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Beyond shallow feelings of complex affect: Non-motor correlates of subjective emotional experience in Parkinson's disease. PLoS One 2023; 18:e0281959. [PMID: 36827296 PMCID: PMC9955984 DOI: 10.1371/journal.pone.0281959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023] Open
Abstract
Affective disorders in Parkinson's disease (PD) concern several components of emotion. However, research on subjective feeling in PD is scarce and has produced overall varying results. Therefore, in this study, we aimed to evaluate the subjective emotional experience and its relationship with autonomic symptoms and other non-motor features in PD patients. We used a battery of film excerpts to elicit Amusement, Anger, Disgust, Fear, Sadness, Tenderness, and Neutral State, in 28 PD patients and 17 healthy controls. Self-report scores of emotion category, intensity, and valence were analyzed. In the PD group, we explored the association between emotional self-reported scores and clinical scales assessing autonomic dysregulation, depression, REM sleep behavior disorder, and cognitive impairment. Patient clustering was assessed by considering relevant associations. Tenderness occurrence and intensity of Tenderness and Amusement were reduced in the PD patients. Tenderness occurrence was mainly associated with the overall cognitive status and the prevalence of gastrointestinal symptoms. In contrast, the intensity and valence reported for the experience of Amusement correlated with the prevalence of urinary symptoms. We identified five patient clusters, which differed significantly in their profile of non-motor symptoms and subjective feeling. Our findings further suggest the possible existence of a PD phenotype with more significant changes in subjective emotional experience. We concluded that the subjective experience of complex emotions is impaired in PD. Non-motor feature grouping suggests the existence of disease phenotypes profiled according to specific deficits in subjective emotional experience, with potential clinical implications for the adoption of precision medicine in PD. Further research on larger sample sizes, combining subjective and physiological measures of emotion with additional clinical features, is needed to extend our findings.
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van der Lijn I, de Haan GA, Huizinga F, van der Feen FE, Rutgers AWF, Stellingwerf C, van Laar T, Heutink J. Self-Reported Visual Complaints in People with Parkinson’s Disease: A Systematic Review. JOURNAL OF PARKINSON'S DISEASE 2022; 12:785-806. [PMID: 35001897 PMCID: PMC9108577 DOI: 10.3233/jpd-202324] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Scientific research increasingly focuses on visual symptoms of people with Parkinson’s disease (PD). However, this mostly involves functional measures, whereas self-reported data are equally important for guiding clinical care. Objective: This review provides an overview of the nature and prevalence of self-reported visual complaints by people with PD, compared to healthy controls. Methods: A systematic literature search was performed. Studies from three databases (PubMed, PsycInfo, and Web of Science) were screened for eligibility. Only studies that reported results of visual self-reports in people with idiopathic PD were included. Results: One hundred and thirty-nine eligible articles were analyzed. Visual complaints ranged from function-related complaints (e.g., blurred vision, double vision, increased sensitivity to light or changes in contrast sensitivity) to activity-related complaints (e.g., difficulty reading, reaching, or driving). Visual complaints were more prevalent in people with PD compared to healthy controls. The presence of visual complaints leads to a reduced quality of life (QoL). Increased prevalence and severity of visual complaints in people with PD are related to longer disease duration, higher disease severity, and off-state. Conclusion: A large proportion of people with PD have visual complaints, which negatively affect QoL. Complaints are diverse in nature, and specific and active questioning by clinicians is advised to foster timely recognition, acknowledgement, and management of these complaints.
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Affiliation(s)
- Iris van der Lijn
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Gera A. de Haan
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Famke Huizinga
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Fleur E. van der Feen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | | | - Catherina Stellingwerf
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
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Li S, Cheng C, Lu L, Ma X, Zhang X, Li A, Chen J, Qian X, Gao X. Hearing Loss in Neurological Disorders. Front Cell Dev Biol 2021; 9:716300. [PMID: 34458270 PMCID: PMC8385440 DOI: 10.3389/fcell.2021.716300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022] Open
Abstract
Sensorineural hearing loss (SNHL) affects approximately 466 million people worldwide, which is projected to reach 900 million by 2050. Its histological characteristics are lesions in cochlear hair cells, supporting cells, and auditory nerve endings. Neurological disorders cover a wide range of diseases affecting the nervous system, including Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), autism spectrum disorder (ASD), etc. Many studies have revealed that neurological disorders manifest with hearing loss, in addition to typical nervous symptoms. The prevalence, manifestations, and neuropathological mechanisms underlying vary among different diseases. In this review, we discuss the relevant literature, from clinical trials to research mice models, to provide an overview of auditory dysfunctions in the most common neurological disorders, particularly those associated with hearing loss, and to explain their underlying pathological and molecular mechanisms.
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Affiliation(s)
- Siyu Li
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Cheng Cheng
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Ling Lu
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Xiaofeng Ma
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
| | - Xiaoli Zhang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Ao Li
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Jie Chen
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Xiaoyun Qian
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Xia Gao
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
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van Wamelen DJ, Sringean J, Trivedi D, Carroll CB, Schrag AE, Odin P, Antonini A, Bloem BR, Bhidayasiri R, Chaudhuri KR. Digital health technology for non-motor symptoms in people with Parkinson's disease: Futile or future? Parkinsonism Relat Disord 2021; 89:186-194. [PMID: 34362670 DOI: 10.1016/j.parkreldis.2021.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is an ongoing digital revolution in the field of Parkinson's disease (PD) for the objective measurement of motor aspects, to be used in clinical trials and possibly support therapeutic choices. The focus of remote technologies is now also slowly shifting towards the broad but more "hidden" spectrum of non-motor symptoms (NMS). METHODS A narrative review of digital health technologies for measuring NMS in people with PD was conducted. These digital technologies were defined as assessment tools for NMS offered remotely in the form of a wearable, downloadable as a mobile app, or any other objective measurement of NMS in PD that did not require a hospital visit and could be performed remotely. Searches were performed using peer-reviewed literature indexed databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Register of Controlled Trials), as well as Google and Google Scholar. RESULTS Eighteen studies deploying digital health technology in PD were identified, for example for the measurement of sleep disorders, cognitive dysfunction and orthostatic hypotension. In addition, we describe promising developments in other conditions that could be translated for use in PD. CONCLUSION Unlike motor symptoms, non-motor features of PD are difficult to measure directly using remote digital technologies. Nonetheless, it is currently possible to reliably measure several NMS and further digital technology developments are underway to offer further capture of often under-reported and under-recognised NMS.
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Affiliation(s)
- Daniel J van Wamelen
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom; Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands.
| | - Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Dhaval Trivedi
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
| | - Camille B Carroll
- Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
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Ayele BA, Zewde YZ, Tafesse A, Sultan A, Friedman JH, Bower JH. Non-Motor Symptoms and Associated Factors in Parkinson's Disease Patients in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study. Ethiop J Health Sci 2021; 31:837-846. [PMID: 34703184 PMCID: PMC8512934 DOI: 10.4314/ejhs.v31i4.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMSs) of Parkinson's disease (PD) were often overlooked and less studied. Little is known about NMSs in Ethiopia. The aim of the study was to determine the prevalence of NMSs and associated factors. METHODS A multi-center cross-sectional observational study was conducted. NMS questionnaire was used to screen for the NMSs. Both descriptive and analytical statistics were used to analyze the data. RESULTS Total of 123 PD patients with median of 4 years were investigated. The mean age of PD patients was 62.9 years. The mean age of PD onset was 58.3 years. In 23.6% the age of onset was below age 50. Males accounted 72.4%. Majority of the patients were on Levodopa alone and 31.7% were on levodopa plus trihexyphenidyl. Longer duration of illness was associated with frequent occurrence of NMSs. Constipation was the commonest NMS (78%), followed by urinary urgency (67.5%) and nocturia (63.4%). An unexplained pain was reported by 45.5 %, cognitive impairment (45.5%), and sleep disturbance was reported by 45.5% of the study participants. Neurophysciatric symptoms were reported by small proportion of the patients. Lower monthly earning was associated with swallowing problem, unexplained weight change, and lighheadness. CONCLUSION The prevalence of NMS was high among PD patients in Ethiopia. Constipation was the commonest NMS. Longer duration of illness was associated with frequent occurrence of NMSs. Lower monthly earning was associated with swallowing problem, unexplained weight change, and lighheadness.
