1
|
Kelley CR, Kauffman JL. Parkinsonian Tremor as Unstable Feedback in a Physiologically Consistent Control Framework. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2665-2675. [PMID: 39018214 DOI: 10.1109/tnsre.2024.3430116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Parkinson's disease (PD) is characterized by decreased dopamine in the basal ganglia that causes excessive tonic inhibition of the thalamus. This excessive inhibition seems to explain inhibitory motor symptoms in PD, but the source of tremor remains unclear. This paper investigates how neural inhibition may change the closed-loop characteristics of the human motor control system to determine how this established pathophysiology could produce tremor. The rate-coding model of neural signals suggests increased inhibition decreases signal amplitude, which could create a mismatch between the closed-loop dynamics and the internal models that overcome proprioceptive feedback delays. This paper aims to identify a candidate model structure with decreased-amplitude-induced tremor in PD that also agrees with previously recorded movements of healthy and cerebellar patients. The optimal feedback control theory of human motor control forms the basis of the model. Key additional elements include gating of undesired movements via the basal ganglia-thalamus-motor cortex circuit and the treatment of the efferent copy of the control input as a measurement in the state estimator. Simulations confirm the model's ability to capture tremor in PD and also demonstrate how disease progression could affect tremor and other motor symptoms, providing insight into the existence of tremor and non-tremor phenotypes. Altogether, the physiological underpinnings of the model structure and the agreement of model predictions with clinical observations provides support for the hypothesis that unstable feedback produces parkinsonian tremor. Consequently, these results also support the associated framework for the neuroanatomy of human motor control.
Collapse
|
2
|
Wu C, Wu H, Zhou C, Guo T, Guan X, Cao Z, Wu J, Liu X, Chen J, Wen J, Qin J, Tan S, Duanmu X, Gu L, Song Z, Zhang B, Huang P, Xu X, Zhang M. The effect of dopamine replacement therapy on cortical structure in Parkinson's disease. CNS Neurosci Ther 2024; 30:e14540. [PMID: 37994682 PMCID: PMC11017430 DOI: 10.1111/cns.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
AIMS To explore the cortical structural reorganization in Parkinson's disease (PD) patients under chronic dopamine replacement therapy (DRT) in cross-sectional and longitudinal data and determine whether these changes were associated with clinical alterations. METHODS A total of 61 DRT-treated, 60 untreated PD patients, and 61 normal controls (NC) were retrospectively included. Structural MRI scans and neuropsychological tests were conducted. Cortical thickness and volume were extracted based on FreeSurfer and were analyzed using general linear model to find statistically significant differences among three groups. Correlation analyses were performed among significant cortical areas, medication treatment (duration and dosage), and neuropsychological tests. Longitudinal cortical structural changes of patients who initiated DRT were analyzed using linear mixed-effect model. RESULTS Significant cortical atrophy was primarily observed in the prefrontal cortex in treated patients, including the cortical thickness of right pars opercularis and the volume of bilateral superior frontal cortex (SFC), left rostral anterior cingulate cortex (rACC), right lateral orbital frontal cortex, right pars orbitalis, and right rostral middle frontal cortex. A negative correlation was detected between the left SFC volume and levodopa equivalent dose (LED) (r = -0.316, p = 0.016), as well as the left rACC volume and medication duration (r = -0.329, p = 0.013). In the patient group, the left SFC volume was positively associated with digit span forward score (r = 0.335, p = 0.017). The left SFC volume reduction was longitudinally correlated with increased LED (standardized coefficient = -0.077, p = 0.001). CONCLUSION This finding provided insights into the influence of DRT on cortical structure and highlighted the importance of drug dose titration in DRT.
