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Ayele R, Macchi ZA, Jordan S, Jones J, Kluger B, Maley P, Hall K, Sumrall M, Lum HD. Holding back in communications with clinicians: Patient and care partner perspectives in Parkinson's disease. PEC INNOVATION 2024; 4:100255. [PMID: 38304553 PMCID: PMC10832496 DOI: 10.1016/j.pecinn.2024.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
Objectives To describe how patients with Parkinson's disease (PD) and care partners choose to share or withhold information from clinicians. Methods This is a qualitative, descriptive study nested within a multisite, randomized clinical trial of outpatient palliative care compared to standard neurologic care for PD. Interviews with patients (n = 30) and care partners (n = 30) explored experiences communicating with neurology clinicians. Thematic analyses identified themes relevant to patient-care partner-clinician communication. Results There were four themes relevant to sharing and/or withholding information from clinicians: (1) Suppressing Concerns During Visits, (2) Care Partner Awareness of Patients' Communication Barriers due to Cognitive Impairment, (3) Limited Sharing of Sensitive or Intimate Issues by Patients and Care Partners, and (4) Patient and Care Partner Suggestions to Overcome 'Holding Back'. Conclusion Limitations to communication between patients, care partners, and clinicians should be acknowledged and recognized in routine Parkinson's disease care to foster accurate disclosure of unmet palliative care and other needs. Triadic communication strategies may help patients and care partners talk about unmet palliative care needs. Innovation By recognizing that cognitive impairment and sensitive topics can be barriers, clinicians can adjust or adopt targeted communication strategies for identifying and discussing care needs.
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Affiliation(s)
- Roman Ayele
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
- College of Nursing, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
- Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, 1800 N. Wheeling Street, Aurora, CO 80045, United States of America
| | - Zachary A. Macchi
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO, 80045, United States of America
| | - Sarah Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
| | - Benzi Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Patrick Maley
- Patient and Caregiver Advisory Council, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, United States of America
| | - Kirk Hall
- Patient and Caregiver Advisory Council, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, United States of America
| | - Malenna Sumrall
- Patient and Caregiver Advisory Council, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, United States of America
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO 80045, United States of America
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Mei S, Wang X, Mao W, Liu Y, Tian Z, Han C, Chan P. Orthostatic Hypotension: a clinical marker for the body-first subtype of patients with Parkinson's Disease. NPJ Parkinsons Dis 2024; 10:173. [PMID: 39256426 DOI: 10.1038/s41531-024-00787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024] Open
Abstract
Our study aimed to investigate the clinical characteristics of PD patients stratified by OH status before and after levodopa challenge to explore the hypothesis that OH might serve as a clinical marker for the body-first subtype of PD. Supine and standing blood pressure were measured in a large cross-sectional cohort of PD patients at the OFF status before and after levodopa challenge test (LCT). Based on OH status, patients were divided into three groups: spontaneous OH (SOH), only levodopa-induced OH (LOH) and non-OH (NOH). Clinical characteristics and associated factors were compared among the groups. A total of 928 patients with a mean age of 62.4 years and average disease duration of 7.9 years were included. There were 224 (24.1%) patients with SOH, 321 (34.6%) with LOH, and 383 (41.3%) with NOH. Compared to NOH, both SOH and LOH were associated with older age, motor fluctuations, and probable rapid eye movement sleep behavior disorder (pRBD). In addition, OH was more associated with cardiovascular and digestive dysfunction, disease severity and worse quality of life. Results of the current study suggest that PD patients developed OH which is more likely to comorbid with RBD, severe autonomic dysfunction and motor fluctuations, consistent with the body-first subtype of PD.
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Affiliation(s)
- Shanshan Mei
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
- Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Xue Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Mao
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
- Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Yue Liu
- Department of Neurology, Boren Hospital, Beijing, China
| | - Zichen Tian
- Washington University School of Medicine, St. Louis, MI, USA
| | - Chao Han
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Piu Chan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
- Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China.
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
- Parkinson's Disease Center of Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
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Argerich J, Garma LD, López-Cano M, Álvarez-Montoya P, Gómez-Acero L, Fernández-Dueñas V, Muñoz-Manchado AB, Aso E, Boxer A, Andres-Benito P, Svenningsson P, Ciruela F. GPR37 processing in neurodegeneration: a potential marker for Parkinson's Disease progression rate. NPJ Parkinsons Dis 2024; 10:172. [PMID: 39256360 DOI: 10.1038/s41531-024-00788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 08/27/2024] [Indexed: 09/12/2024] Open
Abstract
The orphan G protein-coupled receptor 37 (GPR37), widely associated with Parkinson's disease (PD), undergoes proteolytic processing under physiological conditions. The N-terminus domain is proteolyzed by a disintegrin and metalloproteinase 10 (ADAM-10), which generates various membrane receptor forms and ectodomain shedding (ecto-GPR37) in the extracellular environment. We investigated the processing and density of GPR37 in several neurodegenerative conditions, including Lewy body disease (LBD), multiple system atrophy (MSA), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), and Alzheimer's disease (AD). The presence of ecto-GPR37 peptides in the cerebrospinal fluid (CSF) of PD, MSA, CBD and PSP patients was assessed through an in-house nanoluciferase-based immunoassay. This study identified increased receptor processing in early-stage LBD within the PFC and striatum, key brain areas in neurodegeneration. In MSA only the 52 kDa form of GPR37 appeared in the striatum. This form was also significantly elevated in the striatum of AD necropsies. On the contrary, GPR37 processing remained unchanged in the brains of CBD and PSP patients. Furthermore, while CSF ecto-GPR37 increased in PD patients, its levels remained unchanged in MSA, CBD, and PSP subjects. Importantly, patients with PD with rapid progression of the disease did not have elevated ecto-GPR37 in the CSF, while those with slow progression showed a significant increase, suggesting a possible prognostic use of ecto-GPR37 in PD. This research underscores the distinctive processing and density patterns of GPR37 in neurodegenerative diseases, providing crucial insights into its potential role as an indicator of PD progression rates.
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Affiliation(s)
- Josep Argerich
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Leonardo D Garma
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas - CNIO, 28029, Madrid, Spain
| | - Marc López-Cano
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Paula Álvarez-Montoya
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Laura Gómez-Acero
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Víctor Fernández-Dueñas
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Ana B Muñoz-Manchado
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, SE-17177, Sweden
- Department of Pathological Anatomy, Cellular Biology, Histology, History of Science, Legal and Forensic Medicine and Toxicology. Biomedical Research and Innovation Institute of Cadiz (INiBICA). University of Cádiz, 11002, Cádiz, Spain
| | - Ester Aso
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Adam Boxer
- Memory and Aging Center, University of California, San Francisco, CA, 94158, USA
| | - Pol Andres-Benito
- Neurological disorders and neurogenetics Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain
| | - Per Svenningsson
- Laboratory of Translational Neuropharmacology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-17177, Sweden.
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Francisco Ciruela
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain.
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907, L'Hospitalet de Llobregat, Spain.
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Pilotto A, Ashton NJ, Lupini A, Battaglio B, Zatti C, Trasciatti C, Gipponi S, Cottini E, Grossi I, Salvi A, de Petro G, Pizzi M, Canale A, Blennow K, Zetterberg H, Padovani A. Plasma NfL, GFAP, amyloid, and p-tau species as Prognostic biomarkers in Parkinson's disease. J Neurol 2024:10.1007/s00415-024-12669-7. [PMID: 39249107 DOI: 10.1007/s00415-024-12669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION The prognostic role of plasma neurofilament light chain (NfL), phospho-tau, beta-amyloid, and GFAP is still debated in Parkinson's disease (PD). METHODS Plasma p-tau181, p-tau231, Aβ1-40, Aβ1-42, GFAP, and NfL were measured by SIMOA in 136 PD with 2.9 + 1.7 years of follow-up and 76 controls. Differences in plasma levels between controls and PD and their correlation with clinical severity and progression rates were evaluated using linear regression analyses. RESULTS Patients exhibited similar distribution of plasma biomarkers but higher P-tau181, P-tau231 and lower Aβ1-42 compared with controls. NfL and GFAP correlated with baseline motor and non-motor severity measures. At follow-up, NfL emerged as the best predictor of progression with marginal effect of GFAP and p-tau181 adjusting for age, sex, disease duration, and baseline motor severity. CONCLUSION The present findings confirmed plasma NfL as best predictor of progression in PD, with a marginal role of p-tau181 and GFAP.
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Affiliation(s)
- Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy.
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Hospital, Brescia, Italy.
- Neurobiorepository and Laboratory of Advanced Biological Markers, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Alessandro Lupini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Beatrice Battaglio
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Cinzia Zatti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Chiara Trasciatti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Hospital, Brescia, Italy
- Neurobiorepository and Laboratory of Advanced Biological Markers, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Stefano Gipponi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Elisabetta Cottini
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Hospital, Brescia, Italy
| | - Ilaria Grossi
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alessandro Salvi
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giuseppina de Petro
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marina Pizzi
- Division of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Antonio Canale
- Department of Statistical Sciences, University of Padova, Padua, Italy
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, Department of Neurology, Institute On Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, People's Republic of China
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, People's Republic of China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.Zzale Spedali Civili, 1, 25123, Brescia, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Hospital, Brescia, Italy
- Neurobiorepository and Laboratory of Advanced Biological Markers, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
- Brain Health Center, University of Brescia, Brescia, Italy
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Inaltekin A, Kocatürk I. Burden and associated characteristics in caregivers of Parkinson's disease patients. Psychogeriatrics 2024. [PMID: 39238200 DOI: 10.1111/psyg.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/12/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Parkinson's disease (PD) increases patient load and requirements of care. Determining the burden on PD patients' caregivers and associated factors may help to identify methods to reduce caregiver burden. This study investigated the factors associated with caregiver burden among PD patients caregivers. METHODS Eighty-five PD patients and 85 caregivers were included in the study. Zarit Burden Interview (ZBI) was used to measure caregiver burden; the Ways of Coping Scale (WCS) was used for coping; Modified Hoehn-Yahr Staging (MHYS) was used for staging patients. The International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts 1 and 3 were used to evaluate non-motor and motor problems. Caregivers' depression and anxiety levels were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory (BAI). Spearmen correlation coefficient was used to evaluate the relationship of variables with the ZBI score, and multiple linear regression analysis was used to determine the predictors of the ZBI score. RESULTS A positive significant relationship was found between the ZBI score and BAI score, MHYS score, WCS total score, and subscales: keeping to self, seeking refuge in fate, and seeking refuge in supernatural forces. MHYS score, WCS total score, BAI score, and MDS-UPDRS-1 were predictors of the ZBI score. CONCLUSIONS The anxiety levels of caregivers, their ways of coping, and the patient's stage of the disease are important in caregiver burden. Coping ways can be changed to reduce the care burden. Developing psychological interventions for caregivers to change their coping styles can be important.
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Affiliation(s)
- Ali Inaltekin
- Department of Psychiatry, Kastamonu University School of Medicine, Kastamonu, Turkey
| | - Idris Kocatürk
- Department of Neurology, Kastamonu University School of Medicine, Kastamonu, Turkey
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Ponce FA, Shill HA. What Is "Advanced" Parkinson's Disease? Defining What Determines Medicare Coverage for Deep Brain Stimulation in the USA. Stereotact Funct Neurosurg 2024:1-6. [PMID: 39236686 DOI: 10.1159/000540873] [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: 05/23/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The National Coverage Determination (NCD) by the Centers for Medicare and Medicaid Services (CMS) for deep brain stimulation requires that a patient have "advanced idiopathic Parkinson's disease (PD) as determined by Hoehn and Yahr (HY) stage or the Unified Parkinson's Disease Rating Scale part III motor subscale (UPDRS III)." How to apply the HY or UPDRS III scales to define "advanced" PD is unclear. SUMMARY There is an ongoing recovery audit by the CMS of deep brain stimulation cases that were covered by Medicare but are deemed not to have met the NCD requirements and therefore not to have been medically necessary. Whether a hospital is asked to refund Medicare often hinges upon whether medical documentation supports the diagnosis of advanced PD. However, neither the HY nor the UPDRS III scales use "advanced" to define or describe stages of PD. The NCD has an accompanying National Coverage Analysis that reviews the studies that inform the NCD. These studies use "advanced" as well as the HY and UPDRS III scales. This review identifies how the HY and UPDRS III scales were used to categorize advanced PD in the studies that were cited in the National Coverage Analysis. KEY MESSAGES In the studies used for the NCD for deep brain stimulation for PD, an HY score ≥3 or a UPDRS III score ≥30 was used to describe patient cohorts considered to have advanced PD.
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Affiliation(s)
- Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Holly A Shill
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Saeda S, Sumi Y, Fujiwara K, Kadotani H. Blunted tachycardia and cardiac sympathetic denervation in isolated rapid eye movement sleep behavior disorder. BMC Neurol 2024; 24:317. [PMID: 39232705 PMCID: PMC11373284 DOI: 10.1186/s12883-024-03822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Isolated rapid eye movement sleep behavior disorder (iRBD) serves as a prodromal phase of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Blunted tachycardia (BT) during postural changes indicates neurogenic orthostatic hypotension, a marker of autonomic dysfunction. We aimed to investigate whether BT is associated with cardiac sympathetic neurogenic denervation. Additionally, we conducted a preliminary short-term follow-up to examine the potential prognostic significance of BT regarding phenoconversion and mortality. METHODS Forty-three patients with iRBD at Shiga University of Medical Science Hospital underwent active standing tests to identify BT, defined by a specific ratio of decrease in systolic blood pressure to inadequate increase in heart rate after standing, and orthostatic hypotension. 123I-metaiodobenzylguanidine myocardial scintigraphy (123I-MIBG) and dopamine transporter single-photon emission computed tomography (DAT-SPECT) were performed. Participants were followed up for 3.4 ± 2.4 years for phenoconversion and 4.0 ± 2.3 years for mortality assessment, and the risk of events was analyzed using log-rank tests. RESULTS Among the 43 participants (mean age, 72.3 ± 7.9 years; 8 female), 17 met the BT criteria. We found no significant comorbidity-related differences in hypertension or diabetes between the BT(+) and BT(-) groups. Orthostatic hypotension was more prevalent in the BT(+) group than in the BT(-) group (47.1% vs 7.7%, p = 0.003). BT(+) patients were older with a lower early and delayed MIBG uptake; however, no significant differences were observed in DAT accumulation. Phenoconversion was observed in seven (41.2%) BT(+) and seven (26.9%) BT(-) patients. Three deaths were recorded in the BT(+) group (17.6%) and three in the BT(-) group (11.5%). No significant differences were observed in the risk of phenoconversion or mortality between the groups. CONCLUSIONS We have identified the possibility that BT reflects cardiac sympathetic neurogenic denervation in patients with iRBD. Future research is needed to elucidate the potential prognostic value of BT.
