351
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Titova N, Padmakumar C, Lewis SJG, Chaudhuri KR. Parkinson's: a syndrome rather than a disease? J Neural Transm (Vienna) 2016; 124:907-914. [PMID: 28028643 PMCID: PMC5514217 DOI: 10.1007/s00702-016-1667-6] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
Emerging concepts suggest that a multitude of pathology ranging from misfolding of alpha-synuclein to neuroinflammation, mitochondrial dysfunction, and neurotransmitter driven alteration of brain neuronal networks lead to a syndrome that is commonly known as Parkinson’s disease. The complex underlying pathology which may involve degeneration of non-dopaminergic pathways leads to the expression of a range of non-motor symptoms from the prodromal stage of Parkinson’s to the palliative stage. Non-motor clinical subtypes, cognitive and non-cognitive, have now been proposed paving the way for possible subtype specific and non-motor treatments, a key unmet need currently. Natural history of these subtypes remains unclear and need to be defined. In addition to in vivo biomarkers which suggest variable involvement of the cholinergic and noradrenergic patterns of the Parkinson syndrome, abnormal alpha-synuclein accumulation have now been demonstrated in the gut, pancreas, heart, salivary glands, and skin suggesting that Parkinson’s is a multi-organ disorder. The Parkinson’s phenotype is thus not just a dopaminergic motor syndrome, but a dysfunctional multi-neurotransmitter pathway driven central and peripheral nervous system disorder that possibly ought to be considered a syndrome and not a disease.
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Affiliation(s)
- Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education, N.I. Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - C Padmakumar
- Parkinson's Disease Service for the Older Person, Rankin Park Centre, John Hunter Hospital, HNELHD, Newcastle, NSW, Australia
| | | | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, UK.
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, UK.
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352
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Serotonergic dysfunctions and abnormal iron metabolism: Relevant to mental fatigue of Parkinson disease. Sci Rep 2016; 6:19. [PMID: 28442790 PMCID: PMC5431345 DOI: 10.1038/s41598-016-0018-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/31/2016] [Indexed: 01/01/2023] Open
Abstract
Fatigue is a very common non-motor symptom in Parkinson disease (PD) patients. It included physical fatigue and mental fatigue. The potential mechanisms of mental fatigue involving serotonergic dysfunction and abnormal iron metabolism are still unknown. Therefore, we evaluated the fatigue symptoms, classified PD patients into fatigue group and non-fatigue group, and detected the levels of serotonin, iron and related proteins in CSF and serum. In CSF, 5-HT level is significantly decreased and the levels of iron and transferrin are dramatically increased in fatigue group. In fatigue group, mental fatigue score is negatively correlated with 5-HT level in CSF, and positively correlated with the scores of depression and excessive daytime sleepiness, and disease duration, also, mental fatigue is positively correlated with the levels of iron and transferrin in CSF. Transferrin level is negatively correlated with 5-HT level in CSF. In serum, the levels of 5-HT and transferrin are markedly decreased in fatigue group; mental fatigue score exhibits a negative correlation with 5-HT level. Thus serotonin dysfunction in both central and peripheral systems may be correlated with mental fatigue through abnormal iron metabolism. Depression, excessive daytime sleepiness and disease duration were the risk factors for mental fatigue of PD.
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353
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Call to Caution with the Use of Atypical Antipsychotics for Treatment of Depression in Older Adults. Geriatrics (Basel) 2016; 1:geriatrics1040033. [PMID: 31022826 PMCID: PMC6371141 DOI: 10.3390/geriatrics1040033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022] Open
Abstract
Atypical antipsychotics are increasingly being used to manage depression in older adults where these symptoms can often be refractory to first-line treatment with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). Unfortunately, atypical antipsychotics can be associated with the development of extrapyramidal symptoms (EPS), with drug-induced parkinsonism (DIP) being the most common movement disorder induced by this class of medication. The management of treatment-resistant depression in older adults is of particular concern as depression is a common feature of idiopathic Parkinson’s disease (IPD) and can manifest prior to the development of motor symptoms. Herein, we discuss the use of atypical antipsychotics for the management of depression in older adults including the risk of DIP and propose that antipsychotics may potentially unmask IPD.
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354
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Chaudhuri KR, Bhidayasiri R, van Laar T. Unmet needs in Parkinson's disease: New horizons in a changing landscape. Parkinsonism Relat Disord 2016; 33 Suppl 1:S2-S8. [PMID: 27932224 DOI: 10.1016/j.parkreldis.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
The success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.
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Affiliation(s)
- K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital London, UK
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Teus van Laar
- Department of Neurology, University of Groningen, Groningen, The Netherlands
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355
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Warren E, Eccles F, Travers V, Simpson J. The experience of being diagnosed with Parkinson's disease. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/bjnn.2016.12.6.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emma Warren
- Division of Health Research, Lancaster University
| | - Fiona Eccles
- Division of Health Research, Lancaster University
| | - Vicky Travers
- University Hospitals of Morecambe Bay Trust, Lancaster
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356
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Ma JF, Qiao Y, Gao X, Liang L, Liu XL, Li DH, Tang HD, Chen SD. A community-based study of risk factors for probable rapid eye movement sleep behavior disorder. Sleep Med 2016; 30:71-76. [PMID: 28215267 DOI: 10.1016/j.sleep.2016.06.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/12/2016] [Accepted: 06/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To cross-sectionally explore the potential risk factors for rapid eye movement (REM) sleep behavior disorder (RBD) in a community cohort in Shanghai. METHODS Based on the validated RBD screening questionnaire (RBDSQ), we identified individuals with probable RBD (pRBD) in 3635 community-dwelling residents (≥50 years old) from an urban community of Shanghai. Potential risk factors of pRBD, including age, sex, smoking, socioeconomic status, obesity, consumption of tea (surrogate for caffeine intake) and alcohol, medications and chronic disease status, were assessed via questionnaire. We used logistic regression to investigate the associations between these studied factors and pRBD after adjusting for age, sex and other studied factors. RESULTS Based on the RBDSQ score ≥5, 2.70% (3.28% in men and 2.41% in women) participants were considered as pRBD. We found that lower education, presence of head injury, atrial fibrillation, hyperlipidemia, constipation, olfactory disturbance, and imbalance, use of alcoholic beverage, selective serotonin reuptake inhibitor, and benzodiazepine were associated with higher likelihood of having pRBD (P < 0.05 for all). In contrast, male sex, use of coffee or tea, smoking and other factors were not significantly association with altered risk of having pRBD. We did not find significant interaction between sex, age and these factors, in relation to pRBD risk. CONCLUSIONS In this community-based study of older adults, we identified several potential risk factors for concurrent pRBD, including environmental factors and vascular risk factors.
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Affiliation(s)
- Jian-Fang Ma
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yuan Qiao
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Liang Liang
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiao-Li Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dun-Hui Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hui-Dong Tang
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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357
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Borgonovo J, Allende-Castro C, Laliena A, Guerrero N, Silva H, Concha ML. Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease. Parkinsonism Relat Disord 2016; 35:17-24. [PMID: 27889469 DOI: 10.1016/j.parkreldis.2016.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD.
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Affiliation(s)
- Janina Borgonovo
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Camilo Allende-Castro
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Almudena Laliena
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Néstor Guerrero
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Miguel L Concha
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile.
