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Zampogna A, Suppa A, Bove F, Cavallieri F, Castrioto A, Meoni S, Pelissier P, Schmitt E, Chabardes S, Fraix V, Moro E. Disentangling Bradykinesia and Rigidity in Parkinson's Disease: Evidence from Short- and Long-Term Subthalamic Nucleus Deep Brain Stimulation. Ann Neurol 2024; 96:234-246. [PMID: 38721781 DOI: 10.1002/ana.26961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Bradykinesia and rigidity are considered closely related motor signs in Parkinson disease (PD), but recent neurophysiological findings suggest distinct pathophysiological mechanisms. This study aims to examine and compare longitudinal changes in bradykinesia and rigidity in PD patients treated with bilateral subthalamic nucleus deep brain stimulation (STN-DBS). METHODS In this retrospective cohort study, the clinical progression of appendicular and axial bradykinesia and rigidity was assessed up to 15 years after STN-DBS in the best treatment conditions (ON medication and ON stimulation). The severity of bradykinesia and rigidity was examined using ad hoc composite scores from specific subitems of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III). Short- and long-term predictors of bradykinesia and rigidity were analyzed through linear regression analysis, considering various preoperative demographic and clinical data, including disease duration and severity, phenotype, motor and cognitive scores (eg, frontal score), and medication. RESULTS A total of 301 patients were examined before and 1 year after surgery. Among them, 101 and 56 individuals were also evaluated at 10-year and 15-year follow-ups, respectively. Bradykinesia significantly worsened after surgery, especially in appendicular segments (p < 0.001). Conversely, rigidity showed sustained benefit, with unchanged clinical scores compared to preoperative assessment (p > 0.05). Preoperative motor disability (eg, composite scores from the UPDRS-III) predicted short- and long-term outcomes for both bradykinesia and rigidity (p < 0.01). Executive dysfunction was specifically linked to bradykinesia but not to rigidity (p < 0.05). INTERPRETATION Bradykinesia and rigidity show long-term divergent progression in PD following STN-DBS and are associated with independent clinical factors, supporting the hypothesis of partially distinct pathophysiology. ANN NEUROL 2024;96:234-246.
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Affiliation(s)
- Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Francesco Bove
- Neurology Unit, Department of Neuroscience, Sensory Organs and Chest, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Castrioto
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
| | - Sara Meoni
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
| | - Pierre Pelissier
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
| | - Emmanuelle Schmitt
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
| | - Stephan Chabardes
- Division of Neurosurgery, Grenoble Alpes University, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Valerie Fraix
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France
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Gandhi SE, Nodehi A, Lawton MA, Grosset KA, Marshall V, Ben-Shlomo Y, Grosset DG. Dopa Responsiveness in Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 38898616 DOI: 10.1002/mdc3.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/26/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dopaminergic responsiveness is a defining feature of Parkinson's disease (PD). However, there is limited information on how this evolves over time. OBJECTIVES To examine serial dopaminergic responses, if there are distinct patterns, and which factors predict these. METHODS We analyzed data from the Parkinson's Progression Markers Initiative on repeated dopaminergic challenge tests (≥24.5% defined as a definite response). Growth-mixture modeling evaluated for different response patterns and multinomial logistic regression tested for predictors of these clusters. RESULTS 1525 dopaminergic challenge tests were performed in 336 patients. At enrolment, mean age was 61.2 years (SD 9.6), 66.4% were male and disease duration was 0.5 years (SD 0.5). 1 to 2 years after diagnosis, 48.0% of tests showed a definite response, but this proportion increased with longer disease duration (51.1-74.3%). We identified 3 response groups: "Striking" (n = 29, 8.7%); "Excellent" (n = 110; 32.7%) and "Modest" (n = 197, 58.6%). Significant differences were as follows: striking responders commenced treatment earlier (P = 0.02), were less likely to be on dopamine agonist monotherapy (P = 0.01), and had better cognition (P < 0.01) and activities of daily living (P = 0.01). Excellent responders had higher challenge doses (P = 0.03) and were more likely to be on combination therapy (P < 0.01). CONCLUSION Three distinct patterns of the dopaminergic response were observed. As the proportion of PD cases with definite dopa responsiveness increased over time, the initial treatment response may be an unreliable diagnostic aid.
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Affiliation(s)
- Sacha E Gandhi
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Anahita Nodehi
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael A Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Katherine A Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Vicky Marshall
- Institute of Neurological Sciences, Glasgow, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Donald G Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Gandhi SE, Zerenner T, Nodehi A, Lawton MA, Marshall V, Al‐Hajraf F, Grosset KA, Morris HR, Hu MT, Ben‐Shlomo Y, Grosset DG. Motor Complications in Parkinson's Disease: Results from 3343 Patients Followed for up to 12 Years. Mov Disord Clin Pract 2024; 11:686-697. [PMID: 38587023 PMCID: PMC11145112 DOI: 10.1002/mdc3.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Motor complications are well recognized in Parkinson's disease (PD), but their reported prevalence varies and functional impact has not been well studied. OBJECTIVES To quantify the presence, severity, impact and associated factors for motor complications in PD. METHODS Analysis of three large prospective cohort studies of recent-onset PD patients followed for up to 12 years. The MDS-UPDRS part 4 assessed motor complications and multivariable logistic regression tested for associations. Genetic risk score (GRS) for Parkinson's was calculated from 79 single nucleotide polymorphisms. RESULTS 3343 cases were included (64.7% male). Off periods affected 35.0% (95% CI 33.0, 37.0) at 4-6 years and 59.0% (55.6, 62.3) at 8-10 years. Dyskinesia affected 18.5% (95% CI 16.9, 20.2) at 4-6 years and 42.1% (38.7, 45.5) at 8-10 years. Dystonia affected 13.4% (12.1, 14.9) at 4-6 years and 22.8% (20.1, 25.9) at 8-10 years. Off periods consistently caused greater functional impact than dyskinesia. Motor complications were more common among those with higher drug doses, younger age at diagnosis, female gender, and greater dopaminergic responsiveness (in challenge tests), with associations emerging 2-4 years post-diagnosis. Higher Parkinson's GRS was associated with early dyskinesia (0.026 ≤ P ≤ 0.050 from 2 to 6 years). CONCLUSIONS Off periods are more common and cause greater functional impairment than dyskinesia. We confirm previously reported associations between motor complications with several demographic and medication factors. Greater dopaminergic responsiveness and a higher genetic risk score are two novel and significant independent risk factors for the development of motor complications.
