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Zhang Y, Zhu XB, Gan J, Song L, Qi C, Wu N, Wan Y, Hou M, Liu Z. Impulse control behaviors and apathy commonly co-occur in de novo Parkinson's disease and predict the incidence of levodopa-induced dyskinesia. J Affect Disord 2024; 351:895-903. [PMID: 38342317 DOI: 10.1016/j.jad.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Impulse control behaviors (ICBs) and apathy are believed to represent opposite motivational expressions of the same behavioral spectrum involving hypo- and hyperdopaminergic status, but this has been recently debated. Our study aims to estimate the co-occurrence of ICBs and apathy in early Parkinson's disease (PD) and to determine whether this complex neuropsychiatric condition is an important marker of PD prognoses. METHODS Neuropsychiatric symptoms, clinical data, neuroimaging results, and demographic data from de novo PD patients were obtained from the Parkinson's Progression Markers Initiative, a prospective, multicenter, observational cohort. The clinical characteristics of ICBs co-occurring with apathy and their prevalence were analyzed. We compared the prognoses of the different groups during the 8-year follow-up. Multivariate Cox regression analysis was conducted to predict the development of levodopa-induced dyskinesia (LID) using baseline neuropsychiatric symptoms. RESULTS A total of 422 PD patients and 195 healthy controls (HCs) were included. In brief, 87 (20.6 %) de novo PD patients and 37 (19.0 %) HCs had ICBs at baseline. Among them, 23 (26.4 %) de novo PD patients and 3 (8.1 %) HCs had clinical symptoms of both ICBs and apathy. The ICBs and apathy group had more severe non-motor symptoms than the isolated ICBs group. Cox regression analysis demonstrated that the co-occurrence of ICBs and apathy was a risk factor for LID development (HR 2.229, 95 % CI 1.209 to 4.110, p = 0.010). CONCLUSIONS Co-occurrence of ICBs and apathy is common in patients with early PD and may help to identify the risk of LID development.
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Affiliation(s)
- Yu Zhang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Xiao Bo Zhu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China; Department of Neurology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, 1158 Gong yuan East Road, Shanghai 201700, People's Republic of China
| | - Jing Gan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Chen Qi
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Na Wu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Ying Wan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Miaomiao Hou
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China.
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Amin RM, Phillips JJ, Humbert AT, Cholerton BA, Short VD, Smith MJ, Zabetian CP, Mata IF, Kelly VE. Associations between baseline cognitive status and motor outcomes after treadmill training in people with Parkinson's disease: a pilot study. Disabil Rehabil 2024; 46:1082-1091. [PMID: 37010072 PMCID: PMC10545807 DOI: 10.1080/09638288.2023.2189318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the effect of baseline cognition on gait outcomes after a treadmill training program for people with Parkinson's disease (PD). METHODS This pilot clinical trial involved people with PD who were classified as having no cognitive impairment (PD-NCI) or mild cognitive impairment (PD-MCI). Baseline executive function and memory were assessed. The intervention was a 10-week gait training program (twice-weekly treadmill sessions), with structured speed and distance progression and verbal cues for gait quality. Response to intervention was assessed by gait speed measured after week 2 (short-term) and week 10 (long-term). RESULTS Participants (n = 19; 12 PD-NCI, 7 PD-MCI) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS III score of 21.3 (10.7). Gait speed increased at short-term and long-term assessments. The response did not differ between PD-NCI and PD-MCI groups; however, better baseline memory performance and milder PD motor severity were independently associated with greater improvements in gait speed in unadjusted and adjusted models. CONCLUSIONS These findings suggest that memory impairments and more severe motor involvement can influence the response to gait rehabilitation in PD and highlight the need for treatments optimized for people with greater cognitive and motor impairment.IMPLICATIONS FOR REHABILITATIONCognitive deficits in Parkinson's disease (PD) could impact motor learning and gait rehabilitation, yet little is known about the effects of cognitive impairments on the response to rehabilitation in people with PD.This study demonstrates that the response to gait rehabilitation did not differ between people with PD who had no cognitive impairment and those with mild cognitive impairment.Across all participants, better baseline memory was associated with greater improvements in gait speed.Rehabilitation professionals should be mindful of PD severity, as those with more substantial memory and motor impairments may require additional dosing or support to maximize gait training benefits.
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Affiliation(s)
- Raima M. Amin
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | | | - Andrew T. Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brenna A. Cholerton
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie D. Short
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Melissa J. Smith
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Cyrus P. Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ignacio F. Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Valerie E. Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Zhu X, Gan J, Wu N, Zhang Y, Liu Z. The simultaneous presence of demoralization, apathy, and depression has a detrimental impact on both cognitive function and motor symptoms in Parkinson's disease patients. Front Psychiatry 2024; 15:1345280. [PMID: 38404468 PMCID: PMC10884111 DOI: 10.3389/fpsyt.2024.1345280] [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: 11/27/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Parkinson's disease (PD) is marked not only by motor symptoms but also by neuropsychiatric manifestations, including demoralization, apathy, and depression. Understanding the clinical distribution and characteristics of these co-occurring symptoms is crucial for improving quality of life of PD patients. Methods This study enrolled 195 Chinese PD patients from Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine. The study involved analyzing the clinical characteristics related to the simultaneous presence of demoralization, apathy, and depression in PD patients. Linear regression was employed to elucidate the linear trend between the quantity of negative neuropsychiatric symptoms and cognitive function, as well as motor symptoms and motor complications. SPSS mediation models were utilized to investigate whether the severity of cognitive function mediated the connection between multiple negative neuropsychiatric symptoms and motor symptoms. Results Among PD patients, a notable 57.5% experience the presence of multiple concurrent negative neuropsychiatric symptoms. Our investigation unveiled a correlation where patients with more negative neuropsychiatric symptoms displayed heightened cognitive impairment (P=0.048) and more severe motor symptoms (P=0.024), following a linear trend with increasing symptom numbers. Additionally, cognitive impairment played a partial mediating role in the impact of multiple negative neuropsychiatric symptoms on motor symptoms (β=0.747; 95% bootstrap confidence interval: 0.195 to 1.532). Conclusions The co-occurrence of these negative neuropsychiatric symptoms has the potential to worsen cognitive function and motor symptoms in PD patients. Moreover, cognitive impairment was identified as playing a partial mediating role in the relationship between multiple negative neuropsychiatric symptoms and motor symptoms.
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Affiliation(s)
- Xiaobo Zhu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jing Gan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Wu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hu X, Yu L, Li Y, Li X, Zhao Y, Xiong L, Ai J, Chen Q, Wang X, Chen X, Ba Y, Wang Y, Wu X. Piperine improves levodopa availability in the 6-OHDA-lesioned rat model of Parkinson's disease by suppressing gut bacterial tyrosine decarboxylase. CNS Neurosci Ther 2024; 30:e14383. [PMID: 37528534 PMCID: PMC10848080 DOI: 10.1111/cns.14383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
AIM Tyrosine decarboxylase (TDC) presented in the gut-associated strain Enterococcus faecalis can convert levodopa (L-dopa) into dopamine (DA), and its increased abundance would potentially minimize the availability and efficacy of L-dopa. However, the known human decarboxylase inhibitors are ineffective in this bacteria-mediated conversion. This study aims to investigate the inhibition of piperine (PIP) on L-dopa bacterial metabolism and evaluates the synergistic effect of PIP combined with L-dopa on Parkinson's disease (PD). METHODS Metagenomics sequencing was adopted to determine the regulation of PIP on rat intestinal microbiota structure, especially on the relative abundance of E. faecalis. Then, the inhibitory effects of PIP on L-dopa conversion and TDC expression of E. faecalis were tested in vitro. We examined the synergetic effect of the combination of L-dopa and PIP on 6-hydroxydopamine (6-OHDA)-lesioned rats and tested the regulations of L-dopa bioavailability and brain DA level by pharmacokinetics study and MALDI-MS imaging. Finally, we evaluated the microbiota-dependent improvement effect of PIP on L-dopa availability using pseudo-germ-free and E. faecalis-transplanted rats. RESULTS We found that PIP combined with L-dopa could better ameliorate the move disorders of 6-OHDA-lesioned rats by remarkably improving L-dopa availability and brain DA level than L-dopa alone, which was associated with the effect of PIP on suppressing the bacterial decarboxylation of L-dopa via effectively downregulating the abnormal high abundances of E. faecalis and TDC in 6-OHDA-lesioned rats. CONCLUSION Oral administration of L-dopa combined with PIP can improve L-dopa availability and brain DA level in 6-OHDA-lesioned rats by suppressing intestinal bacterial TDC.
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Affiliation(s)
- Xiaolu Hu
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Lan Yu
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Yatong Li
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Xiaoxi Li
- Department of PharmacyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Yimeng Zhao
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Lijuan Xiong
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Jiaxuan Ai
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Qijun Chen
- School of Pharmaceutical SciencesCapital Medical UniversityBeijingChina
| | - Xing Wang
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Xiaoqing Chen
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Yinying Ba
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
| | - Yaonan Wang
- Core facilities of modern pharmaceuticalsCapital Medical UniversityBeijingChina
| | - Xia Wu
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese MedicineCapital Medical UniversityBeijingChina
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Subramanian I, Pushparatnam K, McDaniels B, Mathur S, Post B, Schrag A. Delivering the diagnosis of Parkinson's disease- setting the stage with hope and compassion. Parkinsonism Relat Disord 2024; 118:105926. [PMID: 38129230 DOI: 10.1016/j.parkreldis.2023.105926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA; Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | | | - Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | | | - Bart Post
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Anette Schrag
- UCL Queen Square Institute of Neurology, University College London, London, UK.