Collapse
Affiliation(s)
- Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojie Duanmu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Song
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
3
|
Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
Collapse
Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| |
Collapse
|
4
|
Seger AD, Farrher E, Doppler CEJ, Gogishvili A, Worthoff WA, Filss CP, Barbe MT, Holtbernd F, Shah NJ, Fink GR, Sommerauer M. Putaminal y-Aminobutyric Acid Modulates Motor Response to Dopaminergic Therapy in Parkinson's Disease. Mov Disord 2021; 36:2187-2192. [PMID: 34096652 DOI: 10.1002/mds.28674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Motor response to dopaminergic therapy is a characteristic of patients with Parkinson's disease (PD). Whether nondopaminergic neurotransmitters contribute to treatment response is uncertain. OBJECTIVES The aim of this study is to determine whether putaminal y-aminobutyric acid (GABA) levels are associated with dopaminergic motor response. METHODS We assessed putaminal GABA levels in 19 PD patients and 13 healthy controls (HCs) utilizing ultra-high field proton magnetic resonance spectroscopy. Motor performance was evaluated using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, Part III, in the ON and OFF states. Statistical analysis comprised group comparisons, correlation analysis, and multiple linear regression. RESULTS In PD, GABA levels were significantly higher compared to HCs (1.50 ± 0.26 mM vs. 1.26 ± 0.31 mM, P = 0.022). Furthermore, GABA levels were independent predictors of absolute and relative dopaminergic treatment response. CONCLUSIONS Our findings indicate that elevated putaminal GABA levels are associated with worse dopaminergic response in PD, emphasizing the essential role of nondopaminergic neurotransmitters in motor response. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Aline D Seger
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Ezequiel Farrher
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Christopher E J Doppler
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Ana Gogishvili
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Engineering Physics Department, Georgian Technical University, Tbilisi, Georgia
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany
| | - Florian Holtbernd
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany.,Institute of Neuroscience and Medicine 11 (INM-11), JARA, Forschungszentrum, Jülich, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| |
Collapse
|
5
|
Fabbri M, Coelho M, Abreu D, Ferreira JJ. Levodopa response in later stages of Parkinson's disease: A case-control study. Parkinsonism Relat Disord 2020; 77:160-162. [DOI: 10.1016/j.parkreldis.2019.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022]
|
6
|
Bonomo R, Mostile G, Raciti L, Nicoletti A, Zappia M. Base-peak assessment of levodopa response and detection of fluctuating patients in Parkinson’s disease. Neurol Sci 2020; 41:3769-3773. [DOI: 10.1007/s10072-020-04623-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
|
7
|
Prediction of the Levodopa Challenge Test in Parkinson's Disease Using Data from a Wrist-Worn Sensor. SENSORS 2019; 19:s19235153. [PMID: 31775289 PMCID: PMC6928714 DOI: 10.3390/s19235153] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
The response to levodopa (LR) is important for managing Parkinson’s Disease and is measured with clinical scales prior to (OFF) and after (ON) levodopa. The aim of this study was to ascertain whether an ambulatory wearable device could predict the LR from the response to the first morning dose. The ON and OFF scores were sorted into six categories of severity so that separating Parkinson’s Kinetigraph (PKG) features corresponding to the ON and OFF scores became a multi-class classification problem according to whether they fell below or above the threshold for each class. Candidate features were extracted from the PKG data and matched to the class labels. Several linear and non-linear candidate statistical models were examined and compared to classify the six categories of severity. The resulting model predicted a clinically significant LR with an area under the receiver operator curve of 0.92. This study shows that ambulatory data could be used to identify a clinically significant response to levodopa. This study has also identified practical steps that would enhance the reliability of this test in future studies.
