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Xu Z, Jin L, Chen W, Hu T, Li S, Liang X, Han X, Chen Y, Tang Y, Wang J, Wu D. Using a smartphone-based self-management platform to study sex differences in Parkinson's disease: multicenter, cross-sectional pilot study. BMC Med Inform Decis Mak 2024; 24:176. [PMID: 38907208 PMCID: PMC11191196 DOI: 10.1186/s12911-024-02569-1] [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: 07/31/2023] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) is a distinct and indispensable dimension of clinical characteristics and recent advances have made remote PRO measurement possible. Sex difference in PRO of Parkinson's disease (PD) is hardly extensively researched. METHODS A smartphone-based self-management platform, offering remote PRO measurement for PD patients, has been developed. A total of 1828 PD patients, including 1001 male patients and 827 female patients, were enrolled and completed their PRO submission through this platform. RESULTS Sex differences in PROs have been identified. The female group had a significantly lower height, weight, and body mass index (BMI) than the male group (P < 0.001). For motor symptoms, a higher proportion of patients reporting dyskinesia was observed in the female group. For non-motor symptoms, there is a higher percentage (P < 0.001) as well as severity (P = 0.016) of depression in the female group. More male patients reported hyposmia, lisp, drooling, dysuria, frequent urination, hypersexuality, impotence, daytime sleepiness, and apathy than females (P < 0.05). In contrast, more female patients reported headache, palpation, body pain, anorexia, nausea, urinal incontinence, anxiety, insomnia (P < 0.05) than males. CONCLUSIONS We provide evidence for sex differences in PD through the data collected from our platform. These results highlighted the importance of gender in clinical decision-making, and also support the feasibility of remote PRO measurement through a smartphone-based self-management platform in patients with PD.
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Affiliation(s)
- Zhiheng Xu
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lirong Jin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Weijie Chen
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Shanghai, 200240, China
| | - Tianyu Hu
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Shiyu Li
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiaoniu Liang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xixi Han
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yi Chen
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yilin Tang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Jian Wang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Shanghai, 200240, China.
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2
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Fereshtehnejad SM, Rodríguez-Violante M, Ponce-Rivera MS, Martinez-Ramirez D, Ramirez-Zamora A. COVID-19 and Integrated Multidisciplinary Care Model in Parkinson's Disease: Literature Review & Future Perspectives. Behav Sci (Basel) 2022; 12:447. [PMID: 36421743 PMCID: PMC9687116 DOI: 10.3390/bs12110447] [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: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2024] Open
Abstract
Clinical diversity and multi-systemic manifestations of Parkinson's disease (PD) necessitate the involvement of several healthcare professionals from different disciplines for optimal care. Clinical guidelines recommend that all persons with PD should have access to a broad range of medical and allied health professionals to implement an efficient and effective multidisciplinary care model. This is well supported by growing evidence showing the benefits of multidisciplinary interventions on improving quality of life and disease progression in PD. However, a "multidisciplinary" approach requires gathering healthcare professionals from different disciplines into an integrative platform for collaborative teamwork. With the Coronavirus Disease 2019 (COVID-19) pandemic, implementation of such a multidisciplinary care model has become increasingly challenging due to social distancing mandates, isolation and quarantine, clinics cancellation, among others. To address this problem, multidisciplinary teams are developing innovate virtual platforms to maintain care of people with PD. In the present review, we cover aspects on how SARS-CoV-2 has affected people with PD, their caregivers, and care team members. We also review current evidence on the importance of maintaining patient-centered care in the era of social distancing, and how can we utilize telehealth and innovative virtual platforms for multidisciplinary care in PD.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, 14186 Stockholm, Sweden
| | | | - Monica S. Ponce-Rivera
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 66220, Mexico
| | - Daniel Martinez-Ramirez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 66220, Mexico
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL 32611, USA
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3
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Park CH, Shin NY, Yoo SW, Seo H, Yoon U, Yoo JY, Ahn K, Kim JS. Simulating the progression of brain structural alterations in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:86. [PMID: 35764657 PMCID: PMC9240031 DOI: 10.1038/s41531-022-00349-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/10/2022] [Indexed: 12/01/2022] Open
Abstract
Considering brain structural alterations as neurodegenerative consequences of Parkinson's disease (PD), we sought to infer the progression of PD via the ordering of brain structural alterations from cross-sectional MRI observations. Having measured cortical thinning in gray matter (GM) regions and disintegrity in white matter (WM) regions as MRI markers of structural alterations for 130 patients with PD (69 ± 10 years, 72 men), stochastic simulation based on the probabilistic relationship between the brain regions was conducted to infer the ordering of structural alterations across all brain regions and the staging of structural alterations according to changes in clinical status. The ordering of structural alterations represented WM disintegrity tending to occur earlier than cortical thinning. The staging of structural alterations indicated structural alterations happening mostly before major disease complications such as postural instability and dementia. Later disease states predicted by the sequence of structural alterations were significantly related to more severe clinical symptoms. The relevance of the ordering of brain structural alterations to the severity of clinical symptoms suggests the clinical feasibility of predicting PD progression states.
