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Pisaltu S, Ruotolo I, Sellitto G, Berardi A, Simeon R, Fabbrini G, Galeoto G. Validity and reliability of the Italian version of the short Parkinson's evaluation scale (SPES/SCOPA). Heliyon 2024; 10:e32877. [PMID: 39021984 PMCID: PMC11253227 DOI: 10.1016/j.heliyon.2024.e32877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Background In the medical and rehabilitative field, it is essential to employ tools such as evaluation scales and performance tests to assess the impact of Parkinson's disease on QoL of affected individuals. The Short Parkinson's Evaluation Scale (SPES) is a reliable and valid tool, applicable both in research and clinical practices, useful in assessing motor damage, activities of daily living, and motor complications in patients with Parkinson's disease. The aim of the study is to investigate validity and reliability of the Italian version of the SPES-SCOPA scale. Methods Translation and cultural adaptation were performed. Included patients had diagnosis of Parkinson's disease, no concurrent pathologies, MiniMental test score above 2 and signed informed consent; they were recruited at the Department of Human Neurosciences in Sapienza University of Rome, from February 2023 to November 2023. Test-retest reliability was evaluated through Intraclass Correlation Coefficient (ICC), internal consistency was assessed using Cronbach's Alpha and construct validity using Pearson's correlation between SPES-SCOPA and the gold standard PDQ-39. Results 101 patients were recruited. Inter-rater evaluation was conducted on 62 patients, while 39 underwent an intra-rater assessment. The analysis showed statistically significant data with a Cronbach's Alpha value of 0.89 for the entire scale; test-retest reliability results are statistically significant for all subscales. Correlation between PDQ-39 domains and SPES/SCOPA subscales were statistically significant for most measurements. Conclusion This research shows that the Italian version of SPES-SCOPA scale has excellent psychometric properties.
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Affiliation(s)
| | - I. Ruotolo
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - G. Sellitto
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - A. Berardi
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - R. Simeon
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
| | - G. Fabbrini
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
- IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - G. Galeoto
- Sapienza University of Rome, Department of Human Neuroscience, 00185, Rome, Italy
- IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
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da Costa Pereira JP, Queiroz Júnior JRAD, Medeiros LCD, Araújo Bezerra GK, Porto IVP, Cabral PC, Luz MCLD, Pinho CPS, Romero RA. Sarcopenia and dynapenia is correlated to worse quality of life perception in middle-aged and older adults with Parkinson's disease. Nutr Neurosci 2024; 27:310-318. [PMID: 36932322 DOI: 10.1080/1028415x.2023.2190246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
BACKGROUND There are few studies that assess the relationship between nutritional status and quality of life in individuals with Parkinson's disease, despite the well-established negative impact of sarcopenia and dynapenia on functional capacity and quality of life. These conditions impair protein-muscular status and are prevalent in individuals with Parkinson's disease. This study aimed to examine the relationship between nutritional status, including body composition, functional capacity, and diagnosis of sarcopenia and dynapenia, and quality-of-life perception in individuals with Parkinson's disease. METHODS This is a cross-sectional study conducted in two Parkinson's disease centers in the northeast of Brazil. The researchers assessed muscle strength, muscle mass, and physical performance to diagnose dynapenia, sarcopenia and functional capacity. Quality of life was estimated using the Parkinson's disease Quality of Life Questionnaire. RESULTS We found positive correlations between quality of life and variables such as severity and duration of the disease, as well as positive screening for sarcopenia (p<0.001). Negative correlations were observed between quality of life and muscle strength and functional capacity. The study also found that individuals with sarcopenia and dynapenia had significantly worse quality-of-life scores compared to those who did not have these nutritional outcomes (p <0.05; p <0.001). CONCLUSIONS The presence of sarcopenia, dynapenia, low gait speed, disease duration, and severity had an impact on higher scores in the Parkinson's Disease Quality of Life Questionnaire, indicating a worsening perception of quality of life.
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Affiliation(s)
- Jarson Pedro da Costa Pereira
- Hospital das Clínicas of Pernambuco, Recife, Brazil
- Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | | | | | - Marcella Campos Lima da Luz
- Hospital das Clínicas of Pernambuco, Recife, Brazil
- Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
| | - Cláudia Porto Sabino Pinho
- Hospital das Clínicas of Pernambuco, Recife, Brazil
- Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
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Amo-Salas J, Olivares-Gil A, García-Bustillo Á, García-García D, Arnaiz-González Á, Cubo E. Computer Vision for Parkinson's Disease Evaluation: A Survey on Finger Tapping. Healthcare (Basel) 2024; 12:439. [PMID: 38391815 PMCID: PMC10888014 DOI: 10.3390/healthcare12040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder whose prevalence has steadily been rising over the years. Specialist neurologists across the world assess and diagnose patients with PD, although the diagnostic process is time-consuming and various symptoms take years to appear, which means that the diagnosis is prone to human error. The partial automatization of PD assessment and diagnosis through computational processes has therefore been considered for some time. One well-known tool for PD assessment is finger tapping (FT), which can now be assessed through computer vision (CV). Artificial intelligence and related advances over recent decades, more specifically in the area of CV, have made it possible to develop computer systems that can help specialists assess and diagnose PD. The aim of this study is to review some advances related to CV techniques and FT so as to offer insight into future research lines that technological advances are now opening up.
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Affiliation(s)
- Javier Amo-Salas
- Escuela Politécnica Superior, Departamento de Ingeniería Informática, Universidad de Burgos, 09001 Burgos, Spain
| | - Alicia Olivares-Gil
- Escuela Politécnica Superior, Departamento de Ingeniería Informática, Universidad de Burgos, 09001 Burgos, Spain
| | - Álvaro García-Bustillo
- Facultad de Ciencias de la Salud, Departamento de Ciencias de la Salud, Universidad de Burgos, 09001 Burgos, Spain
| | - David García-García
- Escuela Politécnica Superior, Departamento de Ingeniería Informática, Universidad de Burgos, 09001 Burgos, Spain
| | - Álvar Arnaiz-González
- Escuela Politécnica Superior, Departamento de Ingeniería Informática, Universidad de Burgos, 09001 Burgos, Spain
| | - Esther Cubo
- Servicio de Neurología, Hospital Universitario de Burgos, 09006 Burgos, Spain
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Cubo E, Garcia-Bustillo A, Calvo S, Gámez-Leyva G, Simón-Vicente L, Rivadeneyra J, Miranda J, Madrigal E, Martínez-Martín P, Mir P, Santos-García D. How can I assess my patients with Parkinson's disease during a busy clinic day? Parkinsonism Relat Disord 2023; 114:105773. [PMID: 37607410 DOI: 10.1016/j.parkreldis.2023.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The evaluation of motor impairment in Parkinson's disease (PD) is mainly assessed with the motor subdomain of the Unified Parkinson's Disease Rating scale (UPDRS part III) and, lately, with the MDS-UPDRS part III. To optimize efforts and special needs during specific circumstances in clinical practice, we sought to identify the most sensitive items to assess motor impairment in PD. METHODS We included the COPPADIS-PD cohort and collected the UPDRS part III at baseline (V0), 12 months (V1), and 24 months (V2). Factor analysis and effect size using Cohen's d formula were performed in the Off and On states at V0, V1, and V2. RESULTS We included 667 patients with PD, mean age of 62.59 ± 8.91 years, 410 (60.2%) males, with a median HY stage of 2.00 (1.00; 4.00) at baseline. Over time, the most discriminating items were postural stability and body bradykinesia ("arise from chair" and "gait") in the Off state, right and left upper extremity bradykinesia ("finger tap", "hand movements" and "prono/supination") in the On state. Body bradykinesia and right-left finger tapping were the items with the largest effect size (0.93, 0.84, 0.83, respectively) to assess motor improvement after receiving antiparkinsonian medications over time. CONCLUSION Under specific circumstances, selecting a few items of the UPDRS part III, including postural stability, body bradykinesia, and upper extremity bradykinesia, could be used to create a quick clinical judgment of motor status and improvement in PD.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Spain; University of Burgos, Spain.
| | | | - Sara Calvo
- Research Unit, Hospital Universitario Burgos, Spain
| | | | - Lucia Simón-Vicente
- University of Burgos, Spain; Research Unit, Hospital Universitario Burgos, Spain
| | | | - Javier Miranda
- Neurology Department, Hospital Universitario Burgos, Spain
| | | | - Pablo Martínez-Martín
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | - Pablo Mir
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain; Unidad de Trastornos Del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
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Rizzi B, Nuresi C, Rovacchi C, Bacchini M, Savi F, Falco L, Schianchi L, Scaglioni A, Ciracì C, Costantino C, Buccino G. Motor imagery and action-observation in neurorehabilitation: A study protocol in Parkinson's disease patients. Front Neurol 2022; 13:990618. [PMID: 36267882 PMCID: PMC9577192 DOI: 10.3389/fneur.2022.990618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAction Observation Treatment (AOT) and Motor Imagery (MI) represent very promising cognitive strategies in neuro-rehabilitation. This study aims to compare the effectiveness of the two cognitive strategies, taken alone or combined, in Parkinson's disease patients.Material and methodsThis study is designed as a prospective randomized controlled trial, with four arms. We estimated a sample size of 64 patients (16 in each treatment group) to be able to detect an effect size of F = 0.4 with a statistical significance of 0.05. Primary outcomes will be functional gains in the FIM and UPDRS scales. Secondary outcome measure will be functional gain as revealed by kinematic parameters measured at Gait Analysis.DiscussionThe results of this trial will provide insights into the use of AOT and MI, taken alone or combined, in the rehabilitation of Parkinson's disease patients.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Don Gnocchi Foundation. The study will be conducted in accordance with the 1996 World Medical Association guidelines and according to good clinical practice. The study has been registered on clinicaltrial.gov under the following code: AOTPRFDG. Dissemination will include both submission of the study to peer-reviewed journals and discussion of the study protocol at conferences.