Collapse
|
8
|
Fabbri M, Coelho M, Abreu D, Guedes LC, Rosa MM, Godinho C, Cardoso R, Guimaraes I, Antonini A, Zibetti M, Lopiano L, Ferreira JJ. Dysphagia predicts poor outcome in late-stage Parkinson's disease. Parkinsonism Relat Disord 2019; 64:73-81. [PMID: 30902528 DOI: 10.1016/j.parkreldis.2019.02.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few data exist on the rate of clinical progression for Parkinson's disease (PD) patients who have entered a late stage of the disease. OBJECTIVE Study the clinical progression of a late-stage PD (LSPD) population over one year follow-up. METHODS 50 LSPD patients (Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 in MED ON) underwent an extensive clinical assessment at baseline and after one year and an acute levodopa test at baseline. RESULTS Mean age of LSPD patients (female 46%) was 77.5 ± 5.9 years and mean disease duration was 15.5 ± 6.5 years. At baseline, 76% had levodopa-induced motor complications (MC), usually non-troublesome, 68% were demented, 54% had psychosis and 68% depression. Caregiver distress was high. l-dopa responsiveness was mild (18% ± 12 of improvement on MDS-UPDRS-III). After one-year, 20% of the patients were dead, institutionalized or HY 5. MDS-UPDRS-motor mean score worsened 7.2 ± 10.3 points although there was heterogeneity between patients, and there was a global worsening of non-motor symptoms, mostly in cognition/mood, urinary and gastrointestinal domains. Nevertheless, MC improved despite similar levodopa equivalent dose. Functional independence and quality of life worsened. Dysphagia severity at baseline predicted a poor outcome (death, institutionalization or HY 5) (Hazard ratio 2.3, 95% CI 1.12-4.4; p = 0.01), whereas magnitude of l-dopa response of LSPD patients did not. CONCLUSIONS LSPD patients still present a significant, although heterogeneous, motor and non-motor progression over 1 year. Dysphagia severity predicts the occurrence of additional disease severity milestones and its management must be prioritized.
Collapse
Affiliation(s)
- Margherita Fabbri
- Instituto de Medicina Molecular, Lisbon, Portugal; Department of Neuroscience "Rita Levi Montalcini", University of Torino, Via Cherasco 15, 10124, Turin, Italy
| | - Miguel Coelho
- Instituto de Medicina Molecular, Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Daisy Abreu
- Instituto de Medicina Molecular, Lisbon, Portugal
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular, Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal
| | - Mario M Rosa
- Instituto de Medicina Molecular, Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Catarina Godinho
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro de Investigação Multidisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - Rita Cardoso
- Instituto de Medicina Molecular, Lisbon, Portugal; CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Isabel Guimaraes
- Instituto de Medicina Molecular, Lisbon, Portugal; Department of Speech Therapy, Escola Superior de Saúde de Alcoitão, Estoril, Portugal
| | - Angelo Antonini
- Fondazione Ospedale San Camillo"-I.R.C.C.S, Parkinson and Movement Disorders Unit, Venice, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Via Cherasco 15, 10124, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Via Cherasco 15, 10124, Turin, Italy
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal; CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.
| |
Collapse
|
9
|
Nagao K, Ding C, Ganga G, Alty JE, Clissold BG, McColl CD, Reardon KA, Schiff M, Kempster PA. Inferring the long duration response to levodopa in Parkinson's disease. Parkinsonism Relat Disord 2018; 60:133-137. [PMID: 30217541 DOI: 10.1016/j.parkreldis.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/22/2018] [Accepted: 09/02/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The long duration response to levodopa in Parkinson's disease outlasts drug elimination by days to weeks. Though a substantive part of anti-parkinsonian motor benefit, it cannot easily be observed. OBJECTIVES To infer the magnitude of the long duration response during the first decade of Parkinson's disease and identify factors that influence it. METHODS Serial practically defined off scores of 24 patients from a longitudinal study of levodopa short duration response were used to establish their rate of motor progression. A line of notional untreated disability (as if drug treatment had never been given) with the same progression gradient was the basis for calculation of the long duration response. Predictors of mean long duration response amplitude were identified using a multiple linear regression model. RESULTS Over a mean treatment period of 16.6 ± 4.4 years, annual increase in motor disability was 2.3% of the maximum score. The long duration response composed 49% of total levodopa response during the first decade of treatment, and this proportion was significantly higher soon after commencing levodopa (p = 0.001). Higher pre-treatment motor score (r = 0.60) and lower MMSE (r = 0.60) were the main predictors of a larger long duration response. There was little correlation between long and short duration responses. CONCLUSIONS Long duration responses contribute almost half of the total levodopa benefit during the first decade of treatment. An appreciation of both long and short duration components of drug symptomatic effects is important in clinical trial design to investigate possible neuroprotective treatments.
