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Gandhi SE, Nodehi A, Lawton MA, Grosset KA, Marshall V, Ben-Shlomo Y, Grosset DG. Dopa Responsiveness in Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 38898616 DOI: 10.1002/mdc3.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/26/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dopaminergic responsiveness is a defining feature of Parkinson's disease (PD). However, there is limited information on how this evolves over time. OBJECTIVES To examine serial dopaminergic responses, if there are distinct patterns, and which factors predict these. METHODS We analyzed data from the Parkinson's Progression Markers Initiative on repeated dopaminergic challenge tests (≥24.5% defined as a definite response). Growth-mixture modeling evaluated for different response patterns and multinomial logistic regression tested for predictors of these clusters. RESULTS 1525 dopaminergic challenge tests were performed in 336 patients. At enrolment, mean age was 61.2 years (SD 9.6), 66.4% were male and disease duration was 0.5 years (SD 0.5). 1 to 2 years after diagnosis, 48.0% of tests showed a definite response, but this proportion increased with longer disease duration (51.1-74.3%). We identified 3 response groups: "Striking" (n = 29, 8.7%); "Excellent" (n = 110; 32.7%) and "Modest" (n = 197, 58.6%). Significant differences were as follows: striking responders commenced treatment earlier (P = 0.02), were less likely to be on dopamine agonist monotherapy (P = 0.01), and had better cognition (P < 0.01) and activities of daily living (P = 0.01). Excellent responders had higher challenge doses (P = 0.03) and were more likely to be on combination therapy (P < 0.01). CONCLUSION Three distinct patterns of the dopaminergic response were observed. As the proportion of PD cases with definite dopa responsiveness increased over time, the initial treatment response may be an unreliable diagnostic aid.
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Affiliation(s)
- Sacha E Gandhi
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Anahita Nodehi
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael A Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Katherine A Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Vicky Marshall
- Institute of Neurological Sciences, Glasgow, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Donald G Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Gandhi SE, Zerenner T, Nodehi A, Lawton MA, Marshall V, Al‐Hajraf F, Grosset KA, Morris HR, Hu MT, Ben‐Shlomo Y, Grosset DG. Motor Complications in Parkinson's Disease: Results from 3343 Patients Followed for up to 12 Years. Mov Disord Clin Pract 2024; 11:686-697. [PMID: 38587023 PMCID: PMC11145112 DOI: 10.1002/mdc3.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Motor complications are well recognized in Parkinson's disease (PD), but their reported prevalence varies and functional impact has not been well studied. OBJECTIVES To quantify the presence, severity, impact and associated factors for motor complications in PD. METHODS Analysis of three large prospective cohort studies of recent-onset PD patients followed for up to 12 years. The MDS-UPDRS part 4 assessed motor complications and multivariable logistic regression tested for associations. Genetic risk score (GRS) for Parkinson's was calculated from 79 single nucleotide polymorphisms. RESULTS 3343 cases were included (64.7% male). Off periods affected 35.0% (95% CI 33.0, 37.0) at 4-6 years and 59.0% (55.6, 62.3) at 8-10 years. Dyskinesia affected 18.5% (95% CI 16.9, 20.2) at 4-6 years and 42.1% (38.7, 45.5) at 8-10 years. Dystonia affected 13.4% (12.1, 14.9) at 4-6 years and 22.8% (20.1, 25.9) at 8-10 years. Off periods consistently caused greater functional impact than dyskinesia. Motor complications were more common among those with higher drug doses, younger age at diagnosis, female gender, and greater dopaminergic responsiveness (in challenge tests), with associations emerging 2-4 years post-diagnosis. Higher Parkinson's GRS was associated with early dyskinesia (0.026 ≤ P ≤ 0.050 from 2 to 6 years). CONCLUSIONS Off periods are more common and cause greater functional impairment than dyskinesia. We confirm previously reported associations between motor complications with several demographic and medication factors. Greater dopaminergic responsiveness and a higher genetic risk score are two novel and significant independent risk factors for the development of motor complications.
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Affiliation(s)
- Sacha E. Gandhi
- School of Neuroscience and PsychologyUniversity of GlasgowGlasgowUnited Kingdom
| | - Tanja Zerenner
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Anahita Nodehi
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Michael A. Lawton
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | | | - Falah Al‐Hajraf
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical NeuroscienceOxford UniversityOxfordUnited Kingdom
- Department of Pharmacology and Toxicology, Faculty of MedicineKuwait UniversityKuwait CityKuwait
| | | | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Michele T. Hu
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical NeuroscienceOxford UniversityOxfordUnited Kingdom
| | - Yoav Ben‐Shlomo
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Donald G. Grosset
- School of Neuroscience and PsychologyUniversity of GlasgowGlasgowUnited Kingdom
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Feal Painceiras MJ, García Díaz I, Íñiguez Alvarado MC, Paz JM, Jesús S, Cosgaya M, García Caldentey J, Caballol N, Legarda I, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Vela L, Escalante S, Mendoza Z, Martínez Castrillo JC, Alonso PS, Alonso Losada MG, López Ariztegui N, McAfee D, Martinez-Martin P, Mir P. Response to levodopa in Parkinson's disease over time. A 4-year follow-up study. Parkinsonism Relat Disord 2023; 116:105852. [PMID: 37804623 DOI: 10.1016/j.parkreldis.2023.105852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND AND OBJECTIVE A good response to levodopa is a key factor to indicate device-aided therapies in people with Parkinson's disease (PwPD). The aim of the present study was to analyze the response to levodopa in PwPD with motor fluctuations followed for 4 years. PATIENTS AND METHODS PwPD with motor fluctuations recruited from January 2016 to November 2017 from the COPPADIS cohort and assessed annually (from baseline to 4-year follow-up) during the OFF and ON states were included in this analysis. At each visit, the Unified Parkinson's Disease Rating Scale - part III (UPDRS-III) was applied during the OFF state (without medication during the last 12 h) and during the ON state. General linear model repeated measures were used to test for changes in the mean UPDRS-III-OFF, UPDRS-III-ON, and ΔUPDRS-III (UPDRS-III-OFF - UPDRS-III-ON) between visits. Levodopa equivalent daily dose (LEDD) was included as covariate. RESULTS Sixty-three patients (63.94 ± 8.42 years old; 68.3% males) were included. Mean disease duration was 7.81 ± 3.64 years. From baseline to 4-year follow-up visit, a significant increase in both the UPDRS-III-OFF (from 27.98 ± 9.58 to 31.75 ± 12.39; p = 0.003) and the UPDRS-III-ON (from 15.92 ± 7.93 to 18.84 ± 8.17; p = 0.006) was observed despite the significant increase in the LEDD (from 896.35 ± 355.65 to 1085.51 ± 488.29; p = 0.003). However, no significant differences were detected between visits in the ΔUPDRS-III. CONCLUSION In this cohort of PwPD with motor fluctuations, the response to levodopa did not weaken after a 4-year follow-up.
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Affiliation(s)
| | | | | | | | - Iago García Díaz
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Jose Manuel Paz
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Silvia Jesús
- Unidad de Trastornos Del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain; Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | - Maria A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de ĹHospitalet, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gómez Mayordomo
- Neurology Department, Institute of Neuroscience, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
| | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de La Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Zebenzui Mendoza
- Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | - Pablo Mir
- Unidad de Trastornos Del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
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Araújo-Silva F, Santinelli FB, Felipe I Imaizumi L, Silveira APB, Vieira LHP, Alcock L, Barbieri FA. Temporal dynamics of cortical activity and postural control in response to the first levodopa dose of the day in people with Parkinson's disease. Brain Res 2021; 1775:147727. [PMID: 34788638 DOI: 10.1016/j.brainres.2021.147727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Our understanding of how balance control responds to levodopa over the course of a single day in people with Parkinson's disease (PD) is limited with the majority of studies focused on isolated comparisons of ON vs. OFF levodopa medication. OBJECTIVE To evaluate the temporal dynamics of postural control following the first levodopa dose of the day during a challenging standing task in a group of people with PD. METHODS Changes in postural control were evaluated by monitoring cortical activity (covering frontal, motor, parietal and occipital areas), body sway parameters (force platform), and lower limb muscle activity (tibialis anterior and gastrocnemius medialis) in 15 individuals with PD during a semi-tandem standing task. Participants were assessed during two 60 second trials every 30 minutes (ON-30 ON-60 etc.) for 3 hours after the first matinal dose (ON-180). RESULTS Compared to when tested OFF-medication, cortical activity was increased across all four regions from ON-60 to ON-120 with early increases in alpha and beta band activity observed at ON-30. Levodopa was associated with increased gastrocnemius medialis activity (ON-30 to ON-120) and ankle co-contraction (ON-60 to ON-120). Changes in body sway outcomes (particularly in the anterior-posterior direction) were evident from ON-60 to ON-120. CONCLUSIONS Our results reveal a 60-minute window within which postural control outcomes may be obtained that are different compared to OFF-state and remain stable (from 60-minutes to 120-minutes after levodopa intake). Identifying a window of opportunity for measurement when individuals are optimally medicated is important for observations in a clinical and research setting.