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Affiliation(s)
- Chang-Hyun Park
- Department of Radiology, College of Medicine, Catholic University of Korea, Seoul, Korea.,Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Na-Young Shin
- Department of Radiology, College of Medicine, Catholic University of Korea, Seoul, Korea.
| | - Sang-Won Yoo
- Department of Neurology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Haeseok Seo
- Department of Biomedical Engineering, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan, Gyeongbuk, Korea
| | - Uicheul Yoon
- Department of Biomedical Engineering, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan, Gyeongbuk, Korea
| | - Ji-Yeon Yoo
- Department of Neurology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Kookjin Ahn
- Department of Radiology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, Catholic University of Korea, Seoul, Korea
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4
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Chahine LM, Chin I, Caspell-Garcia C, Standaert DG, Brown E, Smolensky L, Arnedo V, Daeschler D, Riley L, Korell M, Dobkin R, Amondikar N, Gradinscak S, Shoulson I, Dean M, Kwok K, Cannon P, Marek K, Kopil C, Tanner CM, Marrason C. Comparison of an Online-Only Parkinson's Disease Research Cohort to Cohorts Assessed In Person. JOURNAL OF PARKINSONS DISEASE 2021; 10:677-691. [PMID: 31958097 PMCID: PMC7242834 DOI: 10.3233/jpd-191808] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Online tools for data collection could be of value in patient-oriented research. The Fox Insight (FI) study collects data online from individuals with self-reported Parkinson's disease (PD). Comparing the FI cohort to other cohorts assessed through more traditional (in-person) observational research studies would inform the representativeness and utility of FI data. OBJECTIVE To compare self-reported demographic characteristics, symptoms, medical history, and PD medication use of the FI PD cohort to other recent observational research study cohorts assessed with in-person visits. METHODS The FI PD cohort (n = 12,654) was compared to 3 other cohorts, selected based on data accessibility and breadth of assessments: Parkinson's Progression Markers Initiative (PPMI; PD n = 422), Parkinson's Disease Biomarker Program (PDBP; n = 700), and PD participants in the LRRK2 consortium without LRRK2 mutations (n = 508). Demographics, motor and non-motor assessments, and medications were compared across cohorts. Where available, identical items on surveys and assessments were compared; otherwise, expert opinion was used to determine comparable definitions for a given variable. RESULTS The proportion of females was significantly higher in FI (45.56%) compared to PPMI (34.36%) and PDBP (35.71%). The FI cohort had greater educational attainment as compared to all other cohorts. Overall, prevalence of difficulties with motor experiences of daily living and non-motor symptoms in the FI cohort was similar to other cohorts, with only a few significant differences that were generally small in magnitude. Missing data were rare for the FI cohort, except on a few variables. DISCUSSION Patterns of responses to patient-reported assessments obtained online on the PD cohort of the FI study were similar to PD cohorts assessed in-person.
