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Bovenzi R, Conti M, Degoli GR, Cerroni R, Artusi CA, Pierantozzi M, Stefani A, Mercuri NB, Schirinzi T. Pregnancy, fertile life factors, and associated clinical course in PRKN early-onset Parkinson's disease. Neurol Sci 2024; 45:591-599. [PMID: 37658959 PMCID: PMC10791711 DOI: 10.1007/s10072-023-07029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION As the most common cause of autosomal recessive early onset Parkinson's disease (EOPD), parkin type Parkinson's disease (PRKN-PD) may affect female patients in childbearing age. Accordingly, issues related to fertility must be adequately addressed. Here, we landscaped fertile life factors and pregnancy course of a PRKN-PD cohort, including both novel cases directly observed at our center and published ones. METHODS Six patients with confirmed PRKN-PD were examined by a structured interview on reproductive factors and associated modifications of PD disturbances, including one case followed up throughout pregnancy which was described in greater detail. Six studies reporting fertile life factors of nine PRKN-PD patients were reviewed collecting homogeneous data on fertile life and pregnancy course. RESULTS PRKN-PD female patients experienced motor fluctuations with the menstrual cycle, pregnancy, and puerperium, which suggests a role for sex hormones in PD clinical burden. In some cases, abortion and miscarriages occurred during the organogenesis phase in patients receiving oral antiparkinsonian therapy; however, levodopa/benserazide monotherapy resulted to be the safest choice in pregnancy. CONCLUSION Collectively these data disclose the importance of pre-conception counseling in childbearing age PRKN-PD patients and EOPD in general.
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Affiliation(s)
- Roberta Bovenzi
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
| | - Matteo Conti
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
| | - Giulia Rebecca Degoli
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
| | - Rocco Cerroni
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Mariangela Pierantozzi
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
| | - Alessandro Stefani
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
- UOSD Parkinson Centre, Tor Vergata University Hospital, Rome, Italy
| | - Nicola Biagio Mercuri
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy
| | - Tommaso Schirinzi
- Unit of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier, 00133, Rome, Italy.
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Thanprasertsuk S, Phowthongkum P, Hopetrungraung T, Poorirerngpoom C, Sathirapatya T, Wichit P, Phokaewvarangkul O, Vongpaisarnsin K, Bongsebandhu-phubhakdi S, Bhidayasiri R. Levodopa-induced dyskinesia in early-onset Parkinson's disease (EOPD) associates with glucocerebrosidase mutation: A next-generation sequencing study in EOPD patients in Thailand. PLoS One 2023; 18:e0293516. [PMID: 37906549 PMCID: PMC10617711 DOI: 10.1371/journal.pone.0293516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/15/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND With the benefit of using next-generation sequencing (NGS), our aim was to examine the prevalence of known monogenic causes in early-onset Parkinson's disease (EOPD) patients in Thailand. The association between clinical features, such as levodopa-induced dyskinesia (LID), and genotypes were also explored. METHOD NGS studies were carried out for EOPD patients in the Tertiary-referral center for Parkinson's disease and movement disorders. EOPD patients who had LID symptoms were enrolled in this study (n = 47). We defined EOPD as a patient with onset of PD at or below 50 years of age. LID was defined as hyperkinetic movements including chorea, ballism, dystonia, myoclonus, or any combination of these movements resulting from levodopa therapy, which could be peak-dose, off-period, or diphasic dyskinesias. RESULTS Pathogenic variants were identified in 17% (8/47) of the Thai EOPD patients, of which 10.6% (5/47) were heterozygous GBA variants (c.1448T>C in 3 patients and c.115+1G>A in 2 patients), 4.3% (2/47) homozygous PINK1 variants (c.1474C>T) and 2.1% (1/47) a PRKN mutation (homozygous deletion of exon 7). The LID onset was earlier in patients with GBA mutations compared to those without (34.8±23.4 vs 106.2±59.5 months after starting levodopa, respectively, p = 0.001). LID onset within the first 30 months of the disease was also found to be independently associated with the GBA mutation (odds ratio [95% confidence interval] = 25.00 [2.12-295.06], p = 0.011). CONCLUSION Our study highlights the high prevalence of GBA pathogenic variants in Thai patients with EOPD and the independent association of these variants with the earlier onset of LID. This emphasizes the importance of genetic testing in this population.
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Affiliation(s)
- Sekh Thanprasertsuk
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Clinical & Computational Neuroscience (CCCN) Center of Excellence, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Prasit Phowthongkum
- Division of Medical Genetics and Genomics, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center of Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thitipong Hopetrungraung
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Chalalai Poorirerngpoom
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Saraburi Hospital, Saraburi, Thailand
| | - Tikumphorn Sathirapatya
- Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Forensic Genetics Research Unit, Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patsorn Wichit
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Faculty of Physical Therapy, Huachiew Chalermprakiet University, Samut Prakan, Thailand
| | - Onanong Phokaewvarangkul
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Vongpaisarnsin
- Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Forensic Genetics Research Unit, Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saknan Bongsebandhu-phubhakdi
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Jiang SY, Tian T, Yao H, Xia XM, Wang C, Cao L, Hu G, Du RH, Lu M. The cGAS-STING-YY1 axis accelerates progression of neurodegeneration in a mouse model of Parkinson's disease via LCN2-dependent astrocyte senescence. Cell Death Differ 2023; 30:2280-2292. [PMID: 37633968 PMCID: PMC10589362 DOI: 10.1038/s41418-023-01216-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023] Open
Abstract
Recent studies provide clues that astrocyte senescence is correlated with Parkinson's disease (PD) progression, while little is known about the molecular basis for astrocyte senescence in PD. Here, we found that cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) was upregulated in senescent astrocytes of PD and aged mice. Strikingly, deletion of astrocytic cGAS significantly prevented senescence of astrocytes and neurodegeneration. Furthermore, we identified LCN2 as the effector of cGAS-STING signal by RNA-Seq analysis. Genetic manipulation of LCN2 expression proved the regulation of cGAS-STING-LCN2 axis in astrocyte senescence. Additionally, YY1 was discovered as the transcription factor of LCN2 by chromatin immunoprecipitation. Binding of STING to YY1 impedes nuclear translocation of YY1. Herein, we determine the involvement of the cGAS-STING-YY1-LCN2 signaling cascade in the control of astrocyte senescence and PD progression. Together, this work fills the gap in our understanding of astrocyte senescence, and provides potential targets for delaying PD progression.