Collapse
Affiliation(s)
- Kanae Nagao
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Catherine Ding
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Ganesvaran Ganga
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Jane E Alty
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Benjamin G Clissold
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Craig D McColl
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Katrina A Reardon
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Mark Schiff
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Peter A Kempster
- Neurosciences Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia
| |
Collapse
|
10
|
Pieterman M, Adams S, Jog M. Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease. Front Neurol 2018; 9:260. [PMID: 29867708 PMCID: PMC5966537 DOI: 10.3389/fneur.2018.00260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background The levodopa challenge test is routinely used in Parkinson disease (PD) to determine a patient’s motor improvement following levodopa administration [levodopa response (LR)]. LR is most commonly reported as a percent OFF to ON change in the Unified Parkinson Disease Rating Scale (UPDRS) part III score, and occasionally as an absolute difference in score. This inconsistency in LR determination alters how clinical factors such as patient age and disease duration are understood in relation to LR in PD. Objective The aim of this study was to compare the calculation of the LR as either a percent change or difference in UPDRS-III motor score between OFF and ON medication. These two scores were then used to correlate to disease duration, patient age, levodopa duration, levodopa equivalent dose (LED), OFF score, cognition, mood, gait, and quality of life (QOL). Methods 70 PD patients underwent the levodopa challenge test. The UPDRS-III motor examination was performed in the defined OFF and ON medication states to determine LR. Each patient was assessed after 12–14 h without anti-parkinsonian medication and then given three 100/25 mg levodopa/carbidopa tablets. LR was reported as both a difference in score [OFF − ON; absolute LR (aLR)] and as a percent change in score [(OFF − ON)/OFF*100%; %LR]. Patients completed the following non-motor symptom assessment scales: Montreal Cognitive Assessment, Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Parkinson’s Disease Questionnaire, and Geriatric Depression Scale. The effect of the LR calculation method was correlated to the clinical measures. Results The aLR was significantly associated with disease duration (r = 0.40), levodopa duration (r = 0.47), OFF motor score (r = 0.58), and LED (r = 0.31), but not age. The aLR was also found to have a significant relationship with clinical scales assessing cognition (r = 0.41), freezing of gait (r = 0.35), QOL (r = 0.40), and depression (r = 0.30). By contrast, the more commonly used %LR demonstrated no significant relationships with any of the variables tested. Conclusion Although the %LR is more commonly employed in clinical protocols and research studies, the aLR is the superior method for reporting motor response to levodopa in PD given its significant associations with the clinical factors evaluated.
Collapse
Affiliation(s)
- Marcus Pieterman
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Scott Adams
- School of Communication Sciences and Disorders, University of Western Ontario, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Parkinson disease often spans decades of a patient's lifetime. Over time, nonmotor symptoms predominate and may limit dopaminergic therapy. Neurologists continue to play a vital role in treatment. In addition to balancing neurobehavioral complications of Parkinson disease with motor benefit, addressing nonmotor symptoms common in the advanced stage may improve quality of life and reduce symptom burden. Symptoms such as dysphagia, constipation, urinary dysfunction, orthostatic hypotension, and pain respond to nonpharmacologic and pharmacologic therapies. RECENT FINDINGS Evidence for treatment of many nonmotor symptoms is weak or lacking. The evidence for treatment of the atypical parkinsonian syndromes (progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration) in advanced stages is even more scant. SUMMARY Engaging palliative care physicians in the joint care of patients can provide patients with access to expertise in end-of-life issues. Neurologic illnesses have specific hospice criteria to guide clinicians for referrals. Evidence supports that assisting patients with advance directives can result in improved satisfaction with care and improved quality of life in the last weeks of life. Neurologists can remain engaged in their patients' care throughout the course of illness.