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Affiliation(s)
- Shota Saeda
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Koichi Fujiwara
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan.
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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Bortoli AF, Acco FS, Ivaniski-Mello A, Martinez FG, Cechetti F. Comparison of spatiotemporal and angular parameters during shallow water walking in different immersion depths by older adults with and without Parkinson's disease. Gait Posture 2024; 113:295-301. [PMID: 38972171 DOI: 10.1016/j.gaitpost.2024.06.023] [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: 04/18/2023] [Revised: 01/24/2024] [Accepted: 06/26/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND People with Parkinson's Disease (PwPD) have motor symptoms that directly interfere on dry land walking performance. Despite the shallow water walking is a viable and beneficial physical intervention for PwPD, it lacks information on the comparison of the biomechanical responses of the shallow water walking by PwPD and age paired healthy individuals. RESEARCH QUESTION Are there differences in the spatiotemporal and angular responses of shallow water walking by older adults with and without Parkinson's disease? METHODS In this cross-sectional study, ten older adults (9 men/1 women) with Parkinson disease (PwPD group) and ten older adults (3 men/7 women) without Parkinson's disease (Older group) walked in shallow water at self-selected comfortable speed on pool floor in the immersion depths of waist and xiphoid levels. The 2D kinematic data from the sagittal plane was collected to calculate the walking speed, stride length, stride frequency, duty factor, walk ratio, lower limb joints' range of motion and peak angular speed RESULTS: Both groups reduced similarly the walking speed with the immersion depth increase. The speed decrease was achieved by a reducing both the stride frequency and stride length only in the PwPD. The PwPD had lower contact phase than Older in the waist depth, probably due to the reduced risk of fall in water immersion and to attenuate drag force effects. The total range of joint motion was similar between groups, while the peak angular speed of ankle and knee reduced in the deeper depth in both groups. SIGNIFICANCE The present findings can help professionals of aquatic rehabilitation to choose the best depth for exercise programs, according to the treatment objectives. To our knowledge, this was the first study that analyzed spatiotemporal and angular variables during shallow water walking of PwPD at different depths and compared them with older people without Parkinson's disease.
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Affiliation(s)
- Andressa Fiori Bortoli
- Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Fernanda Scalco Acco
- Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - André Ivaniski-Mello
- Laboratory of Biodynamics (LaBiodyn), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- Laboratory of Biodynamics (LaBiodyn), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Cechetti
- Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
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Mikami K, Kamo T, Ichinoseki-Sekine N. Sex-related differences in the posture and vertical perception of gait function in patients with Parkinson's disease. Gait Posture 2024; 113:324-329. [PMID: 39024985 DOI: 10.1016/j.gaitpost.2024.07.006] [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: 04/24/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Although several factors, such as sex and body schema, contribute to gait function, factors for gait dysfunction in Parkinson's disease (PD) have not been elucidated. Postural verticality, a higher-order neural mechanism of gait, is involved in generation of a gait program in healthy individuals; however, its role in patients with PD is unclear. Although subjective postural vertical (SPV), which denotes cognitive information about posture with verticality as the reference axis, is anteriorly and laterally shifted in patients with PD, the presence of sex-related differences in SPV and effect of SPV on gait function remain unclear. Since SPV affects the degree of flexion and lateral bending posture and long-term prognosis of PD, factors affecting SPV in patients with PD should be clarified to improve gait function. RESEARCH QUESTION Is vertical perception of posture (i.e., SPV) related to gait function in patients with PD? Are there any sex-related differences? METHODS The gait and SPV were evaluated in 59 adult outpatients with PD (31 men and 28 women) using five gait (step length, walking speed, coefficient of variation of step time [step CV], cadence, and mean gait acceleration [acceleration]) and two SPV (SPV in the sagittal and coronal planes) assessments and compared between the sexes. RESULTS No sex-related differences were observed in the SPV in patients with PD. The SPV and gait assessments demonstrated no association in men. Walking speed and SPV in the sagittal plane (p = 0.029), and step CV and SPV in the coronal (p = 0.018) and sagittal planes (p = 0.032) were correlated in women. SIGNIFICANCE Although no sex-related differences in the SPV were observed, our results demonstrated that the SPV is involved in gait function in women but not in men with PD.
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Affiliation(s)
- Kyohei Mikami
- Department of Rehabilitation, Noborito Neurology Clinic, Kawasaki, Japan; Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan.
| | - Tsutomu Kamo
- Department of Neurology, Noborito Neurology Clinic, Kawasaki, Japan
| | - Noriko Ichinoseki-Sekine
- Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan; School of Health and Sports Science, Juntendo University, Inzai, Japan
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10
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Mazzetti S, Contaldi E, Basellini MJ, Novello C, Calogero AM, Straniero L, Garrì F, Ferri V, Calandrella D, Del Sorbo F, Asselta R, Cereda E, Cappelletti G, Isaias IU, Pezzoli G. Comparing GBA1-Parkinson's disease and idiopathic Parkinson's disease: α-Synuclein oligomers and synaptic density as biomarkers in the skin biopsy. Brain Pathol 2024:e13284. [PMID: 39219308 DOI: 10.1111/bpa.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/21/2024] [Indexed: 09/04/2024] Open
Abstract
The main genetic risk factors for Parkinson's disease (PD) are presently represented by variants in GBA1 gene encoding for the β-glucocerebrosidase (GCase). Searching for a peripheral biomarker that can be used for selecting and monitoring patients in clinical trials targeting GBA1-associated PD (GBA1-PD) is a current challenge. We previously demonstrated that α-synuclein oligomers expressed as proximity ligation assay (PLA) score in synaptic terminals of skin biopsy are a reliable biomarker for distinguishing idiopathic PD (iPD) from healthy controls (HC). This cross-sectional study investigates an unexplored cohort of GBA1-PD (n = 27) compared to 28 HC, and 36 iPD cases to (i) analyze α-synuclein oligomers and quantify them throughout PLA score, (ii) investigate GCase expression in brain and synaptic terminals targeting the sweat gland, (iii) unravel indicators that could differentiate patients with specific GBA1 mutations. PLA score discriminates GBA1-PD from HC with sensitivity = 88.9% (95% CI 70.84-97.65), specificity = 88.5% (95% CI 69.85-97.55), and PPV = 88.9% (95% CI 73.24-95.90), AUC value = 0.927 (95% CI 0.859-0.996). No difference was found between GBA1-PD patients and iPD, suggesting a common pathological pathway based on α-synuclein oligomers. GCase score did not differ in GBA1-PD, iPD, and HC in the synaptic terminals, whereas a positive correlation was found between PLA score and GCase score. Moreover, a significant increase in synaptic density was observed in GBA1-PD compared to iPD and HC (P < 0.0001). Employing ROC curve to discriminate GBA1-PD from iPD, we found an AUC value for synaptic density = 0.855 (95% CI 0.749-0.961) with sensitivity = 85.2% (95% CI 66.27%-95.81%), specificity = 77.1% (95% CI 59.86%-89.58%), and PPV = 74.19% (60.53%-84.35%). The highest synaptic density values were observed in p.N409S patients. This work points out to the value of both PLA score and synaptic density in distinguishing GBA1-PD from iPD and to their potential to stratify and monitor patients in the context of new pathway-specific therapeutic options.
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Affiliation(s)
- Samanta Mazzetti
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | | | | | - Claudia Novello
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Maria Calogero
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Letizia Straniero
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Federica Garrì
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Valentina Ferri
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
- Parkinson Institute, ASST "G.Pini-CTO", Milan, Italy
| | - Daniela Calandrella
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
- Parkinson Institute, ASST "G.Pini-CTO", Milan, Italy
| | | | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Graziella Cappelletti
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
- Center of Excellence on Neurodegenerative Diseases, Università degli Studi di Milano, Milan, Italy
| | - Ioannis Ugo Isaias
- Parkinson Institute, ASST "G.Pini-CTO", Milan, Italy
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
- Parkinson Institute, ASST "G.Pini-CTO", Milan, Italy
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11
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Samanci B, Tan S, Michielse S, Kuijf ML, Temel Y. Habenula volume change in Parkinson's disease: A 7T MRI study. Brain Res Bull 2024; 215:111002. [PMID: 38871257 DOI: 10.1016/j.brainresbull.2024.111002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/08/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by motor and early non-motor symptoms. The habenula is implicated in the pathophysiology of depression. This study investigates habenular volume in PD patients without clinical depression to show the changes in PD unrelated to depression. METHODS The study used high-resolution 7 Tesla MRI data from the TRACK-PD study involving 104 PD patients and 44 healthy controls (HCs). The habenula was manually segmented, and volumes were measured, considering demographic data and depression scores via the Beck Depression Inventory (BDI). RESULTS No significant correlation was found between habenular volume and BDI scores in PD patients or HCs. However, the PD group exhibited a significantly larger mean and right habenular volume than HCs. Although PD patients showed higher BDI scores, indicating more subthreshold depression, these did not correlate with the habenular volume. CONCLUSION The results suggest that while the habenula may be involved in the symptoms of PD, its role in depression within this cohort is unclear. The changes might be related to the role of the habenula in motor symptoms. This study provides a new perspective on the role of the habenula in PD, but future research could lead to a greater understanding of the neuroanatomical features of the habenula in PD.
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Affiliation(s)
- Bedia Samanci
- School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands; Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sonny Tan
- School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Michielse
- School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands
| | - Mark L Kuijf
- School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Yasin Temel
- School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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12
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Güneş Gencer GY, Akkurt L, Aktaş H, Şimşek Erdem N. Investigation of the reliability and validity of the Turkish version of the Comprehensive Coordination Scale in patients with Parkinson's disease. Clin Neurol Neurosurg 2024; 244:108455. [PMID: 39059284 DOI: 10.1016/j.clineuro.2024.108455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/07/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The Comprehensive Coordination Scale (CCS) is a valid, reliable scale for evaluating motor coordination, described as the ability to produce context-dependent movements of multiple body parts in both spatial and temporal domains in patients with chronic stroke. The aim of this study was to develop a Turkish version of the CCS that can be used to evaluate coordination in Parkinson's disease patients and to test its validity and reliability. METHODS Thirty-four patients with Parkinson's disease (18 females, 16 males) with a mean age of 67.55± 10.93 years were included. The 9-Hole Peg Test (9 HPT), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), Functional Reach Test (FRT), and Modified Hoehn and Yahr (H&Y) were administered to the patients. RESULTS In the correlation analysis for convergent validity, the CCS-TR showed a moderate negative correlation with both the 9 HPT and the TUG test (r=-0.684 and -0.641, respectively). There were also moderate positive correlations observed between the CCS-TR and the FRT and BBS (r=0.607 and 0.657, respectively). The total CCS-TR had excellent intrarater reliability (ICC=0.99; 95 % CI: 0.98-0.99) and interrater reliability (ICC=0.90; 95 % CI: 0.81-0.95). The CCS-TR subscales had excellent intrarater reliability (ICC: range 0.98 from 0.99). For intrarater agreement, the ICC was 0.99, and for interrater agreement, the ICC was 0.90 (excellent agreement). CONCLUSION The results of the present study indicate that the Turkish version of the CCS is a reliable and valid coordination scale that can be used in patients with Parkinson's disease.
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Affiliation(s)
| | - Lütfiye Akkurt
- Kutahya Health Sciences University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kütahya, Turkey.
| | - Hayri Aktaş
- Antalya Bilim University, Health Services Vocational School, Physiotherapy Program, Antalya, Turkey.
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13
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You Z, Ma S, Xu H, Wu Z, You Z. Comorbidity of white matter lesions in parkinson's disease: a study on risk factors and phenotypic differences. Neurol Sci 2024:10.1007/s10072-024-07735-x. [PMID: 39214869 DOI: 10.1007/s10072-024-07735-x] [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: 01/22/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Comorbidity of white matter lesions (WMLs) in idiopathic Parkinson's disease (PD) is becoming increasingly common. OBJECTIVE To analyze the risk factors and phenotypic differences for the occurrence and severity of WMLs in patients with PD. METHODS A total of 123 PD patients underwent clinical, laboratory, and magnetic resonance imaging (MRI) evaluations. RESULTS PD patients with WMLs were found to have a higher association with age, Modified Hoehn & Yahr stage (H-Y stage), and hypertension. There was a certain correlation between the severity of WMLs and PD phenotypes. 89% of PD patients had periventricular hyperintensities (PVH). Additionally, the score of the modified version of the Scheltens visual rating scale of PVH in the postural instability gait difficulty (PIGD) phenotype of PD was significantly higher than that in the tremor-dominant (TD) phenotype. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in the PIGD group were significantly lower than those in the TD group. Furthermore, compared with the TD group, the serum homocysteine level was significantly higher in the PIGD group. CONCLUSIONS Age, H-Y stage, and hypertension are independent risk factors for WMLs in PD, and the severity of WMLs is related to the phenotype of PD patients. Our study found that PVH is the most common occurrence of WMLs in Parkinson's disease, and the burden of PVH is significantly higher in the PIGD phenotype compared to the TD phenotype of PD. Additionally, the PIGD phenotype is associated with more severe cognitive decline and elevated homocysteine levels.
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Affiliation(s)
- Zhifei You
- Department of Neurology, The Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu Province, China
| | - Shuyu Ma
- Department of Neurology, Dalian Medical University, Dalian, Liaoning Province, China
| | - Hui Xu
- Department of Neurosurgery, Nantong Hospital of Traditional Chinese Medicine, Affiliated Traditional Chinese Medicine Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Zhonghua Wu
- Department of Neurosurgery, The Sixth People's Hospital of Nantong, Nantong, Jiangsu Province, China
| | - Zhengchen You
- Department of Emergency, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, No.366 Taihu Road, Taizhou Medical High-tech Zone, Jiangsu Province, 225300, China.