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Affiliation(s)
- Si-Yuan Jiang
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Tian Tian
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Hang Yao
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Xiao-Mei Xia
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Cong Wang
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Lei Cao
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Gang Hu
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China
| | - Ren-Hong Du
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China.
| | - Ming Lu
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu, 211166, PR China.
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Angelopoulou E, Bozi M, Simitsi AM, Koros C, Antonelou R, Papagiannakis N, Maniati M, Poula D, Stamelou M, Vassilatis DK, Michalopoulos I, Geronikolou S, Scarmeas N, Stefanis L. Clinical differences between early-onset and mid-and-late-onset Parkinson's disease: Data analysis of the Hellenic Biobank of Parkinson's disease. J Neurol Sci 2022; 442:120405. [PMID: 36081304 DOI: 10.1016/j.jns.2022.120405] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Age at onset is one of the most critical factors contributing to the clinical heterogeneity of Parkinson's disease (PD), and available evidence is rather conflicting. OBJECTIVE The aim of this study is to investigate the clinical differences between early-onset PD (EOPD) and mid-and-late-onset PD (MLOPD) in the Greek population, based on the existing data of the Hellenic Biobank of PD (HBPD). METHODS HBPD contains information of PD cases from two centers in Greece during 2006-2017. Patients with the A53T mutation in the SNCA gene or mutations in the GBA1 gene were excluded. Associations between clinical characteristics (motor and non-motor symptoms, side of onset, first symptom, motor complications) and MLOPD versus EOPD were explored with a single logistic regression model adjusting for gender, family history of PD, disease and dopaminergic therapy duration, disease severity (UPDRS III), levodopa equivalent daily dose, as well as each of the other clinical characteristics. RESULTS 675 patients (129 EOPD, 546 MLOPD) were included. EOPD was more frequently associated with dystonia (OR 0.19, 95% CI 0.08-0.50, p < 0.01) and motor complications (0.23, 0.07-0.76, 0.02), compared to MLOPD. Bilateral onset (9.38, 1.05-84.04, 0.045) and autonomic dysfunction (2.31, 1.04-5.11, 0.04) were more frequently associated with MLOPD. CONCLUSIONS EOPD and MLOPD display distinct clinical profiles, regarding motor and non-motor symptoms, side of onset and motor complications in the Greek population. These differences may reflect diverse pathophysiological backgrounds, potentially attributed to genetic or age-related epigenetic influences.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece; Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece; Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Maria Bozi
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece
| | - Athina-Maria Simitsi
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece
| | - Christos Koros
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece
| | - Roubina Antonelou
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece
| | - Nikolaos Papagiannakis
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece; Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Matina Maniati
- Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Dafni Poula
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Maria Stamelou
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece
| | - Demetrios K Vassilatis
- Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Ioannis Michalopoulos
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Styliani Geronikolou
- Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, 710 West 168th Street, New York, NY 10032, USA
| | - Leonidas Stefanis
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 72-74, Athens 115 28, Greece; 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Greece; Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Soranou Efesiou 4, Athens 115 27, Greece.
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Virameteekul S, Phokaewvarangkul O, Bhidayasiri R. Profiling the most elderly parkinson's disease patients: Does age or disease duration matter? PLoS One 2021; 16:e0261302. [PMID: 34937068 PMCID: PMC8694485 DOI: 10.1371/journal.pone.0261302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite our ageing populations, elderly patients are underrepresented in clinical research, and ageing research is often separate from that of Parkinson's disease (PD). To our knowledge, no previous study has focused on the most elderly ('old-old', age ≥ 85 years) patients with PD to reveal how age directly influences PD clinical progression. OBJECTIVE We compared the clinical characteristics and pharmacological profiles, including complications of levodopa treatment, disease progression, disabilities, and comorbidities of the old-old with those of comparable younger ('young-old', age 60-75 years) PD patients. In addition, within the old-old group, we compared those with a short disease duration (< 10 years at the time of diagnosis) to those with a long disease duration ≥10 years to investigate whether prognosis was related to disease progression or aging. METHODS This single-centre, case-control study compared 60 old-old to 92 young-old PD patients, matched for disease duration. Patients in the old-old group were also divided equally (30:30) into two subgroups (short and long disease duration) with the same mean age. We compared the groups based on several clinical measures using a conditional logistic regression. RESULTS By study design, there were no differences between age groups when comparing disease duration, however, the proportion of men decreased with age (p = 0.002). At a comparable length of PD duration of 10 years, the old-old PD patients predominantly had significantly greater postural instability and gait disturbance (p = 0.006), higher motor scope of the Unified Parkinson's Disease Rating Scale (UPDRS-III, p<0.0001), and more advanced Hoehn & Yahr (H&Y) stage (p<0.0001). The Non-Motor Symptoms Questionnaire (NMSQuest) score was also significantly higher among the old-old (p<0.0001) compared to the young-old patients. Moreover, the distribution of NMS also differed between ages, with features of gastrointestinal problems (p<0.0001), urinary problems (p = 0.004), sleep disturbances and fatigue (p = 0.032), and cognitive impairment (p<0.0001) significantly more common in the old-old group, whereas sexual problems (p = 0.012), depression, and anxiety (p = 0.032) were more common in the young-old. No differences were found in visual hallucinations, cerebrovascular disease, and miscellaneous domains. While young-old PD patients received higher levodopa equivalent daily doses (p<0.0001) and developed a significant greater rate of dyskinesia (p = 0.002), no significant difference was observed in the rate of wearing-off (p = 0.378). Old-old patients also had greater disability, as measured by the Schwab and England scale (p<0.0001) and had greater milestone frequency specifically for dementia (p<0.0001), wheelchair placement (p<0.0001), nursing home placement (p = 0.019), and hospitalisation in the past 1 year (p = 0.05). Neither recurrent falls (p = 0.443) nor visual hallucinations (p = 0.607) were documented significantly more often in the old-old patients. CONCLUSIONS Age and disease duration were independently associated with clinical presentation, course, and progression of PD. Age was the main predictor, but disease duration also had a strong effect, suggesting that factors of the ageing process beyond the disease process itself cause PD in the most elderly to be more severe.