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Affiliation(s)
- Biniyam A Ayele
- Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Yared Zenebe Zewde
- Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Abenet Tafesse
- Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Amir Sultan
- Gastroenterology and Hepatology Division, Department of Internal Medicine, College of Health Sciences, Addis Ababa University
| | - Joseph H Friedman
- Stanley Aronson Chair in Neurodegenerative Disorders, Director of Movement Disorders Program, Butler Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - James H Bower
- Chair of Division of Movement Disorders, Department of Neurology, Mayo clinic, Rochester, Minnesota, USA
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Erro R, Landolfi A, D'Agostino G, Pace L, Picillo M, Scarano M, Cuocolo A, Pappatá S, Vitale C, Pellecchia MT, Monteleone P, Barone P. Bipolar Disorder and Parkinson's Disease: A 123I-Ioflupane Dopamine Transporter SPECT Study. Front Neurol 2021; 12:652375. [PMID: 33927683 PMCID: PMC8076537 DOI: 10.3389/fneur.2021.652375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: Bipolar disorder (BD) has been suggested to be a risk factor for the development of Parkinson's disease (PD). Standard treatment of BD includes drugs that are known to induce drug-induced parkinsonism (DIP). Clinical differentiation between PD and DIP is crucial and might be aided by functional neuroimaging of the dopaminergic nigrostriatal pathway. Methods: Twenty consecutive BD patients with parkinsonism were clinically assessed and underwent 123I-ioflupane dopamine transporter single-photon emission computer tomography (SPECT). Imaging data of BD patients with pathological scans were further compared to a population of 40 de novo PD patients. Results: Four BD patients had abnormal scans, but their clinical features and cumulative exposure to both antipsychotic drugs and lithium were similar to those of BD patients with normal dopamine transporter imaging. BD patients with pathological scans had putaminal binding ratio and putamen-to-caudate ratios higher than those of PD patients despite a similar motor symptom burden. Conclusions: Up to 20% of BD patients with parkinsonism might have an underlying dopaminergic deficit, which would not be due to cumulative exposure to offending drugs and is ostensibly higher than expected in the general population. This supports the evidence that BD represents a risk factor for subsequent development of neurodegenerative parkinsonism, the nature of which needs to be elucidated.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Annamaria Landolfi
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Giulia D'Agostino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Leonardo Pace
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Department of Diagnostic Imaging and Radiotherapy, Azienda Ospedaliera Universitaria (AOU) San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Marina Picillo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Massimo Scarano
- Department of Diagnostic Imaging and Radiotherapy, Azienda Ospedaliera Universitaria (AOU) San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Sabina Pappatá
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Carmine Vitale
- Department of Motor Sciences and Wellness, University Parthenope, Naples, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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Mestre TA, Fereshtehnejad SM, Berg D, Bohnen NI, Dujardin K, Erro R, Espay AJ, Halliday G, van Hilten JJ, Hu MT, Jeon B, Klein C, Leentjens AF, Marinus J, Mollenhauer B, Postuma R, Rajalingam R, Rodríguez-Violante M, Simuni T, Surmeier DJ, Weintraub D, McDermott MP, Lawton M, Marras C. Parkinson's Disease Subtypes: Critical Appraisal and Recommendations. JOURNAL OF PARKINSON'S DISEASE 2021; 11:395-404. [PMID: 33682731 PMCID: PMC8150501 DOI: 10.3233/jpd-202472] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), there is heterogeneity in the clinical presentation and underlying biology. Research on PD subtypes aims to understand this heterogeneity with potential contribution for the knowledge of disease pathophysiology, natural history and therapeutic development. There have been many studies of PD subtypes but their impact remains unclear with limited application in research or clinical practice. OBJECTIVE To critically evaluate PD subtyping systems. METHODS We conducted a systematic review of PD subtypes, assessing the characteristics of the studies reporting a subtyping system for the first time. We completed a critical appraisal of their methodologic quality and clinical applicability using standardized checklists. RESULTS We included 38 studies. The majority were cross-sectional (n = 26, 68.4%), used a data-driven approach (n = 25, 65.8%), and non-clinical biomarkers were rarely used (n = 5, 13.1%). Motor characteristics were the domain most commonly reported to differentiate PD subtypes. Most of the studies did not achieve the top rating across items of a Methodologic Quality checklist. In a Clinical Applicability Checklist, the clinical importance of differences between subtypes, potential treatment implications and applicability to the general population were rated poorly, and subtype stability over time and prognostic value were largely unknown. CONCLUSION Subtyping studies undertaken to date have significant methodologic shortcomings and most have questionable clinical applicability and unknown biological relevance. The clinical and biological signature of PD may be unique to the individual, rendering PD resistant to meaningful cluster solutions. New approaches that acknowledge the individual-level heterogeneity and that are more aligned with personalized medicine are needed.
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Affiliation(s)
- Tiago A. Mestre
- Parkinson’s disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Research Institute, Ottawa, ON, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Nicolaas I. Bohnen
- Departments of Radiology & Neurology, University of Michigan, University of Michigan Udall Center, Ann Arbor VAMC, Ann Arbor, MI, USA
| | - Kathy Dujardin
- Movement Disorders Department, Center of Excellence for Neurodegenerative Diseases LiCEND, Lille, France
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi (SA), Italy
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Glenda Halliday
- Brain and Mind Centre and Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | | | - Michele T. Hu
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Neurology Department, Oxford, United Kingdom
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Albert F.G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center Goettingen, Department of Neurology, Kassel, Germany
| | - Ronald Postuma
- Department of Neurology, McGill University, Montreal, Quebec, Canada
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | | | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - D. James Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania; Parkinson’s Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Michael P. McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Connie Marras
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
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Urinary Dysfunction Is Associated with Nigrostriatal Dopaminergic Degeneration in Early and Untreated Patients with Parkinson's Disease. PARKINSON'S DISEASE 2020; 2020:4981647. [PMID: 33354313 PMCID: PMC7737470 DOI: 10.1155/2020/4981647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/23/2020] [Accepted: 11/15/2020] [Indexed: 01/17/2023]
Abstract
The aim of the present study was to determine the relation between urinary dysfunction and nigrostriatal dopaminergic degeneration in early and untreated Parkinson's disease (PD). The data were obtained from Parkinson's Progression Markers Initiative database. Two hundred and seventy-five patients and 149 healthy controls were included in our analysis. Urinary symptoms were evaluated with the Scale for Outcomes in Parkinson's Disease for Autonomic Symptoms (SCOPA-AUT). We performed correlation analyses between 123I-FP-CIT SPECT imaging data and severity of urinary symptoms in patients with PD and healthy controls. Early and untreated patients with PD exhibited worse urinary symptoms when compared with healthy controls. The severity of urinary symptoms significantly correlated with dopamine transporter binding levels in the caudate and the putamen. After controlling for age and sex, the severity of storage symptoms significantly correlated with dopamine transporter binding levels in the less affected side of the putamen (r = −0.172, p=0.004). The correlation was observed in both male (r = −0.152, p=0.043) and female patients (r = −0.217, p=0.034). No correlations were found between dopamine transporter binding levels and voiding symptoms in male or female patients, or any urinary symptoms in healthy controls. Worse storage symptoms reflect greater nigrostriatal dopaminergic loss in early and untreated PD.