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Affiliation(s)
- Beatrice Rizzi
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Christian Nuresi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudio Rovacchi
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Massimo Bacchini
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Federica Savi
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Lucia Falco
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Luca Schianchi
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Augusto Scaglioni
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Chiara Ciracì
- Department of Neuromotor Rehabilitation, Santa Maria ai Servi Center, Don Carlo Gnocchi Foundation ONLUS, Parma, Italy
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giovanni Buccino
- Division of Neuroscience, Università Vita-Salute San Raffaele, Milan, Italy
- IRCCS San Raffaele, Milan, Italy
- *Correspondence: Giovanni Buccino
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Rajan R, Saini A, Verma B, Choudhary N, Gupta A, Vishnu VY, Bhatia R, Singh MB, Srivastava AK, Srivastava MVP. Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease. Mov Disord Clin Pract 2020; 7:803-809. [PMID: 33043076 DOI: 10.1002/mdc3.13032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022] Open
Abstract
Background Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown. Objectives To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG). Methods We conducted a cross-sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society-Unified Parkinson's Disease Rating Scale items 2.13 and 3.11). Results We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 ± 11.8 years and a duration of symptoms 6.3 ± 6.9 years. Median ACB score was 4 (range 0-12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43-4.53; P < 0.001) and FOG using patient-reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68-6.07; P < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27-4.6, P = 0.007). Conclusion Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Arti Saini
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Bhawna Verma
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Nishu Choudhary
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Anu Gupta
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | | | - Rohit Bhatia
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Mamta B Singh
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Achal K Srivastava
- Department of Neurology All India Institute of Medical Sciences New Delhi India
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Camacho-Conde JA, Campos-Arillo VM. The phenomenology of pain in Parkinson's disease. Korean J Pain 2020; 33:90-96. [PMID: 31888323 PMCID: PMC6944372 DOI: 10.3344/kjp.2020.33.1.90] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 01/02/2023] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disorder that is the second most common disorder after Alzheimer's disease. PD includes both "motor" and "non-motor" symptoms, one of which is pain. The aim of this study was to investigate the clinical characteristics of pain in patients with PD. Methods This cross-sectional study included 250 patients diagnosed with PD, 70% of which had mild to moderate PD (stages 2/3 of Hoehn and Yahr scale). The average age was 67.4 years, and the average duration since PD diagnosis was 7.1 years. Relevant data collected from PD patients were obtained from their personal medical history. Results The prevalence of pain was found to be high (82%), with most patients (79.2%) relating their pain to PD. Disease duration was correlated with the frequency of intense pain (R: 0.393; P < 0.05). PD pain is most frequently perceived as an electrical current (64%), and two pain varieties were most prevalent (2.60 ± 0.63). Our findings confirm links between pain, its evolution over time, its multi-modal character, the wide variety of symptoms of PD, and the female sex. Conclusions Our results demonstrated that the pain felt by PD patients is mainly felt as an electrical current, which contrasts with other studies where the pain is described as burning and itching. Our classification is innovative because it is based on anatomy, whereas those of other authors were based on syndromes.
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Taghizadeh G, Martinez-Martin P, Meimandi M, Habibi SAH, Jamali S, Dehmiyani A, Rostami S, Mahmuodi A, Mehdizadeh M, Fereshtehnejad SM. Barthel Index and modified Rankin Scale: Psychometric properties during medication phases in idiopathic Parkinson disease. Ann Phys Rehabil Med 2019; 63:500-504. [PMID: 31816448 DOI: 10.1016/j.rehab.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/04/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Independence in activities of daily living (ADL) is one of the most important aspects in planning treatment for people with Parkinson disease (PD). The Barthel Index (BI) and modified Rankin Scale (mRS) are commonly used in neurological diseases. OBJECTIVE This study was conducted to confirm the validity and reliability of the BI and mRS in PD during ON and OFF medication phases. METHODS We included 260 individuals with a diagnosis of idiopathic PD. The disability in ADL was measured by the BI, mRS, Parkinson's Disease Questionnaire-39 (PDQ-39), Unified Parkinson Disease Rating Scale-Activities of Daily Living (UPDRS-ADL), and Schwab and England ADL scale (SE). Test-retest, inter-rater reliability, and internal consistency were assessed by the intra-class correlation (ICC) and Cronbach α coefficients. Dimensionality was evaluated by factor analysis. Convergent validity was assessed by the SE, Berg Balance Scale (BBS), PDQ-39 and UPDRS-ADL. RESULTS For the 260 participants (187 [71.9%] males; mean [SD] age 60.3 [12.3] years), both the BI and mRS achieved an acceptable level of test-retest and inter-rater reliability (ICC=0.77 to 0.91) in ON and OFF medication phases. The Cronbach α for BI was 0.85 and 0.88, respectively. We found 1 and 2 factors for BI in ON and OFF phases, respectively. Investigation of convergent validity showed moderate to high correlation for the BI with the UPDRS-ADL, SE, PDQ-39 (ADL), BBS and mRS scores in ON and OFF phases (ρ=0.51-0.74) and mRS with SE, UPDRS-ADL, PDQ-39 (ADL) and BBS scores (ρ=0.48-0.82). CONCLUSION The BI and mRS showed acceptable validity and reliability to measure the degree of disability in patients with PD in daily activities in both ON and OFF medication phases.
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Affiliation(s)
- Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Mahsa Meimandi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Sayed Amir Hasan Habibi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Shamsi Jamali
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Arian Dehmiyani
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Siavash Rostami
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Alieh Mahmuodi
- Department of Aging, University of Social Welfare Rehabilitation Sciences, Tehran, Iran
| | - Maryam Mehdizadeh
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Division of Neurology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Holden SK, Medina LD, Hoyt B, Sillau SH, Berman BD, Goldman JG, Weintraub D, Kluger BM. Validation of a performance-based assessment of cognitive functional ability in Parkinson's disease. Mov Disord 2018; 33:1760-1768. [PMID: 30306618 PMCID: PMC6261681 DOI: 10.1002/mds.27487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 08/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outcome measures that capture functional abilities related to cognition offer the potential to demonstrate real-world effectiveness of cognitive-enhancing treatments. However, distinguishing functional disability related to cognition from that attributed to motor symptoms can be difficult in PD. A performance-based functional assessment allows for direct observation of activity of daily living skills and separation of cognitive from motoric disabilities. OBJECTIVES Validate the University of California San Diego Performance-Based Skills Assessment in PD. METHODS One hundred PD participants, ranging from normal cognition to dementia, completed the University of California San Diego Performance-Based Skills Assessment, a performance-based measure of cognitively demanding activities of daily living, as well as a neuropsychological battery and motor examination. Cognitive classification was determined by consensus conference, blinded to University of California San Diego Performance-Based Skills Assessment scores. Psychometric properties of the University of California San Diego Performance-Based Skills Assessment, including internal consistency, test-retest and inter-rater reliability, and discriminant validity for dementia, were examined. RESULTS The University of California San Diego Performance-Based Skills Assessment demonstrated strong internal consistency (Cronbach's α = 0.82) and test-retest reliability (r = 0.89) and correlated strongly with global cognition (Mattis Dementia Rating Scale: r = 0.80; P < 0.001). University of California San Diego Performance-Based Skills Assessment regression models indicated greater contribution from cognitive explanatory variables (marginal partial: R2 = 0.33) than motor variables (marginal partial: R2 = 0.05), controlling for age, education, disease duration, and l-dopa equivalent dose. Additionally, the University of California San Diego Performance-Based Skills Assessment exhibited strong discriminant validity for dementia (area under the curve = 0.91). CONCLUSIONS The University of California San Diego Performance-Based Skills Assessment is a valid measure of functional abilities related to cognition rather than motor symptoms in PD. Furthermore, it reliably distinguishes demented from nondemented participants. The University of California San Diego Performance-Based Skills Assessment may be considered as an outcome measure that combines cognitive and functional abilities in treatment trials for cognitive impairment in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Brian Hoyt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stefan H. Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian D. Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Neurology Section, Denver VA Medical Center, Denver, Colorado, USA
| | - Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson’s Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Weintraub
- Parkinson’s Disease and Mental Illness Research Education, Clinical and Education Centers, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benzi M. Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Mohamed AAB, Mohamed GF, Elnady HM, Sayed MA, Imam AM, Hassan MM, Ahmed SR. Evaluation of dysphagia in different phenotypes of early and idiopathic Parkinsonism. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:28. [PMID: 30416335 PMCID: PMC6208737 DOI: 10.1186/s41983-018-0031-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 10/09/2018] [Indexed: 01/25/2023] Open
Abstract
Background Parkinsonism (PD) is a common neurodegenerative disorders into which dysphagia occurs mainly in the late stage and to a lesser extent in an early stage. Diagnosis of dysphagia particularly in early idiopathic Parkinson's disease (IPD) is important as dysphagia affects the quality of life of patients and most of the patients are unaware of this important symptom. Method Fifty-four patients were enrolled in this study presented with early IPD attending to the outpatient clinic of Sohag University Hospital. All PD patients were assessed by using Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn and Yahr scale. IPD patients were classified into tremor dominant (TD) and postural instability/gait disorder (PIGD) phenotypes. Swallowing disturbance questionnaire (SDQ) and fiberoptic endoscopic evaluation of swallowing (FEES) were used to evaluate dysphagia. Results Thirty-five percent of patients experienced dysphagia when the patients were questioned, and this percent rises to 40% on using FEES. The results of SDQ were significantly correlated to the results of more accurate FEES. The percentage of dysphagia was higher in patients with PIGD than TD phenotype. Dysphagia was significantly associated with the mean of the Mini-Mental State Examination (MMSE), UPDRS, and modified Hoehn and Yahr scale. Conclusions Dysphagia is a prevalent symptom in early IPD and significantly correlated with Parkinsonism phenotype, UPDRS, and modified Hoehn and Yahr scale.