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Affiliation(s)
- Sasivimol Virameteekul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Distinct patterns of speech disorder in early-onset and late-onset de-novo Parkinson's disease. NPJ Parkinsons Dis 2021; 7:98. [PMID: 34764299 PMCID: PMC8585880 DOI: 10.1038/s41531-021-00243-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022] Open
Abstract
Substantial variability and severity of dysarthric patterns across Parkinson’s disease (PD) patients may reflect distinct phenotypic differences. We aimed to compare patterns of speech disorder in early-onset PD (EOPD) and late-onset PD (LOPD) in drug-naive patients at early stages of disease. Speech samples were acquired from a total of 96 participants, including two subgroups of 24 de-novo PD patients and two subgroups of 24 age- and sex-matched young and old healthy controls. The EOPD group included patients with age at onset below 51 (mean 42.6, standard deviation 6.1) years and LOPD group patients with age at onset above 69 (mean 73.9, standard deviation 3.0) years. Quantitative acoustic vocal assessment of 10 unique speech dimensions related to respiration, phonation, articulation, prosody, and speech timing was performed. Despite similar perceptual dysarthria severity in both PD subgroups, EOPD showed weaker inspirations (p = 0.03), while LOPD was characterized by decreased voice quality (p = 0.02) and imprecise consonant articulation (p = 0.03). In addition, age-independent occurrence of monopitch (p < 0.001), monoloudness (p = 0.008), and articulatory decay (p = 0.04) was observed in both PD subgroups. The worsening of consonant articulation was correlated with the severity of axial gait symptoms (r = 0.38, p = 0.008). Speech abnormalities in EOPD and LOPD share common features but also show phenotype-specific characteristics, likely reflecting the influence of aging on the process of neurodegeneration. The distinct pattern of imprecise consonant articulation can be interpreted as an axial motor symptom of PD.
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Meng J, Wang F, Ji L, Liang Y, Nian W, Song L, Zhu A. Comprehensive methylation profile of CSF cfDNA revealed pathogenesis and diagnostic markers for early-onset Parkinson's disease. Epigenomics 2021; 13:1637-1651. [PMID: 34664993 DOI: 10.2217/epi-2021-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Early-onset Parkinson's disease (EOPD) is one uncommon Parkinson's disease subtype with characteristic clinicopathological features. The full epigenomic profile of EOPD is largely unknown. Methods: We performed the first study to investigate the EOPD full methylation profile of cerebrospinal fluid (CSF) cell-free DNA (cfDNA) from 26 EOPD patients and 10 control patients. Results: 2220 differentially methylated genes were identified in EOPD. Hypermethylation far outweighed hypomethylation in gene numbers. Clustering and enrichment analyses identified aberrant neuronal function and immune response. Weighted correlation network analysis demonstrated significant correlation between methylation signatures and clock drawing test (CDT), mini-mental state examination (MMSE), education, working status, alcohol drinking history and Hamilton anxiety scale (HAMA). Several key networking genes in EOPD aberrant methylation were also identified. Conclusions: The methylation profile and signatures of CSF cfDNA were revealed for the first time in EOPD. Aberrant methylation signatures were correlated with education, working status, alcohol drinking history, CDT, MMSE and HAMA.