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9
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Picillo M, Phokaewvarangkul O, Poon YY, McIntyre CC, Beylergil SB, Munhoz RP, Kalia SK, Hodaie M, Lozano AM, Fasano A. Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease. Mov Disord 2020; 36:672-680. [PMID: 33165964 PMCID: PMC8048876 DOI: 10.1002/mds.28382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background No clinical trials have been specifically designed to compare medical treatments after surgery in Parkinson's disease (PD). Objective Study's objective was to compare the efficacy and safety of levodopa versus dopamine agonist monotherapy after deep brain stimulation (DBS) in PD. Methods Thirty‐five surgical candidates were randomly assigned to receive postoperative monotherapy with either levodopa or dopamine agonist in a randomized, single‐blind study. All patients were reevaluated in short‐ (3 months), mid‐ (6 months), and long‐term (2.5 years) follow‐up after surgery. The primary outcome measure was the change in the Non‐Motor Symptoms Scale (NMSS) 3 months after surgery. Secondary outcome measures were the percentage of patients maintaining monotherapy, change in motor symptoms, and specific non‐motor symptoms (NMS). Analysis was performed primarily in the intention‐to‐treat population. Results Randomization did not significantly affect the primary outcome (difference in NMSS between treatment groups was 4.88 [95% confidence interval: −11.78–21.53, P = 0.566]). In short‐ and mid‐term follow‐up, monotherapy was safe and feasible in more than half of patients (60% in short‐ and 51.5% in mid‐term follow‐up), but it was more often possible for patients on levodopa. The ability to maintain dopamine agonist monotherapy was related to optimal contact location. In the long term, levodopa monotherapy was feasible only in a minority of patients (34.2%), whereas dopamine agonist monotherapy was not tolerated due to worsening of motor conditions or occurrence of impulse control disorders. Conclusions This trial provides evidence for simplifying pharmacological treatment after functional neurosurgery for PD. The reduction in dopamine receptor agonists should be attempted while monitoring for occurrence of NMSs, such as apathy and sleep disturbances. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Marina Picillo
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Centre for Neurodegenerative Diseases (CEMAND), University of Salerno, Salerno, Italy
| | - Onanong Phokaewvarangkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Krembil Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Krembil Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Krembil Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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10
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Belvisi D, Fabbrini A, De Bartolo MI, Costanzo M, Manzo N, Fabbrini G, Defazio G, Conte A, Berardelli A. The Pathophysiological Correlates of Parkinson's Disease Clinical Subtypes. Mov Disord 2020; 36:370-379. [PMID: 33037859 DOI: 10.1002/mds.28321] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Possible pathophysiological mechanisms underlying Parkinson's disease (PD) clinical subtypes are unknown. The objective of this study was to identify pathophysiological substrate of PD subtypes using neurophysiological techniques. METHODS One hundred de novo PD patients participated. We collected patient demographic and clinical data, which were used to perform a hierarchical cluster analysis. The neurophysiological assessment tested primary motor cortex excitability and plasticity using transcranial magnetic stimulation. To evaluate motor performance, we performed a kinematic analysis of fast index finger abduction. To investigate sensory function and sensorimotor mechanisms, we measured the somatosensory temporal discrimination threshold at rest and during movement, respectively. RESULTS Hierarchical cluster analysis identified 2 clinical clusters. Cluster I ("mild motor-predominant") included patients who had milder motor and nonmotor symptoms severity than cluster II patients, who had a combination of severe motor and nonmotor manifestations (diffuse malignant). We observed that the diffuse malignant subtype had increased cortical excitability and reduced plasticity compared with the mild motor-predominant subtype. Kinematic analysis of motor performance demonstrated that the diffuse malignant subtype was significantly slower than the mild motor-predominant subtype. Conversely, we did not observe any significant differences in sensory function or sensorimotor integration between the two PD subtypes. CONCLUSIONS De novo PD subtypes showed different patterns of motor system dysfunction, whereas sensory function and sensorimotor integration mechanisms did not differ between subtypes. Our findings suggest that the subtyping of PD patients is not a mere clinical classification but reflects different pathophysiological mechanisms. Neurophysiological parameters may represent promising biomarkers to evaluate PD subtypes and their progression. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniele Belvisi
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Matteo Costanzo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Antonella Conte
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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11
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Dysautonomia Is Linked to Striatal Dopamine Deficits and Regional Cerebral Perfusion in Early Parkinson Disease. Clin Nucl Med 2020; 45:e342-e348. [PMID: 32520498 DOI: 10.1097/rlu.0000000000003107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the association between autonomic dysfunction and striatal dopamine depletion or metabolic changes in de novo Parkinson disease (PD). METHODS Based on the Composite Autonomic Severity Score (CASS), patients with de novo PD were classified into PD with (PD-AUT+) and without autonomic dysfunction (PD-AUT-) groups. We compared the dopamine transporter (DAT) availability in the striatum by quantitatively measuring F-FP-CIT PET between both groups. We also assessed the association between DAT availability and the CASS. In addition, we compared regional uptake in early-phase images of F-FP-CIT PET as well as cortical thickness between the PD-AUT+ and PD-AUT- groups. RESULTS The PD-AUT+ group had significantly lower DAT availability in all striatal subregions than did the PD-AUT- group. The total CASS was significantly correlated with DAT availability in all striatal subregions. In addition, the subscores of the adrenergic component were correlated with DAT availability in all striatal subregions. The subscores of the cardiovagal component were negatively correlated with DAT availability in the caudate and ventral striatum. In early-phase F-FP-CIT PET, the PD-AUT+ group exhibited decreased regional perfusion in the parieto-occipital areas and increased regional perfusion in the pallidothalamic, pontocerebellar, inferior frontal, and primary motor areas compared with the PD-AUT- group. There were no regions of different cortical thickness between the PD groups. CONCLUSIONS The present study revealed that autonomic dysfunction is closely linked to striatal dopamine depletion and prominent PD-related perfusion patterns in de novo PD, suggesting a greater pathological burden in patients with dysautonomia.
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12
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Erro R, Picillo M, Scannapieco S, Cuoco S, Pellecchia MT, Barone P. The role of disease duration and severity on novel clinical subtypes of Parkinson disease. Parkinsonism Relat Disord 2020; 73:31-34. [PMID: 32224439 DOI: 10.1016/j.parkreldis.2020.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/21/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION One of the latest subtyping systems of Parkinson disease (PD) identifies motor severity, cognitive dysfunction, dysautonomia, and rapid eye movement behavior disorder as key features for phenotyping patients into three different subtypes (i.e., mild motor-predominant, diffuse-malignant and intermediate). Since PD subtypes are clinically most relevant if they are mutually exclusive and consistent over-time, we explored the impact of disease stage and duration on these novel subtypes. METHODS One-hundred-twenty-two consecutive patients, with a disease duration ranging from 0 to 20 years, were allocated as suggested into these three subtypes. The relationship between either disease duration or stage, as measured by the Hoehn and Yahr staging, and subtype allocation was explored. RESULTS Significant differences in subtype distribution were observed across patients stratified according to either disease duration or staging, with the diffuse-malignant subtypes increasing in prevalence as the disease advanced. Both disease duration and staging were independent predictors of subtype allocation. CONCLUSIONS These novel PD subtypes are significantly influenced by disease duration and staging, which might suggest that they do not represent mutually exclusive disease pathways. This should be taken into account when attempting correlations with putative biomarkers of disease progression.