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358
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Yilmaz R, Gräber S, Roeben B, Suenkel U, von Thaler AK, Heinzel S, Metzger FG, Eschweiler GW, Maetzler W, Berg D, Liepelt-Scarfone I. Cognitive Performance Patterns in Healthy Individuals with Substantia Nigra Hyperechogenicity and Early Parkinson's Disease. Front Aging Neurosci 2016; 8:271. [PMID: 27895578 PMCID: PMC5108760 DOI: 10.3389/fnagi.2016.00271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/28/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction: Hyperechogenicity of the substantia nigra (SN+) is a risk marker for Parkinson’s disease (PD) which can be detected before the diagnosis. In healthy individuals, SN+ has been associated with slight deficits in specific cognitive functions, suggesting cognitive impairment as a possible pre-diagnostic marker for PD. However, the pattern of cognitive deficits associated with SN+ has not yet been compared with those present in PD. Methods: Data of 262 healthy individuals with normal echogenicity (SN-) and 48 healthy individuals with SN+ were compared with 82 early stage PD patients using the “Consortium to Establish a Registry for Alzheimer’s disease” test battery. First, the test clusters (factors) were identified using a principal component analysis (PCA). Mean group performance of cognitive tests belonging to distinct factors, according to the PCA, and single subtest performances were compared using analyses of variance. Second, the number of individuals with abnormal cognitive performances (z-score < -1.0) were compared between groups. Results: Verbal memory, semantic and executive function, and praxis were identified as components of cognitive performances. The SN+ group performed significantly worse than the SN- group in tests assessing semantic and executive function, with a non-significant decrease in verbal memory. On the subtest level, individuals of the SN+ group scored significantly lower than the SN- group on the Boston Naming Test (BNT; p = 0.008). In all subtests, the percentages of PD patients with values below the cut-off for abnormal performance were higher than in the SN- group. Moreover, more individuals from the SN+ group scored below the cut-off in the BNT (SN- = 8.4%, SN+ = 20.8%, p = 0.01) and TMT-B (SN- = 6.9%, SN+ = 16.7%, p = 0.02), compared to the SN- group. Conclusion: This study confirms poorer performance of healthy individuals with SN+ compared to SN- in specific cognitive domains. However, against the SN- group, the cognitive profile of the SN+ group was not fully consistent with the profile of early PD patients. Our data argues that cognitive impairment associated with SN+ might differ slightly from that seen in early PD. Compensational mechanisms in the early phases of neurodegeneration, and the fact that only a subgroup of SN+ will develop PD, may partly explain these differences.
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Affiliation(s)
- Rezzak Yilmaz
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen Tuebingen, Germany
| | - Susanne Gräber
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative DiseasesTuebingen, Germany
| | - Benjamin Roeben
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative DiseasesTuebingen, Germany
| | - Ulrike Suenkel
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen Tuebingen, Germany
| | - Anna-Katharina von Thaler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen Tuebingen, Germany
| | - Sebastian Heinzel
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University of TuebingenTuebingen, Germany; Geriatric Center at the University Hospital of TuebingenTuebingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of TuebingenTuebingen, Germany; Geriatric Center at the University Hospital of TuebingenTuebingen, Germany
| | - Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany; Geriatric Center at the University Hospital of TuebingenTuebingen, Germany
| | - Daniela Berg
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative DiseasesTuebingen, Germany
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359
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Lill CM. Genetics of Parkinson's disease. Mol Cell Probes 2016; 30:386-396. [PMID: 27818248 DOI: 10.1016/j.mcp.2016.11.001] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 12/30/2022]
Abstract
Almost two decades after the identification of SNCA as the first causative gene in Parkinson's disease (PD) and the subsequent understanding that genetic factors play a substantial role in PD development, our knowledge of the genetic architecture underlying this disease has vastly improved. Approximately 5-10% of patients suffer from a monogenic form of PD where autosomal dominant mutations in SNCA, LRRK2, and VPS35 and autosomal recessive mutations in PINK1, DJ-1, and Parkin cause the disease with high penetrance. Furthermore, recent whole-exome sequencing have described autosomal recessive DNAJC6 mutations in predominately atypical, but also cases with typical PD. In addition, several other genes have been linked to atypical Parkinsonian phenotypes. However, the vast majority of PD is genetically complex, i.e. it is caused by the combined action of common genetic variants in concert with environmental factors. By the application of genome-wide association studies, 26 PD risk loci have been established to date. Similar to other genetically complex diseases, these show only moderate effects on PD risk. Increasing this etiologic complexity, many of the involved genetic and environmental risk factors likely interact in an intricate fashion. This article aims to provide a comprehensive overview of the current knowledge in PD genetics.
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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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360
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Horvath S, Ritz BR. Increased epigenetic age and granulocyte counts in the blood of Parkinson's disease patients. Aging (Albany NY) 2016; 7:1130-42. [PMID: 26655927 PMCID: PMC4712337 DOI: 10.18632/aging.100859] [Citation(s) in RCA: 262] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It has been a long standing hypothesis that blood tissue of PD Parkinson's disease (PD) patients may exhibit signs of accelerated aging. Here we use DNA methylation based biomarkers of aging (“epigenetic clock”) to assess the aging rate of blood in two ethnically distinct case-control data sets. Using n=508 Caucasian and n=84 Hispanic blood samples, we assess a) the intrinsic epigenetic age acceleration of blood (IEAA), which is independent of blood cell counts, and b) the extrinsic epigenetic age acceleration rate of blood (EEAA) which is associated with age dependent changes in blood cell counts. Blood of PD subjects exhibits increased age acceleration according to both IEAA (p=0.019) and EEAA (p=6.1×10−3). We find striking differences in imputed blood cell counts between PD cases and controls. Compared to control subjects, PD subjects contains more granulocytes (p=1.0×10−9 in Caucasians, p=0.00066 in Hispanics) but fewer T helper cells (p=1.4×10−6 in Caucasians, p=0.0024 in Hispanics) and fewer B cells (p=1.6×10−5 in Caucasians, p=4.5×10−5 in Hispanics). Overall, this study shows that the epigenetic age of the immune system is significantly increased in PD patients and that granulocytes play a significant role.
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Affiliation(s)
- Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Beate R Ritz
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA.,Department of Environmental Health, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
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361
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Ascherio A, Schwarzschild MA. The epidemiology of Parkinson's disease: risk factors and prevention. Lancet Neurol 2016; 15:1257-1272. [PMID: 27751556 DOI: 10.1016/s1474-4422(16)30230-7] [Citation(s) in RCA: 1077] [Impact Index Per Article: 134.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 12/12/2022]
Abstract
Since 2006, several longitudinal studies have assessed environmental or behavioural factors that seem to modify the risk of developing Parkinson's disease. Increased risk of Parkinson's disease has been associated with exposure to pesticides, consumption of dairy products, history of melanoma, and traumatic brain injury, whereas a reduced risk has been reported in association with smoking, caffeine consumption, higher serum urate concentrations, physical activity, and use of ibuprofen and other common medications. Randomised trials are investigating the possibility that some of the negative risk factors might be neuroprotective and thus beneficial in individuals with early Parkinson's disease, particularly with respect to smoking (nicotine), caffeine, and urate. In the future, it might be possible to identify Parkinson's disease in its prodromal phase and to promote neuroprotective interventions before the onset of motor symptoms. At this time, however, the only intervention that seems justifiable for the primary prevention of Parkinson's disease is the promotion of physical activity, which is likely to be beneficial for the prevention of several chronic diseases.
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Affiliation(s)
- Alberto Ascherio
- Departments of Epidemiology and Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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362
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Pausch C, Schomburg R, Wagenpfeil S, Wollenweber FA, Bayer C, Fassbender K, Behnke S. Neuropsychological impairment in prodromal Parkinson's disease. J Neurol Sci 2016; 371:117-120. [PMID: 27871431 DOI: 10.1016/j.jns.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Christoph Pausch
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Robert Schomburg
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Kirrberger Str. 100, 66421 Homburg/Saar, Germany
| | - Frank Arne Wollenweber
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Caroline Bayer
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Stefanie Behnke
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany.