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An JH, Han KD, Jung JH, Jeon HJ. Association of physical activity with the risk of Parkinson's disease in depressive disorder: A nationwide longitudinal cohort study. J Psychiatr Res 2023; 167:93-99. [PMID: 37862909 DOI: 10.1016/j.jpsychires.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/14/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Regular physical activity (PA) has been suggested as effective disease preventable strategies for Parkinson's disease (PD). Depression often precedes PD but whether PA also would reduce the risk of PD in patients with depression has not been known. The aim of study is to examine the association of regular PA with risk of PD among patients with depressive disorder. A total of 1,342,282 patients with depressive disorder were identified from a nationwide health screening cohort from 2010 to 2016. The exposure was changes in pattern of regular PA between pre-and post-diagnosis of depressive disorder, categorized as four groups; 1) no PA, 2) increased PA, 3) decreased PA, and 4) maintaining PA. The outcome was risk of incident PD, calculated using multivariate adjusted Cox proportional hazards regressions according to the PA categorization. Total of 8901 PD cases (0.66%) were developed during 5.3 years of follow-up period. Maintaining PA group was associated with the lowest risk of PD (adjusted hazard ratio [aHR] 0.89, 95% CI 0.83-0.97) among all other PA groups with depressive disorder (with no PA group as reference). Otherwise, decreased PA group significantly increased the risk of PD (aHR 1.10, 95% CI 1.03-1.16). Those who maintained PA before and after diagnosis of depressive disorder were associated with lower risk of incident PD.
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Affiliation(s)
- Ji Hyun An
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management& Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced, Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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7
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He P, Gao Y, Shi L, Li Y, Jiang S, Tie Z, Qiu Y, Ma G, Zhang Y, Nie K, Wang L. Motor progression phenotypes in early-stage Parkinson's Disease: A clinical prediction model and the role of glymphatic system imaging biomarkers. Neurosci Lett 2023; 814:137435. [PMID: 37562710 DOI: 10.1016/j.neulet.2023.137435] [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: 04/22/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Substantial heterogeneity of motor symptoms in Parkinson's disease (PD) poses a challenge to disease prediction. OBJECTIVES The aim of this study was to construct a nomogram model that can distinguish different longitudinal trajectories of motor symptom changes in early-stage PD patients. METHODS Data on 90 patients with 5-years of follow-up were collected from the Parkinson's Progression Marker Initiative (PPMI) cohort. We used a latent class mixed modeling (LCMM) to identify distinct progression patterns of motor symptoms, and backward stepwise logistic regression with baseline information was conducted to identify the potential predictors for motor trajectory and to develop a nomogram. The performance of the nomogram model was then evaluated using the optimism-corrected C-index for internal validation, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for discrimination, the calibration curve for predictive accuracy, and decision curve analysis (DCA) for its clinical value. RESULTS We identified two trajectories for motor progression patterns. The first, Class 1 (Motor deteriorated group), was characterized by sustained, continuously worsening motor symptoms, and the second, Class 2 (Motor stable group), had stable motor symptoms throughout the follow-up period. The best combination of 7 baseline variables was identified and assembled into the nomogram: Scopa-AUT [odds ratio (OR), 1.11; p = 0.091], Letter number sequencing (LNS) (OR, 0.76; p = 0.068), the asymmetry index of putamen (OR, 0.95; p = 0.034), mean caudate uptake (OR, 0.14; p = 0.086), CSF pTau/α-synuclein (OR, 0.00; p = 0.011), CSF tTau/Aβ (OR, 25434806; p = 0.025), and the index for diffusion tensor image analysis along the perivascular space (ALPS-index) (OR, 0.02; p = 0.030). The nomogram achieved good discrimination, with an original AUC of 0.901 (95% CI, 0.813-0.989), and the bias-corrected concordance index (C-index) with 1,000 bootstraps was 0.834. The calibration curve and DCA also suggested both the high accuracy and clinical usefulness of the nomogram, respectively. CONCLUSIONS This study proposes an effective nomogram to predict different motor progression patterns in early-stage PD. Furthermore, the imaging biomarker indicating glymphatic function could be an independent predictive factor for PD motor progression.
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Affiliation(s)
- Peikun He
- School of Medicine, South China University of Technology, Guangzhou 510006, China; Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yuyuan Gao
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; BrainNow Research Institute, Shenzhen, Guangdong Province, China
| | - Yanyi Li
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuolin Jiang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zihui Tie
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yihui Qiu
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guixian Ma
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Kun Nie
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Lijuan Wang
- School of Medicine, South China University of Technology, Guangzhou 510006, China; Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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Ivaniski-Mello A, Müller VT, de Liz Alves L, Casal MZ, Haas AN, Correale L, Kanitz AC, Martins VF, Gonçalves AK, Martinez FG, Peyré-Tartaruga LA. Determinants of Dual-task Gait Speed in Older Adults with and without Parkinson's Disease. Int J Sports Med 2023; 44:744-750. [PMID: 37130568 DOI: 10.1055/a-2085-1429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mobility difficulties for people with Parkinson's disease (PwPD) are more pronounced when they perform a simultaneous cognitive task while walking. Although it is known that neurodegeneration results in widespread motor and brain impairments, few studies have comprehensively examined possible physical and mental determinants of dual task walking in PwPD. In this cross-sectional study, we aimed to investigate if and how muscle strength (sit-to-stand 30-sec test), cognition (mini-mental state examination) and functionality (timed up and go test) affect walking performance (10-meter walking test) with and without arithmetic dual task from older adults with and without Parkinson's disease. Walking speed was reduced by 16% and 11% with arithmetic dual task for PwPD (from 1.07±0.28 to 0.91±0.29 m.s-1, p<0.001) and older adults (from 1.32±0.28 to 1.16±0.26 m.s-1, p=0.002) compared to essential walking. The cognitive state was similar among the groups, but it was only associated with the dual-task walking speed in PwPD. In PwPD, lower limb strength was the better predictor of speed, whereas mobility was more related to it in older adults. Therefore, future exercise interventions aiming to improve walking in PwPD should consider these findings to maximize their effectiveness.
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Affiliation(s)
- André Ivaniski-Mello
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vivian Torres Müller
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas de Liz Alves
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcela Zimmermann Casal
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Nogueira Haas
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Luca Correale
- Department of Public Health, Experimental Medicine and Forensic Sciences, University of Pavia, Pavia, Italy
| | - Ana Carolina Kanitz
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Valéria Feijó Martins
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andréa Kruger Gonçalves
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Alexandre Peyré-Tartaruga
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Kashihara K, Kitayama M. Time Taken for and Causes of a Decline to Hoehn and Yahr Stage 5 in Patients with Parkinson's Disease. Intern Med 2023; 62:711-716. [PMID: 35945019 PMCID: PMC10037007 DOI: 10.2169/internalmedicine.8922-21] [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] [Indexed: 11/06/2022] Open
Abstract
Objective Prediction of time until and causes of becoming bedridden may help patients with Parkinson's disease (PD) plan their productive lives. This study assessed the relationship between the age at the PD onset and time taken to reach Hoehn and Yahr stage (HY) 5 as well as the causes of motor decline to HY5 in Japanese patients with PD. Patients We enrolled patients with PD who visited our institute between April 2015 and December 2020, met the UK brain bank criteria, had medical records from the early PD stage, and had had HY5 for over three months. The relationship between the age at the PD onset and the disease duration was evaluated. Data on the possible causes of motor decline to HY5 were obtained from patients, caregivers or medical records. Results In total, 123 patients with PD (mean age at the PD onset was 69.3 years old; 80 women and 43 men) were included. The age at the PD onset was significantly and negatively correlated with the time until the decline to HY5. Among the 123 patients, 49 reported that the natural course of PD caused the decline to HY5. Possible events that accelerated the motor decline to HY5 included traumatic injury, pneumonia, and other medical or social conditions that might have resulted in reduced daily activities. Conclusion The time until the decline to HY5 can be estimated based on the age at the PD onset. In addition to natural PD progression, medical or social conditions that reduce physical activity may accelerate motor decline to HY5.
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Affiliation(s)
- Kenichi Kashihara
- Department of Neurology, Okayama Kyokuto Hospital, Japan
- Okayama Neurology Clinic, Japan
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10
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Laurent L, Koskas P, Estrada J, Sebbagh M, Lacaille S, Raynaud-Simon A, Lilamand M. Tinetti balance performance is associated with mortality in older adults with late-onset Parkinson's disease: a longitudinal study. BMC Geriatr 2023; 23:54. [PMID: 36717787 PMCID: PMC9887890 DOI: 10.1186/s12877-023-03776-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is associated with a 3-fold mortality risk, which is closely related to advancing age. Evidence is lacking regarding the factors associated with the risks of mortality or nursing-home (NH) admission, in elderly patients with PD. We aimed at identifying the clinical characteristics associated with these outcomes, in older community-dwelling patients with late-onset PD. METHODS Retrospective, observational analysis of data from geriatric day hospital patients. Motor assessment included Unified Parkinson Disease Rating Scale (UPDRS) part III score, Tinetti Performance Oriented Mobility Assessment (POMA) balance and gait tests, and gait speed. Levodopa equivalent dose, comorbidity, cognitive performance, Activities of Daily Living performance were examined. Cox proportional hazards models were performed to identify the factors associated with mortality and NH admission rate (maximum follow-up time = 5 years). RESULTS We included 98 patients, mean age 79.4 (SD = 5.3) of whom 18 (18.3%) died and 19 (19.4%) were admitted into NH, over a median follow-up of 4 years. In multivariate Cox models, poor balance on the Tinetti POMA scale (HR = 0.82 95%CI (0.66-0.96), p = .023) and older age (HR = 1.12 95%CI (1.01-1.25), p = .044) were the only variables significantly associated with increased mortality risk. A Tinetti balance score below 11/16 was associated with a 6.7 hazard for mortality (p = .006). No specific factor was associated with NH admissions. CONCLUSIONS Age and the Tinetti POMA score were the only factors independently associated with mortality. The Tinetti POMA scale should be considered for balance assessment and as a screening tool for the most at-risk individuals, in this population.