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Affiliation(s)
- Roberto Erro
- Center for Neurodegenerative Disease-CEMAND, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy.
| | - Marina Picillo
- Center for Neurodegenerative Disease-CEMAND, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Sara Scannapieco
- Center for Neurodegenerative Disease-CEMAND, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Disease-CEMAND, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Disease-CEMAND, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Paolo Barone
- Center for Neurodegenerative Disease-CEMAND, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
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13
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Scarpa A, Cassandro C, Vitale C, Ralli M, Policastro A, Barone P, Cassandro E, Pellecchia MT. A comparison of auditory and vestibular dysfunction in Parkinson's disease and Multiple System Atrophy. Parkinsonism Relat Disord 2020; 71:51-57. [PMID: 32032926 DOI: 10.1016/j.parkreldis.2020.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Vertigo and disequilibrium are common symptoms in idiopathic Parkinson's disease (PD) and in Multiple System Atrophy (MSA). Hearing loss has been recently recognized as an additional non-motor feature in PD. The aim of this study is to evaluate audio-vestibular function in patients affected by PD and MSA. METHODS Fifteen patients with PD, 16 patients with MSA and 20 age-matched healthy controls (HC) were enrolled. Audio-vestibular examination included pure-tone audiometry (PTA), vestibular bed-side examination, video Head Impulse Test (vHIT), and cervical Vestibular-Evoked Myogenic Potentials (cVEMPs). RESULTS PD and MSA patients showed worse PTA thresholds compared to HC at high frequencies. MSA patients showed worse PTA thresholds at 125 Hz compared to HC. In patients with PD, a direct correlation between disease duration and PTA thresholds was found at 2000 Hz and 4000 Hz. In patients with MSA, disease duration was directly related to PTA thresholds at 125 Hz and 250 Hz. Among PD patients, cVEMPs were absent bilaterally in 46.7% and unilaterally in 13.3% of the subjects. Among MSA patients, cVEMPs were absent bilaterally in 26.7% and unilaterally in 40% of the subjects; p13 latency was significantly increased in PD patients as compared to HC. A significant inverse relationship was found between disease duration and cVEMP amplitude in MSA patients. CONCLUSION We found that high-frequency hearing loss and cVEMP abnormalities are frequent features of both MSA and PD, suggesting that an audio-vestibular dysfunction may be present in these patients even in the absence of self-reported auditory or vestibular symptoms.
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Affiliation(s)
- Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Carmine Vitale
- Department of Motor Sciences and Wellness, University Parthenope, Naples, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University Rome, Rome, Italy
| | | | - Paolo Barone
- Neuroscience Section, Department of Medicine and Surgery, University of Salerno, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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14
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Erro R, Picillo M, Amboni M, Savastano R, Scannapieco S, Cuoco S, Santangelo G, Vitale C, Pellecchia MT, Barone P. Comparing postural instability and gait disorder and akinetic‐rigid subtyping of Parkinson disease and their stability over time. Eur J Neurol 2019; 26:1212-1218. [DOI: 10.1111/ene.13968] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/04/2019] [Indexed: 01/19/2023]
Affiliation(s)
- R. Erro
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
| | - M. Picillo
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
| | - M. Amboni
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
- Institute of Diagnosis and Health IDC‐Hermitage Capodimonte Naples Italy
| | - R. Savastano
- Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona' SalernoItaly
| | - S. Scannapieco
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
| | - S. Cuoco
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
| | - G. Santangelo
- Department of Psychology University of Campania Luigi Vanvitelli CasertaItaly
| | - C. Vitale
- Institute of Diagnosis and Health IDC‐Hermitage Capodimonte Naples Italy
- Department of Motor Sciences and Wellness University ‘Parthenope’ Naples Italy
| | - M. T. Pellecchia
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
| | - P. Barone
- Center for Neurodegenerative Disease – CEMAND Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Baronissi (SA) Italy
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15
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Chung SJ, Bae YJ, Jun S, Yoo HS, Kim SW, Lee YH, Sohn YH, Lee SK, Seong JK, Lee PH. Dysautonomia is associated with structural and functional alterations in Parkinson disease. Neurology 2019; 92:e1456-e1467. [DOI: 10.1212/wnl.0000000000007181] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023] Open
Abstract
ObjectiveTo investigate whether the presence of autonomic dysfunction is associated with white matter and functional connectivities and the level of cognitive performance in patients with de novo Parkinson disease (PD).MethodsSeventy-five patients with de novo PD underwent a comprehensive autonomic function test and were classified into 2 groups according to the Composite Autonomic Severity Score (CASS; 30 with moderate to severe autonomic dysfunction [CASS 4–10, PD-AUT+] and 45 without significant autonomic dysfunction [CASS 0–3, PD-AUT−]). Network-based statistics and a graph theoretical analysis were performed to assess the interregional white matter connectivity using diffusion tensor imaging. We also performed analyses of resting-state functional connectivity and compared cognitive performance between the 2 groups.ResultsThere were no significant differences in demographic characteristics and vascular risk factors between the PD-AUT+ and PD-AUT− groups. The PD-AUT+ group showed poorer cognitive performance on frontal/executive function than the PD-AUT− group. The PD-AUT+ group exhibited severely disrupted white matter connectivity in both fronto-subcortical and posterior cortical regions, which was well correlated with the severity of autonomic dysfunction assessed by the CASS. In addition, functional connectivity within the executive control network and dorsal attention network negatively correlated with the CASS.ConclusionsOur results suggest that autonomic dysfunction is associated with disrupted white matter and functional brain connectivity as well as cognitive impairment in de novo patients with PD.
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16
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Chadha-Patel A. Management of Fluctuating Parkinson’s Disease: From Science to Clinical Wisdom. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10314895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This symposium took place at the 4th Congress of the European Academy of Neurology (EAN) 2018 in Lisbon, Portugal, and focussed on the effective management of fluctuating Parkinson’s disease (PD). Prof Poewe introduced the topic by explaining how response fluctuations, including wearing-off, remain a key priority in the effective management of PD. Wearing-off fluctuations are often categorised as motor or non-motor, but the reality is that patients are frequently affected by both, with a significant impact on daily activities and quality of life. Prof Stocchi went on to explain that management strategies include adjunct therapies with catechol-O-methyl transferase (COMT) inhibitors, monoamine oxidase (MAO)-B inhibitors, and dopamine agonists. Clinical experience shows that within a few years most patients will be receiving a cocktail of these drugs to manage PD symptoms. Although many antiparkinsonian drug classes have overlapping indications, they have distinct mechanisms of action that can complement each other. Opicapone is a third generation, highly potent and effective COMT inhibitor that received European Union (EU) market approval in 2016 as an adjunct to levodopa for PD patients experiencing response fluctuations. While the efficacy and safety of once-daily opicapone have been proven in clinical studies, Prof Ebersbach gave an overview of real-life data from his own clinics, which show that the benefits of opicapone can be observed within 3 days of treatment initiation. The final presentation from Dr Morgante considered the management of non-motor symptoms in PD. Classically, these non-motor symptoms have been managed as non-urgent symptoms but are now recognised as a significant source of disability. It is vital for clinicians to recognise that many of these symptoms respond to treatment.
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17
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Prange S, Danaila T, Laurencin C, Caire C, Metereau E, Merle H, Broussolle E, Maucort-Boulch D, Thobois S. Age and time course of long-term motor and nonmotor complications in Parkinson disease. Neurology 2018; 92:e148-e160. [DOI: 10.1212/wnl.0000000000006737] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/11/2018] [Indexed: 01/12/2023] Open
Abstract
ObjectiveTo determine the time course of hazard for motor and nonmotor milestones of Parkinson disease (PD) in the long term and to investigate whether risk scales nonlinearly with time is instrumental in identifying changes in pathological processes and evaluating disease-modifying therapies in PD.MethodsOutpatients with PD at the Lyon University Movement Disorders Center were evaluated for 7 clinical milestones in this retrospective cohort study, encompassing 4 domains of PD progression: (1) motor (motor fluctuations, dyskinesias); (2) axial (postural instability and falls, freezing of gait); (3) neuropsychiatric (impulse control disorders, hallucinations); and (4) cognitive (dementia) complications. For each complication, we estimated the outcome-specific hazard using parsimonious smooth parametric Poisson regression models allowing for nonlinear scaling over disease duration, age at diagnosis, current age, and their interaction.ResultsA total of 1,232 patients with PD experienced 1,527 disease-related complications in up to 12 years of follow-up. Specific to each complication, hazard rates increased dramatically starting from diagnosis and were highest for motor fluctuations and lowest for dementia up to 6 years after diagnosis in patients aged 65 years at diagnosis. Nonlinear patterns indicated dramatic changes in the course of PD after 5 years and predicted more severe axial prognosis after 70 years and for motor fluctuations, dyskinesias, and impulse control disorders before 60 years at diagnosis.ConclusionTime course of motor and nonmotor milestones in PD is determined by disease duration and age at diagnosis in nonlinear patterns and their interaction. This indicates disease- and age-specific thresholds across the multiple neurodegenerative processes accumulating in PD at different paces.