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Affiliation(s)
| | | | | | | | - Ethan Brown
- University of California, and San Francisco Veterans Affairs Medical Care Plan, San Francisco, CA, USA
| | - Luba Smolensky
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Daisy Daeschler
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Monica Korell
- University of California, and San Francisco Veterans Affairs Medical Care Plan, San Francisco, CA, USA
| | - Roseanne Dobkin
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Stephen Gradinscak
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | | | - Marissa Dean
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Kwok
- Theravance Biopharma, San Francisco, CA, USA
| | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline M Tanner
- University of California, and San Francisco Veterans Affairs Medical Care Plan, San Francisco, CA, USA
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5
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Schneider RB, Omberg L, Macklin EA, Daeschler M, Bataille L, Anthwal S, Myers TL, Baloga E, Duquette S, Snyder P, Amodeo K, Tarolli CG, Adams JL, Callahan KF, Gottesman J, Kopil CM, Lungu C, Ascherio A, Beck JC, Biglan K, Espay AJ, Tanner C, Oakes D, Shoulson I, Novak D, Kayson E, Ray Dorsey E, Mangravite L, Schwarzschild MA, Simuni T. Design of a virtual longitudinal observational study in Parkinson's disease (AT-HOME PD). Ann Clin Transl Neurol 2021; 8:308-320. [PMID: 33350601 PMCID: PMC7886038 DOI: 10.1002/acn3.51236] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/11/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The expanding power and accessibility of personal technology provide an opportunity to reduce burdens and costs of traditional clinical site-centric therapeutic trials in Parkinson's disease and generate novel insights. The value of this approach has never been more evident than during the current COVID-19 pandemic. We sought to (1) establish and implement the infrastructure for longitudinal, virtual follow-up of clinical trial participants, (2) compare changes in smartphone-based assessments, online patient-reported outcomes, and remote expert assessments, and (3) explore novel digital markers of Parkinson's disease disability and progression. METHODS Participants from two recently completed phase III clinical trials of inosine and isradipine enrolled in Assessing Tele-Health Outcomes in Multiyear Extensions of Parkinson's Disease trials (AT-HOME PD), a two-year virtual cohort study. After providing electronic informed consent, individuals complete annual video visits with a movement disorder specialist, smartphone-based assessments of motor function and socialization, and patient-reported outcomes online. RESULTS From the two clinical trials, 226 individuals from 42 states in the United States and Canada enrolled. Of these, 181 (80%) have successfully downloaded the study's smartphone application and 161 (71%) have completed patient-reported outcomes on the online platform. INTERPRETATION It is feasible to conduct a large-scale, international virtual observational study following the completion of participation in brick-and-mortar clinical trials in Parkinson's disease. This study, which brings research to participants, will compare established clinical endpoints with novel digital biomarkers and thereby inform the longitudinal follow-up of clinical trial participants and design of future clinical trials.
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Affiliation(s)
- Ruth B. Schneider
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Eric A. Macklin
- Biostatistics CenterMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Margaret Daeschler
- The Michael J. Fox Foundation for Parkinson’s ResearchNew YorkNew YorkUSA
| | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson’s ResearchNew YorkNew YorkUSA
| | - Shalini Anthwal
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Taylor L. Myers
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Elizabeth Baloga
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sidney Duquette
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Katherine Amodeo
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Christopher G Tarolli
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Jamie L. Adams
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Joshua Gottesman
- The Michael J. Fox Foundation for Parkinson’s ResearchNew YorkNew YorkUSA
| | - Catherine M. Kopil
- The Michael J. Fox Foundation for Parkinson’s ResearchNew YorkNew YorkUSA
| | - Codrin Lungu
- Division of Clinical ResearchNational Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
| | - Alberto Ascherio
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | | | - Kevin Biglan
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Eli Lilly and CompanyIndianapolisIndianaUSA
| | - Alberto J. Espay
- Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Caroline Tanner
- Department of NeurologyWeill Institute for NeurosciencesUniversity of CaliforniaSan Francisco Veterans Affairs Health Care SystemSan FranciscoCaliforniaUSA
| | - David Oakes
- Department of BiostatisticsUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ira Shoulson
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Grey Matter TechnologiesSarasotaFloridaUSA
| | - Dan Novak
- Parkinson’s FoundationNew YorkNew YorkUSA
| | - Elise Kayson
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Earl Ray Dorsey
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - Tanya Simuni
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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6
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Schneider RB, Myers TL, Rowbotham HM, Luff MK, Amodeo K, Sharma S, Wilson R, Jensen-Roberts S, Auinger P, McDermott MP, Alcalay RN, Biglan K, Kinel D, Tanner C, Winter-Evans R, Augustine EF, Cannon P, Holloway RG, Dorsey ER. A Virtual Cohort Study of Individuals at Genetic Risk for Parkinson's Disease: Study Protocol and Design. JOURNAL OF PARKINSONS DISEASE 2020; 10:1195-1207. [PMID: 32568109 PMCID: PMC7505001 DOI: 10.3233/jpd-202019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The rise of direct-to-consumer genetic testing has enabled many to learn of their possible increased risk for rare diseases, some of which may be suitable for gene-targeted therapies. However, recruiting a large and representative population for rare diseases or genetically defined sub-populations of common diseases is slow, difficult, and expensive. Objective: To assess the feasibility of recruiting and retaining a cohort of individuals who carry a genetic mutation linked to Parkinson’s disease (G2019S variant of LRRK2); to characterize this cohort relative to the characteristics of traditional, in-person studies; and to evaluate this model’s ability to create an engaged study cohort interested in future clinical trials of gene-directed therapies. Methods: This single-site,3-year national longitudinal observational study will recruit between 250 to 350 LRRK2 carriers without Parkinson’s disease and approximately 50 with the condition. Participants must have undergone genetic testing by the personal genetics company, 23andMe, Inc., have knowledge of their carrier status, and consent to be contacted for research studies. All participants undergo standardized assessments, including video-based cognitive and motor examination, and complete patient-reported outcomes on an annual basis. Results: 263 individuals living in 33 states have enrolled. The cohort has a mean (SD) age of 56.0 (15.9) years, 59% are female, and 76% are of Ashkenazi Jewish descent. 233 have completed the baseline visit: 47 with self-reported Parkinson’s disease and 186 without. Conclusions: This study establishes a promising model for developing a geographically dispersed and well-characterized cohort ready for participation in future clinical trials of gene-directed therapies.