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Affiliation(s)
| | - Gharib Fawi Mohamed
- 1Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Egypt
| | - Hassan Mohamed Elnady
- 1Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Egypt
| | | | - Ahmed Mamdouh Imam
- 2Phoniatric Unit, Faculty of medicine, Department of Otolaryngology, Sohag University, Sohag Governorate, Egypt
| | - Megahed Mohamed Hassan
- 2Phoniatric Unit, Faculty of medicine, Department of Otolaryngology, Sohag University, Sohag Governorate, Egypt
| | - Sherihan Rezk Ahmed
- 1Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Egypt
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11
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Nilashi M, Ibrahim O, Ahmadi H, Shahmoradi L, Farahmand M. A hybrid intelligent system for the prediction of Parkinson's Disease progression using machine learning techniques. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2017.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Holden SK, Finseth T, Sillau SH, Berman BD. Progression of MDS-UPDRS Scores Over Five Years in De Novo Parkinson Disease from the Parkinson's Progression Markers Initiative Cohort. Mov Disord Clin Pract 2017; 5:47-53. [PMID: 29662921 DOI: 10.1002/mdc3.12553] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UDPRS) is a commonly used tool to measure Parkinson disease (PD) progression. Longitudinal changes in MDS-UPDRS scores in de novo PD have not been established. Objective Determine progression rates of MDS-UPDRS scores in de novo PD. Methods 362 participants from the Parkinson's Progression Markers Initiative, a multicenter longitudinal cohort study of de novo PD, were included. Longitudinal progression of MDS-UPDRS total and subscale scores were modeled using mixed model regression. Results MDS-UPDRS scores increased in a linear fashion over five years in de novo PD. MDS-UPDRS total score increased an estimated 4.0 points/year, Part I 0.25 points/year, Part II 1.0 points/year, and Part III 2.4 points/year. Conclusions The expected average progression of MDS-UPDRS scores in de novo PD from this study can assist in clinical monitoring and provide comparative data for detection of disease modification in treatment trials.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Taylor Finseth
- Department of Neurology, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA.,Neurology Section, Denver VA Medical Center, Denver, CO USA
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13
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Chen Y, Gao C, Sun Q, Pan H, Huang P, Ding J, Chen S. MicroRNA-4639 Is a Regulator of DJ-1 Expression and a Potential Early Diagnostic Marker for Parkinson's Disease. Front Aging Neurosci 2017; 9:232. [PMID: 28785216 PMCID: PMC5519626 DOI: 10.3389/fnagi.2017.00232] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023] Open
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disorder and has profound impacts on the daily lives of patients. However, there is a lack of effective biomarkers for early diagnosis, and the mechanisms of PD pathogenesis remain obscure. microRNAs (miRNAs) are post-transcriptional gene regulators and can be easily detected in plasma, which suggests a promising role as diagnostic markers. Here, we aimed to explore a peripheral biomarker, which not only can be applied for early diagnosis of PD but also has the potential to be a therapeutic target. Through miRNA microarray screening and further validation in plasma from 169 sporadic PD patients, 170 healthy controls, and 60 essential tremor (ET) patients, hsa-miR-4639-5p level was identified to be significantly up-regulated in PD patients. Also, it was able to discriminate between early PD patients (disease duration ≤2 years or Hoehn and Yahr stage 1–2.5) and healthy controls. Furthermore, hsa-miR-4639-5p was shown to negatively regulate DJ-1 (PARK7), a well-known PD-related gene, in the post-transcriptional level. Abnormal up-regulation of hsa-miR-4639-5p caused down-regulation of DJ-1 protein level, leading to severe oxidative stress and neuronal death. In conclusion, hsa-miR-4639-5p has the potential to be a peripheral diagnostic biomarker and therapeutic target for early PD.
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Affiliation(s)
- Yimeng Chen
- Laboratory of Neurodegenerative Diseases, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of Chinese Academy of SciencesShanghai, China.,Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China.,Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Chao Gao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China.,School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong UniversityShanghai, China
| | - Qian Sun
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Hong Pan
- Laboratory of Neurodegenerative Diseases, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of Chinese Academy of SciencesShanghai, China.,Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China.,Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Jianqing Ding
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Shengdi Chen
- Laboratory of Neurodegenerative Diseases, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of Chinese Academy of SciencesShanghai, China.,Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China.,Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
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14
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Abu Snineh M, Camicioli R, Miyasaki JM. Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns. Parkinsonism Relat Disord 2017; 39:77-79. [DOI: 10.1016/j.parkreldis.2017.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/23/2017] [Accepted: 03/07/2017] [Indexed: 01/15/2023]
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15
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Tahmasian M, Rochhausen L, Maier F, Williamson KL, Drzezga A, Timmermann L, Van Eimeren T, Eggers C. Impulsivity is Associated with Increased Metabolism in the Fronto-Insular Network in Parkinson's Disease. Front Behav Neurosci 2015; 9:317. [PMID: 26648853 PMCID: PMC4664667 DOI: 10.3389/fnbeh.2015.00317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/08/2015] [Indexed: 12/25/2022] Open
Abstract
Various neuroimaging studies demonstrated that the fronto-insular network is implicated in impulsive behavior. We compared glucose metabolism (as a proxy measure of neural activity) among 24 patients with Parkinson’s disease (PD) who presented with low or high levels of impulsivity based on the Barratt Impulsiveness Scale 11 (BIS) scores. Subjects underwent 18-fluorodeoxyglucose positron emission tomography (FDG-PET) and the voxel-wise group difference of FDG-metabolism was analyzed in Statistical Parametric Mapping (SPM8). Subsequently, we performed a partial correlation analysis between the FDG-metabolism and BIS scores, controlling for covariates (i.e., age, sex, severity of disease and levodopa equivalent daily doses). Voxel-wise group comparison revealed higher FDG-metabolism in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and right insula in patients with higher impulsivity scores. Moreover, there was a positive correlation between the FDG-metabolism and BIS scores. Our findings provide evidence that high impulsivity is associated with increased FDG-metabolism within the fronto-insular network in PD.
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Affiliation(s)
- Masoud Tahmasian
- Department of Neurology, University Hospital of Cologne Cologne, Germany ; Department of Nuclear Medicine, University Hospital of Cologne Cologne, Germany ; Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Luisa Rochhausen
- Department of Neurology, University Hospital of Cologne Cologne, Germany
| | - Franziska Maier
- Department of Neurology, University Hospital of Cologne Cologne, Germany
| | - Kim L Williamson
- Department of Neurology, University Hospital of Cologne Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Cologne Cologne, Germany
| | - Thilo Van Eimeren
- Department of Neurology, University Hospital of Cologne Cologne, Germany ; Department of Nuclear Medicine, University Hospital of Cologne Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Cologne Cologne, Germany
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16
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Mariotti P, Quaranta D, Di Giacopo R, Bentivoglio AR, Mazza M, Martini A, Canestri J, Della Marca G. Rapid eye movement sleep behavior disorder: a window on the emotional world of Parkinson disease. Sleep 2015; 38:287-94. [PMID: 25325501 DOI: 10.5665/sleep.4416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 07/17/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES REM sleep behavior disorder (RBD) is a parasomnia characterized by motor activity during sleep with dream mentation. Aggressiveness has been considered a peculiar feature of dreams associated with RBD, despite normal score in aggressiveness scales during wakefulness. We aimed to measure daytime aggressiveness and analyze dream contents in a population of patients with Parkinson disease (PD) with and without RBD. DESIGN This is a single-center prospective observational study; it concerns the description of the clinical features of a medical disorder in a case series. SETTING The study was performed in the Department of Neurosciences of the Catholic University in Rome, Italy. PATIENTS Three groups of subjects were enrolled: patients with PD plus RBD, patients with PD without RBD, and healthy controls. INTERVENTIONS The diagnosis of RBD was determined clinically and confirmed by means of overnight, laboratory-based video-polysomnography. For the evaluation of diurnal aggressiveness, the Buss-Perry Aggression Questionnaire (BPAQ) was used. The content of dreams was evaluated by means of the methods of Hall and Van De Castle. MEASUREMENTS AND RESULTS Patients with PD without RBD displayed higher levels of anger, and verbal and physical aggressiveness than patients with PD and RBD and controls. Patients with PD and RBD and controls did not differ in hostility. CONCLUSIONS It can be hypothesized that a noradrenergic impairment at the level of the locus coeruleus could, at the same time, explain the presence of RBD, as well as the reduction of diurnal aggressiveness. This finding also suggests a role for REM sleep in regulating homeostasis of emotional brain function.
