurologists. J Neural Transm (Vienna) 2019; 126:1273-1280. [PMID: 31396705 PMCID: PMC6765045 DOI: 10.1007/s00702-019-02053-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is a major non-motor feature of Parkinson’s disease (PD) that may affect the quality of life of many patients. In a Dutch survey, we demonstrated that neurologists often fail to discuss sexuality with their patients. Our objective was to determine to which extent neurologists in Spain and Germany address sexuality with their patients and whether cross-cultural differences exist. A 30-item questionnaire was sent out to 1650 German and 460 Spanish neurologists. The questionnaire addressed attitudes, knowledge, barriers, and feelings of responsibility regarding sexuality in PD. 160 German and 32 Spanish respondents completed and returned the questionnaire. The majority of German and Spanish participants discuss sexual dysfunction ‘regularly’ with male patients (61.7% and 78.9%, respectively), but ‘seldom’ with female patients (68.8% and 78.1%, respectively). Important barriers for German and Spanish respondents to discuss sexual dysfunction were patients not expressing sexual complaints spontaneously (52.9% and 75.0%, respectively) and insufficient consultation time (32.2% and 71.9%, respectively). Sexual dysfunction in PD was considered important by 68.3% of German and 96.9% of Spanish participants. German and Spanish neurologists do not routinely discuss sexual dysfunction with their patients, although many of them consider it important to address this topic. It is unclear why this lack of discussing sexual dysfunction is especially found for female patients and whether cultural aspects are involved. We recommend a self-assessment tool for patients to track their symptoms prior to consultation visits and advocate local guidelines that formulate who is responsible for discussing sexual dysfunction.
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Affiliation(s)
- F B B de Rooy
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - C Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246, Hamburg, Germany
| | - B Schönwald
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246, Hamburg, Germany
| | - P Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - C Rodriguez-Blazquez
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - H W Elzevier
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - A A van der Plas
- Department of Neurology, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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247
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Fayyad M, Salim S, Majbour N, Erskine D, Stoops E, Mollenhauer B, El-Agnaf OMA. Parkinson's disease biomarkers based on α-synuclein. J Neurochem 2019; 150:626-636. [PMID: 31265130 DOI: 10.1111/jnc.14809] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease and is estimated to affect approximately 1-4% of individuals aged over 60 years old. Although considerable efforts have been invested into developing disease-modifying therapies for Parkinson's disease, such efforts have been confounded by the difficulty in accurately diagnosing Parkinson's disease during life to enable accurate patient stratification for clinical trialling of candidate therapeutics. Therefore, the search for effective biomarkers that can be accurately evaluated during life with non-invasive means is a pressing issue in the field. Since the discovery of α-synuclein (α-syn) as a protein linked to a familial form of Parkinson's disease, later identified as the major protein component of the neuropathological hallmark of idiopathic Parkinson's disease, considerable interest has focused on this protein and its distinct conformers. We describe here the progress that has been made in the area of Parkinson's disease biomarker discovery with a focus on α-synuclein. In particular, we highlight the novel assays that have been employed and the increasing complexity in evaluating α-synuclein with regard to the considerable diversity of conformers that exist in the biofluids and peripheral tissues under disease conditions. "This article is part of the Special Issue Synuclein."
