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Alizadeh N, Packer TL, Jaswal S, Sturkenboom I, Warner G. Client Perceptions of the Individual Packer Managing Fatigue Program: A Mixed-Method Evaluation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:632-641. [PMID: 39086144 PMCID: PMC11408948 DOI: 10.1177/15394492241262740] [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] [Indexed: 08/02/2024]
Abstract
Fatigue is common, but under-recognized in Parkinson's disease (PD), with limited treatment options. The aim of this study is to explore the experience of people with PD (PwPD) regarding content and delivery of the individual Packer Managing Fatigue program. This mixed-method study (n = 12) was conducted concurrently with a pilot randomized controlled trial. Data were collected using questionnaires, interviews, and focus groups. Five themes emerged: the program is helpful; the program has strengths; areas for improvement; individual online delivery is feasible; and more support from occupational therapist would be helpful. Quantitative findings confirmed feasibility with high ratings on questionnaires and confidence to use learned strategies. The findings inform future implementation of the Packer Managing Fatigue program and contribute to understanding the needs of PwPD. Future studies might explore program's effectiveness as stand-alone treatment or in combination with other approaches. Tailoring fatigue programs to PwPD's unique needs and characteristics of PD fatigue is suggested.
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Affiliation(s)
| | - Tanya L Packer
- Dalhousie University, Halifax, Nova Scotia, Canada
- Umeå University, Umeå, Sweden
| | | | | | - Grace Warner
- Dalhousie University, Halifax, Nova Scotia, Canada
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2
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Bai X, Guo T, Guan X, Zhou C, Wu J, Wu H, Liu X, Wu C, Chen J, Wen J, Qin J, Tan S, DuanMu X, Gu L, Gao T, Huang P, Zhang B, Xu X, Zheng X, Zhang M. Cortical microstructural alterations in different stages of Parkinson's disease. Brain Imaging Behav 2024:10.1007/s11682-024-00931-5. [PMID: 39331345 DOI: 10.1007/s11682-024-00931-5] [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] [Accepted: 09/12/2024] [Indexed: 09/28/2024]
Abstract
To explore the cortical microstructural alterations in Parkinson's disease (PD) at different stages. 149 PD patients and 76 healthy controls were included. PD patients were divided into early stage PD (EPD) (Hoehn-Yahr stage ≤ 2) and moderate-to-late stage PD (MLPD) (Hoehn-Yahr stage ≥ 2.5) according to their Hoehn-Yahr stages. All participants underwent two-shell diffusion MRI and the images were fitted to Neurite Orientation Dispersion and Density Imaging (NODDI) model to obtain the neurite density index (NDI) and orientation dispersion index (ODI) to reflect the cortical microstructure. We used gray matter-based spatial statistics method to compare the voxel-wise cortical NODDI metrics between groups. Partial correlation was used to correlate the NODDI metrics and global composite outcome in PD patients. Compared with healthy controls, EPD patients showed lower ODI in widespread regions, covering bilateral frontal, temporal, parietal and occipital cortices, as well as regional lower NDI in bilateral cingulate and frontal lobes. Compared with healthy controls, MLPD patients showed lower ODI and NDI in more widespread regions. Compared with EPD patients, MLPD patients showed lower ODI in bilateral temporal, parietal and occipital cortices, where the ODI values were negatively correlated with global composite outcome in PD patients. PD patients showed widespread cortical microstructural degeneration, characterized by reduced neurite density and orientation dispersion, and the cortical neuritic microstructure exhibit progressive degeneration during the progression of PD.
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Grants
- 82271935, 81971577, 82171888, 82202091 and 82001767 the National Natural Science Foundation of China
- 82271935, 81971577, 82171888, 82202091 and 82001767 the National Natural Science Foundation of China
- 82271935, 81971577, 82171888, 82202091 and 82001767 the National Natural Science Foundation of China
- 82271935, 81971577, 82171888, 82202091 and 82001767 the National Natural Science Foundation of China
- LY22H180002 and LQ21H180008 the Natural Science Foundation of Zhejiang Province
- LY22H180002 and LQ21H180008 the Natural Science Foundation of Zhejiang Province
- 2016YFC1306600 the 13th Five-year Plan for National Key Research and Development Program of China
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Affiliation(s)
- Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Chengqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiaojie DuanMu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiangwu Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
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Kalbe E, Folkerts AK, Witt K, Buhmann C, Liepelt-Scarfone I. German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions. J Neurol 2024:10.1007/s00415-024-12503-0. [PMID: 39120709 DOI: 10.1007/s00415-024-12503-0] [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: 04/10/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND AND OBJECTIVE Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders. METHODS The recommendations were based on literature reviews, other relevant guidelines, and expert opinions. RESULTS Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety. CONCLUSIONS In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.
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Affiliation(s)
- Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Science, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
- Research Center of Neurosensory Science, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Neurology, Evangelical Hospital, Oldenburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Clinic Eppendorf, Hamburg, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls Universität Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- IB-Hochschule, Stuttgart, Germany
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4
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Onder H, Comoglu S. Investigation of the nonmotor symptoms in patients with STN-DBS therapy in comparison with those without STN-DBS. J Neural Transm (Vienna) 2024; 131:931-940. [PMID: 38684577 DOI: 10.1007/s00702-024-02778-y] [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: 01/27/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
The impact of STN-DBS on NMS remains rather as an underestimated topic. Besides, the significance of NMSs in QOL indexes of PD subjects with STN-DBS is unknown. We primarily aimed to evaluate the NMSs and their significance in QOL indexes in PD subjects comparatively with and without STN-DBS therapy. We enrolled all consecutive PD subjects with and without STN-DBS who applied to our movement disorders outpatient clinics between January/2023 and September/2023. We performed comprehensive assessments of the motor and nonmotor features including the clinical scales of Movement Disorder Society-sponsored revision of the MDS-UPDRS, NMSS, HAM-A, HAM-D, and the PDQ-39. Overall, 48 PD subjects with STN-DBS and 161 without STN-DBS treatment were included. The comparative analyses revealed that the sub-scores of the MDS-UPDRS-2, -3 and -4 were higher in the STN-DBS group. However, the MDS-UDPRS-1 and the total scores of the NMSS were similar between groups. Among eight subitems of the NMSS, only, the sub scores of the mood/cognition and the gastrointestinal tract differed. Remarkably, the significant correlations between the scores of the QOL and the NMSS scores in the STN-DBS (-) group, did not persist within the STN-DBS group. Remarkably, the correlations between the NMSS and PQQ-39 disappeared for most of the sub scores within the STN-DBS group. We found indirect evidence regarding the benefit of STN-DBS therapy on NMSs in our cross-sectional study. Besides, we found weaker impact of NMSs in QOL indexes in PD subjects with STN-DBS therapy.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Etlik City Hospital, Varlık, Halil Sezai Erkut Street. No:5, 06170 Yenimahalle, 06110, Ankara, Turkey.
| | - Selcuk Comoglu
- Neurology Clinic, Etlik City Hospital, Varlık, Halil Sezai Erkut Street. No:5, 06170 Yenimahalle, 06110, Ankara, Turkey
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5
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Oosterhof TH, Darweesh SKL, Bloem BR, de Vries NM. Considerations on How to Prevent Parkinson's Disease Through Exercise. JOURNAL OF PARKINSON'S DISEASE 2024:JPD240091. [PMID: 39031383 DOI: 10.3233/jpd-240091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
The increasing prevalence of people with Parkinson's disease (PD) necessitates a high priority for finding interventions to delay or even prevent the onset of PD. There is converging evidence that exercise may exert disease-modifying effects in people with clinically manifest PD, but whether exercise also has a preventive effect or is able to modify the progression of the pathology in the prodromal phase of PD is unclear. Here we provide some considerations on the design of trials that aim to prevent PD through exercise. First, we discuss the who could benefit from exercise, and potential exercise-related risks. Second, we discuss what specific components of exercise mediate the putative disease-modifying effects. Third, we address how methodological challenges such as blinding, adherence and remote monitoring could be handled and how we can measure the efficacy of exercise as modifier of the course of prodromal PD. We hope that these considerations help in designing exercise prevention trials for persons at risk of developing PD.
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Affiliation(s)
- Thomas H Oosterhof
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Nienke M de Vries
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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6
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Alnajjar AZ, Abouelmagd ME, Krayim A, AbdelMeseh M, Bushara N, Nabil Y. Efficacy of cognitive behavioral therapy for anxiety and depression in Parkinson's disease patients: an updated systematic review and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07659-6. [PMID: 38958793 DOI: 10.1007/s10072-024-07659-6] [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: 01/28/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Parkinson's disease (PD) patients often experience non-motor symptoms like depression and anxiety, significantly impacting their quality of life. With the limited effectiveness of pharmacological treatments, effective non-pharmacological interventions are needed. This systematic review and meta-analysis aimed to evaluate the efficacy of cognitive-behavioral therapy (CBT) in reducing depression and anxiety symptoms in PD patients. METHODS Randomized controlled trials (RCTs) exploring CBT's effectiveness for depression and anxiety in PD patients were included. Studies published until April 2023 were identified from PubMed, Web of Science, and Scopus. Methodological quality was assessed using the Risk of Bias-2 (ROB-2) tool. Statistical analysis involved calculating the standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) using Review Manager 5.4.1. RESULTS The systematic review included 12 studies involving 241 PD patients. CBT led to a substantial reduction in anxiety (SMD -0.95, 95% CI [-1.15 to -0.74], P < 0.00001) and depression (SMD -1.02, 95% CI [-1.39 to -0.65], P < 0.0001). Both traditional CBT and tele-CBT (administered over the phone or internet) were effective in treating depression and anxiety. Traditional CBT improved depression (SMD -1.16, 95% CI [-1.83 to -0.49], P < 0.00001), while tele-CBT showed comparable results (SMD -0.90, 95% CI [-1.31 to -0.48], P < 0.00001). For anxiety, both traditional CBT (SMD -0.94, 95% CI [-1.25 to -0.63], P < 0.00001) and tele-CBT (SMD -0.95, 95% CI [-1.22 to -0.67], P < 0.00001) significantly reduced symptoms. In conclusion, this systematic review and meta-analysis demonstrated the efficacy of CBT in reducing depression and anxiety in PD patients. Healthcare providers are encouraged to integrate CBT into their treatment protocols. However, additional high-quality studies with longer-term follow-up assessments are needed to further enhance understanding in this area. PROSPERO REGISTRATION CRD42023424758.
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Affiliation(s)
| | | | | | | | | | - Yehia Nabil
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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7
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Ye M, Ji Q, Liu Q, Xu Y, Tao E, Zhan Y. Olfactory Dysfunction and Long-Term Trajectories of Sleep Disorders among early Parkinson's Disease: Findings from a Longitudinal Cohort. Neuroepidemiology 2024:1-10. [PMID: 38768570 DOI: 10.1159/000539330] [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: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Previous studies have suggested a connection between impaired olfactory function and an increased risk of rapid eye movement sleep behavior disorder (RBD) in individuals diagnosed with Parkinson's disease (PD). However, there is a gap in knowledge regarding the potential impact of olfactory dysfunction on the long-term patterns of sleep disorders among early PD patients. METHODS Data from the Parkinson's Progression Markers Initiative program included 589 participants with assessments of sleep disorders using the Epworth Sleepiness Scale (ESS) and RBD Screening Questionnaire (RBDSQ). Olfactory dysfunction at baseline was measured using the University of Pennsylvania Smell Identification Test. Trajectories of sleep disorders over a 5-year follow-up were identified using group-based trajectory modeling, and the relationship between olfactory dysfunction and sleep disorder trajectories was examined through binomial logistic regression. RESULTS Two distinct trajectories of sleep disorders over the 5-year follow-up period were identified, characterized by maintaining a low or high ESS score and a low or high RBDSQ score. An inversion association was observed between olfactory function measures and trajectories of excessive daytime sleepiness (odds ratio [OR] = 0.97, 95% confidence interval [CI] 0.95, 1.00, p = 0.038), after controlling for potential covariates. Similarly, olfactory function showed a significant association with lower trajectories of probable RBD (OR = 0.96, 95% CI 0.94, 0.98, p = 0.001) among early PD individuals. Consistent findings were replicated across alternative analytical models. CONCLUSIONS Our findings indicated that olfactory dysfunction was associated with unfavorable long-term trajectories of sleep disorders among early PD.