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Affiliation(s)
- Paolo Mariotti
- Unit of Child Neuropsychiatry, Catholic University, Rome, Italy.,International Psychoanalytical Association and Italian Psychoanalytical Association
| | | | | | | | - Marianna Mazza
- Institute of Psychiatry, Catholic University, Rome, Italy
| | | | - Jorge Canestri
- International Psychoanalytical Association and Italian Psychoanalytical Association
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17
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Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, Tumas V, Fernandes RMF, Eckeli AL. Excessive fragmentary myoclonus in patients with Parkinson’s disease: prevalence and clinico-polysomnographic profile. Sleep Breath 2015; 19:997-1002. [DOI: 10.1007/s11325-014-1098-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/04/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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18
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Objectifying facial expressivity assessment of Parkinson's patients: preliminary study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:427826. [PMID: 25478003 PMCID: PMC4247960 DOI: 10.1155/2014/427826] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/22/2014] [Indexed: 12/02/2022]
Abstract
Patients with Parkinson's disease (PD) can exhibit a reduction of spontaneous facial expression, designated as “facial masking,” a symptom in which facial muscles become rigid. To improve clinical assessment of facial expressivity of PD, this work attempts to quantify the dynamic facial expressivity (facial activity) of PD by automatically recognizing facial action units (AUs) and estimating their intensity. Spontaneous facial expressivity was assessed by comparing 7 PD patients with 8 control participants. To voluntarily produce spontaneous facial expressions that resemble those typically triggered by emotions, six emotions (amusement, sadness, anger, disgust, surprise, and fear) were elicited using movie clips. During the movie clips, physiological signals (facial electromyography (EMG) and electrocardiogram (ECG)) and frontal face video of the participants were recorded. The participants were asked to report on their emotional states throughout the experiment. We first examined the effectiveness of the emotion manipulation by evaluating the participant's self-reports. Disgust-induced emotions were significantly higher than the other emotions. Thus we focused on the analysis of the recorded data during watching disgust movie clips. The proposed facial expressivity assessment approach captured differences in facial expressivity between PD patients and controls. Also differences between PD patients with different progression of Parkinson's disease have been observed.
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19
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Martino DJ, Strejilevich SA, Manes F. Neurocognitive functioning in early-onset and late-onset older patients with euthymic bipolar disorder. Int J Geriatr Psychiatry 2013; 28:142-8. [PMID: 22451354 DOI: 10.1002/gps.3801] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/27/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Most neurocognitive studies have not taken into account the fact that older patients with bipolar disorder (BD) are a heterogeneous population. The main goal of this study was to compare neurocognitive performance and extrapyramidal symptoms in older patients with early-onset BD (EO-BD) and late-onset BD (LO-BD). METHODS Euthymic older patients with EO-BD (n = 20), LO-BD (n = 20), and healthy controls (n = 20) were evaluated with traditional clinical instruments and measures of exposure to psychotropic drugs, as well as extrapyramidal symptoms. All subjects completed an extensive neuropsychological battery. RESULTS Patients with EO-BD showed poorer performance than healthy controls in two measures of verbal memory and two measures of executive functions, whereas patients with LO-BD exhibited lower performance scores than healthy controls in almost all of the measures assessed. Impairments in the LO-BD group included even neurocognitive domains typically spared in mixed-age patients. Additionally, there was a trend toward displaying higher extrapyramidal symptoms in the LO-BD group compared with both EO-BD and healthy control groups. In both patient groups, psychosocial functioning was related with executive dysfunction and extrapyramidal symptoms. CONCLUSIONS Patients with LO-BD may have more extensive and severe cognitive impairments, as well as higher vulnerability to extrapyramidal symptoms, compared with patients with EO-BD. Cognitive-motor disturbances may help to explain impairments in daily functioning among older patients with EO-BD and LO-BD during remission.
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Affiliation(s)
- Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
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20
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Dubayova T, Krokavcova M, Nagyova I, Rosenberger J, Gdovinova Z, Middel B, Groothoff JW, van Dijk JP. Type D, anxiety and depression in association with quality of life in patients with Parkinson’s disease and patients with multiple sclerosis. Qual Life Res 2012; 22:1353-60. [DOI: 10.1007/s11136-012-0257-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
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21
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Dugger BN, Murray ME, Boeve BF, Parisi JE, Benarroch EE, Ferman TJ, Dickson DW. Neuropathological analysis of brainstem cholinergic and catecholaminergic nuclei in relation to rapid eye movement (REM) sleep behaviour disorder. Neuropathol Appl Neurobiol 2012; 38:142-52. [PMID: 21696423 DOI: 10.1111/j.1365-2990.2011.01203.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Rapid eye movement sleep behaviour disorder (RBD) is characterized by loss of muscle atonia during rapid eye movement sleep and is associated with dream enactment behaviour. RBD is often associated with α-synuclein pathology, and we examined if there is a relationship of RBD with cholinergic neuronal loss in the pedunculopontine/laterodorsal tegmental nucleus (PPN/LDT), compared to catecholaminergic neurones in a neighbouring nucleus, the locus coeruleus (LC). METHODS This retrospective study utilized human brain banked tissues of 11 Lewy body disease (LBD) cases with RBD, 10 LBD without RBD, 19 Alzheimer's disease (AD) and 10 neurologically normal controls. Tissues were stained with choline acetyl transferase immunohistochemistry to label neurones of PPN/LDT and tyrosine hydroxylase for the LC. The burden of tau and α-synuclein pathology was measured in the same regions with immunohistochemistry. RESULTS Both the LC and PPN/LDT were vulnerable to α-synuclein pathology in LBD and tau pathology in AD, but significant neuronal loss was only detected in these nuclei in LBD. Greater cholinergic depletion was found in both LBD groups, regardless of RBD status, when compared with normals and AD. There were no differences in either degree of neuronal loss or burden of α-synuclein pathology in LBD with and without RBD. CONCLUSIONS Whether decreases in brainstem cholinergic neurones in LBD contribute to RBD is uncertain, but our findings indicate these neurones are highly vulnerable to α-synuclein pathology in LBD and tau pathology in AD. The mechanism of selective α-synuclein-mediated neuronal loss in these nuclei remains to be determined.
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Affiliation(s)
- B N Dugger
- Department of Pathology and Neuroscience Psychology, Mayo Clinic, Jacksonville, FL 32224, USA
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22
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Mittermeyer G, Christine CW, Rosenbluth KH, Baker SL, Starr P, Larson P, Kaplan PL, Forsayeth J, Aminoff MJ, Bankiewicz KS. Long-term evaluation of a phase 1 study of AADC gene therapy for Parkinson's disease. Hum Gene Ther 2012; 23:377-81. [PMID: 22424171 DOI: 10.1089/hum.2011.220] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the results of a long-term follow-up of subjects in a phase 1 study of AAV2-hAADC (adeno-associated virus type 2-human aromatic L-amino acid decarboxylase) gene therapy for the treatment of Parkinson's disease (PD). Ten patients with moderately advanced PD received bilateral putaminal infusions of either a low or a high dose of AAV2-hAADC vector. An annual positron emission tomography (PET) imaging with [(18)F]fluoro-L-m-tyrosine tracer was used for evaluation of AADC expression, and a standard clinical rating scale [Unified Parkinson's Disease Rating Scale (UPDRS)] was used to assess effect. Our previous analysis of the 6-month data suggested that this treatment was acutely safe and well tolerated. We found that the elevated PET signal observed in the first 12 months persisted over 4 years in both dose groups. A significantly increased PET value compared with the presurgery baseline was maintained over the 4-year monitoring period. The UPDRS in all patients off medication for 12 hr improved in the first 12 months, but displayed a slow deterioration in subsequent years. This analysis demonstrates that apparent efficacy continues through later years with an acceptable safety profile. These data indicate stable transgene expression over 4 years after vector delivery and continued safety, but emphasize the need for a controlled efficacy trial and the use of a higher vector dose.