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Affiliation(s)
- Fabiana Araújo-Silva
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Felipe B Santinelli
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Luis Felipe I Imaizumi
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Aline P B Silveira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Luiz H P Vieira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Fabio A Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil.
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Chung SJ, Yoo HS, Lee HS, Lee YH, Baik K, Jung JH, Ye BS, Sohn YH, Lee PH. Baseline cognitive profile is closely associated with long-term motor prognosis in newly diagnosed Parkinson's disease. J Neurol 2021; 268:4203-4212. [PMID: 33942161 DOI: 10.1007/s00415-021-10529-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the association between cognitive function at baseline and the progression of motor disability in Parkinson's disease (PD). METHODS We consecutively enrolled 257 drug-naïve patients with early-stage PD (follow-up > 2 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to yield four cognitive function factors and composite scores thereof: Factor 1 (visual memory/visuospatial), Factor 2 (verbal memory), Factor 3 (frontal/executive), and Factor 4 (attention/working memory/language). The global cognitive composite score of each patient was calculated based on these factors. Subsequently, we assessed the effect of baseline cognitive function on long-term motor outcomes, namely levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and rate of longitudinal increases in levodopa-equivalent dose (LED). RESULTS Cox regression analysis demonstrated that higher Factor 3 (frontal/executive) composite scores (i.e., better cognitive performance) were associated with early development of LID [hazard ratio (HR), 1.507; p = 0.003], whereas higher Factor 1 (visual memory/visuospatial) composite scores (i.e., better cognitive performance) were associated with a lower risk for FOG (HR 0.683; p = 0.017). We noted that higher global cognitive composite scores were associated with a lower risk for developing FOG (HR 0.455; p = 0.045). The linear mixed model demonstrated that higher global cognitive composite scores and better cognitive performance in visual memory/visuospatial function were associated with slower longitudinal increases in LED. CONCLUSIONS These findings suggest that baseline cognitive profiles have prognostic implications on several motor aspects in patients with PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Fernandes EJ, Poetini MR, Barrientos MS, Bortolotto VC, Araujo SM, Santos Musachio EA, De Carvalho AS, Leimann FV, Gonçalves OH, Ramborger BP, Roehrs R, Prigol M, Guerra GP. Exposure to lutein-loaded nanoparticles attenuates Parkinson's model-induced damage in Drosophila melanogaster: Restoration of dopaminergic and cholinergic system and oxidative stress indicators. Chem Biol Interact 2021; 340:109431. [PMID: 33716020 DOI: 10.1016/j.cbi.2021.109431] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/27/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
Parkinson's is a neurodegenerative disease, characterized by the loss of dopaminergic neurons, cholinergic alterations and oxidative damages. Lutein is widely known by its antioxidants properties. In the present study, we investigated whether lutein-loaded nanoparticles protects against locomotor damage and neurotoxicity induced by Parkinson's disease model in Drosophila melanogaster, as well as possible mechanisms of action. First, the nanoparticles were characterized by physicochemical methods, demonstrating that water affinity was improved by the encapsulation of lutein into the polymeric encapsulant matrix. The fruit flies of 1-4 days old were divided into four groups and exposed to a standard diet (control), a diet containing either rotenone (500 μM), lutein-loaded nanoparticles (6 μM) or rotenone (500 μM) and lutein-loaded nanoparticles (6 μM) for 7 days. The survival percentage was assessed, the flies were submitted to negative geotaxis, open field tasks and the determination of dopamine levels, tyrosine hydroxylase (TH) and acetylcholinesterase activities and oxidative stress indicators (superoxide dismutase, catalase, thiobarbituric acid reactive substances and glutathione S-transferase) were carried out. The exposure to lutein-loaded nanoparticles protected against locomotor damage and the decrease survival rate induced by rotenone, besides, it restored the dopamine levels, TH and acetylcholinesterase activities and oxidative stress indicators. These results provide evidence that lutein-loaded nanoparticles are an alternative treatment for rotenone-induced damage, and suggest the involvement of dopaminergic and cholinergic system and oxidative stress.
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Affiliation(s)
- Eliana Jardim Fernandes
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Marcia Rósula Poetini
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Magna Sotelo Barrientos
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil
| | - Vandreza Cardoso Bortolotto
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Stífani Machado Araujo
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Elize Aparecida Santos Musachio
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Amarilis Santos De Carvalho
- Programa de Pós-Graduação em Tecnologia de Alimentos, Universidade Tecnológica Federal do Paraná - Campus Campo Mourão, 87301-006, Campo Mourão, PR, Brazil
| | - Fernanda Vitória Leimann
- Programa de Pós-Graduação em Tecnologia de Alimentos, Universidade Tecnológica Federal do Paraná - Campus Campo Mourão, 87301-006, Campo Mourão, PR, Brazil
| | - Odinei Hess Gonçalves
- Programa de Pós-Graduação em Tecnologia de Alimentos, Universidade Tecnológica Federal do Paraná - Campus Campo Mourão, 87301-006, Campo Mourão, PR, Brazil
| | - Bruna Piaia Ramborger
- Grupo Interdisciplinar de Pesquisa em Prática de Ensino (GIPPE), Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Rafael Roehrs
- Grupo Interdisciplinar de Pesquisa em Prática de Ensino (GIPPE), Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Marina Prigol
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Gustavo Petri Guerra
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil.
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Gut microbiota-derived metabolite trimethylamine N-oxide as a biomarker in early Parkinson's disease. Nutrition 2020; 83:111090. [PMID: 33418492 DOI: 10.1016/j.nut.2020.111090] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to investigate the potential of using changes in the plasma levels of trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, as a biomarker in early Parkinson's disease (PD). METHODS Plasma TMAO levels were measured in 85 patients with drug-naïve early stage PD and 20 healthy controls. A linear mixed model was used to assess longitudinal changes in levodopa-equivalent dose (LED) during follow-up (>2 y) in three tertile PD groups according to plasma TMAO levels. Additionally, a Cox regression analysis was performed to assess the effect of plasma TMAO levels on dementia conversion. RESULTS Plasma TMAO levels of patients with PD were lower than those of healthy controls. A linear mixed model demonstrated that patients with PD and lower levels of TMAO (<4.75 μmol/L; i.e., lowest tertile group) exhibited faster increases in LED over time. The Cox regression model did not reveal that plasma TMAO level was associated with the risk for dementia conversion (P = 0.488). However, when we divided patients with PD into two subgroups according to bet cutoff TMAO level to maximize the log-rank statistics, the PD group with a low plasma TMAO level (<6.92 μmol/L) had a higher risk (with borderline statistical significance) for PD-dementia conversion than the group with a high TMAO level (hazard ratio: 7.565; 95% confidence interval, 1.004-57.019; P = 0.050). CONCLUSIONS The results demonstrate that lower baseline plasma TMAO levels are associated with faster increases in LED and tend to increase the risk for PD-dementia conversion, suggesting the prognostic implications of TMAO in early stage PD.