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Affiliation(s)
- Meijie Ye
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China,
| | - Qianqian Ji
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Qi Liu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yue Xu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Enxiang Tao
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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8
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Rocha RMS, Faria-Fortini ID, Scalzo PL. Telephone-based application of the Activities of Daily Living Questionnaire in patients with Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-8. [PMID: 38857888 DOI: 10.1055/s-0044-1787135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND The Activities of Daily Living Questionnaire (ADLQ) focuses on assessing the ability to perform activities of daily living (ADLs) based on the self-perception of individuals with Parkinson's disease (PD). A Brazilian Portuguese version of the questionnaire is available (ADLQ-Brazil), and further investigation is needed to fully assess its measurement properties. OBJECTIVE To investigate construct and concurrent validity of the telephone-based administration of the ADLQ-Brazil with community individuals with PD. METHODS There were 50 adults with PD (mean age: 68 ± 9.5 years) invited to answer the ADLQ-Brazil on two randomized occasions, face-to-face and by telephone, 7 to 10 days apart. Clinical-based measures including the Movement Disorder Society-Sponsored Revision of the Unified Parkinson Disease Rating Scale, Timed Up and Go Test, Nine Hole Peg Test, Mini-Balance Evaluation Systems Test, Apathy Scale, Beck Depression Inventory, Modified Fatigue Impact Scale, and Parkinson Disease Quality of Life Questionnaire were applied during the first session, to establish construct validity. RESULTS The total scores on the ADLQ-Brazil were significantly associated with the clinical-based measures, thus providing evidence of construct validity. No significant differences were observed between the mean scores obtained with the face-to-face and telephone-based administration of the questionnaire (95%CI = 0.997). A high level of agreement was found in the total scores obtained between both applications of the ADLQ-Brazil (95%CI = 0.994-0.998), and most of the individual items had, on average, moderate agreement. CONCLUSION The findings provide psychometric support for the ADLQ-Brazil as a telephone interview to assess the performance of ADLs in individuals with PD.
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Affiliation(s)
- Rafaela Moura Santos Rocha
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Iza de Faria-Fortini
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Departamento de Terapia Ocupacional, Belo Horizonte MG, Brazil
| | - Paula Luciana Scalzo
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte MG, Brazil
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Doherty M, Chukwusa E, McQuillan R, Cranfield F, Gao W. The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data. J Palliat Med 2024; 27:622-629. [PMID: 38597932 DOI: 10.1089/jpm.2023.0437] [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] [Indexed: 04/11/2024] Open
Abstract
Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.
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Affiliation(s)
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | | | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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10
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Honma M, Terao Y. Modulation of time in Parkinson's disease: a review and perspective on cognitive rehabilitation. Front Psychiatry 2024; 15:1379496. [PMID: 38686125 PMCID: PMC11056500 DOI: 10.3389/fpsyt.2024.1379496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Time cognition is an essential function of human life, and the impairment affects a variety of behavioral patterns. Neuropsychological approaches have been widely demonstrated that Parkinson's disease (PD) impairs time cognitive processing. Many researchers believe that time cognitive deficits are due to the basal ganglia, including the striatum or subthalamic nucleus, which is the pathomechanism of PD, and are considered to produce only transient recovery due to medication effects. In this perspective, we focus on a compensatory property of brain function based on the improved time cognition independent of basal ganglia recovery and an overlapping structure on the neural network based on an improved inhibitory system by time cognitive training, in patients with PD. This perspective may lead to restoring multiple functions through single function training.
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Affiliation(s)
- Motoyasu Honma
- Department of Physiology, Showa University School of Medicine, Tokyo, Japan
| | - Yasuo Terao
- Department of Medical Physiology, Kyorin University of School of Medicine, Tokyo, Japan
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11
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Ye M, Kang X, Karlsson IK, Wang Y, Ji Q, Liu Q, Xu X, Hägg S, Fang F, Wirdefeldt K, Zhan Y. Associations between Sleep Disorders and Impulsive-Compulsive Behaviors in Parkinson's Disease: A Prospective Cohort Study. Neuroepidemiology 2024; 58:256-263. [PMID: 38325344 PMCID: PMC11302741 DOI: 10.1159/000536555] [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: 11/16/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To examine the associations of excessive daytime sleepiness (EDS) and probable rapid eye movement sleep behavior disorder (pRBD), respectively, with impulsive-compulsive behaviors (ICBs) over a 5-year follow-up in patients with early Parkinson's disease (PD). METHODS The Parkinson's Progression Markers Initiative is a multicenter cohort study based on an ongoing and open-ended registry. Longitudinal associations of sleep disorders with ICB over 5-year follow-up visits were estimated using generalized linear mixed-effects models among PD participants. RESULTS A total of 825 PD participants were enrolled at baseline. The study sample had a median baseline age of 63.1 (interquartile range: 55.6-69.3) years and comprised 496 (61.5%) men. Among them, 201 (24.9%) had ICB at baseline. In the generalized mixed-effects models, EDS (odds ratio [OR] = 1.09, 95% confidence interval [CI] 1.05, 1.12) and RBD (OR = 1.07, 95% CI 1.03, 1.12) were substantially associated with higher odds of developing ICB over time in PD patients, after multivariate adjustment including age, gender, family history, GDS score, STAI-Y score, MDS-UPDRS part III score, LEDD, and disease duration. Consistent results were observed when stratifying by age at baseline, gender, and PD family history. CONCLUSIONS The study findings suggest a longitudinal association between EDS and pRBD with an increased risk of developing ICB in patients with PD. The findings emphasize the significance of evaluating and addressing sleep disorders in PD patients as a potential approach to managing ICB.
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Affiliation(s)
- Meijie Ye
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China,
| | - Xiaoying Kang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ida K Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yu Wang
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Qianqian Ji
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Qi Liu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Xiaowei Xu
- Department of Neurology, The Seventh Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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12
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Zhang P, Huang P, Li Y, Du J, Luo N, He Y, Liu J, He G, Cui S, Zhang W, Li G, Shen X, Jun L, Chen S. Relationships Between Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease: Indication from Gut Microbiota Alterations. Aging Dis 2024; 15:357-368. [PMID: 37307829 PMCID: PMC10796088 DOI: 10.14336/ad.2023.0518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023] Open
Abstract
Rapid eye movement sleep behavior disorder (RBD) has a close relationship with Parkinson's disease (PD) and was even regarded as the most reliable hallmark of prodromal PD. RBD might have similar changes in gut dysbiosis to PD, but the relationship between RBD and PD in gut microbial alterations is rarely studied. In this study, we aim to investigate whether there were consistent changes between RBD and PD in gut microbiota, and found some specific biomarkers in RBD that might indicate phenoconversion to PD. Alpha-diversity showed no remarkable difference and beta-diversity showed significant differences based on the unweighted (R = 0.035, P = 0.037) and weighted (R = 0.0045, P = 0.008) UniFrac analysis among idiopathic RBD (iRBD), PD with RBD, PD without RBD and normal controls (NC). Enterotype distribution indicated iRBD, PD with RBD and PD without RBD were Ruminococcus-dominant while NC were Bacteroides-dominant. 7 genera (4 increased: Aerococcus, Eubacterium, Gordonibacter and Stenotrophomonas, 3 decreased: Butyricicoccus, Faecalibacterium and Haemophilus) were consistently changed in iRBD and PD with RBD. Among them, 4 genera (Aerococcus, Eubacterium, Butyricicoccus, Faecalibacterium) remained distinctive in the comparison between PD with RBD and PD without RBD. Through clinical correlation analysis, Butyricicoccus and Faecalibacterium were found negatively correlated with the severity of RBD (RBD-HK). Functional analysis showed iRBD had similarly increased staurosporine biosynthesis to PD with RBD. Our study indicates that RBD had similar gut microbial changes to PD. Decreased Butyricicoccus and Faecalibacterium might be potential hallmarks of phenoconversion of RBD to PD.
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Affiliation(s)
- Pingchen Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Yuanyuan Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Juanjuan Du
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Ningdi Luo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Yixi He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Jin Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Guiying He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Shishuang Cui
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Weishan Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Gen Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Xin Shen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Liu Jun
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
- Lab for Translational Research of Neurodegenerative Diseases, Shanghai Institute for Advanced Immunochemical Studies (SIAIS), Shanghai Tech University, Shanghai 201210, China
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13
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Sujith P, Arjunan P, Iype T, Natarajan V. Correlation Between Depression and Quality of Life Among Patients With Parkinson's Disease: An Analytical Cross-Sectional Study. Cureus 2024; 16:e54736. [PMID: 38523931 PMCID: PMC10960943 DOI: 10.7759/cureus.54736] [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] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Parkinson's disease (PD) is a progressive complex degenerative disorder characterised by several motor and non-motor symptoms that result in disability and deterioration of the patient's quality of life (QOL). Depression is the most common non-motor symptom that may severely alter the QOL. The objective of this study was to examine the correlation between depression and QOL among patients with PD who received treatment from a movement disorder clinic of a tertiary care teaching hospital in South India. Methods This was an analytical cross-sectional study conducted among 220 PD patients who received treatment from a movement disorder clinic of a tertiary care teaching hospital in South India. The participants aged between 40 and 80 years, who can comprehend Malayalam or English and were clinically diagnosed with PD according to United Kingdom PD Society Brain Bank criteria were included in the study. Depression was assessed using the Hospital Anxiety and Depression Scale, motor function using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III, and the quality of life was assessed using the Parkinson's Disease Questionnaire 39. Results The results of this study showed that there was a significant positive correlation between depression and QOL (r=0.699, p<0.01) among patients with PD who received treatment from a tertiary care teaching hospital. The correlation with domains of QOL also identified that depression was significantly correlated with all domains of QOL and more to the emotional domain of QOL (r=0.799, p<0.01). Conclusion Depression is the most common neuropsychiatric condition in PD and the most important determinant of QOL. Depression may occur at any stage of PD and can significantly impact the QOL of patients and their caregivers. Hence it should be recognized early and managed by pharmacological and nonpharmacological measures to improve the QOL.