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Affiliation(s)
- Gabriele Mittermeyer
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
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Hauser RA, Lyons KE, Pahwa R. The UPDRS-8: a brief clinical assessment scale for Parkinson's disease. Int J Neurosci 2012; 122:333-7. [PMID: 22329569 DOI: 10.3109/00207454.2012.657381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We evaluated a brief, 8-item version of the Unified Parkinson's Disease Rating Scale (UPDRS) using two existing patient databases. One database included 1,445 PD patients. Spearman correlation between UPDRS-8 motor scores and full UPDRS motor scores was .765 (p < .001). Correlation between total UPDRS-8 scores and full UPDRS total scores (parts I-III) was .798 (p < .001). Correlation between total UPDRS-8 scores and total 39-item PD questionnaire (PDQ-39) scores was .629 (p < .001). In 177 patients undergoing deep brain stimulation (DBS), UPDRS-8 motor scores were similarly significantly sensitive to change as full UPDRS motor scores in assessing change from the medication OFF state to the medication ON state at baseline and from the medication OFF state at baseline to the medication OFF/stimulation ON state 1 year post-DBS. The UPDRS-8 focuses on items that are most relevant for clinical decision making. In this study, the UPDRS-8 exhibited good correlation with the full UPDRS and the PDQ-39. We therefore believe that it can provide a useful, rapid assessment of PD patients in clinical practice. Whether it might be useful in clinical trials depends on demonstrating that it is also sensitive to relatively small changes in clinical status.
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Affiliation(s)
- Robert A Hauser
- Departments of Neurology, Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, USA.
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Archer T, Kostrzewa RM, Beninger RJ, Palomo T. Staging neurodegenerative disorders: structural, regional, biomarker, and functional progressions. Neurotox Res 2011; 19:211-34. [PMID: 20393891 DOI: 10.1007/s12640-010-9190-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 03/02/2010] [Accepted: 03/30/2010] [Indexed: 12/11/2022]
Abstract
The notion of staging in the neurodegenerative disorders is modulated by the constant and progressive loss of several aspects of brain structural integrity, circuitry, and neuronal processes. These destructive processes eventually remove individuals' abilities to perform at sufficient and necessary functional capacity at several levels of disease severity. The classification of (a) patients on the basis of diagnosis, risk prognosis, and intervention outcome, forms the basis of clinical staging, and (b) laboratory animals on the basis of animal model of brain disorder, extent of insult, and dysfunctional expression, provides the components for the clinical staging and preclinical staging, respectively, expressing associated epidemiological, biological, and genetic characteristics. The major focus of clinical staging in the present account stems from the fundamental notions of Braak staging as they describe the course and eventual prognosis for Alzheimer's disease, Lewy Body dementia, and Parkinson's disease. Mild cognitive impairment, which expresses the decline in episodic and semantic memory performance below the age-adjusted normal range without marked loss of global cognition or activities of daily living, and the applications of longitudinal magnetic resonance imaging, major instruments for the monitoring of either disease progression in dementia, present important challenges for staging concepts. Although Braak notions present the essential basis for further developments, current staging conceptualizations seem inadequate to comply with the massive influx of information dealing with neurodegenerative processes in brain, advanced both under clinical realities, and discoveries in the laboratory setting. The contributions of various biomarkers of disease progression, e.g., amyloid precursor protein, and neurotransmitter system imbalances, e.g., dopamine receptor supersensitivity and interactive propensities, await their incorporation into the existing staging models thereby underlining the ongoing, dynamic feature of the staging of brain disorders.
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Affiliation(s)
- Trevor Archer
- Department of Psychology, University of Gothenburg, Box 500, SE-405 30 Gothenburg, Sweden.
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25
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Sage MD, Johnston RE, Almeida QJ. Comparison of exercise strategies for motor symptom improvement in Parkinson’s disease. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aims: To evaluate the effectiveness of four exercise interventions on motor symptoms of Parkinson’s disease (PD). Materials and methods: This was a quasi-experimental trial with 89 participants assigned to one of four exercise programs (aquatic, aerobic, strength and sensory attention-focused exercise) or a control group. All groups were assessed by a blinded evaluator with the Unified Parkinson’s Disease Rating Scale (UPDRS III) motor section before exercises began (pre-test), immediately following exercise (post-test) and a subgroup was followed for a 6-week nonexercise washout period (washout). Results: Only sensory attention-focused exercise resulted in significant symptomatic improvement relative to nonexercising control participants. The sensory (6.7 points) and strength training (5.5 points) groups also had significant UPDRS III reductions from pre- to post-exercise. These benefits were not maintained after the washout period. Conclusion: Of the exercise modalities tested, sensory attention-focused exercise and strength training were the most effective strategies for individuals with PD. Future randomized trials are needed to confirm these results and compare other promising strategies aimed at specific pathophysiological deficits of PD.
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Affiliation(s)
- Michael D Sage
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Canada
| | - Rose E Johnston
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Canada
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SPES/SCOPA and MDS-UPDRS: Formulas for converting scores of two motor scales in Parkinson’s disease. Parkinsonism Relat Disord 2011; 17:632-4. [DOI: 10.1016/j.parkreldis.2011.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/09/2011] [Accepted: 05/26/2011] [Indexed: 11/20/2022]
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Buccino G, Gatti R, Giusti MC, Negrotti A, Rossi A, Calzetti S, Cappa SF. Action observation treatment improves autonomy in daily activities in Parkinson's disease patients: results from a pilot study. Mov Disord 2011; 26:1963-4. [PMID: 21547952 DOI: 10.1002/mds.23745] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 02/06/2011] [Accepted: 03/15/2011] [Indexed: 11/09/2022] Open
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28
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Evans JR, Barker RA. Defining meaningful outcome measures in trials of disease-modifying therapies in Parkinson's disease. Expert Opin Pharmacother 2011; 12:1249-58. [PMID: 21345151 DOI: 10.1517/14656566.2011.548807] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Murray ME, Senjem ML, Petersen RC, Hollman JH, Preboske GM, Weigand SD, Knopman DS, Ferman TJ, Dickson DW, Jack CR. Functional impact of white matter hyperintensities in cognitively normal elderly subjects. ACTA ACUST UNITED AC 2010; 67:1379-85. [PMID: 21060015 DOI: 10.1001/archneurol.2010.280] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the impact white matter hyperintensities (WMH) detected on magnetic resonance imaging have on motor dysfunction and cognitive impairment in elderly subjects without dementia. DESIGN Cross-sectional study. SETTING Population-based study on the incidence and prevalence of cognitive impairment in Olmsted County, Minnesota. PARTICIPANTS A total of 148 elderly subjects (65 men) without dementia ranging in age from 73 to 91 years. MAIN OUTCOME MEASURES We measured the percentage of the total white matter volume classified as WMH in a priori-defined brain regions (ie, frontal, temporal, parietal, occipital, periventricular, or subcortical). Motor impairment was evaluated qualitatively using the Unified Parkinson's Disease Rating Scale summary measures of motor skills and quantitatively using a digitized portable walkway system. Four cognitive domains were evaluated using z scores of memory, language, executive function, and visuospatial reasoning. RESULTS A higher WMH proportion in all regions except the occipital lobe was associated with lower executive function z score (P value <.01). A higher WMH proportion in all regions, but most strongly for the parietal lobe, correlated with higher Unified Parkinson's Disease Rating Scale gait, posture, and postural stability sum (P value <.01). A higher WMH proportion, whether periventricular, subcortical, or lobar, correlated with reduced velocity (P value <.001). CONCLUSIONS We conclude that executive function is the primary cognitive domain affected by WMH burden. The data suggest that WMH in the parietal lobe are chiefly responsible for reduced balance and postural support compared with the other 3 lobes and may alter integration of sensory information via parietal lobe dysfunction in the aging brain. Parietal white matter changes were not the predominant correlate with motor speed, lending evidence to a global involvement of neural networks in gait velocity.
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Affiliation(s)
- Melissa E Murray
- Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, Florida, USA
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Siddiqui MS, Fernandez HH, Garvan CW, Kirsch-Darrow L, Bowers D, Rodriguez RL, Jacobson CE, Rosado C, Vaidyanathan S, Foote KD, Okun MS. Inappropriate crying and laughing in Parkinson disease and movement disorders. World J Biol Psychiatry 2010; 10:234-40. [PMID: 18609421 DOI: 10.1080/15622970701639445] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine in a pilot study inappropriate crying and laughing (also termed pseudobulbar affect (PBA)) and underlying mood disturbances in a large clinic based population of Parkinson's disease and movement disorder patients. BACKGROUND PBA is characterized by uncontrollable laughter without mirth, or alternatively crying without the feeling of sadness. It is a common condition affecting more than one million people with neurological diseases. While PBA has been studied in many neurological diseases, little is known about its prevalence in movement disorders, or its relationship to more chronic mood disturbances. We carried out this pilot study to examine this relationship. METHODS Seven hundred and nineteen out of 860 consecutive patients who visited our Movement Disorders Center met inclusion criteria (i.e. > or = 18 years of age, formal diagnosis by a movement disorder specialist, completion of PBA questionnaire, and absence of brain surgery including deep brain stimulation). All subjects were interviewed for symptoms of PBA during their visit. In addition, 661 of these patients completed both the Visual Analog Mood Scale (VAMS) and Beck Depression Inventory I (BDI-I). RESULTS Thirty-seven of the 719 reported PBA symptoms; 75.7% (28/37) had pathological 'crying', 13.5% (5/37) had pathological 'laughing' and 10.8% (4/37) had both. The prevalence of PBA in individual diagnostic categories was: 4.7% (18/387) of idiopathic Parkinson's disease (PD), 2.7% (2/74) of primary dystonia, 3.1% (2/65) of essential tremor (ET), 7.8% (8/108) of patients with other forms of Parkinsonism, 21.7% (5/23) of psychogenic movement disorders, 0% (0/18) of patients with combined PD and ET, and 4.5% (2/44) of other movement disorders. Patients with PBA had a higher total BDI score (P=0.0278) and VAMS 'tiredness' score (P=0.0109). In patients on antidepressant therapy the prevalence of PBA was 7.1% compared to 2.7% in the group not on therapy (P=0.0094). CONCLUSION PBA was present in most movement disorders, but especially prevalent in parkinsonism. PBA patients in this cohort had more chronic depressive symptoms and tiredness.