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Affiliation(s)
- Sacha E. Gandhi
- School of Neuroscience and PsychologyUniversity of GlasgowGlasgowUnited Kingdom
| | - Tanja Zerenner
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Anahita Nodehi
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Michael A. Lawton
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | | | - Falah Al‐Hajraf
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical NeuroscienceOxford UniversityOxfordUnited Kingdom
- Department of Pharmacology and Toxicology, Faculty of MedicineKuwait UniversityKuwait CityKuwait
| | | | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Michele T. Hu
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical NeuroscienceOxford UniversityOxfordUnited Kingdom
| | - Yoav Ben‐Shlomo
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Donald G. Grosset
- School of Neuroscience and PsychologyUniversity of GlasgowGlasgowUnited Kingdom
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Feal Painceiras MJ, García Díaz I, Íñiguez Alvarado MC, Paz JM, Jesús S, Cosgaya M, García Caldentey J, Caballol N, Legarda I, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Vela L, Escalante S, Mendoza Z, Martínez Castrillo JC, Alonso PS, Alonso Losada MG, López Ariztegui N, McAfee D, Martinez-Martin P, Mir P. Response to levodopa in Parkinson's disease over time. A 4-year follow-up study. Parkinsonism Relat Disord 2023; 116:105852. [PMID: 37804623 DOI: 10.1016/j.parkreldis.2023.105852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND AND OBJECTIVE A good response to levodopa is a key factor to indicate device-aided therapies in people with Parkinson's disease (PwPD). The aim of the present study was to analyze the response to levodopa in PwPD with motor fluctuations followed for 4 years. PATIENTS AND METHODS PwPD with motor fluctuations recruited from January 2016 to November 2017 from the COPPADIS cohort and assessed annually (from baseline to 4-year follow-up) during the OFF and ON states were included in this analysis. At each visit, the Unified Parkinson's Disease Rating Scale - part III (UPDRS-III) was applied during the OFF state (without medication during the last 12 h) and during the ON state. General linear model repeated measures were used to test for changes in the mean UPDRS-III-OFF, UPDRS-III-ON, and ΔUPDRS-III (UPDRS-III-OFF - UPDRS-III-ON) between visits. Levodopa equivalent daily dose (LEDD) was included as covariate. RESULTS Sixty-three patients (63.94 ± 8.42 years old; 68.3% males) were included. Mean disease duration was 7.81 ± 3.64 years. From baseline to 4-year follow-up visit, a significant increase in both the UPDRS-III-OFF (from 27.98 ± 9.58 to 31.75 ± 12.39; p = 0.003) and the UPDRS-III-ON (from 15.92 ± 7.93 to 18.84 ± 8.17; p = 0.006) was observed despite the significant increase in the LEDD (from 896.35 ± 355.65 to 1085.51 ± 488.29; p = 0.003). However, no significant differences were detected between visits in the ΔUPDRS-III. CONCLUSION In this cohort of PwPD with motor fluctuations, the response to levodopa did not weaken after a 4-year follow-up.
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Affiliation(s)
| | | | | | | | - Iago García Díaz
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Jose Manuel Paz
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Silvia Jesús
- Unidad de Trastornos Del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain; Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | - Maria A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de ĹHospitalet, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gómez Mayordomo
- Neurology Department, Institute of Neuroscience, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
| | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de La Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Zebenzui Mendoza
- Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | - Pablo Mir
- Unidad de Trastornos Del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
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5
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Terasawa Y, Ikuno K, Fujii S, Nishi Y, Tanizawa E, Nabeshima S, Okada Y. Unveiling the Impact of Outpatient Physiotherapy on Specific Motor Symptoms in Parkinson's Disease: A Prospective Cohort Study. BRAIN & NEUROREHABILITATION 2023; 16:e26. [PMID: 38047098 PMCID: PMC10689867 DOI: 10.12786/bn.2023.16.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 12/05/2023] Open
Abstract
Understanding how outpatient physiotherapy impacts on specific motor symptoms in Parkinson's disease (PD) is important for multidisciplinary care, but these points have not been clarified. We investigated the impact of outpatient physiotherapy on individual motor symptoms in PD patients. Fifty-five PD patients participated in the prospective cohort study, which examined the changes in motor symptoms after 90 min of outpatient physiotherapy program (1×/week for 10 weeks) and at 3 months follow-up. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score and tremor, rigidity, bradykinesia, and axial scores were assessed and compared pre-intervention, post-intervention, and at follow-up. Significant level was set at 0.05. Their MDS-UPDRS motor score and axial score significantly decreased post-intervention and at the follow-up. In the analysis differentiating effects based on the severity of motor symptoms according to the MDS-UPDRS motor score, only the moderate-severe group showed significant decreases in their MDS-UPDRS motor score, bradykinesia, and axial scores post-intervention, as well as in their MDS-UPDRS motor score, rigidity, bradykinesia, and axial scores at the follow-up. These findings suggest the outpatient physiotherapy might provide benefits, particularly in managing axial symptoms and bradykinesia, for community dwelling PD patients with moderate-severe motor symptoms within a multidisciplinary care framework.
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Affiliation(s)
- Yuta Terasawa
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Koki Ikuno
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Shintaro Fujii
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Yuki Nishi
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Emi Tanizawa
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | | | - Yohei Okada
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Liu Y, Lawton MA, Lo C, Bowring F, Klein JC, Querejeta-Coma A, Scotton S, Welch J, Razzaque J, Barber T, Ben-Shlomo Y, Hu MT. Longitudinal Changes in Parkinson's Disease Symptoms with and Without Rapid Eye Movement Sleep Behavior Disorder: The Oxford Discovery Cohort Study. Mov Disord 2021; 36:2821-2832. [PMID: 34448251 DOI: 10.1002/mds.28763] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) comorbid with rapid eye movement sleep behavior disorder (RBD) may show more severe motor and nonmotor symptoms, suggesting a distinct PD subtype. OBJECTIVE The aim of this study was to investigate the impact of RBD on the longitudinal change of motor and nonmotor symptoms in patients with PD. METHODS Patients with early PD (diagnosed within 3.5 years) recruited from 2010 to 2019 were followed every 18 months in the Oxford Parkinson's Disease Centre Discovery cohort. At each visit, we used standard questionnaires and measurements to assess demographic features and motor and nonmotor symptoms (including RBD, daytime sleepiness, mood, autonomic symptoms, cognition, and olfaction). Data were analyzed with linear mixed effects and Cox regression models. Possible RBD (pRBD) was longitudinally determined according to RBD Screening Questionnaire scores. RESULTS A total of 923 patients were recruited (mean age: 67.1 ± 9.59 years; 35.9% female), and 788 had follow-up assessment(s) (mean: 4.8 ± 1.98 years, range: 1.3-8.3). Among them, 33.3% were identified as pRBD (PD + pRBD). Patients with PD + pRBD had more severe baseline symptoms and showed faster progression on Movement Disorder Society-Unified Parkinson's Disease Rating Scale parts I and III, Purdue Pegboard test, and Beck Depression Inventory scores. Moreover, PD + pRBD was associated with an increased level of risk for mild cognitive impairment (hazard ratio [HR] = 1.36, 95% confidence interval [CI]: 1.01-1.83), freezing of gait (HR = 1.42, 95% CI: 1.10-1.86), and frequent falling (HR = 1.62, 95% CI: 1.02-2.60). CONCLUSIONS Patients with PD + pRBD progress faster on motor, mood, and cognitive symptoms, confirming a more aggressive PD subtype that can be identified at baseline and has major clinical implications. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yaping Liu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael A Lawton
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christine Lo
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Francesca Bowring
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Johannes C Klein
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Agustin Querejeta-Coma
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom.,Department of Neurology, Infanta Elena University Hospital, Valdemoro, Spain.,Department of Neurology, Rey Juan Carlos University Hospital, Móstoles, Spain
| | - Sangeeta Scotton
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Jessica Welch
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Jamil Razzaque
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Thomas Barber
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Yoav Ben-Shlomo
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