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14
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Chua J, Tan B, Wong D, Garhöfer G, Liew XW, Popa-Cherecheanu A, Loong Chin CW, Milea D, Li-Hsian Chen C, Schmetterer L. Optical coherence tomography angiography of the retina and choroid in systemic diseases. Prog Retin Eye Res 2024; 103:101292. [PMID: 39218142 DOI: 10.1016/j.preteyeres.2024.101292] [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: 05/17/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Optical coherence tomography angiography (OCTA) has transformed ocular vascular imaging, revealing microvascular changes linked to various systemic diseases. This review explores its applications in diabetes, hypertension, cardiovascular diseases, and neurodegenerative diseases. While OCTA provides a valuable window into the body's microvasculature, interpreting the findings can be complex. Additionally, challenges exist due to the relative non-specificity of its findings where changes observed in OCTA might not be unique to a specific disease, variations between OCTA machines, the lack of a standardized normative database for comparison, and potential image artifacts. Despite these limitations, OCTA holds immense potential for the future. The review highlights promising advancements like quantitative analysis of OCTA images, integration of artificial intelligence for faster and more accurate interpretation, and multi-modal imaging combining OCTA with other techniques for a more comprehensive characterization of the ocular vasculature. Furthermore, OCTA's potential future role in personalized medicine, enabling tailored treatment plans based on individual OCTA findings, community screening programs for early disease detection, and longitudinal studies tracking disease progression over time is also discussed. In conclusion, OCTA presents a significant opportunity to improve our understanding and management of systemic diseases. Addressing current limitations and pursuing these exciting future directions can solidify OCTA as an indispensable tool for diagnosis, monitoring disease progression, and potentially guiding treatment decisions across various systemic health conditions.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Xin Wei Liew
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Emergency University Hospital, Department of Ophthalmology, Bucharest, Romania
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France
| | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.
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15
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Cavallieri F, Lucchi C, Grisanti S, Monfrini E, Fioravanti V, Toschi G, Di Rauso G, Rossi J, Di Fonzo A, Biagini G, Valzania F. Neurosteroid Levels in GBA Mutated and Non-Mutated Parkinson's Disease: A Possible Factor Influencing Clinical Phenotype? Biomolecules 2024; 14:1022. [PMID: 39199409 PMCID: PMC11352262 DOI: 10.3390/biom14081022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024] Open
Abstract
Neurosteroids are pleiotropic molecules involved in various neurodegenerative diseases with neuroinflammation. We assessed neurosteroids' serum levels in a cohort of Parkinson's Disease (PD) patients with heterozygous glucocerebrosidase (GBA) mutations (GBA-PD) compared with matched cohorts of consecutive non-mutated PD (NM-PD) patients and healthy subjects with (GBA-HC) and without (NM-HC) GBA mutations. A consecutive cohort of GBA-PD was paired for age, sex, disease duration, Hoehn and Yahr stage, and comorbidities with a cohort of consecutive NM-PD. Two cohorts of GBA-HC and HC were also considered. Clinical assessment included the Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Montreal Cognitive Assessment (MoCA). Serum samples were processed and analyzed by liquid chromatography coupled with the triple quadrupole mass spectrometry. Twenty-two GBA-PD (males: 11, age: 63.68), 22 NM-PD (males: 11, age: 63.05), 14 GBA-HC (males: 8; age: 49.36), and 15 HC (males: 4; age: 60.60) were studied. Compared to NM-PD, GBA-PD showed more hallucinations and psychosis (p < 0.05, Fisher's exact test) and higher MDS-UPDRS part-II (p < 0.05). Most of the serum neurosteroids were reduced in both GBA-PD and NM-PD compared to the respective control cohorts, except for 5α-dihydroprogesterone. Allopregnanolone was the only neurosteroid significantly lower (p < 0.01, Dunn's test) in NM-PD compared to GBA-PD patients. Only in GBA-PD, allopregnanolone, and pregnanolone levels correlated (Spearman) with a more severe MDS-UPDRS part-III. Allopregnanolone levels also negatively correlated with MoCA scores, and pregnanolone levels correlated with more pronounced bradykinesia. This pilot study provides the first observation of changes in neurosteroid peripheral levels in GBA-PD. The involvement of the observed changes in the development of neuropsychological and motor symptoms of GBA-PD deserves further attention.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.C.); (V.F.); (G.T.); (G.D.R.); (J.R.); (F.V.)
| | - Chiara Lucchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Sara Grisanti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Edoardo Monfrini
- Neurology Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (A.D.F.)
| | - Valentina Fioravanti
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.C.); (V.F.); (G.T.); (G.D.R.); (J.R.); (F.V.)
| | - Giulia Toschi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.C.); (V.F.); (G.T.); (G.D.R.); (J.R.); (F.V.)
| | - Giulia Di Rauso
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.C.); (V.F.); (G.T.); (G.D.R.); (J.R.); (F.V.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Jessica Rossi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.C.); (V.F.); (G.T.); (G.D.R.); (J.R.); (F.V.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (A.D.F.)
| | - Giuseppe Biagini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Franco Valzania
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.C.); (V.F.); (G.T.); (G.D.R.); (J.R.); (F.V.)
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16
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Shin C, Kim SI, Park SH, Kim JM, Lee JY, Chung SJ, Kim JW, Ahn TB, Park KW, Shin JH, Lee CY, Lee HJ, Kong SH, Suh YS, Kim HJ, Yang HK, Jeon B. Diagnostic accuracy and predictors of alpha-synuclein accumulation in the gastrointestinal tract of Parkinson's disease. NPJ Parkinsons Dis 2024; 10:155. [PMID: 39147801 PMCID: PMC11327357 DOI: 10.1038/s41531-024-00766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024] Open
Abstract
The only characteristic of alpha-synuclein (AS) accumulation in the gastrointestinal (GI) tract of Parkinson's disease (PD) found in pathological studies is the "rostrocaudal gradient," which describes the more frequent presence of AS accumulation in the upper GI tract than in the lower GI tract. This study aimed to determine the diagnostic accuracy and identify predictors of AS accumulation in the GI tract of PD patients. The frequency of AS accumulation in the GI tract was compared between PD patients (N = 97) who underwent radical GI surgery for cancer and individually matched controls (N = 94). We evaluated AS accumulation in the neural structures using phosphorylated AS immunohistochemistry. A multivariable logistic regression analysis was conducted to determine the predictors of AS accumulation in the GI tract of PD patients. The frequency of AS accumulation was significantly higher in PD patients (75.3%) than in controls (8.5%, p-value < 0.001). The sensitivity and specificity of the full-layer evaluation were 75.3% and 91.5%, respectively. When the evaluation was confined to the mucosal/submucosal layer, the sensitivity and specificity were 46.9% and 94.7%, respectively. The rostrocaudal gradient of AS accumulation was found in PD patients. The duration from symptom onset to surgery was significantly longer in PD patients with AS accumulation (4.9 ± 4.9 years) than in PD patients without AS accumulation (1.8 ± 4.1 years, p-value = 0.005). Both disease duration and rostrocaudal gradient independently predicted the presence of AS accumulation in the GI tract of PD patients. Our study suggests PD-related AS accumulation in the GI tract follows a temporally increasing but spatially static progression pattern.
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Affiliation(s)
- Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, 20, Bodeum 7-ro, Sejong-si, Republic of Korea
| | - Seong-Ik Kim
- Department of Pathology, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Republic of Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Kye Won Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
- Pacific Parkinson Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Chan Young Lee
- Department of Neurology, Ewha Womans University Mokdong Hospital, 1071 Annyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Chung-ang University Health Care System Hyundae Hospital, Namyangju-si, Gyeonggi-do, Republic of Korea.
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17
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Lokhov PG, Trifonova OP, Balashova EE, Maslov DL, Ugrumov MV, Archakov AI. Application of clinical blood metabogram for diagnosis of early-stage Parkinson's disease: a pilot study. Front Mol Biosci 2024; 11:1407974. [PMID: 39206052 PMCID: PMC11350164 DOI: 10.3389/fmolb.2024.1407974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
In terms of time, cost, and reproducibility of clinical laboratory tests, a mass spectrometric clinical blood metabogram (CBM) enables the investigation of the blood metabolome. Metabogram's components provide clinically relevant information by describing related groups of blood metabolites connected to humoral regulation, the metabolism of lipids, carbohydrates and amines, lipid intake into the organism, and liver function. For further development of the CBM approach, the ability of CBM to detect metabolic changes in the blood in the early stages of Parkinson's disease (PD) was studied in this work. In a case-control study (n = 56), CBM enabled the detection of the signature in blood metabolites related to 1-2.5 clinical stages of PD, according to the modified Hoehn and Yahr scale, which is formed by alterations in eicosanoids, phospholipids and, presumably, in the butadione metabolism. The CBM component-based diagnostic accuracy reached 77%, with a specificity of 71% and sensitivity of 82%. The research results extend the range of disorders for which CBM is applicable and offer new opportunities for revealing PD-specific metabolic alterations and diagnosing early-stage PD.
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Affiliation(s)
- Petr G. Lokhov
- Laboratory of Mass Spectrometric Metabolomic Diagnostics, Institute of Biomedical Chemistry, Moscow, Russia
| | - Oxana P. Trifonova
- Laboratory of Mass Spectrometric Metabolomic Diagnostics, Institute of Biomedical Chemistry, Moscow, Russia
| | - Elena E. Balashova
- Laboratory of Mass Spectrometric Metabolomic Diagnostics, Institute of Biomedical Chemistry, Moscow, Russia
| | - Dmitry L. Maslov
- Laboratory of Mass Spectrometric Metabolomic Diagnostics, Institute of Biomedical Chemistry, Moscow, Russia
| | - Michael V. Ugrumov
- Laboratory of Neural and Neuroendocrine Regulations, Koltzov Institute of Developmental Biology of the Russian Academy of Sciences, Moscow, Russia
| | - Alexander I. Archakov
- Laboratory of Mass Spectrometric Metabolomic Diagnostics, Institute of Biomedical Chemistry, Moscow, Russia
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18
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Tanrikulu AM, Ozdilek B, Agirbasli M. Serum Levels of Plasminogen Activator Inhibitor-1 in Patients with Parkinson's Disease. Med Princ Pract 2024:1-7. [PMID: 39134015 DOI: 10.1159/000540854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 08/08/2024] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVES The aim of the study was to investigate serum plasminogen activator inhibitor-1 (PAI-1) levels of patients with Parkinson's disease (PD) and their relationship with clinical findings and treatment of disease. METHODS The study included 125 PD patients and 48 healthy controls. Patients have been taking effective dopaminergic treatment regularly. The clinical severity of parkinsonism was assessed using the Hoehn and Yahr (HY) staging scale and the Unified PD Rating Scale (UPDRS). PAI-1 level analysis was performed by enzyme-linked immunosorbent assay. RESULTS Patients with PD had significantly lower serum PAI-1 levels than healthy controls (p < 0.001). Correlations with clinical findings showed only a marginally positive correlation between serum PAI-1 and HY score (r = 0.170, p = 0.05). In contrast, no significant correlation was demonstrated with the UPDRS score or other clinical parameters. CONCLUSION This is the first comprehensive analysis of serum PAI-1 levels in patients with PD. The distribution of PAI-1 in PD appears to be complex. The study results implicate that the paradoxical effects of tissue plasminogen activator on the brain parenchyma can be important in the pathophysiology of PD. Future studies are needed to elucidate the role of fibrinolytic system components in PD.
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Affiliation(s)
| | - Betul Ozdilek
- Department of Neurology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
- Clinic of Neurology, Ministry of Health Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Agirbasli
- Department of Cardiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
- Clinic of Cardiology, Ministry of Health Goztepe Training and Research Hospital, Istanbul, Turkey
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19
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Kobak Tur E, Ari BC. Serum cholesterol levels and Parkinson's disease: a detailed investigation in Turkish population. Neurol Res 2024:1-7. [PMID: 39128854 DOI: 10.1080/01616412.2024.2390193] [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: 05/30/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Parkinson's disease (PD) involves the progressive loss of dopaminergic neurons and the accumulation of α-synuclein. Elevated cholesterol levels may exacerbate α-synuclein aggregation, potentially contributing to PD. This study investigates the link between lipid profiles and PD severity, as well as cognitive functions in patients, aiming to inform pathogenesis and management strategies. METHODS Data from 250 PD patients and 100 healthy controls were analyzed. Serum cholesterol levels were compared with disease severity using Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn & Yahr Rating Scale (mH&Y). Mini-Mental State Examination (MMSE) assessed cognitive functions. RESULTS Of the participants, 45.4% were female, 54.6% male, with a mean age of 69.09 ± 11.13 years. Mean UPDRS score was 52.34 ± 26.32, mH&Y was 2.28 ± 0.91. Patients had significantly higher HDL levels (47.92 ± 11.63) than controls (45.40 ± 13.89) (p = 0.024). HDL levels were significantly higher in patients with cognitive impairment than in patients with cognitive normal (p = 0.004). On the contrary, triglyceride levels were significantly lower in those with cognitive impairment compared to those with cognitively normal (p = 0.005). Multivariate logistic regression showed being male associated with 3.796 times higher risk of illness, and HDL is associated with 1.030 times increased illness risk. CONCLUSION High HDL levels and male gender particularly increase the risk of Parkinson's disease. Additionally, HDL and triglyceride levels affect the cognition of PD patients. Further studies on the impact of cholesterol metabolism on the pathogenesis of PD could contribute to identifying effective treatment targets.
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Affiliation(s)
- Esma Kobak Tur
- Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Buse Cagla Ari
- Department of Neurology, Bahçeşehir University Medical Faculty, Istanbul, Turkey
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20
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Wu J, Yang M, Zhang Y, Ren YK, Ding CW, Ying CC, Wu QR, Wang CS, Sheng YJ, Mao P, Chen XF, Zhang YC, Liu CF. Changes in the correlation between substantia nigra hyperechogenicity area and Parkinson's disease severity at different Hoehn and Yahr stages. Neurol Sci 2024:10.1007/s10072-024-07697-0. [PMID: 39090356 DOI: 10.1007/s10072-024-07697-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND It is debatable whether the area of substantia nigra hyperechogenicity (SN+) in transcranial sonography (TCS) is related to Parkinson's disease (PD) severity. Iron deposition, which is associated with the formation of SN+, may have different effects on dopamine nerve function as PD progresses. However, little research has explored the association between the SN + area and disease severity of PD in stages. METHODS 612 PD patients with sufficient bone window were retrospectively included from a PD database, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) scores. Based on the Hoehn and Yahr (H-Y) scale, we classified the patients into seven groups (H-Y stage 1, 1.5, 2, 2.5, 3, 4, and 5) and then analyzed the correlations between the SN + area and the UPDRS scores separately. RESULTS Our results indicated a U-shaped relationship between the initial-SN + area and disease severity in PD: In the H-Y stage 1 group, the initial-SN + area was negatively correlated with the UPDRS total score (r = - 0.456, p < 0.001) and UPDRS-III score (r = - 0.497, p < 0.001). No correlation was observed in the groups of H-Y stages 1.5, 2, and 2.5. In the groups of H-Y stage ≥ 3, the initial-SN + area was positively correlated with the UPDRS total score and UPDRS-III score, with strongest correlation in the H-Y stage 5 group (all p values < 0.05). Moreover, the larger SN + area and average SN + area showed a similar evolutionary trend of correlation with UPDRS total score and UPDRS-III score. CONCLUSIONS Our study indicated a U-shaped correlation between the SN + area with the UPDRS total score and UPDRS-III score as H-Y stage progressed. The evolution of the correlation may reflect the evolution of underlying pathological mechanisms related to iron deposition in the substantia nigra.