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Affiliation(s)
- Louise Laurent
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Pierre Koskas
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Janina Estrada
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Mélanie Sebbagh
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Sophie Lacaille
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Agathe Raynaud-Simon
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France
| | - Matthieu Lilamand
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.7429.80000000121866389INSERM UMR-S 1144 research unit, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Lariboisière-Fernand Widal, Geriatric department, 200 rue du Fbg St Denis, 75010 Paris, France
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11
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Onset of Postural Instability in Parkinson's Disease Depends on Age rather than Disease Duration. PARKINSON'S DISEASE 2022; 2022:6233835. [PMID: 36506486 PMCID: PMC9734006 DOI: 10.1155/2022/6233835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022]
Abstract
Background Postural instability and falls are considered a major factor of impaired quality of life in patients with advanced Parkinson's disease (PD). The knowledge of the time at which postural instability occurs will help to provide the evidence required to introduce fall-prevention strategies at the right time in PD. Objective To investigate whether postural instability of patients with different age at disease onset is associated with age or with disease duration of PD. Methods Patients diagnosed with sporadic PD between 1991 and 2017 and postural instability (according to the International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, item 3.12 postural instability) were included, with strict inclusion criteria including regular follow-ups, agreement on data use, and exclusion of comorbidities affecting the free stand. Results Applying these strict inclusion criteria, we included 106 patients. Those younger than 50 years at PD onset took significantly longer to develop postural instability (n = 23 patients, median: 18.4 years) compared with patients with later onset of PD (50-70 years, n = 66, median: 14.2 years, p < 0.001; and >70 years, n = 17, median: 5.7 years, p < 0.001, Kruskal-Wallis test followed by Dunn's multiple comparisons test). There was no association between total MDS-UPDRS III (as a measure of motor symptom severity) at onset of postural instability. Conclusions In PD, postural instability is primarily associated with the age of the patient and not with disease duration.
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12
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Nishiwaki H, Ito M, Hamaguchi T, Maeda T, Kashihara K, Tsuboi Y, Ueyama J, Yoshida T, Hanada H, Takeuchi I, Katsuno M, Hirayama M, Ohno K. Short chain fatty acids-producing and mucin-degrading intestinal bacteria predict the progression of early Parkinson's disease. NPJ Parkinsons Dis 2022; 8:65. [PMID: 35650236 PMCID: PMC9160257 DOI: 10.1038/s41531-022-00328-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/05/2022] [Indexed: 01/07/2023] Open
Abstract
To elucidate the relevance of gut dysbiosis in Parkinson’s disease (PD) in disease progression, we made random forest models to predict the progression of PD in two years by gut microbiota in 165 PD patients. The area under the receiver operating characteristic curves (AUROCs) of gut microbiota-based models for Hoehn & Yahr (HY) stages 1 and 2 were 0.799 and 0.705, respectively. Similarly, gut microbiota predicted the progression of Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III scores in an early stage of PD with AUROC = 0.728. Decreases of short-chain fatty acid-producing genera, Fusicatenibacter, Faecalibacterium, and Blautia, as well as an increase of mucin-degrading genus Akkermansia, predicted accelerated disease progression. The four genera remained unchanged in two years in PD, indicating that the taxonomic changes were not the consequences of disease progression. PD patients with marked gut dysbiosis may thus be destined to progress faster than those without gut dysbiosis.
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Affiliation(s)
- Hiroshi Nishiwaki
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mikako Ito
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomonari Hamaguchi
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Maeda
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | | | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Jun Ueyama
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takumi Yoshida
- Department of Computer Science, Nagoya Institute of Technology, Nagoya, Japan
| | - Hiroyuki Hanada
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Ichiro Takeuchi
- Department of Computer Science, Nagoya Institute of Technology, Nagoya, Japan.,Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Hirayama
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kinji Ohno
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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13
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Ogata T, Hashiguchi H, Hori K, Hirobe Y, Ono Y, Sawada H, Inaba A, Orimo S, Miyake Y. Foot Trajectory Features in Gait of Parkinson’s Disease Patients. Front Physiol 2022; 13:726677. [PMID: 35600314 PMCID: PMC9114796 DOI: 10.3389/fphys.2022.726677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Parkinson’s disease (PD) is a progressive neurological disorder characterized by movement disorders, such as gait instability. This study investigated whether certain spatial features of foot trajectory are characteristic of patients with PD. The foot trajectory of patients with mild and advanced PD in on-state and healthy older and young individuals was estimated from acceleration and angular velocity measured by inertial measurement units placed on the subject’s shanks, just above the ankles. We selected six spatial variables in the foot trajectory: forward and vertical displacements from heel strike to toe-off, maximum clearance, and change in supporting leg (F1 to F3 and V1 to V3, respectively). Healthy young individuals had the greatest F2 and F3 values, followed by healthy older individuals, and then mild PD patients. Conversely, the vertical displacements of mild PD patients were larger than the healthy older individuals. Still, those of healthy older individuals were smaller than the healthy young individuals except for V3. All six displacements of the advanced PD patients were smaller than the mild PD patients. To investigate features in foot trajectories in detail, a principal components analysis and soft-margin kernel support vector machine was used in machine learning. The accuracy in distinguishing between mild PD patients and healthy older individuals and between mild and advanced PD patients was 96.3 and 84.2%, respectively. The vertical and forward displacements in the foot trajectory was the main contributor. These results reveal that large vertical displacements and small forward ones characterize mild and advanced PD patients, respectively.
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Affiliation(s)
- Taiki Ogata
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
- *Correspondence: Taiki Ogata,
| | - Hironori Hashiguchi
- Department of Computational Intelligence and System Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Koyu Hori
- Department of Computational Intelligence and System Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Yuki Hirobe
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Yumi Ono
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Hiroyuki Sawada
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Yoshihiro Miyake
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
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14
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Zhang L, Chen Y, Liang X, Wang L, Wang J, Tang Y, Zhu X. Prediction of Quality of Life in Patients With Parkinson’s Disease With and Without Excessive Daytime Sleepiness: A Longitudinal Study. Front Aging Neurosci 2022; 14:846563. [PMID: 35493927 PMCID: PMC9045750 DOI: 10.3389/fnagi.2022.846563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Objective There is a lack of longitudinal studies that directly compare the quality of life (QoL) and investigate the impact of clinical factors on QoL across different excessive daytime sleepiness (EDS) statuses in Parkinson’s disease (PD); therefore, we aimed to compare QoL and reveal the potential heterogeneous predictors of QoL between patients with PD with and without EDS. Methods We collected clinical data among 306 patients with PD over 2 years. EDS was assessed by the Epworth Sleepiness Scale and QoL was measured with the 39-item Parkinson’s Disease Questionnaire. Results We found that at both baseline and follow-up, patients with PD with EDS had poorer QoL and suffered more non-motor symptoms including depression and clinical probable rapid eye movement sleep behavior disorder (cpRBD). The generalized linear mixed model analysis indicated that the major predictors of QoL in PD with EDS were the akinetic-rigid type, disease duration, and total levodopa equivalent dose, while in PD without EDS, the primary determinants of QoL were Hoehn and Yahr, Mini-Mental State Examination (MMSE), and cpRBD. Conclusion Patients with PD with EDS presented with poorer QoL. Besides, the baseline predictors of future QoL differed between patients with PD with and without EDS. These findings remind clinicians to target specific clinical factors when attempting to improve QoL among patients with PD.
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Affiliation(s)
- Lixia Zhang
- Department of Neurology, Taizhou Second People’s Hospital, Taizhou, China
| | - Yajing Chen
- Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoniu Liang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lan Wang
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Jian Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yilin Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yilin Tang,
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Xiaodong Zhu,
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15
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The emerging postural instability phenotype in idiopathic Parkinson disease. NPJ Parkinsons Dis 2022; 8:28. [PMID: 35304493 PMCID: PMC8933561 DOI: 10.1038/s41531-022-00287-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/01/2022] [Indexed: 01/15/2023] Open
Abstract
Identification of individuals at high risk for rapid progression of motor and cognitive signs in Parkinson disease (PD) is clinically significant. Postural instability and gait dysfunction (PIGD) are associated with greater motor and cognitive deterioration. We examined the relationship between baseline clinical factors and the development of postural instability using 5-year longitudinal de-novo idiopathic data (n = 301) from the Parkinson’s Progressive Markers Initiative (PPMI). Logistic regression analysis revealed baseline features associated with future postural instability, and we designated this cohort the emerging postural instability (ePI) phenotype. We evaluated the resulting ePI phenotype rating scale validity in two held-out populations which showed a significantly higher risk of postural instability. Emerging PI phenotype was identified before onset of postural instability in 289 of 301 paired comparisons, with a median progression time of 972 days. Baseline cognitive performance was similar but declined more rapidly in ePI phenotype. We provide an ePI phenotype rating scale (ePIRS) for evaluation of individual risk at baseline for progression to postural instability.
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16
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Subramanian I, Mathur S, Oosterbaan A, Flanagan R, Keener AM, Moro E. Unmet Needs of Women Living with Parkinson's Disease: Gaps and Controversies. Mov Disord 2022; 37:444-455. [DOI: 10.1002/mds.28921] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Indu Subramanian
- Department of Neurology David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
- Parkinson's Disease Research, Education, and Clinical Center, Greater Los Angeles Veterans Affairs Medical Center Los Angeles California USA
| | | | - Annelien Oosterbaan
- Department of Neurology Radboud University Medical Center Nijmegen The Netherlands
| | | | - Adrienne M. Keener
- Department of Neurology David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
- Parkinson's Disease Research, Education, and Clinical Center, Greater Los Angeles Veterans Affairs Medical Center Los Angeles California USA
| | - Elena Moro
- Grenoble Alpes University, Faculty of Medicine, Division of Neurology CHUGA, Grenoble Institute of Neurosciences Grenoble France
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17
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Ren Y, Jiang H, Pu J, Li L, Wu J, Yan Y, Zhao G, Guttuso TJ, Zhang B, Feng J. Molecular Features of Parkinson's Disease in Patient-Derived Midbrain Dopaminergic Neurons. Mov Disord 2022; 37:70-79. [PMID: 34564901 PMCID: PMC8901260 DOI: 10.1002/mds.28786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite intense efforts to develop an objective diagnostic test for Parkinson's disease, there is still no consensus on biomarkers that can accurately diagnose the disease. OBJECTIVE Identification of biomarkers for idiopathic Parkinson's disease (PD) may enable accurate diagnosis of the disease. We tried to find molecular and cellular differences in dopaminergic (DA) neurons derived from healthy subjects and idiopathic PD patients with or without rest tremor at onset. METHODS We measured the expression of genes controlling dopamine synthesis, sequestration, and catabolism as well as the levels of corresponding metabolites and reactive oxygen species in midbrain DA neurons differentiated from induced pluripotent stem cells (iPSCs) of healthy subjects and PD patients with or without rest tremor. RESULTS Significant differences in DA-related gene expression, metabolites, and oxidative stress were found between midbrain DA neurons derived from healthy subjects and patients with PD. DA neurons derived from PD patients with or without rest tremor at onset exhibited significant differences in the levels of some of these transcripts, metabolites, and oxidative stress. CONCLUSION The unique combination of these quantifiable molecular and cellular traits in iPSC-derived midbrain DA neurons can distinguish healthy subjects from idiopathic PD patients and segregate PD patients with or without rest tremor at onset. The strategy may be used to develop an objective diagnostic test for PD.