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Snyder A, Gruber-Baldini AL, Rainer von Coelln F, Savitt JM, Reich SG, Armstrong MJ, Shulman LM. Comparison of Mini-Mental State Examination and Montreal Cognitive Assessment Ratings Across Levels of Parkinson's Disease Severity. JOURNAL OF PARKINSONS DISEASE 2021; 11:1995-2003. [PMID: 34366371 DOI: 10.3233/jpd-212705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is common in Parkinson's disease (PD) and an important cause of disability. Screening facilitates early detection of CI and has implications for management. Preclinical disability is when patients have functional limitations but maintain independence through compensatory measures. OBJECTIVE The objective of this study was to investigate the relationship between scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) with levels of PD severity and disability. METHODS PD patients (n = 2,234) in a large observational study were stratified by disease severity, based on Total Unified Parkinson's Disease Rating Scale (Total UPDRS) and Hoehn and Yahr (HY) stage. Using MMSE (n = 1,184) or MoCA (n = 1,050) and basic (ADL) and instrumental activities of daily living (IADL) scales for disability, linear regression analysis examined associations between cognitive status and disability. RESULTS Cognition and disability were highly correlated, with the strongest correlation between IADL and MoCA. Only 16.0% of mean MMSE scores were below threshold for CI (28) and only in advanced PD (Total UPDRS 60+, HY≥3). MoCA scores fell below CI threshold (26) in 66.2% of the sample and earlier in disease (Total UPDRS 30+, HY≥2), corresponding with impairments in ADLs. CONCLUSION In a large clinical dataset, a small fraction of MMSE scores fell below cutoff for CI, reinforcing that MMSE is an insensitive screening tool in PD. MoCA scores indicated CI earlier in disease and coincided with disability. This study shows that MoCA, but not MMSE is sensitive to the emergence of early cognitive impairment in PD and correlates with the concomitant onset of disability.
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Affiliation(s)
- Allison Snyder
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Rainer von Coelln
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph M Savitt
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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8
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Kulshreshtha D, Pieterman M, Gilmore G, Jog M. Optimizing the selection of Parkinson's disease patients for neuromodulation using the levodopa challenge test. J Neurol 2021; 269:846-852. [PMID: 34191078 DOI: 10.1007/s00415-021-10666-8] [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: 04/20/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), early stages are associated with a good long-duration response and as the disease advances, the short-duration response predominates. The transition between the long-duration and short-duration responses may be an important and measurable intermediate stage. A critical criterion in determining the candidature for neuromodulation is a beneficial response to an 'off-on' levodopa challenge test. This test is usually reserved for those that have already developed marked short-duration response and are candidates for deep brain stimulation (DBS) surgery. However, identifying those that are in transition may allow DBS to be offered earlier. OBJECTIVE The objective of the study was to determine if the transition from a long-duration to a short-duration response can be assessed on a levodopa challenge test. METHODS An 'off-on" levodopa challenge test was done in sixty-five PD patients divided into four groups based on the disease duration. RESULTS OFF motor scores increased in all groups [Mean ± STD; 22.94 ± 8.52, 31.53 ± 9.87, 34.05 ± 9.50, and 33.92 ± 10.15 in groups 1-4, respectively] while a significant response to medication was maintained on 'off-on' testing. The mean levodopa equivalency dose in groups 1 and 2 was significantly less than in groups 3 and 4. This transition occurred between years 7 and 9 of disease duration. CONCLUSION Performing a regular levodopa challenge test, when levodopa dose increases substantially, should be considered to determine the ideal time for DBS in patients with Parkinson's disease.
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Affiliation(s)
- Dinkar Kulshreshtha
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, 339 Windermere road, London, ON, N6A 5A5, Canada
| | - Marcus Pieterman
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, 339 Windermere road, London, ON, N6A 5A5, Canada
| | - Greydon Gilmore
- School of Biomedical Engineering, Western University, London, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, 339 Windermere road, London, ON, N6A 5A5, Canada.
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9
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Seger AD, Farrher E, Doppler CEJ, Gogishvili A, Worthoff WA, Filss CP, Barbe MT, Holtbernd F, Shah NJ, Fink GR, Sommerauer M. Putaminal y-Aminobutyric Acid Modulates Motor Response to Dopaminergic Therapy in Parkinson's Disease. Mov Disord 2021; 36:2187-2192. [PMID: 34096652 DOI: 10.1002/mds.28674] [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: 02/19/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Motor response to dopaminergic therapy is a characteristic of patients with Parkinson's disease (PD). Whether nondopaminergic neurotransmitters contribute to treatment response is uncertain. OBJECTIVES The aim of this study is to determine whether putaminal y-aminobutyric acid (GABA) levels are associated with dopaminergic motor response. METHODS We assessed putaminal GABA levels in 19 PD patients and 13 healthy controls (HCs) utilizing ultra-high field proton magnetic resonance spectroscopy. Motor performance was evaluated using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, Part III, in the ON and OFF states. Statistical analysis comprised group comparisons, correlation analysis, and multiple linear regression. RESULTS In PD, GABA levels were significantly higher compared to HCs (1.50 ± 0.26 mM vs. 1.26 ± 0.31 mM, P = 0.022). Furthermore, GABA levels were independent predictors of absolute and relative dopaminergic treatment response. CONCLUSIONS Our findings indicate that elevated putaminal GABA levels are associated with worse dopaminergic response in PD, emphasizing the essential role of nondopaminergic neurotransmitters in motor response. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Aline D Seger
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Ezequiel Farrher
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Christopher E J Doppler
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Ana Gogishvili
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Engineering Physics Department, Georgian Technical University, Tbilisi, Georgia
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany
| | - Florian Holtbernd
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany.,Institute of Neuroscience and Medicine 11 (INM-11), JARA, Forschungszentrum, Jülich, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
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10
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Fernandes EJ, Poetini MR, Barrientos MS, Bortolotto VC, Araujo SM, Santos Musachio EA, De Carvalho AS, Leimann FV, Gonçalves OH, Ramborger BP, Roehrs R, Prigol M, Guerra GP. Exposure to lutein-loaded nanoparticles attenuates Parkinson's model-induced damage in Drosophila melanogaster: Restoration of dopaminergic and cholinergic system and oxidative stress indicators. Chem Biol Interact 2021; 340:109431. [PMID: 33716020 DOI: 10.1016/j.cbi.2021.109431] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/27/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
Parkinson's is a neurodegenerative disease, characterized by the loss of dopaminergic neurons, cholinergic alterations and oxidative damages. Lutein is widely known by its antioxidants properties. In the present study, we investigated whether lutein-loaded nanoparticles protects against locomotor damage and neurotoxicity induced by Parkinson's disease model in Drosophila melanogaster, as well as possible mechanisms of action. First, the nanoparticles were characterized by physicochemical methods, demonstrating that water affinity was improved by the encapsulation of lutein into the polymeric encapsulant matrix. The fruit flies of 1-4 days old were divided into four groups and exposed to a standard diet (control), a diet containing either rotenone (500 μM), lutein-loaded nanoparticles (6 μM) or rotenone (500 μM) and lutein-loaded nanoparticles (6 μM) for 7 days. The survival percentage was assessed, the flies were submitted to negative geotaxis, open field tasks and the determination of dopamine levels, tyrosine hydroxylase (TH) and acetylcholinesterase activities and oxidative stress indicators (superoxide dismutase, catalase, thiobarbituric acid reactive substances and glutathione S-transferase) were carried out. The exposure to lutein-loaded nanoparticles protected against locomotor damage and the decrease survival rate induced by rotenone, besides, it restored the dopamine levels, TH and acetylcholinesterase activities and oxidative stress indicators. These results provide evidence that lutein-loaded nanoparticles are an alternative treatment for rotenone-induced damage, and suggest the involvement of dopaminergic and cholinergic system and oxidative stress.