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Affiliation(s)
- Jie Meng
- Institution of Geriatric, Qinghai Provincial People's Hospital, Xining, 810007, PR China.,Department of Neurology & State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, & Collaborative Innovation Center for Biotherapy, Chengdu, 610041, PR China
| | - Fenglin Wang
- Department of genetics and cell biology, College of Life Sciences, Nankai University, Tianjin, 300071, PR China
| | - Lei Ji
- Institution of Geriatric, Qinghai Provincial People's Hospital, Xining, 810007, PR China
| | - Yuhua Liang
- Institution of Geriatric, Qinghai Provincial People's Hospital, Xining, 810007, PR China
| | - Wei Nian
- Institution of Geriatric, Qinghai Provincial People's Hospital, Xining, 810007, PR China
| | - Lele Song
- Institution of Geriatric, Qinghai Provincial People's Hospital, Xining, 810007, PR China.,Department of Radiotherapy, The Eighth Medical Center of the Chinese PLA General Hospital, Beijing, 100091, PR China
| | - Aiqin Zhu
- Institution of Geriatric, Qinghai Provincial People's Hospital, Xining, 810007, PR China
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Kurihara K, Mishima T, Fujioka S, Tsuboi Y. Efficacy and safety evaluation of safinamide as an add-on treatment to levodopa for parkinson's disease. Expert Opin Drug Saf 2021; 21:137-147. [PMID: 34597253 DOI: 10.1080/14740338.2022.1988926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While levodopa is still the most effective treatment for Parkinson's disease, concerns about long-term complications such as wearing-off and dyskinesia with levodopa usage remain. AREAS COVERED Safinamide is a highly selective and reversible monoamine oxidase B inhibitor introduced in the European Union, Japan, and the United States as an adjunctive agent to levodopa in PD patients with motor fluctuation. This review outlines the pharmacological properties, therapeutic effects, and tolerability of safinamide as an adjunct to levodopa in patients with advanced PD. Efficacy and safety findings from double-blind and placebo-controlled clinical trials for safinamide as an adjunct therapy to levodopa for PD are summarized. EXPERT OPINION Safinamide was well tolerated as a treatment for PD, and there was no significant difference in the frequency and severity of adverse events between the safinamide and placebo groups. It was also suggested that safinamide had a beneficial effect on the accompanying non-motor symptoms such as PD-related pain. Safinamide may exhibit neuroprotective effects through antioxidant and anti-glutamate effects, and research on the disease-modifying effect of PD is desired in the future.
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Affiliation(s)
| | | | | | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University Fukuoka, Japan
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Yahalom G, Rigbi A, Israeli-Korn S, Krohn L, Rudakou U, Ruskey JA, Benshimol L, Tsafnat T, Gan-Or Z, Hassin-Baer S, Greenbaum L. Age at Onset of Parkinson's Disease Among Ashkenazi Jewish Patients: Contribution of Environmental Factors, LRRK2 p.G2019S and GBA p.N370S Mutations. JOURNAL OF PARKINSONS DISEASE 2021; 10:1123-1132. [PMID: 32310186 DOI: 10.3233/jpd-191829] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Both genetic and environmental factors contribute to Parkinson's disease (PD) risk. OBJECTIVE We investigated the potential association of several relevant variables with PD age at onset (AAO), focusing on LRRK2 p.G2019S and GBA p.N370S mutations. METHODS Ashkenazi Jewish (AJ) PD patients, screened for LRRK2 and GBA mutations, underwent an interview regarding exposure to the following environmental and lifestyle factors: cigarette smoking, consumption of coffee, tea and alcohol, head injury and rural living. Multivariate linear regression (adjusted for sex) was used to examine the association with AAO, and models included LRRK2 p.G2019S and GBA p.N370S mutation status (carrier/non-carriers), single environmental variable and their interactions terms, as independent variables. RESULTS 225 Israeli AJ PD patients were enrolled: 65 LRRK2 p.G2019S mutation carriers, 60 GBA p.N370S carriers and 100 non-carries of these mutations. In the dichotomized exposure/non-exposure analyses, positive LRRK2 p.G2019S status was associated with younger AAO in all models, at nominal or near significant levels (p = 0.033-0.082). Smoking was associated with older AAO (p = 0.032), and the interaction between GBA p.N370S and history of head injury was associated with younger AAO (p = 0.049), both at nominal significance. There was no indication of a consistent main effect for GBA p.N370S status or significant LRRK2 p.G2019S-environmental factor interaction. In the dose-dependent analyses, increased coffee and tea consumption levels were associated with older AAO (p = 0.001 and p = 0.002, respectively). CONCLUSIONS Our results suggest that genetic and environmental factors may affect AAO in PD patients, but validation in additional samples is required.
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Affiliation(s)
- Gilad Yahalom
- Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel.,Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Movement Disorders Clinic and Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amihai Rigbi
- Faculty of Education, Beit Berl College, Kfar Saba, Israel
| | - Simon Israeli-Korn
- Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel.,Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lynne Krohn
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Lior Benshimol
- Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Tal Tsafnat
- Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Human Genetics, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Sharon Hassin-Baer
- Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel.,Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Greenbaum
- Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
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10
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立花 久. [Diagnosis and treatment of old-onset Parkinson's disease]. Nihon Ronen Igakkai Zasshi 2021; 58:341-352. [PMID: 34483156 DOI: 10.3143/geriatrics.58.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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LRRK2 at the Crossroad of Aging and Parkinson's Disease. Genes (Basel) 2021; 12:genes12040505. [PMID: 33805527 PMCID: PMC8066012 DOI: 10.3390/genes12040505] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023] Open
Abstract
Parkinson's disease (PD) is a heterogeneous neurodegenerative disease characterized by the progressive loss of dopaminergic neurons in the substantia nigra pars compacta and the widespread occurrence of proteinaceous inclusions known as Lewy bodies and Lewy neurites. The etiology of PD is still far from clear, but aging has been considered as the highest risk factor influencing the clinical presentations and the progression of PD. Accumulating evidence suggests that aging and PD induce common changes in multiple cellular functions, including redox imbalance, mitochondria dysfunction, and impaired proteostasis. Age-dependent deteriorations in cellular dysfunction may predispose individuals to PD, and cellular damages caused by genetic and/or environmental risk factors of PD may be exaggerated by aging. Mutations in the LRRK2 gene cause late-onset, autosomal dominant PD and comprise the most common genetic causes of both familial and sporadic PD. LRRK2-linked PD patients show clinical and pathological features indistinguishable from idiopathic PD patients. Here, we review cellular dysfunctions shared by aging and PD-associated LRRK2 mutations and discuss how the interplay between the two might play a role in PD pathologies.