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363
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Mahlknecht P, Seppi K, Poewe W. The Concept of Prodromal Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:681-97. [PMID: 26485429 PMCID: PMC4927924 DOI: 10.3233/jpd-150685] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Parkinson’s disease (PD) is currently clinically defined by a set of cardinal motor features centred on the presence of bradykinesia and at least one additional motor symptom out of tremor, rigidity or postural instability. However, converging evidence from clinical, neuropathological, and imaging research suggests initiation of PD-specific pathology prior to appearance of these classical motor signs. This latent phase of neurodegeneration in PD is of particular relevance in relation to the development of disease-modifying or neuroprotective therapies which would require intervention at the earliest stages of disease. A key challenge in PD research, therefore, is to identify and validate markers for the preclinical and prodromal stages of the illness. Currently, several nonmotor symptoms have been associated with an increased risk to develop PD in otherwise healthy individuals and ongoing research is aimed at validating a variety of candidate PD biomarkers based on imaging, genetic, proteomic, or metabolomic signatures, supplemented by work on tissue markers accessible to minimally invasive biopsies. In fact, the recently defined MDS research criteria for prodromal PD have included combinations of risk and prodromal markers allowing to define target populations of future disease modification trials.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Austria.,Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Austria
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364
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Ongre SO, Larsen JP, Tysnes OB, Herlofson K. Fatigue in early Parkinson's disease: the Norwegian ParkWest study. Eur J Neurol 2016; 24:105-111. [DOI: 10.1111/ene.13161] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S. O. Ongre
- Department of Neurology; Sorlandet Hospital; Arendal Norway
| | - J. P. Larsen
- Network for Medical Sciences; University of Stavanger; Stavanger Norway
| | - O. B. Tysnes
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - K. Herlofson
- Department of Neurology; Sorlandet Hospital; Arendal Norway
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365
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Campolo J, De Maria R, Cozzi L, Parolini M, Bernardi S, Proserpio P, Nobili L, Gelosa G, Piccolo I, Agostoni EC, Trivella MG, Marraccini P. Antioxidant and inflammatory biomarkers for the identification of prodromal Parkinson's disease. J Neurol Sci 2016; 370:167-172. [PMID: 27772753 DOI: 10.1016/j.jns.2016.09.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/09/2016] [Accepted: 09/25/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We explored the role of oxidative stress and inflammatory molecules as potential Parkinson (PD) biomarkers and correlated biological with non-motor abnormalities (olfactory impairment and dysautonomia), in patients with idiopathic REM behavior disorder (iRBD) (prodromal PD) and established PD. METHODS We recruited 11 iRBD and 15 patients with idiopathic PD (Hohen&Yahr 1-3, on L-DOPA and dopamine agonists combination therapy) and 12 age- and sex-matched controls (CTRL). We measured total olfactory score (TOS), autonomic function [deep breathing (DB), lying to standing (LS) and Valsalva manoeuvre (VM) ratios], blood reduced glutathione (Br-GSH), oxidative stress and inflammatory markers (neopterin). RESULTS Anosmia was similarly prevalent in iRBD (36%) and PD (33%) patients, but absent in CTRL. Orthostatic hypotension was more common among iRBD (73%) and PD (60%) than in CTRL (25%). By univariable ordinal logistic regression, TOS, Br-GSH, LS and VM ratio worsened from CTRL to iRBD and PD groups. Only reduced Br-GSH levels (p=0.037, OR=0.994; 95%CI 0.988-1.000) were independently associated to PD. TOS correlated with Br-GSH (R=0.34, p=0.037), VM ratio (R=0.43, p=0.015), and neopterin (rho=0.39, p=0.016). CONCLUSIONS Reduced systemic antioxidant capacity is found in prodromal and overt PD and may represent, in association with olfactory loss and cardiovascular dysautonomia, a useful biomarker for an integrative, early diagnosis of PD.
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Affiliation(s)
- Jonica Campolo
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Renata De Maria
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy.
| | - Lorena Cozzi
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Marina Parolini
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Stefano Bernardi
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Paola Proserpio
- Epilepsy Surgery Centre, Centre of Sleep Medicine, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Lino Nobili
- Epilepsy Surgery Centre, Centre of Sleep Medicine, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Giorgio Gelosa
- Neurology and Stoke Unit, Department of Neuroscience, ASST-Great Metropolitan Hospital Niguarda, Milan, Italy
| | | | - Elio C Agostoni
- Neurology and Stoke Unit, Department of Neuroscience, ASST-Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Maria G Trivella
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Paolo Marraccini
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
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366
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Martino T, Melchionda D, Tonti P, De Francesco V, Lalla A, Specchio LM, Avolio C. Weight loss and decubitus duodenal ulcer in Parkinson’s disease treated with levodopa–carbidopa intestinal gel infusion. J Neural Transm (Vienna) 2016; 123:1395-1398. [PMID: 27614656 DOI: 10.1007/s00702-016-1618-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/04/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Tommaso Martino
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy.
| | - Donato Melchionda
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | - Paolo Tonti
- Gastroenterology Unit-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Alessandra Lalla
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Carlo Avolio
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
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367
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Weintraub D. Progress Regarding Parkinson's Disease Psychosis: It's No Illusion. Mov Disord Clin Pract 2016; 3:431-434. [PMID: 30363521 PMCID: PMC6178612 DOI: 10.1002/mdc3.12377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and NeurologyUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Veterans AffairsParkinson's Disease and Mental Illness Research and Education and Clinical Centers (PADRECC and MIRECC)PhiladelphiaPennsylvaniaUSA
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368
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Maillet A, Krack P, Lhommée E, Météreau E, Klinger H, Favre E, Le Bars D, Schmitt E, Bichon A, Pelissier P, Fraix V, Castrioto A, Sgambato-Faure V, Broussolle E, Tremblay L, Thobois S. The prominent role of serotonergic degeneration in apathy, anxiety and depression inde novoParkinson’s disease. Brain 2016; 139:2486-502. [DOI: 10.1093/brain/aww162] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/27/2016] [Indexed: 01/09/2023] Open
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369
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Iranzo A, Santamaria J, Tolosa E. Idiopathic rapid eye movement sleep behaviour disorder: diagnosis, management, and the need for neuroprotective interventions. Lancet Neurol 2016; 15:405-19. [PMID: 26971662 DOI: 10.1016/s1474-4422(16)00057-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 12/21/2022]
Abstract
Idiopathic rapid eye movement (REM) sleep behaviour disorder (IRBD) manifests as unpleasant dreams and vigorous behaviours during REM sleep that can result in injuries. Patients with IRBD have no known neurological diseases or motor or cognitive complaints; however, this sleep disorder is not harmless. In most cases, IRBD is the prelude of the synucleinopathies Parkinson's disease, dementia with Lewy bodies, or, less frequently, multiple system atrophy. Patients can show abnormalities that are characteristic of the synucleinopathies, and longitudinal follow-up shows that most patients develop parkinsonism and cognitive impairments with time. Thus, diagnosis of IRBD needs to be accurate and involves informing the patient of the risk of developing a neurodegenerative disease. It is extraordinary for a sleep disorder to precede the full expression of a neurodegenerative disease, which renders IRBD of particular interest in studies of the prodromal stage of the synucleinopathies, and in the development of neuroprotective interventions to stop or slow neurodegenerative deterioration before motor and cognitive symptomatology emerges. Such therapeutics do not currently exist, and thus represent an unmet need in IRBD.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain.
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Eduardo Tolosa
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
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370
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Elbaz A. Prodromal symptoms of Parkinson's disease: Implications for epidemiological studies of disease etiology. Rev Neurol (Paris) 2016; 172:503-511. [PMID: 27503097 DOI: 10.1016/j.neurol.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/07/2016] [Indexed: 12/16/2022]
Abstract
In recent years, there has been a major shift in our understanding of the course of Parkinson's disease (PD) from a disease of the brain to a disease of long latency, characterized by the progressive emergence of multiple non-motor symptoms, including hyposmia, constipation, depression, anxiety, rapid eye movement (REM) sleep behavior disorder and excessive daytime sleepiness, as well as subtle motor signs, before the typical motor signs appear. Epidemiological studies have made major contributions by allowing better characterization of subsequent PD risk in relation to non-motor symptoms. Such findings have profound implications for the conduct of epidemiological studies examining risk and protective factors in PD, and the interpretation of their findings. Given the length of the prodromal period, reverse causation in particular is a major concern with many reported associations. One striking feature of PD etiology, compared with other diseases, is the presence of numerous inverse associations. If these associations are truly causal, they would have major implications for disease prevention and for slowing disease progression. However, whether these associations are truly causal remains to be demonstrated in future studies. Experimental studies play an important role by offering a better understanding of the underlying mechanisms. Well-designed epidemiological studies using innovative approaches will also be key in elucidating whether these intriguing associations are causal or a consequence of reverse causation.
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Affiliation(s)
- A Elbaz
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Inserm, Villejuif, France.