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Affiliation(s)
- Yong Ren
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA
| | - Houbo Jiang
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA
| | - Jiali Pu
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA,Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Li
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA
| | - Jianbo Wu
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA
| | - Yaping Yan
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guohua Zhao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Thomas J. Guttuso
- Department of Neurology, State University of New York at Buffalo, Buffalo, New York, USA
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China,Correspondence to: Prof. Jian Feng, Department of Physiology and Biophysics, State University of New York at Buffalo, 955 Main Street, Buffalo, NY 14203, USA, ; or Prof. Baorong Zhang, Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China;
| | - Jian Feng
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York, USA,Correspondence to: Prof. Jian Feng, Department of Physiology and Biophysics, State University of New York at Buffalo, 955 Main Street, Buffalo, NY 14203, USA, ; or Prof. Baorong Zhang, Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China;
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18
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Risco JR, Kelly AG, Holloway RG. Prognostication in neurology. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:175-193. [PMID: 36055715 DOI: 10.1016/b978-0-323-85029-2.00003-8] [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: 06/15/2023]
Abstract
Prognosticating is central to primary palliative care in neurology. Many neurologic diseases carry a high burden of troubling symptoms, and many individuals consider health states due to neurologic disease worse than death. Many patients and families report high levels of need for information at all disease stages, including information about prognosis. There are many barriers to communicating prognosis including prognostic uncertainty, lack of training and experience, fear of destroying hope, and not enough time. Developing the right mindset, tools, and skills can improve one's ability to formulate and communicate prognosis. Prognosticating is subject to many biases which can dramatically affect the quality of patient care; it is important for providers to recognize and reduce them. Patients and surrogates often do not hear what they are told, and even when they hear correctly, they form their own opinions. With practice and self-reflection, one can improve their prognostic skills, help patients and families create honest roadmaps of the future, and deliver high-quality person-centered care.
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Affiliation(s)
- Jorge R Risco
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Adam G Kelly
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Robert G Holloway
- Department of Neurology, University of Rochester, Rochester, NY, United States.
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19
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Smits HJG, Assili S, Kauw F, Philippens MEP, de Bree R, Dankbaar JW. Prognostic imaging variables for recurrent laryngeal and hypopharyngeal carcinoma treated with primary chemoradiotherapy: A systematic review and meta-analysis. Head Neck 2021; 43:2202-2215. [PMID: 33797818 PMCID: PMC8252607 DOI: 10.1002/hed.26698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy. Methods A systematic search was performed in PubMed and EMBASE (1990–2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated. Results Twenty‐two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut‐off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors. Conclusion Pretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
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Affiliation(s)
- Hilde J G Smits
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Sanam Assili
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Frans Kauw
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marielle E P Philippens
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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20
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Detection of Parkinson's Disease Early Progressors Using Routine Clinical Predictors. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-77211-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Cragg JJ, Azoulay L, Collins G, De Vera MA, Etminan M, Lalji F, Gershon AS, Guyatt G, Harrison M, Jutzeler C, Kassam R, Kendzerska T, Lynd L, Mansournia MA, Sadatsafavi M, Tong B, Warner FM, Tremlett H. The reporting of observational studies of drug effectiveness and safety: recommendations to extend existing guidelines. Expert Opin Drug Saf 2021; 20:1-8. [PMID: 33170749 DOI: 10.1080/14740338.2021.1849134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The use of observational data to assess drug effectiveness and safety can provide relevant information, much of which may not be feasible to obtain through randomized clinical trials. Because observational studies provide critical drug safety and effectiveness information that influences drug policy and prescribing practices, transparent, consistent, and accurate reporting of these studies is critical. AREAS COVERED We provide recommendations to extend existing reporting guidelines, covering the main components of primary research studies (methods, results, discussion). EXPERT OPINION Our recommendations include extending drug safety and effectiveness guidelines to include explicit checklist items on: study registration, causal diagrams, rationale for measures of effect, comprehensive assessment of bias, comprehensive data cleaning steps, drug equivalents, subject-level drug data visualization, sex and gender-based analyses and results, patient-oriented outcomes, and patient involvement in research.
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Affiliation(s)
- Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, BC, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University , Montreal, QC, Canada
| | - Gary Collins
- Centre for Statistics in Medicine, University of Oxford , Oxford, United Kingdom & EQUATOR
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Mahyar Etminan
- Departments of Ophthalmology and Medicine, Faculty of Medicine, University of British Columbia , Vancouver, BC, Canada
| | - Fawziah Lalji
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto , Toronto, Ontario
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact, McMaster University , Hamilton, Ontario, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences (CHEOS), St. Paul's Hospital , Vancouver, BC, Canada
| | - Catherine Jutzeler
- Department of Biosystems Science & Engineering, ETH Zurich , Zurich, Switzerland
| | - Rosemin Kassam
- School of Population and Public Health, University of British Columbia , Vancouver, BC, Canada
| | | | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, BC, Canada
| | - Freda M Warner
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, University of British Columbia , Vancouver, BC, Canada
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Santos-García D, de Deus Fonticoba T, Suárez Castro E, Aneiros Díaz A, Cores Bartolomé C, Feal Panceiras MJ, Paz González JM, Valdés Aymerich L, García Moreno JM, Blázquez Estrada M, Jesús S, Mir P, Aguilar M, Planellas LL, García Caldentey J, Caballol N, Legarda I, Cabo López I, López Manzanares L, Ávila Rivera MA, Catalán MJ, López Díaz LM, Borrué C, Álvarez Sauco M, Vela L, Cubo E, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Pascual-Sedano B, Seijo M, Ruíz Martínez J, Valero C, Kurtis M, González Ardura J, Prieto Jurczynska C, Martinez-Martin P. Quality of life and non-motor symptoms in Parkinson's disease patients with subthreshold depression. J Neurol Sci 2020; 418:117109. [PMID: 32927370 DOI: 10.1016/j.jns.2020.117109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. MATERIAL AND METHODS PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. RESULTS The frequency of depressive symptoms was higher in PD patients (n = 694) than in controls (n = 207) (p < 0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1 ± 12.8 vs 11.6 ± 10; p < 0.0001) and global QoL (EUROHIS-QOL8; 3.7 ± 0.5 vs 4 ± 0.5; p < 0.0001) were significantly worse in subD (n = 120) than nonD (n = 348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9 ± 32 vs 29.1 ± 25.8;p < 0.0001). Non-motor symptoms burden (NMSS;OR = 1.019;95%CI 1.011-1.028; p < 0.0001), neuropsychiatric symptoms (NPI; OR = 1.091; 95%CI 1.045-1.139; p < 0.0001), impulse control behaviors (QUIP-RS; OR = 1.035; 95%CI 1.007-1063; p = 0.013), quality of sleep (PDSS; OR = 0.991; 95%CI 0.983-0.999; p = 0.042), and fatigue (VAFS-physical; OR = 1.185; 95%CI 1.086-1.293; p < 0.0001; VAFS-mental; OR = 1.164; 95%CI 1.058-1.280; p = 0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. CONCLUSIONS SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.