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Chen L, Cai G, Weng H, Yu J, Yang Y, Huang X, Chen X, Ye Q. More Sensitive Identification for Bradykinesia Compared to Tremors in Parkinson's Disease Based on Parkinson's KinetiGraph (PKG). Front Aging Neurosci 2020; 12:594701. [PMID: 33240078 PMCID: PMC7670912 DOI: 10.3389/fnagi.2020.594701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022] Open
Abstract
The effective management and therapies for Parkinson's disease (PD) require appropriate clinical evaluation. The Parkinson's KinetiGraph (PKG) is a wearable sensor system that can monitor the motion characteristics of PD objectively and continuously. This study was aimed to assess the correlations between PKG data and clinical scores of bradykinesia, rigidity, tremor, and fluctuation. It also aims to explore the application value of identifying early motor symptoms. An observational study of 100 PD patients wearing the PKG for ≥ 6 days was performed. It provides a series of data, such as the bradykinesia score (BKS), percent time tremor (PTT), dyskinesia score (DKS), and fluctuation and dyskinesia score (FDS). PKG data and UPDRS scores were analyzed, including UPDRS III total scores, UPDRS III-bradykinesia scores (UPDRS III-B: items 23-26, 31), UPDRS III-rigidity scores (UPDRS III-R: item 22), and scores from the Wearing-off Questionnaire (WOQ-9). This study shows that there was significant correlation between BKS and UPDRS III scores, including UPDRS III total scores, UPDRS III-B, and UPDRS III-R scores (r = 0.479-0.588, p ≤ 0.001), especially in the early-stage group (r = 0.682, p < 0.001). Furthermore, we found that BKS in patients with left-sided onset (33.57 ± 5.14, n = 37) is more serious than in patients with right-sided onset (29.87 ± 6.86, n = 26). Our findings support the feasibility of using the PKG to detect abnormal movements, especially bradykinesia in PD. It is suitable for the early detection, remote monitoring, and timely treatment of PD symptoms.
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Affiliation(s)
- Lina Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guoen Cai
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huidan Weng
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiao Yu
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu Yang
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuanyu Huang
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaochun Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
- Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Qinyong Ye
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
- Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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9
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The Effect of Virtual Reality on the Ability to Perform Activities of Daily Living, Balance During Gait, and Motor Function in Parkinson Disease Patients: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2020; 99:917-924. [PMID: 32304383 DOI: 10.1097/phm.0000000000001447] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease. METHODS We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality. RESULTS Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = -1.66, 95% CI = -2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals' ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007). CONCLUSIONS The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.
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10
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Ng JH, See AAQ, Xu Z, King NKK. Longitudinal medication profile and cost savings in Parkinson's disease patients after bilateral subthalamic nucleus deep brain stimulation. J Neurol 2020; 267:2443-2454. [PMID: 32367298 DOI: 10.1007/s00415-020-09741-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Deep brain stimulation of the subthalamic nucleus (STN DBS) has been shown to reduce antiparkinsonian medication in Parkinson's disease. We aimed to investigate the changes in long-term medication profile with STN DBS. METHODS Antiparkinsonian medication data for 56 patients were collected from as early as 3 years before STN DBS up to 10 years after. Cost spending on medication changes was analyzed. Mean levodopa equivalent daily dose (LEDD) was projected 10 years into the future based on preoperative data to create a comparator group wherein the patients did not undergo STN DBS. Use of neuroleptics and antidepressants was also recorded. RESULTS LEDD requirement was significantly reduced by a mean of 31 ± 2% over 10 years after DBS, from 1049 ± 381 mg at pre-DBS baseline, to 713 ± 392 mg at 1 year post-DBS, and 712 ± 385 mg at 10 years post-DBS. This was associated with a mean reduction of 35 ± 3% in medicine cost. Modeled LEDD requirements for not having STN DBS were in the range of 1489 mg to 2721 mg at 10 years post-DBS (109-282% higher than the observed mean LEDD in DBS cohort). The proportion of patients increased from 5% before STN DBS to 14% at 10 year post-DBS for neuroleptics, and 11-23% for antidepressants. CONCLUSION STN DBS led to LEDD reduction and antiparkinsonian medication cost savings in our South-East Asian cohort. Medication reduction with STN DBS in our cohort over the 10-year period was comparable to those reported in Western populations.
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Affiliation(s)
- Jing Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nicolas Kon Kam King
- Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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11
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Thomas GEC, Leyland LA, Schrag AE, Lees AJ, Acosta-Cabronero J, Weil RS. Brain iron deposition is linked with cognitive severity in Parkinson's disease. J Neurol Neurosurg Psychiatry 2020; 91:418-425. [PMID: 32079673 PMCID: PMC7147185 DOI: 10.1136/jnnp-2019-322042] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dementia is common in Parkinson's disease (PD) but measures that track cognitive change in PD are lacking. Brain tissue iron accumulates with age and co-localises with pathological proteins linked to PD dementia such as amyloid. We used quantitative susceptibility mapping (QSM) to detect changes related to cognitive change in PD. METHODS We assessed 100 patients with early-stage to mid-stage PD, and 37 age-matched controls using the Montreal Cognitive Assessment (MoCA), a validated clinical algorithm for risk of cognitive decline in PD, measures of visuoperceptual function and the Movement Disorders Society Unified Parkinson's Disease Rating Scale part 3 (UPDRS-III). We investigated the association between these measures and QSM, an MRI technique sensitive to brain tissue iron content. RESULTS We found QSM increases (consistent with higher brain tissue iron content) in PD compared with controls in prefrontal cortex and putamen (p<0.05 corrected for multiple comparisons). Whole brain regression analyses within the PD group identified QSM increases covarying: (1) with lower MoCA scores in the hippocampus and thalamus, (2) with poorer visual function and with higher dementia risk scores in parietal, frontal and medial occipital cortices, (3) with higher UPDRS-III scores in the putamen (all p<0.05 corrected for multiple comparisons). In contrast, atrophy, measured using voxel-based morphometry, showed no differences between groups, or in association with clinical measures. CONCLUSIONS Brain tissue iron, measured using QSM, can track cognitive involvement in PD. This may be useful to detect signs of early cognitive change to stratify groups for clinical trials and monitor disease progression.
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Affiliation(s)
| | | | - Anette-Eleonore Schrag
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
- Movement Disorders Consortium, University College London, London, UK
| | - Andrew John Lees
- Reta Lila Institute for Brain Studies, University College London, London, UK
| | | | - Rimona Sharon Weil
- Dementia Research Centre, UCL Institute of Neurology, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
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12
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Chung SJ, Yoo HS, Lee YH, Lee HS, Lee PH, Sohn YH. Initial motor reserve and long-term prognosis in Parkinson's disease. Neurobiol Aging 2020; 92:1-6. [PMID: 32320836 DOI: 10.1016/j.neurobiolaging.2020.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/03/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022]
Abstract
There are individual differences in motor deficits, despite a similar degree of dopamine neuronal loss in Parkinson's disease (PD), called motor reserve (MR). Factors enhancing MR have been documented previously, but the influence of initial MR on the long-term prognosis remains unclear. In this longitudinal study, we enrolled 205 patients with de novo PD to estimate individual MR based on initial motor deficits and striatal dopamine depletion using the residual-based approach. We assessed the risk of developing levodopa-induced dyskinesia (LID) or freezing of gait (FOG) and longitudinal increases in levodopa-equivalent dose (LED) according to MR estimates using the Cox regression model and linear mixed model, respectively. Throughout the follow-up period (≥3 years), greater MR estimates were associated with a lower risk for LID and FOG. In addition, patients with high MR received lower LED than those with low MR. These findings suggest that the initial MR, that is, individual's capacity to cope with PD-related pathologies, can be maintained with disease progression and can modulate the risk for LID or FOG.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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13
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Chung SJ, Yoo HS, Lee YH, Lee PH, Sohn YH. Heterogeneous Patterns of Striatal Dopamine Loss in Patients with Young- versus Old-Onset Parkinson's Disease: Impact on Clinical Features. J Mov Disord 2019; 12:113-119. [PMID: 31158944 PMCID: PMC6547040 DOI: 10.14802/jmd.18064] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/22/2019] [Indexed: 01/15/2023] Open
Abstract
Objective Ample evidence has suggested that age at onset of Parkinson’s disease (PD) is associated with heterogeneous clinical features in individuals. We hypothesized that this may be attributed to different patterns of nigrostriatal dopamine loss. Methods A total of 205 consecutive patients with de novo PD who underwent 18F-FP-CIT PET scans (mean follow-up duration, 6.31 years) were divided into three tertile groups according to their age at onset of parkinsonian motor symptoms. Striatal dopamine transporter (DAT) availability was compared between the old- (n = 73) and young-onset (n = 66) groups. In addition, the risk of developing freezing of gait (FOG) and longitudinal requirements for dopaminergic medications were examined. Results The old-onset PD group (mean age at onset, 72.66 years) exhibited more severe parkinsonian motor signs than the young-onset group (52.58 years), despite comparable DAT availability in the posterior putamen; moreover, the old-onset group exhibited more severely decreased DAT availability in the caudate than the young-onset group. A Cox regression model revealed that the old-onset PD group had a higher risk for developing FOG than the young-onset group [hazard ratio 2.523, 95% confidence interval (1.239–5.140)]. The old-onset group required higher doses of dopaminergic medications for symptom control than the young-onset group over time. Conclusion The present study demonstrated that the old-onset PD group exhibited more severe dopamine loss in the caudate and were more likely to develop gait freezing, suggesting that age at onset may be one of the major determinants of the pattern of striatal dopamine depletion and progression of gait disturbance in PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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14
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Evaluation of a sensor algorithm for motor state rating in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:112-117. [PMID: 30935826 DOI: 10.1016/j.parkreldis.2019.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A treatment response objective index (TRIS) was previously developed based on sensor data from pronation-supination tests. This study aimed to examine the performance of TRIS for medication effects in a new population sample with Parkinson's disease (PD) and its usefulness for constructing individual dose-response models. METHODS Twenty-five patients with PD performed a series of tasks throughout a levodopa challenge while wearing sensors. TRIS was used to determine motor changes in pronation-supination tests following a single levodopa dose, and was compared to clinical ratings including the Treatment Response Scale (TRS) and six sub-items of the UPDRS part III. RESULTS As expected, correlations between TRIS and clinical ratings were lower in the new population than in the initial study. TRIS was still significantly correlated to TRS (rs = 0.23, P < 0.001) with a root mean square error (RMSE) of 1.33. For the patients (n = 17) with a good levodopa response and clear motor fluctuations, a stronger correlation was found (rs = 0.38, RMSE = 1.29, P < 0.001). The mean TRIS increased significantly when patients went from the practically defined off to their best on state (P = 0.024). Individual dose-response models could be fitted for more participants when TRIS was used for modelling than when TRS ratings were used. CONCLUSION The objective sensor index shows promise for constructing individual dose-response models, but further evaluations and retraining of the TRIS algorithm are desirable to improve its performance and to ensure its clinical effectiveness.