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371
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Noyce AJ, Lees AJ, Schrag AE. The prediagnostic phase of Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:871-8. [PMID: 26848171 PMCID: PMC4975823 DOI: 10.1136/jnnp-2015-311890] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
The field of prediagnostic Parkinson's disease (PD) is fast moving with an expanding range of clinical and laboratory biomarkers, and multiple strategies seeking to discover those in the earliest stages or those 'at risk'. It is widely believed that the highest likelihood of securing neuroprotective benefit from drugs will be in these subjects, preceding current point of diagnosis of PD. In this review, we outline current knowledge of the prediagnostic phase of PD, including an up-to-date review of risk factors (genetic and environmental), their relative influence, and clinical features that occur prior to diagnosis. We discuss imaging markers across a range of modalities, and the emerging literature on fluid and peripheral tissue biomarkers. We then explore current initiatives to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials, what we are learning from these initiatives, and how these studies will bring the field closer to realistically commencing primary or secondary preventive trials for PD. Further progress in this field hinges on greater clinical and biological description, and understanding of the prediagnostic, peridiagnostic and immediate postdiagnostic stages of PD. Identifying subjects 3-5 years before they are currently diagnosed may be an ideal group for neuroprotective trials. At the very least, these initiatives will help clarify the stage before and around diagnosis, enabling the field to push into unchartered territory at the earliest stages of disease.
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Affiliation(s)
- Alastair John Noyce
- Department of Molecular Neuroscience, Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK
| | - Andrew John Lees
- Department of Molecular Neuroscience, Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK
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372
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Darweesh SK, Verlinden VJ, Adams HH, Uitterlinden AG, Hofman A, Stricker BH, van Duijn CM, Koudstaal PJ, Ikram MA. Genetic risk of Parkinson’s disease in the general population. Parkinsonism Relat Disord 2016; 29:54-9. [DOI: 10.1016/j.parkreldis.2016.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/14/2016] [Accepted: 05/29/2016] [Indexed: 01/11/2023]
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373
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Chaudhuri KR, Sauerbier A. Parkinson disease. Unravelling the nonmotor mysteries of Parkinson disease. Nat Rev Neurol 2016; 12:10-1. [PMID: 26714657 DOI: 10.1038/nrneurol.2015.236] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Parkinson disease (PD) is now regarded as a mixed motor, nonmotor and multiorgan disorder rather than a pure movement disorder. Nonmotor symptoms (NMS) have underpinned this conceptual change, and new criteria for clinical and prodromal diagnosis of PD, incorporating a range of NMS, have recently been published.
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Affiliation(s)
- K Ray Chaudhuri
- Maurice Wohl Clinical Neuroscience Institute, King's College London, 5 Cutcombe Road, London SE5 9RT, UK
| | - Anna Sauerbier
- Maurice Wohl Clinical Neuroscience Institute, King's College London, 5 Cutcombe Road, London SE5 9RT, UK
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374
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Berg D, Postuma RB, Adler CH, Bloem BR, Chan P, Dubois B, Gasser T, Goetz CG, Halliday G, Joseph L, Lang AE, Liepelt-Scarfone I, Litvan I, Marek K, Obeso J, Oertel W, Olanow CW, Poewe W, Stern M, Deuschl G. MDS research criteria for prodromal Parkinson's disease. Mov Disord 2016; 30:1600-11. [PMID: 26474317 DOI: 10.1002/mds.26431] [Citation(s) in RCA: 820] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
This article describes research criteria and probability methodology for the diagnosis of prodromal PD. Prodromal disease refers to the stage wherein early symptoms or signs of PD neurodegeneration are present, but classic clinical diagnosis based on fully evolved motor parkinsonism is not yet possible. Given the lack of clear neuroprotective/disease-modifying therapy for prodromal PD, these criteria were developed for research purposes only. The criteria are based upon the likelihood of prodromal disease being present with probable prodromal PD defined as ≥80% certainty. Certainty estimates rely upon calculation of an individual's risk of having prodromal PD, using a Bayesian naïve classifier. In this methodology, a previous probability of prodromal disease is delineated based upon age. Then, the probability of prodromal PD is calculated by adding diagnostic information, expressed as likelihood ratios. This diagnostic information combines estimates of background risk (from environmental risk factors and genetic findings) and results of diagnostic marker testing. In order to be included, diagnostic markers had to have prospective evidence documenting ability to predict clinical PD. They include motor and nonmotor clinical symptoms, clinical signs, and ancillary diagnostic tests. These criteria represent a first step in the formal delineation of early stages of PD and will require constant updating as more information becomes available.
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Affiliation(s)
- Daniela Berg
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Charles H Adler
- The Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Piu Chan
- Xuanwu Hospital of Capitol of Medical University, Beijing, China
| | | | - Thomas Gasser
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | - Glenda Halliday
- Neuroscience Research Australia & University of NSW, Randwick, Australia
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Anthony E Lang
- Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - José Obeso
- University of Navarra-FIMA, Pamplona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - C Warren Olanow
- Department of Neurology, The Mount Sinai Hospital, New York, New York, USA
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Matthew Stern
- Penn Neurological Institute, Philadelphia, Pennsylvania, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
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375
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Stirpe P, Hoffman M, Badiali D, Colosimo C. Constipation: an emerging risk factor for Parkinson's disease? Eur J Neurol 2016; 23:1606-1613. [PMID: 27444575 DOI: 10.1111/ene.13082] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/09/2016] [Indexed: 12/11/2022]
Abstract
Constipation is the most prominent and disabling manifestation of lower gastrointestinal (GI) dysfunction in Parkinson's disease (PD). The prevalence of constipation in PD patients ranges from 24.6% to 63%; this variability is due to the different criteria used to define constipation and to the type of population enrolled in the studies. In addition, constipation may play an active role in the pathophysiological changes that underlie motor fluctuations in advanced PD through its negative effects on absorption of levodopa. Several clinical studies now consistently suggest that constipation may precede the first occurrence of classical motor features in PD. Studies in vivo, using biopsies of the GI tract and more recently functional imaging investigations, showed the presence of α-synuclein (α-SYN) aggregates and neurotransmitter alterations in enteric tissues. All these findings support the Braak proposed model for the pathophysiology of α-SYN aggregates in PD, with early pathological involvement of the enteric nervous system and dorsal motor nucleus of the vagus. Therefore, constipation could have the potential sensitivity to be used as a clinical biomarker of the prodromal phase of the disease. The use of colonic biopsies to look at α-SYN pathology, once confirmed by larger prospective studies, might eventually represent a feasible, albeit partially invasive, new diagnostic biomarker for PD.
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Affiliation(s)
- P Stirpe
- Department of Neurology, Institute for Research and Medical Care (IRCCS) San Raffaele, Rome, Italy
| | - M Hoffman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - D Badiali
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - C Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy. ,
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376
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Sierra M, Carnicella S, Strafella AP, Bichon A, Lhommée E, Castrioto A, Chabardes S, Thobois S, Krack P. Apathy and Impulse Control Disorders: Yin & Yang of Dopamine Dependent Behaviors. JOURNAL OF PARKINSONS DISEASE 2016; 5:625-36. [PMID: 25870025 DOI: 10.3233/jpd-150535] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Neuropsychiatric symptoms are common non-motor symptoms in Parkinson's disease (PD). Apathy and impulse control disorders (ICD) are two opposite motivational expressions of a continuous behavioural spectrum involving hypo- and hyperdopaminergia. Both syndromes share pathological (decreased vs increased) dopamine receptor stimulation states. Apathy belongs to the spectrum of hypodopaminergic symptoms together with anhedonia, anxiety and depression. Apathy is a key symptom of PD which worsens with disease progression. Animal models, imaging and pharmacological studies concur in pointing out dopaminergic denervation in the aetiology of parkinsonian apathy with a cardinal role of decreased tonic D2/D3 receptor stimulation. ICDs are part of the hyperdopaminergic behavioural spectrum, which also includes punding, and dopamine dysregulation syndrome (DDS), which are all related to non-physiological dopaminergic stimulation induced by antiparkinsonian drugs. According to clinical data tonic D2/D3 receptor stimulation can be sufficient to induce ICDs. Clinical observations in drug addiction and PD as well as data from studies in dopamine depleted rodents provide hints allowing to argue that both pulsatile D1 and D2 receptor stimulation and the severity of dopaminergic denervation are risk factors to develop punding behavior and DDS. Imaging studies have shown that the brain structures involved in drug addiction are also involved in hyperdopaminergic behaviours with increase of bottom-up appetitive drive and decrease in prefrontal top down behavioural control.