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Affiliation(s)
- D Santos-García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - T de Deus Fonticoba
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - E Suárez Castro
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - A Aneiros Díaz
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - C Cores Bartolomé
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - J M Paz González
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - L Valdés Aymerich
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | - S Jesús
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - P Mir
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | - N Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - I Cabo López
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - M A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M J Catalán
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L M López Díaz
- Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - C Borrué
- Hospital Infanta Sofía, Madrid, Spain
| | | | - L Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - E Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | - M G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | - I Gastón
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - B Pascual-Sedano
- Hospital de Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - M Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - C Valero
- Hospital Arnau de Vilanova, Valencia, Spain
| | - M Kurtis
- Hospital Ruber Internacional, Madrid, Spain
| | | | | | - P Martinez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain; CIBERNED, Instituto de Salud Carlos III, Madrid. COPPADIS Study Group, Spain
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23
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Devos D, Hirsch E, Wyse R. Seven Solutions for Neuroprotection in Parkinson's Disease. Mov Disord 2020; 36:306-316. [PMID: 33184908 DOI: 10.1002/mds.28379] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra and accumulation of iron and alpha-synuclein; it follows a characteristic pattern throughout the nervous system. Despite decades of successful preclinical neuroprotective studies, no drug has then shown efficacy in clinical trials. Considering this dilemma, we have reviewed and organized solutions of varying importance that can be exclusive or additive, and we outline approaches to help generate successful development of neuroprotective drugs for PD: (1) select patients in which the targeted mechanism is involved in the pathological process associated with the monitoring of target engagement, (2) combine treatments that target multiple pathways, (3) establish earliest interventions and develop better prodromal biomarkers, (4) adopt rigorous methodology and specific disease-relevant designs for disease-modifying clinical trials, (5) customize drug with better brain biodistribution, (6) prioritize repurposed drugs as a first line approach, and (7) adapt preclinical models to the targeted mechanisms with translational biomarkers to increase their predictive value. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David Devos
- Department of Medical Pharmacology, Expert Center for Parkinson, CHU-Lille, Lille Neuroscience & Cognition, Inserm, zUMR-S1172, LICEND, University of Lille, Lille, France
| | - Etienne Hirsch
- Institut du Cerveau-ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Richard Wyse
- The Cure Parkinson's Trust, London, United Kingdom
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24
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Chahine LM, Siderowf A, Barnes J, Seedorff N, Caspell-Garcia C, Simuni T, Coffey CS, Galasko D, Mollenhauer B, Arnedo V, Daegele N, Frasier M, Tanner C, Kieburtz K, Marek K. Predicting Progression in Parkinson's Disease Using Baseline and 1-Year Change Measures. JOURNAL OF PARKINSONS DISEASE 2020; 9:665-679. [PMID: 31450510 PMCID: PMC6839498 DOI: 10.3233/jpd-181518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improved prediction of Parkinson's disease (PD) progression is needed to support clinical decision-making and to accelerate research trials. OBJECTIVES To examine whether baseline measures and their 1-year change predict longer-term progression in early PD. METHODS Parkinson's Progression Markers Initiative study data were used. Participants had disease duration ≤2 years, abnormal dopamine transporter (DAT) imaging, and were untreated with PD medications. Baseline and 1-year change in clinical, cerebrospinal fluid (CSF), and imaging measures were evaluated as candidate predictors of longer-term (up to 5 years) change in Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score and DAT specific binding ratios (SBR) using linear mixed-effects models. RESULTS Among 413 PD participants, median follow-up was 5 years. Change in MDS-UPDRS from year-2 to last follow-up was associated with disease duration (β= 0.351; 95% CI = 0.146, 0.555), male gender (β= 3.090; 95% CI = 0.310, 5.869), and baseline (β= -0.199; 95% CI = -0.315, -0.082) and 1-year change (β= 0.540; 95% CI = 0.423, 0.658) in MDS-UPDRS; predictors in the model accounted for 17.6% of the variance in outcome. Predictors of percent change in mean SBR from year-2 to last follow-up included baseline rapid eye movement sleep behavior disorder score (β= -0.6229; 95% CI = -1.2910, 0.0452), baseline (β= 7.232; 95% CI = 2.268, 12.195) and 1-year change (β= 45.918; 95% CI = 35.994,55.843) in mean striatum SBR, and 1-year change in autonomic symptom score (β= -0.325;95% CI = -0.695, 0.045); predictors in the model accounted for 44.1% of the variance. CONCLUSIONS Baseline clinical, CSF, and imaging measures in early PD predicted change in MDS-UPDRS and dopamine-transporter binding, but the predictive value of the models was low. Adding the short-term change of possible predictors improved the predictive value, especially for modeling change in dopamine-transporter binding.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janel Barnes
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Nicholas Seedorff
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany and Paracelsus-Elena-Klinik, Kassel, Germany
| | | | - Nichole Daegele
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Mark Frasier
- The Michael J. Fox Foundation, New York, NY, USA
| | - Caroline Tanner
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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25
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Schrag A, Quinn N. What contributes to quality of life in Parkinson's disease: a re-evaluation. J Neurol Neurosurg Psychiatry 2020; 91:563-565. [PMID: 32139651 DOI: 10.1136/jnnp-2019-322379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Anette Schrag
- UCL Institute of Neurology, University College London, London, UK
| | - Niall Quinn
- UCL Institute of Neurology, University College London, London, UK
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26
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Craig CE, Jenkinson NJ, Brittain J, Grothe MJ, Rochester L, Silverdale M, Alho AT, Alho EJ, Holmes PS, Ray NJ. Pedunculopontine Nucleus Microstructure Predicts Postural and Gait Symptoms in Parkinson's Disease. Mov Disord 2020; 35:1199-1207. [DOI: 10.1002/mds.28051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Chesney E. Craig
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan University Manchester United Kingdom
| | - Ned J. Jenkinson
- School of Sport, Exercise and Rehabilitation Sciences, and Centre for Human Brain Healththe University of Birmingham Birmingham United Kingdom
| | - John‐Stuart Brittain
- Behavioural Brain Sciences Centre, School of PsychologyUniversity of Birmingham Birmingham United Kingdom
| | - Michel J. Grothe
- German Center for Neurodegenerative Diseases Rostock Germany
- Movement Disorder Unit, Neurology and Neurophysiology Service, Seville Institute of Biomedicine, Virgen del Rocío University Hospital, University of Seville Seville Spain
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Newcastle upon Tyne United Kingdom
| | - Monty Silverdale
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science CentreUniversity of Manchester Manchester United Kingdom
| | - Ana T.D.L. Alho
- Department of Neurology, Faculty of Medicine, University of Sao Paulo, Functional Neurosurgery Division, Institute of Psychiatry‐HCFMUSP São Paulo Brazil
- Hospital Israelita Albert Einstein, Brain Institute São Paulo Brazil
| | - Eduardo J.L. Alho
- Department of Neurology, Faculty of Medicine, University of Sao Paulo, Functional Neurosurgery Division, Institute of Psychiatry‐HCFMUSP São Paulo Brazil
| | - Paul S. Holmes
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan University Manchester United Kingdom
| | - Nicola J. Ray
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan University Manchester United Kingdom
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27
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Campos-Sousa RN, Araújo de Sousa I, James Almeida K, Augusto Dias de Castro I, Cosme Soares de Oliveira-Filho M, M.A.B. Quagliato E. Longitudinal analysis of functional disabilities, cognitive decline and risk of dementia in women with Parkinson’s disease and detrusor overactivity. J Clin Neurosci 2020; 75:85-88. [DOI: 10.1016/j.jocn.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
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28
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Wang CY, Chan L, Wu D, Chi WC, Yen CF, Liao HF, Hong CT, Liou TH. Effect of Cognitive Disability and Ambulation Status on Functioning in Moderate-to-Advanced Parkinson Disease. Front Neurol 2020; 10:1360. [PMID: 31998219 PMCID: PMC6962294 DOI: 10.3389/fneur.2019.01360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 12/23/2022] Open
Abstract
Background: As the disease progresses to moderate to advanced stages, people with Parkinson's disease (PwP) are likely to have various degrees of disability due to the motor and non-motor symptoms, such as ambulatory difficulty and cognitive impairment. The objective of this study was to investigate the impact of cognition and ambulation status on the functioning and disability of PwP using the World Health Orgnaization Disability Assessment Schedule 2.0 (WHODAS 2.0). Materials and Methods: A group of 10,581 PwP with Hoehn and Yahr Staging 3 and above were collected from a database of disability evaluation and functional assessment using the Taiwan Data Bank of Persons with Disability between July 2012 and October 2018. WHODAS 2.0 was administered and all PwP were grouped based on their ambulatory status, which was assessed by 3-m back and forth walk and cognitive ability, assessed by WHODAS 2.0 first domain with cut-off level at 58. Results: Non-ambulation and cognitive disability contributed independently to disability in all aspects of WHODAS 2.0 survey, including self-care, getting along with others, performing life activities and participation in society. Compared to ambulation status, cognitive disability had a greater negative impact on functioning in all aspects. Conclusion: Cognitive disability was associated with greater disability in moderate to advanced PwP than non-ambulatory status. The results of this study may indicate that cognition preservation is essential to ameliorate functional impairment and disability in moderate to advanced PwP.
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Affiliation(s)
- Chen Yu Wang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Public Health, Tzu Chi University, Hualien City, Taiwan
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
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29
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Tsiouris KM, Konitsiotis S, Koutsouris DD, Fotiadis DI. Prognostic factors of Rapid symptoms progression in patients with newly diagnosed parkinson's disease. Artif Intell Med 2020; 103:101807. [PMID: 32143804 DOI: 10.1016/j.artmed.2020.101807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Tracking symptoms progression in the early stages of Parkinson's disease (PD) is a laborious endeavor as the disease can be expressed with vastly different phenotypes, forcing clinicians to follow a multi-parametric approach in patient evaluation, looking for not only motor symptomatology but also non-motor complications, including cognitive decline, sleep problems and mood disturbances. Being neurodegenerative in nature, PD is expected to inflict a continuous degradation in patients' condition over time. The rate of symptoms progression, however, is found to be even more chaotic than the vastly different phenotypes that can be expressed in the initial stages of PD. In this work, an analysis of baseline PD characteristics is performed using machine learning techniques, to identify prognostic factors for early rapid progression of PD symptoms. Using open data from the Parkinson's Progression Markers Initiative (PPMI) study, an extensive set of baseline patient evaluation outcomes is examined to isolate determinants of rapid progression within the first two and four years of PD. The rate of symptoms progression is estimated by tracking the change of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score over the corresponding follow-up period. Patients are ranked according to their progression rates and those who expressed the highest rates of MDS-UPDRS total score increase per year of follow-up period are assigned into the rapid progression class, using 5- and 10-quantiles partition. Classification performance against the rapid progression class was evaluated in a per quantile partition analysis scheme and in quantile-independent approach, respectively. The results shown a more accurate patient discrimination with quantile partitioning, however, a much more compact subset of baseline factors is extracted in the latter, making a more suitable for actual interventions in practice. Classification accuracy improved in all cases when using the longer 4-year follow-up period to estimate PD progression, suggesting that a prolonged patient evaluation can provide better outcomes in identifying rapid progression phenotype. Non-motor symptoms are found to be the main determinants of rapid symptoms progression in both follow-up periods, with autonomic dysfunction, mood impairment, anxiety, REM sleep behavior disorders, cognitive decline and memory impairment being alarming signs at baseline evaluation, along with rigidity symptoms, certain laboratory blood test results and genetic mutations.
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Affiliation(s)
- Kostas M Tsiouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, GR15773, Athens, Greece; Unit of Medical Technology and Intelligent Information Systems, Dept. of Material Science and Engineering, University of Ioannina, GR45110, Ioannina, Greece
| | - Spiros Konitsiotis
- Dept. of Neurology, Medical School, University of Ioannina, GR45110, Ioannina, Greece
| | - Dimitrios D Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, GR15773, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Material Science and Engineering, University of Ioannina, GR45110, Ioannina, Greece; Dept. of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR45110, Ioannina, Greece.