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12
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Peña E, Mohammad TM, Almohammed F, AlOtaibi T, Nahrir S, Khan S, Poghosyan V, Johnson MD, Bajwa JA. Individual Magnetoencephalography Response Profiles to Short-Duration L-Dopa in Parkinson's Disease. Front Hum Neurosci 2021; 15:640591. [PMID: 33790752 PMCID: PMC8005574 DOI: 10.3389/fnhum.2021.640591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
Clinical responses to dopamine replacement therapy for individuals with Parkinson’s disease (PD) are often difficult to predict. We characterized changes in MDS-UPDRS motor factor scores resulting from a short-duration L-Dopa response (SDR), and investigated how the inter-subject clinical differences could be predicted from motor cortical magnetoencephalography (MEG). MDS-UPDRS motor factor scores and resting-state MEG recordings were collected during SDR from twenty individuals with a PD diagnosis. We used a novel subject-specific strategy based on linear support vector machines to quantify motor cortical oscillatory frequency profiles that best predicted medication state. Motor cortical profiles differed substantially across individuals and showed consistency across multiple data folds. There was a linear relationship between classification accuracy and SDR of lower limb bradykinesia, although this relationship did not persist after multiple comparison correction, suggesting that combinations of spectral power features alone are insufficient to predict clinical state. Factor score analysis of therapeutic response and novel subject-specific machine learning approaches based on subject-specific neuroimaging provide tools to predict outcomes of therapies for PD.
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Affiliation(s)
- Edgar Peña
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Tareq M Mohammad
- National Neuroscience Nursing Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fedaa Almohammed
- Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tahani AlOtaibi
- Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahpar Nahrir
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sheraz Khan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Massachusetts Institute of Technology, Boston, MA, United States.,McGovern Institute for Brain Research, Massachusetts Institute of Technology (MIT), Cambridge, MA, United States
| | - Vahe Poghosyan
- Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Jawad A Bajwa
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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13
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Clinical Study of 668 Indian Subjects with Juvenile, Young, and Early Onset Parkinson's Disease. Can J Neurol Sci 2021; 49:93-101. [PMID: 33685545 DOI: 10.1017/cjn.2021.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the demographic pattern of juvenile-onset parkinsonism (JP, <20 years), young-onset (YOPD, 20-40 years), and early onset (EOPD, 40-50 years) Parkinson's disease (PD) in India. MATERIALS AND METHODS We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included. RESULTS A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sleep-related issues more common in EOPD subjects. Overall, dyskinesias were documented in 32.8%. YOPD subjects had a higher frequency of dyskinesia than EOPD subjects (39.9% vs. 25.5%), but they were first noted later in the disease course (5.7 vs. 4.4 years). CONCLUSION This large cohort shows differing clinical patterns in JP, YOPD, and EOPD cases. We propose that cutoffs of <20, <40, and <50 years should preferably be used to define JP, YOPD, and EOPD.
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14
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Ozery-Flato M, Goldschmidt Y, Shaham O, Ravid S, Yanover C. Framework for identifying drug repurposing candidates from observational healthcare data. JAMIA Open 2020; 3:536-544. [PMID: 33623890 PMCID: PMC7886555 DOI: 10.1093/jamiaopen/ooaa048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Observational medical databases, such as electronic health records and insurance claims, track the healthcare trajectory of millions of individuals. These databases provide real-world longitudinal information on large cohorts of patients and their medication prescription history. We present an easy-to-customize framework that systematically analyzes such databases to identify new indications for on-market prescription drugs. MATERIALS AND METHODS Our framework provides an interface for defining study design parameters and extracting patient cohorts, disease-related outcomes, and potential confounders in observational databases. It then applies causal inference methodology to emulate hundreds of randomized controlled trials (RCTs) for prescribed drugs, while adjusting for confounding and selection biases. After correcting for multiple testing, it outputs the estimated effects and their statistical significance in each database. RESULTS We demonstrate the utility of the framework in a case study of Parkinson's disease (PD) and evaluate the effect of 259 drugs on various PD progression measures in two observational medical databases, covering more than 150 million patients. The results of these emulated trials reveal remarkable agreement between the two databases for the most promising candidates. DISCUSSION Estimating drug effects from observational data is challenging due to data biases and noise. To tackle this challenge, we integrate causal inference methodology with domain knowledge and compare the estimated effects in two separate databases. CONCLUSION Our framework enables systematic search for drug repurposing candidates by emulating RCTs using observational data. The high level of agreement between separate databases strongly supports the identified effects.
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Affiliation(s)
| | - Yaara Goldschmidt
- Formerly Healthcare Informatics, IBM Research-Haifa, Mount Carmel Haifa, Israel
| | - Oded Shaham
- Formerly Healthcare Informatics, IBM Research-Haifa, Mount Carmel Haifa, Israel
| | - Sivan Ravid
- Healthcare Informatics, IBM Research-Haifa, Mount Carmel Haifa, Israel
| | - Chen Yanover
- Formerly Healthcare Informatics, IBM Research-Haifa, Mount Carmel Haifa, Israel
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15
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Abstract
Early descriptions of subtypes of Parkinson's disease (PD) are dominated by the approach of predetermined groups. Experts defined, from clinical observation, groups based on clinical or demographic features that appeared to divide PD into clinically distinct subsets. Common bases on which to define subtypes have been motor phenotype (tremor dominant vs akinetic-rigid or postural instability gait disorder types), age, nonmotor dominant symptoms, and genetic forms. Recently, data-driven approaches have been used to define PD subtypes, taking an unbiased statistical approach to the identification of PD subgroups. The vast majority of data-driven subtyping has been done based on clinical features. Biomarker-based subtyping is an emerging but still quite undeveloped field. Not all of the subtyping methods have established therapeutic implications. This may not be surprising given that they were born largely from clinical observations of phenotype and not in observations regarding treatment response or biological hypotheses. The next frontier for subtypes research as it applies to personalized medicine in PD is the development of genotype-specific therapies. Therapies for GBA-PD and LRRK2-PD are already under development. This review discusses each of the major subtyping systems/methods in terms of its applicability to therapy in PD, and the opportunities and challenges designing clinical trials to develop the evidence base for personalized medicine based on subtypes.