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Affiliation(s)
- Ruth B Schneider
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Taylor L Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Katherine Amodeo
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Renee Wilson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stella Jensen-Roberts
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Peggy Auinger
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael P McDermott
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Roy N Alcalay
- Department of Neurology, Columbia University, New York, NY, USA
| | - Kevin Biglan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Eli Lilly and Company, Indianapolis, IN, USA
| | - Daniel Kinel
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Caroline Tanner
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Robert G Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
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7
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Tarolli CG, Zimmerman GA, Goldenthal S, Feldman B, Berk S, Siddiqi B, Kopil CM, Chowdhury S, Biglan KM, Dorsey ER, Adams JL. Video research visits for atypical parkinsonian syndromes among Fox Trial Finder participants. Neurol Clin Pract 2019. [PMID: 32190415 DOI: 10.1212/cpj.0000000000000680 10.1212/cpj.0000000000000680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Use of video research visits in neurologic conditions is rising, but their utility has not been assessed in atypical parkinsonian syndromes. We sought to evaluate the diagnostic concordance between video-based vs self-reported diagnoses of multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies, and corticobasal syndrome. We also assessed patient satisfaction with video-based visits. Methods We conducted a study of video-based research visits in individuals with an atypical parkinsonian syndrome enrolled in The Michael J. Fox Foundation's Fox Trial Finder. Participants completed a recorded real-time video visit with a remote evaluator who was blinded to the participant's self-reported diagnosis. The investigator conducted a structured interview and performed standard assessments of motor function. Following the visit, the investigator selected the most likely diagnosis. The recorded visit was reviewed by a second blinded investigator who also selected the most likely diagnosis. We evaluated diagnostic concordance between the 2 independent investigators and assessed concordance between investigator consensus diagnosis and self-reported diagnosis using Cohen's kappa. We assessed participant satisfaction with a survey. Results We enrolled 45 individuals with atypical parkinsonian syndromes, and 44 completed the investigator-performed video assessment. We demonstrated excellent concordance in diagnosis between the investigators (κ = 0.83) and good reliability of self-reported diagnosis (κ = 0.73). More than 90% of participants were satisfied or very satisfied with the convenience, comfort, and overall visit. Conclusions Video research visits are feasible and reliable in those with an atypical parkinsonian syndrome. These visits represent a promising option for reducing burden and extending the reach of clinical research to individuals with these rare and disabling conditions.
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Affiliation(s)
- Christopher G Tarolli
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Grace A Zimmerman
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Steven Goldenthal
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Blake Feldman
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Sarah Berk
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Bernadette Siddiqi
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Catherine M Kopil
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Sohini Chowdhury
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Kevin M Biglan
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - E Ray Dorsey
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Jamie L Adams
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
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8
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Tarolli CG, Zimmerman GA, Goldenthal S, Feldman B, Berk S, Siddiqi B, Kopil CM, Chowdhury S, Biglan KM, Dorsey ER, Adams JL. Video research visits for atypical parkinsonian syndromes among Fox Trial Finder participants. Neurol Clin Pract 2019; 10:7-14. [PMID: 32190415 DOI: 10.1212/cpj.0000000000000680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/23/2019] [Indexed: 11/15/2022]
Abstract
Background Use of video research visits in neurologic conditions is rising, but their utility has not been assessed in atypical parkinsonian syndromes. We sought to evaluate the diagnostic concordance between video-based vs self-reported diagnoses of multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies, and corticobasal syndrome. We also assessed patient satisfaction with video-based visits. Methods We conducted a study of video-based research visits in individuals with an atypical parkinsonian syndrome enrolled in The Michael J. Fox Foundation's Fox Trial Finder. Participants completed a recorded real-time video visit with a remote evaluator who was blinded to the participant's self-reported diagnosis. The investigator conducted a structured interview and performed standard assessments of motor function. Following the visit, the investigator selected the most likely diagnosis. The recorded visit was reviewed by a second blinded investigator who also selected the most likely diagnosis. We evaluated diagnostic concordance between the 2 independent investigators and assessed concordance between investigator consensus diagnosis and self-reported diagnosis using Cohen's kappa. We assessed participant satisfaction with a survey. Results We enrolled 45 individuals with atypical parkinsonian syndromes, and 44 completed the investigator-performed video assessment. We demonstrated excellent concordance in diagnosis between the investigators (κ = 0.83) and good reliability of self-reported diagnosis (κ = 0.73). More than 90% of participants were satisfied or very satisfied with the convenience, comfort, and overall visit. Conclusions Video research visits are feasible and reliable in those with an atypical parkinsonian syndrome. These visits represent a promising option for reducing burden and extending the reach of clinical research to individuals with these rare and disabling conditions.