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Affiliation(s)
- Priya Sujith
- Nursing, Government College of Nursing, Thiruvananthapuram, IND
- Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Porkodi Arjunan
- Medical Surgical Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Thomas Iype
- Neurology, Medical College Thiruvananthapuram, Thiruvananthapuram, IND
| | - Venkatesh Natarajan
- Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Yuan J, Liu Y, Liao H, Tan C, Cai S, Shen Q, Liu Q, Wang M, Tang Y, Li X, Liu J, Zi Y. Alterations in cortical volume and complexity in Parkinson's disease with depression. CNS Neurosci Ther 2024; 30:e14582. [PMID: 38421103 PMCID: PMC10851315 DOI: 10.1111/cns.14582] [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: 08/05/2023] [Revised: 11/09/2023] [Accepted: 12/17/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS The aim of this study is to investigate differences in gray matter volume and cortical complexity between Parkinson's disease with depression (PDD) patients and Parkinson's disease without depression (PDND) patients. METHODS A total of 41 PDND patients, 36 PDD patients, and 38 healthy controls (HC) were recruited and analyzed by Voxel-based morphometry (VBM) and surface-based morphometry (SBM). Differences in gray matter volume and cortical complexity were compared using the one-way analysis of variance (ANOVA) and correlated with the Hamilton Depression Scale-17 (HAMD-17) scores. RESULTS PDD patients exhibited significant cortical atrophy in various regions, including bilateral medial parietal-occipital-temporal lobes, right dorsolateral temporal lobes, bilateral parahippocampal gyrus, and bilateral hippocampus, compared to HC and PDND groups. A negative correlation between the GMV of left precuneus and HAMD-17 scores in the PDD group tended to be significant (r = -0.318, p = 0.059). Decreased gyrification index was observed in the bilateral insular and dorsolateral temporal cortex. However, there were no significant differences found in fractal dimension and sulcal depth. CONCLUSION Our research shows extensive cortical structural changes in the insular cortex, parietal-occipital-temporal lobes, and hippocampal regions in PDD. This provides a morphological perspective for understanding the pathophysiological mechanism underlying depression in Parkinson's disease.
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Affiliation(s)
- Jiaying Yuan
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yujing Liu
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Haiyan Liao
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Clinical Research Center For Medical Imaging in Hunan ProvinceChangshaChina
| | - Changlian Tan
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Sainan Cai
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Qin Shen
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Qinru Liu
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Min Wang
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yuqing Tang
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Xu Li
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Jun Liu
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Clinical Research Center For Medical Imaging in Hunan ProvinceChangshaChina
| | - Yuheng Zi
- Department of Radiology, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
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15
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Batzu L, Podlewska A, Gibson L, Chaudhuri KR, Aarsland D. A general clinical overview of the non-motor symptoms in Parkinson's disease: Neuropsychiatric symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 174:59-97. [PMID: 38341232 DOI: 10.1016/bs.irn.2023.11.001] [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: 02/12/2024]
Abstract
The heterogeneity of non-motor features observed in people with Parkinson's disease (PD) is often dominated by one or more symptoms belonging to the neuropsychiatric spectrum, such as cognitive impairment, psychosis, depression, anxiety, and apathy. Due to their high prevalence in people with PD (PwP) and their occurrence in every stage of the disease, from the prodromal to the advanced stage, it is not surprising that PD can be conceptualised as a complex neuropsychiatric disorder. Despite progress in understanding the pathophysiological mechanisms underlying the neuropsychiatric signs and symptoms in PD, and better identification and diagnosis of these symptoms, effective treatments are still a major unmet need. The impact of these symptoms on the quality of life of PwP and caregivers, as well as their contribution to the overall non-motor symptom burden can be greater than that of motor symptoms and require a personalised, holistic approach. In this chapter, we provide a general clinical overview of the major neuropsychiatric symptoms of PD.
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Affiliation(s)
- Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Aleksandra Podlewska
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Lucy Gibson
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway.
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16
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Sujith P, Arjunan P, Iype T, Natarajan V. Depression in Patients With Parkinson's Disease: A Hospital-Based Cross-Sectional Study. Cureus 2023; 15:e47214. [PMID: 38022066 PMCID: PMC10653116 DOI: 10.7759/cureus.47214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Depression, a common non-motor symptom in Parkinson's disease (PD), is often underdiagnosed and can significantly impact the quality of life (QOL) and treatment outcomes. Specific disease-related factors and non-specific factors may contribute to depression, and these factors should be identified early to plan the appropriate interventions that promote positive mood. The study aimed to assess the prevalence of depression in PD patients and to find out the factors associated with depression among patients with PD attending the neurology OPD of a tertiary care teaching hospital in Trivandrum. METHODS A cross-sectional study was conducted at the neurology OPD of Government Medical College Hospital, Trivandrum, from December 2021 to February 2023. We included patients with PD diagnosed according to the United Kingdom PD Society Brain Bank criteria. We collected data from 220 patients with PD by interview technique. Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety in this study. Staging and the severity of the motor symptoms were assessed using the Hoehn and Yahr scale and the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS UPDRS Part III), respectively. RESULTS Among 220 patients with PD, 31.8% (95% CI: 4.36-5.40) had depression. The non-specific variables, such as education, living arrangements, and gender, and disease-specific variables, such as the severity of motor symptoms (MDS UPDRS Part III score) and the Hoehn and Yahr staging of PD, had a statistically significant association with depression. Logistic regression analysis showed that the severity of motor symptoms (OR=2.69, p=0.004)) and female gender (OR=1.830, p= 0.05) were the independent factors associated with depression. CONCLUSION Depression is a common non-motor symptom of PD that is often underdiagnosed and undertreated and can significantly impact the QOL of patients and their caregivers. Hence, it should be identified early and managed by pharmacological and non-pharmacological strategies.
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Affiliation(s)
- Priya Sujith
- Medical Surgical Nursing, Government College of Nursing, Trivandrum, IND
- Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Porkodi Arjunan
- Medical Surgical Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Thomas Iype
- Neurology, Government Medical College, Trivandrum, IND
| | - Venkatesh Natarajan
- Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Schootemeijer S, de Vries NM, Macklin EA, Roes KCB, Joosten H, Omberg L, Ascherio A, Schwarzschild MA, Bloem BR. The STEPWISE study: study protocol for a smartphone-based exercise solution for people with Parkinson's Disease (randomized controlled trial). BMC Neurol 2023; 23:323. [PMID: 37700241 PMCID: PMC10496249 DOI: 10.1186/s12883-023-03355-8] [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: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Exercise has various health benefits for people with Parkinson's disease (PD). However, implementing exercise into daily life and long-term adherence remain challenging. To increase a sustainable engagement with physical activity of people with PD, interventions that are motivating, accessible, and scalable are needed. We primarily aim to investigate whether a smartphone app (STEPWISE app) can increase physical activity (i.e., step count) in people with PD over one year. Our second aim is to investigate the potential effects of the intervention on physical fitness, and motor- and non-motor function. Our third aim is to explore whether there is a dose-response relationship between volume of physical activity and our secondary endpoints. METHODS STEPWISE is a double-blind, randomized controlled trial. We aim to include 452 Dutch people with PD who can walk independently (Hoehn & Yahr stages 1-3) and who do not take more than 7,000 steps per day prior to inclusion. Physical activity levels are measured as step counts on the participant's own smartphone and scaled as percentage of each participant's baseline. Participants are randomly assigned to an active control group with an increase of 5-20% (active controls) or any of the three intervention arms with increases of 25-100% (intermediate dose), 50-200% (large dose), or 100-400% (very large dose). The primary endpoint is change in step count as measured by the STEPWISE smartphone app from baseline to 52 weeks. For our primary aim, we will evaluate the between-group difference in average daily step count change from baseline to 52 weeks. For our second aim, measures of physical fitness, and motor- and non-motor function are included. For our third aim, we will associate 52-week changes in step count with 52-week changes in secondary outcomes. DISCUSSION This trial evaluates the potential of a smartphone-based intervention to increase activity levels in people with PD. We envision that motivational apps will increase adherence to physical activity recommendations and could permit conduct of remote clinical trials of exercise for people with PD or those at risk of PD. TRIAL REGISTRATION ClinicalTrials.gov; NCT04848077; 19/04/2021. CLINICALTRIALS gov/ct2/show/NCT04848077.
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Affiliation(s)
- Sabine Schootemeijer
- DisordersDonders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nienke M de Vries
- DisordersDonders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kit C B Roes
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, the Netherlands
| | - Hilde Joosten
- Department of Sports Medicine, Canisius Wilhelmina Hospital, Burgemeester Daleslaan 27, Nijmegen, 6532 CL, the Netherlands
| | | | - Alberto Ascherio
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael A Schwarzschild
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Mass General Institute for Neurodegenerative Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Bastiaan R Bloem
- DisordersDonders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands.
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18
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Huang P, Zhang P, Du J, Gao C, Liu J, Tan Y, Chen S. Association of fecal short-chain fatty acids with clinical severity and gut microbiota in essential tremor and its difference from Parkinson's disease. NPJ Parkinsons Dis 2023; 9:115. [PMID: 37460569 DOI: 10.1038/s41531-023-00554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
Diagnosis of essential tremor (ET) at an early stage can be difficult, especially when distinguishing it from healthy controls (HCs) and Parkinson's disease (PD). Recently, stool sample analysis of gut microbiota and its metabolites provides new ways to detect novel biomarkers for neurodegenerative diseases. Short-chain fatty acids (SCFAs), as the main metabolites of gut microbiota, were reduced in the feces of PD. However, fecal SCFAs in ET have never been investigated. We aimed to investigate the fecal SCFA levels in ET, assess their relationships with clinical symptoms and gut microbiota, and identify their potential diagnostic abilities. Fecal SCFAs and gut microbiota in 37 ET, 37 de novo PD and 35 HC were measured. Constipation, autonomic dysfunction and tremor severity were evaluated by scales. ET had lower fecal propionic, butyric and isobutyric acid levels than HC. Combined propionic, butyric and isobutyric acid distinguished ET from HC with an AUC of 0.751 (95% CI: 0.634-0.867). ET had lower fecal isovaleric and isobutyric acid levels than PD. Isovaleric and isobutyric acid differentiated ET from PD with an AUC of 0.743 (95% CI: 0.629-0.857). Fecal propionic acid was negatively correlated with constipation and autonomic dysfunction. Isobutyric and isovaleric acid were negatively associated with tremor severity. Lowered fecal SCFAs were related to a decreased abundance of Faecalibacterium and Catenibacterium in ET. In conclusion, fecal SCFAs were decreased in ET and correlated with clinical severity and gut microbiota changes. Fecal propionic, butyric, isobutyric and isovaleric acid might be potential diagnostic and differential diagnostic biomarkers for ET.
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Affiliation(s)
- Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Pingchen Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Juanjuan Du
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Chao Gao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Jin Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Yuyan Tan
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China.
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China.
- Lab for Translational Research of Neurodegenerative Diseases, Shanghai Institute for Advanced Immunochemical Studies (SIAIS), Shanghai Tech University, 201210, Shanghai, China.