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Affiliation(s)
- Muneera Fayyad
- Neurological Disorder Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar
| | - Safa Salim
- Neurological Disorder Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar
| | - Nour Majbour
- Neurological Disorder Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar
| | - Daniel Erskine
- Institute of Neuroscience, Ageing Research Laboratories Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Omar M A El-Agnaf
- Neurological Disorder Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar
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248
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Maraki MI, Stefanis L, Yannakoulia M, Kosmidis MH, Xiromerisiou G, Dardiotis E, Hadjigeorgiou GM, Sakka P, Scarmeas N, Stamelou M. Motor function and the probability of prodromal Parkinson's disease in older adults. Mov Disord 2019; 34:1345-1353. [PMID: 31314148 DOI: 10.1002/mds.27792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Identification and characterization of Parkinson's disease (PD) in its prodromal stage is crucial. OBJECTIVE The objective of this study was to investigate the association between motor function and the probability of prodromal PD in a community-dwelling older population. METHODS We used data from a population-based cohort of older adults (HELIAD study). Subjective motor function was evaluated with a 12-item motor symptoms questionnaire and objective motor function indirectly with a physical activity questionnaire and two gait speed tests. The probability of prodromal PD was calculated according to the Movement Disorder Society research criteria for n = 1731 without PD. Regression multiadjusted models were used to investigate the associations between each motor measure and prodromal PD probability. RESULTS For each unit increase in motor symptoms score and for each kcal/kg/day lower energy expenditure (corresponding to 20 minutes of light walking/day for a 75-kg man) there was a 27% and 3% higher probability for prodromal PD, respectively (P < 0.001). Having at least one subjective motor symptom increased the odds of having possible/probable prodromal PD (n = 49; P < 0.05). Including subjective and indirect motor variables in the same model showed that both (symptoms and physical activity) contributed significantly to the model (P < 0.01). Excluding subthreshold parkinsonism from the calculation showed that gait speed less than 0.8 m/s was also associated with a higher prodromal PD probability score (P < 0.001). CONCLUSIONS Subjective motor symptoms as well as simple objective motor measures of physical activity or gait speed are associated with a higher probability of prodromal PD in older adults. These data may serve to enable the early identification of prodromal PD cohorts, particularly if they are confirmed in longitudinal studies. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Maria I Maraki
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Section of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Georgios M Hadjigeorgiou
- School of Medicine, University of Thessaly, Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus, Cyprus, Greece
| | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Marousi, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, USA
| | - Maria Stamelou
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Parkinson's Disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece
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249
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Lysen TS, Darweesh SKL, Ikram MK, Luik AI, Ikram MA. Sleep and risk of parkinsonism and Parkinson's disease: a population-based study. Brain 2019; 142:2013-2022. [PMID: 31038176 PMCID: PMC6911221 DOI: 10.1093/brain/awz113] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/12/2019] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
Sleep disturbances may signal presence of prodromal parkinsonism, including Parkinson's disease. Whether general sleep quality or duration in otherwise healthy subjects is related to the risk of parkinsonism remains unclear. We hypothesized that both worse self-reported sleep quality and duration, as well as a longitudinal deterioration in these measures, are associated with the risk of parkinsonism, including Parkinson's disease. In the prospective population-based Rotterdam Study, we assessed sleep quality and duration with the Pittsburgh Sleep Quality Index in 7726 subjects (mean age 65 years, 57% female) between 2002 and 2008, and again in 5450 subjects between 2009 and 2014. Participants were followed until 2015 for a diagnosis of parkinsonism and Parkinson's disease. Outcomes were assessed using multiple modalities: interviews, physical examination, and continuous monitoring of pharmacy records and medical records of general practitioners. We used Cox regression to associate sleep, and changes in sleep over time, with incident parkinsonism and Parkinson's disease, adjusting for age, sex, education and smoking status. Over 64 855 person-years in 13 years of follow-up (mean: 8.4 years), 75 participants developed parkinsonism, of whom 47 developed Parkinson's disease. We showed that within the first 2 years of follow-up, worse sleep quality {hazard ratio (HR) 2.38 per standard deviation increase [95% confidence interval (CI 0.91-6.23)]} and shorter sleep duration [HR 0.61 per standard deviation increase (95% CI 0.31-1.21)] related to a higher risk of parkinsonism. Associations of worse sleep quality [HR 3.86 (95% CI 1.19-12.47)] and shorter sleep duration [HR 0.48 (95% CI 0.23-0.99)] with Parkinson's disease were more pronounced, and statistically significant, compared to parkinsonism. This increased risk disappeared with longer follow-up duration. Worsening of sleep quality [HR 1.76 per standard deviation increase (95% CI 1.12-2.78)], as well as shortening of sleep duration [HR 1.72 per standard deviation decrease (95% CI 1.08-2.72)], were related to Parkinson's disease risk in the subsequent 6 years. Therefore, we argue that in the general population, deterioration of sleep quality and duration are markers of the prodromal phase of parkinsonism, including Parkinson's disease.
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Affiliation(s)
- Thom S Lysen
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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250
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Schrag A, Zhelev S, Hotham S, Merritt R, Khan K, Graham L. Heterogeneity in progression of prodromal features in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:275-279. [DOI: 10.1016/j.parkreldis.2019.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/10/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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