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Affiliation(s)
- María Sierra
- Service of Neurology, University Hospital "Marqués de Valdecilla (IFIMAV)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | | | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit - E.J. Safra Parkinson Disease Program, Toronto Western Hospital and Research Institute, UHN & Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Ontario, Canada
| | - Amélie Bichon
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Eugénie Lhommée
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Anna Castrioto
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Stephan Chabardes
- Department of Neurosurgery CHU de Grenoble, Joseph Fourier University, Grenoble, France and INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Stéphane Thobois
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France; Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
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377
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Sveinbjornsdottir S. The clinical symptoms of Parkinson's disease. J Neurochem 2016; 139 Suppl 1:318-324. [PMID: 27401947 DOI: 10.1111/jnc.13691] [Citation(s) in RCA: 652] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 12/11/2022]
Abstract
In this review, the clinical features of Parkinson's disease, both motor and non-motor, are described in the context of the progression of the disease. Also briefly discussed are the major treatment strategies and their complications. Parkinson's disease is a slowly progressing neurodegenerative disorder, causing impaired motor function with slow movements, tremor and gait and balance disturbances. A variety of non-motor symptoms are common in Parkinson's disease. They include disturbed autonomic function with orthostatic hypotension, constipation and urinary disturbances, a variety of sleep disorders and a spectrum of neuropsychiatric symptoms. This article describes the different clinical symptoms that may occur and the clinical course of the disease. This article is part of a special issue on Parkinson disease.
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Affiliation(s)
- Sigurlaug Sveinbjornsdottir
- Department of Neurology, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK. .,Queen Mary School of Medicine and Dentistry, University of London, London, UK.
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378
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Kostić VS, Tomić A, Ječmenica‐Lukić M. The Pathophysiology of Fatigue in Parkinson's Disease and its Pragmatic Management. Mov Disord Clin Pract 2016; 3:323-330. [PMID: 30363584 PMCID: PMC6178705 DOI: 10.1002/mdc3.12343] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Fatigue is 1 of the most common and most disabling symptoms among patients with Parkinson's disease (PD) and has a significant impact on their quality of life. Yet the pathophysiology of fatigue is poorly understood, while its treatment is "limited to an empirical approach based on plausible hypotheses." METHODS PubMed was searched for articles with the key words "Parkinson's disease" or "parkinsonism" and "fatigue" that were published by or before August 2015. The analysis of articles, which were selected on subjective grounds, was used to review the current knowledge of pathophysiology and treatment outcomes in studies focused on fatigue in PD. CONCLUSIONS Clinical and experimental findings support the view that fatigue is a primary manifestation of PD. The main hypothesized pathophysiological mechanisms include abnormal basal ganglia (BG)-cortical mechanisms, particularly frontal loops, and an imbalance between neurotransmitters (e.g., dopamine [DA] and serotonin), along with an altered hypothalamus-pituitary-adrenal axis, neuroinflammation, cardiac sympathetic denervation, etc. Pragmatic treatment of fatigue in patients with PD includes various pharmacological (dopaminergic and psychostimulant drugs, antidepressants) and nonpharmacological strategies, although current knowledge suffers from insufficient evidence to support the use of any drug or nondrug therapy.
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Affiliation(s)
- Vladimir S. Kostić
- Institute of Neurology CCSSchool of MedicineUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Tomić
- Institute of Neurology CCSSchool of MedicineUniversity of BelgradeBelgradeSerbia
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379
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Adams-Carr KL, Bestwick JP, Shribman S, Lees A, Schrag A, Noyce AJ. Constipation preceding Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87:710-6. [PMID: 26345189 DOI: 10.1136/jnnp-2015-311680] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/10/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review published literature to estimate the magnitude of association between premorbid constipation and later diagnosis of Parkinson's disease. BACKGROUND Constipation is a recognised non-motor feature of Parkinson's and has been reported to predate diagnosis in a number of observational studies. METHODS A systematic review and meta-analysis was carried out following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) criteria. A literature search was undertaken in December 2014 using PubMed and the search terms 'Parkinson's disease' and 'constipation'. Articles were screened for suitability and reviewed against inclusion and exclusion criteria. Studies were included if they assessed constipation by means of a structured questionnaire or if constipation/drugs used to treat constipation were coded in patient medical records. Data were extracted using a standardised template and effect size estimates combined using a fixed-effects model. Heterogeneity was explored with the I(2) statistic. RESULTS 9 studies were included in the meta-analysis, with a combined sample size of 741 593 participants. Those with constipation had a pooled OR of 2.27 (95% CI 2.09 to 2.46) for developing subsequent Parkinson's disease compared with those without constipation. Weak evidence for heterogeneity was found (I(2)=18.9%, p=0.282). Restricting analysis to studies assessing constipation more than 10 years prior to Parkinson's disease gave a pooled OR of 2.13 (95% CI 1.78 to 2.56; I(2)=0.0%). CONCLUSIONS This systematic review and meta-analysis demonstrates that people with constipation are at a higher risk of developing Parkinson's disease compared with those without and that constipation can predate Parkinson's diagnosis by over a decade.
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Affiliation(s)
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Samuel Shribman
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Lees
- Institute of Neurology, University College London, London, UK
| | - Anette Schrag
- Institute of Neurology, University College London, London, UK
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380
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Heinzel S, Roeben B, Ben-Shlomo Y, Lerche S, Alves G, Barone P, Behnke S, Berendse HW, Bloem BR, Burn D, Dodel R, Grosset DG, Hu M, Kasten M, Krüger R, Moccia M, Mollenhauer B, Oertel W, Suenkel U, Walter U, Wirdefeldt K, Liepelt-Scarfone I, Maetzler W, Berg D. Prodromal Markers in Parkinson's Disease: Limitations in Longitudinal Studies and Lessons Learned. Front Aging Neurosci 2016; 8:147. [PMID: 27445791 PMCID: PMC4916171 DOI: 10.3389/fnagi.2016.00147] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/07/2016] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence supports a prodromal neurodegenerative process preceding the clinical onset of Parkinson's disease (PD). Studies have identified several different prodromal markers that may have the potential to predict the conversion from healthy to clinical PD but use considerably different approaches. We systematically reviewed 35 longitudinal studies reporting prodromal PD features and evaluated the methodological quality across 10 different predefined domains. We found limitations in the following domains: PD diagnosis (57% of studies), prodromal marker assessments (51%), temporal information on prodromal markers or PD diagnosis (34%), generalizability of results (17%), statistical methods (accounting for at least age as confounder; 17%), study design (14%), and sample size (9%). However, no limitations regarding drop-out (or bias investigation), or report of inclusion/exclusion criteria or prodromal marker associations were revealed. Lessons learned from these limitations and additional aspects of current prodromal marker studies in PD are discussed to provide a basis for the evaluation of findings and the improvement of future research in prodromal PD. The observed heterogeneity of studies, limitations and analyses might be addressed in future longitudinal studies using a, yet to be established, modular minimal set of assessments improving comparability of findings and enabling data sharing and combined analyses across studies.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol Bristol, UK
| | - Stefanie Lerche
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Guido Alves
- Norwegian Centre for Movement Disorders and Department of Neurology, Stavanger University Hospital Stavanger, Norway
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno Salerno, Italy
| | - Stefanie Behnke
- Department of Neurology, University of Homburg Homburg, Germany
| | - Henk W Berendse
- Department of Neurology and Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology Nijmegen, Netherlands
| | - David Burn
- Institute of Neuroscience, Newcastle University Newcastle Upon Tyne, UK
| | - Richard Dodel
- Department of Neurology, Philipps-University Marburg Marburg, Germany
| | - Donald G Grosset
- Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, UK
| | - Michele Hu
- Oxford Parkinson's Disease Centre and Nuffield Department of Clinical Neurosciences, University of Oxford Oxford, UK
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck Lübeck, Germany
| | - Rejko Krüger
- Clinical and Experimental Neuroscience, Luxembourg Center for Systems Biomedicine Belva, Luxembourg
| | - Marcello Moccia
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno Salerno, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-KlinikKassel, Germany; Department of Neuropathology, University Medical CenterGöttingen, Germany
| | - Wolfgang Oertel
- Department of Neurology, Philipps-University Marburg Marburg, Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Uwe Walter
- Department of Neurology, University of Rostock Rostock, Germany
| | - Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics and Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany
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381
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Schrag A, Sauerbier A, Chaudhuri KR. New clinical trials for nonmotor manifestations of Parkinson's disease. Mov Disord 2016; 30:1490-504. [PMID: 26371623 DOI: 10.1002/mds.26415] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/22/2015] [Accepted: 08/03/2015] [Indexed: 11/07/2022] Open
Abstract
Nonmotor manifestations in Parkinson's disease (PD) encompass a range of clinical features, including neuropsychiatric problems, autonomic dysfunction, sleep disorders, fatigue, and pain. Despite their importance for patients' quality of life, the evidence base for their treatment is relatively sparse. Nevertheless, the last few years have seen a number of new trials starting that specifically address nonmotor features as an outcome measure in clinical trials. Large randomized, controlled trials in the last 3 years reported improvement of psychosis with the new selective serotonin 5-HT2A inverse agonist pimavanserin and of postural hypotension with the oral norepinephrine precursor droxidopa. Smaller new randomized, controlled trials support the effectiveness of Deep Brain Stimulation and opiates for pain, of rivastigmine for apathy and piribedil for apathy post-DBS, group cognitive behavioral therapy for depression and/or anxiety, continuous positive airway pressure for sleep apnea in PD and doxepin for insomnia, and of solifenacin succinate and transcutaneous tibial nerve stimulation for urinary symptoms. A number of new smaller or open trials as well as post-hoc analyses of randomized, controlled trials have suggested usefulness of other treatments, and new randomized, controlled trials are currently ongoing.