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Affiliation(s)
- Jian Wu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Min Yang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Ying Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Ya Kun Ren
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Chang Wei Ding
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Chen Chu Ying
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Qiao Rui Wu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Cai Shan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Yu Jing Sheng
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Pan Mao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Xiao Fang Chen
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China
| | - Ying Chun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China.
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Antonsson M, Johansson K, Bonde Dalemo A, Ivehorn Axelsson C, Burge Å, Lesueur U, Hartelius L. Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson's disease or multiple sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:475-492. [PMID: 37787640 DOI: 10.1080/17549507.2023.2243402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE This study explored how respiration, voice, and speech were affected following expiratory muscle strength training (EMST) and maintenance training in persons with Parkinson's disease (PD) or multiple sclerosis (MS). METHOD Nine participants with PD and six with MS participated in a randomised study, where the effects of EMST, sham, and maintenance treatment were investigated. Outcome measures included maximum expiratory pressure (MEP); maximum phonation time (MPT); intelligibility; verbal diadochokinesis (DDK); speech rate; a self-report form on voice, speech, and communication; and open questions about how the participants experienced the intervention. Group comparisons were performed within and between groups. RESULT The PD and the MS groups both improved significantly in MEP, and this improvement remained after 3 months of maintenance EMST. An improvement was also seen in DDK. Post-EMST, 33% of the PD group and 80% of the MS group reported a positive effect on communication. CONCLUSION The results of this study support previous evidence that EMST has positive effects on expiratory pressure in persons with PD or MS, but its effect on voice and speech remains unclear. Since subjective reports of the intervention and effects on communication were predominantly positive, further research is needed on larger groups to explore appropriate outcome measures.
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Affiliation(s)
- Malin Antonsson
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Johansson
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bonde Dalemo
- Speech and Language Pathology Unit, Skaraborg Hospital, Gothenburg, Region Västra Götaland, Sweden
| | | | - Åsa Burge
- Department of Neurology, Angered Hospital, Region Västra Götaland, Sweden
| | - Ulrike Lesueur
- Department of Neurology, Angered Hospital, Region Västra Götaland, Sweden
| | - Lena Hartelius
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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22
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Khalil RM, Shulman LM, Gruber-Baldini AL, Shakya S, Fenderson R, Van Hoven M, Hausdorff JM, von Coelln R, Cummings MP. Simplification of Mobility Tests and Data Processing to Increase Applicability of Wearable Sensors as Diagnostic Tools for Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2024; 24:4983. [PMID: 39124030 PMCID: PMC11314738 DOI: 10.3390/s24154983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/21/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Quantitative mobility analysis using wearable sensors, while promising as a diagnostic tool for Parkinson's disease (PD), is not commonly applied in clinical settings. Major obstacles include uncertainty regarding the best protocol for instrumented mobility testing and subsequent data processing, as well as the added workload and complexity of this multi-step process. To simplify sensor-based mobility testing in diagnosing PD, we analyzed data from 262 PD participants and 50 controls performing several motor tasks wearing a sensor on their lower back containing a triaxial accelerometer and a triaxial gyroscope. Using ensembles of heterogeneous machine learning models incorporating a range of classifiers trained on a set of sensor features, we show that our models effectively differentiate between participants with PD and controls, both for mixed-stage PD (92.6% accuracy) and a group selected for mild PD only (89.4% accuracy). Omitting algorithmic segmentation of complex mobility tasks decreased the diagnostic accuracy of our models, as did the inclusion of kinesiological features. Feature importance analysis revealed that Timed Up and Go (TUG) tasks to contribute the highest-yield predictive features, with only minor decreases in accuracy for models based on cognitive TUG as a single mobility task. Our machine learning approach facilitates major simplification of instrumented mobility testing without compromising predictive performance.
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Affiliation(s)
- Rana M. Khalil
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA;
| | - Lisa M. Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (L.M.S.); (R.F.); (M.V.H.)
| | - Ann L. Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.L.G.-B.); (S.S.)
| | - Sunita Shakya
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.L.G.-B.); (S.S.)
| | - Rebecca Fenderson
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (L.M.S.); (R.F.); (M.V.H.)
| | - Maxwell Van Hoven
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (L.M.S.); (R.F.); (M.V.H.)
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6492416, Israel;
- Department of Physical Therapy, Faculty of Medicine & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Rainer von Coelln
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (L.M.S.); (R.F.); (M.V.H.)
| | - Michael P. Cummings
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA;
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23
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Schejter‐Margalit T, Binyamin NB, Thaler A, Maidan I, Cedarbaum JM, Orr‐Urtreger A, Gana Weisz M, Goldstein O, Giladi N, Mirelman A, Kizony R. Validity of the Short Weekly Calendar Planning Activity in patients with Parkinson disease and nonmanifesting LRRK2 and GBA carriers. Eur J Neurol 2024; 31:e16327. [PMID: 38743695 PMCID: PMC11235808 DOI: 10.1111/ene.16327] [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: 08/21/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Subtle executive dysfunction is common in people newly diagnosed with Parkinson disease (PD), even when general cognitive abilities are intact. This study examined the Short Weekly Calendar Planning Activity (WCPA-10)'s known-group construct validity, comparing persons with PD to healthy controls (HCs) and nonmanifesting carriers of LRRK2 and GBA gene mutations to HCs. Additionally, convergent and ecological validity was examined. METHODS The study included 73 participants: 22 with idiopathic PD (iPD) who do not carry any of the founder GBA mutations or LRRK2-G2019S, 29 nonmanifesting carriers of the G2019S-LRRK2 (n = 14) and GBA (n = 15) mutations, and 22 HCs. Known-group validity was determined using the WCPA-10, convergent validity by also using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT), and ecological validity by using the WCPA-10, Schwab and England Activities of Daily Living Scale (SE ADL), and Physical Activity Scale for the Elderly (PASE). RESULTS Known-group validity of the WCPA-10 was established for the iPD group only; they followed fewer rules (p = 0.020), were slower (p = 0.003) and less efficient (p = 0.001), used more strategies (p = 0.017) on the WCPA-10, and achieved significantly lower CTT scores (p < 0.001) than the HCs. The nonmanifesting carriers and HCs were similar on all cognitive tests. Convergent and ecological validity of the WCPA-10 were partially established, with few correlations between WCPA-10 outcome measures and the MoCA (r = 0.50, r = 0.41), CTT-2 (r = 0.43), SE ADL (r = 0.41), and PASE (r = 0.54, r = 0.46, r = 0.31). CONCLUSIONS This study affirms the known-group validity for most (four) WCPA-10 scores and partially confirms its convergent and ecological validity for PD.
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Affiliation(s)
- Tamara Schejter‐Margalit
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Occupational Therapy DepartmentUniversity of HaifaHaifaIsrael
| | | | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Jesse M. Cedarbaum
- Yale University School of Medicine and Coeruleus Clinical SciencesWoodbridgeConnecticutUSA
| | - Avi Orr‐Urtreger
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
- Genomic Research Laboratory for NeurodegenerationTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Mali Gana Weisz
- Genomic Research Laboratory for NeurodegenerationTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Orly Goldstein
- Genomic Research Laboratory for NeurodegenerationTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Rachel Kizony
- Occupational Therapy DepartmentUniversity of HaifaHaifaIsrael
- Occupational TherapySheba Medical CenterTel HashomerIsrael
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24
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Pereira LG, Rodrigues P, Viero FT, Kudsi SQ, Frare JM, Rech CT, Graiczicki G, Trevisan G. Prevalence of radicular neuropathic pain in idiopathic Parkinson's disease: A systematic review and meta-analysis. Ageing Res Rev 2024; 99:102374. [PMID: 38936433 DOI: 10.1016/j.arr.2024.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Parkinson's disease (PD) is estimated to impact up to 1 % of the global population aged 60 years and older. Among the non-motor manifestations of idiopathic PD, radicular neuropathic pain emerges as a noteworthy concern due to its potential for debility in affected individuals. In, this systematic review and meta-analysis we aimed to evaluate the prevalence of radicular neuropathic pain and thus provide evidence of how this painful symptom affects the lives of patients with idiopathic PD. We registered the research protocol for this study in PROSPERO (CRD42022327220). We searched the Embase, Scopus, and PubMed platforms for studies on PD and neuropathic pain until April 2023. The search yielded 36 articles considered to have a low risk of bias. The prevalence of radicular neuropathic pain in patients with PD was 12.7 %, without a difference when we consider the duration of diagnosis (cut-off < 7 years) or levodopa dosage (cut-off <600 mg/dL). Moreover, there was no variation in the prevalence of radicular neuropathic pain regarding a Hoehn and Yahr stage cut-off of <2.5 or >2.5. Of note, a limited number of patients received pain treatment (21.5 %). We also found that the source of publication bias is the use of the Ford criteria (FC), suggesting that this type of diagnostic criteria may contribute to an underdiagnosis of radicular neuropathic pain in patients with PD. This study underlines the necessity for a more discerning and comprehensive approach to the diagnosis and management of radicular neuropathic pain in patients with idiopathic PD.
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Affiliation(s)
- Leonardo Gomes Pereira
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Patrícia Rodrigues
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Fernanda Tibolla Viero
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Sabrina Qader Kudsi
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Julia Maria Frare
- Graduated Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Chaiane Tais Rech
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Gabriela Graiczicki
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil
| | - Gabriela Trevisan
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, (RS) 97105-900, Brazil.
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25
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Ban R, Ahn J, Simpkins C, Lazarus J, Yang F. Dynamic gait stability in people with mild to moderate Parkinson's disease. Clin Biomech (Bristol, Avon) 2024; 118:106316. [PMID: 39059102 DOI: 10.1016/j.clinbiomech.2024.106316] [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: 05/02/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Falls are a serious health threat for people with Parkinson's disease. Dynamic gait stability has been associated with fall risk. Developing effective fall prevention interventions requires a sound understanding of how Parkinson's disease affects dynamic gait stability. This study compared dynamic gait stability within the Feasible Stability Region framework between people with and without Parkinson's disease during level walking at a self-selected speed. METHODS Twenty adults with Parkinson's disease and twenty age- and gender-matched healthy individuals were recruited. Dynamic gait stability at two gait instants: touchdown and liftoff, was assessed as the primary outcome measurement. Spatiotemporal gait parameters, including stance phase duration, step length, gait speed, and cadence were determined as explanatory variables. FINDINGS People with Parkinson's disease walked more slowly (p < 0.001) with a shorter step (p = 0.05), and prolonged stance phase (p = 0.04) than their healthy peers with moderate to large effect sizes. Dynamic gait stability did not show any group-associated differences (p > 0.36). INTERPRETATION Despite the different gait parameters between groups, people with Parkinson's disease exhibited similar dynamic gait stability to their healthy counterparts. To compensate for the potential dynamic gait stability deficit resulting from slow gait speed, individuals with Parkinson's disease adopted a short step length to shift the center of mass motion state closer to the Feasible Stability Region. Our findings could provide insight into the impact of Parkinson's disease on the control of dynamic gait stability.
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Affiliation(s)
- Rebecca Ban
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Jiyun Ahn
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Joash Lazarus
- Atlanta Neuroscience Institute, Atlanta, GA 30327, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA.
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Hamed SA, Hadad AFE. The effect of anticholinergic drugs on cognition of patients with Parkinson's disease: a cohort study from the Egyptian population. Expert Rev Clin Pharmacol 2024; 17:743-753. [PMID: 38781022 DOI: 10.1080/17512433.2024.2359955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Cognitive dysfunction is a non-motor manifestation of Parkinson's disease (PD). We aimed to determine the frequency and patterns of cognitive dysfunction in treated patients with PD and their predictors. RESEARCH DESIGN AND METHODS This study included 80 patients (male = 48; female = 32) and 30 healthy individuals. They underwent neuropsychiatric evaluations. Measurements included Beck's depression inventory - II (BDI-II), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). RESULTS Patients had mean age of 55.56 ± 9.06 yrs, duration of PD of 4.86 ± 2.71 yrs and Hoehn and Yahr Scoring of 2.19 ± 0.89. They were on levodopa/carbidopa therapy and adjuvant therapy with benztropine mesylate, an anticholinergic drug, (n = 51) or amantadine sulfate, a dopaminergic drug, (n = 29). Sixteen (20%) had moderate depressive symptoms. Mild and moderate cognitive impairments were reported in 38.8% and 28.8% (by MMSE) and 46.3% and 31.3% (by MoCA). Patients had lower global cognitive scoring (p = 0.0001) and scorings of different cognitive functions (naming, attention, language, abstraction, memory and orientation) than controls. Patients treated with benztropine had lower cognition than with amantadine. Correlation analyses showed that lower cognition was only associated with chronic PD and its treatment (p = 0.0001). CONCLUSIONS Cognitive dysfunction is common with PD (77.5%) particularly with anticholinergic drugs. De-prescription of anticholinergics is recommended for patients with PD.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
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Tan WQ, Liu Q, Cen MJ, Leong II, Pan ZQ, Liao MX, Zhuang LX. Efficacy of hyperbaric oxygen therapy as an adjunct therapy in the treatment of sleep disorders among patients with Parkinson's disease: a meta-analysis. Front Neurol 2024; 15:1328911. [PMID: 39144713 PMCID: PMC11322060 DOI: 10.3389/fneur.2024.1328911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Objective To systematically evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjunct therapy for treating sleep disorders in patients with Parkinson's disease (PD). Methods We conducted comprehensive searches in eight databases from inception through September 2023, including PubMed, Cochrane Library, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database. The objective was to identify randomized controlled trials (RCTs) evaluating HBOT's effectiveness in alleviating sleep disorder symptoms in PD patients as an adjunct therapy. Literature screening and data extraction were independently executed by the authors. Meta-analyses were performed using Review Manager 5.3 software, and publication bias and sensitivity analyses were assessed using Stata 17.0 software. Results Seven RCTs involving 461 participants were included. The findings revealed that the addition of HBOT significantly enhanced sleep efficiency (MD = 15.26, 95% CI [10.89, 19.63], p < 0.00001), increased time in bed (MD = 69.65, 95% CI [43.01, 96.30], p < 0.00001), total sleep time (MD = 75.87, 95% CI [25.42, 126.31], p = 0.003), slow-wave sleep (SWS) time (MD = 6.14, 95% CI [3.95, 8.34], p < 0.00001), and rapid eye movement sleep (REM) time (MD = 4.07, 95% CI [2.05, 6.08], p < 0.0001), and reduced awakening frequency (MD = -11.55, 95% CI [-15.42, -7.68], p < 0.00001) and sleep latency (MD = -6.60, 95% CI [-9.43, -3.89], p < 0.00001). Additionally, significant improvements were observed in the Pittsburgh Sleep Quality Index (PSQI) (MD = -2.52, 95% CI [-2.85, -2.18], p < 0.00001), Epworth Sleepiness Scale (ESS) (MD = -2.90, 95% CI [-3.34, -2.47], p < 0.00001), Unified Parkinson's Disease Rating Scale Part III (UPDRS III) (MD = -1.32, 95% CI [-2.16, -0.47], p = 0.002), and Hoehn and Yahr grading (H-Y grading) (MD = -0.15, 95% CI [-0.28, -0.01], p = 0.03). Conclusion The current meta-analysis supports the efficacy of HBOT as an adjunct therapy in managing sleep disorders in PD patients. It is recommended for PD patients experiencing sleep disturbances.Systematic review registration:https://www.crd.york.ac.uk/, identifier: CRD42023462201.