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Affiliation(s)
- Eliana Jardim Fernandes
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Marcia Rósula Poetini
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Magna Sotelo Barrientos
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil
| | - Vandreza Cardoso Bortolotto
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Stífani Machado Araujo
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Elize Aparecida Santos Musachio
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Amarilis Santos De Carvalho
- Programa de Pós-Graduação em Tecnologia de Alimentos, Universidade Tecnológica Federal do Paraná - Campus Campo Mourão, 87301-006, Campo Mourão, PR, Brazil
| | - Fernanda Vitória Leimann
- Programa de Pós-Graduação em Tecnologia de Alimentos, Universidade Tecnológica Federal do Paraná - Campus Campo Mourão, 87301-006, Campo Mourão, PR, Brazil
| | - Odinei Hess Gonçalves
- Programa de Pós-Graduação em Tecnologia de Alimentos, Universidade Tecnológica Federal do Paraná - Campus Campo Mourão, 87301-006, Campo Mourão, PR, Brazil
| | - Bruna Piaia Ramborger
- Grupo Interdisciplinar de Pesquisa em Prática de Ensino (GIPPE), Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Rafael Roehrs
- Grupo Interdisciplinar de Pesquisa em Prática de Ensino (GIPPE), Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Marina Prigol
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil
| | - Gustavo Petri Guerra
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas - LaftamBio, Universidade Federal Do Pampa - Campus Itaqui, 97650-000, Itaqui, RS, Brazil; Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa - Campus Uruguaiana, 97508-000, Uruguaiana, RS, Brazil.
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11
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Bonomo R, Mostile G, Raciti L, Nicoletti A, Zappia M. Base-peak assessment of levodopa response and detection of fluctuating patients in Parkinson’s disease. Neurol Sci 2020; 41:3769-3773. [DOI: 10.1007/s10072-020-04623-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
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12
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Kempster P. Predicting levodopa-induced dyskinesia. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:185-186. [PMID: 32321051 DOI: 10.1590/0004-282x20200023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Peter Kempster
- Monash Medical Centre, Neurosciences Department, Clayton, Australia
- Monash University, School of Clinical Sciences, Department of Medicine, Clayton, Australia
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13
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Macleod AD, Counsell CE. Treatment Responsiveness of Motor Features in Parkinson's Disease: A Matched Case-Control Analysis. Mov Disord Clin Pract 2020; 7:45-51. [PMID: 31970211 PMCID: PMC6962676 DOI: 10.1002/mdc3.12856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment response in PD is important clinically and for research diagnostic criteria, but few objective data show treatment-responsiveness of PD motor features. OBJECTIVES To evaluate the treatment response of motor features to moderate treatment doses in a "real-world" PD cohort. METHODS We analyzed data from a community-based incident cohort of PD in North-East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (1) patients with an increase of at least 300 mg of levodopa-equivalent dose (LED) and (2) patients without treatment change, matched for age, sex, and disease duration. RESULTS We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300 to 375 mg/day. Forty-two percent with treatment increase had ≥30% improvement in overall UPDRS motor score, a further 35% had substantial subjective improvement, but only 1 had an objective excellent (>70%) treatment response. Women responded better than men by 5.4 points (95% confidence interval [CI]: 2.7-8.1). All motor features improved with treatment, but after adjustment for age, sex, and initial score, only rest tremor (P < 0.001), rigidity (P = 0.01), bradykinesia (<0.001), posture (P = 0.01), and gait (P = 0.03) had significant improvements, compared to those with no treatment change. Dopa-less-responsive motor items, taken together, had small statistically significant relative improvements (1.1-point difference [95% CI: 0.4-1.8]; P = 0.004). CONCLUSIONS Motor items sometimes previously considered dopa unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.
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Affiliation(s)
- Angus D. Macleod
- Institute of Applied Health Sciences, University of AberdeenAberdeenUnited Kingdom
| | - Carl E. Counsell
- Institute of Applied Health Sciences, University of AberdeenAberdeenUnited Kingdom
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14
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Prediction of the Levodopa Challenge Test in Parkinson's Disease Using Data from a Wrist-Worn Sensor. SENSORS 2019; 19:s19235153. [PMID: 31775289 PMCID: PMC6928714 DOI: 10.3390/s19235153] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
The response to levodopa (LR) is important for managing Parkinson’s Disease and is measured with clinical scales prior to (OFF) and after (ON) levodopa. The aim of this study was to ascertain whether an ambulatory wearable device could predict the LR from the response to the first morning dose. The ON and OFF scores were sorted into six categories of severity so that separating Parkinson’s Kinetigraph (PKG) features corresponding to the ON and OFF scores became a multi-class classification problem according to whether they fell below or above the threshold for each class. Candidate features were extracted from the PKG data and matched to the class labels. Several linear and non-linear candidate statistical models were examined and compared to classify the six categories of severity. The resulting model predicted a clinically significant LR with an area under the receiver operator curve of 0.92. This study shows that ambulatory data could be used to identify a clinically significant response to levodopa. This study has also identified practical steps that would enhance the reliability of this test in future studies.