Collapse
|
12
|
Albin RL, Leventhal DK. The missing, the short, and the long: Levodopa responses and dopamine actions. Ann Neurol 2017; 82:4-19. [PMID: 28543679 DOI: 10.1002/ana.24961] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/05/2017] [Accepted: 05/13/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Roger L Albin
- Department of Neurology, University of Michigan; Neurology Service & Geriatrics Research, Education, and Clinical Center, VA Ann Arbor Healthcare System; and, University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI
| | - Daniel K Leventhal
- Department of Neurology, University of Michigan; and Neurology Service & Geriatrics Research, Education, and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI
| |
Collapse
|
13
|
Gee M, Dukart J, Draganski B, Wayne Martin WR, Emery D, Camicioli R. Regional volumetric change in Parkinson's disease with cognitive decline. J Neurol Sci 2017; 373:88-94. [DOI: 10.1016/j.jns.2016.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/08/2016] [Accepted: 12/16/2016] [Indexed: 11/17/2022]
|
14
|
Aygun D, Kocabicak E, Yildiz MO, Temel Y. Effect of Age and Disease Duration on the Levodopa Response in Patients with Advanced Parkinson's Disease for Deep Brain Stimulation of the Subthalamic Nucleus. Front Neurol 2016; 7:97. [PMID: 27445964 PMCID: PMC4921481 DOI: 10.3389/fneur.2016.00097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/10/2016] [Indexed: 11/13/2022] Open
Abstract
Background Deep brain stimulation (DBS) has become a preferred option for the treatment of motor symptoms in patients with advanced Parkinson’s disease (PD). A good levodopa response (LR) is considered the most important criterion in determining the suitability of a patient for DBS. However, the effect of age and disease duration (DD) on the LR is still a subject of discussion. Objective Here, we investigated the effect of age and DD on the preoperative LR in PD patients to be selected for DBS. Methods From August 2011 to May 2015, 54 consecutive patients (29 men and 25 women) with advanced PD were evaluated for DBS of the STN and included in this retrospective study. Results Thirty-seven patients were found suitable for DBS of the STN and 29 of them underwent bilateral surgery. We found no significant correlation between DD and the LR. However, there was a significant negative correlation between the patients’ age and the LR. Conclusion The results indicate that the patients’ age, rather than DD, has a negative effect on the LR. The study, therefore, indicates that PD patients with an advanced age and with a poor LR are not good candidates for DBS of the STN.
Collapse
Affiliation(s)
- Dursun Aygun
- Department of Neurology, Ondokuz Mayis University , Samsun , Turkey
| | - Ersoy Kocabicak
- Department of Neurosurgery, Ondokuz Mayis University, Samsun, Turkey; Department of Neurosurgery, Maastricht Medical Center, Maastricht, Netherlands; Department of Translational Neuroscience, Maastricht Medical Center, Maastricht, Netherlands
| | | | - Yasin Temel
- Department of Neurosurgery, Maastricht Medical Center, Maastricht, Netherlands; Department of Translational Neuroscience, Maastricht Medical Center, Maastricht, Netherlands
| |
Collapse
|
15
|
Ding C, Ganesvaran G, Alty JE, Clissold BG, McColl CD, Reardon KA, Schiff M, Srikanth V, Kempster PA. Study of levodopa response in Parkinson's disease: Observations on rates of motor progression. Mov Disord 2016; 31:589-92. [DOI: 10.1002/mds.26497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Catherine Ding
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Ganga Ganesvaran
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Jane E. Alty
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | | | - Craig D. McColl
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Katrina A. Reardon
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Mark Schiff
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
| | - Velandai Srikanth
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
- Stroke and Ageing Research Group, Vascular Brain Aging Division, Department of Medicine, School of Clinical Sciences; Monash University; Melbourne Victoria Australia
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - Peter A. Kempster
- Neurosciences Department; Monash Medical Center; Clayton Victoria Australia
- Department of Medicine; Monash University; Clayton Victoria Australia
| |
Collapse
|
16
|
Hu MTM, Szewczyk-Królikowski K, Tomlinson P, Nithi K, Rolinski M, Murray C, Talbot K, Ebmeier KP, Mackay CE, Ben-Shlomo Y. Predictors of cognitive impairment in an early stage Parkinson's disease cohort. Mov Disord 2014; 29:351-9. [PMID: 24395708 PMCID: PMC4235340 DOI: 10.1002/mds.25748] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 12/22/2022] Open
Abstract
The impact of Parkinson’s disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen-month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non-motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non-motor features, suggesting that this reflects a faster progressive phenotype.
Collapse
Affiliation(s)
- Michele T M Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, United Kingdom; Department of Clinical Neurology, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Parkinson's Disease Centre, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|