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Affiliation(s)
- Mustafa S Siddiqui
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Abstract
Parkinson disease (PD) is a progressive neurologic condition that causes motor and nonmotor manifestations. Treatment provides symptomatic benefit but no current treatment has been proven to slow disease progression. Research studies of PD require a means of rating the severity of disease by measurement of motor manifestations, assessment of ability to perform daily functional activities, and symptomatic response to medication. The most common rating scales are the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr staging, and the Schwab and England rating of activities of daily living. Each of these rating scales are described, including detailed instructions on how to implement these ratings. Although these are the most widely applied rating scales of PD, there are still substantial limitations to these scales that must be considered when using them for research. Finally, some common applications of these scales are described.
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Affiliation(s)
- Joel S Perlmutter
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Dubayova T, Nagyova I, Havlikova E, Rosenberger J, Gdovinova Z, Middel B, van Dijk JP, Groothoff JW. The association of type D personality with quality of life in patients with Parkinson's disease. Aging Ment Health 2009; 13:905-12. [PMID: 19888711 DOI: 10.1080/13607860903046529] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. Type D personality is characterized by ineffective coping strategies that reduce QoL in patients with coronary heart disease. The aim of this study was to evaluate whether Type D personality also predicts QoL in patients with Parkinson's disease (PD). In addition, gender differences in Type D personalities are explored. METHODS The sample consisted of 153 PD patients (51.4% males; mean age 67.9 +/- 9.3 years). DS-14 was used to measure Type D personality, negative affectivity (NA) and social inhibition (SI). The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL, and the Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess functional status. The regression model consisted of disease severity, disease duration, age and DS-14 and its two scales (NA and SI). RESULTS Type D is negatively associated with overall QoL in PD patients and most subscales of the PDQ-39. Type D explained emotional well-being in both genders but was significant in the models for stigma, cognition, and communication only in men. NA and SI played a less important role in women in comparison with men. CONCLUSION Type D personality is an important part of the QoL model in PD patients of both genders, especially in the NA scale. The gender differences suggest that male and female PD patients require different coping strategies.
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Affiliation(s)
- Tatiana Dubayova
- Department of Neurology, Medical Faculty, University of PJ Safarik, Kosice, Slovakia.
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Christine CW, Starr PA, Larson PS, Eberling JL, Jagust WJ, Hawkins RA, VanBrocklin HF, Wright JF, Bankiewicz KS, Aminoff MJ. Safety and tolerability of putaminal AADC gene therapy for Parkinson disease. Neurology 2009; 73:1662-9. [PMID: 19828868 DOI: 10.1212/wnl.0b013e3181c29356] [Citation(s) in RCA: 297] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In Parkinson disease (PD), the benefit of levodopa therapy becomes less marked over time, perhaps because degeneration of nigrostrial neurons causes progressive loss of aromatic l-amino acid decarboxylase (AADC), the enzyme that converts levodopa into dopamine. In a primate model of PD, intrastriatal infusion of an adeno-associated viral type 2 vector containing the human AADC gene (AAV-hAADC) results in robust response to low-dose levodopa without the side effects associated with higher doses. These data prompted a clinical trial. METHODS Patients with moderately advanced PD received bilateral intraputaminal infusion of AAV-hAADC vector. Low-dose and high-dose cohorts (5 patients in each) were studied using standardized clinical rating scales at baseline and 6 months. PET scans using the AADC tracer [(18)F]fluoro-L-m-tyrosine (FMT) were performed as a measure of gene expression. RESULTS The gene therapy was well tolerated, but 1 symptomatic and 2 asymptomatic intracranial hemorrhages followed the operative procedure. Total and motor rating scales improved in both cohorts. Motor diaries also showed increased on-time and reduced off-time without increased "on" time dyskinesia. At 6 months, FMT PET showed a 30% increase of putaminal uptake in the low-dose cohort and a 75% increase in the high-dose cohort. CONCLUSION This study provides class IV evidence that bilateral intrastriatal infusion of adeno-associated viral type 2 vector containing the human AADC gene improves mean scores on the Unified Parkinson's Disease Rating Scale by approximately 30% in the on and off states, but the surgical procedure may be associated with an increased risk of intracranial hemorrhage and self-limited headache.
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Affiliation(s)
- C W Christine
- Department of Neurology, University of California, San Francisco, CA 94143-0114, USA
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van Rooden SM, Visser M, Verbaan D, Marinus J, van Hilten JJ. Motor patterns in Parkinson's disease: a data-driven approach. Mov Disord 2009; 24:1042-7. [PMID: 19353712 DOI: 10.1002/mds.22512] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To identify patterns of motor disturbances in Parkinson's disease (PD) and evaluate their relation with other PD domains. A cohort of 399 PD patients was randomly divided into two samples. Factors within the motor section of the SPES/SCOPA were identified by exploratory factor analysis on data from the first sample and next tested by confirmatory factor analysis in the second sample. Relations with other PD domains were evaluated by regression analyses. A four factor model was found to be valid. This included a tremor, a bradykinetic-rigid, and two axial factors. One axial factor ("rise", "gait", "postural instability") was associated with age and cognition, while the other axial factor ("freezing", "speech", "swallowing") was related to dopaminergic medication and complications of therapy. Both other factors showed no relevant associations with demographic and clinical characteristics. The identification of motor factors and their relation with other domains of the disease may help to elucidate the mechanisms responsible for these associations and provide an objective base for further research on subtypes in PD.
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Montes J, Gordon AM, Pandya S, De Vivo DC, Kaufmann P. Clinical outcome measures in spinal muscular atrophy. J Child Neurol 2009; 24:968-78. [PMID: 19509409 DOI: 10.1177/0883073809332702] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spinal muscular atrophy is one of the most devastating neurological diseases of childhood. Affected infants and children suffer from often severe muscle weakness caused by degeneration of lower motor neurons in the spinal cord and brainstem. Identification of the causative genetic mutation in most cases has resulted in development of potential treatment strategies. To test these new drugs, clinically feasible outcomes are needed. Several different assessments, validated in spinal muscular atrophy or similar disorders, are being used by national and international research groups; however, their sensitivity to detect change is unknown. Acceptance of a few standardized, easily administered, and functionally meaningful outcomes, applicable to the phenotypic spectrum of spinal muscular atrophy, is needed. Consensus is imperative to facilitate collaboration and explore the ability of these measures to identify the therapeutic effect of disease-modifying agents. Following is an evidence-based review of available clinical outcome measures in spinal muscular atrophy.
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Affiliation(s)
- Jacqueline Montes
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA.
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Christine CW, Langston JW, Turner RS, Starr PA. The neurophysiology and effect of deep brain stimulation in a patient with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced parkinsonism. J Neurosurg 2009; 110:234-8. [PMID: 19099380 DOI: 10.3171/2008.8.jns08882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Parkinsonism caused by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) exposure was first identified in intravenous drug users. This neurotoxicant has since been used extensively in nonhuman primates to induce an experimental model of Parkinson disease (PD). In this study, the authors examined the intraoperative physiological characteristics and efficacy of subthalamic nucleus deep brain stimulation (DBS) in 1 of only 4 known living patients with MPTP-induced parkinsonism. The physiological recordings were consistent with recordings from MPTP-treated primates and humans with PD, thus providing further validation for the MPTP model in the study of the neurophysiology of the nigrostriatal dopaminergic deficit in PD. Furthermore, DBS produced a significant clinical improvement in this patient similar to the improvement seen after DBS in patients with idiopathic PD. This unique case has important implications for translational research that employs the MPTP-primate model for symptomatic therapy in PD.
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Dubayova T, Nagyova I, Havlikova E, Rosenberger J, Gdovinova Z, Middel B, van Dijk JP, Groothoff JW. Neuroticism and extraversion in association with quality of life in patients with Parkinson's disease. Qual Life Res 2008; 18:33-42. [PMID: 18989757 DOI: 10.1007/s11136-008-9410-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 10/15/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. The aim of this study is to explore whether neuroticism and extraversion contribute to the variance in QoL in patients with Parkinson's disease (PD) when controlled for age, functional status and disease duration. METHODS The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL and the Unified Parkinson's Disease Rating Scale (UPDRS) for disease severity. Neuroticism and extraversion were measured with the Eysenck Personality Questionnaire (EPQR-A). Multiple linear regression analysis was then used to assess the contribution of neuroticism and extraversion to QoL. RESULTS The sample consisted of 153 PD patients (48.4% women; 67.9 +/- 9.3 years; mean disease duration 7.5 +/- 5.8 years). Neuroticism was, after disease severity, the second most important variable associated with QoL in PD patients, in particular for domains associated with psychological processes: emotional well-being, social support, stigma and communication. A higher score in extraversion was significantly associated with better emotional well-being in males, but surprisingly, with worse emotional well-being in females. CONCLUSIONS After functional status, personality traits were clearly associated with QoL in PD patients. Therefore, they should be taken into account by health-care professionals in their appraisal of patient complaints.