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15
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Pieterman M, Adams S, Jog M. Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease. Front Neurol 2018; 9:260. [PMID: 29867708 PMCID: PMC5966537 DOI: 10.3389/fneur.2018.00260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background The levodopa challenge test is routinely used in Parkinson disease (PD) to determine a patient’s motor improvement following levodopa administration [levodopa response (LR)]. LR is most commonly reported as a percent OFF to ON change in the Unified Parkinson Disease Rating Scale (UPDRS) part III score, and occasionally as an absolute difference in score. This inconsistency in LR determination alters how clinical factors such as patient age and disease duration are understood in relation to LR in PD. Objective The aim of this study was to compare the calculation of the LR as either a percent change or difference in UPDRS-III motor score between OFF and ON medication. These two scores were then used to correlate to disease duration, patient age, levodopa duration, levodopa equivalent dose (LED), OFF score, cognition, mood, gait, and quality of life (QOL). Methods 70 PD patients underwent the levodopa challenge test. The UPDRS-III motor examination was performed in the defined OFF and ON medication states to determine LR. Each patient was assessed after 12–14 h without anti-parkinsonian medication and then given three 100/25 mg levodopa/carbidopa tablets. LR was reported as both a difference in score [OFF − ON; absolute LR (aLR)] and as a percent change in score [(OFF − ON)/OFF*100%; %LR]. Patients completed the following non-motor symptom assessment scales: Montreal Cognitive Assessment, Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Parkinson’s Disease Questionnaire, and Geriatric Depression Scale. The effect of the LR calculation method was correlated to the clinical measures. Results The aLR was significantly associated with disease duration (r = 0.40), levodopa duration (r = 0.47), OFF motor score (r = 0.58), and LED (r = 0.31), but not age. The aLR was also found to have a significant relationship with clinical scales assessing cognition (r = 0.41), freezing of gait (r = 0.35), QOL (r = 0.40), and depression (r = 0.30). By contrast, the more commonly used %LR demonstrated no significant relationships with any of the variables tested. Conclusion Although the %LR is more commonly employed in clinical protocols and research studies, the aLR is the superior method for reporting motor response to levodopa in PD given its significant associations with the clinical factors evaluated.
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Affiliation(s)
- Marcus Pieterman
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Scott Adams
- School of Communication Sciences and Disorders, University of Western Ontario, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
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16
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Albin RL, Leventhal DK. The missing, the short, and the long: Levodopa responses and dopamine actions. Ann Neurol 2017; 82:4-19. [PMID: 28543679 DOI: 10.1002/ana.24961] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/05/2017] [Accepted: 05/13/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Roger L Albin
- Department of Neurology, University of Michigan; Neurology Service & Geriatrics Research, Education, and Clinical Center, VA Ann Arbor Healthcare System; and, University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI
| | - Daniel K Leventhal
- Department of Neurology, University of Michigan; and Neurology Service & Geriatrics Research, Education, and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI
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17
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The Effect of Dopaminergic Medication on Joint Kinematics during Haptic Movements in Individuals with Parkinson's Disease. Behav Neurol 2017; 2017:2358386. [PMID: 28496293 PMCID: PMC5414587 DOI: 10.1155/2017/2358386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 11/17/2022] Open
Abstract
This study examined whether altered joint angular motion during haptic exploration could account for a decline in haptic sensitivity in individuals with PD by analyzing joint position data during haptic exploration of a curved contour. Each participant's hand was passively moved by a robotic arm along the edges of a virtual box (5 cm × 15 cm) with a curved left wall. After each trial, participants indicated whether the contour was curved or straight. Visual, auditory, and tactile cues were occluded, and an electrogoniometer recorded shoulder and elbow joint angles during each trial. The PD group in the OFF state had a higher mean detection threshold (4.67 m−1) than the control group (3.06 m−1). Individuals with PD in the OFF state also had a significantly greater magnitude of shoulder abduction than those in the ON state (p = 0.003) and a smaller magnitude of elbow flexion than those in the ON state or compared to the control group (both p < 0.001). These findings suggest that individuals with PD employ joint configurations that may contribute to haptic insensitivity. Dopamine replacement therapy improved joint configurations during haptic exploration in patients with PD, suggesting a role for dopaminergic dysfunction in PD-related haptic insensitivity.
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18
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Mendes A, Gonçalves A, Vila-Chã N, Calejo M, Moreira I, Fernandes J, Damásio J, Teixeira-Pinto A, Krack P, Lima AB, Cavaco S. Statistical Models of Parkinson’s Disease Progression: Predictive Validity in a 3-Year Follow-up. JOURNAL OF PARKINSONS DISEASE 2016; 6:793-804. [DOI: 10.3233/jpd-160877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandre Mendes
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Vila-Chã
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Margarida Calejo
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Moreira
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Fernandes
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Damásio
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Armando Teixeira-Pinto
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Krack
- Department of Clinical Neurosciences, Clinic of Neurology, Geneva University Hospital, Geneva, Switzerland
- Department of Basic Neurosciences, Medical Faculty, University of Geneva, Geneva, Switzerland
| | | | - Sara Cavaco
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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19
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Aygun D, Kocabicak E, Yildiz MO, Temel Y. Effect of Age and Disease Duration on the Levodopa Response in Patients with Advanced Parkinson's Disease for Deep Brain Stimulation of the Subthalamic Nucleus. Front Neurol 2016; 7:97. [PMID: 27445964 PMCID: PMC4921481 DOI: 10.3389/fneur.2016.00097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/10/2016] [Indexed: 11/13/2022] Open
Abstract
Background Deep brain stimulation (DBS) has become a preferred option for the treatment of motor symptoms in patients with advanced Parkinson’s disease (PD). A good levodopa response (LR) is considered the most important criterion in determining the suitability of a patient for DBS. However, the effect of age and disease duration (DD) on the LR is still a subject of discussion. Objective Here, we investigated the effect of age and DD on the preoperative LR in PD patients to be selected for DBS. Methods From August 2011 to May 2015, 54 consecutive patients (29 men and 25 women) with advanced PD were evaluated for DBS of the STN and included in this retrospective study. Results Thirty-seven patients were found suitable for DBS of the STN and 29 of them underwent bilateral surgery. We found no significant correlation between DD and the LR. However, there was a significant negative correlation between the patients’ age and the LR. Conclusion The results indicate that the patients’ age, rather than DD, has a negative effect on the LR. The study, therefore, indicates that PD patients with an advanced age and with a poor LR are not good candidates for DBS of the STN.