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19
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Vaccarino AL, Black SE, Gilbert Evans S, Frey BN, Javadi M, Kennedy SH, Lam B, Lam RW, Lasalandra B, Martens E, Masellis M, Milev R, Mitchell S, Munoz DP, Sparks A, Swartz RH, Tan B, Uher R, Evans KR. Rasch analyses of the Quick Inventory of Depressive Symptomatology Self-Report in neurodegenerative and major depressive disorders. Front Psychiatry 2023; 14:1154519. [PMID: 37333922 PMCID: PMC10273843 DOI: 10.3389/fpsyt.2023.1154519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Background Symptoms of depression are present in neurodegenerative disorders (ND). It is important that depression-related symptoms be adequately screened and monitored in persons living with ND. The Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) is a widely-used self-report measure to assess and monitor depressive severity across different patient populations. However, the measurement properties of the QIDS-SR have not been assessed in ND. Aim To use Rasch Measurement Theory to assess the measurement properties of the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) in ND and in comparison to major depressive disorder (MDD). Methods De-identified data from the Ontario Neurodegenerative Disease Research Initiative (NCT04104373) and Canadian Biomarker Integration Network in Depression (NCT01655706) were used in the analyses. Five hundred and twenty participants with ND (Alzheimer's disease or mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia and Parkinson's disease) and 117 participants with major depressive disorder (MDD) were administered the QIDS-SR. Rasch Measurement Theory was used to assess measurement properties of the QIDS-SR, including unidimensionality and item-level fit, category ordering, item targeting, person separation index and reliability and differential item functioning. Results The QIDS-SR fit well to the Rasch model in ND and MDD, including unidimensionality, satisfactory category ordering and goodness-of-fit. Item-person measures (Wright maps) showed gaps in item difficulties, suggesting poor precision for persons falling between those severity levels. Differences between mean person and item measures in the ND cohort logits suggest that QIDS-SR items target more severe depression than experienced by the ND cohort. Some items showed differential item functioning between cohorts. Conclusion The present study supports the use of the QIDS-SR in MDD and suggest that the QIDS-SR can be also used to screen for depressive symptoms in persons with ND. However, gaps in item targeting were noted that suggests that the QIDS-SR cannot differentiate participants falling within certain severity levels. Future studies would benefit from examination in a more severely depressed ND cohort, including those with diagnosed clinical depression.
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Affiliation(s)
| | - Sandra E. Black
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benjamin Lam
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mario Masellis
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Sara Mitchell
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Douglas P. Munoz
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | | | - Richard H. Swartz
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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20
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Xu Y, Geng C, Tang T, Huang J, Hou Y. How to prevent cognitive overload in the walking-arithmetic dual task among patients with Parkinson's disease. BMC Neurol 2023; 23:205. [PMID: 37231372 DOI: 10.1186/s12883-023-03231-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Participants with Parkinson's disease (PD) may experience difficulty during certain dual-task (DT) tests. Thus, it is necessary to keep the cognitive load within the limits of their ability. OBJECTIVE To identify cognitive overload and its influence on the walking and auditory addition and subtraction (AAS, all values within the range of 0-20) DT performance of patients with PD. STUDY DESIGN A cross-sectional observational study with convenience sampling. SETTING Outpatient clinic of the Department of Neurology. SUBJECTS Sixteen patients with PD and 15 sex- and age- matched people elderly healthy controls (HCs). METHODS Verbal calculation responses and gait parameters were collected from the two groups in the 2-min single arithmetic task (2-min SAT), 2-min single walking task (2-min SWT), and 2-min walking-arithmetic dual task (2-min WADT). RESULTS The group differences in the lower-limb gait parameters increased in the 2-min WADT (P < 0.01), and those in the arm, trunk, and waist parameters did not change (P > 0.05). In the 2-min SAT, the calculation speed of the PD group was significantly lower than that of the HC group (P < 0.01). In the 2-min WADT, both groups made more errors (P < 0.05), especially the PD group (P = 0.00). PD group miscalculations occurred in the first half of the 2-min SAT but were uniformly distributed in the 2-min WADT. The HC group and PD group had subtraction self-correction rates of 31.25% and 10.25%, respectively. The PD group tended to make subtraction errors when the value of the first operand was 20 or 13.46 ± 2.60 and when the value of the second and third operands were 7.75 ± 2.51 (P = 0.3657) and 8.50 ± 4.04 (P = 0.170), respectively. CONCLUSIONS Cognitive overload was observed in patients with PD. This was mainly reflected in the failure of gait control and accurate calculation, indicated by gait parameters of the lower limbs and accuracy of calculation. To impose a constant cognitive load, the amount added or subtracted, especially in subtraction with borrowing, should not be mixed during a sequential arithmetic problem in the DT, and equations with the value of the first operand equal to 20 or approximately 13, the value of the second operand approximately 7, or the value of the third operand of approximately 9 should be excluded in the AAS DT. TRIAL REGISTRATION Clinical trial registration number: ChiCTR1800020158.
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Affiliation(s)
- Ying Xu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China
| | - Canru Geng
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China
| | - Tong Tang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China
| | - Juanying Huang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, Jiangsu, 215000, China.
| | - Ying Hou
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China.
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21
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Gomes ESA, Van den Heuvel OA, Rietberg MB, De Groot V, Hirsch MA, Van de Berg WDJ, Jaspers RT, Vriend C, Vanbellingen T, Van Wegen EEH. (HIIT-The Track) High-Intensity Interval Training for People with Parkinson's Disease: Individual Response Patterns of (Non-)Motor Symptoms and Blood-Based Biomarkers-A Crossover Single-Case Experimental Design. Brain Sci 2023; 13:849. [PMID: 37371330 DOI: 10.3390/brainsci13060849] [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: 04/26/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Physical exercise is receiving increasing interest as an augmentative non-pharmacological intervention in Parkinson's disease (PD). This pilot study primarily aimed to quantify individual response patterns of motor symptoms to alternating exercise modalities, along with non-motor functioning and blood biomarkers of neuroplasticity and neurodegeneration. MATERIALS & METHODS People with PD performed high-intensity interval training (HIIT) and continuous aerobic exercise (CAE) using a crossover single-case experimental design. A repeated assessment of outcome measures was conducted. The trajectories of outcome measures were visualized in time series plots and interpreted relative to the minimal clinically important difference (MCID) and smallest detectable change (SDC) or as a change in the positive or negative direction using trend lines. RESULTS Data of three participants were analyzed and engaging in physical exercise seemed beneficial for reducing motor symptoms. Participant 1 demonstrated improvement in motor function, independent of exercise modality; while for participant 2, such a clinically relevant (positive) change in motor function was only observed in response to CAE. Participant 3 showed improved motor function after HIIT, but no comparison could be made with CAE because of drop-out. Heterogeneous responses on secondary outcome measures were found, not only between exercise modalities but also among participants. CONCLUSION Though this study underpins the positive impact of physical exercise in the management of PD, large variability in individual response patterns to the interventions among participants makes it difficult to identify clear exercise-induced adaptations in functioning and blood biomarkers. Further research is needed to overcome methodological challenges in measuring individual response patterns.
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Affiliation(s)
- Elvira S Amaral Gomes
- Department of Rehabilitation Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Odile A Van den Heuvel
- Department of Anatomy & Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Marc B Rietberg
- Department of Rehabilitation Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Vincent De Groot
- Department of Rehabilitation Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neuroinfection & Neuroinflammation, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Mark A Hirsch
- Carolinas Medical Center, Atrium Health Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, Charlotte, NC 28203, USA
- Wake Forest School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Winston-Salem, NC 27157, USA
| | - Wilma D J Van de Berg
- Department of Anatomy & Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Richard T Jaspers
- Laboratory of Myology, Department of Human Movement Science, Faculty of Behavioural and Movement Sciences, Location Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Tissue Function & Regeneration, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Chris Vriend
- Department of Anatomy & Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Tim Vanbellingen
- Gerontechnology and Rehabilitation Group, University of Bern, 3008 Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - Erwin E H Van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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22
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Pagonabarraga J, Álamo C, Castellanos M, Díaz S, Manzano S. Depression in Major Neurodegenerative Diseases and Strokes: A Critical Review of Similarities and Differences among Neurological Disorders. Brain Sci 2023; 13:brainsci13020318. [PMID: 36831861 PMCID: PMC9954482 DOI: 10.3390/brainsci13020318] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Depression and anxiety are highly prevalent in most neurological disorders and can have a major impact on the patient's disability and quality of life. However, mostly due to the heterogeneity of symptoms and the complexity of the underlying comorbidities, depression can be difficult to diagnose, resulting in limited recognition and in undertreatment. The early detection and treatment of depression simultaneously with the neurological disorder is key to avoiding deterioration and further disability. Although the neurologist should be able to identify and treat depression initially, a neuropsychiatry team should be available for severe cases and those who are unresponsive to treatment. Neurologists should be also aware that in neurodegenerative diseases, such as Alzheimer's or Parkinson's, different depression symptoms could develop at different stages of the disease. The treatment options for depression in neurological diseases include drugs, cognitive-behavioral therapy, and somatic interventions, among others, but often, the evidence-based efficacy is limited and the results are highly variable. Here, we review recent research on the diagnosis and treatment of depression in the context of Alzheimer's disease, Parkinson's disease, and strokes, with the aim of identifying common approaches and solutions for its initial management by the neurologist.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Correspondence:
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital and Biomedical Research Institute, 15006 La Coruña, Spain
| | - Samuel Díaz
- Headaches Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Sagrario Manzano
- Department of Neurology, Infanta Leonor University Hospital, 28031 Madrid, Spain
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23
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Patel RA, Blasucci L, Mahajan A. A pilot study of a 12-week community-based boxing program for Parkinson's disease. J Clin Neurosci 2023; 107:64-67. [PMID: 36512938 DOI: 10.1016/j.jocn.2022.12.006] [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: 08/16/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Community-based exercise programs for Parkinson's disease (PD) have gained popularity. Our understanding of such programs on non-motor features is limited. We characterized the effect of a 12-week community-based boxing exercise program on motor and non-motor symptoms in people with Parkinson's disease (PwPD). METHODS In this prospective observational study, PwPD underwent a 12-week community-based boxing program (2 sessions per week, for a total of 24 sessions). The following assessments were performed by a movement disorders neurologist at baseline and after completion of the program: MDS-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) in a modified version since assessments were performed virtually due to COVID-19 pandemic, MDS Non-Motor Rating Scale (MDS-NMS), Hamilton Depression Rating Scale (HDRS), Lilli Apathy Rating Scale (LARS), Parkinson's Disease Questionaire-39 (PDQ-39), and Schwab and England Activities of Daily Living scale (SE-ADL). Pre- and post-assessments were compared using Wilcoxon signed rank test; only participants who completed the program and both assessments were analyzed. RESULTS A total of 14 PwPD agreed to be a part of the study and completed assessments. All participants were ambulatory and functionally independent at baseline. Total non-motor feature severity (MDS-NMS, p = 0.0031), depression (HDRS, p = 0.015), and motor features (MDS-UPDRS PART 3 modified, p = 0.023) all improved significantly after the intervention. Scales on apathy (LARS, p = 0.29), Parkinson's disease-specific health related quality (PDQ-39, p = 0.093), and activities of daily living (SE-ADL, p = 0.32) did not demonstrate significant change. CONCLUSION PwPD who participated in a community-based, pilot boxing program showed improvements in motor exam and non-motor symptoms.
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Affiliation(s)
- Roshni Abee Patel
- Rush University Medical Center, Dept of Neurological Sciences, 1725 W Harrison Ave Ste 755, Chicago, IL 60612, USA; Jesse Brown VA Medical Center, Neurology Service, 820 S Damen Ave, Chicago, IL 60612, USA
| | - Lucia Blasucci
- Rush University Medical Center, Dept of Neurological Sciences, 1725 W Harrison Ave Ste 755, Chicago, IL 60612, USA
| | - Abhimanyu Mahajan
- Rush University Medical Center, Dept of Neurological Sciences, 1725 W Harrison Ave Ste 755, Chicago, IL 60612, USA.