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18
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Valentino F, Bartolotta TV, Cosentino G, Mastrilli S, Arnao V, Aridon P, Scurria S, Pavone A, Pavone C, D'Amelio M. Urological dysfunctions in patients with Parkinson's disease: clues from clinical and non-invasive urological assessment. BMC Neurol 2018; 18:148. [PMID: 30236066 PMCID: PMC6146523 DOI: 10.1186/s12883-018-1151-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/12/2018] [Indexed: 12/23/2022] Open
Abstract
Background Autonomic nervous system dysfunction, common in patients with Parkinson’s disease (PD), causes significant morbidity and it is correlated with poor quality of life. To assess frequency of urinary symptoms in patients with PD, without conditions known to interfere with urinary function. Methods Non-demented PD patients were consecutively enrolled from the outpatients clinic of our department. Scales investigating motor and non-motor symptoms were carried out. Evaluation of urinary dysfunctions was carried out using the AUTonomic Scale for Outcomes in Parkinson’s disease (SCOPA-AUT) questionnaire. Patients underwent noninvasive urological studies (nUS), including uroflowmetry and ultrasound of the urinary tract. Results Forty-eight (20 women, 42%) out of 187 PD patients met the inclusion criteria and were enrolled in the study. Mean SCOPA-AUT score was 14.1 ± 6.9 (urinary symptoms subscore 5.2 ± 3.8). Among those evaluated by the SCOPA-AUT scale, the urinary symptoms were among the most common complaints (93.8%). At nUS mean maximum flow rate (Qmax) was 17.9 ± 9.1 ml/s, and mean postvoid residual (PVR) urine volume was 24.4 ± 44.1 ml. Ultrasound investigation documented prostate hypertrophy in 12 male patients (42.8%). Urinary items of the SCOPA-AUT (SCOPA-U subscore) correlated with measures of disease severity only in female patients. Conclusion Urinary symptoms and abnormal findings in nUS are common in PD. Though nigrostriatal degeneration might be responsible for urinary symptoms also in the early-intermediate stage of the disease, when urinary dysfunction occurs other medical conditions need to be excluded.
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Affiliation(s)
- Francesca Valentino
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università degli studi Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Dipartimento di Biopatologia e Biotecnologie Mediche (DIBIMED), Università degli studi Palermo, Palermo, Italy
| | - Giuseppe Cosentino
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università degli studi Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Sergio Mastrilli
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università degli studi Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Valentina Arnao
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università degli studi Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Paolo Aridon
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università degli studi Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Salvatore Scurria
- Dipartimento Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Università degli studi Palermo, Palermo, Italy
| | | | - Carlo Pavone
- Dipartimento Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Università degli studi Palermo, Palermo, Italy
| | - Marco D'Amelio
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università degli studi Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
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Analysis of the clinical features of early Parkinson's disease with comparatively integrated intestinal function. Neurol Sci 2018; 39:1847-1856. [PMID: 30019200 DOI: 10.1007/s10072-018-3502-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Constipation is among the most frequently delineated nonmotor symptoms (NMS) with a high occurrence in Parkinson's disease (PD). The purpose of our study was to investigate whether PD with comparatively integrated intestinal function (without constipation) in the early stage had different clinical features compared to constipated PD. METHOD We conducted a study of 105 consecutive de novo as well as early treated (treated for shorter than 3 months), aged 50 years or older outpatients. Subjects were administered motor and nonmotor questionnaires as well as constipation associated examinations. Then, we explored the distinctive features of nonconstipated contrasted to constipated PD by using univariate, multiple regression analysis and correlation analysis. RESULTS Nonconstipated PD tended to have fewer motor deficits, as well as lower Hoehn and Yahr (H&Y) stage and they mainly presented as tremor-dominant (TD), while constipated group had a higher occurrence of posture instability and gait difficulty (PIGD); nonconstipated patients were inclined to live in urban area, the NMSloads and prevalence of NMS were lower compared to constipated ones. Correlation analysis found a discord between NMSloads and disease severity based on H&Y stage and motor scores in nonconstipated PD. CONCLUSIONS These results suggest that PD without constipation in early stage may represent a unique clinical phenotype, which may be more benign than PD with constipation.
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Mito Y, Yabe I, Yaguchi H, Takei T, Terae S, Tajima Y. Relation of overactive bladder with motor symptoms and dopamine transporter imaging in drug-naïve Parkinson's disease. Parkinsonism Relat Disord 2018; 50:37-41. [PMID: 29449184 DOI: 10.1016/j.parkreldis.2018.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/04/2017] [Accepted: 02/07/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of the present study was to determine the relation of urinary dysfunction with motor symptoms and nigrostriatal neuron loss in drug-naïve patients with Parkinson's disease (PD). We therefore examined the relation of overactive bladder (OAB) symptoms with motor symptoms and striatal dopamine transporter (DAT) binding measured by [123-Iodine]-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodophenylnortropane) dopamine transporter single-photon emission computed tomography (123I-FP-CIT SPECT). PATIENTS AND METHODS Thirty-one untreated PD patients (12 men and 19 women with a mean age of 71.2 ± 6.7 years) were included in this study. Patients were evaluated with overactive bladder symptom score (OABSS) and divided into an OAB group and Non-OAB group. They underwent clinical assessments and 123I-FP-CIT SPECT imaging. Motor symptoms were assessed using Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS The results showed that UPDRS motor score (p = 0.01) and akinetic-rigid score (p = 0.002) were higher and that striatal DAT availability (p = 0.01) was lower in the OAB group than in the Non-OAB group. However, tremor score, age, and duration of PD showed no significant differences between the OAB group and Non-OAB group. CONCLUSIONS Urinary dysfunction in untreated PD is related with increase in motor symptoms (especially bradykinesia and axial symptoms) and reduction of striatal DAT availability.
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Affiliation(s)
- Yasunori Mito
- Department of Neurology, Sapporo City General Hospital, Kita 11-Nishi 13, Chuo Ku, Sapporo, Hokkaido, 060-8604, Japan.
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Sapporo City General Hospital, Kita 11-Nishi 13, Chuo Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Toshiki Takei
- Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Satoshi Terae
- Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Yasutaka Tajima
- Department of Neurology, Sapporo City General Hospital, Kita 11-Nishi 13, Chuo Ku, Sapporo, Hokkaido, 060-8604, Japan
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Serra MC, Landry A, Juncos JL, Markland AD, Burgio KL, Goode PS, Johnson TM, Vaughan CP. Increased odds of bladder and bowel symptoms in early Parkinson's disease. Neurourol Urodyn 2017; 37:1344-1348. [PMID: 29095515 DOI: 10.1002/nau.23443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 12/11/2022]
Abstract
AIMS To compare the prevalence of urinary and bowel symptoms in a sample of adults with early Parkinson's disease (PD) and healthy controls (HC). METHODS Data were obtained from the Michael J. Fox Parkinson's Progression Markers Initiative (PPMI). Prevalent bladder (urinary incontinence (UI) and nighttime voiding) and bowel (constipation and fecal incontinence (FI)) symptoms were defined as occurring at least sometimes when queried using the Scale for Outcomes in PD for Autonomic Symptoms. RESULTS The proportion of men (65% vs 64%) and the mean age (61.0 ± 9.7 vs 60.2 ± 11.2 years) was similar between early PD (n = 423) and HC (n = 195). UI and constipation were more prevalent among early PD versus HC (UI: 26.7% vs 8.2%, constipation: 32.4% vs 11.8%; P's < 0.0001). Prevalent nighttime voiding was high among both groups, but not significantly different (82.5% vs 84.1%, P = 0.62). FI was infrequent in both. The odds of UI and constipation were significantly higher in early PD even after adjustment for age, sex, cognition, and overactive bladder (UI model only), constipation (UI and constipation models only), depression, and anxiety medication usage (UI: OR: 4.39 [95% CI: 2.92, 5.87]; constipation: 3.34 [2.20, 4.42]; P's < 0.0001). CONCLUSIONS While constipation is known to precede PD diagnosis, these data suggest that the occurrence of UI is elevated in early PD compared to a well-matched HC population.