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Affiliation(s)
- Dursun Aygun
- Department of Neurology, Ondokuz Mayis University , Samsun , Turkey
| | - Ersoy Kocabicak
- Department of Neurosurgery, Ondokuz Mayis University, Samsun, Turkey; Department of Neurosurgery, Maastricht Medical Center, Maastricht, Netherlands; Department of Translational Neuroscience, Maastricht Medical Center, Maastricht, Netherlands
| | | | - Yasin Temel
- Department of Neurosurgery, Maastricht Medical Center, Maastricht, Netherlands; Department of Translational Neuroscience, Maastricht Medical Center, Maastricht, Netherlands
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20
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Fabbri M, Coelho M, Abreu D, Guedes LC, Rosa MM, Costa N, Antonini A, Ferreira JJ. Do patients with late-stage Parkinson's disease still respond to levodopa? Parkinsonism Relat Disord 2016; 26:10-6. [DOI: 10.1016/j.parkreldis.2016.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
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21
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Kobayashi M, Ohira T, Mihara B, Fujimaki T. Changes in intracortical inhibition and clinical symptoms after STN-DBS in Parkinson’s disease. Clin Neurophysiol 2016; 127:2031-7. [DOI: 10.1016/j.clinph.2016.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
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22
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Fasano A, Aquino CC, Krauss JK, Honey CR, Bloem BR. Axial disability and deep brain stimulation in patients with Parkinson disease. NATURE REVIEWS. NEUROLOGY 2015. [PMID: 25582445 DOI: 10.1038/nrneurol.2014.252.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Camila C Aquino
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Christopher R Honey
- Division of Neurosurgery at the University of British Columbia, 8105-2775 Laurel Street, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, PO Box 9101, 6500 HB Nijmegen, Netherlands
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Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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Zhuang X, Mazzoni P, Kang UJ. The role of neuroplasticity in dopaminergic therapy for Parkinson disease. Nat Rev Neurol 2013; 9:248-56. [PMID: 23588357 DOI: 10.1038/nrneurol.2013.57] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dopamine replacement is a mainstay of therapeutic strategies for Parkinson disease (PD). The motor response to therapy involves an immediate improvement in motor function, known as the short-duration response (SDR), followed by a long-duration response (LDR) that develops more slowly, over weeks. Here, we review evidence in patients and animal models suggesting that dopamine-dependent corticostriatal plasticity, and retention of such plasticity in the absence of dopamine, are the mechanisms underlying the LDR. Conversely, experience-dependent aberrant plasticity that develops slowly under reduced dopamine levels could contribute substantially to PD motor symptoms before initiation of dopamine replacement therapy. We place these findings in the context of the role of dopamine in basal ganglia function and corticostriatal plasticity, and provide a new framework suggesting that therapies that enhance the LDR could be more effective than those targeting the SDR. We further propose that changes in neuroplasticity constitute a form of disease modification that is distinct from prevention of degeneration, and could be responsible for some of the unexplained disease-modifying effects of certain therapies. Understanding such plasticity could provide novel therapeutic approaches that combine rehabilitation and pharmacotherapy for treatment of neurological and psychiatric disorders involving basal ganglia dysfunction.
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Affiliation(s)
- Xiaoxi Zhuang
- Department of Neurobiology, University of Chicago Medicine and Biological Sciences, 947 South 58th Street, MC 0926, Chicago, IL 60637, USA
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25
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Ganga G, Alty JE, Clissold BG, McColl CD, Reardon KA, Schiff M, Kempster PA. Longitudinal study of levodopa in Parkinson's disease: effects of the advanced disease phase. Mov Disord 2013; 28:476-81. [PMID: 23390112 DOI: 10.1002/mds.25335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 10/22/2012] [Accepted: 11/28/2012] [Indexed: 11/08/2022] Open
Abstract
Thirty-four patients have been studied from the time of initiation of pharmacological treatment in a long-term prospective study of levodopa effects and disease progression in Parkinson's disease. Objective motor scoring of the response to levodopa in defined off states was performed every 3 years. The mean time from the initiation of levodopa treatment to the most recent measurements was 18.2 years. Of 8 patients who are still alive, only 3 had none of the features of the advanced disease phase (dementia, hallucinations, frequent falling). Off-phase motor function worsened at a yearly rate of 1.9% of the maximum disability score, although the plots of the serial scores showed that the magnitude of the levodopa response is well preserved. There was little difference in the rate of progression between patients with tremor-dominant and non-tremor-dominant motor subtypes. Those who developed dementia had more rapid deterioration of motor scores, with significantly worse off-phase (P = .008) and on-phase (P = .03) motor function. A graph of serial scores of patients who have died, aligned for time of death, showed an upward curving trend of motor disability in the last 5 years of the disease course. Its advanced phase may reveal that Parkinson's disease has an exponential pattern of progression.
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Affiliation(s)
- Ganesvaran Ganga
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
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26
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Petrovic IN, Ling H, Asi Y, Ahmed Z, Kukkle PL, Hazrati LN, Lang AE, Revesz T, Holton JL, Lees AJ. Multiple system atrophy-parkinsonism with slow progression and prolonged survival: a diagnostic catch. Mov Disord 2012; 27:1186-90. [PMID: 22806758 DOI: 10.1002/mds.25115] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/23/2012] [Accepted: 06/14/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disease leading to severe physical impairment, with a disease duration from onset to death of 6-9 years. METHODS The clinical and neuropathological features of 4 MSA cases with disease duration of 15 years or more were analyzed. RESULTS All patients presented with parkinsonism and had a mean latency of 11 years before the development of dysautonomia. Mean duration from onset of first symptoms to anterocollis, inspiratory stridor, and dysphagia was 9 years. Despite the limited levodopa response, all patients developed levodopa-induced dyskinesia. CONCLUSIONS Late appearance of dysautonomia is a favorable prognostic factor in MSA-P. Greater awareness of this uncommon "benign" subgroup of MSA will improve diagnostic accuracy and help to more accurately inform treatment options.
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Affiliation(s)
- Igor N Petrovic
- National Hospital for Neurology and Neurosurgery, Queen Square, and the Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom
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28
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Evans AH, Farrell MJ, Gibson SJ, Helme RD, Lim SY. Dyskinetic patients show rebound worsening of affect after an acute L-dopa challenge. Parkinsonism Relat Disord 2012; 18:514-9. [DOI: 10.1016/j.parkreldis.2012.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 01/05/2012] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
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Abstract
Parkinson disease (PD) is characterized by a wide variety of motor and nonmotor symptoms. Although recently nonmotor symptoms have gained considerable relevance and interest, especially in advanced stages, motor symptoms define the main core of PD and are essential for clinical diagnosis. In this article, we review the characteristics, presentation, and evolution of motor symptoms in early PD.