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30
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Coughlin DG, Hurtig H, Irwin DJ. Pathological Influences on Clinical Heterogeneity in Lewy Body Diseases. Mov Disord 2020; 35:5-19. [PMID: 31660655 PMCID: PMC7233798 DOI: 10.1002/mds.27867] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/06/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022] Open
Abstract
PD, PD with dementia, and dementia with Lewy bodies are clinical syndromes characterized by the neuropathological accumulation of alpha-synuclein in the CNS that represent a clinicopathological spectrum known as Lewy body disorders. These clinical entities have marked heterogeneity of motor and nonmotor symptoms with highly variable disease progression. The biological basis for this clinical heterogeneity remains poorly understood. Previous attempts to subtype patients within the spectrum of Lewy body disorders have centered on clinical features, but converging evidence from studies of neuropathology and ante mortem biomarkers, including CSF, neuroimaging, and genetic studies, suggest that Alzheimer's disease beta-amyloid and tau copathology strongly influence clinical heterogeneity and prognosis in Lewy body disorders. Here, we review previous clinical biomarker and autopsy studies of Lewy body disorders and propose that Alzheimer's disease copathology is one of several likely pathological contributors to clinical heterogeneity of Lewy body disorders, and that such pathology can be assessed in vivo. Future work integrating harmonized assessments and genetics in PD, PD with dementia, and dementia with Lewy bodies patients followed to autopsy will be critical to further refine the classification of Lewy body disorders into biologically distinct endophenotypes. This approach will help facilitate clinical trial design for both symptomatic and disease-modifying therapies to target more homogenous subsets of Lewy body disorders patients with similar prognosis and underlying biology. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David G Coughlin
- University of Pennsylvania Health System, Department of Neurology
- Digital Neuropathology Laboratory
- Lewy Body Disease Research Center of Excellence
| | - Howard Hurtig
- University of Pennsylvania Health System, Department of Neurology
| | - David J Irwin
- University of Pennsylvania Health System, Department of Neurology
- Digital Neuropathology Laboratory
- Lewy Body Disease Research Center of Excellence
- Frontotemporal Degeneration Center, Philadelphia PA, USA 19104
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31
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Abraham DS, Gruber-Baldini AL, Magder LS, McArdle PF, Tom SE, Barr E, Schrader K, Shulman LM. Sex differences in Parkinson's disease presentation and progression. Parkinsonism Relat Disord 2019; 69:48-54. [PMID: 31677455 PMCID: PMC6982644 DOI: 10.1016/j.parkreldis.2019.10.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/06/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Females have a reduced risk of Parkinson's disease (PD). However, it is unclear if sex is a prognostic factor. We aimed to examine differences in presentation, physician- and patient-reported PD outcomes, and progression by sex in a large clinical cohort. METHODS This study was a secondary analysis of a cohort of PD patients seen at a tertiary care center. Sociodemographic and clinical characteristics, treatment, care timing, and outcomes were examined by sex. Sex differences in progression of impairment, disability, and health-related quality of life (HRQoL) were tested with five-year piecewise linear mixed-effects models. A mediation analysis assessed drivers of sex differences. RESULTS The study included 914 males and 549 females. Females had significantly less social support, more psychological distress, and worse self-reported (but not physician-reported) disability and HRQoL at initial PD care visits, compared to males. Addressing anxiety symptoms may attenuate this difference. PD progression sex differences were minimal. CONCLUSION PD progression does not differ by sex, yet patient-reported measures of disease severity are worse in females than males. To attenuate this sex difference in disease experience, psychological distress screening and management, particularly targeting females, should be implemented as part of PD clinical care.
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Affiliation(s)
- Danielle S Abraham
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Ann L Gruber-Baldini
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laurence S Magder
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick F McArdle
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah E Tom
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Erik Barr
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katrina Schrader
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Barbe MT, Tonder L, Krack P, Debû B, Schüpbach M, Paschen S, Dembek TA, Kühn AA, Fraix V, Brefel-Courbon C, Wojtecki L, Maltête D, Damier P, Sixel-Döring F, Weiss D, Pinsker M, Witjas T, Thobois S, Schade-Brittinger C, Rau J, Houeto JL, Hartmann A, Timmermann L, Schnitzler A, Stoker V, Vidailhet M, Deuschl G. Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications. Mov Disord 2019; 35:82-90. [PMID: 31755599 DOI: 10.1002/mds.27892] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. OBJECTIVE Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM-trial). METHODS One hundred twenty-four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item-14 of the UPDRS-II at baseline and follow-up. The posture, instability, and gait-difficulty subscore of the UPDRS-III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication-off and medication-on conditions. RESULTS Fifty-two percent in both groups had freezing of gait at baseline based on UPDRS-II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication-off and medication-on conditions. CONCLUSIONS Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication-off condition compared to best medical treatment in these patients. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Paul Krack
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Bettina Debû
- Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France
| | - Michael Schüpbach
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.,Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France.,Institute of Neurology, Konolfingen, Switzerland
| | - Steffen Paschen
- Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Valerie Fraix
- Université Grenoble Alpes, INSERM 1216, Grenoble Institut Neurosciences, Grenoble, France; Neurology Department, Grenoble University Hospital, Grenoble, France.,Neurology Department, Grenoble University Hospital, Grenoble, France
| | | | - Lars Wojtecki
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - David Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France
| | | | | | - Daniel Weiss
- Centre of Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Marcus Pinsker
- Division of Stereotactic and Functional Neurosurgery, University Medical Center, Freiburg, Freiburg, Germany
| | - Tatiana Witjas
- Department of Neurology, Timone University Hospital, UMR 7289, CNRS Marseille, Marseille, France
| | - Stephane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Bron, France; Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France
| | | | - Jörn Rau
- The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU of Poitiers, University of Poitiers, Poitiers, France
| | - Andreas Hartmann
- Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France
| | - Lars Timmermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Universitätsklinikum Giessen und Marburg, Marburg Campus, Marburg, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | | | - Marie Vidailhet
- Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Department of Neurology, Salpêtriere University Hospital, AP-HP, Paris, France
| | - Günther Deuschl
- Department of Neurology, UKSH, Kiel Campus Christian-Albrechts-University, Kiel, Germany
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Rate of Progression in Activity and Participation Outcomes in Exercisers with Parkinson's Disease: A Five-Year Prospective Longitudinal Study. PARKINSONS DISEASE 2019; 2019:5679187. [PMID: 31662843 PMCID: PMC6778930 DOI: 10.1155/2019/5679187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/12/2019] [Accepted: 07/02/2019] [Indexed: 11/25/2022]
Abstract
Background Rates of progression of motor symptoms and physical performance show declines between 2% and 7% annually in community samples with Parkinson's disease (PD). However, the effects of ongoing exercise behaviors on progression rates have not been considered. Objective The primary purpose of this prospective, longitudinal study was to examine the annual rates of progression in activity and participation measures over five years in community-based exercisers with PD. Methods A cohort of 55 regular exercisers with idiopathic PD was assessed at baseline and 1, 2, and 5 years. Regular exercise was defined as scores of 4-5 on the Stages for Readiness to Exercise Scale and a self-reported average of at least 60 minutes of exercise/week within six months of each testing session. Unadjusted and adjusted annual progression rates for activity and participation measures were calculated with a standardized equation of change from baseline. A linear mixed model with covariates of age at PD diagnosis and PD subtype was used to determine adjusted change scores. Results Annual progression rates for unadjusted and adjusted variables were similar, and none exceeded 1.7% across time points for this group of exercisers with PD. Older age at PD diagnosis significantly contributed to faster progression of walking and balance functions. A nonlinear trajectory of the PD progression was demonstrated across most activity and participation outcomes. Conclusions Annual progression rates demonstrated by this sample of exercisers were lower than those previously reported for motor decline in general samples with PD. Assessing activity and participation outcomes longitudinally at interim time points was important for understanding the trajectory of change over time. The lower rates of progression in this study warrant further investigation into the long-term effects of exercise in PD.
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Lin WC, Huang YC, Leong CP, Chen MH, Chen HL, Tsai NW, Tso HH, Chen PC, Lu CH. Associations Between Cognitive Functions and Physical Frailty in Patients With Parkinson's Disease. Front Aging Neurosci 2019; 11:283. [PMID: 31736737 PMCID: PMC6831640 DOI: 10.3389/fnagi.2019.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Parkinson’s disease (PD) is a neurodegenerative disease manifested by both motor and non-motor dysfunctions and co-existence of cognitive impairment and physical frailty is common. Given that research in this area is limited, a better understanding of associated factors with physical frailty could provide a focused screening method and facilitate early intervention in PD. Methods: Seventy-six patients with idiopathic PD were recruited and Fried’s criteria of physical frailty were used to group all participants. Comprehensive cognitive tests and clinical characteristics were measured, and univariate and multivariate analysis was performed to explore the relationship between clinical factors or neuropsychological functions. Results: Twenty-nine patients with PD (38%) exhibited physical frailty. Compared to PD patients without frailty, PD patients with frailty were older in age and demonstrated worse disease severity and poorer cognitive functions, including attention, executive function, memory, speech and language, and visuospatial function (p < 0.05). Further, stepwise logistic regression analysis revealed that disease severity by the Unified Parkinson’s Disease Rating Scale (UPDRS) total score (OR: 1.065; 95% CI: 1.033–1.099) and executive function (OR: 0.724; 95% CI: 0.581–0.877) were independent risk factors for predicting physical frailty (p = 0.003 and 0.002). The best cut-off points are 46 in UPDRS (sensitivity: 62.1%; specificity: 91.5%). Conclusions: Executive function impairment is an independent risk factor for the development of physical frailty with disease progression. Awareness of such comorbidity might provide a screening tool to facilitate investigation in their underlying etiology and early intervention for frailty prevention.
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Affiliation(s)
- Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Hsin Tso
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Hu B, Chomiak T. Wearable technological platform for multidomain diagnostic and exercise interventions in Parkinson's disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 147:75-93. [PMID: 31607363 DOI: 10.1016/bs.irn.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Physical activity and exercise have become a central component of medical management of chronic illness, particular for the elderly who suffer from neurodegenerative disorders that impair their cognition and mobility. This chapter summarizes our recent research showing that a new generation of wearable technology can be adopted as diagnostic and rehabilitation tools for people living with Parkinson's disease. For example, wearable device-enabled 6-min walking test can be automated to eliminate human supervision and many other technical factors that confound the results with conventional testing. With reduced cost and increased test standardization, the technology can be adopted for population-based screening of cardiovascular fitness and gait rehabilitation training efficacy associated with many medical conditions. The Ambulosono platform for multidomain exercise intervention, in particular, has the potential to deliver lasting clinical benefits in slowing PD progression. The platform, through the integration of brisk walking with behavioral shaping strategies such as contingency reinforcement, anticipatory motor control and musical motivational stimulation, creates a home exercise regime that can transform monotonous walking into a pleasurable daily activity and habit.