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15
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Lang M, Pfister FMJ, Frohner J, Abedinpour K, Pichler D, Fietzek U, Um TT, Kulic D, Endo S, Hirche S. A Multi-Layer Gaussian Process for Motor Symptom Estimation in People With Parkinson's Disease. IEEE Trans Biomed Eng 2019; 66:3038-3049. [PMID: 30794163 DOI: 10.1109/tbme.2019.2900002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The assessment of Parkinson's disease (PD) poses a significant challenge, as it is influenced by various factors that lead to a complex and fluctuating symptom manifestation. Thus, a frequent and objective PD assessment is highly valuable for effective health management of people with Parkinson's disease (PwP). Here, we propose a method for monitoring PwP by stochastically modeling the relationships between wrist movements during unscripted daily activities and corresponding annotations about clinical displays of movement abnormalities. We approach the estimation of PD motor signs by independently modeling and hierarchically stacking Gaussian process models for three classes of commonly observed movement abnormalities in PwP including tremor, (non-tremulous) bradykinesia, and (non-tremulous) dyskinesia. We use clinically adopted severity measures as annotations for training the models, thus allowing our multi-layer Gaussian process prediction models to estimate not only their presence but also their severities. The experimental validation of our approach demonstrates strong agreement of the model predictions with these PD annotations. Our results show that the proposed method produces promising results in objective monitoring of movement abnormalities of PD in the presence of arbitrary and unknown voluntary motions, and makes an important step toward continuous monitoring of PD in the home environment.
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16
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The Pattern of Striatal Dopamine Depletion as a Prognostic Marker in De Novo Parkinson Disease. Clin Nucl Med 2018; 43:787-792. [DOI: 10.1097/rlu.0000000000002251] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Nagao K, Ding C, Ganga G, Alty JE, Clissold BG, McColl CD, Reardon KA, Schiff M, Kempster PA. Inferring the long duration response to levodopa in Parkinson's disease. Parkinsonism Relat Disord 2018; 60:133-137. [PMID: 30217541 DOI: 10.1016/j.parkreldis.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/22/2018] [Accepted: 09/02/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The long duration response to levodopa in Parkinson's disease outlasts drug elimination by days to weeks. Though a substantive part of anti-parkinsonian motor benefit, it cannot easily be observed. OBJECTIVES To infer the magnitude of the long duration response during the first decade of Parkinson's disease and identify factors that influence it. METHODS Serial practically defined off scores of 24 patients from a longitudinal study of levodopa short duration response were used to establish their rate of motor progression. A line of notional untreated disability (as if drug treatment had never been given) with the same progression gradient was the basis for calculation of the long duration response. Predictors of mean long duration response amplitude were identified using a multiple linear regression model. RESULTS Over a mean treatment period of 16.6 ± 4.4 years, annual increase in motor disability was 2.3% of the maximum score. The long duration response composed 49% of total levodopa response during the first decade of treatment, and this proportion was significantly higher soon after commencing levodopa (p = 0.001). Higher pre-treatment motor score (r = 0.60) and lower MMSE (r = 0.60) were the main predictors of a larger long duration response. There was little correlation between long and short duration responses. CONCLUSIONS Long duration responses contribute almost half of the total levodopa benefit during the first decade of treatment. An appreciation of both long and short duration components of drug symptomatic effects is important in clinical trial design to investigate possible neuroprotective treatments.
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Affiliation(s)
- Kanae Nagao
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Catherine Ding
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Ganesvaran Ganga
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Jane E Alty
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Benjamin G Clissold
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Craig D McColl
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Katrina A Reardon
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Mark Schiff
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Peter A Kempster
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia
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18
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Modreanu R, Cerquera SC, Martí MJ, Ríos J, Sánchez-Gómez A, Cámara A, Fernández M, Compta Y. Cross-sectional and longitudinal associations of motor fluctuations and non-motor predominance with cerebrospinal τ and Aβ as well as dementia-risk in Parkinson's disease. J Neurol Sci 2016; 373:223-229. [PMID: 28131192 DOI: 10.1016/j.jns.2016.12.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/19/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
Experimental, neuropathological and cerebrospinal fluid (CSF) studies support τ and amyloid-β (Aβ) relevance in Parkinson's disease (PD) related dementia. Lesser motor fluctuations (MFs) and non-motor features have also been related to PD-dementia. Yet, little is known about the association of MFs and non-motor symptoms with CSF τ and Aβ in PD. We hypothesized that lesser MFs and non-motor predominance are related to these CSF markers and dementia-risk in PD. We studied 58 PD patients (dementia at baseline, n=21; dementia at 18-months, n=35) in whom CSF Aβ and τ had been determined with ELISA techniques. MFs and a number of non-motor symptoms (apathy, anxiety, irritability, depression, visual hallucinations, spatial disorientation, memory complaints) over disease course were dichotomized as absent-mild vs. moderate-severe by retrospective clinical chart review blind to CSF findings. Non-motor predominance was defined as ≥3 non-motor symptoms (after the cohort-median of non-motor symptoms per patient) with ≥2 being moderate-severe and ≥1 having been present from onset, with all these being more disabling overall than motor features. Cross-sectionally, CSF biomarkers were non-parametrically compared according to dichotomized MFs and non-motor predominance. Longitudinally, dementia was the outcome (dependent variable), CSF markers, MFs and non-motor predominance were the predictors (independent variables), and potential modifiers as age, sex, and memory complaints were the covariates in binary regression models. Absent-mild MFs were associated with higher CSF τ markers and shorter time-to-dementia, while non-motor predominance and decreasing CSF Aβ independently increased longitudinal dementia-risk. In summary, absent-mild MFs, non-motor predominance and CSF τ and Aβ might define endophenotypes related to the timing or risk of dementia in PD.
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Affiliation(s)
- Raluca Modreanu
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain; Parkinson's Disease and Movement Disorders Unit, Neurology Service, Segeberger Kliniken, Bad Segeberg, Germany
| | - Sonia Catalina Cerquera
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain; Neurology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - María José Martí
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain
| | - José Ríos
- Statistics and Methodologic Support Unit, Unitat d'Avaluació, Suport i Prevenció (UASP), Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Almudena Sánchez-Gómez
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain
| | - Ana Cámara
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain
| | - Manel Fernández
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Catalonia, Spain.