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24
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Artigas NR, Dutra ACL, Soares NM, Pereira GM, Leotti VB, Krimberg JS, Pagnussat ADS, Rieder CRDM. Depressive symptoms and axial motor disorders in individuals with Parkinson's disease: a cross-sectional study. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1126-1133. [PMID: 36577411 PMCID: PMC9797277 DOI: 10.1055/s-0042-1758444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depression is an important nonmotor symptom of Parkinson's disease (PD) and has been associated with the motor symptoms in these individuals. OBJECTIVES To determine whether there are relationships between depressive symptoms and abnormalities in axial postural alignment and axial motor deficits, especially postural instability, and trunk rigidity in PD. METHODS In this cross-sectional study, 65 individuals were evaluated using the Beck Depression Inventory-II (BDI-II) for the analysis of depressive symptoms and underwent a postural assessment of head, trunk, and hip sagittal alignment through computerized photogrammetry. The MDS-UPDRS was used to assess clinical aspects of PD, the Trunk Mobility Scale was used to assess axial rigidity, and the MiniBESTest to assess balance. To determine the relationship between depressive symptoms and postural alignment, multiple linear regression analysis was performed. RESULTS The participants with depressive symptoms had more severe motor deficits as well as greater trunk rigidity and worse postural instability (p < 0.05). When the postural angles were compared between men and women using Student's t-test, it was found that men had greater flexion angles of the head (p = 0.003) and trunk (p = 0.017). Using multiple linear regression analysis corrected for the age and sex of the participants, we verified that the anterior trunk inclination was significantly larger in the PD population with depressive symptoms (R2 = 0.453, β = 0.116, and p = 0.045). CONCLUSION PD individuals with depressive symptoms have more severe flexed trunk posture, mainly in older men. Additionally, more severe depressive symptoms are associated with worsening postural instability, trunk rigidity and motor deficits in this population.
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Affiliation(s)
- Nathalie Ribeiro Artigas
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.,Address for correspondence Nathalie Ribeiro Artigas
| | - Ana Carolina Leonardi Dutra
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
| | - Nayron Medeiros Soares
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
| | - Gabriela Magalhães Pereira
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
| | - Vanessa Bielefeldt Leotti
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, Departamento de Estatística, Porto Alegre RS, Brazil.
| | - Julia Schneider Krimberg
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Vida e da Saúde, Porto Alegre RS, Brazil.
| | - Aline de Souza Pagnussat
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil.
| | - Carlos Roberto de Mello Rieder
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Clínica Médica, Divisão de Neurologia, Porto Alegre RS, Brazil.
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25
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Fritz NE, Kegelmeyer DA, Rao AK, Quinn L, Kloos AD. Clinical Decision Trees to Guide Physical Therapy Management of Persons with Huntington's Disease. J Huntingtons Dis 2022; 11:435-453. [PMID: 36155527 PMCID: PMC9837690 DOI: 10.3233/jhd-220549] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 2020, our group published physical therapy clinical practice guidelines (CPG) for people with Huntington's disease (HD). The guideline recommendations were categorized according to six primary movement impairment classifications. OBJECTIVE To facilitate implementation of this CPG, we have developed guideline-based algorithms for physical therapy assessments and interventions and recommendations for therapists to overcome barriers to CPG implementation for people with HD. METHODS We conducted a literature review of papers that evaluated physical therapy interventions in individuals with HD (n = 26) to identify assessments for each of the primary movement impairment classifications, and then searched for papers (n = 28) that reported their clinometric/psychometric properties in HD. Assessments were evaluated using modified Movement Disorder Society Committee on Rating Scales criteria and other relevant criteria. RESULTS We identified a "core set" of physical therapy assessments for persons with HD, including the Six Minute Walk Test, Timed Up and Go Test, Berg Balance Scale, and the Medical Outcomes Study Short Form 36 (SF-36). We then developed guideline-based decision trees to assist in decision making and implementation of the CPG into practice for persons with HD across the continuum of care. Finally, we developed strategies for overcoming barriers to implementation, such as seeking specialized training in HD, engaging caretakers or family members to help the person with HD to exercise, and establishing clinical pathways that support early physical therapy referrals. CONCLUSION Knowledge translation documents such as this are essential to promoting implementation of the physical therapy CPGs into clinical practice.
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Affiliation(s)
- Nora E. Fritz
- Departments of Health Care Sciences and Neurology, Wayne State University, Detroit, MI, USA,Correspondence to: Nora Fritz, PhD, PT, DPT, NCS, Wayne State University, Departments of Health Care Sciences and Neurology, 259 Mack Avenue #2324, Detroit, MI 48201, USA. Tel.: +1 313 577 1096; E-mail:
| | - Deb A. Kegelmeyer
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Ashwini K. Rao
- Program in Physical Therapy, Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Anne D. Kloos
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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26
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Shirahige L, Leimig B, Baltar A, Bezerra A, de Brito CVF, do Nascimento YSO, Gomes JC, Teo WP, Dos Santos WP, Cairrão M, Fonseca A, Monte-Silva K. Classification of Parkinson's disease motor phenotype: a machine learning approach. J Neural Transm (Vienna) 2022; 129:1447-1461. [PMID: 36335541 DOI: 10.1007/s00702-022-02552-y] [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: 05/23/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
To assess the cortical activity in people with Parkinson's disease (PwP) with different motor phenotype (tremor-dominant-TD and postural instability and gait difficulty-PIGD) and to compare with controls. Twenty-four PwP (during OFF and ON medication) and twelve age-/sex-/handedness-matched healthy controls underwent electrophysiological assessment of spectral ratio analysis through electroencephalography (EEG) at resting state and during the hand movement. We performed a machine learning method with 35 attributes extracted from EEG. To verify the efficiency of the proposed phenotype-based EEG classification the random forest and random tree were tested (performed 30 times, using a tenfolds cross validation in Weka environment). The analyses based on phenotypes indicated a slowing down of cortical activity during OFF medication state in PwP. PD with TD phenotype presented this characteristic at resting and the individuals with PIGD presented during the hand movement. During the ON state, there is no difference between phenotypes at resting nor during the hand movement. PD phenotypes may influence spectral activity measured by EEG. Random forest machine learning provides a slightly more accurate, sensible and specific approach to distinguish different PD phenotypes. The phenotype of PD might be a clinical characteristic that could influence cortical activity.
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Affiliation(s)
- Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, w/n Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil.,Post-graduation Program of Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Brenda Leimig
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, w/n Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
| | - Adriana Baltar
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, w/n Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil.,Post-graduation Program of Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Amanda Bezerra
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, w/n Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
| | | | | | - Juliana Carneiro Gomes
- Department of Biomedical Engineering, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | | | - Marcelo Cairrão
- Neurodynamics Laboratory, Department of Physiology, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - André Fonseca
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, São Paulo, São Paulo, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, w/n Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil.
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27
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Ryu DW, Yoo SW, Oh YS, Lee KS, Ha S, Kim JS. Comparison of disease progression between brain-predominant Parkinson's disease versus Parkinson's disease with body-involvement phenotypes. Neurobiol Dis 2022; 174:105883. [DOI: 10.1016/j.nbd.2022.105883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/28/2022] Open
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28
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Wakode S, Hulke S, Wakode NS, Pathak T, Shrivastava R, Thakare A, Malhotra V. Assessing Neurocognition (P300) and Correlating Them to Depression Rating Scales in Patients With Major Depressive Disorder. Cureus 2022; 14:e31084. [PMID: 36475152 PMCID: PMC9720034 DOI: 10.7759/cureus.31084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Major depression is a chronic condition that may affect cognition. Cognitive disturbances may affect clinical scales used to assess the severity of depression. AIMS To find an association between cognitive disturbance as objectively recorded using event-related potentials (P300) with the Hamilton rating scale for depression (HAM-D) and Montgomery-Asberg depression rating scale (MADRS) in newly diagnosed cases of major depression. METHODS AND MATERIAL A cross-sectional study with a sample size of 46 diagnosed cases of major depression. The assessment was done using the HAM-D and MADRS. The P300 assessment was done with the auditory oddball paradigm using the Nihon Kohden NCV-SMG-EP system (Tokyo, Japan). STATISTICAL ANALYSIS Pearson correlation analysis was used to study the association between various parameters of P300 and the HAM-D and MADRS depression rating scales. RESULTS A significant correlation was found between A21- P300 amplitude Cz and the MADRS score. No significant correlation was seen between other P300 parameters and HAM-D and MADRS scales. CONCLUSIONS As the results were objectively recorded using various parameters of event-related potentials (P300), cognitive impairment was not significantly associated with depression rating scales i.e., the HAM-D and MADRS scores.
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Affiliation(s)
- Santosh Wakode
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Sandip Hulke
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Naina S Wakode
- Anatomy, Atal Bihari Vajpayee Government Medical College, Vidisha, IND
| | - Tanusha Pathak
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Avinash Thakare
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Varun Malhotra
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
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Weintraub D, Aarsland D, Biundo R, Dobkin R, Goldman J, Lewis S. Management of psychiatric and cognitive complications in Parkinson's disease. BMJ 2022; 379:e068718. [PMID: 36280256 DOI: 10.1136/bmj-2021-068718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy
- Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer Goldman
- Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders, Chicago, IL
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Chendo I, Fabbri M, Godinho C, Simões RM, Sousa CS, Coelho M, Voon V, Ferreira JJ. High frequency of Depressive Disorders and Suicidal Phenomena in Late-Stage Parkinson´s Disease - A Cross-Sectional Study. J Geriatr Psychiatry Neurol 2022:8919887221135556. [PMID: 36278309 DOI: 10.1177/08919887221135556] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depressive disorders (DD) are widely recognized as one of the most frequent neuropsychiatric disorders in Parkinson´s disease. Patients with late-stage Parkinson´s disease (LSPD) continue to be a neglected population, and little is known about DD frequency in LSPD. OBJECTIVES To determine the frequency of DD in LSPD patients through a clinical diagnostic interview (CDI) and according to diagnostic DSM- 5 criteria. Secondary objectives were to determine the predictive ability of depressive scales to detect DD, to identify potential predictors of DD in LSPD and, to evaluate suicidal phenomena in LSPD. METHODS A cross-sectional study including LSPD patients (≥7 years from symptom onset and Hoehn and Yahr scale score >3 or a Schwab and England scale score <50% in the ON condition) was conducted. Patients were subjected to psychiatric, neurological, and neuropsychological evaluations. Six depression scales were applied. RESULTS 92 LSPD patients were included. 59.78% of LSPD patients had a current diagnosis of DD according to CDI, 38.04% patients had a diagnosis of major depressive disorder, and 21.72% non-major depressive disorder. Suicidal ideation was present in 36.96% of patients. All applied scales were able to detect depressive disorders. CONCLUSIONS More than half of LSPD patients met DD diagnostic criteria and over one-third were diagnosed with major depressive disorder. Overall, the LSPD population seem to have a unique clinical phenotype regarding the frequency and features of DD, whose early identification and treatment could improve the quality of life of patients and caregivers.
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Affiliation(s)
- Inês Chendo
- Psychiatry Department, Department of Neurosciences, 70899Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Margherita Fabbri
- 89237Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) Do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Almada, Portugal
| | - Rita Moiron Simões
- CNS - Campus Neurológico, Torres Vedras, Portugal.,Neurology Department, 467035Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Severiano Sousa
- 89237Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel Coelho
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Neurology Service, Department of Neurosciences, 70899Hospital Santa Maria, Lisbon, Portugal
| | - Valerie Voon
- Department of Psychiatry, 104867University of Cambridge, UK
| | - Joaquim J Ferreira
- CNS - Campus Neurológico, Torres Vedras, Portugal.,89237Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Oliveira CDA, Gondim ITGDO, Azevedo IM, Alves CRR, Asano NMJ, Coriolano MDGWDS. Influência da estratégia de Estimulação Auditiva Rítmica com música associada à fisioterapia sobre os sintomas depressivos no Parkinson. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/200258011022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
RESUMO A sintomatologia depressiva (SD) é comum na doença de Parkinson (DP) e considerada fator importante para má qualidade de vida e incapacidade do indivíduo. Intervenções terapêuticas baseadas em ritmo e música, a exemplo da Estimulação Auditiva Rítmica (EAR), têm sido utilizadas no tratamento da mobilidade e parecem influenciar positivamente o estado de humor do paciente. O objetivo deste estudo é avaliar o efeito da EAR com música associada à fisioterapia no estado de humor de pessoas com DP, com ênfase na SD. Trata-se de estudo quase experimental, com amostra de 18 pacientes com idades entre 40 e 80 anos e diagnóstico clínico de DP idiopática nos estágios leve a moderado. Os pacientes foram randomizados em dois grupos: grupo EAR e grupo-controle (GC). A SD foi avaliada por meio da versão em português do Inventário de Depressão de Beck (BDI). Os escores do BDI apresentaram redução em ambos os grupos. Entretanto, apenas no grupo EAR essa redução foi significativa, com diferença média no escore três vezes maior do que no GC.