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Affiliation(s)
- Wei-qiang Tan
- Guangxi University of Chinese Medicine, Nanning, China
| | - Qing Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-jun Cen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ian I. Leong
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhao-quan Pan
- Guangxi University of Chinese Medicine, Nanning, China
| | - Mu-xi Liao
- Shenzhen Nanshan District Chinese Medicine Hospital (The First Affiliated Hospital of Guangzhou University of Chinese Medicine at Nanshan District, Shenzhen city), Shenzhen, China
| | - Li-xing Zhuang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Burns J, Landes RD, Pillai L, Virmani T. Tandem gait step-width increases more rapidly in more severely affected people with Parkinson's disease. Parkinsonism Relat Disord 2024; 127:107078. [PMID: 39096549 DOI: 10.1016/j.parkreldis.2024.107078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Tandem gait performance reportedly predicts fall risk in people with Parkinson's disease (PwPD) and help distinguish PwPD from atypical parkinsonism. In a cross-sectional study, we previously showed that tandem gait step-width widens with increasing Hoehn and Yahr (H&Y) staging scores. In this longitudinal study, we aimed to determine if progression in tandem gait deficits is dependent on disease severity in PwPD. METHODS Participants underwent an instrumented tandem gait measurement every 6 months for at least 2 years. The mean and variability of 4 tandem gait parameters were calculated at each visit: step-width, step-length, step-time, and step-velocity. The change in these parameters over time for 3 H&Y groups (stage 1, 2 and 2.5+) compared to aging controls was determined using a random coefficients regression model. The annual percent change in tandem gait parameters was correlated with initial disease features using Kendall's τB. RESULTS 66 participants were analyzed (46 PD, 20 controls). Mean step-width increased over time in an H&Y stage-dependent manner, with H&Y 2 and H&Y 2.5+ experiencing increases of 6% and 10% per year (p = 0.001 and 0.024 respectively). Annual percent-change in step-width was correlated with initial motor Unified Parkinson's Disease Rating Scale (UPDRS) scores (Kendall's τB = 0.229), total UPDRS scores (τB = 0.249), H&Y scores (τB = 0.266) and inversely correlated with Montreal Cognitive Assessment (MoCA) scores (τB = -0.209; ps ≤ 0.019). CONCLUSION Tandem gait step-width widens over time more rapidly in more severely affected PD patients. These results suggest that tandem gait should be routinely clinically evaluated and considered in the management of imbalance in PwPD.
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Affiliation(s)
- Jennie Burns
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Reid D Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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Turcu-Stiolica A, Naidin MS, Halmagean S, Ionescu AM, Pirici I. The Impact of the Dietary Intake of Vitamin B12, Folic Acid, and Vitamin D3 on Homocysteine Levels and the Health-Related Quality of Life of Levodopa-Treated Patients with Parkinson's Disease-A Pilot Study in Romania. Diagnostics (Basel) 2024; 14:1609. [PMID: 39125485 PMCID: PMC11311973 DOI: 10.3390/diagnostics14151609] [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: 07/02/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that the levodopa treatment of Parkinson's disease (PD) elevates circulating homocysteine levels, which are associated with an increased risk of cardiovascular and neurological disorders, or thrombosis. The present trial aimed to examine whether the intake of vitamin B12, folic acid, and vitamin D3 supplements improved homocysteine level and quality of life (QoL). MATERIALS AND METHODS An interventional prospective trial was conducted in multiple centers across Romania. Participants with clinically established PD taking at least 300 mg/day of levodopa for more than 1 year received a daily tablet of a supplement containing 800 UI of vitamin D3, 1000 µg of folic acid, and 15 µg of vitamin B12. They were followed for 6 months and their serum homocysteine, vitamin B12, vitamin D, and QoL scores were measured at baseline and at 6 months of treatment. QoL was measured using a 15D questionnaire, which assesses mobility, vision, hearing, breathing, sleeping, eating, speech, excretion, usual activities, mental function, discomfort and symptoms, depression, distress, vitality, and sexual activity. RESULTS Twenty-four PD patients with a mean age of 71 ± 5.04 years (54.2% male and 45.8% female) finished the study. After the intervention, the mean score of speech, mental function, discomfort and symptoms, depression, and QoL significantly increased (p < 0.05 for all). Also, the serum homocysteine and vitamin D were significantly enhanced (p < 0.0001 and p = 0.025, respectively). Changes in vitamin B12 were not statistically significant at 6 months of treatment (p = 0.996). No gender differences were found among the changes that we have demonstrated for homocysteine, vitamin B12, vitamin D, and QoL levels (p < 0.05 for all). CONCLUSIONS The findings of this study showed that the dietary intake of vitamin B12, folic acid, and vitamin D3 remarkably decreased the dimensions of homocysteine and finally increased the total score of QoL in PD patients. We have successfully captured the potential benefits of the supplementation regimen over time and provided insights into the broader implications for managing PD with a focus on nutritional support.
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Affiliation(s)
- Adina Turcu-Stiolica
- Pharmaceutical Management and Marketing, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela-Simona Naidin
- Pharmaceutical Management and Marketing, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | - Ana Maria Ionescu
- Department of Neurology, Ovidius University, 900123 Constanta, Romania;
| | - Ionica Pirici
- Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Bovenzi R, Conti M, Simonetta C, Bissacco J, Mascioli D, Michienzi V, Pieri M, Cerroni R, Liguori C, Pierantozzi M, Stefani A, Mercuri NB, Schirinzi T. Contribution of testosterone and estradiol in sexual dimorphism of early-onset Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02811-0. [PMID: 39052119 DOI: 10.1007/s00702-024-02811-0] [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: 05/06/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
Early-onset Parkinson's disease (EOPD) occurs during the fertile life, when circulating neuroactive sex hormones might enhance the sexual dimorphism of the disease. Here, we aimed to examine how sex hormones can contribute to sex differences in EOPD patients. A cohort of 34 EOPD patients, 20 males and 14 females, underwent comprehensive clinical evaluation of motor and non-motor disturbances. Blood levels of estradiol, total testosterone, follicle-stimulating hormone, and luteinizing hormone were measured in all patients and correlated to clinical features. We found that female patients exhibited greater non-motor symptoms and a relatively higher rate of dystonia than males. In females, lower estradiol levels accounted for higher MDS-UPDRS-II and III scores and more frequent motor complications, while lower testosterone levels were associated with a major occurrence of dystonia. In male patients, no significant correlations emerged. In conclusion, this study highlighted the relevance of sex hormone levels in the sexual dimorphism and unique phenotype of EOPD.
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Affiliation(s)
- Roberta Bovenzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Matteo Conti
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Clara Simonetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Jacopo Bissacco
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Davide Mascioli
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Vito Michienzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Massimo Pieri
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Clinical Biochemistry, Tor Vergata University Hospital, Rome, Italy
| | - Rocco Cerroni
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Mariangela Pierantozzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Alessandro Stefani
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
- UOSD Parkinson Centre, Tor Vergata University Hospital, Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, Rome, 00133, Italy.
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Stoyanova-Piroth G, Milanov I, Stambolieva K. Association between pain threshold and manifested pain assessed using a PD-specific pain scale in Parkinson's disease. Front Neurol 2024; 15:1420696. [PMID: 39131046 PMCID: PMC11312374 DOI: 10.3389/fneur.2024.1420696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
Background The neurodegenerative process in Parkinson's disease (PD) affects both dopaminergic and non-dopaminergic structures, which determine the wide range of motor and non-motor symptoms (NMS), including different types of pain. Diverse mechanisms contribute to pain in PD. Abnormal nociceptive processing is considered a distinctive feature of the disease. Objective In the present study, we used a validated PD-specific pain assessment tool to investigate self-reported pain in PD patients and to analyze the association with the objective pain threshold. Methods The RIII component of the nociceptive flexor reflex was assessed in 35 patients with PD and was compared to 40 healthy controls. Self-reported pain was measured using the Bulgarian version of the King's Parkinson's Disease Pain Scale (KPPS-BG). A correlation analysis was used to investigate the relationship between the objective nociceptive threshold and PD pain as assessed by KPPS-BG. Results PD patients had a significantly lower RIII threshold than control individuals (the mean SD value was 6.24 ± 1.39 vs. 10.33 ± 1.64) when assessed in the "off" state. A statistically significant (p < 0.05) fairly negative Spearman's correlation was observed between the decreased spinal nociceptive threshold and fluctuation-related pain (-0.31). Domain 4, "nocturnal pain" (-0.21), and the KPPS-BG total score (-0.21) showed a weak negative correlation. An insignificant positive correlation was found between domain 6-"discoloration, edema/swelling"-and the RIII threshold. A higher Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score and modified Hoehn and Yahr (H&Y) scale are associated with a decreased nociceptive flexor reflex threshold. Conclusion The results of the present study demonstrate the important role of increased spinal nociception in the occurrence of pain, which is associated with fluctuations and, to a lesser extent, nocturnal pain.
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Affiliation(s)
- Galina Stoyanova-Piroth
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
- ZURZACH Care, Neurorehabilitation, Rehaklinik Baden Dättwil, Baden, Switzerland
| | - Ivan Milanov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
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Yalçin M, Peralta AR, Bentes C, Silva C, Guerreiro T, Ferreira JJ, Relógio A. Molecular characterization of the circadian clock in patients with Parkinson's disease-CLOCK4PD Study protocol. PLoS One 2024; 19:e0305712. [PMID: 39028707 PMCID: PMC11259294 DOI: 10.1371/journal.pone.0305712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/02/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Circadian rhythms (CRs) orchestrate intrinsic 24-hour oscillations which synchronize an organism's physiology and behaviour with respect to daily cycles. CR disruptions have been linked to Parkinson's Disease (PD), the second most prevalent neurodegenerative disorder globally, and are associated to several PD-symptoms such as sleep disturbances. Studying molecular changes of CR offers a potential avenue for unravelling novel insights into the PD progression, symptoms, and can be further used for optimization of treatment strategies. Yet, a comprehensive characterization of the alterations at the molecular expression level for core-clock and clock-controlled genes in PD is still missing. METHODS AND ANALYSIS The proposed study protocol will be used to characterize expression profiles of circadian genes obtained from saliva samples in PD patients and controls. For this purpose, 20 healthy controls and 70 PD patients will be recruited. Data from clinical assessment, questionnaires, actigraphy tracking and polysomnography will be collected and clinical evaluations will be repeated as a follow-up in one-year time. We plan to carry out sub-group analyses considering several clinical factors (e.g., biological sex, treatment dosages, or fluctuation of symptoms), and to correlate reflected changes in CR of measured genes with distinct PD phenotypes (diffuse malignant and mild/motor-predominant). Additionally, using NanoStringⓇ multiplex technology on a subset of samples, we aim to further explore potential CR alterations in hundreds of genes involved in neuropathology pathways. DISCUSSION CLOCK4PD is a mono-centric, non-interventional observational study aiming at the molecular characterization of CR alterations in PD. We further plan to determine physiological modifications in sleep and activity patterns, and clinical factors correlating with the observed CR changes. Our study may provide valuable insights into the intricate interplay between CR and PD with a potential to be used as a predictor of circadian alterations reflecting distinct disease phenotypes, symptoms, and progression outcomes.
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Affiliation(s)
- Müge Yalçin
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Ana Rita Peralta
- EEG/Sleep Laboratory, Department Neurosciences and Mental Health, Unidade Local de Saude Santa Maria—ULSSM, Lisbon, Portugal
- Department of Neurology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS-Campus Neurológico, Torres Vedras, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Bentes
- EEG/Sleep Laboratory, Department Neurosciences and Mental Health, Unidade Local de Saude Santa Maria—ULSSM, Lisbon, Portugal
- Department of Neurology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J. Ferreira
- Department of Neurology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS-Campus Neurológico, Torres Vedras, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Angela Relógio
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
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McGinley JL, Nakayama Y. Exercise for People with Parkinson's Disease: Updates and Future Considerations. Phys Ther Res 2024; 27:67-75. [PMID: 39257520 PMCID: PMC11382789 DOI: 10.1298/ptr.r0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/22/2024] [Indexed: 09/12/2024]
Abstract
Parkinson's disease (PD) is now the world's fastest-growing neurological disorder with rapidly rising prevalence and increasing demand for effective health services. Recent research has focused on the importance of early diagnosis and proactive management of physical function. Accumulating evidence indicates that reduced physical activity levels and mild pre-clinical disability are present in many people prior to a clinical diagnosis, perhaps developing over years. Early referral to a physiotherapist at the time of diagnosis is now recommended in global guidelines. Multiple forms of exercise have been found to have benefits in early and mid-stage disease across a range of motor and non-motor symptoms. Evidence from longitudinal studies confirms that disability is delayed when regular exercise is sustained over long periods. Exercise is now recognized as an essential component of treatment, in combination with medical therapies. Contemporary physiotherapy interventions now combine health behavior change techniques with physical exercise to promote the development of long-term exercise adherence. Advances in technology and digital health have progressed quickly and now offer opportunities for remote assessment and monitoring, remote exercise supervision, and support adherence through feedback and motivational strategies. Recent biomedical discoveries forecast improved earlier and more accurate diagnosis of PD, allowing opportunities for earlier interventions. Current research in progress will provide important insights into the dose and intensity of aerobic exercise in PD. Physiotherapists have important roles in advocacy and education in conjunction with care delivery to support access to evidence-based care for all people with PD.