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30
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Single photon emission computed tomography striatal asymmetry index may predict dopaminergic responsiveness in Parkinson disease. Clin Neuropharmacol 2011; 34:71-3. [PMID: 21406999 DOI: 10.1097/wnf.0b013e318211f945] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Parkinson disease (PD) is a neurodegenerative disorder, characterized by the excellent response to l-dopa and by asymmetry of neurological signs. The aim of the present study is to investigate a possible relationship between responsiveness to l-dopa in patients with PD and asymmetry detected by single photon emission computed tomography (SPECT) with [I]FP-CIT (DaTSCAN). METHODS We performed a retrospective study in 20 patients with PD never previously exposed to l-dopa, who had undergone (1) a short-term l-dopa test with l-dopa/carbidopa 250/25 mg to quantify dopaminergic responsiveness, and (2) a SPECT with DaTSCAN to assess the degree of nigrostriatal neuronal degeneration. We estimated the magnitude and the duration of the response to l-dopa test as well as the striatal asymmetry index (SAI) detected by SPECT with DaTSCAN. RESULTS At l-dopa short-term test, most patients showed at least a mild response to the drug, and only 3 patients presented no response. Overall, the Unified Parkinson's Disease Rating Scale-Motor Examination section score at baseline was 24.9 ± 8.2, and that at peak was 21.2 ± 8 with a magnitude of the response scoring 16 ± 13.9%; the duration was 254 ± 91.2 minutes. The caudate and putamen uptakes of DaTSCAN were lower contralaterally to the most affected side. A significant positive correlation between the SAI and the magnitude of the response to l-dopa was found (r = 0.64, P = 0.002). Linear regression model provided an increase of 0.76 units of magnitude of l-dopa response every SAI unit. CONCLUSIONS Asymmetry resulted positively related to the magnitude of the response to l-dopa short-term test and may be usefully used to predict dopaminergic responsiveness in patients with PD.
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31
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Levodopa effect on electromyographic activation patterns of tibialis anterior muscle during walking in Parkinson's disease. Gait Posture 2011; 33:436-41. [PMID: 21256751 DOI: 10.1016/j.gaitpost.2010.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 12/09/2010] [Accepted: 12/23/2010] [Indexed: 02/02/2023]
Abstract
Previous studies have reported that patients with Parkinson's disease (PD) show, in the "off medication" state, a reduced activation of tibialis anterior (TA) in the late swing-early stance phase of the gait cycle. In PD patients the pathophysiological picture may cause differences among the stride cycles. Our aims were to evaluate how frequently TA activity is reduced in the late swing-early stance phase and if there is a relationship between the TA pattern and the clinical picture. Thirty PD patients were studied 2 h after Levodopa administration ("on-med") and 12 h after Levodopa wash-out ("off-med"). They were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS III) and surface electromyography of TA and gastrocnemius medialis (GM). The root mean square (RMS) of the TA activity in late swing-early stance phase (RMS-A) was normalized as a percent of the RMS of the TA activity in late stance-early swing (RMS-B). RMS-A was reduced in 30% of patients in the "off-med" condition. Within these patients, the percentage of stride cycles with reduced RMS-A, ranged between 28% and 83%. After Levodopa intake, no stride cycle showed reduced RMS-A. Patients with reduced RMS-A had a lower UPDRS III total score in the "on-med" rather than in the "off-med" condition (p=0.02). Our data confirm and extend previous observations indicating that, in "off-med" the function of TA is impaired in those patients clinically more responsive to Levodopa. TA activation is reduced in a relatively high percent of gait cycles in the "off-med" state. Since the variability of TA activation disappears after Levodopa administration, this phenomenon could be the expression of an abnormal dopaminergic drive.
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32
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Foki T, Pirker W, Klinger N, Geißler A, Rath J, Steinkellner T, Hoellinger I, Gruber S, Haubenberger D, Lehrner J, Pusswald G, Trattnig S, Auff E, Beisteiner R. FMRI correlates of apraxia in Parkinson's disease patients OFF medication. Exp Neurol 2010; 225:416-22. [DOI: 10.1016/j.expneurol.2010.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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33
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Li KY, Pickett K, Nestrasil I, Tuite P, Konczak J. The effect of dopamine replacement therapy on haptic sensitivity in Parkinson’s disease. J Neurol 2010; 257:1992-8. [DOI: 10.1007/s00415-010-5646-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/10/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
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Sharma JC, Bachmann CG, Linazasoro G. Classifying risk factors for dyskinesia in Parkinson's disease. Parkinsonism Relat Disord 2010; 16:490-7. [PMID: 20598622 DOI: 10.1016/j.parkreldis.2010.06.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/01/2010] [Accepted: 06/06/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently there is no classification of risk factors applicable to an individual patient with Parkinson's disease for the development of dyskinesia. METHODS We conducted literature search to identify and classifying risk factors into groups - (a) intrinsic vs extrinsic and (b) modifiable vs non-modifiable. RESULTS Younger age, young age of onset and severity of PD are major intrinsic non-modifiable risk factors for dyskinesia, female gender is another factor but not independent of other factors. Genetic expression and plasticity may determine pre-disposition to age of onset of PD and dyskinesia, these are currently non-modifiable factors arising due to an interaction of intrinsic and extrinsic factors. Lower initial body weight and weight loss during the course of the disease increase the risk of dyskinesia. Levodopa dose per kilogram body weight is a more significant risk factor than absolute levodopa dose. Early use of longer acting non-levodopa (i.e. dopamine agonists) medications delays the onset of dyskinesia. Interaction between body weight, levodopa dose and mode and duration of drug delivery is a significant modifiable factor. CONCLUSION Dyskinesia in PD arises as a consequence of the interaction of intrinsic versus extrinsic and modifiable versus non-modifiable factors. Identification and manipulation of modifiable factors for an individual patient may reduce the risk and burden of dyskinesia. Adjustment of levodopa dose according to body weight during the course of the disease seems to be a significant modifiable risk factor for dyskinesia.
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Affiliation(s)
- J C Sharma
- Consultant Physician and Honorary Professor, Sherwood Forest hospitals NHS Trust, University of Nottingham, UK.
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35
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Alty JE, Clissold BG, McColl CD, Reardon KA, Shiff M, Kempster PA. Longitudinal study of the levodopa motor response in Parkinson's disease: relationship between cognitive decline and motor function. Mov Disord 2010; 24:2337-43. [PMID: 19890972 DOI: 10.1002/mds.22800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In this prospective study of 34 patients with Parkinson's disease (PD), measurements of the short duration levodopa motor response have been performed every 3 years in defined off states. The mean time from initiation of levodopa treatment was 14.8 years, and 17 patients survived to the latest assessment stage. Off phase motor function worsened at a yearly rate of 2.2% of the maximum disability score. The magnitude of the levodopa response is well preserved as the disease progresses, and patients who developed motor fluctuations maintained better on phase motor function than nonfluctuators (P = 0.01). Ten patients, of whom 5 survive, developed dementia. There was no difference in pretreatment disability or initial levodopa response between demented and nondemented subjects. However, dementia was associated with worse on and off motor disability scores after 11 and 14 years (P < 0.001), and a smaller levodopa response magnitude after 14 years (P = 0.008). The plot of sequential scores shows the association between cognitive decline and accelerating increase in motor disability. This suggests that the advanced phase of PD, when Lewy body pathology involves the cerebral cortex, progresses in an exponential rather than linear fashion.