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Oliveira CDA, Gondim ITGDO, Azevedo IM, Alves CRR, Asano NMJ, Coriolano MDGWDS. Influence of Rhythmic Auditory Stimulation using music associated with physical therapy on depressive symptoms in Parkinson’s. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/200258011022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
ABSTRACT Depressive symptoms are commonly found in Parkinson’s disease and are considered an important factor for an individual’s poor quality of life and disability. Therapeutic interventions based on rhythm and music, such as rhythmic auditory stimulation, have been used to treat the mobility and seem to positively influence on mood. This study aims to evaluate the effect of rhythmic auditory stimulation using music associated with physical therapy on mood in individuals with Parkinson’s, with an emphasis on depressive symptoms. This is a quasi-experimental study with a final sample of 18 patients aged 40-80 years, with a clinical diagnosis of idiopathic Parkinson’s disease, in the mild to moderate stages of the disease. Patients were randomized into two groups: Rhythmic Auditory Stimulation and Control Groups. Depressive symptoms were assessed using the Portuguese version of the Beck Depression Inventory. Both groups reduced their The Beck Depression Inventory scores. However, only in the Rhythmic Auditory Stimulation Group the reduction was significant, with a mean difference in the inventory score three times greater than the Control Group.
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Timblin H, Rahmani E, Ryczek CA, Hill CR, Jones JD. Physical inactivity links depressive symptoms and cognitive functioning among individuals with Parkinson's disease. Neuropsychology 2022; 36:505-512. [PMID: 35737532 PMCID: PMC9620779 DOI: 10.1037/neu0000837] [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] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is a neurodegenerative disorder caused by disruption of dopamine-producing cells. PD is associated with motor symptoms and nonmotor symptoms including depression and cognitive impairment. Past research suggests an association between depression and cognitive impairment in PD. Physical activity may have a therapeutic effect on both depression and cognitive impairment. The present study investigates if physical activity mediates the association between depressive symptoms and cognition in a longitudinal sample of individuals with PD. METHOD Participants include individuals newly diagnosed with PD (N = 487) enrolled in the Parkinson's Progression Marker Initiative (PPMI). Participants completed an array of neuropsychological tests over the course of 5 years, as well as questionnaires of depression and physical activity. Between-person and within-person effects of depression and cognition mediated through physical activity were analyzed using structural equation modeling. RESULTS A significant direct effect demonstrated depression was associated with worse global cognitive functioning. Furthermore, there was a significant indirect within-person effect, indicating that physical activity fully mediated the association between depression and cognition. Individuals who became more depressed over time became less physically active and subsequently experienced cognitive decline over the 5-year period. CONCLUSIONS Findings have implications for prognostic detection and/or the role of physical activity interventions to buffer effects of depression on cognitive impairment among individuals diagnosed with PD. Physical interventions may potentially be implemented among depressed persons to preserve cognitive functioning. Worsened depression early during PD may be a risk factor for inactivity and cognitive diminishment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Chen J, Tuersun Y, Yang J, Xiong M, Wang Y, Rao X, Jiang S. Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis. BMC MEDICAL EDUCATION 2022; 22:627. [PMID: 35982434 PMCID: PMC9388213 DOI: 10.1186/s12909-022-03683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province. METHODS This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant. RESULTS A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students. CONCLUSIONS This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.
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Affiliation(s)
- Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
| | | | - Jiao Yang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Man Xiong
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Yueying Wang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Xinyi Rao
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Shuai Jiang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Institute for Hospital Management of Henan Province, Zhengzhou, China.
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Zhang P, Huang P, Du J, He Y, Liu J, He G, Cui S, Zhang W, Li G, Chen S. Specific gut microbiota alterations in essential tremor and its difference from Parkinson's disease. NPJ Parkinsons Dis 2022; 8:98. [PMID: 35931717 PMCID: PMC9355955 DOI: 10.1038/s41531-022-00359-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Essential tremor (ET) is the most common movement disorder and share overlapping symptoms with Parkinson’s disease (PD), making differential diagnosis challenging. Gut dysbiosis is regarded crucial in the pathogenesis of PD. Since ET patients also has comorbidity in gastrointestinal disorders, the relationship between gut microbiota and ET really worth investigating and may help distinguishing ET from PD. Fecal samples from 54 ET, 67 de novo PD and 54 normal controls (NC) were collected for 16S ribosomal RNA gene sequencing and quantitative real-time PCR. ET showed lower species richness (Chao1 index) than NC and PD. ET was with Bacteroides-dominant enterotype, while PD was with Ruminococcus-dominant enterotype. Compared with NC, 7 genera were significantly reduced in ET, 4 of which (Ruminococcus, Romboutsia, Mucispirillum, and Aeromonas) were identified to be distinctive with an area under the curve (AUC) of 0.705. Compared to PD, 26 genera were found significantly different from ET, 4 of which (Bacteroides, Fusobacterium, Phascolarctobacterium, and Lachnospira) were found distinguishable with an AUC of 0.756. Clinical association results indicated that Proteus was associated with disease severity (TETRAS) of ET, while Klebsiella was linked to depression and anxiety in ET. Functional predictions revealed that 4 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were altered in ET. This study reveals gut dysbiosis in ET and it provides new insight into the pathogenesis of ET and helps distinguishing ET from PD.
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Affiliation(s)
- Pingchen Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Juanjuan Du
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yixi He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jin Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Guiying He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Shishuang Cui
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Weishan Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Gen Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China. .,Lab for Translational Research of Neurodegenerative Diseases, Shanghai Institute for Advanced Immunochemical Studies (SIAIS), Shanghai Tech University, Shanghai, 201210, People's Republic of China.
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Song S, Luo Z, Li C, Huang X, Shiroma EJ, Simonsick EM, Chen H. Depressive symptoms before and after Parkinson’s diagnosis—A longitudinal analysis. PLoS One 2022; 17:e0272315. [PMID: 35905124 PMCID: PMC9337685 DOI: 10.1371/journal.pone.0272315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Depression is common in Parkinson’s disease (PD). It is however unclear when and how depressive symptoms develop and progress in the course of PD development. Objective To assess how depressive symptoms evolve in PD, using repeated measures. Methods In 2994 older adults, ages 70–79 years, depressive symptoms were assessed 8 times over 11 years using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). For each PD patient at each time point, we calculated the difference between CESD-10 score and its expected value estimated based on data from individuals without PD, and then realigned the time scale in reference to the year of PD diagnosis. We examined longitudinal changes in CESD-10 scores before and after PD diagnosis using a joint modeling approach to account for competing risks of non-participation and death. Results A total of 79 PD patients were identified at enrollment or during the follow-up, with repeatedly assessed depressive symptom data up to 9 years before and after PD diagnosis. We found a monotonic trend of increasing CESD-10 score in PD patients throughout the observational period (p = 0.002). The observed scores became higher than expected approximately 7 years before PD diagnosis and significantly different 1 year before PD diagnosis. Conclusions Increasing depressive symptomatology appears to precede PD diagnosis by a few years.
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Affiliation(s)
- Shengfang Song
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Xuemei Huang
- Department of Neurology, Hersey Medical Center, Pennsylvania State University, Hersey, PA, United States of America
| | - Eric J. Shiroma
- Intramural Research Program of the National Institute on Aging, Baltimore, MD, United States of America
| | - Eleanor M. Simonsick
- Intramural Research Program of the National Institute on Aging, Baltimore, MD, United States of America
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
- * E-mail:
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Sampedro F, Martínez‐Horta S, Horta‐Barba A, Grothe MJ, Labrador‐Espinosa MA, Jesús S, Adarmes‐Gomez A, Carrillo F, Puig‐Davi A, Roldan‐Lora F, Aguilar‐Barbera M, Pastor P, Escalante Arroyo S, Solano‐Vila B, Cots‐Foraster A, Ruiz‐Martínez J, Carrillo‐Padilla F, Pueyo‐Morlans M, Gonzalez‐Aramburu I, Infante‐Ceberio J, Hernandez‐Vara J, de Fabregues‐Boixar O, de Deus Fonticoba T, Avila A, Martínez‐Castrillo JC, Bejr‐Kasem H, Campolongo A, Pascual‐Sedano B, Martínez‐Martín P, Santos‐García D, Mir P, Garcia‐Ruiz PJ, Kulisevsky J. Clinical and structural brain correlates of hypomimia in early‐stage Parkinson’s disease. Eur J Neurol 2022; 29:3720-3727. [DOI: 10.1111/ene.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Frederic Sampedro
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Saul Martínez‐Horta
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Andrea Horta‐Barba
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Michel J. Grothe
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | - Miguel A. Labrador‐Espinosa
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | - Silvia Jesús
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | - Astrid Adarmes‐Gomez
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | - Fatima Carrillo
- Movement Disorders Unit, Neurology Department, Hospital Universitario Virgen del Rocío Seville Spain
| | - Arnau Puig‐Davi
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Florinda Roldan‐Lora
- Unidad de Radiodiagnostico, Hospital Universitario Virgen del Rocío Seville Spain
| | | | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa Barcelona Spain
| | | | - Berta Solano‐Vila
- Institut Catala de la Salud (Girona), Institut d’Assistencia Sanitaria (IAS) Spain
| | - Anna Cots‐Foraster
- Institut Catala de la Salud (Girona), Institut d’Assistencia Sanitaria (IAS) Spain
| | - Javier Ruiz‐Martínez
- Instituto de Investigacion Biodonostia, Hospital Universitario Donostia San Sebastian Spain
| | | | | | - Isabel Gonzalez‐Aramburu
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Marques de Valdecilla Santander Spain
| | - Jon Infante‐Ceberio
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Marques de Valdecilla Santander Spain
| | - Jorge Hernandez‐Vara
- Neurology Department and Neurodegenerative Diseases Research Group, Vall D’Hebron Universitary Campus Barcelona Spain
| | - Oriol de Fabregues‐Boixar
- Neurology Department and Neurodegenerative Diseases Research Group, Vall D’Hebron Universitary Campus Barcelona Spain
| | | | - Asuncion Avila
- Consorci Sanitari Integral, Hospital General de L’Hospitalet, L’Hospitalet de Llobregat Barcelona Spain
| | | | - Helena Bejr‐Kasem
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Antonia Campolongo
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Berta Pascual‐Sedano
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
| | - Pablo Martínez‐Martín
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
| | | | - Pablo Mir
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | | | - Jaime Kulisevsky
- Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III Madrid Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau Barcelona Spain
- Instituto de Investigacion del Hospital de Sant Pau Barcelona Spain
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Hong ZM, Williams J, Bulloch A, Patten SB. Alternative scoring of the Patient Health Questionnaire-9 in neurological populations: an approach based on a predictive algorithm deriving from individual item scores. Gen Hosp Psychiatry 2022; 77:37-39. [PMID: 35526426 DOI: 10.1016/j.genhosppsych.2022.04.011] [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: 02/28/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study objective was to assess whether machine learning methods could improve predictive performance of the PHQ-9 for depression in patients with neurological disease. Specifically, we assessed whether a predictive algorithm deriving from all nine items could outperform the tradition of summing the items and applying a cut-point. METHOD Data from the NEEDS Study was used (n = 825). Demographic data, PHQ-9 scores, and MDD diagnoses (via the SCID) were obtained. Logistic LASSO, logistic regression, and non-parametric ROC analyses were performed. The ROC curve was used to identify the optimal cut-point for regression-derived predictive algorithms using the Youden method. RESULTS The traditional approach to PHQ-9 scoring had a classification accuracy of 85.1% (sensitivity: 84.5%; specificity: 85.2%). The logistic LASSO regression model had a classification accuracy of 85.6% (sensitivity: 83.3%; specificity: 86.1%). The logistic regression model had a classification accuracy of 85.8% (sensitivity: 91.4%; specificity: 84.8%). Both models had similar areas under the curve values (logistic LASSO: 0.9097; logistic regression: 0.9026). CONCLUSIONS The current cut-off threshold approach to PHQ-9 scoring and interpretation remains clinically appropriate.