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Affiliation(s)
- Jennifer L McGinley
- Physiotherapy Department, Melbourne School of Health Sciences, The University of Melbourne, Australia
| | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Japan
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Barba L, Bellomo G, Oeckl P, Chiasserini D, Gaetani L, Torrigiani EG, Paoletti FP, Steinacker P, Abu-Rumeileh S, Parnetti L, Otto M. CSF neurosecretory proteins VGF and neuroserpin in patients with Alzheimer's and Lewy body diseases. J Neurol Sci 2024; 462:123059. [PMID: 38850771 DOI: 10.1016/j.jns.2024.123059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND VGF and neuroserpin are neurosecretory proteins involved in the pathophysiology of neurodegenerative diseases. We aimed to evaluate their cerebrospinal fluid (CSF) concentrations in patients with Alzheimer's disease (AD) and Lewy body disease (LBD). METHODS We measured CSF VGF [AQEE] peptide and neuroserpin levels in 108 LBD patients, 76 AD patients and 37 controls, and tested their associations with clinical scores and CSF AD markers. RESULTS We found decreased CSF levels of VGF [AQEE] in patients with LBD and dementia compared to controls (p = 0.016) and patients with AD-dementia (p = 0.011), but with significant influence of age and sex distribution. Moreover, we observed, on the one hand, a significant associations between lower VGF [AQEE] and neuroserpin levels and poorer cognitive performance (i.e., lower Mini-Mental State Examination scores). On the other hand, higher levels of CSF tau proteins, especially pTau181, were significantly associated with higher concentrations of VGF [AQEE] and neuroserpin. Indeed, LBD patients with AD-like CSF profiles, especially T+ profiles, had higher levels of VGF [AQEE] and neuroserpin compared to controls and LBD/T- cases. DISCUSSION CSF VGF [AQEE] and neuroserpin may show a complex relationship with cognitive decline when the levels are reduced, and with AD pathology when levels are increased. They may represent novel markers of neurosecretory impairment in neurodegenerative disorders.
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Affiliation(s)
- Lorenzo Barba
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Giovanni Bellomo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Patrick Oeckl
- Department of Neurology, Ulm University, Helmholzstrasse 8/1, 89081 Ulm, Germany; German Center for Neurodegenerative Diseases (DZNE e.V.), Helmholzstrasse 8/1, 89081 Ulm, Germany
| | - Davide Chiasserini
- Section of Biochemistry, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Edoardo Guido Torrigiani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Federico Paolini Paoletti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Petra Steinacker
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Markus Otto
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany.
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De Jesus S, Daya A, Blumberger L, Lewis MM, Leslie D, Tabbal SD, Dokholyan R, Snyder AM, Mailman RB, Huang X. Prevalence of Late-Stage Parkinson's Disease in the US Healthcare System: Insights from TriNetX. Mov Disord 2024. [PMID: 38962960 DOI: 10.1002/mds.29900] [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: 01/17/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Patients in late-stage Parkinson's disease (PDLS) are caregiver-dependent, have low quality of life, and higher healthcare costs. OBJECTIVE To estimate the prevalence of PDLS patients in the current US healthcare system. METHODS We downloaded the 2010-2022 data from the TriNetX Diamond claims network that consists of 92 US healthcare sites. PD was identified using standard diagnosis codes, and PDLS was identified by the usage of wheelchair dependence, personal care assistance, and/or presence of diagnoses of dementia. Age of PDLS identification and survival information were obtained and stratified by demographic and the disability subgroups. RESULTS We identified 1,031,377 PD patients in the TriNetX database. Of these, 18.8% fitted our definition of PDLS (n = 194,297), and 10.2% met two or more late-stage criteria. Among all PDLS, the mean age of PDLS identification was 78.1 (±7.7) years, and 49% were already reported as deceased. PDLS patients were predominantly male (58.5%) with similar distribution across PDLS subgroups. The majority did not have race (71%) or ethnicity (69%) information, but for the available information >90% (n = 53,162) were White, 8.2% (n = 5121) Hispanic/Latino, 7.8% (n = 4557) Black, and <0.01% (n = 408) Asian. Of the PDLS cohort, 71.6% identified with dementia, 12.9% had personal care assistance, and 4.8% were wheelchair-bound. CONCLUSIONS Late-stage patients are a significant part of the PD landscape in the current US healthcare system, and largely missed by traditional motor-based disability staging. It is imperative to include this population as a clinical, social, and research priority. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sol De Jesus
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Annika Daya
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Liba Blumberger
- Department of Public Health Science, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mechelle M Lewis
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Doug Leslie
- Department of Public Health Science, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Samer D Tabbal
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Rachel Dokholyan
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Amanda M Snyder
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Richard B Mailman
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Translational Brain Research Center, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Shimozono T, Shiiba T, Takano K. Radiomics score derived from T1-w/T2-w ratio image can predict motor symptom progression in Parkinson's disease. Eur Radiol 2024:10.1007/s00330-024-10886-2. [PMID: 38958697 DOI: 10.1007/s00330-024-10886-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/08/2024] [Accepted: 04/26/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES To clarify the association between a radiomics score (Rad-score) derived from T1-weighted signal intensity to T2-weighted signal intensity (T1-w/T2-w) ratio images and the progression of motor symptoms in Parkinson's disease (PD). MATERIALS AND METHODS This retrospective study included patients with PD enrolled in the Parkinson's Progression Markers Initiative. The Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III score ≥ 33 and/or Hoehn and Yahr stage ≥ 3 indicated motor function decline. The Rad-score was constructed using radiomics features extracted from T1-w/T2-w ratio images. The Kaplan-Meier analysis and Cox regression analyses were used to assess the time differences in motor function decline between the high and low Rad-score groups. RESULTS A total of 171 patients with PD were divided into training (n = 101, mean age at baseline, 61.6 ± 9.3 years) and testing (n = 70, mean age at baseline, 61.6 ± 10 years). The patients in the high Rad-score group had a shorter time to motor function decline than those in the low Rad-score group in the training dataset (log-rank test, p < 0.001) and testing dataset (log-rank test, p < 0.001). The multivariate Cox regression using the Rad-score and clinical factors revealed a significant association between the Rad-score and motor function decline in the training dataset (HR = 2.368, 95%CI:1.423-3.943, p < 0.001) and testing dataset (HR = 2.931, 95%CI:1.472-5.837, p = 0.002). CONCLUSION Rad-scores based on radiomics features derived from T1-w/T2-w ratio images were associated with the progression of motor symptoms in PD. CLINICAL RELEVANCE STATEMENT The radiomics score derived from the T1-weighted/T2-weighted ratio images offers a predictive tool for assessing the progression of motor symptom in patients with PD. KEY POINTS Radiomics score derived from T1-weighted/T2-weighted ratio images is correlated with the motor symptoms of Parkinson's disease. A high radiomics score correlated with faster motor function decline in patients with Parkinson's disease. The proposed radiomics score offers predictive insight into the progression of motor symptoms of Parkinson's disease.
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Affiliation(s)
- Takuya Shimozono
- Department of Neuroimaging and Brain Science, Major in Health Science, Graduate School of Health Sciences, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuro Shiiba
- Department of Molecular Imaging, Clinical Collaboration Unit, School of Medical Sciences, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Kazuki Takano
- Department of Molecular Imaging, Clinical Collaboration Unit, School of Medical Sciences, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Conti M, Garasto E, Bovenzi R, Ferrari V, Mercuri NB, Di Giuliano F, Cerroni R, Pierantozzi M, Schirinzi T, Stefani A, Rocchi C. Insular and limbic abnormal functional connectivity in early-stage Parkinson's disease patients with autonomic dysfunction. Cereb Cortex 2024; 34:bhae270. [PMID: 38967041 DOI: 10.1093/cercor/bhae270] [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: 04/02/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
Autonomic symptoms in Parkinson's disease result from variable involvement of the central and peripheral systems, but many aspects remain unclear. The analysis of functional connectivity has shown promising results in assessing the pathophysiology of Parkinson's disease. This study aims to investigate the association between autonomic symptoms and cortical functional connectivity in early Parkinson's disease patients using high-density EEG. 53 early Parkinson's disease patients (F/M 18/35) and 49 controls (F/M 20/29) were included. Autonomic symptoms were evaluated using the Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction score. Data were recorded with a 64-channel EEG system. We analyzed cortical functional connectivity, based on weighted phase-lag index, in θ-α-β-low-γ bands. A network-based statistic was used to perform linear regression between Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction score and functional connectivity in Parkinson's disease patients. We observed a positive relation between the Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction score and α-functional connectivity (network τ = 2.8, P = 0.038). Regions with higher degrees were insula and limbic lobe. Moreover, we found positive correlations between the mean connectivity of this network and the gastrointestinal, cardiovascular, and thermoregulatory domains of Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction. Our results revealed abnormal functional connectivity in specific areas in Parkinson's disease patients with greater autonomic symptoms. Insula and limbic areas play a significant role in the regulation of the autonomic system. Increased functional connectivity in these regions might represent the central compensatory mechanism of peripheral autonomic dysfunction in Parkinson's disease.
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Affiliation(s)
- Matteo Conti
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Elena Garasto
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Roberta Bovenzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Ferrari
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Nicola B Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Rocco Cerroni
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
- UOSD Parkinson Centre, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Mariangela Pierantozzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Tommaso Schirinzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Alessandro Stefani
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
- UOSD Parkinson Centre, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Camilla Rocchi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
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Fabbri M, Rousseau V, Corvol JC, Sommet A, Tubach F, De Rycke Y, Bertille N, Selvarasa Y, Carvalho S, Chaigneau V, Brefel-Courbon C, Ory-Magne F, Tessier S, Tir M, Bereau M, Meissner WG, Thiriez C, Marques A, Remy P, Schneider V, Moro E, Defebvre L, Houeto JL, Prange S, Eusebio A, Geny C, Frismand S, Damier P, Reuther CG, Castelnovo G, Benatru I, De Maindreville AD, Drapier S, Maltête D, Lagha-Boukbiza O, Rascol O. Amantadine use in the French prospective NS-Park cohort. J Neural Transm (Vienna) 2024; 131:799-811. [PMID: 38578434 DOI: 10.1007/s00702-024-02772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess amantadine use and associated factors in the patients with Parkinson's disease (PD). BACKGROUND Immediate-release amantadine is approved for the treatment of PD and is largely used in clinical practice to treat "levodopa-induced dyskinesia (LIDs). Its use varies according to countries and PD stages. The prospective NS-Park cohort collects features of PD patients followed by 26 French PD Expert Centres. METHODS Variables used for the analyses included demographics, motor and non-motor PD symptoms and motor complications [motor fluctuations (MFs), LIDs)], antiparkinsonian pharmacological classes and levodopa equivalent daily dose (LEDD). We evaluated: (i) prevalence of amantadine use and compared clinical features of amantadine users vs. non-users (cross-sectional analysis); (ii) factors associated with amantadine initiation (longitudinal analysis); (iii) amantadine effect on LIDs, MFs, apathy, impulse control disorders and freezing of gait (Fog) (longitudinal analysis). RESULTS Amantadine use prevalence was 12.6% (1,585/12,542, median dose = 200 mg). Amantadine users were significantly younger, with longer and more severe PD symptoms, greater LEDD and more frequent use of device-aided/surgical treatment. Factors independently associated with amantadine initiation were younger age, longer PD duration, more frequent LIDs, MFs and FoG, higher LEDD and better cognitive function. 9 of the 658 patients on amantadine had stopped it at the following visit, after 12-18 months (1.3%). New users of amantadine presented a higher improvement in LIDs and MF compared to amantadine never users. CONCLUSIONS About 12% of PD patients within the French NS-Park cohort used amantadine, mostly those with younger age and more severe PD. Amantadine initiation was associated with a subsequent reduction in LIDs and MFs.
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Affiliation(s)
- Margherita Fabbri
- Department of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC1436, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France.
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire-Faculté de Médecine, Toulouse, France.