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Affiliation(s)
- Jane E Alty
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
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36
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Garcia BG, Neely MD, Deutch AY. Cortical regulation of striatal medium spiny neuron dendritic remodeling in parkinsonism: modulation of glutamate release reverses dopamine depletion-induced dendritic spine loss. ACTA ACUST UNITED AC 2010; 20:2423-32. [PMID: 20118184 DOI: 10.1093/cercor/bhp317] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Striatal medium spiny neurons (MSNs) receive glutamatergic afferents from the cerebral cortex and dopaminergic inputs from the substantia nigra (SN). Striatal dopamine loss decreases the number of MSN dendritic spines. This loss of spines has been suggested to reflect the removal of tonic dopamine inhibitory control over corticostriatal glutamatergic drive, with increased glutamate release culminating in MSN spine loss. We tested this hypothesis in two ways. We first determined in vivo if decortication reverses or prevents dopamine depletion-induced spine loss by placing motor cortex lesions 4 weeks after, or at the time of, 6-hydroxydopamine lesions of the SN. Animals were sacrificed 4 weeks after cortical lesions. Motor cortex lesions significantly reversed the loss of MSN spines elicited by dopamine denervation; a similar effect was observed in the prevention experiment. We then determined if modulating glutamate release in organotypic cocultures prevented spine loss. Treatment of the cultures with the mGluR2/3 agonist LY379268 to suppress corticostriatal glutamate release completely blocked spine loss in dopamine-denervated cultures. These studies provide the first evidence to show that MSN spine loss associated with parkinsonism can be reversed and point to suppression of corticostriatal glutamate release as a means of slowing progression in Parkinson's disease.
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Affiliation(s)
- Bonnie G Garcia
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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37
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Viallet F, Gayraud D, Bonnefoi B, Renie L, Aurenty R. Morbo di Parkinson idiopatico: aspetti clinici, diagnostici e terapeutici. Neurologia 2010. [DOI: 10.1016/s1634-7072(10)70494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Romito LM, Contarino MF, Vanacore N, Bentivoglio AR, Scerrati M, Albanese A. Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: long-term observation. Mov Disord 2009; 24:557-63. [PMID: 19097175 DOI: 10.1002/mds.22390] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long-term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on-period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long-term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures.
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Affiliation(s)
- Luigi M Romito
- Fondazione IRCCS Istituto Neurologico, Carlo Besta, Milano I-20133, Italy
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39
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Seo JH, Cheon SM, Kim JW. The Correlation of ON and OFF Status With Clinical Characteristics in Patients With Parkinson’s Disease. J Mov Disord 2008. [DOI: 10.14802/jmd.08012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Gait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology. Curr Opin Neurol 2008; 21:461-71. [PMID: 18607208 DOI: 10.1097/wco.0b013e328305bdaf] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Gait disorders and balance impairments are one of the most incapacitating symptoms of Parkinson's disease. Here, we discuss the latest findings regarding epidemiology, assessment, pathophysiology and treatment of gait and balance impairments in Parkinson's disease. RECENT FINDINGS Recent studies have confirmed the high rate and high risk of falls of patients with Parkinson's disease. Therefore, it is crucial to detect patients who are at risk of falling and how to prevent falls. Several studies have shown that multiple balance tests improve the prediction of falls in Parkinson's disease. Difficulty turning may be caused by axial rigidity, affected interlimb coordination and asymmetries. Turning difficulties are easily assessed by timed performance and the number of steps during a turn. Impaired sensorimotor integration, inability of switching between sensory modalities and lack of compensatory stepping may all contribute to the high incidence of falls in patients with Parkinson's disease. Similarly, various studies highlighted that pharmacotherapy, neurosurgery and physiotherapy may adversely affect balance and gait in Parkinson's disease. SUMMARY Insights into the pathophysiology of Parkinson's disease continue to grow. At the same time, it is becoming clear that some patients may in fact deteriorate with treatment. Future research should focus on the development and evaluation of multifactorial fall prevention strategies.
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Lim SY, Farrell MJ, Gibson SJ, Helme RD, Lang AE, Evans AH. Do dyskinesia and pain share common pathophysiological mechanisms in Parkinson's disease? Mov Disord 2008; 23:1689-95. [DOI: 10.1002/mds.22111] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Dopaminergic modulation of cortico-cortical functional connectivity in Parkinson's disease: An MEG study. Exp Neurol 2008; 213:191-5. [DOI: 10.1016/j.expneurol.2008.05.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 05/25/2008] [Accepted: 05/29/2008] [Indexed: 11/17/2022]
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Nyholm D, Lennernäs H. Irregular gastrointestinal drug absorption in Parkinson's disease. Expert Opin Drug Metab Toxicol 2008; 4:193-203. [DOI: 10.1517/17425255.4.2.193] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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45
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Neely MD, Schmidt DE, Deutch AY. Cortical regulation of dopamine depletion-induced dendritic spine loss in striatal medium spiny neurons. Neuroscience 2007; 149:457-64. [PMID: 17888581 PMCID: PMC2094700 DOI: 10.1016/j.neuroscience.2007.06.044] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 06/20/2007] [Accepted: 06/22/2007] [Indexed: 11/28/2022]
Abstract
The proximate cause of Parkinson's disease is striatal dopamine depletion. Although no overt toxicity to striatal neurons has been reported in Parkinson's disease, one of the consequences of striatal dopamine loss is a decrease in the number of dendritic spines on striatal medium spiny neurons (MSNs). Dendrites of these neurons receive cortical glutamatergic inputs onto the dendritic spine head and dopaminergic inputs from the substantia nigra onto the spine neck. This synaptic arrangement suggests that dopamine gates corticostriatal glutamatergic drive onto spines. Using triple organotypic slice cultures composed of ventral mesencephalon, striatum, and cortex of the neonatal rat, we examined the role of the cortex in dopamine depletion-induced dendritic spine loss in MSNs. The striatal dopamine innervation was lesioned by treatment of the cultures with the dopaminergic neurotoxin 1-methyl-4-phenylpyridinium (MPP+) or by removing the mesencephalon. Both MPP+ and mesencephalic ablation decreased MSN dendritic spine density. Analysis of spine morphology revealed that thin spines were preferentially lost after dopamine depletion. Removal of the cortex completely prevented dopamine depletion-induced spine loss. These data indicate that the dendritic remodeling of MSNs seen in parkinsonism occurs secondary to increases in corticostriatal glutamatergic drive, and suggest that modulation of cortical activity may be a useful therapeutic strategy in Parkinson's disease.
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Affiliation(s)
- M D Neely
- Department of Psychiatry, Vanderbilt University Medical Center, Vanderbilt Psychiatric Hospital, Suite 313, 1601 23rd Avenue South, Nashville, TN 37212, USA.
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