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Yoshii F, Moriya Y, Ohnuki T, Takahashi W, Ryo M. Early Motor Fluctuations in a Patient with Striatonigral Degeneration. Case Rep Neurol 2016; 8:243-250. [PMID: 28101035 PMCID: PMC5216213 DOI: 10.1159/000453254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/05/2016] [Indexed: 11/19/2022] Open
Abstract
We report a 44-year-old female with striatonigral degeneration (SND) who showed wearing-off oscillations after 4 months of levodopa treatment. The patient presented with asymmetric left-side dominant rigidity, and levodopa was effective at first. However, she began to show wearing-off oscillations of motor symptoms, which gradually worsened thereafter. Fluid-attenuated inversion recovery sequence magnetic resonance imaging (MRI) showed linear lateral putamen hyperintensities, and positron emission tomography (PET) studies using 18F-fluorodopa (FD) and 11C-N-methylspiperon (NMSP) showed a marked decrease of radioactivity in the right putamen, especially in the posterior putamen. The results of MRI and 2 PET studies with FD and NMSP were well consistent with the diagnosis of SND.
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Affiliation(s)
- Fumihito Yoshii
- *Fumihito Yoshii, MD, Department of Neurology, Tokai University Oiso Hospital, 21-1 Gakkyou, Oiso, Naka-gun, Kanagawa 259-0198 (Japan), E-Mail
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Ling H, Kearney S, Yip HLK, Silveira-Moriyama L, Revesz T, Holton JL, Strand C, Davey K, Mok KY, Polke JM, Lees AJ. Parkinson's disease without nigral degeneration: a pathological correlate of scans without evidence of dopaminergic deficit (SWEDD)? J Neurol Neurosurg Psychiatry 2016. [PMID: 26209716 DOI: 10.1136/jnnp-2015-310756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe 5 cases of Parkinson's disease lacking any detectable histopathology. BACKGROUND The diagnosis of Parkinson's disease is supported histologically by the findings of α-synuclein immunopositive Lewy bodies and neurites and severe substantia nigra cell loss. Bradykinesia as defined by slowness of initiation of movement and a progressive reduction in speed and amplitude on finger tapping is a clinical correlate of pars compacta nigral degeneration. There are very few published cases of Parkinson's disease in which no pathological abnormality was found, and some of these cases were in hindsight thought to have probably been cases of indeterminate senile tremor or dystonic tremor. METHODS Retrospective case notes review of the Queen Square Brain Bank archival collection and detailed neuropathological analysis of the selected cases. RESULTS 5 cases considered to have Parkinson's disease by neurologists throughout the entirety of their illness that lacked any histopathological findings known to be associated with Parkinson's syndromes were identified out of a total number of 773 brains with a final clinical diagnosis of Parkinson's disease in the Queen Square Brain Bank. Retrospective case note analysis did not suggest dystonic tremor or indeterminate tremor in any of them. There was a reduction in tyrosine hydroxylase (TH) density in the striatum in these cases when compared with healthy controls, but not in the substantia nigra. CONCLUSIONS Striatal dopamine deficiency without nigral cell loss is the most likely explanation for the clinical findings; other possible explanations include slowness due to comorbidities misinterpreted as bradykinesia, a tardive syndrome related to undisclosed previous neuroleptic exposure, or 'soft age-related' parkinsonian signs. These cases emphasise the need to regularly review the diagnosis in cases of suspected Parkinson's disease and highlight the need for precision in the neurological examination particularly of elderly patients. These cases may represent a distinct entity of diagnostic exclusion and may be considered one explanation for the radiological phenomenon of SWEDD (scans without evidence of dopaminergic deficit).
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Affiliation(s)
- Helen Ling
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Seamus Kearney
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Belfast Health and Social Care Trust, Belfast, Ireland
| | - Helen Lai Kuen Yip
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital TWGHs, Hong Kong, Hong Kong Neuro-medical Unit, Department of Medicine and Geriatrics, Kwong Wah Hospital TWGHs, Hong Kong, Hong Kong
| | - Laura Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Postgraduate Program in Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Tamas Revesz
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Janice L Holton
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Catherine Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Karen Davey
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Kin Ying Mok
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, Hong Kong
| | - James M Polke
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
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Tomas D, Stanic D, Chua HK, White K, Boon WC, Horne M. Restoration of the Dopamine Transporter through Cell Therapy Improves Dyskinesia in a Rat Model of Parkinson's Disease. PLoS One 2016; 11:e0153424. [PMID: 27077649 PMCID: PMC4831749 DOI: 10.1371/journal.pone.0153424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
The dyskinesia of Parkinson's Disease is most likely due to excess levels of dopamine in the striatum. The mechanism may be due to aberrant synthesis but also, a deficiency or absence of the Dopamine Transporter. In this study we have examined the proposition that reinstating Dopamine Transporter expression in the striatum would reduce dyskinesia. We transplanted c17.2 cells that stably expressed the Dopamine Transporter into dyskinetic rats. There was a reduction in dyskinesia in rats that received grafts expressing the Dopamine Transporter. Strategies designed to increase Dopamine Transporter in the striatum may be useful in treating the dyskinesia associated with human Parkinson's Disease.
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Affiliation(s)
- D. Tomas
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia, 3010
| | - D. Stanic
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia, 3010
| | - H. K. Chua
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia, 3010
| | - K. White
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia, 3010
| | - W. C. Boon
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia, 3010
| | - M. Horne
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia, 3010
- Department of Medicine, University of Melbourne, St Vincent’s Hospital, Fitzroy, Victoria, Australia, 3065
- * E-mail:
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22
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Ding C, Ganesvaran G, Alty JE, Clissold BG, McColl CD, Reardon KA, Schiff M, Srikanth V, Kempster PA. Study of levodopa response in Parkinson's disease: Observations on rates of motor progression. Mov Disord 2016; 31:589-92. [DOI: 10.1002/mds.26497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Catherine Ding
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Ganga Ganesvaran
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Jane E. Alty
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | | | - Craig D. McColl
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Katrina A. Reardon
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Mark Schiff
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Velandai Srikanth
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
- Stroke and Ageing Research Group, Vascular Brain Aging Division, Department of Medicine, School of Clinical Sciences; Monash University; Melbourne Victoria Australia
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - Peter A. Kempster
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
- Department of Medicine; Monash University; Clayton Victoria Australia
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Abstract
Introduction Establishing the presence and severity of fluctuations is important in managing Parkinson’s Disease yet there is no reliable, objective means of doing this. In this study we have evaluated a Fluctuation Score derived from variations in dyskinesia and bradykinesia scores produced by an accelerometry based system. Methods The Fluctuation Score was produced by summing the interquartile range of bradykinesia scores and dyskinesia scores produced every 2 minutes between 0900-1800 for at least 6 days by the accelerometry based system and expressing it as an algorithm. Results This Score could distinguish between fluctuating and non-fluctuating patients with high sensitivity and selectivity and was significant lower following activation of deep brain stimulators. The scores following deep brain stimulation lay in a band just above the score separating fluctuators from non-fluctuators, suggesting a range representing adequate motor control. When compared with control subjects the score of newly diagnosed patients show a loss of fluctuation with onset of PD. The score was calculated in subjects whose duration of disease was known and this showed that newly diagnosed patients soon develop higher scores which either fall under or within the range representing adequate motor control or instead go on to develop more severe fluctuations. Conclusion The Fluctuation Score described here promises to be a useful tool for identifying patients whose fluctuations are progressing and may require therapeutic changes. It also shows promise as a useful research tool. Further studies are required to more accurately identify therapeutic targets and ranges.
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Evans AH, Kettlewell J, McGregor S, Kotschet K, Griffiths RI, Horne M. A conditioned response as a measure of impulsive-compulsive behaviours in Parkinson's disease. PLoS One 2014; 9:e89319. [PMID: 24586685 PMCID: PMC3933354 DOI: 10.1371/journal.pone.0089319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/17/2014] [Indexed: 01/01/2023] Open
Abstract
Objectives Parkinson's Disease patients wore a device on the wrist that gave reminders to take levodopa and also measured bradykinesia and dyskinesia. Consumption of medications was acknowledged by placing the thumb on the device. Some patients performed this acknowledgement repeatedly and unconsciously. This study examines whether this behaviour reflected increased impulsivity. Methods and Results Twenty five participants were selected because they had i) excess acknowledgements described above or ii) Impulsive-Compulsive Behaviours or iii) neither of these. A blinded assessor applied clinical scales to measure Impulsive-Compulsive Behaviours, cognition, depression, anxiety and apathy. A Response Ratio, representing the number of acknowledgements/number of doses (expressed as a percentage) was tightly correlated with ratings of Impulsive-Compulsive Behaviours (r2 = 0.79) in 19/25 subjects. Some of these patients had dyskinesia, which was higher with extraneous responses than with response indicating medication consumption. Six of the 25 subjects had high Impulsive-Compulsive Behaviour Scores, higher apathy scores, low levels of dyskinesia and normal Response Ratios. Patients without ICB (low RR) also had low dyskinesia levels regardless of the relevance of the response. Conclusion An elevated Response Ratio is a specific measure of a type of ICB where increased incentive salience is attributed to cues by the presence of high striatal dopamine levels, manifested by high levels of dyskinesia. This study also points to a second form of ICBs which occur in the absence of dyskinesia, has normal Response Ratios and higher apathy scores, and may represent prefrontal pathology.