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Affiliation(s)
- Connie Marras
- Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - K Ray Chaudhuri
- Parkinson's Foundation International Centre of Excellence, King's College Hospital and King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - Tiago A Mestre
- The Ottawa Hospital Research Institute and University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
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16
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Chen Y, Gu X, Ou R, Zhang L, Hou Y, Liu K, Cao B, Wei Q, Li C, Song W, Zhao B, Wu Y, Cheng J, Shang H. Evaluating the Role of
SNCA
,
LRRK2
, and
GBA
in Chinese Patients With
Early‐Onset
Parkinson's Disease. Mov Disord 2020; 35:2046-2055. [PMID: 32677286 DOI: 10.1002/mds.28191] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/24/2020] [Accepted: 06/08/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yongping Chen
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojing Gu
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyu Zhang
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kuncheng Liu
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyu Li
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wu
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiu Cheng
- Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Department of Neurology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
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17
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Lo Monaco MR, Petracca M, Vetrano DL, Di Stasio E, Fusco D, Ricciardi D, Laudisio A, Zuccalà G, Onder G, Bentivoglio AR. Safinamide as an adjunct therapy in older patients with Parkinson's disease: a retrospective study. Aging Clin Exp Res 2020; 32:1369-1373. [PMID: 31981101 DOI: 10.1007/s40520-020-01469-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Safinamide, as a levodopa adjunct, is effective in reducing motor fluctuations in Parkinson's disease (PD) patients; however, scarce evidence is available regarding its use in older PD patients. AIM To evaluate the safety and tolerability of safinamide as an adjunct therapy in patients aged ≥ 60 years with advanced PD. METHODS A retrospective study including 203 PD patients admitted to a geriatric day hospital, who were evaluated following an extensive clinical protocol. Safinamide use was categorized as never used, ongoing, and withdrawn. Potential correlations of Safinamide withdrawal were investigated in stepwise backward logistic regression models. RESULTS A total of 44 out of 203 participants were current or former users of Safinamide. Overall, 14 (32%) patients discontinued due to treatment-emergent adverse events (TEAEs). Withdrawal was not associated with older age. CONCLUSIONS Safinamide as an adjunct therapy in patients aged ≥ 60 years with advanced PD was found to be safe and well-tolerated in older patients. There were no specific demographic or clinical characteristics associated with suspension.
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Affiliation(s)
- Maria Rita Lo Monaco
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy.
| | - Martina Petracca
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Davide Liborio Vetrano
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Aging Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - Enrico Di Stasio
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
- Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Domenico Fusco
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Diego Ricciardi
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Alice Laudisio
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Giuseppe Zuccalà
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Graziano Onder
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Anna Rita Bentivoglio
- Fondazione Policlinico Universitario "Agostino Gemelli"-IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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18
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Cell Ratio Differences in Peripheral Blood between Early- and Late-Onset Parkinson's Disease: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2072635. [PMID: 31781596 PMCID: PMC6874872 DOI: 10.1155/2019/2072635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022]
Abstract
Objectives To explore the differences of immune disorders in peripheral blood between patients with early-onset Parkinson's disease (EOPD) and late-onset Parkinson's disease (LOPD). Methods We retrospectively reviewed medical records of Parkinson's disease (PD) patients and healthy controls between June 2002 and July 2017. At last, we included 117 PD patients who were divided into EOPD and LOPD according to whether onset age of PD was after 50 and 99 controls divided into E-Control (match for EOPD) and L-Control (match for LOPD) according to whether their age was after 53 which was onset age plus median of disease duration. We compared the ratios of cells between multiple groups and performed the multinominal logistic regression analysis to explore the relationship between ratios and subtypes of PD. We also carried out the receiver operating characteristic (ROC) curve analysis to estimate the diagnostic value of the variable. Results Lymphocyte-red blood cell ratio (LRR) was lower in LOPD compared with that in EOPD or L-Control. LRR was also negatively associated with LOPD (OR: 0.623; 95% CI: 0.397–0.980; P=0.040). The ROC curve analysis showed the optimal cutoff value of 4.53 (×10−4) of LRR for discrimination of LOPD versus L-Control (sensitivity: 0.596, specificity: 0.764). The area under curve (AUC) was 0.721. As for LOPD versus EOPD, the optimal threshold of LRR was 4.10 (×10−4) (sensitivity: 0.516, specificity: 0.745). AUC was 0.641. Conclusions Peripheral immune disorders might play an important part in the pathological progression of LOPD. Also, LRR has potential diagnostic value.