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Affiliation(s)
- Monica C Serra
- US Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alexus Landry
- Department of Biology, Louisiana State University, Baton Rouge, Louisiana
| | - Jorge L Juncos
- Department of Neurology, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Birmingham, Alabama.,Division of Geriatrics, Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn L Burgio
- Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Birmingham, Alabama.,Division of Geriatrics, Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia S Goode
- Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Birmingham, Alabama.,Division of Geriatrics, Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Theodore M Johnson
- US Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Camille P Vaughan
- US Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
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22
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Erro R, Brigo F, Tamburin S, Zamboni M, Antonini A, Tinazzi M. Nutritional habits, risk, and progression of Parkinson disease. J Neurol 2017; 265:12-23. [PMID: 29018983 DOI: 10.1007/s00415-017-8639-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 12/17/2022]
Abstract
Parkinson disease (PD) is a multifactorial disease, where a genetic predisposition combines with putative environmental risk factors. Mounting evidence suggests that the initial PD pathological manifestations may be located in the gut to subsequently affect brain areas. Moreover, several lines of research demonstrated that there are bidirectional connections between the central nervous system and the gut, the "gut-brain axis" that influences both brain and gastrointestinal function. This opens a potential therapeutic window suggesting that specific dietary strategies may interact with the disease process and influence the risk of PD or modify its course. Dietary components can also theoretically modulate the chronic activation of the inflammatory response that is associated with aging, the strongest risk factor for PD, that has been suggested to hasten the underlying neurodegenerative process in PD. Here, we reviewed the evidence supporting an association between certain dietary compound and either the risk or progression of PD and have provided an overview of the possible pathomechanisms linking nutrition and neurodegeneration. The results of our review would not support a clear role for any dietary components in reducing the risk or progression of PD. However, the evidence favouring a connection between gut abnormalities, inflammation, and neurodegeneration in PD have become too compelling to be ignored, so that further research, also in the field of nutritional genomics, is highly warranted.
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Affiliation(s)
- Roberto Erro
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. .,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Stefano Tamburin
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Mauro Zamboni
- Section of Geriatrics, Department of Medicine, Division of Geriatrics, University of Verona, Verona, Italy
| | - Angelo Antonini
- Parkinson Unit, IRCCS Hospital San Camillo and 1st Neurology Clinic, AO Universitaria Padua, Padua, Italy
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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23
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Barone P, Erro R, Picillo M. Quality of Life and Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:499-516. [PMID: 28802930 DOI: 10.1016/bs.irn.2017.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Health-related quality of life (HRQoL) is defined as "the perception and evaluation by patients themselves of the impact caused on their lives by the disease and its consequences." HRQoL is conceptualized as a combination of physical, psychological, and social well-being in the context of a particular disease. Following earlier studies revolving on the impact of the classic motor symptoms of Parkinson's disease on HRQoL, mounting evidence have been produced that nonmotor symptoms (NMS) significantly and independently contribute to worse HRQoL. This holds particularly true for such NMS such as neuropsychiatric disturbances, cognitive impairment, and fatigue, the burden of which might well exceed the effects of the motor symptoms. Nonetheless, there is very sparse evidence on how to manage these NMS and whether targeting NMS would in fact lead to an improvement of HRQoL, which calls for the need of future trials with NMS as primary outcomes.
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Affiliation(s)
- Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy.
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy; University College London, Institute of Neurology, London, United Kingdom
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy
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24
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Picillo M, Palladino R, Barone P, Erro R, Colosimo C, Marconi R, Morgante L, Antonini A. The PRIAMO study: urinary dysfunction as a marker of disease progression in early Parkinson's disease. Eur J Neurol 2017; 24:788-795. [PMID: 28425642 DOI: 10.1111/ene.13290] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE New venues are currently being explored to predict disease progression in Parkinson's disease (PD), such as non-motor subtypes and models merging motor and non-motor symptoms (NMS). By involving a subgroup of 585 patients from the PRIAMO (Parkinson Disease Non-motor Symptoms) study, the present 24-month longitudinal prospective analysis aimed to demonstrate that urinary dysfunction is an early marker of higher motor and non-motor burden as well as lower health-related quality of life. METHODS AND RESULTS Multivariable mixed-effect logistic regression models controlling for demographic and clinical variables showed that the following NMS domains were associated with urinary dysfunction: gastrointestinal [odds ratio (OR) 2.57, 95% confidence interval (CI) 1.67-3.97, P < 0.001], cardiovascular (OR 2.22, 95% CI 1.18-4.17, P = 0.013), skin (OR 1.81, 95% CI 1.06-3.08, P = 0.029), sleep (OR 2.06, 95% CI 1.34-3.16, P = 0.001), pain (OR 1.85, 95% CI 1.21-2.83, P = 0.004), fatigue (OR 2.40, 95% CI 1.56-3.68, P < 0.001), apathy (OR 2.79, 95% CI 1.72-4.52, P < 0.001) and respiratory (OR 1.82, 95% CI 1.02-3.23, P = 0.039). Analysis also demonstrated that urinary dysfunction was associated with higher motor disability (coefficient 1.73, 95% CI 0.68-2.78, P = 0.001) and lower health-related quality of life (coefficient -0.05, 95% CI -0.08 to -0.02, P < 0.001, and coefficient -3.49, 95% CI -5.21 to -1.77, P < 0.001) but not with more severe cognitive disability (coefficient -0.34, 95% CI -0.92 to 0.24, P = 0.251). CONCLUSIONS This is the first prospective longitudinal study involving a large cohort of PD patients demonstrating the relevance of urinary dysfunction as an early marker of higher motor and non-motor disability as well as lower health-related quality of life. These findings support a role for urinary dysfunction as an early marker of more severe disease progression.
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Affiliation(s)
- M Picillo
- Neuroscience Section, Department of Medicine and Surgery, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Salerno, Italy
| | - R Palladino
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.,Department of Public Health, School of Medicine, University 'Federico II', Naples, Italy
| | - P Barone
- Neuroscience Section, Department of Medicine and Surgery, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Salerno, Italy
| | - R Erro
- Neuroscience Section, Department of Medicine and Surgery, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Salerno, Italy.,Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - C Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - R Marconi
- Neurology Division, Misericordia Hospital, Grosseto, Italy
| | - L Morgante
- Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, University of Messina, Messina, Italy
| | - A Antonini
- Parkinson and Movement Disorders Unit, IRCCS Fondazione Ospedale San Camillo, Venice, Italy.,Department of Neurosciences (DNS), Padova University, Padova, Italy
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25
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Pagano G, Niccolini F, Yousaf T, Wilson H, Polychronis S, Chaudhuri KR, Politis M. Urinary dysfunction in early de novo patients with Parkinson's disease. Mov Disord 2017; 32:939-940. [DOI: 10.1002/mds.26967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gennaro Pagano
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience (IoPPN); King's College London; London UK
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
| | - Flavia Niccolini
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience (IoPPN); King's College London; London UK
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
| | - Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience (IoPPN); King's College London; London UK
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
| | - Heather Wilson
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience (IoPPN); King's College London; London UK
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
| | - Sotirios Polychronis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience (IoPPN); King's College London; London UK
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience (IoPPN); King's College London; London UK
- National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience; King's College London and Kings College Hospital; London UK
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26
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27
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Nodel MR, Ukraintseva YV, Yakhno NN. Syndrome of rapid eye movement sleep behavior disorder and nocturia in Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:15-20. [DOI: 10.17116/jnevro20171179115-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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28
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Titova N, Padmakumar C, Lewis SJG, Chaudhuri KR. Parkinson's: a syndrome rather than a disease? J Neural Transm (Vienna) 2016; 124:907-914. [PMID: 28028643 PMCID: PMC5514217 DOI: 10.1007/s00702-016-1667-6] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
Emerging concepts suggest that a multitude of pathology ranging from misfolding of alpha-synuclein to neuroinflammation, mitochondrial dysfunction, and neurotransmitter driven alteration of brain neuronal networks lead to a syndrome that is commonly known as Parkinson’s disease. The complex underlying pathology which may involve degeneration of non-dopaminergic pathways leads to the expression of a range of non-motor symptoms from the prodromal stage of Parkinson’s to the palliative stage. Non-motor clinical subtypes, cognitive and non-cognitive, have now been proposed paving the way for possible subtype specific and non-motor treatments, a key unmet need currently. Natural history of these subtypes remains unclear and need to be defined. In addition to in vivo biomarkers which suggest variable involvement of the cholinergic and noradrenergic patterns of the Parkinson syndrome, abnormal alpha-synuclein accumulation have now been demonstrated in the gut, pancreas, heart, salivary glands, and skin suggesting that Parkinson’s is a multi-organ disorder. The Parkinson’s phenotype is thus not just a dopaminergic motor syndrome, but a dysfunctional multi-neurotransmitter pathway driven central and peripheral nervous system disorder that possibly ought to be considered a syndrome and not a disease.