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Affiliation(s)
- Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, United Kingdom
| | - Anna Sauerbier
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
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382
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Salat D, Noyce AJ, Schrag A, Tolosa E. Challenges of modifying disease progression in prediagnostic Parkinson's disease. Lancet Neurol 2016; 15:637-48. [DOI: 10.1016/s1474-4422(16)00060-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/28/2016] [Accepted: 02/05/2016] [Indexed: 12/19/2022]
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383
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Castrioto A, Thobois S, Carnicella S, Maillet A, Krack P. Emotional manifestations of PD: Neurobiological basis. Mov Disord 2016; 31:1103-13. [DOI: 10.1002/mds.26587] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/22/2016] [Accepted: 01/24/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anna Castrioto
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GINGrenoble France
- InsermU1216Grenoble France
- Movement Disorders Unit, Neurology Department, CHU de GrenobleGrenoble France
| | - Stéphane Thobois
- CNRS, UMR 5229, Centre de Neurosciences CognitivesBron France
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C; Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles MérieuxLyon France
| | - Sebastien Carnicella
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GINGrenoble France
- InsermU1216Grenoble France
| | - Audrey Maillet
- CNRS, UMR 5229, Centre de Neurosciences CognitivesBron France
| | - Paul Krack
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GINGrenoble France
- InsermU1216Grenoble France
- Movement Disorders Unit, Neurology Department, CHU de GrenobleGrenoble France
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384
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Svensson E, Farkas DK, Gradus JL, Lash TL, Sørensen HT. Adjustment disorder and risk of Parkinson's disease. Eur J Neurol 2016; 23:751-6. [PMID: 26756302 PMCID: PMC4803588 DOI: 10.1111/ene.12933] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/04/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE It has been postulated that stress is part of the etiological process of Parkinson's disease (PD). The risk of PD was examined in a cohort of patients with adjustment disorders, a diagnosis made in the presence of a severe response to a stressful life event. METHODS Using Danish medical registries, PD occurrence was examined in a nationwide population-based cohort of patients with adjustment disorder diagnosed between 1995 and 2011. The standardized incidence ratio of PD was calculated as the ratio of observed to expected cases, stratified by time and potential risk factors, including depression and anxiety. RESULTS Our adjustment disorder cohort (67 786 patients) was followed for a median of 8 years (interquartile range 4, 12.6 years). During follow-up, 119 patients developed PD, versus 64 expected, corresponding to a standardized incidence ratio of 1.84 (95% confidence interval 1.53, 2.20). Consistent results were observed after stratification on potential risk factors, including depression and anxiety. CONCLUSION Adjustment disorder, a diagnosis made in the presence of severe response to stressful life events, was associated with an increased risk of PD.
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Affiliation(s)
- Elisabeth Svensson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jaimie L. Gradus
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- National Center for PTSD, VA Boston Healthcare System, USA
- Departments of Psychiatry and Epidemiology, Boston University, USA
| | - Timothy L. Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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385
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Rodríguez-Violante M, de Saráchaga AJ, Cervantes-Arriaga A, Millán-Cepeda R, Leal-Ortega R, Estrada-Bellmann I, Zuñiga-Ramírez C. Self-Perceived Pre-Motor Symptoms Load in Patients with Parkinson’s Disease: A Retrospective Study. JOURNAL OF PARKINSONS DISEASE 2016; 6:183-90. [DOI: 10.3233/jpd-150705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mayela Rodríguez-Violante
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Adib Jorge de Saráchaga
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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386
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Majláth Z, Török N, Toldi J, Vécsei L. Promising therapeutic agents for the treatment of Parkinson’s disease. Expert Opin Biol Ther 2016; 16:787-99. [DOI: 10.1517/14712598.2016.1164687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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387
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Magnard R, Vachez Y, Carcenac C, Krack P, David O, Savasta M, Boulet S, Carnicella S. What can rodent models tell us about apathy and associated neuropsychiatric symptoms in Parkinson's disease? Transl Psychiatry 2016; 6:e753. [PMID: 26954980 PMCID: PMC4872443 DOI: 10.1038/tp.2016.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022] Open
Abstract
In addition to classical motor symptoms, Parkinson's disease (PD) patients display incapacitating neuropsychiatric manifestations, such as apathy, anhedonia, depression and anxiety. These hitherto generally neglected non-motor symptoms, have gained increasing interest in medical and scientific communities over the last decade because of the extent of their negative impact on PD patients' quality of life. Although recent clinical and functional imaging studies have provided useful information, the pathophysiology of apathy and associated affective impairments remains elusive. Our aim in this review is to summarize and discuss recent advances in the development of rodent models of PD-related neuropsychiatric symptoms using neurotoxin lesion-based approaches. The data collected suggest that bilateral and partial lesions of the nigrostriatal system aimed at inducing reliable neuropsychiatric-like deficits while avoiding severe motor impairments that may interfere with behavioral evaluation, is a more selective and efficient strategy than medial forebrain bundle lesions. Moreover, of all the different classes of pharmacological agents, D2/D3 receptor agonists such as pramipexole appear to be the most efficient treatment for the wide range of behavioral deficits induced by dopaminergic lesions. Lesion-based rodent models, therefore, appear to be relevant tools for studying the pathophysiology of the non-motor symptoms of PD. Data accumulated so far confirm the causative role of dopaminergic depletion, especially in the nigrostriatal system, in the development of behavioral impairments related to apathy, depression and anxiety. They also put forward D2/D3 receptors as potential targets for the treatment of such neuropsychiatric symptoms in PD.