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Affiliation(s)
- Tatiana Dubayova
- Kosice Institute for Society and Health, P. J. Safarik University, Kosice, Slovakia.
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Haaxma CA, Bloem BR, Borm GF, Horstink MW. Comparison of a timed motor test battery to the Unified Parkinson's Disease Rating Scale-III in Parkinson's disease. Mov Disord 2008; 23:1707-17. [DOI: 10.1002/mds.22197] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 2008; 88:733-46. [PMID: 18356292 DOI: 10.2522/ptj.20070214] [Citation(s) in RCA: 541] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Distinguishing between a clinically significant change and change due to measurement error can be difficult. The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale (BBS), forward and backward functional reach, the Romberg Test and the Sharpened Romberg Test (SRT) with eyes open and closed, the Activities-specific Balance Confidence (ABC) Scale, the Six-Minute Walk Test (6MWT), comfortable and fast gait speed, the Timed "Up & Go" Test (TUG), the Medical OUTCOMES Study 36-Item Short-Form Health Survey (SF-36), and the Unified Parkinson Disease Rating Scale (UPDRS) in people with parkinsonism. SUBJECTS Thirty-seven community-dwelling adults with parkinsonism (mean age=71 years) participated. The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale; however, the scores ranged from 1 to 4. METHODS Subjects were tested twice by the same raters, with 1 week between tests. Test-retest reliability was calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated using a 95% confidence interval (MDC(95)). RESULTS The ICCs for test-retest reliability were above .90 for the BBS, ABC Scale, SRT with eyes closed, 6MWT, and comfortable and fast gait speeds. The MDC(95) values for those functional tests were: BBS=5/56, ABC Scale=13%, SRT with eyes closed=19 seconds, 6MWT=82 m, comfortable gait speed=0.18 m/s, and fast gait speed=0.25 m/s. The ICCs for test-retest reliability of SF-36 scores were above .80, with the exception of the social functioning subscale. The MDC(95) values for the SF-36 ranged between 19% and 45%. The MDC(95) values for the UPDRS Activities of Daily Living section, Motor Examination section, and total scores were 4/52, 11/108, and 13/176, respectively. DISCUSSION AND CONCLUSION Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinically significant. High test-retest reliability of scores for the BBS, ABC Scale, SRT with eyes closed, 6MWT, and gait speed make them trustworthy functional assessments in people with parkinsonism. The SF-36 and UPDRS provide quality-of-life and disease severity rating values in the ongoing assessment of people with parkinsonism.
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Leinweber B, Möller JC, Scherag A, Reuner U, Günther P, Lang CJG, Schmidt HHJ, Schrader C, Bandmann O, Czlonkowska A, Oertel WH, Hefter H. Evaluation of the Unified Wilson's Disease Rating Scale (UWDRS) in German patients with treated Wilson's disease. Mov Disord 2008; 23:54-62. [PMID: 17960799 DOI: 10.1002/mds.21761] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Wilson's disease (WD) is an inherited autosomal-recessive disorder of copper metabolism characterized by a wide variety of neurological, hepatic, and psychiatric symptoms. The aim of the present study was the development and evaluation of a clinical rating scale, termed Unified Wilson's Disease Rating Scale (UWDRS), to assess the whole spectrum of clinical symptoms in WD. Altogether 107 patients (mean age 37.6 +/- 11.9 years; 46 male, 61 female) with treated WD participated in the study. Cronbach's alpha as a measure of the internal consistency for the entire scale was 0.92, whereas the intraclass correlation coefficient (ICC) was 0.98 (confidence interval (CI(95%)) 0.97-0.99), indicating an excellent interrater reliability as determined in 32 patients. Besides the total score was significantly correlated with the earning capacity of the patients as indicated by an estimated Spearman's rho approximately 0.54 (CI(95%) 0.40-0.69, P < 0.001). In summary, the UWDRS appears to be a promising tool to assess the disease severity in WD. Its usefulness in clinical research and drug trials should be further addressed.
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Martino DJ, Igoa A, Marengo E, Scápola M, Ais ED, Strejilevich SA. Cognitive and motor features in elderly people with bipolar disorder. J Affect Disord 2008; 105:291-5. [PMID: 17573121 DOI: 10.1016/j.jad.2007.05.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 04/29/2007] [Accepted: 05/15/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although elderly people will represent one third of the bipolar population in a few years, data about cognitive and motor features in these patients are very scarce. The aim of this study was to compare the cognitive and motor functioning between elderly euthymic patients with bipolar disorder (BD) and healthy controls, as well as to determine the degree of correlation with psychosocial functioning. METHODS Euthymic older adults with BD (n=20) and healthy controls (n=20) were evaluated with traditional clinical instruments and measures of exposure to psychotropic drugs and extrapyramidal symptoms. All subjects completed an extensive neuropsychological battery. RESULTS Patients with BD had more extrapyramidal symptoms and worse performance than healthy controls in psychomotor speed, verbal memory, and executive functions even after controlling sub-clinical symptomatology. These findings were not associated with age at onset or length of illness or with current pharmacological exposure. Psychosocial functioning correlated negatively with performance in psychomotor speed and executive function, and with extrapyramidal symptoms. LIMITATIONS The small sample size and cross-sectional design. CONCLUSIONS Older adult patients with BD in a euthymic state could have a similar cognitive and motor profile to that described in younger euthymic bipolar patients. Cognitive-motor disturbances may help to explain impairments in daily functioning among elderly patients with bipolar disorder during remission.
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Affiliation(s)
- Diego J Martino
- Favaloro Foundation, Neurosciences Institute, Bipolar Disorders Program, 1428 Ciudad de Buenos Aires, Argentina.
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Haffenden A, Khan U, Kiss ZHT, Suchowersky O. Surgery for Parkinson's disease improves disability but not impairment components of the UPDRS-II. Parkinsonism Relat Disord 2007; 13:399-405. [PMID: 17368072 DOI: 10.1016/j.parkreldis.2007.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/02/2007] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
The Unified Parkinson's Disease Rating Scale (UPDRS) activities of daily living (ADL) items have been described as reflecting both disability (true ADL items) and impairment (rather than ADLs). As a result of combining these scores, UPDRS part II scores may not accurately reflect the impact of surgery on ADLs [Hariz G.M., Lindberg M., Hariz M.I., Bergenheim A.T. Does the ADL part of the unified Parkinson's disease rating scale measure ADL? An evaluation in patients after pallidotomy and thalamic deep brain stimulation. Mov Disord 2003;18:373-81.]. The goal of the present study was to assess the metric properties of the ADL section of the UPDRS in terms of its ability to measure surgical change. We tested the effects of unilateral pallidotomy (N=14) and bilateral subthalamic nucleus (STN) DBS (N=11) on both disability and impairment components of the UPDRS-II at uniform follow-up assessment periods of 6 months and 1 year, with a subset of pallidotomy patients (N=9) re-assessed at 2 years. Across the follow-up periods in both patient groups, items identified as best reflecting disability showed significant improvement from pre-surgical levels, whereas items representing impairment showed no overall change. Consistent with this, change in total ADL scores was tempered by the inclusion of the impairment items. Because the measurement of a patient's functional status is important in determining the effectiveness of an intervention, analysis of appropriate items from the UPDRS ADL section is imperative.
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Affiliation(s)
- A Haffenden
- Movement Disorders and Therapeutic Brain Stimulation Program, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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Högl B, Gschliesser V. RLS assessment and sleep questionnaires in practice – Lessons learned from Parkinson’s disease. Sleep Med 2007; 8 Suppl 2:S7-12. [PMID: 17567533 DOI: 10.1016/j.sleep.2007.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In recent years, a whole range of interesting and useful scales have been made available for the assessment of patients with restless legs syndrome (RLS). These can be more or less divided into severity scales (IRLS, RLS-6, JHSS), quality of life scales, and instruments for specific details (e.g. to improve diagnostic accuracy; RLS-DI), or to assess the presence and severity of augmentation (ASRS, SIDA). This manuscript reviews these scales, their specific strengths and weaknesses, validation status and results of their use in RLS populations. Specific scales are already well established in Parkinson's disease, and a more widespread and frequent use of scales and questionnaires will also enhance clinical care and long-term monitoring of patients with RLS.