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Affiliation(s)
- Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education, N.I. Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - C Padmakumar
- Parkinson's Disease Service for the Older Person, Rankin Park Centre, John Hunter Hospital, HNELHD, Newcastle, NSW, Australia
| | | | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, UK.
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, UK.
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29
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Kim JS, Park IS, Park HE, Kim SY, Yun JA, Jung CK, Sung HY, Lee JK, Kang WK. α-Synuclein in the colon and premotor markers of Parkinson disease in neurologically normal subjects. Neurol Sci 2016; 38:171-179. [DOI: 10.1007/s10072-016-2745-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/11/2016] [Indexed: 01/28/2023]
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30
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Kotagal V, Lineback C, Bohnen NI, Albin RL. Orthostatic hypotension predicts motor decline in early Parkinson disease. Parkinsonism Relat Disord 2016; 32:127-129. [PMID: 27639815 DOI: 10.1016/j.parkreldis.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/02/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Orthostatic hypotension is increasingly reported as a risk factor for development of late-stage disease features in Parkinson disease (PD). Less is known about its significance in individuals with early PD who are often targeted for neuroprotective trials. METHODS Using data from the CALM-PD trial (n = 275), we explored whether early orthostatic hypotension predicts a decline in the Unified Parkinson's Disease Rating Scale (UPDRS) II (activities of daily living) or UDPRS III (motor) score after 102 weeks. We also explored risk factors for worsening orthostatic hypotension over a nearly 2-year period. RESULTS After controlling for age, disease duration, gender, study drug, change in mini-mental status exam score, levodopa equivalent dose, and baseline UPDRS II or III score respectively, the degree of orthostatic hypotension at enrollment associated with a worsening in UPDRS motor score (t = 2.40, p = 0.017) at week 102 but not with UPDRS ADL score (t = 0.83, p = 0.409). Worsening in orthostatic hypotension during the study associated with longer disease duration (t = 2.37, p = 0.019) and lower body mass index (BMI) (t = -2.96, p = 0.003). CONCLUSIONS Baseline orthostatic hypotension is a predictor of UPDRS motor decline in individuals with early PD and should be accounted for in clinical trial design. Low BMI may predict orthostatic hypotension in PD.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States.
| | - Christina Lineback
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States; Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, United States; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease, Ann Arbor, MI, United States
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease, Ann Arbor, MI, United States
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31
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Moccia M, Erro R, Picillo M, Vitale C, Longo K, Amboni M, Pellecchia MT, Barone P. Caffeine consumption and the 4-year progression of de novo Parkinson's disease. Parkinsonism Relat Disord 2016; 32:116-119. [PMID: 27622969 DOI: 10.1016/j.parkreldis.2016.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/13/2016] [Accepted: 08/03/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Higher caffeine consumption has been associated with reduced risk of Parkinson's disease (PD), and with a more benign progression of motor and non-motor symptoms (NMS). The present observational cohort study investigated motor and non-motor correlates of caffeine consumption in de novo PD. METHODS 79 newly diagnosed, drug naïve PD patients have been included and followed up for 4 years. The total caffeine use was calculated with the Caffeine Consumption Questionnaire. Following study variables were recorded at baseline, and after 2 and 4 years: UPDRS part III, UPDRS part IV, l-dopa Equivalent Daily Dose (LEDD), NMS Questionnaire (NMSQuest), and the time occurring from PD diagnosis to the need for l-dopa treatment. Age, gender and disease duration were included as covariates in the statistical models. RESULTS The average daily caffeine consumption was 296.1 ± 157.2 mg. At Cox regression models, higher caffeine consumption was associated with a lower rate of starting l-Dopa treatment (HR = 0.630; 95%CI = 0.382-0.996). At the mixed-effects linear regression models considering the whole study period, each additional espresso cup per day (50 mg of caffeine) was more likely associated with 5-point lower UPDRS part III total score (Coef = -0.01; 95%CI = -0.02 to 0.00), with 50% reduced LEDD (Coef = -0.01; 95%CI = -0.15 to 0.00; p = 0.021), and with 5-point lower NMSQuest total score (Coef = -0.01; 95%CI = -0.01 to 0.00), but not with UPDRS part IV total score (Coef = -0.00; 95%CI = -0.00 to 0.00). CONCLUSION Caffeine consumption was associated with a reduced accrual of motor and non-motor disability during 4-year follow-up in de novo PD, highlighting the rationale for using adenosine A2A antagonists since the early phases of PD.
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Affiliation(s)
- Marcello Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom; Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Carmine Vitale
- Department of Motor Sciences, University Parthenope, Naples, Italy; Neurology Clinic, IDC-Hermitage-Capodimonte, Naples, Italy
| | - Katia Longo
- Neurology Clinic, IDC-Hermitage-Capodimonte, Naples, Italy
| | | | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy.