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Affiliation(s)
- Zachary M Hong
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Jeanne Williams
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Andrew Bulloch
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Scott B Patten
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
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Tsuboi T, Satake Y, Hiraga K, Yokoi K, Hattori M, Suzuki M, Hara K, Ramirez-Zamora A, Okun MS, Katsuno M. Effects of MAO-B inhibitors on non-motor symptoms and quality of life in Parkinson's disease: A systematic review. NPJ Parkinsons Dis 2022; 8:75. [PMID: 35697709 PMCID: PMC9192747 DOI: 10.1038/s41531-022-00339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
Non-motor symptoms (NMS) are common among patients with Parkinson's disease and reduce patients' quality of life (QOL). However, there remain considerable unmet needs for NMS management. Three monoamine oxidase B inhibitors (MAO-BIs), selegiline, rasagiline, and safinamide, have become commercially available in many countries. Although an increasing number of studies have reported potential beneficial effects of MAO-BIs on QOL and NMS, there has been no consensus. Thus, the primary objective of this study was to provide an up-to-date systematic review of the QOL and NMS outcomes from the available clinical studies of MAO-BIs. We conducted a literature search using the PubMed, Scopus, and Cochrane Library databases in November 2021. We identified 60 publications relevant to this topic. Overall, rasagiline and safinamide had more published evidence on QOL and NMS changes compared with selegiline. This was likely impacted by selegiline being introduced many years prior to the field embarking on the study of NMS. The impact of MAO-BIs on QOL was inconsistent across studies, and this was unlikely to be clinically meaningful. MAO-BIs may potentially improve depression, sleep disturbances, and pain. In contrast, cognitive and olfactory dysfunctions are likely unresponsive to MAO-BIs. Given the paucity of evidence and controlled, long-term studies, the effects of MAO-BIs on fatigue, autonomic dysfunctions, apathy, and ICD remain unclear. The effects of MAO-BIs on static and fluctuating NMS have never been investigated systematically. More high-quality studies will be needed and should enable clinicians to provide personalized medicine based on a non-motor symptom profile.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Yuki Satake
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Hiraga
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsunori Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neurology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Makoto Hattori
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical laboratory, Nagoya University Hospital, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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40
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Chen J, Song L, Yang A, Dong G, Zhao XM. Disrupted long-range gene regulations elucidate shared tissue-specific mechanisms of neuropsychiatric disorders. Mol Psychiatry 2022; 27:2720-2730. [PMID: 35379909 DOI: 10.1038/s41380-022-01529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022]
Abstract
Neurological and psychiatric disorders have overlapped phenotypic profiles, but the underlying tissue-specific functional processes remain largely unknown. In this study, we explore the shared tissue-specificity among 14 neuropsychiatric disorders through the disrupted long-range gene regulations by GWAS-identified regulatory SNPs. Through Hi-C interactions, averagely 38.0% and 17.2% of the intergenic regulatory SNPs can be linked to target protein-coding genes in brain and non-brain tissues, respectively. Interestingly, while the regulatory target genes in the brain tend to enrich in nervous system development related processes, those in the non-brain tissues are inclined to interfere with synapse and neuroinflammation related processes. Compared to psychiatric disorders, neurological disorders present more prominently the neuroinflammatory processes in both brain and non-brain tissues, indicating an intrinsic difference in mechanisms. Through tissue-specific gene regulatory networks, we then constructed disorder similarity networks in two brain and three non-brain tissues, highlighting both known disorder clusters (e.g. the neurodevelopmental disorders) and unexpected disorder clusters (e.g. Parkinson's disease is consistently grouped with psychiatric disorders). We showcase the potential pharmaceutical applications of the small bowel and its disorder clusters, illustrated by the known drug targets NR1I3 and NFACT1, and their small bowel-specific regulatory modules. In conclusion, disrupted long-range gene regulations in both brain and non-brain tissues contribute to the similarity among distinct clusters of neuropsychiatric disorders, and the tissue-specifically shared functions and regulators for disease clusters may provide insights for future therapeutic investigations.
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Affiliation(s)
- Jingqi Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China. .,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China. .,Zhangjiang Fudan International Innovation Center, Shanghai, China.
| | - Liting Song
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China
| | - Anyi Yang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China
| | - Guiying Dong
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China. .,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China. .,Zhangjiang Fudan International Innovation Center, Shanghai, China.
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41
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Szymkowicz SM, Jones JD, Timblin H, Ryczek CA, Taylor WD, May PE. Apathy as a Within-Person Mediator of Depressive Symptoms and Cognition in Parkinson's Disease: Longitudinal Mediation Analyses. Am J Geriatr Psychiatry 2022; 30:664-674. [PMID: 34922823 PMCID: PMC9106826 DOI: 10.1016/j.jagp.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Greater depressive symptoms are associated with worse cognitive functions in Parkinson's disease (PD); however, it is unclear what underlying factors drive this association. Apathy commonly develops in PD and may be a pathway through which depressive symptoms negatively influence cognition. Prior research examining depressive symptoms, apathy, and cognition in PD is limited by being predominantly cross-sectional. This study examined the role of apathy as a within- and between-person mediator for the longitudinal relationships between depression severity and cognitive functioning in patients with early PD. METHODS Participants included 487 individuals newly diagnosed with PD followed annually for up to 5 years by the Parkinson's Progression Marker Initiative. At each visit, participants completed depressive symptom measures, apathy ratings, and cognitive tests. Multi-level structural equation models examined both the within- and between-person effects of depressive symptoms on cognition through apathy, controlling for demographics and motor severity. RESULTS At the within-person level, apathy mediated the association between depressive symptoms and select cognitive functions (global cognition, attention/working memory, visuospatial functions, and immediate verbal memory; indirect effects, bootstrap p's <0.05). Significant between-person direct effects were found for depressive symptoms predicting apathy (boostrap p <0.001) and lower scores on most cognitive tests (bootstrap p's <0.05). However, the indirect effects did not reach significance, suggesting between-person mediation did not occur. CONCLUSION Findings suggest worsening of depressive symptoms over time in patients with PD may be a risk factor for increased apathy and subsequent decline in specific cognitive functions.
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Affiliation(s)
- Sarah M Szymkowicz
- Department of Psychiatry and Behavioral Sciences (SMS, WDT), Vanderbilt University Medical Center, Nashville, TN.
| | - Jacob D Jones
- Department of Psychology (JDJ, HT, CAR), California State University San Bernardino, San Bernardino, CA
| | - Holly Timblin
- Department of Psychology (JDJ, HT, CAR), California State University San Bernardino, San Bernardino, CA
| | - Cameron A Ryczek
- Department of Psychology (JDJ, HT, CAR), California State University San Bernardino, San Bernardino, CA
| | - Warren D Taylor
- Department of Psychiatry and Behavioral Sciences (SMS, WDT), Vanderbilt University Medical Center, Nashville, TN
| | - Pamela E May
- Department of Neurological Sciences (PEM), University of Nebraska Medical Center, Omaha, NE
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Prange S, Klinger H, Laurencin C, Danaila T, Thobois S. Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment. Drugs Aging 2022; 39:417-439. [PMID: 35705848 PMCID: PMC9200562 DOI: 10.1007/s40266-022-00942-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/11/2022]
Abstract
Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson’s disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.
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Affiliation(s)
- Stéphane Prange
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Univ Lyon, Université Claude Bernard Lyon 1, Oullins, France.
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43
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Alizadeh N, Packer TL, Sturkenboom I, Eskes G, Warner G. Managing Fatigue in Parkinson's Disease: Protocol for a Pilot Randomized Controlled Trial. Can J Occup Ther 2022; 89:180-189. [PMID: 35287487 PMCID: PMC9136370 DOI: 10.1177/00084174221085449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background. Fatigue is a disabling symptom of Parkinson’s disease (PD). Managing Fatigue: A Six-Week Energy Conservation Intervention was developed to improve the occupational performance of people with fatigue. Efficacy of this program has not been established in PD. Purpose. This study will assess feasibility of the Managing Fatigue: Individual Program (MFIP) delivered via videoconference, the Randomized Controlled Trial (RCT) protocol, and the preliminary effectiveness of the MFIP. Methods. A mixed-methods approach nested in a pilot RCT, randomizing 54 participants 1:1 to usual care or MFIP arms, will be employed to evaluate the feasibility and preliminary effectiveness of MFIP. Qualitative and quantitative data will be collected simultaneously. Implications. Results will identify evidence for establishing protocol requirements for a full-scale RCT. Knowledge of the effectiveness of the one-to-one videoconference delivery format of the program has the potential to enhance the accessibility and the quality of care of the PD population.
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Affiliation(s)
| | - Tanya L. Packer
- Neda Alizadeh, School of Occupational Therapy, 5869 University Ave, Halifax, NS B3H 4R2.
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44
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The Value of ‘Cow Signs’ in the Assessment of the Quality of Nutrition on Dairy Farms. Animals (Basel) 2022; 12:ani12111352. [PMID: 35681817 PMCID: PMC9179339 DOI: 10.3390/ani12111352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this review is to provide dairy farm advisors, consultants, nutritionists, practitioners, and their dairy farmer clients with an additional toolkit that can be used in the assessment of the quality of their dairy cattle nutrition. Cow signs are behavioral, physiological, and management parameters that can be observed and measured. They are detected by examining and observing the cattle. Other physiological parameters such as fecal scoring, rumen fill, and body condition scoring are also included in ‘cow signs’. The assessment should be both qualitative and quantitative; for example, is the cattle individual lame and what is the severity of lameness. The ‘diagnosis’ of a problem should be based on establishing a farm profile of ‘cow signs’ and other relevant information. Information gathered through assessment of cow signs should be used as an advisory tool to assist and improve decision making. Cow signs can be used as part of an investigation and or farm audit.