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Affiliation(s)
- Bin Hu
- Division of Translational Neuroscience, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Taylor Chomiak
- Division of Translational Neuroscience, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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REM sleep behavior disorder predicts functional dependency in early Parkinson's disease. Parkinsonism Relat Disord 2019; 66:138-142. [DOI: 10.1016/j.parkreldis.2019.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/13/2019] [Accepted: 07/20/2019] [Indexed: 02/08/2023]
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Perepezko K, Hinkle JT, Shepard MD, Fischer N, Broen MP, Leentjens AFG, Gallo J, Pontone GM. Social role functioning in Parkinson's disease: A mixed-methods systematic review. Int J Geriatr Psychiatry 2019; 34:1128-1138. [PMID: 31069845 PMCID: PMC6949188 DOI: 10.1002/gps.5137] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is a progressive neurodegenerative disease that often impedes activities of daily living (ADL) and social functioning. Impairment in these areas can alter social roles by interfering with employment status, household management, friendships, and other relationships. Understanding how PD affects social functioning can help clinicians choose management strategies that mitigate these changes. METHODS We conducted a mixed-methods systematic review of existing literature on social roles and social functioning in PD. A tailored search strategy in five databases identified 51 full-text reports that fulfilled the inclusion criteria and passed the quality appraisal. We aggregated and analyzed the results from these studies and then created a narrative summary. RESULTS Our review demonstrates how PD causes many people to withdraw from their accustomed social roles and experience deficits in corresponding activities. We describe how PD symptoms (eg, tremor, facial masking, and neuropsychiatric symptoms) interfere with relationships (eg, couple, friends, and family) and precipitate earlier departure from the workforce. Additionally, several studies demonstrated that conventional PD therapy has little positive effect on social role functioning. CONCLUSIONS Our report presents critical insight into how PD affects social functioning and gives direction to future studies and interventions (eg, couple counseling and recreational activities).
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Affiliation(s)
- Kate Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared T. Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Medical Scientist Training Program, Baltimore, MD, USA
| | - Melissa D. Shepard
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martinus P.G. Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joe Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lo C, Arora S, Baig F, Lawton MA, El Mouden C, Barber TR, Ruffmann C, Klein JC, Brown P, Ben-Shlomo Y, de Vos M, Hu MT. Predicting motor, cognitive & functional impairment in Parkinson's. Ann Clin Transl Neurol 2019; 6:1498-1509. [PMID: 31402628 PMCID: PMC6689691 DOI: 10.1002/acn3.50853] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We recently demonstrated that 998 features derived from a simple 7-minute smartphone test could distinguish between controls, people with Parkinson's and people with idiopathic Rapid Eye Movement sleep behavior disorder, with mean sensitivity/specificity values of 84.6-91.9%. Here, we investigate whether the same smartphone features can be used to predict future clinically relevant outcomes in early Parkinson's. METHODS A total of 237 participants with Parkinson's (mean (SD) disease duration 3.5 (2.2) years) in the Oxford Discovery cohort performed smartphone tests in clinic and at home. Each test assessed voice, balance, gait, reaction time, dexterity, rest, and postural tremor. In addition, standard motor, cognitive and functional assessments and questionnaires were administered in clinic. Machine learning algorithms were trained to predict the onset of clinical outcomes provided at the next 18-month follow-up visit using baseline smartphone recordings alone. The accuracy of model predictions was assessed using 10-fold and subject-wise cross validation schemes. RESULTS Baseline smartphone tests predicted the new onset of falls, freezing, postural instability, cognitive impairment, and functional impairment at 18 months. For all outcome predictions AUC values were greater than 0.90 for 10-fold cross validation using all smartphone features. Using only the 30 most salient features, AUC values greater than 0.75 were obtained. INTERPRETATION We demonstrate the ability to predict key future clinical outcomes using a simple smartphone test. This work has the potential to introduce individualized predictions to routine care, helping to target interventions to those most likely to benefit, with the aim of improving their outcome.
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Affiliation(s)
- Christine Lo
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Siddharth Arora
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Somerville College, University of Oxford, Oxford, UK
| | - Fahd Baig
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Claire El Mouden
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas R Barber
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Claudio Ruffmann
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Johannes C Klein
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Maarten de Vos
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Parkinson's progression prediction using machine learning and serum cytokines. NPJ PARKINSONS DISEASE 2019; 5:14. [PMID: 31372494 PMCID: PMC6658482 DOI: 10.1038/s41531-019-0086-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/03/2019] [Indexed: 12/16/2022]
Abstract
The heterogeneous nature of Parkinson’s disease (PD) symptoms and variability in their progression complicates patient treatment and interpretation of clinical trials. Consequently, there is much interest in developing models that can predict PD progression. In this study we have used serum samples from a clinically well characterized longitudinally followed Michael J Fox Foundation cohort of PD patients with and without the common leucine-rich repeat kinase 2 (LRRK2) G2019S mutation. We have measured 27 inflammatory cytokines and chemokines in serum at baseline and after 1 year to investigate cytokine stability. We then used the baseline measurements in conjunction with machine learning models to predict longitudinal clinical outcomes after 2 years follow up. Using the normalized root mean square error (NRMSE) as a measure of performance, the best prediction models were for the motor symptom severity scales, with NRMSE of 0.1123 for the Hoehn and Yahr scale and 0.1193 for the unified Parkinson’s disease rating scale part three (UPDRS III). For each model, the top variables contributing to prediction were identified, with the chemokines macrophage inflammatory protein one alpha (MIP1α), and monocyte chemoattractant protein one (MCP1) making the biggest peripheral contribution to prediction of Hoehn and Yahr and UPDRS III, respectively. These results provide information on the longitudinal assessment of peripheral inflammatory cytokines in PD and give evidence that peripheral cytokines may have utility for aiding prediction of PD progression using machine learning models.
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Halmi Z, Dinya E, Málly J. Destroyed non-dopaminergic pathways in the early stage of Parkinson's disease assessed by posturography. Brain Res Bull 2019; 152:45-51. [PMID: 31295517 DOI: 10.1016/j.brainresbull.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The early stage of Parkinson's disease (PD) (Hoehn-Yahr (HY) I-II stages) is characterized by a negative pull test, which clinically excludes postural instability. Previous studies with dynamic posturography detected balance disturbances even at the onset of the disease but the age dependency or prediction of dyskinesia with dynamic posturography are not known. OBJECTIVE/HYPOTHESIS We hypothesized that the postural instability evoked by dynamic posturography was part of the early stage of PD. Furthermore, we studied how we can provoke dyskinesia. METHODS Postural instability with static and dynamic posturography (passing balls with different weights around the body) was studied in 45 patients with PD in their HY I, II stages. They were compared with 35 age-matched healthy controls. Eighteen patients with dyskinesia were involved in the study. Fourteen patients were followed for two years. RESULTS The pathway and velocity of the movement assessed by static and the dynamic posturography were significantly higher in the group >65 years than that of age-matched healthy controls, while the group ≤65 years showed a significant increment only in the antero-posterior sway during dynamic posturography. The imbalance of patients with dyskinesia was significantly (p < 0.05) provoked by dynamic posturography compared to patients with PD without dyskinesia. The results were independent of age. CONCLUSION Postural instability is part of the early symptoms of PD. Non-dopaminergic pathways may be involved in the early stage of PD.
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Affiliation(s)
- Zsófia Halmi
- Dept. Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary
| | - Elek Dinya
- Semmelweis Univ. Digital Health Dept., Budapest, Hungary
| | - Judit Málly
- Inst. of Neurorehabilitation, Sopron, Hungary.
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Combs-Miller SA, Moore ES. Predictors of outcomes in exercisers with Parkinson disease: A two-year longitudinal cohort study. NeuroRehabilitation 2019; 44:425-432. [DOI: 10.3233/nre-182641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Stephanie A. Combs-Miller
- University of Indianapolis, Krannert School of Physical Therapy, Interprofessional Health and Aging Studies, Indianapolis, IN, USA
| | - Elizabeth S. Moore
- University of Indianapolis, Krannert School of Physical Therapy, Interprofessional Health and Aging Studies, Indianapolis, IN, USA
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Xu J, Zhang M. Use of Magnetic Resonance Imaging and Artificial Intelligence in Studies of Diagnosis of Parkinson's Disease. ACS Chem Neurosci 2019; 10:2658-2667. [PMID: 31083923 DOI: 10.1021/acschemneuro.9b00207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder. It has a delitescent onset and a slow progress. The clinical manifestations of PD in patients are highly heterogeneous. Thus, PD diagnosis process is complex and mainly depends on the professional knowledge and experience of the physician. Magnetic resonance imaging (MRI) could detect the small changes in the brain of PD patients, and quantitative analysis of brain MRI may improve the clinical diagnosis efficiency. However, due to the complexity of clinical courses in PD and the high dimensionality in multimodal MRI data, traditional mathematical analysis could not effectively extract the huge information in them. Up to now, the accuracy of PD diagnosis in large sample size is still unsatisfying. As artificial intelligence (AI) is becoming more mature, varieties of statistical models and machine learning (ML) algorithms have been used for quantitative imaging data analysis to explore a diagnostic result. This review aims to state an overview of existing research recently that used statistical ML/AI methods to perform quantitative analysis of MR image data for the study of PD diagnosis. First we review the recent research in three subareas: diagnosis, differential diagnosis, and subtyping of PD. Then we described the overall workflow from MR image to classification result. Finally, we summarized a critical assessment of the current research and provide some recommendations for likely future research developments and trends.