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Affiliation(s)
| | - Jade Kettlewell
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
| | | | - Katya Kotschet
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Robert I. Griffiths
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
| | - Malcolm Horne
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital, Fitzroy, Victoria, Australia
- Department of Medicine, St Vincent's Hospital, Fitzroy, Victoria, Australia
- * E-mail:
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Ganga G, Alty JE, Clissold BG, McColl CD, Reardon KA, Schiff M, Kempster PA. Longitudinal study of levodopa in Parkinson's disease: effects of the advanced disease phase. Mov Disord 2013; 28:476-81. [PMID: 23390112 DOI: 10.1002/mds.25335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 10/22/2012] [Accepted: 11/28/2012] [Indexed: 11/08/2022] Open
Abstract
Thirty-four patients have been studied from the time of initiation of pharmacological treatment in a long-term prospective study of levodopa effects and disease progression in Parkinson's disease. Objective motor scoring of the response to levodopa in defined off states was performed every 3 years. The mean time from the initiation of levodopa treatment to the most recent measurements was 18.2 years. Of 8 patients who are still alive, only 3 had none of the features of the advanced disease phase (dementia, hallucinations, frequent falling). Off-phase motor function worsened at a yearly rate of 1.9% of the maximum disability score, although the plots of the serial scores showed that the magnitude of the levodopa response is well preserved. There was little difference in the rate of progression between patients with tremor-dominant and non-tremor-dominant motor subtypes. Those who developed dementia had more rapid deterioration of motor scores, with significantly worse off-phase (P = .008) and on-phase (P = .03) motor function. A graph of serial scores of patients who have died, aligned for time of death, showed an upward curving trend of motor disability in the last 5 years of the disease course. Its advanced phase may reveal that Parkinson's disease has an exponential pattern of progression.
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Affiliation(s)
- Ganesvaran Ganga
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
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26
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Moore ST, Dilda V, Hakim B, Macdougall HG. Validation of 24-hour ambulatory gait assessment in Parkinson's disease with simultaneous video observation. Biomed Eng Online 2011; 10:82. [PMID: 21936884 PMCID: PMC3184280 DOI: 10.1186/1475-925x-10-82] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/21/2011] [Indexed: 11/30/2022] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disorder resulting in motor disturbances that can impact normal gait. Although PD initially responds well to pharmacological treatment, as the disease progresses efficacy often fluctuates over the course of the day, and clinical management would benefit from long-term objective measures of gait. We have previously described a small device worn on the shank that uses acceleration and angular velocity sensors to calculate stride length and identify freezing of gait in PD patients. In this study we extend validation of the gait monitor to 24-h using simultaneous video observation of PD patients. Methods A sleep laboratory was adapted to perform 24-hr video monitoring of patients while wearing the device. Continuous video monitoring of a sleep lab, hallway, kitchen and conference room was performed using a 4-camera security system and recorded to hard disk. Subjects (3) wore the gait monitor on the left shank (just above the ankle) for a 24-h period beginning around 5 pm in the evening. Accuracy of stride length measures were assessed at the beginning and end of the 24-h epoch. Two independent observers rated the video logs to identify when subjects were walking or lying down. Results The mean error in stride length at the start of recording was 0.05 m (SD 0) and at the conclusion of the 24 h epoch was 0.06 m (SD 0.026). There was full agreement between observer coding of the video logs and the output from the gait monitor software; that is, for every video observation of the subject walking there was a corresponding pulse in the monitor data that indicated gait. Conclusions The accuracy of ambulatory stride length measurement was maintained over the 24-h period, and there was 100% agreement between the autonomous detection of locomotion by the gait monitor and video observation.
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Affiliation(s)
- Steven T Moore
- Human Aerospace Laboratory, Department of Neurology, Mount Sinai School of Medicine, New York NY 10029, USA.
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Single photon emission computed tomography striatal asymmetry index may predict dopaminergic responsiveness in Parkinson disease. Clin Neuropharmacol 2011; 34:71-3. [PMID: 21406999 DOI: 10.1097/wnf.0b013e318211f945] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Parkinson disease (PD) is a neurodegenerative disorder, characterized by the excellent response to l-dopa and by asymmetry of neurological signs. The aim of the present study is to investigate a possible relationship between responsiveness to l-dopa in patients with PD and asymmetry detected by single photon emission computed tomography (SPECT) with [I]FP-CIT (DaTSCAN). METHODS We performed a retrospective study in 20 patients with PD never previously exposed to l-dopa, who had undergone (1) a short-term l-dopa test with l-dopa/carbidopa 250/25 mg to quantify dopaminergic responsiveness, and (2) a SPECT with DaTSCAN to assess the degree of nigrostriatal neuronal degeneration. We estimated the magnitude and the duration of the response to l-dopa test as well as the striatal asymmetry index (SAI) detected by SPECT with DaTSCAN. RESULTS At l-dopa short-term test, most patients showed at least a mild response to the drug, and only 3 patients presented no response. Overall, the Unified Parkinson's Disease Rating Scale-Motor Examination section score at baseline was 24.9 ± 8.2, and that at peak was 21.2 ± 8 with a magnitude of the response scoring 16 ± 13.9%; the duration was 254 ± 91.2 minutes. The caudate and putamen uptakes of DaTSCAN were lower contralaterally to the most affected side. A significant positive correlation between the SAI and the magnitude of the response to l-dopa was found (r = 0.64, P = 0.002). Linear regression model provided an increase of 0.76 units of magnitude of l-dopa response every SAI unit. CONCLUSIONS Asymmetry resulted positively related to the magnitude of the response to l-dopa short-term test and may be usefully used to predict dopaminergic responsiveness in patients with PD.
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28
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Van Lieshout PHHM, Steele CM, Lang AE. Tongue control for swallowing in Parkinson's disease: effects of age, rate, and stimulus consistency. Mov Disord 2011; 26:1725-9. [PMID: 21542018 DOI: 10.1002/mds.23690] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/14/2011] [Accepted: 01/31/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with Parkinson's disease often suffer from swallowing problems, especially at more advanced stages of the disease. Efficient swallows require well-coordinated tongue movements during bolus flow, but little is known about such movements in Parkinson's disease. METHODS The current study presents data on tongue movements for patients with mild to moderate Parkinson's disease (n=10), age-matched adults (n=13), and younger healthy adults (n=15). RESULTS Participants with Parkinson's disease showed smaller and more variable movements in the horizontal movement plane, indicating that tongue movements are affected in early stages of Parkinson's disease. CONCLUSIONS The small and more variable movements in the horizontal plane of Patients with Parkinson's disease may pose challenges for swallowing liquids efficiently and safely.
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Affiliation(s)
- Pascal H H M Van Lieshout
- Department of Speech-Language Pathology, University of Toronto, and Toronto Western Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
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Levodopa effect on electromyographic activation patterns of tibialis anterior muscle during walking in Parkinson's disease. Gait Posture 2011; 33:436-41. [PMID: 21256751 DOI: 10.1016/j.gaitpost.2010.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 12/09/2010] [Accepted: 12/23/2010] [Indexed: 02/02/2023]
Abstract
Previous studies have reported that patients with Parkinson's disease (PD) show, in the "off medication" state, a reduced activation of tibialis anterior (TA) in the late swing-early stance phase of the gait cycle. In PD patients the pathophysiological picture may cause differences among the stride cycles. Our aims were to evaluate how frequently TA activity is reduced in the late swing-early stance phase and if there is a relationship between the TA pattern and the clinical picture. Thirty PD patients were studied 2 h after Levodopa administration ("on-med") and 12 h after Levodopa wash-out ("off-med"). They were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS III) and surface electromyography of TA and gastrocnemius medialis (GM). The root mean square (RMS) of the TA activity in late swing-early stance phase (RMS-A) was normalized as a percent of the RMS of the TA activity in late stance-early swing (RMS-B). RMS-A was reduced in 30% of patients in the "off-med" condition. Within these patients, the percentage of stride cycles with reduced RMS-A, ranged between 28% and 83%. After Levodopa intake, no stride cycle showed reduced RMS-A. Patients with reduced RMS-A had a lower UPDRS III total score in the "on-med" rather than in the "off-med" condition (p=0.02). Our data confirm and extend previous observations indicating that, in "off-med" the function of TA is impaired in those patients clinically more responsive to Levodopa. TA activation is reduced in a relatively high percent of gait cycles in the "off-med" state. Since the variability of TA activation disappears after Levodopa administration, this phenomenon could be the expression of an abnormal dopaminergic drive.