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Affiliation(s)
- R Magnard
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Y Vachez
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - C Carcenac
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - P Krack
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Grenoble, France
| | - O David
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - M Savasta
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Boulet
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Carnicella
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Inserm U1216, Grenoble Institute of Neuroscience, Site Santé La Tronche - BP 170, 38042 Grenoble, France. E-mail:
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388
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Yilmaz R, Behnke S, Liepelt-Scarfone I, Roeben B, Pausch C, Runkel A, Heinzel S, Niebler R, Suenkel U, Eschweiler GW, Maetzler W, Berg D. Substantia nigra hyperechogenicity is related to decline in verbal memory in healthy elderly adults. Eur J Neurol 2016; 23:973-8. [DOI: 10.1111/ene.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- R. Yilmaz
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - S. Behnke
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - I. Liepelt-Scarfone
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - B. Roeben
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - C. Pausch
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - A. Runkel
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - S. Heinzel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - R. Niebler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - U. Suenkel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - G. W. Eschweiler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - W. Maetzler
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - D. Berg
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
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389
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Predicting Parkinson disease in the community using a nonmotor risk score. Eur J Epidemiol 2016; 31:679-84. [PMID: 26898908 PMCID: PMC4977330 DOI: 10.1007/s10654-016-0130-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/13/2016] [Indexed: 02/08/2023]
Abstract
At present, there are no validated methods to identify persons who are at increased risk for Parkinson Disease (PD) from the general population. We investigated the clinical usefulness of a recently proposed non-motor risk score for PD (the PREDICT-PD risk score) in the population-based Rotterdam Study. At baseline (1990), we constructed a weighted risk score based on 10 early nonmotor features and risk factors in 6492 persons free of parkinsonism and dementia. We followed these persons for up to 20 years (median 16.1 years) for the onset of PD until 2011. We studied the association between the PREDICT-PD risk score and incident PD using competing risk regression models with adjustment for age and sex. In addition, we assessed whether the PREDICT-PD risk score improved discrimination (C-statistics) and risk classification (net reclassification improvement) of incident PD beyond age and sex. During follow-up, 110 persons were diagnosed with incident PD. The PREDICT-PD risk score was associated with incident PD (hazard ratio [HR] = 1.30; 95 % confidence interval [1.06; 1.59]) and yielded a small, non-significant improvement in overall discrimination (ΔC-statistic = 0.018[-0.005; 0.041]) and risk classification (net reclassification improvement = 0.172[-0.017; 0.360]) of incident PD. In conclusion, the PREDICT-PD risk score only slightly improves long-term prediction of PD in the community.
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390
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Environmental risk factors and Parkinson's disease: An umbrella review of meta-analyses. Parkinsonism Relat Disord 2016; 23:1-9. [DOI: 10.1016/j.parkreldis.2015.12.008] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 12/26/2022]
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391
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Nyström H, Nordström A, Nordström P. Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort. PLoS Med 2016; 13:e1001954. [PMID: 26836965 PMCID: PMC4737490 DOI: 10.1371/journal.pmed.1001954] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 12/24/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Low muscle strength has been found in late adolescence in individuals diagnosed with Parkinson disease (PD) 30 y later. This study investigated whether this lower muscle strength also may translate into increased risks of falling and fracture before the diagnosis of PD. METHODS AND FINDINGS Among all Swedish citizens aged ≥50 y in 2005, two nested case-control cohorts were compiled. In cohort I, individuals diagnosed with PD during 1988-2012 (n = 24,412) were matched with up to ten controls (n = 243,363), and the risk of fall-related injuries before diagnosis of PD was evaluated. In cohort II, individuals with an injurious fall in need of emergency care during 1988-2012 (n = 622,333) were matched with one control (n = 622,333), and the risk of PD after the injurious fall was evaluated. In cohort I, 18.0% of cases and 11.5% of controls had at least one injurious fall (p < 0.001) prior to PD diagnosis in the case. Assessed by conditional logistic regression analysis adjusted for comorbid diagnoses and education level, PD was associated with increased risks of injurious fall up to 10 y before diagnosis (odds ratio [OR] 1.19, 95% CI 1.08-1.31; 7 to <10 y before diagnosis) and hip fracture ≥15 y before diagnosis (OR 1.36, 95% CI 1.10-1.69; 15-26 y before diagnosis). In cohort II, 0.7% of individuals with an injurious fall and 0.5% of controls were diagnosed with PD during follow-up (p < 0.001). The risk of PD was increased for up to 10 y after an injurious fall (OR 1.18, 95% CI 1.02-1.37; 7 to <10 y after diagnosis). An important limitation is that the diagnoses were obtained from registers and could not be clinically confirmed for the study. CONCLUSIONS The increased risks of falling and hip fracture prior to the diagnosis of PD may suggest the presence of clinically relevant neurodegenerative impairment many years before the diagnosis of this disease.
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Affiliation(s)
- Helena Nyström
- Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- * E-mail:
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392
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393
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Friedman JH, Beck JC, Chou KL, Clark G, Fagundes CP, Goetz CG, Herlofson K, Kluger B, Krupp LB, Lang AE, Lou JS, Marsh L, Newbould A, Weintraub D. Fatigue in Parkinson's disease: report from a mutidisciplinary symposium. NPJ Parkinsons Dis 2016; 2:15025. [PMID: 27239558 PMCID: PMC4883681 DOI: 10.1038/npjparkd.2015.25] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/28/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a severe problem for many people living with Parkinson's disease (PD). Best estimates suggest that more than 50% of patients experience this debilitating symptom. Little is known about its etiology or treatment, making the understanding of fatigue a true unmet need. As part of the Parkinson's Disease Foundation Community Choice Research Program, patients, caregivers, and scientists attended a symposium on fatigue on 16 and 17 October 2014. We present a summary of that meeting, reviewing what is known about the diagnosis and treatment of fatigue, its physiology, and what we might learn from multiple sclerosis (MS), depression, and cancer-disorders in which fatigue figures prominently too. We conclude with focused recommendations to enhance our understanding and treatment of this prominent problem in PD.
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Affiliation(s)
- Joseph H Friedman
- Movement Disorders Program, Butler Hospital, Province, RI, USA
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - James C Beck
- Parkinson’s Disease Foundation, New York, NY, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan Health System, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gracia Clark
- Parkinson’s Disease Foundation, New York, NY, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, M.D. Anderson Cancer Center, Houston, TX, USA
- Department of Health Disparities, Houston, TX, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Karen Herlofson
- Department of Neurology, Sorlandet Hospital, Arendal, Norway
| | - Benzi Kluger
- Department of Neurology, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Lauren B Krupp
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Anthony E Lang
- Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Clinic and Edmond J Safra Program in Parkinson’s Disease, Toronto, ON, Canada
| | - Jao-Shin Lou
- University of North Dakota School of Medicine and Health Services, Sanford Health, Grand Forks, ND, USA
| | - Laura Marsh
- Department of Psychiatry, Baylor College of Medicine, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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394
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Fernández-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The Clinical Phenotype of Idiopathic Rapid Eye Movement Sleep Behavior Disorder at Presentation: A Study in 203 Consecutive Patients. Sleep 2016; 39:121-32. [PMID: 26940460 DOI: 10.5665/sleep.5332] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the clinical phenotype of idiopathic rapid eye movement (REM) sleep behavior disorder (IRBD) at presentation in a sleep center. METHODS Clinical history review of 203 consecutive patients with IRBD identified between 1990 and 2014. IRBD was diagnosed by clinical history plus video-polysomnographic demonstration of REM sleep with increased electromyographic activity linked to abnormal behaviors. RESULTS Patients were 80% men with median age at IRBD diagnosis of 68 y (range, 50-85 y). In addition to the already known clinical picture of IRBD, other important features were apparent: 44% of the patients were not aware of their dream-enactment behaviors and 70% reported good sleep quality. In most of these cases bed partners were essential to convince patients to seek medical help. In 11% IRBD was elicited only after specific questioning when patients consulted for other reasons. Seven percent did not recall unpleasant dreams. Leaving the bed occurred occasionally in 24% of subjects in whom dementia with Lewy bodies often developed eventually. For the correct diagnosis of IRBD, video-polysomnography had to be repeated in 16% because of insufficient REM sleep or electromyographic artifacts from coexistent apneas. Some subjects with comorbid obstructive sleep apnea reported partial improvement of RBD symptoms following continuous positive airway pressure therapy. Lack of therapy with clonazepam resulted in an increased risk of sleep related injuries. Synucleinopathy was frequently diagnosed, even in patients with mild severity or uncommon IRBD presentations (e.g., patients who reported sleeping well, onset triggered by a life event, nocturnal ambulation) indicating that the development of a neurodegenerative disease is independent of the clinical presentation of IRBD. CONCLUSIONS We report the largest IRBD cohort observed in a single center to date and highlight frequent features that were not reported or not sufficiently emphasized in previous publications. Physicians should be aware of the full clinical expression of IRBD, a sleep disturbance that represents a neurodegenerative disease. COMMENTARY A commentary on this article appears in this issue on page 7.