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32
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Erro R, Picillo M, Vitale C, Amboni M, Moccia M, Santangelo G, Pellecchia MT, Barone P. The non-motor side of the honeymoon period of Parkinson's disease and its relationship with quality of life: a 4-year longitudinal study. Eur J Neurol 2016; 23:1673-1679. [DOI: 10.1111/ene.13106] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/09/2016] [Indexed: 01/16/2023]
Affiliation(s)
- R. Erro
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; London UK
- Department of Neuroscience, Biomedicine and Movement Science; University of Verona; Verona Italy
| | - M. Picillo
- Department of Medicine and Surgery; Center for Neurodegenerative diseases (CEMAND), Neuroscience Section; University of Salerno; Baronissi (SA) Italy
| | - C. Vitale
- University Parthenope; Naples Italy
- IDC-Hermitage-Capodimonte; Naples Italy
| | - M. Amboni
- IDC-Hermitage-Capodimonte; Naples Italy
| | - M. Moccia
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - G. Santangelo
- Department of Psychology, Second University of Naples; Caserta Italy
| | - M. T. Pellecchia
- Department of Medicine and Surgery; Center for Neurodegenerative diseases (CEMAND), Neuroscience Section; University of Salerno; Baronissi (SA) Italy
| | - P. Barone
- Department of Medicine and Surgery; Center for Neurodegenerative diseases (CEMAND), Neuroscience Section; University of Salerno; Baronissi (SA) Italy
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Erro R, Picillo M, Vitale C, Palladino R, Amboni M, Moccia M, Pellecchia MT, Barone P. Clinical clusters and dopaminergic dysfunction in de-novo Parkinson disease. Parkinsonism Relat Disord 2016; 28:137-40. [PMID: 27158121 DOI: 10.1016/j.parkreldis.2016.04.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/11/2016] [Accepted: 04/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The heterogeneity of PD suggests the existence of different subtypes. While some motor clusters have been consistently identified, little is known about non-motor PD subtypes and motor-non-motor interplay. Research in this regard has produced somewhat contradictory results, which might be biased by the inclusion of treated patients. PATIENTS AND METHODS We performed a non-hierarchical cluster analysis using both motor and non-motor data on 398 newly diagnosed untreated PD patients enrolled in the Parkinson's Progressive Marker Initiative (PPMI) study. We further evaluated whether dopaminergic dysfunction, as measured by (123)[I]-FP-CIT SPECT scan, could explain, at least partially, the observed difference between the clusters. RESULTS Three clusters were identified. Group 1 was characterized by the lowest motor and non-motor burden, whereas group 2 and 3 had similar motor disability, but different non-motor involvement, especially with regards to apathy and hallucinations. (123)[I]-FP-CIT binding values paralleled motor disability burden among the 3 clusters, but further multivariate analyses also revealed a negative correlation with depression. DISCUSSION Our results confirm the motor as well as non-motor heterogeneity of PD, suggesting the existence of 3 different subtypes. Dopaminergic dysfunction only marginally explains the non-motor variability of PD. Identification of such clusters can have important implications for generating novel pathophysiological hypotheses and therapeutic strategies.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom; Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Carmine Vitale
- University Parthenope, Naples, Italy; IDC-Hermitage-Capodimonte, Naples, Italy
| | - Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College London, United Kingdom
| | | | - Marcello Moccia
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy.
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Picillo M, Palladino R, Moccia M, Erro R, Amboni M, Vitale C, Barone P, Pellecchia MT. Gender and non motor fluctuations in Parkinson's disease: A prospective study. Parkinsonism Relat Disord 2016; 27:89-92. [PMID: 27066847 DOI: 10.1016/j.parkreldis.2016.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/21/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In Parkinson's disease (PD), non motor symptoms can fluctuate either along or irrespective to motor on/off phenomena. Prospective studies suggest that higher motor scores and levodopa dosage, younger age at onset and female gender represent risk factors for motor fluctuations' development. Yet, the predictors of development of non motor fluctuations (NMF) are less clear. In this prospective study, we aimed to assess the relationship between NMF and gender along with other potential risk factors. METHODS Forty-seven (16 women/31 men) de novo, drug-naïve PD patients have been followed for 4 years since diagnosis. Motor and non motor fluctuations were evaluated with the 19-item Wearing off Questionnaire (WOQ-19). The association between gender and NMF was explored with multivariable regression models adjusted for age at onset, motor and non motor symptoms at diagnosis and levodopa intake at follow up. RESULTS Female gender was more likely associated with a diagnosis of NMF (adjusted odds ratio, AOR = 5.33,95%CI = 1.21-23.4, p = 0.027), but not with a diagnosis of generic wearing off at follow up (OR = 3.66, 95%CI = 0.8-16.8, p = 0.097). Women had greater likelihood of developing higher WOQ-19 Non motor scores (AOR = 4.58, 95%CI = 1.23-17.03, p = 0.023), but not higher WOQ-19 Total scores (AOR = 2.88, 95%CI = 0.86-9.71, p = 0.087) compared to men. Notwithstanding, no gender differences were detected in medication intake. CONCLUSIONS We showed that female gender represents a major risk factor for the development of NMF. There were no gender differences in medication intake, thus NMF in women remain mostly underestimated and not properly treated. From a practical standpoint, clinicians should take into account the role of gender in the management of NMF in PD.
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Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College, London, United Kingdom; Department of Public Health, Federico II University, Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Roberto Erro
- Department of Neurological and Movement Sciences, University of Verona, Policlinico Borgo Roma, Verona, Italy
| | | | - Carmine Vitale
- IDC Hermitage-Capodimonte, Naples, Italy; University Parthenope, Naples, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy.
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Marras C, Chaudhuri KR. Nonmotor features of Parkinson's disease subtypes. Mov Disord 2016; 31:1095-102. [PMID: 26861861 DOI: 10.1002/mds.26510] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 01/05/2023] Open
Abstract
Parkinson's disease is highly heterogeneous in early clinical features and later outcomes. This makes classifying subgroups of PD relevant to clinical research and practice, particularly if they are prognostically relevant. Subgroups have been defined both on the basis of motor and nonmotor features, and subgroups have been determined either empirically, based on clinical observation, or using data-driven analytic techniques. Previous studies have examined both the overall number and the nature of nonmotor symptoms and signs in tremor-dominant compared with non-tremor-dominant subtypes, and longitudinal studies identify nonmotor symptoms as important markers of prognosis and important defining features of PD subtypes. Autonomic features seem to preferentially affect individuals with non-tremor-dominant PD subtype early in the disease. Later in the disease cognitive disturbance distinguishes this phenotype. Pathological and neuroimaging studies provide substantial evidence for fundamental biological differences between tremor-dominant and postural instability gait disorder/akinetic-rigid subtypes. Biomarker studies point toward non-tremor-dominant PD as representing more advanced and diffuse neurodegeneration than tremor-dominant PD, encompassing dopaminergic and nondopaminergic as well as synuclein and nonsynuclein (Abeta) pathologies. This aligns with clinical studies that find a higher burden of nonmotor symptoms in non-tremor-dominant PD. The mounting evidence for the relevance of nonmotor features in PD subtypes behooves us to begin to investigate the biological underpinnings of subtypes defined by both motor and nonmotor features. This may be challenging, as PD subtypes are unlikely to be distinct nonoverlapping entities but are more likely to represent typical phenotypes within a multidimensional spectrum resulting from variable contributions of a number of simultaneous pathological processes. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Connie Marras
- Toronto Western Hospital Morton and Gloria Shulman Mov Disord Centre and the Edmond J. Safra Program in PD, University of Toronto, Toronto, Ontario, Canada
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital and University Hospital Lewisham; and Kings College and Institute of Psychiatry, London, UK
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Visanji N, Marras C. The relevance of pre-motor symptoms in Parkinson’s disease. Expert Rev Neurother 2015; 15:1205-17. [DOI: 10.1586/14737175.2015.1083423] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The range and nature of non-motor symptoms in drug-naive Parkinson's disease patients: a state-of-the-art systematic review. NPJ PARKINSONS DISEASE 2015; 1:15013. [PMID: 28725682 PMCID: PMC5516558 DOI: 10.1038/npjparkd.2015.13] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/16/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022]
Abstract
Non-motor symptoms (NMS) are a key component of Parkinson’s disease (PD). A range of NMS, most notably impaired sense of smell, sleep dysfunction, and dysautonomia are present from the ‘pre-motor’ phase to the final palliative stage. Theories as to the pathogenesis of PD such as those proposed by Braak and others also support the occurrence of NMS in PD years before motor symptoms start. However, research addressing the range and nature of NMS in PD has been confounded by the fact that many NMS arise as part of drug-related side effects. Thus, drug-naive PD (DNPD) patients provide an ideal population to study the differences in the presentation of NMS. The aim of this paper is therefore to systematically review all the available studies of NMS in DNPD patients. We believe this is the first review of its kind. The current review confirms the increasing research being conducted into NMS in DNPD patients as well as the necessity for further investigation into less-studied NMS, such as pain. Moreover, the data confirms non-motor heterogeneity among PD patients, and, therefore, further research into the concept of non-motor subtyping is encouraged. The review suggests that the clinical assessment of NMS should be integral to any assessment of PD in clinical and research settings.
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Erro R. The non-motor heterogeneity of Parkinson disease. Neurol Sci 2015; 36:1705-6. [DOI: 10.1007/s10072-015-2233-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/23/2015] [Indexed: 12/27/2022]
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