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19
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Getz SJ, Levin B. Cognitive and Neuropsychiatric Features of Early Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:769-785. [PMID: 29077803 DOI: 10.1093/arclin/acx091] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
The clinical definition of Parkinson's disease (PD) is based on cardinal motor features including bradykinesia as well as an additional symptom of tremor, postural instability, or rigidity. Evidence from neuropathological, imaging, and clinical research suggests a premotor, early phase of PD pathology. Further understanding of the earliest biomarkers of PD is crucial for the development of neuroprotective, disease modifying, cognitive, and psychiatric interventions. Recent research has explored early non-motor markers of PD pathology. This issue is especially timely as the International Parkinson and Movement Disorder Society has recently provided a research definition for prodromal PD which includes combinations of prodromal markers and risk factors aimed at identifying target populations for disease-prevention trials. In this review of early PD, we will outline early non-motor symptoms, early cognitive and neuropsychiatric features, neuropsychological assessment strategies, emerging evidence for early biomarkers, and treatment recommendations.
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Affiliation(s)
- Sarah J Getz
- Department of Neurology, Division of Neuropsychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie Levin
- Department of Neurology, Division of Neuropsychology, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Cheon SM, Jang I, Lee MH, Kim DK, Jeon H, Cha DS. Sorbus alnifolia protects dopaminergic neurodegeneration in Caenorhabditis elegans. PHARMACEUTICAL BIOLOGY 2017; 55:481-486. [PMID: 27937005 PMCID: PMC5490792 DOI: 10.1080/13880209.2016.1251468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/19/2016] [Accepted: 10/18/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT The twigs of Sorbus alnifolia (Sieb. et Zucc.) K. Koch (Rosaceae) have been used to treat neurological disorders as a traditional medicine in Korea. However, there are limited data describing the efficacy of S. alnifolia in Parkinson's disease (PD). OBJECTIVE This study was conducted to identify the protective effects of the methanol extracts of S. alnifolia (MESA) on the dopaminergic (DA) neurodegeneration in Caenorhabditis elegans. MATERIALS AND METHODS To test the neuroprotective action of MESA, viability assay was performed after 48 h exposure to 1-methyl-4-phenylpyridine (MMP+) in PC12 cells and C. elegans (400 μM and 2 mM of MMP+, respectively). Fluorescence intensity was quantified using transgenic mutants such as BZ555 (Pdat-1::GFP) and and UA57 (Pdat-1::GFP and Pdat-1::CAT-2) to determine MESA's effects on DA neurodegeneration in C. elegans. Aggregation of α-synuclein was observed using NL5901 strain (unc-54p::α-synuclein::YFP). MESA's protective effects on the DA neuronal functions were examined by food-sensing assay. Lifespan assay was conducted to test the effects of MESA on the longevity. RESULTS MESA restored MPP+-induced loss of viability in both PC12 cells and C. elegans (85.8% and 54.9%, respectively). In C. elegans, MESA provided protection against chemically and genetically-induced DA neurodegeneration, respectively. Moreover, food-sensing functions were increased 58.4% by MESA in the DA neuron degraded worms. MESA also prolonged the average lifespan by 25.6%. However, MESA failed to alter α-synuclein aggregation. DISCUSSION AND CONCLUSIONS These results revealed that MESA protects DA neurodegeneration and recovers diminished DA neuronal functions, thereby can be a valuable candidate for the treatment of PD.
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Affiliation(s)
- Se-Myeong Cheon
- College of Pharmacy, Woosuk University, Jeonbuk, Republic of Korea
| | - Insoo Jang
- Department of Korean Internal Medicine, Woosuk University, Jeonbuk, Republic of Korea
| | - Myon-Hee Lee
- Department of Medicine, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Dae Keun Kim
- College of Pharmacy, Woosuk University, Jeonbuk, Republic of Korea
| | - Hoon Jeon
- College of Pharmacy, Woosuk University, Jeonbuk, Republic of Korea
| | - Dong Seok Cha
- College of Pharmacy, Woosuk University, Jeonbuk, Republic of Korea
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21
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. The prevalence of PD increases with age. The spectrum of clinical features, the rate of progression of the disease, the burden of nonmotor symptoms, and the response to medications are different in older patients with PD from the relatively younger patients. Management of symptoms of PD in older patients is challenging because of possible existence of several age-related systemic illness. While dealing with older patients, it is crucial not to attribute all the physical symptoms to PD. Thorough evaluation for existence of diseases such as normal pressure hydrocephalus and vascular parkinsonism which partially mimic the symptoms of PD carries immense importance. Medical management of parkinsonian symptoms should be preferred with levodopa monotherapy. However, in patients with significant motor fluctuations, dopaminergic agents may be added with caution, as they are notorious for several adverse reactions. Nonmotor symptoms must be provided high importance as they substantially worsen the quality of life. In addition to parkinsonian symptoms, older patients with PD may need to undergo surgery for several conditions. Meticulous perioperative management is crucial as older patients with PD may face several surgery-related complications compared to the younger patients. Compliance to treatment is an important issue in old age. Hence multidisciplinary approach to management of PD in older patients should be emphasized.
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Octogenarian parkinsonism - Clinicopathological observations. Parkinsonism Relat Disord 2017; 37:50-57. [PMID: 28109723 DOI: 10.1016/j.parkreldis.2017.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/08/2016] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Parkinson's disease is the second most common neurodegenerative disorder for which old age is the best known risk. The proportion of elderly in the world is increasing, resulting in larger pool of people at risk for Parkinson's disease. Several other neurodegenerative disorders also produce Parkinson syndrome. Distinguishing between those variants is only possible with pathological examination of brain. No autopsy confirmed study of 80 years and older onset in parkinsonism cases has been reported. Clinical features of different PS variants, response to treatment and progression of disease in this age group remain to be determined. METHODS Patients evaluated at Movement Disorders Clinic Saskatchewan are offered a choice of autopsy at no cost. The brain is studied by board certified neuropathologist. RESULTS Thirty cases with clinical diagnosis of parkinsonism (onset ≥80 years) came to autopsy. Twenty-one (70%) had Parkinson's disease alone and two (6.7%) had an additional movement disorder. The progression of Parkinson's disease was accelerated, and dementia evolved earlier than reported in the younger onset cases. Most cases that tolerated an adequate dose improved on levodopa. CONCLUSION Parkinson's disease is the most common variant in the octogenarian population. Most patients benefit from levodopa, and should be tried on the drug when diagnosis of parkinsonism is made.