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Affiliation(s)
- Ana Fernández-Arcos
- Neurology Service, Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, University of Barcelona Medical School, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, University of Barcelona Medical School, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Mónica Serradell
- Neurology Service, Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, University of Barcelona Medical School, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Carles Gaig
- Neurology Service, Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, University of Barcelona Medical School, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, University of Barcelona Medical School, IDIBAPS, CIBERNED, Barcelona, Spain
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395
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Noyce AJ, Nalls MA. Mendelian Randomization - the Key to Understanding Aspects of Parkinson's Disease Causation? Mov Disord 2015; 31:478-83. [PMID: 26695521 PMCID: PMC4943230 DOI: 10.1002/mds.26492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/20/2015] [Accepted: 10/25/2015] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease has multiple determinants and is associated with a wide range of exposures that appear to modify risk in traditional observational studies, including numerous lifestyle and environmental factors. Across other fields of medicine, Mendelian randomization has emerged as a powerful method to examine whether associations between exposures and disease outcomes are causal. Here we discuss the concept of Mendelian randomization, its potential relevance to Parkinson's disease, and suggest avenues through which the method could be employed to further understanding of the causal basis of Parkinson's disease. © 2015 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alastair J Noyce
- Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
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396
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Villeneuve LM, Purnell PR, Stauch KL, Fox HS. Neonatal mitochondrial abnormalities due to PINK1 deficiency: Proteomics reveals early changes relevant to Parkinson׳s disease. Data Brief 2015; 6:428-32. [PMID: 26866053 PMCID: PMC4710791 DOI: 10.1016/j.dib.2015.11.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 12/03/2022] Open
Abstract
Parkinson׳s disease (PD), the second most common neurodegenerative disorder, affects roughly 7–10 million people worldwide. A wide array of research has suggested that PD has a mitochondrial component and that mitochondrial dysfunction occurs well in advance of the clinical manifestation of the disease. Previous work by our lab has categorized the mitochondrial disorder associated with Parkinson׳s disease in a PINK1 knockout rat model. This model develops Parkinson׳s disease in a spontaneous, predictable manner. Our findings demonstrated PINK1-deficient rats at 4 months of age had mitochondrial proteomic and functional abnormalities before the onset of Parkinsonian symptoms (6 months) such as the movement disorder, loss of midbrain dopaminergic neurons, or the progressive degeneration present at 9 months. With this in mind, our group investigated the PINK1 knockout genetic rat model at postnatal day 10 to determine if the observed alterations at 4 months were present at an earlier time point. Using a proteomic analysis of brain mitochondria, we identified significant mitochondrial proteomic alterations in the absence of mitochondrial functional changes suggesting the observed alterations are part of the mitochondrial pathways leading to PD. Specifically, we identified differentially expressed proteins in the PINK1 knockout rat involved in glycolysis, the tricarboxylic acid cycle, and fatty acid metabolism demonstrating abnormalities occur well in advance of the manifestation of clinical symptoms. Additionally, 13 of the differentially expressed proteins have been previously identified in older PINK1 knockout animals as differentially regulated suggesting these proteins may be viable markers of the PD pathology, and further, the abnormally regulated pathways could be targeted for therapeutic interventions. All raw data can be found in Supplementary Table 1.
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Affiliation(s)
- Lance M Villeneuve
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Phillip R Purnell
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Kelly L Stauch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Howard S Fox
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, United States
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397
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Diederich NJ, Goldman JG, Stebbins GT, Goetz CG. Failing as doorman and disc jockey at the same time: Amygdalar dysfunction in Parkinson's disease. Mov Disord 2015; 31:11-22. [PMID: 26650182 DOI: 10.1002/mds.26460] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 02/01/2023] Open
Abstract
In Braak's model of ascending degeneration in Parkinson's disease (PD), involvement of the amygdala occurs simultaneously with substantia nigra degeneration. However, the clinical manifestations of amygdalar involvement in PD have not been fully delineated. Considered a multitask manager, the amygdala is a densely connected "hub," coordinating and integrating tasks ranging from prompt, multisensorial emotion recognition to adequate emotional responses and emotional tuning of memories. Although phylogenetically predisposed to handle fear, the amygdala handles both aversive and positive emotional inputs. In PD, neuropathological and in vivo studies suggest primarily amygdalar hypofunction. However, as dopamine acts as an inverted U-shaped amygdalar modulator, medication-induced hyperactivity of the amygdala can occur. We propose that amygdalar (network) dysfunction contributes to reduced recognition of negative emotional face expressions, impaired theory of mind, reactive hypomimia, and impaired decision making. Similarly, impulse control disorders in predisposed individuals, hallucinations, anxiety, and panic attacks may be related to amygdalar dysfunction. When available, we discuss amygdala-independent trigger mechanisms of these symptoms. Although dopaminergic agents have mostly an activation effect on amygdalar function, adaptive and compensatory network changes may occur as well, but these have not been sufficiently explored. In conclusion, our model of amygdalar involvement brings together several elements of Parkinson's disease phenomenology heretofore left unexplained and provides a framework for testable hypotheses in patients during life and in autopsy analyses.
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Affiliation(s)
- Nico J Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.,Centre for Systems Biomedicine, University of Luxembourg, Campus Esch-Belval, Esch-s.-Alzette, Luxembourg.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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398
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Autonomic dysfunction in subjects at high risk for Parkinson's disease. J Neurol 2015; 262:2643-52. [PMID: 26530505 DOI: 10.1007/s00415-015-7888-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 12/15/2022]
Abstract
Aim of this project was to evaluate autonomic dysfunction in subjects proposed to be at high risk to develop Parkinson's disease (PD) compared to control subjects and PD patients at different disease stages. Combinations of substantia nigra hyperechogenicity (SN+) assessed by transcranial ultrasound (TCS), hyposmia, lifetime prevalence of depression and mild PD-specific motor signs were used to identify subjects at high risk for motor Parkinson's disease (HR-PD). Supine and standing blood pressure (BP), hearth rate (HR), orthostatic, urinary, sexual and bowel symptoms were evaluated in HR-PD, healthy control subjects and PD patients, divided into mild and advanced stages. The study group consisted of 113 PD patients (mild PD n = 71, advanced PD, n = 42), 40 HR-PD individuals and 50 controls. Compared to controls, HR-PD subjects complained more often about urinary (p = 0.002) and bowel dysfunction (p = 0.001) and had a higher diastolic BP drop after standing (p = 0.01). The cumulative number of autonomic symptoms differentiated PD as well as HR-PD significantly from controls (p < 0.001). Advanced PD patients presented often and severe orthostatic symptoms, not significantly different from mild PD after concomitant medication correction. Our results support the presence of urinary and bowel dysfunction in subjects at high risk for motor PD. Presence and severity of orthostatic symptoms was higher during stages and increase in advanced stages, at least partly due to increase in dopaminergic and conflicting medication. Understanding the progression of non-motor aspects in PD might offer the possibility to use them as targets for disease-modifying therapies.
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399
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A diagnostic algorithm for Parkinson's disease: what next? Lancet Neurol 2015; 14:971-3. [PMID: 26271531 DOI: 10.1016/s1474-4422(15)00192-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
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400
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Schmitt I, Kaut O, Khazneh H, deBoni L, Ahmad A, Berg D, Klein C, Fröhlich H, Wüllner U. L-dopa increases α
-synuclein DNA methylation in Parkinson's disease patients in vivo
and in vitro. Mov Disord 2015; 30:1794-801. [DOI: 10.1002/mds.26319] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/27/2015] [Accepted: 06/03/2015] [Indexed: 01/10/2023] Open
Affiliation(s)
- Ina Schmitt
- Department of Neurology; UKB; Bonn Germany
- German Center for Neurodegenerative Diseases (DZNE); Bonn Germany
| | | | | | | | - Ashar Ahmad
- Bonn-Aachen International Center for IT, University of Bonn; Germany
| | - Daniela Berg
- German Center for Neurodegenerative Diseases (DZNE); Bonn Germany
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research; Tübingen Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck; Lübeck Germany
| | - Holger Fröhlich
- Bonn-Aachen International Center for IT, University of Bonn; Germany
| | - Ullrich Wüllner
- Department of Neurology; UKB; Bonn Germany
- German Center for Neurodegenerative Diseases (DZNE); Bonn Germany
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