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Martínez‐Martín P, Cubo E. Scales to measure parkinsonism. HANDBOOK OF CLINICAL NEUROLOGY 2007; 83:289-327. [DOI: 10.1016/s0072-9752(07)83012-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Phoenix C, Schaefer AM, Elson JL, Morava E, Bugiani M, Uziel G, Smeitink JA, Turnbull DM, McFarland R. A scale to monitor progression and treatment of mitochondrial disease in children. Neuromuscul Disord 2006; 16:814-20. [PMID: 17123819 DOI: 10.1016/j.nmd.2006.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 07/26/2006] [Accepted: 08/04/2006] [Indexed: 11/26/2022]
Abstract
Mitochondrial diseases affect all age groups, but those with childhood onset often seem to experience the greatest burden of disability. In some paediatric patients this can be explained by a cumulative disability acquired over many years. In others, additional factors, including the nature and severity of the molecular defect, must be considered. To date, no large-scale studies have attempted to document the natural history of paediatric mitochondrial disease. This is in part at least, because no assessment tool has been available to plot the temporal course of a disease with such a diverse clinical spectrum. This paper describes how a practical and semi-quantitative rating scale has been devised for children with mitochondrial disease, the Newcastle paediatric mitochondrial disease scale (NPMDS). The scale is multi-dimensional and reproducible, offering a tool through which mitochondrial disease progression can be objectively monitored. We anticipate that use of this tool will facilitate both longitudinal natural history studies and the assessment of future therapeutic interventions.
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Affiliation(s)
- C Phoenix
- Mitochondrial Research Group, 4th Floor, The Medical School, Framlington Place, University of Newcastle upon Tyne, UK
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Martinez-Martin P, Prieto L, Forjaz MJ. Longitudinal metric properties of disability rating scales for Parkinson's disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2006; 9:386-93. [PMID: 17076869 DOI: 10.1111/j.1524-4733.2006.00131.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES This study analyzes the longitudinal metric attributes of three Parkinson's disease (PD) disability scales, taking Hoehn and Yahr (HY) staging as the reference measure of PD progression. METHODS A sample of 87 PD patients was assessed during regular medical visits, using the HY, the Unified Parkinson's Disease Rating Scale--Activities of Daily Living Section (UPDRS-ADL), the Schwab and England Scale (SES), and the Intermediate Scale for Assessment of PD (ISAPD), across a follow-up period of 2.6 +/- 1.0 years. RESULTS The following cross-sectional attributes were analyzed, at baseline and again on conclusion of the study: floor and ceiling effects, convergent validity, reliability, and standard error of measurement, all of which were found to be adequate. Longitudinal reproducibility values (intraclass correlation coefficient) were 0.81 (ISAPD) to 0.84 (UPDRS-ADL). Insofar as longitudinal validity was concerned, the change scores of the three disability scales correlated significantly with the HY change score, absolute value r = 0.33 to 0.45, P < 0.003. Slightly lower values were found when taking the annual rate of change, absolute value r = 0.20 to 0.36. The three scales were acceptable, even though there were small differences among them. The "minimal clinically important difference" proposed for these scales is: SES, -6; UPDRS-ADL, +2; ISAPD, +1.5 points. CONCLUSIONS The three scales proved adequate for longitudinal assessment of PD disability. UPDRS-ADL was more precise and ISAPD more consistent. Magnitude of change and correlation with change in HY were slightly higher with the ISAPD. Effect size and standardized response mean for the minimal change in HY were higher for the UPDRS-ADL.
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Affiliation(s)
- Pablo Martinez-Martin
- Unit of Neuroepidemiology, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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Forjaz MJ, Martinez-Martin P. Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: Part II, construct and content validity. Mov Disord 2006; 21:1892-8. [PMID: 16958134 DOI: 10.1002/mds.21071] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article is the second of a two-part series concerning the metric properties of the following three Parkinson's disease (PD) scales: modified Hoehn and Yahr staging (H&Y), Schwab and England (S&E), and Unified Parkinson's Disease Rating Scale (UPDRS) 3.0. Part II focuses on construct and content validity. To assess construct validity, a sample of 1,136 PD patients completed the above-mentioned PD scales. Correlation coefficients between measures of disability and dysfunction [S&E, UPDRS Activities of Daily Living (ADL), and UPDRS Motor Examination] were |r| = 0.69-0.77, indicating good convergent validity. Results showed that the S&E (F(5,945) = 193.47; P < 0.0001) and UPDRS subscales discriminated between modified H&Y stages (F(20,2784) = 25.28; P < 0.001). A panel of 12 to 13 international experts rated the relevance of the scales and items. This enabled the scales' content validity index to be calculated, which ranged from 41.7% (UPDRS Mentation) to 83.3% (UPDRS Motor Examination). In conclusion, while the modified H&Y, S&E, and UPDRS displayed satisfactory construct validity, the content validity of all scales except UPDRS Motor Examination failed to attain adequate standards.
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Affiliation(s)
- Maria João Forjaz
- Neuroepidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
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Visser M, Marinus J, Stiggelbout AM, van Hilten JJ. Responsiveness of impairments and disabilities in Parkinson's disease. Parkinsonism Relat Disord 2006; 12:314-8. [PMID: 16621658 DOI: 10.1016/j.parkreldis.2006.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 01/19/2006] [Indexed: 10/24/2022]
Abstract
The objective of this study is to evaluate the responsiveness of items of the Activities of Daily Living (ADL) and Motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) in patients with Parkinson's Disease (PD). A standardized Response Mean (SRM) per item was calculated using data of four trials (n=376) that randomised patients with early PD to dopamine agonist (DA) monotherapy or placebo. In the ADL section, the SRMs ranged from -0.04 (no effect) to -0.50 (moderate effect). Hand functions were the most responsive ADL items with 'handwriting' showing the largest response. Self-assessed symptoms were the least responsive. In the Motor section, SRMs ranged from -0.09 to -0.60 with bradykinesia items showing the largest response, especially the item 'finger taps'. The tremor items showed the smallest response, however, rest tremor arms was much more responsive than rest tremor of the head and legs or postural tremor. SRMs in the placebo group ranged from 0.08 to -0.21 in the ADL section and from 0.03 to -0.35 in the Motor section. ADL and motor items have comparable and mostly small effect sizes. The most responsive items are in the ADL section hand functions and in the Motor section bradykinesia items. A more responsive ADL section would omit the self-assessed symptoms and the Motor section would retain only rest tremor arms of the tremor items.
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Affiliation(s)
- M Visser
- Department of Neurology, K5 Q 92, Leiden University Medical Centre, P.O. Box 9600, NL-2300 RC Leiden, The Netherlands.
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Post B, Merkus MP, de Bie RMA, de Haan RJ, Speelman JD. Unified Parkinson's disease rating scale motor examination: are ratings of nurses, residents in neurology, and movement disorders specialists interchangeable? Mov Disord 2006; 20:1577-84. [PMID: 16116612 DOI: 10.1002/mds.20640] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The Unified Parkinson's Disease Rating Scale (UPDRS) is widely used for the clinical evaluation of Parkinson's disease (PD). We assessed the rater variability of the UPDRS Motor examination (UPDRS-ME) of nurse practitioners, residents in neurology, and a movement disorders specialist (MDS) compared to a senior MDS. We assessed the videotaped UPDRS-ME of 50 PD patients. Inter-rater and intra-rater variability were estimated using weighted kappa (kappa(w)) and intraclass correlation coefficients (ICC). Additionally, inter-rater agreement was quantified by calculation of the mean difference between 2 raters and its 95% limits of agreement. Intra-rater agreement was also estimated by calculation of a 95% repeatability limits. The kappa(w) and ICC statistics indicated good to very good inter-rater and intra-rater reliability for the majority of individual UPDRS items and the sum score of the UPDRS-ME in all raters. However, for inter-rater agreement, it appeared that both nurses, residents, and the MDS consistently assigned higher scores than the senior MDS. Mean differences ranged between 1.7 and 5.4 (all differences P < 0.05), with rather wide 95% limits of agreement. The intra-rater 95% repeatability limits were rather wide. We found considerable rater difference for the whole range of UPDRS-ME scores between a senior MDS and nurse practitioners, residents in neurology, and the MDS. This finding suggests that the amount by which raters may disagree should be quantified before starting longitudinal studies of disease progression or clinical trials. Finally, evaluation of rater agreement should always include the assessment of the extent of bias between different raters.
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Affiliation(s)
- Bart Post
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
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Martinez-Martin P, Forjaz MJ. Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: Part I, feasibility, scaling assumptions, reliability, and precision. Mov Disord 2006; 21:1182-8. [PMID: 16673397 DOI: 10.1002/mds.20916] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article sought to assess the feasibility, scaling assumptions, reliability, precision, and factor analysis of the three most widely used rating scales in Parkinson's disease (PD): modified Hoehn and Yahr (HY), Schwab and England (SE), and Unified Parkinson's Disease Rating Scale (UPDRS). A multicenter sample of 1,136 PD patients was assessed. The percentage of missing data was 8% for SE, HY, and UPDRS mentation, and almost negligible (<2%) for the other UPDRS subscales. A high floor effect was found for UPDRS mentation (23%) and complications scales (36%). Item content validity, measured by multitrait scaling analysis, was adequate for all UPDRS subscales (scaling successes > 90%). Internal consistency coefficients for the UPDRS scales ranged from 0.79 (mentation) to 0.92 (activities of daily living and motor). Factor structure of the UPDRS mentation, activities of daily living, and complications subscales was replicated. As a whole, the HY, SE, and UPDRS are acceptable, consistent, and potentially sensitive rating scales.
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Affiliation(s)
- Pablo Martinez-Martin
- Neuroepidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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