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30
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Alty JE, Clissold BG, McColl CD, Reardon KA, Shiff M, Kempster PA. Longitudinal study of the levodopa motor response in Parkinson's disease: relationship between cognitive decline and motor function. Mov Disord 2010; 24:2337-43. [PMID: 19890972 DOI: 10.1002/mds.22800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In this prospective study of 34 patients with Parkinson's disease (PD), measurements of the short duration levodopa motor response have been performed every 3 years in defined off states. The mean time from initiation of levodopa treatment was 14.8 years, and 17 patients survived to the latest assessment stage. Off phase motor function worsened at a yearly rate of 2.2% of the maximum disability score. The magnitude of the levodopa response is well preserved as the disease progresses, and patients who developed motor fluctuations maintained better on phase motor function than nonfluctuators (P = 0.01). Ten patients, of whom 5 survive, developed dementia. There was no difference in pretreatment disability or initial levodopa response between demented and nondemented subjects. However, dementia was associated with worse on and off motor disability scores after 11 and 14 years (P < 0.001), and a smaller levodopa response magnitude after 14 years (P = 0.008). The plot of sequential scores shows the association between cognitive decline and accelerating increase in motor disability. This suggests that the advanced phase of PD, when Lewy body pathology involves the cerebral cortex, progresses in an exponential rather than linear fashion.
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Affiliation(s)
- Jane E Alty
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
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31
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Abstract
Parkinson disease (PD) is a progressive neurologic condition that causes motor and nonmotor manifestations. Treatment provides symptomatic benefit but no current treatment has been proven to slow disease progression. Research studies of PD require a means of rating the severity of disease by measurement of motor manifestations, assessment of ability to perform daily functional activities, and symptomatic response to medication. The most common rating scales are the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr staging, and the Schwab and England rating of activities of daily living. Each of these rating scales are described, including detailed instructions on how to implement these ratings. Although these are the most widely applied rating scales of PD, there are still substantial limitations to these scales that must be considered when using them for research. Finally, some common applications of these scales are described.
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Affiliation(s)
- Joel S Perlmutter
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Di Stefano A, Sozio P, Iannitelli A, Cerasa LS. New drug delivery strategies for improved Parkinson's disease therapy. Expert Opin Drug Deliv 2009; 6:389-404. [DOI: 10.1517/17425240902870405] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dopaminergic modulation of cortico-cortical functional connectivity in Parkinson's disease: An MEG study. Exp Neurol 2008; 213:191-5. [DOI: 10.1016/j.expneurol.2008.05.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 05/25/2008] [Accepted: 05/29/2008] [Indexed: 11/17/2022]
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34
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Lee J, Zhu WM, Stanic D, Finkelstein DI, Horne MH, Henderson J, Lawrence AJ, O'Connor L, Tomas D, Drago J, Horne MK. Sprouting of dopamine terminals and altered dopamine release and uptake in Parkinsonian dyskinaesia. Brain 2008; 131:1574-87. [DOI: 10.1093/brain/awn085] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Nyholm D, Lennernäs H. Irregular gastrointestinal drug absorption in Parkinson's disease. Expert Opin Drug Metab Toxicol 2008; 4:193-203. [DOI: 10.1517/17425255.4.2.193] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Ho AK, Bradshaw JL, Iansek R. For better or worse: The effect of levodopa on speech in Parkinson's disease. Mov Disord 2008; 23:574-80. [PMID: 18163453 DOI: 10.1002/mds.21899] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aileen K Ho
- Department of Psychology, School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom.
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Moore ST, MacDougall HG, Gracies JM, Ondo WG. Locomotor response to levodopa in fluctuating Parkinson’s disease. Exp Brain Res 2007; 184:469-78. [PMID: 17828529 DOI: 10.1007/s00221-007-1113-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 08/16/2007] [Indexed: 11/29/2022]
Abstract
The aim of this study was to quantify the dynamic response of locomotion to the first oral levodopa administration of the day in patients with fluctuating Parkinson's disease (PD). Stride length, walking speed, cadence and gait variability were measured with an ambulatory gait monitor in 13 PD patients (8 males) with a clinical history of motor fluctuations. The Unified Parkinson's Disease Rating Scale (UPDRS) gait score (part 29) was also determined by a movement disorders specialist from video recordings. Subjects arrived in the morning in an 'off' state (no PD medication) and walked for a maximum length of 100 m. They then took their usual morning dose of oral levodopa and repeated the walking task at 13 min intervals (on average) over a 90 min period. Changes in stride length over time were fit with a Hill (Emax) function. Latency (time until stride length increased 15% of the difference between baseline and maximum response) and the Hill coefficient (shape of the 'off-on' transition) were determined from the fitted curve. Latency varied from 4.7 to 53.3 min post-administration [23.31 min (SD 14.9)], and was inversely correlated with age at onset of PD (R = -0.83; P = 0.0004). The Hill coefficient (H) ranged from a smooth hyperbolic curve (0.9) to an abrupt 'off-on' transition (16.9), with a mean of 8.1 (SD 4.9). H correlated with disease duration (R = 0.67; P = 0.01) and latency (R = 0.67; P = 0.01), and increased with Hoehn & Yahr stage in the 'off' state (P = 0.02) from 5.7 (SD 3.5) (H&Y III) to 11.9 (SD 4.7) (H&Y IV). Walking speed correlated with changes in mean stride length, whereas cadence and gait variability did not. UPDRS gait score also reflected improving gait in the majority of subjects (8), providing clinical confirmation of the objective measures of the locomotor response to levodopa. Increasing abruptness (H) of the 'off-on' transition with disease duration is consistent with results from finger-tapping studies, and may reflect reduced buffering capacity of pre-synaptic nigrostriatal dopaminergic neurons. Ambulatory monitoring of gait objectively measures the dynamic locomotor response to levodopa, and this information could be used to improve daily management of motor fluctuations.
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Affiliation(s)
- Steven T Moore
- Department of Neurology, Mount Sinai School of Medicine, Box 1135, 1 E 100th St., New York, NY 10029, USA.
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Tetrud JW. Balancing short-term symptom control and long-term functional outcomes in patients with Parkinson's disease. CNS Spectr 2007; 12:275-86. [PMID: 17426665 DOI: 10.1017/s1092852900021039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Levodopa has played a central role in the treatment of Parkinson's disease for nearly 40 years and remains the single most effective symptomatic treatment for the disease. However, the response to levodopa therapy changes over time, and its long-term use is commonly associated with disabling motor complications. For this reason, the appropriate role of levodopa in the treatment of Parkinson's disease-in particular, the question of when to initiate therapy with the drug-has been a matter of controversy. Because levodopa is the most effective treatment for Parkinson's disease, the management of this disease becomes a matter of balancing short-term symptom control with long-term functional outcomes. This article provides an overview of the basis for levodopa-associated motor complications and their impact on patients' clinical function and quality of life, followed by a discussion of strategies for managing these complications to achieve optimum symptom control while minimizing the adverse effects of long-term therapy.
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Affiliation(s)
- James W Tetrud
- Movement Disorders Center, The Parkinson's Institute, Sunnyvale, CA 94089, USA.
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Abstract
During the past decade, there has been a remarkable progress in our understanding of the biology of Parkinson disease (PD), which has been translated into searching for novel therapy for PD. Much focus is shifted from the development of drugs that only relieve PD symptoms to new generation of remedies that can potentially protect dopaminergic neurons and modify the disease course. Several novel therapeutic approaches have been tested in preclinical experiments and in clinical trials, including molecules targeting on genes involved in the pathogenesis of the disease, neurotrophic factors critical for dopaminergic neuron survival and function, new generation of dopamine receptor agonists that may possess neuroprotective effects, and agents of antioxidation, antiinflammation, and antiapoptosis. The results of these studies will shed new light to our hope that PD can be cured in the future.