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Affiliation(s)
- Christopher G Tarolli
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Grace A Zimmerman
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Steven Goldenthal
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Blake Feldman
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Sarah Berk
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Bernadette Siddiqi
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Catherine M Kopil
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Sohini Chowdhury
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Kevin M Biglan
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - E Ray Dorsey
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
| | - Jamie L Adams
- Department of Neurology (CGT, GAZ, KMB, JLA), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, SG, BF, ERD, JLA), University of Rochester Medical Center, NY; The Michael J. Fox Foundation for Parkinson's Research (SB, BS, CMK, SC), New York; and Early Phase Clinical Development (KMB), Neurosciences, Eli Lilly and Company, Indianapolis, IN
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Abstract
The 25 years since the identification of the gene responsible for Huntington disease (HD) have stood witness to profound discoveries about the nature of the disease and its pathogenesis. Despite this progress, however, the development of disease-modifying therapies has thus far been slow. Preclinical validation of the therapeutic potential of disrupted pathways in HD has led to the advancement of pharmacological agents, both novel and repurposed, for clinical evaluation. The most promising therapeutic approaches include huntingtin (HTT) lowering and modification as well as modulation of neuroinflammation and synaptic transmission. With clinical trials for many of these approaches imminent or currently ongoing, the coming years are promising not only for HD but also for more prevalent neurodegenerative disorders, such as Alzheimer and Parkinson disease, in which many of these pathways have been similarly implicated.
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Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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12
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Dorsey ER, Wagner JD, Bull MT, Rizzieri A, Grischkan J, Achey MA, Sherer T, Chowdhury S, Meunier C, Cappelletti L, Rocker C, Richard IH, Schwarz H, Kang G, Ahmad SH, Biemiller RA, Biglan KM. Feasibility of Virtual Research Visits in Fox Trial Finder. JOURNAL OF PARKINSONS DISEASE 2016; 5:505-15. [PMID: 26406130 PMCID: PMC4923707 DOI: 10.3233/jpd-150549] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Fox Trial Finder is an online registry for individuals with and without Parkinson disease (PD) interested in participating in PD research. However, distance or disability could prevent such individuals from participating in traditional, clinic-based research at major centers. Objective: Use videoconferencing to connect participants to specialists to: (1) demonstrate feasibility of virtual research visits within this population (2) collect phenotypic data of the participants, (3) validate self-reported diagnosis, and (4) gauge interest in virtual research visits. Methods: We solicited volunteers throughout the United States through Fox Trial Finder. Interested individuals with PD provided consent, were given web cameras if needed, completed baseline surveys, and downloaded videoconferencing software remotely. Participants had a test connection and assessment appointment which included the Montreal Cognitive Assessment (MoCA), then a virtual research visit with a neurologist who reviewed their history and assessed their PD using a modified Movement Disorders Society Unified Parkinson’s Disease Rating Scale. Neurologists assessed PD diagnosis and symptomatology. Physicians and participants were surveyed about their experience. Results: Of 204 individuals who consented, 166 (81% ) individuals from 39 states completed all visits. The mean age was 62 and mean disease duration was 8.0 years. Mean MoCA score was 26.5, and mean modified MDS-UPDRS motor score was 22.8 (out of a possible 124). Neurologists judged PD as the most likely diagnosis in 97% of cases. Overall satisfaction with the visits was 79% (satisfied or very satisfied) among neurologists and 93% among participants. Conclusions: Through virtual research visits, neurologists engaged, characterized, and validated self-reported diagnosis in individuals with PD over a broad geography. This model may facilitate future research participation.