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France.
| | - Vanessa Rousseau
- Department of Clinical Pharmacology, Clinical Investigation Center CIC1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Christophe Corvol
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Paris, France
- Department of Neurology, Assistance Publique Hôpitaux de Paris, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | - Agnès Sommet
- Department of Clinical Pharmacology, Clinical Investigation Center CIC1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, F75013, Paris, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, F75013, Paris, France
| | - Nathalie Bertille
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, F75013, Paris, France
| | - Yajiththa Selvarasa
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Paris, France
- Department of Neurology, Assistance Publique Hôpitaux de Paris, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stephanie Carvalho
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Paris, France
- Department of Neurology, Assistance Publique Hôpitaux de Paris, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Christine Brefel-Courbon
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center CIC1436, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse NeuroImaging Center, Inserm, University of Toulouse 3, Toulouse, France
| | - Fabienne Ory-Magne
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Service de Neurologie, Centre Hospitalier Universitaire, Toulouse, Université de Toulouse-Toulouse 3, INSERM, UMR1214 Toulouse NeuroImaging Centre "TONIC," Center of Excellence in Neurodegeneration (CoEN), NeuroToul, Parkinson Expert Center, Clinical Investigation Center CIC1436, Toulouse, France
| | - Samuel Tessier
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire-Faculté de Médecine, Toulouse, France
| | - Melissa Tir
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, University Hospital of Amiens, Amiens, France
| | - Matthieu Bereau
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, University Hospital of Besançon, Besançon, France
| | - Wassilios G Meissner
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, NS-Park/FCRIN Network, 33000, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, UMR5293, 33000, Bordeaux, France
- Dept. Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research, Christchurch, New Zealand
| | - Claire Thiriez
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology and Parkinson Expert Centre, Caen University-Hospital, Caen, France
| | - Ana Marques
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Neurology Department, Université Clermont Auvergne, EA7280 NPsy-Sydo, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Philippe Remy
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Centre Expert Parkinson, Neurologie, CHU Henri Mondor, AP-HP, Equipe NPI, IMRB INSERM Et Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Vincent Schneider
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Département de Neurologie, Centre Hospitalier Universitaire François Mitterrand, Université de Bourgogne, Dijon, France
| | - Elena Moro
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Unité des Troubles du Movement, Service de Neurologie, Coordinatrice du Pole PRENELE, CHU de Grenoble, Assesseur Relations Internationales, Faculté de Médécine, Université Grenoble Alpes, President Elect, European Academy of Neurology, Grenoble, France
| | - Luc Defebvre
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Movement Disorders Department, Lille University, Inserm 1172, Lille, France
| | - Jean Luc Houeto
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, Limoges University Hospital, Inserm, U1094, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, 87042, Limoges Cedex 01, France
| | - Stephane Prange
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Expert Parkinson Center, Lyon University, Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Oullins, France
- Marc Jeannerod Institute for Cognitive Neuroscience, CNRS, UMR 5229, Bron, France
| | - Alexandre Eusebio
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Movement Disorders Unit, Neurology Department, University Hospital of Marseille, Marseille, France
| | - Christian Geny
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- EuroMov, Univ. Montpellier, Montpellier, France
- Department of Neurology, CHRU Montpellier, Montpellier, France
| | - Solène Frismand
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Service de Neurologie, Centre Expert Parkinson, Centre Mémoire de Ressources et de Recherche de Lorraine, Hôpital Central Nancy, Nancy, France
| | - Philippe Damier
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Service de Neurologie, CHU Nantes, INSERM, CIC, 1413, Nantes, France
| | - Caroline Giordana Reuther
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Giovanni Castelnovo
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, University Hospital of Nîmes, Nîmes, France
| | - Isabelle Benatru
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Departement of Neurology, Poitiers University Hospital, INSERM, CHU de Poitiers, Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Anne Doe De Maindreville
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, Hôpital Maison Blanche, Reims, France
| | - Sophie Drapier
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, Pontchaillou University Hospital, CIC INSERM 1414, Rennes, France
| | - David Maltête
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, CEP Rouen, INSERM U1239, Mont-Saint-Aignan, France
| | - Ouhaid Lagha-Boukbiza
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC1436, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire-Faculté de Médecine, Toulouse, France
- French NS-PARK/F-CRIN Network, Clermont-Ferrand, France
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Kondo Y, Ariake Y, Suzuki I, Kato T, Furukawa K, Bando K, Nakashiba A, Watabe T, Miyazaki Y, Mukai Y, Hara T, Takahashi Y. Two-minute standing endurance test for axial postural abnormalities in patients with Parkinson's disease. Gait Posture 2024; 112:81-87. [PMID: 38749293 DOI: 10.1016/j.gaitpost.2024.05.001] [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: 01/24/2024] [Revised: 04/06/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Photo-based measurement methods are used to assess axial postural abnormalities (PA) in Parkinson's disease (PD). However, they capture only moments in time. We developed the 2-minute standing endurance test (2 M-SET), which specifically captures temporal changes in posture, as a novel dynamic method for measuring axial PA in patients with PD. RESEARCH QUESTION This study aimed to verify the effectiveness and validity of the 2 M-SET for capturing temporal changes in axial PA in patients with PD. METHODS Twenty-eight patients with PD participated. The participants attempted to maintain an upright posture for 2 minutes during three tasks: standing, stepping in place, and walking. The rate of change in postural angle was recorded at 10-second intervals. Based on the results, the 2 M-SET was developed. Therapists evaluated the 2 M-SET using the NeuroPostureApp© to measure anterior trunk flexion (ATF) angles and lateral trunk flexion (LTF) angles at 0, 10, 30, 60, and 120 seconds. To assess reliability, the congruence between the measurements obtained by the therapists and those obtained using a three-dimensional motion-analysis system was examined. For validity, we assessed whether the ATF and LTF angles measured by the therapists could accurately capture postural changes at regular intervals over time. RESULTS The average postural changes over 2 minutes for the standing, stepping in place, and gait tasks were 59.2±83.5%, 37.6±30.7%, and 45.4±50.6%, respectively. The intraclass correlation coefficients showed high reliability, with values of 0.985 and 0.970 for the ATF and LTF angles, respectively. SIGNIFICANCE The results of our proposed 2 M-SET method, which uses temporal photo-based measurements to assess the patient's ability to maintain an upright standing position for 2 minutes, demonstrate the potential to capture temporal changes in axial PA. DATA AVAILABILITY STATEMENT The data supporting the findings of this study are available upon reasonable request and approval from the local ethics committee.
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Affiliation(s)
- Yuki Kondo
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yosuke Ariake
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ippei Suzuki
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taro Kato
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kota Furukawa
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kyota Bando
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsushi Nakashiba
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuya Watabe
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuta Miyazaki
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yohei Mukai
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takatoshi Hara
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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da Silva Castanheira J, Wiesman AI, Hansen JY, Misic B, Baillet S. The neurophysiological brain-fingerprint of Parkinson's disease. EBioMedicine 2024; 105:105201. [PMID: 38908100 PMCID: PMC11253223 DOI: 10.1016/j.ebiom.2024.105201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Research in healthy young adults shows that characteristic patterns of brain activity define individual "brain-fingerprints" that are unique to each person. However, variability in these brain-fingerprints increases in individuals with neurological conditions, challenging the clinical relevance and potential impact of the approach. Our study shows that brain-fingerprints derived from neurophysiological brain activity are associated with pathophysiological and clinical traits of individual patients with Parkinson's disease (PD). METHODS We created brain-fingerprints from task-free brain activity recorded through magnetoencephalography in 79 PD patients and compared them with those from two independent samples of age-matched healthy controls (N = 424 total). We decomposed brain activity into arrhythmic and rhythmic components, defining distinct brain-fingerprints for each type from recording durations of up to 4 min and as short as 30 s. FINDINGS The arrhythmic spectral components of cortical activity in patients with Parkinson's disease are more variable over short periods, challenging the definition of a reliable brain-fingerprint. However, by isolating the rhythmic components of cortical activity, we derived brain-fingerprints that distinguished between patients and healthy controls with about 90% accuracy. The most prominent cortical features of the resulting Parkinson's brain-fingerprint are mapped to polyrhythmic activity in unimodal sensorimotor regions. Leveraging these features, we also demonstrate that Parkinson's symptom laterality can be decoded directly from cortical neurophysiological activity. Furthermore, our study reveals that the cortical topography of the Parkinson's brain-fingerprint aligns with that of neurotransmitter systems affected by the disease's pathophysiology. INTERPRETATION The increased moment-to-moment variability of arrhythmic brain-fingerprints challenges patient differentiation and explains previously published results. We outline patient-specific rhythmic brain signaling features that provide insights into both the neurophysiological signature and symptom laterality of Parkinson's disease. Thus, the proposed definition of a rhythmic brain-fingerprint of Parkinson's disease may contribute to novel, refined approaches to patient stratification. Symmetrically, we discuss how rhythmic brain-fingerprints may contribute to the improved identification and testing of therapeutic neurostimulation targets. FUNDING Data collection and sharing for this project was provided by the Quebec Parkinson Network (QPN), the Pre-symptomatic Evaluation of Novel or Experimental Treatments for Alzheimer's Disease (PREVENT-AD; release 6.0) program, the Cambridge Centre for Aging Neuroscience (Cam-CAN), and the Open MEG Archives (OMEGA). The QPN is funded by a grant from Fonds de Recherche du Québec - Santé (FRQS). PREVENT-AD was launched in 2011 as a $13.5 million, 7-year public-private partnership using funds provided by McGill University, the FRQS, an unrestricted research grant from Pfizer Canada, the Levesque Foundation, the Douglas Hospital Research Centre and Foundation, the Government of Canada, and the Canada Fund for Innovation. The Brainstorm project is supported by funding to SB from the NIH (R01-EB026299-05). Further funding to SB for this study included a Discovery grant from the Natural Sciences and Engineering Research Council of Canada of Canada (436355-13), and the CIHR Canada research Chair in Neural Dynamics of Brain Systems (CRC-2017-00311).
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Affiliation(s)
| | - Alex I Wiesman
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Justine Y Hansen
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Bratislav Misic
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Sylvain Baillet
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
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Mandat VH, Zdunek PR, Krolicki B, Mandat T. Alterations of non-motor symptoms in Parkinson's disease, after of subthalamic deep brain stimulation. World Neurosurg X 2024; 23:100375. [PMID: 38623314 PMCID: PMC11017340 DOI: 10.1016/j.wnsx.2024.100375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
The effect of subthalamic deep brain stimulation (STN DBS) on motor symptoms of Parkinson's disease (PD) has been thoroughly analyzed. The influence of STN DBS on non-motor symptoms (NMS) is still debatable. We analyzed the effect of STN DBS on NMS in PD. Materials and methods 17 PD patients were qualified for STN DBS according to CAPSIT-PD criteria. Demographic data and clinical status according to the Hoehn-Yahr (H-Y) were recorded. The efficacy of STN DBS on NMS was measured with the NMS Scale before surgery and twelve months after surgery. Results Global NMS Scale score decreased by 1-75 points (mean 25,67) in 12 patients. No improvement or deterioration was reported in 5 patients (29%). The mean age of the improved group was 56 years and 59,8 years in the non-improved group. The mean duration of PD in the improved group was 11 years and 21 years in the non-improved group. In the non-improved group, four patients were rated 4 and one patients 3 according to the H-Y Scale. In the improved group, two patients were rated 4, six patients 3 and four patients 2 according to the H-Y Scale The most significant improvement of the NMS Scale was recorded in the domain IV- Perceptual problems/Hallucinations- (by 77%), domain I- Cardiovascular including falls- (by 68%) and domain III- Mood/Cognition- (by 58%). Deterioration of the NMS Scale was reported in the domain IX- Miscellaneous- (by 10%) and the domain VII- Urinary- (by 6%). Conclusions STN DBS has a positive impact on NMS among PD patients. The most important factors that influence improvement are: young age, short disease duration, and good clinical status measured with the H-Y Scale. The NMS Scale domains that tend to respond the best are the domains I, III and IV. The NMS Scale domains that might deteriorate after STN DBS are the domains VII and IX.
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Affiliation(s)
- Victor H. Mandat
- Department of Neurosurgery, Maria Sklodowska-Curie National Institute of Oncology, Warsaw, Poland
- University of Toronto, Toronto, Canada
| | - Paweł R. Zdunek
- Department of Neurosurgery, Maria Sklodowska-Curie National Institute of Oncology, Warsaw, Poland
| | - Bartosz Krolicki
- Department of Neurosurgery, Maria Sklodowska-Curie National Institute of Oncology, Warsaw, Poland
| | - Tomasz Mandat
- Department of Neurosurgery, Maria Sklodowska-Curie National Institute of Oncology, Warsaw, Poland
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Li S, Zhu Y, Lai H, Da X, Liao T, Liu X, Deng F, Chen L. Increased prevalence of vertebrobasilar dolichoectasia in Parkinson's disease and its effect on white matter microstructure and network. Neuroreport 2024; 35:627-637. [PMID: 38813904 DOI: 10.1097/wnr.0000000000002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
This study aimed to investigate the prevalence of vertebrobasilar dolichoectasia (VBD) in Parkinson's disease (PD) patients and analyze its role in gray matter changes, white matter (WM) microstructure and network alterations in PD. This is a cross-sectional study including 341 PD patients. Prevalence of VBD in these PD patients was compared with general population. Diffusion tensor imaging and T1-weighted imaging analysis were performed among 174 PD patients with or without VBD. Voxel-based morphometry analysis was used to estimate gray matter volume changes. Tract-based spatial statistics and region of interest-based analysis were used to evaluate WM microstructure changes. WM network analysis was also performed. Significantly higher prevalence of VBD in PD patients was identified compared with general population. Lower fractional anisotropy and higher diffusivity, without significant gray matter involvement, were found in PD patients with VBD in widespread areas. Decreased global and local efficiency, increased hierarchy, decreased degree centrality at left Rolandic operculum, increased betweenness centrality at left postcentral gyrus and decreased average connectivity strength between and within several modules were identified in PD patients with VBD. VBD is more prevalent in PD patients than general population. Widespread impairments in WM microstructure and WM network involving various motor and nonmotor PD symptom-related areas are more prominent in PD patients with VBD compared with PD patients without VBD.
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Affiliation(s)
- Sichen Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ozawa M, Morishima R, Shimizu T, Takahashi K. Correlation with sympathetic skin response, 123I-MIBG scintigraphy, and 123I-FP-CIT SPECT in Parkinson's disease. Neurophysiol Clin 2024; 54:102956. [PMID: 38422587 DOI: 10.1016/j.neucli.2024.102956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD), and other parkinsonian syndromes are known to cause striatonigral dopaminergic system dysfunction and autonomic disturbances, including the vasomotor and sudomotor nervous systems. The detection of 123I-FP-CIT SPECT (DaT scan) imaging and autonomic dysfunction helps differentiate PD from multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). The sympathetic skin response (SSR) is a simple, non-invasive electrophysiological test that assesses the sympathetic sudomotor nervous system. It is reported that the SSR is impaired in patients with PD, MSA, and PSP. OBJECTIVE To study the relationship between SSR, 123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy and DaT scan imaging parameters in patients with PD, MSA, and PSP. METHODS The study included 62, 25, and 19 patients with PD, MSA, and PSP, respectively. The SSR, MIBG cardiac scintigraphy, and DaT scan imaging were examined. The amplitude and latency of the SSR were measured in all limbs and were compared with the results of MIBG cardiac scintigraphy and DAT scan imaging. RESULTS The SSR amplitudes were lower than reported normal subjects' reference values in PD, MSA, and PSP. The SSR amplitude only correlated with MIBG cardiac scintigraphy and DaT scan imaging parameters in PD. Multiple regression analyses also showed a significant relationship between the amplitudes of SSR and DaT scan imaging in PD. CONCLUSION Unlike MSA, and PSP, the sudomotor nervous system is parallelly involved with cardiac sympathetic and central dopaminergic dysfunction from the early stage of PD.
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Affiliation(s)
- Masakazu Ozawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan; Department of Neurology, The Jikei University School of medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan.