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45
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Tenison E, Lithander FE, Smith MD, Pendry-Brazier D, Ben-Shlomo Y, Henderson EJ. Needs of patients with parkinsonism and their caregivers: a protocol for the PRIME-UK cross-sectional study. BMJ Open 2022; 12:e057947. [PMID: 35545401 PMCID: PMC9096540 DOI: 10.1136/bmjopen-2021-057947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION People with parkinsonism are a highly heterogeneous group and the disease encompasses a spectrum of motor and non-motor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. While parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe the broad range of health needs for people with parkinsonism and their carers in relation to their symptomatology, disability, disease stage, comorbidities and sociodemographic characteristics. METHODS AND ANALYSIS In this single site cross-sectional study, people with parkinsonism will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support, if required, to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes. Results will be displayed as descriptive statistics and regression models will be used to test simple associations and interactions. ETHICS AND DISSEMINATION This protocol was approved by the London-Brighton & Sussex Research Ethics Committee (REC reference 20/LO/0890). The results of this protocol will be disseminated through publication in an international peer-reviewed journal; presentation at academic meetings and conferences; and a lay summary uploaded to the PRIME-Parkinson website. TRIAL REGISTRATION NUMBER ISRCTN11452969; Pre-results.
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Affiliation(s)
- Emma Tenison
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Fiona E Lithander
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Matthew D Smith
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Szymkowicz SM, Ellis LJ, May PE. The 3-Item "Apathy" Subscale Within the GDS-15 Is Not Supported in De Novo Parkinson's Disease Patients: Analysis of the PPMI Cohort. J Geriatr Psychiatry Neurol 2022; 35:309-316. [PMID: 33461367 PMCID: PMC9637029 DOI: 10.1177/0891988720988908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined individual components of the Geriatric Depression Scale-15 (GDS-15) to determine whether the 3-item Withdrawal-Apathy-Lack of Vigor (WAV) subscale, which has been validated in older adults and advanced Parkinson's disease (PD), was applicable to newly diagnosed patients with PD. Baseline Parkinson's Progression Markers Initiative (PPMI) data (n = 345), including GDS-15 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) depression, apathy, and anxiety scores, were examined. Data reduction techniques (i.e., principal components, confirmatory factor analyses) were used. Model fit was poor for the previously identified GDS-15 factor structures. Via principal components analysis, 5 components were identified, none of which reflected the 3-item WAV subscale previously reported in the literature. Internal consistency of the GDS-15 was acceptable, as was the internal consistency for the largest component (labeled "Dysphoria"). All 5 components significantly correlated with the MDS-UPDRS depression, apathy, and anxiety items. Model fit was fair for the "Dysphoria" factor only. Overall, the 3-item WAV factor reported in previous literature was not supported in this sample of de novo PD patients.
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Affiliation(s)
- Sarah M. Szymkowicz
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Pamela E. May
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
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47
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Hinkle JT, Mills KA, Perepezko K, Pontone GM. Bidirectional Correlations Between Dopaminergic Function and Motivation in Parkinson's Disease. J Geriatr Psychiatry Neurol 2022; 35:353-362. [PMID: 33622073 PMCID: PMC8382801 DOI: 10.1177/0891988721996802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test the hypothesis that striatal dopamine function influences motivational alterations in Parkinson disease (PD), we compared vesicular monoamine transporter 2 (VMAT2) and dopamine transporter (DaT) imaging data in PD patients with impulse control disorders (ICDs), apathy, or neither. METHODS We extracted striatal binding ratios (SBR) from VMAT2 PET imaging (18F-AV133) and DaTscans from the Parkinson's Progression Markers Initiative (PPMI) multicenter observational study. Apathy and ICDs were assessed using the Movement Disorders Society-revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP), respectively. We used analysis of variance (ANOVA) and log-linear mixed-effects (LME) regression to model SBRs with neurobehavioral metrics. RESULTS Among 23 participants (mean age 62.7 years, mean disease duration 1.8 years) with VMAT2 imaging data, 5 had apathy, 5 had an ICD, and 13 had neither. ANOVA indicated strong groupwise differences in VMAT2 binding in right anterior putamen [F(2,20) = 16.2, p < 0.0001), right posterior putamen [F(2,20) = 16.9, p < 0.0001), and right caudate [F(2,20) = 6.8, p = 0.006)]. Post-hoc tests and repeated-measures analysis with LME regression also supported right striatal VMAT2 elevation in the ICD group and reduction in the apathy group relative to the group with neither ICD nor apathy. DaT did not exhibit similar correlations, but normalizing VMAT2 with DaT SBR strengthened bidirectional correlations with ICD (high VMAT2/DaT) and apathy (low VMAT2/DaT) in all striatal regions bilaterally. CONCLUSIONS Our findings constitute preliminary evidence that striatal presynaptic dopaminergic function helps describe the neurobiological basis of motivational dysregulation in PD, from high in ICDs to low in apathy.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A Mills
- Department of Neurology, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kate Perepezko
- Department of Mental Health, 25802Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health, Baltimore, MD, USA
| | - Gregory M Pontone
- Department of Psychiatry, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
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48
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Hattori N, Kogo Y, Koebis M, Ishida T, Suzuki I, Tsuboi Y, Nomoto M. The Effects of Safinamide Adjunct Therapy on Depression and Apathy in Patients With Parkinson's Disease: Post-hoc Analysis of a Japanese Phase 2/3 Study. Front Neurol 2022; 12:752632. [PMID: 35222225 PMCID: PMC8869178 DOI: 10.3389/fneur.2021.752632] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Neuropsychiatric symptoms in Parkinson's disease (PD) have been shown to significantly affect quality of life (QOL). We investigated the impact of safinamide on depression and apathy when administered as an adjunct to levodopa in Japanese patients with PD. Methods This was a post-hoc analysis of data from a phase 2/3 clinical study of safinamide in Japanese patients with PD experiencing wearing-off (JapicCTI-153056; https://www.clinicaltrials.jp/cti-user/trial/ShowDirect.jsp?japicId=JapicCTI-153056). Patients received placebo, safinamide 50 mg, or safinamide 100 mg as an adjunct therapy. The endpoints for this analysis were changes from baseline to Week 24 in the Unified Parkinson's Disease Rating Scale (UPDRS) Part I item 3 (depression) and item 4 (apathy) scores and the Parkinson's Disease Questionnaire (PDQ-39) “emotional well-being” domain score. Subgroup analyses investigated the relationship between neuropsychologic symptoms and improvements in motor fluctuation and assessed which patient populations might be expected to obtain neuropsychologic benefit from safinamide. Results Compared with placebo, safinamide (both doses) significantly improved UPDRS Part I item 3 scores in the overall analysis population, and the 100-mg dose improved UPDRS Part I item 4 scores in the population with apathy at baseline. Changes in the PDQ-39 “emotional well-being” score showed numerical, but not significant, dose-related improvements. Notable reductions in depression were associated with a change in daily ON-time ≥1 h, pain during OFF-time at baseline, and female sex. Conclusions The results from this post-hoc analysis of the Japanese phase 2/3 study suggest that safinamide could bring benefits to patients with PD who have mild depression, pain during the OFF phase. In addition, safinamide might provide particular benefits for patients with PD who have mild apathy and female.
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Affiliation(s)
- Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuki Kogo
- Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | | | | | - Ippei Suzuki
- Medicine Development Center, Eisai Co., Ltd., Tokyo, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Masahiro Nomoto
- Department of Neurology, Saiseikai Imabari Center for Health and Welfare, Ehime, Japan
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Kleykamp BA, Ferguson MC, McNicol E, Bixho I, Arnold LM, Edwards RR, Fillingim R, Grol-Prokopczyk H, Ohrbach R, Turk DC, Dworkin RH. The prevalence of comorbid chronic pain conditions among patients with temporomandibular disorders: A systematic review. J Am Dent Assoc 2022; 153:241-250.e10. [PMID: 34952681 DOI: 10.1016/j.adaj.2021.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/19/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND This systematic review was designed to evaluate the presence of comorbid conditions among patients with temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED The authors reviewed studies that reported the prevalence or incidence of chronic pain conditions or psychiatric disorders (anxiety, mood, personality disorders) among patients with any type of TMD. The authors calculated sample size-weighted prevalence estimates when data were reported in 2 or more studies for the same comorbid condition. RESULTS A total of 9 prevalence studies and no incidence studies were eligible for review; 8 of the studies examined chronic pain comorbidities. Weighted estimates showed high prevalence of pain comorbidities across studies, including current chronic back pain (66%), myofascial syndrome (50%), chronic stomach pain (50%), chronic migraine headache (40%), irritable bowel syndrome (19%), and fibromyalgia (14%). A single study examined psychiatric disorders and found that current depression was the most prevalent disorder identified (17.5%). CONCLUSIONS AND PRACTICAL IMPLICATIONS There is a high prevalence of comorbid chronic pain conditions among patients with TMDs, with more than 50% of patients reporting chronic back pain, myofascial syndrome, and chronic stomach pain. Psychiatric disorders among patients with different types of TMDs were studied less commonly in this pain population. Knowledge of the distribution of these and other comorbid disease conditions among patients with different types of TMDs can help dentists and other health care providers to identify personalized treatment strategies, including the coordination of care across medical specialties.
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Chang PL, Goldstein FC, Burgio KL, Juncos JL, McGwin G, Muirhead L, Markland AD, Johnson TM, Vaughan CP. Exploratory evaluation of baseline cognition as a predictor of perceived benefit in a study of behavioral therapy for urinary incontinence in Parkinson disease. Neurourol Urodyn 2022; 41:841-846. [PMID: 35181928 PMCID: PMC8957523 DOI: 10.1002/nau.24891] [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: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/10/2022]
Abstract
AIMS While behavior-based pelvic floor muscle exercise therapy is an effective treatment for overactive bladder in Parkinson's disease (PD) patients, cognitive function may be a predictor of rehabilitation outcomes. METHODS In a planned exploratory analysis, participants who had a Montreal Cognitive Assessment (MoCA) with a score ≥18 who were randomized in a clinical trial to behavioral treatment were classified by perceived improvement (Benefit vs. No Benefit) as reported on a validated Satisfaction and Benefit Questionnaire. General cognition (MoCA), motor procedural learning (Serial reaction time task), verbal memory (Buschke delayed recall), spatial memory (Nonverbal/Spatial selective reminding test), and working memory (Wisconsin card sorting task) were compared between the two groups using Wilcoxon rank-sum test. RESULTS Of the 26 participants randomized to behavioral treatment (70% male, mean age 71 ± 6.1 years), 22 participants (85%) reported Benefit and four reported No Benefit. General cognition, motor procedural learning, verbal memory, spatial memory, and working memory did not differ between these groups. While the difference between the time to complete the final practiced series and the random series of the Serial Reaction Time Task (SRTT) was statistically similar between the groups, the Benefit group performed the random sequence more quickly (567.0 ± 136.5 ms) compared to the No Benefit group (959.4 ± 443.0 ms; p = 0.03) and trended toward faster performance in the final practiced series. CONCLUSIONS Perceived benefit from behavioral treatment for overactive bladder was not associated with measures of baseline cognition other than faster completion of the SRTT. This is noteworthy because many behavior-based therapy studies exclude participants with mild cognitive impairment. Additional studies may evaluate if domain-specific cognitive function, particularly the assessment of implicit memory, could lead to individualized behavioral therapy recommendations.
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Affiliation(s)
- PL Chang
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Decatur, Georgia
| | - FC Goldstein
- Department of Neurology, Emory University, Atlanta, Georgia
| | - KL Burgio
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - JL Juncos
- Department of Neurology, Emory University, Atlanta, Georgia
| | - G McGwin
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - L Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, GA
| | - AD Markland
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - TM Johnson
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, GA,Division of General Internal Medicine, Department of Medicine, Emory University, Atlanta, Georgia,Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
| | - CP Vaughan
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Decatur, Georgia,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, GA
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