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Affiliation(s)
- E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States.,CHET, University of Rochester Medical Center, Rochester, New York, United States
| | | | - Michael T Bull
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | | | - Justin Grischkan
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Meredith A Achey
- CHET, University of Rochester Medical Center, Rochester, New York, United States
| | - Todd Sherer
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Sohini Chowdhury
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Claire Meunier
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Lily Cappelletti
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Charlotte Rocker
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Irene H Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - Heidi Schwarz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - Gail Kang
- University of California Berkeley, Berkeley, California, United States
| | - Stacy H Ahmad
- Department of Cell Biology and Pathology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rachel A Biemiller
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - Kevin M Biglan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States.,CHET, University of Rochester Medical Center, Rochester, New York, United States
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Kieburtz K, Olanow CW. Advances in clinical trials for movement disorders. Mov Disord 2015; 30:1580-7. [PMID: 26307591 DOI: 10.1002/mds.26371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
In the past several years, there have been several innovations in the design of clinical trials assessing new therapies for patients with movement disorders. These include attempts to address difficulties in conducting clinical trials in treated patients in the advanced stages of their illness, demonstrating disease-modifying effects or a reduction in the development of cumulative disability, and assessing the effects of interventions in patients in the premanifest state of their disease. In addition, there have been advances in clinical trial methodologies and changes in regulatory guidelines that permit the performance of more efficient studies, with a reduction in the cost and duration of the development period. These will be reviewed in the present article. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Karl Kieburtz
- University of Rochester School of Medicine, Rochester, New York, USA
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Dorsey ER, Venuto C, Venkataraman V, Harris DA, Kieburtz K. Novel methods and technologies for 21st-century clinical trials: a review. JAMA Neurol 2015; 72:582-8. [PMID: 25730665 PMCID: PMC4708881 DOI: 10.1001/jamaneurol.2014.4524] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE New technologies are rapidly reshaping health care. However, their effect on drug development to date generally has been limited. OBJECTIVES To evaluate disease modeling and simulation, alternative study design, novel objective measures, virtual research visits, and enhanced participant engagement and to examine their potential effects as methods and tools on clinical trials. EVIDENCE REVIEW We conducted a systematic search of relevant terms on PubMed (disease modeling and clinical trials; adaptive design, clinical trials, and neurology; Internet, clinical trials, and neurology; and telemedicine, clinical trials, and neurology), references of previous publications, and our files. The search encompassed articles published from January 1, 2000, through November 30, 2014, and produced 7976 articles, of which 22 were determined to be relevant and are included in this review. FINDINGS Few of these new methods and technologies have been applied to neurology clinical trials. Clinical outcomes, including cognitive and stroke outcomes, increasingly are captured remotely. Other therapeutic areas have successfully implemented many of these tools and technologies, including web-enabled clinical trials. CONCLUSIONS AND RELEVANCE Increased use of new tools and approaches in future clinical trials can enhance the design, improve the assessment, and engage participants in the evaluation of novel therapies for neurologic disorders.
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Affiliation(s)
- E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York2Center for Human Experimental Therapeutics, University of Rochester Medical Center, Rochester, New York
| | - Charles Venuto
- Department of Neurology, University of Rochester Medical Center, Rochester, New York2Center for Human Experimental Therapeutics, University of Rochester Medical Center, Rochester, New York
| | - Vinayak Venkataraman
- currently a medical student at Duke University School of Medicine, Durham, North Carolina
| | - Denzil A Harris
- Center for Human Experimental Therapeutics, University of Rochester Medical Center, Rochester, New York
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York2Center for Human Experimental Therapeutics, University of Rochester Medical Center, Rochester, New York4Clinical and Translational Sciences Institute, University of Roche
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15
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Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9:e99377. [PMID: 24927169 PMCID: PMC4057148 DOI: 10.1371/journal.pone.0099377] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background and Objective In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD. Methods Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software. Results Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) −4.34, 95% confidence interval (CI) −6.67–−2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83–5.66), functional reach test (MD: 3.89, 95% CI: 1.73–6.04), Timed Up and Go test (MD: −0.75, 95% CI: −1.30–−0.21), stride length (standardized MD: 0.56, 95% CI: 0.03–1.09), health-related quality of life (standardized MD: −1.10, 95% CI: −1.81–−0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes. Conclusions Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.
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