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Affiliation(s)
- Sheng Chen
- Institute of Neurology, Ruijin Hospital, Shanghai 2nd Medical University, Shanghai, China
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Chan PLS, Nutt JG, Holford NHG. Importance of within subject variation in levodopa pharmacokinetics: a 4 year cohort study in Parkinson's disease. J Pharmacokinet Pharmacodyn 2006; 32:307-31. [PMID: 16320098 DOI: 10.1007/s10928-005-0039-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 05/04/2005] [Indexed: 10/25/2022]
Abstract
The purpose of the study was to describe the population pharmacokinetics of levodopa in patients with Parkinson's disease studied in 5 trials (10 occasions) over 4 years. Twenty previously untreated Parkinsonian patients were investigated. Each trial consisted of a 2-hr IV infusion of levodopa (1 mg/kg/h) with concomitant oral carbidopa given on two occasions separated by 72 hr with no levodopa in between. This trial design was repeated at 6, 12, 24 and 48 months. A two-compartment pharmacokinetic model with central volume (V1), peripheral volume (V2), clearance (CL) and inter-compartmental clearance (CL(ic)) was used to fit plasma levodopa concentrations. The model accounted for levodopa dosing prior to each trial and endogenous levodopa synthesis. Population parameter estimates (geometric mean) and population parameter variability (PPV; SD of normal distribution) were V1 11.4 l/70 kg (0.44), CL 30.9 l/h/70 kg (0.25), V2 27.3 l/70 kg (0.27), and CL(ic) 34.6 l/h/70 kg (0.48). PPV was partitioned into between subject variability (BSV) which was 0.12 V1, 0.13 CL, 0.15 V(2), 0.28 CL(ic), within trial variability (WTV) which was 0.16 V1, 0.13 CL, 0.08 V2, 0.18 CL(ic) and between trial variability (BTV) which was 0.40 V1, 0.17 CL, 0.21 V2, 0.34 CL(ic.) Neither structural nor random levodopa pharmacokinetic parameters were associated with the time course of development of fluctuation in motor response. Variability in levodopa pharmacokinetic parameters (particularly V1) may result in variability in plasma levodopa concentrations that could contribute to fluctuations in motor response.
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Affiliation(s)
- Phylinda L S Chan
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand.
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Sato K, Hatano T, Yamashiro K, Kagohashi M, Nishioka K, Izawa N, Mochizuki H, Hattori N, Mori H, Mizuno Y. Prognosis of Parkinson's disease: Time to stage III, IV, V, and to motor fluctuations. Mov Disord 2006; 21:1384-95. [PMID: 16763980 DOI: 10.1002/mds.20993] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We report a long-term outcome on a large cohort of Japanese patients with Parkinson's disease (PD). A total of 1,768 (793 men, 975 women) consecutive patients visited our clinic from 1 January 1989 to 31 December 2002. Among them, 1,183 patients (531 men, 652 women) came to our clinic within 5 years from the onset of disease and at the Hoehn & Yahr Stage III or less at the first visit. Long-term outcome was evaluated in this subcohort of the patients. We examined the duration to reach Stage III, IV, and V, and the duration to develop wearing off and dyskinesia. Time to reach Stage III was slightly but significantly shorter in women, in that 23.8% of men and 35.3% of women reached Stage III by the end of the 5th year; 49.7% of men and 63.3% of women reached Stage III by the end of the 10th year, and 88.9% of men and 79.9% of women by the end of the 15th year (P < 0.001). Also, durations to develop wearing off and dyskinesia were shorter in women compared to men. These data suggest that the disease progression may be slightly faster for women. Young-onset patients showed significantly longer duration to reach Stage III, IV, and V but shorter duration to develop wearing off and dyskinesia. Not many studies are available in the literature on the long-term outcome of PD, and our data would be useful as a reference.
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Affiliation(s)
- Kenichi Sato
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
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Clissold BG, McColl CD, Reardon KR, Shiff M, Kempster PA. Longitudinal study of the motor response to levodopa in Parkinson's disease. Mov Disord 2006; 21:2116-21. [PMID: 17029259 DOI: 10.1002/mds.21126] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In this prospective study of 34 patients with Parkinson's disease, measurements of the short duration levodopa motor response have been performed in defined off states at 3 yearly intervals over a mean period of 11.4 years from the point of commencement of levodopa treatment. Twenty-two patients were still available for study; 10 had died and 2 were lost to follow-up. The levodopa motor response amplitude increases over the first 5 years of treatment, and thereafter, on and off scores worsen in parallel with conservation of the response. Patients who developed motor fluctuations within the first 5 years of treatment had, on average, a stronger response to levodopa with significantly better on phase motor function (P = 0.003). Although the proportion of "midline" motor disability (affecting gait, balance, and cranial motor function) increases with time, these deficits do not actually become unresponsive to levodopa. Patients who developed dementia had a significantly more rapid decline in motor function. The latest graph of serial scores for the whole cohort shows an upward curving or exponential increase in motor disability after the first decade of treatment. Applying a notional untreated disability line to this graph--an estimate of the disability that would have accrued if drugs had never been given--we suggest that the long-duration response to levodopa eventually runs down with disease progression.
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Chan PLS, Nutt JG, Holford NHG. Pharmacokinetic and Pharmacodynamic Changes During the First Four Years of Levodopa Treatment in Parkinson’s Disease. J Pharmacokinet Pharmacodyn 2005; 32:459-84. [PMID: 16320101 DOI: 10.1007/s10928-005-0055-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 05/20/2005] [Indexed: 11/27/2022]
Abstract
The purpose of this analysis is to describe how levodopa pharmacokinetic and pharmacodynamic parameters change over the first 4 years of long-term levodopa treatment in patients with Parkinson's disease. Twenty previously untreated Parkinsonian patients were admitted to the general clinical research center (GCRC) for 4 days at the beginning of long-term levodopa therapy and 6, 12, 24 and 48 months later. On each GCRC admission, patients received a 2 hr IV infusion of levodopa on day 1 and day 4 with no oral levodopa between the infusions. After the first GCRC admission patients were treated with oral levodopa dosed for optimal control of Parkinsonism. Motor function was measured by finger tapping rate. A pharmacokinetic-pharmacodynamic model incorporating 3 effect compartments was used to fit the individual plasma levodopa concentrations and tapping rates. Motor function before the first levodopa infusion (E0(1)) improved over the first 20 months and subsequently returned to the initial baseline at the start of the study. A similar pattern was seen in motor function before the second infusion (E0(2)) after the 3 days levodopa withdrawal, with a decline predicted to fall below the initial baseline at the start of the study by 6 years. Eight patients showed an increase in maximum tapping rate with levodopa (E(max)) approaching a steady state after 16 months. Ten patients showed an increase in E(max) with a peak at 31 months. One patient showed a linear decrease and another patient did not change over the 48 months. Longitudinal progress models were used to describe the time course of pharmacokinetic and pharmacodynamic parameters over 4 years. Peak treatment benefit, defined as the difference between E(max) and E0(1) or E0(2) (D(max)1 or D(max)2), increased with time particularly after the 3-day levodopa withdrawal. Deterioration of pre-dose motor function (E0) as disease progresses coupled with a greater amplitude of response due to levodopa (D(max)) could be a key factor contributing to motor fluctuations associated with long-term levodopa treatment.
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Affiliation(s)
- Phylinda L S Chan
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand.
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Charles PD, Padaliya BB, Newman WJ, Gill CE, Covington CD, Fang JY, So SA, Tramontana MG, Konrad PE, Davis TL. Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs. Parkinsonism Relat Disord 2004; 10:475-9. [PMID: 15542007 DOI: 10.1016/j.parkreldis.2004.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 05/15/2004] [Accepted: 05/20/2004] [Indexed: 12/01/2022]
Abstract
This study reports a retrospective analysis of 16 patients to determine changes in medication costs associated with deep brain stimulation of the bilateral subthalamic nucleus (DBS B-STN). Antiparkinsonian medication (APMED) costs were evaluated pre- and post-operatively at 1 and 2 years, based on prescribed dosages. After treatment with DBS, patients experienced a 32% reduction in APMED costs after 1 year and a 39% reduction after 2 years. Hypothetical projections of total potential savings are presented, accounting for increasingly complex medication regimens and medication cost inflation. DBS patients may experience a significant long-term reduction in the cost of their pharmacologic treatment.
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Affiliation(s)
- P David Charles
- The Movement Disorders Clinic, Department of Neurology, Vanderbilt University Medical Center, 2100 Pierce Avenue, Suite 352 MCS, Vanderbilt University, Nashville, TN 37212-3375, USA.
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