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Affiliation(s)
- Jingjing Xu
- Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 31000, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 31000, China
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Parnetti L, Gaetani L, Eusebi P, Paciotti S, Hansson O, El-Agnaf O, Mollenhauer B, Blennow K, Calabresi P. CSF and blood biomarkers for Parkinson's disease. Lancet Neurol 2019; 18:573-586. [PMID: 30981640 DOI: 10.1016/s1474-4422(19)30024-9] [Citation(s) in RCA: 323] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 01/09/2023]
Abstract
In the management of Parkinson's disease, reliable diagnostic and prognostic biomarkers are urgently needed. The diagnosis of Parkinson's disease mostly relies on clinical symptoms, which hampers the detection of the earliest phases of the disease-the time at which treatment with forthcoming disease-modifying drugs could have the greatest therapeutic effect. Reliable prognostic markers could help in predicting the response to treatments. Evidence suggests potential diagnostic and prognostic value of CSF and blood biomarkers closely reflecting the pathophysiology of Parkinson's disease, such as α-synuclein species, lysosomal enzymes, markers of amyloid and tau pathology, and neurofilament light chain. A combination of multiple CSF biomarkers has emerged as an accurate diagnostic and prognostic model. With respect to early diagnosis, the measurement of CSF α-synuclein aggregates is providing encouraging preliminary results. Blood α-synuclein species and neurofilament light chain are also under investigation because they would provide a non-invasive tool, both for early and differential diagnosis of Parkinson's disease versus atypical parkinsonian disorders, and for disease monitoring. In view of adopting CSF and blood biomarkers for improving Parkinson's disease diagnostic and prognostic accuracy, further validation in large independent cohorts is needed.
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Affiliation(s)
- Lucilla Parnetti
- Section of Neurology, Laboratory of Clinical Neurochemistry, Department of Medicine, University of Perugia, Perugia, Italy.
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paolo Eusebi
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Silvia Paciotti
- Section of Neurology, Laboratory of Clinical Neurochemistry, Department of Medicine, University of Perugia, Perugia, Italy; Section of Physiology and Biochemistry, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Omar El-Agnaf
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Education City, Doha, Qatar
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany; University Medical Center, Department of Neurology, Göttingen, Germany
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Paolo Calabresi
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
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Amara AW, Chahine L, Seedorff N, Caspell-Garcia CJ, Coffey C, Simuni T. Self-reported physical activity levels and clinical progression in early Parkinson's disease. Parkinsonism Relat Disord 2019; 61:118-125. [DOI: 10.1016/j.parkreldis.2018.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 01/16/2023]
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Gaßner H, Raccagni C, Eskofier BM, Klucken J, Wenning GK. The Diagnostic Scope of Sensor-Based Gait Analysis in Atypical Parkinsonism: Further Observations. Front Neurol 2019; 10:5. [PMID: 30723450 PMCID: PMC6349719 DOI: 10.3389/fneur.2019.00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/03/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Differentiating idiopathic Parkinson's disease (IPD) from atypical Parkinsonian disorders (APD) is challenging, especially in early disease stages. Postural instability and gait difficulty (PIGD) are substantial motor impairments of IPD and APD. Clinical evidence implies that patients with APD have larger PIGD impairment than IPD patients. Sensor-based gait analysis as instrumented bedside test revealed more gait deficits in APD compared to IPD. However, the diagnostic value of instrumented bedside tests compared to clinical assessments in differentiating APD from IPD patients have not been evaluated so far. Objective: The objectives were (a) to evaluate whether sensor-based gait parameters provide additional information to validated clinical scores in differentiating APD from matched IPD patients, and (b) to investigate if objective, instrumented gait assessments have comparable discriminative power to clinical scores. Methods: In a previous study we have recorded instrumented gait parameters in patients with APD (Multiple System Atrophy and Progressive Supranuclear Palsy). Here, we compared gait parameters to those of retrospectively pairwise disease duration-, age-, and gender-matched IPD patients in order to address this new research questions. To this aim, the PIGD score was calculated as sum of the MDS-UPDRS-3-items “gait,” “postural stability,” “arising from chair,” and “posture.” Gait characteristics were evaluated in standardized gait tests using an instrumented, sensor-based gait analysis system. Machine learning algorithms were used to extract spatio-temporal gait parameters. Receiver Operating Characteristic analysis was performed in order to detect the discriminative power of the instrumented vs. the clinical bedside tests in differentiating IPD from APD. Results: Sensor-based stride length, gait velocity, toe off angle, and parameters representing gait variability significantly differed between IPD and APD groups. ROC analysis revealed a high Area Under the Curve (AUC) for PIGD score (0.919), and UPDRS-3 (0.848). Particularly, the objective parameters stance time variability (0.841), swing time variability (0.834), stride time variability (0.821), and stride length variability (0.804) reached high AUC's as well. Conclusions: PIGD symptoms showed high discriminative power in differentiating IPD from APD supporting gait disorders as substantial diagnostic target. Sensor-based gait variability parameters provide metric, objective added value, and serve as complementary outcomes supporting clinical diagnostics and long-term home-monitoring concepts.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Faust-Socher A, Duff-Canning S, Grabovsky A, Armstrong MJ, Rothberg B, Eslinger PJ, Meaney CA, Schneider RB, Tang-Wai DF, Fox SH, Zadikoff C, Kennedy N, Chou KL, Persad C, Litvan I, Mast BT, Gerstenecker AT, Weintraub S, Reginold W, Marras C. Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. Dement Geriatr Cogn Disord 2019; 47:187-197. [PMID: 31315127 PMCID: PMC7186910 DOI: 10.1159/000496454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). METHODS PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. RESULTS One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. CONCLUSION Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.
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Affiliation(s)
- Achinoam Faust-Socher
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada,Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Sarah Duff-Canning
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Arthur Grabovsky
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Brandon Rothberg
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Paul J. Eslinger
- Departments of Neurology, Neural and Behavioral Sciences, and Radiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Christopher A. Meaney
- Division of Biostatistics, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruth B. Schneider
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - David F. Tang-Wai
- Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, ON
| | - Susan H. Fox
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Nancy Kennedy
- Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL, USA
| | - Kelvin L. Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Carol Persad
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neuroscience, UC San Diego, San Diego, CA, USA
| | - Benjamin T. Mast
- Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Adam T. Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra Weintraub
- Department of Psychiatry and Behavioural Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Reginold
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada,
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Allali G, Blumen HM, Devanne H, Pirondini E, Delval A, Van De Ville D. Brain imaging of locomotion in neurological conditions. Neurophysiol Clin 2018; 48:337-359. [PMID: 30487063 PMCID: PMC6563601 DOI: 10.1016/j.neucli.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/20/2023] Open
Abstract
Impaired locomotion is a frequent and major source of disability in patients with neurological conditions. Different neuroimaging methods have been used to understand the brain substrates of locomotion in various neurological diseases (mainly in Parkinson's disease) during actual walking, and while resting (using mental imagery of gait, or brain-behavior correlation analyses). These studies, using structural (i.e., MRI) or functional (i.e., functional MRI or functional near infra-red spectroscopy) brain imaging, electrophysiology (i.e., EEG), non-invasive brain stimulation (i.e., transcranial magnetic stimulation, or transcranial direct current stimulation) or molecular imaging methods (i.e., PET, or SPECT) reveal extended brain networks involving both grey and white matters in key cortical (i.e., prefrontal cortex) and subcortical (basal ganglia and cerebellum) regions associated with locomotion. However, the specific roles of the various pathophysiological mechanisms encountered in each neurological condition on the phenotype of gait disorders still remains unclear. After reviewing the results of individual brain imaging techniques across the common neurological conditions, such as Parkinson's disease, dementia, stroke, or multiple sclerosis, we will discuss how the development of new imaging techniques and computational analyses that integrate multivariate correlations in "large enough datasets" might help to understand how individual pathophysiological mechanisms express clinically as an abnormal gait. Finally, we will explore how these new analytic methods could drive our rehabilitative strategies.
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Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; EA 7369, URePSSS, Unité de Recherche Pluridisciplinaire Sport Santé Société, Université du Littoral Côte d'Opale, Calais, France
| | - Elvira Pirondini
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Arnaud Delval
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Unité Inserm 1171, Faculté de Médecine, Université de Lille, Lille, France
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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The Pattern of Striatal Dopamine Depletion as a Prognostic Marker in De Novo Parkinson Disease. Clin Nucl Med 2018; 43:787-792. [DOI: 10.1097/rlu.0000000000002251] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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O'Gorman Tuura RL, Baumann CR, Baumann-Vogel H. Beyond Dopamine: GABA, Glutamate, and the Axial Symptoms of Parkinson Disease. Front Neurol 2018; 9:806. [PMID: 30319535 PMCID: PMC6168661 DOI: 10.3389/fneur.2018.00806] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: The axial symptoms of Parkinson disease (PD) include difficulties with balance, posture, speech, swallowing, and locomotion with freezing of gait, as well as axial rigidity. These axial symptoms impact negatively on quality of life for many patients, yet remain poorly understood. Dopaminergic treatments typically have little effect on the axial symptoms of PD, suggesting that disruptions in other neurotransmitter systems beyond the dopamine system may underlie these symptoms. The purpose of the present study was to examine the relationship between the axial symptoms of PD and GABA and glutamate levels quantified with magnetic resonance spectroscopy. Methods: The participant group included 20 patients with PD and 17 healthy control participants. Water-scaled GABA and Glx (glutamate + glutamine) concentrations were derived from GABA-edited MEGA-PRESS spectra acquired from the left basal ganglia and prefrontal cortex, and additional water-scaled Glx concentrations were acquired from standard PRESS spectra acquired from the pons. Spectra were analyzed with LCModel. The axial symptoms of PD were evaluated from subscales of the Unified Parkinson's Disease rating scale (MDS-UPDRS). Results: PD patients demonstrated significantly higher GABA levels in the basal ganglia, which correlated with the degree of gait disturbance. Basal ganglia Glx levels and prefrontal GABA and Glx levels did not differ significantly between patient and control groups, but within the PD group prefrontal Glx levels correlated negatively with difficulties turning in bed. Results from an exploratory subgroup analysis indicate that the associations between GABA, Glx, and axial symptoms scores are typically more prominent in akinetic-rigid patients than in tremor-dominant patients. Conclusion: Alterations in GABAergic and glutamatergic neurotransmission may contribute to some of the axial symptoms of PD.
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