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan
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Pisaltu S, Ruotolo I, Sellitto G, Berardi A, Simeon R, Fabbrini G, Galeoto G. Validity and reliability of the Italian version of the short Parkinson's evaluation scale (SPES/SCOPA). Heliyon 2024; 10:e32877. [PMID: 39021984 PMCID: PMC11253227 DOI: 10.1016/j.heliyon.2024.e32877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Background In the medical and rehabilitative field, it is essential to employ tools such as evaluation scales and performance tests to assess the impact of Parkinson's disease on QoL of affected individuals. The Short Parkinson's Evaluation Scale (SPES) is a reliable and valid tool, applicable both in research and clinical practices, useful in assessing motor damage, activities of daily living, and motor complications in patients with Parkinson's disease. The aim of the study is to investigate validity and reliability of the Italian version of the SPES-SCOPA scale. Methods Translation and cultural adaptation were performed. Included patients had diagnosis of Parkinson's disease, no concurrent pathologies, MiniMental test score above 2 and signed informed consent; they were recruited at the Department of Human Neurosciences in Sapienza University of Rome, from February 2023 to November 2023. Test-retest reliability was evaluated through Intraclass Correlation Coefficient (ICC), internal consistency was assessed using Cronbach's Alpha and construct validity using Pearson's correlation between SPES-SCOPA and the gold standard PDQ-39. Results 101 patients were recruited. Inter-rater evaluation was conducted on 62 patients, while 39 underwent an intra-rater assessment. The analysis showed statistically significant data with a Cronbach's Alpha value of 0.89 for the entire scale; test-retest reliability results are statistically significant for all subscales. Correlation between PDQ-39 domains and SPES/SCOPA subscales were statistically significant for most measurements. Conclusion This research shows that the Italian version of SPES-SCOPA scale has excellent psychometric properties.
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Affiliation(s)
| | - I. Ruotolo
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - G. Sellitto
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - A. Berardi
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - R. Simeon
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - G. Fabbrini
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
- IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - G. Galeoto
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
- IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
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Alushaj E, Hemachandra D, Ganjavi H, Seergobin KN, Sharma M, Kashgari A, Barr J, Reisman W, Khan AR, MacDonald PA. Increased mean diffusivity of the caudal motor SNc identifies patients with REM sleep behaviour disorder and Parkinson's disease. NPJ Parkinsons Dis 2024; 10:128. [PMID: 38951528 PMCID: PMC11217278 DOI: 10.1038/s41531-024-00731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Idiopathic rapid eye movement sleep behaviour disorder (iRBD)-a Parkinson's disease (PD) prodrome-might exhibit neural changes similar to those in PD. Substantia nigra pars compacta (SNc) degeneration underlies motor symptoms of PD. In iRBD and early PD (ePD), we measured diffusion MRI (dMRI) in the caudal motor SNc, which overlaps the nigrosome-1-the earliest-degenerating dopaminergic neurons in PD-and in the striatum. Nineteen iRBD, 26 ePD (1.7 ± 0.03 years), and 46 age-matched healthy controls (HCs) were scanned at Western University, and 47 iRBD, 115 ePD (0.9 ± 0.01 years), and 56 HCs were scanned through the Parkinson's Progression Markers Initiative, using 3T MRI. We segmented the SNc and striatum into subregions using automated probabilistic tractography to the cortex. We measured mean diffusivity (MD) and fractional anisotropy (FA) along white-matter bundles and subregional surfaces. We performed group-level and classification analyses. Increased caudal motor SNc surface MD was the only iRBD-HCs and ePD-HCs difference replicating across datasets (padj < 0.05). No iRBD-ePD differences emerged. Caudal motor SNc surface MD classified patient groups from HCs at the single-subject level with good-to-excellent balanced accuracy in an independent sample (0.91 iRBD and 0.86 iRBD and ePD combined), compared to fair performance for total SNc surface MD (0.72 iRBD and ePD). Caudal motor SNc surface MD correlated significantly with MDS-UPDRS-III scores in ePD patients. Using dMRI and automated segmentation, we detected changes suggesting altered microstructural integrity in iRBD and ePD in the nigrostriatal subregion known to degenerate first in PD. Surface MD of the caudal motor SNc presents a potential measure for inclusion in neuroimaging biomarkers of iRBD and PD.
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Affiliation(s)
- Erind Alushaj
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Dimuthu Hemachandra
- Robarts Research Institute, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Hooman Ganjavi
- Department of Psychiatry, Western University, London, ON, Canada
| | - Ken N Seergobin
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Manas Sharma
- Department of Radiology, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Alia Kashgari
- Department of Medicine, Respirology Division, Western University, London, ON, Canada
| | - Jennifer Barr
- Department of Psychiatry, Western University, London, ON, Canada
| | - William Reisman
- Department of Medicine, Respirology Division, Western University, London, ON, Canada
| | - Ali R Khan
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Penny A MacDonald
- Western Institute for Neuroscience, Western University, London, ON, Canada.
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
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Bowman T, Pergolini A, Carrozza MC, Lencioni T, Marzegan A, Meloni M, Vitiello N, Crea S, Cattaneo D. Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson's disease: a case series. J Neuroeng Rehabil 2024; 21:110. [PMID: 38926876 PMCID: PMC11202340 DOI: 10.1186/s12984-024-01403-z] [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: 01/20/2023] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION People with Parkinson's Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects' awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice. METHODS In this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05). RESULTS After training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects' walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events. CONCLUSION The BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments. TRIAL REGISTRATION The study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).
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Affiliation(s)
- Thomas Bowman
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56127, Italy.
| | - Andrea Pergolini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
| | - Maria Chiara Carrozza
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- National Research Council of Italy (CNR), Rome, Italy
| | | | | | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, Milan, Italy
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Shulskaya MV, Semenova EI, Rudenok MM, Partevian SA, Lukashevich MV, Karabanov AV, Fedotova EY, Illarioshkin SN, Slominsky PA, Shadrina MI, Alieva AK. Analysis of LRRN3, MEF2C, SLC22A, and P2RY12 Gene Expression in the Peripheral Blood of Patients in the Early Stages of Parkinson's Disease. Biomedicines 2024; 12:1391. [PMID: 39061965 PMCID: PMC11273708 DOI: 10.3390/biomedicines12071391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 07/28/2024] Open
Abstract
Parkinson's disease (PD) is one of the most common human neurodegenerative diseases. Belated diagnoses of PD and late treatment are caused by its elongated prodromal phase. Thus, searching for new candidate genes participating in the development of the pathological process in the early stages of the disease in patients who have not yet received therapy is relevant. Changes in mRNA and protein levels have been described both in the peripheral blood and in the brain of patients with PD. Thus, analysis of changes in the mRNA expression in peripheral blood is of great importance in studying the early stages of PD. This work aimed to analyze the changes in MEF2C, SLC22A4, P2RY12, and LRRN3 gene expression in the peripheral blood of patients in the early stages of PD. We found a statistically relevant and PD-specific change in the expression of the LRRN3 gene, indicating a disruption in the processes of neuronal regeneration and the functioning of synapses. The data obtained during the study indicate that this gene can be considered a potential biomarker of the early stages of PD.
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Affiliation(s)
- Marina V Shulskaya
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Ekaterina I Semenova
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Margarita M Rudenok
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Suzanna A Partevian
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Maria V Lukashevich
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Alexei V Karabanov
- Federal State Scientific Institution, Scientific Center of Neurology, Russian Academy of Sciences (RAS), Volokolamskoye sh., 80, Moscow 125367, Russia
| | - Ekaterina Yu Fedotova
- Federal State Scientific Institution, Scientific Center of Neurology, Russian Academy of Sciences (RAS), Volokolamskoye sh., 80, Moscow 125367, Russia
| | - Sergey N Illarioshkin
- Federal State Scientific Institution, Scientific Center of Neurology, Russian Academy of Sciences (RAS), Volokolamskoye sh., 80, Moscow 125367, Russia
| | - Petr A Slominsky
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Maria I Shadrina
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
| | - Anelya Kh Alieva
- Laboratory of Molecular Genetics of Hereditary Diseases, National Research Center "Kurchatov Institute", Kurchatova pl., 2, Moscow 123082, Russia
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Muñoz-Mata BG, Dorantes-Méndez G, Piña-Ramírez O. Classification of Parkinson's disease severity using gait stance signals in a spatiotemporal deep learning classifier. Med Biol Eng Comput 2024:10.1007/s11517-024-03148-2. [PMID: 38884852 DOI: 10.1007/s11517-024-03148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
Parkinson's disease (PD) is a degenerative nervous system disorder involving motor disturbances. Motor alterations affect the gait according to the progression of PD and can be used by experts in movement disorders to rate the severity of the disease. However, this rating depends on the expertise of the clinical specialist. Therefore, the diagnosis may be inaccurate, particularly in the early stages of PD where abnormal gait patterns can result from normal aging or other medical conditions. Consequently, several classification systems have been developed to enhance PD diagnosis. In this paper, a PD gait severity classification algorithm was developed using vertical ground reaction force (VGRF) signals. The VGRF records used are from a public database that includes 93 PD patients and 72 healthy controls adults. The work presented here focuses on modeling each foot's gait stance phase signals using a modified convolutional long deep neural network (CLDNN) architecture. Subsequently, the results of each model are combined to predict PD severity. The classifier performance was evaluated using ten-fold cross-validation. The best-weighted accuracies obtained were 99.296(0.128)% and 99.343(0.182)%, with the Hoehn-Yahr and UPDRS scales, respectively, outperforming previous results presented in the literature. The classifier proposed here can effectively differentiate gait patterns of different PD severity levels based on gait signals of the stance phase.
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Affiliation(s)
- Brenda G Muñoz-Mata
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, Av. Parque Chapultepec 1570, San Luis Potosí, 78295, San Luis Potosí, México
| | - Guadalupe Dorantes-Méndez
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, Av. Parque Chapultepec 1570, San Luis Potosí, 78295, San Luis Potosí, México.
| | - Omar Piña-Ramírez
- Departamento de Bioinformática y Análisis Estadísticos, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Montes Urales 800, Ciudad de México, 11000, Ciudad de México, México
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49
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Spinelli EG, Ghirelli A, Bottale I, Basaia S, Canu E, Castelnovo V, Volontè MA, Galantucci S, Magnani G, Caso F, Cecchetti G, Caroppo P, Prioni S, Villa C, Josephs KA, Whitwell JL, Filippi M, Agosta F. Stepwise Functional Brain Architecture Correlates with Atrophy in Progressive Supranuclear Palsy. Mov Disord 2024. [PMID: 38881298 DOI: 10.1002/mds.29887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/19/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Stepwise functional connectivity (SFC) detects whole-brain functional couplings of a selected region of interest at increasing link-step topological distances. OBJECTIVE This study applied SFC to test the hypothesis that stepwise architecture propagating from the disease epicenter would shape patterns of brain atrophy in patients with progressive supranuclear palsy-Richardson's syndrome (PSP-RS). METHODS Thirty-six patients with PSP-RS and 44 age-matched healthy control subjects underwent brain magnetic resonance imaging on a 3-T scanner. The disease epicenter was defined as the peak of atrophy observed in an independent cohort of 13 cases with postmortem confirmation of PSP pathology and used as seed region for SFC analysis. First, we explored SFC rearrangements in patients with PSP-RS, as compared with age-matched control subjects. Subsequently, we tested SFC architecture propagating from the disease epicenter as a determinant of brain atrophy distribution. RESULTS The disease epicenter was identified in the left midbrain tegmental region. Compared with age-matched control subjects, patients with PSP-RS showed progressively widespread decreased SFC of the midbrain with striatal and cerebellar regions through direct connections and sensorimotor cortical regions through indirect connections. A correlation was found between average link-step distance from the left midbrain in healthy subjects and brain volumes in patients with PSP-RS (r = 0.38, P < 0.001). CONCLUSIONS This study provides comprehensive insights into the topology of functional network rearrangements in PSP-RS and demonstrates that the brain architectural topology, as described by SFC propagating from the disease epicenter, shapes the pattern of atrophic changes in PSP-RS. Our findings support the view of a network-based pathology propagation in this primary tauopathy. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alma Ghirelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Bottale
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Giuseppe Magnani
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Cecchetti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Caroppo
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Prioni
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Villa
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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50
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Gronostay A, Jost ST, Silverdale M, Rizos A, Loehrer PA, Evans J, Sauerbier A, Indi D, Leta V, Reker P, Fink GR, Ashkan K, Antonini A, Nimsky C, Visser-Vandewalle V, Martinez-Martin P, Ray Chaudhuri K, Timmermann L, Dafsari HS. Stratifying quality of life outcome in subthalamic stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2024; 95:630-638. [PMID: 38124227 DOI: 10.1136/jnnp-2023-332272] [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: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD) improves quality of life (QoL), motor and non-motor symptoms (NMS). However, in previous studies, 43%-49% of patients did not experience clinically relevant postoperative QoL improvement. To inform individualised prediction of postoperative QoL improvement, we developed a stratification analysis of QoL outcomes based on preoperative non-motor total burden, severity of motor progression and motor response in levodopa challenge tests. METHODS This was a prospective, open-label, multicentre, international study with a 6-month follow-up. A distribution-based threshold identified 'QoL responders' in the PDQuestionnaire-8 Summary Index (PDQ-8 SI). After baseline stratification based on the NMS Scale, Hoehn and Yahr Scale and levodopa response assessed with the Unified PD Rating Scale-III, we compared postoperative QoL response between these strata. To assess the clinical usefulness and statistical feasibility of stratifications, we compared cumulative distribution function curves, respectively PDQ-8 within-stratum variation. RESULTS All main outcomes improved postoperatively. Based on the 8.1 points threshold for clinically meaningful PDQ-8 SI improvement, only 80/161 patients were classified as 'QoL responders'. The absolute risk reductions for QoL non-response among respective non-motor, motor progression and levodopa response strata were 23%, 8% and 3%, respectively. Only non-motor stratification reduced PDQ-8 within-stratum variation compared with the overall cohort. CONCLUSIONS Non-motor stratification, but not motor progression or levodopa response stratification, is clinically useful and statistically feasible for personalised preoperative prediction of postoperative QoL outcome of STN-DBS for PD. Our findings highlight that non-motor assessments are necessary components of a case-based, holistic approach of DBS indication evaluations geared towards optimising postoperative QoL outcomes. TRIAL REGISTRATION NUMBER GermanClinicalTrialsRegister: #6735.
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Affiliation(s)
- Alexandra Gronostay
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | | | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK
| | - Anna Sauerbier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Donya Indi
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Valentina Leta
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Paul Reker
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Haidar S Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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