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Mendes A, Gonçalves A, Vila-Chã N, Calejo M, Moreira I, Fernandes J, Damásio J, Teixeira-Pinto A, Krack P, Lima AB, Cavaco S. Statistical Models of Parkinson’s Disease Progression: Predictive Validity in a 3-Year Follow-up. JOURNAL OF PARKINSONS DISEASE 2016; 6:793-804. [DOI: 10.3233/jpd-160877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandre Mendes
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Vila-Chã
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Margarida Calejo
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Moreira
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Fernandes
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Damásio
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Armando Teixeira-Pinto
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Krack
- Department of Clinical Neurosciences, Clinic of Neurology, Geneva University Hospital, Geneva, Switzerland
- Department of Basic Neurosciences, Medical Faculty, University of Geneva, Geneva, Switzerland
| | | | - Sara Cavaco
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Rizek P, Kumar N, Jog MS. An update on the diagnosis and treatment of Parkinson disease. CMAJ 2016; 188:1157-1165. [PMID: 27221269 DOI: 10.1503/cmaj.151179] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Rizek
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Niraj Kumar
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Mandar S Jog
- Department of Clinical Neurological Sciences, Western University, London, Ont.
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Fabbri M, Coelho M, Abreu D, Guedes LC, Rosa MM, Costa N, Antonini A, Ferreira JJ. Do patients with late-stage Parkinson's disease still respond to levodopa? Parkinsonism Relat Disord 2016; 26:10-6. [DOI: 10.1016/j.parkreldis.2016.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
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Pagano G, Ferrara N, Brooks DJ, Pavese N. Age at onset and Parkinson disease phenotype. Neurology 2016; 86:1400-1407. [PMID: 26865518 DOI: 10.1212/wnl.0000000000002461] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore clinical phenotype and characteristics of Parkinson disease (PD) at different ages at onset in recently diagnosed patients with untreated PD. METHODS We have analyzed baseline data from the Parkinson's Progression Markers Initiative database. Four hundred twenty-two patients with a diagnosis of PD confirmed by DaTSCAN imaging were divided into 4 groups according to age at onset (onset younger than 50 years, 50-59 years, 60-69 years, and 70 years or older) and investigated for differences in side, type and localization of symptoms, occurrence/severity of motor and nonmotor features, nigrostriatal function, and CSF biomarkers. RESULTS Older age at onset was associated with a more severe motor and nonmotor phenotype, a greater dopaminergic dysfunction on DaTSCAN, and reduction of CSF α-synuclein and total tau. The most common presentation was the combination of 2 or 3 motor symptoms (bradykinesia, resting tremor, and rigidity) with rigidity being more common in the young-onset group. In about 80% of the patients with localized onset, the arm was the most affected part of the body, with no difference across subgroups. CONCLUSIONS Although the presentation of PD symptoms is similar across age subgroups, the severity of motor and nonmotor features, the impairment of striatal binding, and the levels of CSF biomarkers increase with age at onset. The variability of imaging and nonimaging biomarkers in patients with PD at different ages could hamper the results of future clinical trials.
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Affiliation(s)
- Gennaro Pagano
- From the Department of Medicine (G.P., D.J.B., N.P.), Neurology Imaging Unit, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medical Sciences (G.P., N.F.), Federico II University of Naples; Salvatore Maugeri Foundation (N.F.), IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy; and Department of Clinical Medicine-Center for Functionally Integrative Neuroscience (D.J.B., N.P.), Aarhus University, Denmark
| | - Nicola Ferrara
- From the Department of Medicine (G.P., D.J.B., N.P.), Neurology Imaging Unit, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medical Sciences (G.P., N.F.), Federico II University of Naples; Salvatore Maugeri Foundation (N.F.), IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy; and Department of Clinical Medicine-Center for Functionally Integrative Neuroscience (D.J.B., N.P.), Aarhus University, Denmark
| | - David J Brooks
- From the Department of Medicine (G.P., D.J.B., N.P.), Neurology Imaging Unit, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medical Sciences (G.P., N.F.), Federico II University of Naples; Salvatore Maugeri Foundation (N.F.), IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy; and Department of Clinical Medicine-Center for Functionally Integrative Neuroscience (D.J.B., N.P.), Aarhus University, Denmark
| | - Nicola Pavese
- From the Department of Medicine (G.P., D.J.B., N.P.), Neurology Imaging Unit, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medical Sciences (G.P., N.F.), Federico II University of Naples; Salvatore Maugeri Foundation (N.F.), IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy; and Department of Clinical Medicine-Center for Functionally Integrative Neuroscience (D.J.B., N.P.), Aarhus University, Denmark.
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Belin J, Houéto JL, Constans T, Hommet C, de Toffol B, Mondon K. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects]. Rev Neurol (Paris) 2015; 171:841-52. [PMID: 26573332 DOI: 10.1016/j.neurol.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022]
Abstract
Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects.
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Affiliation(s)
- J Belin
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France.
| | - J L Houéto
- Service de neurologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - T Constans
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - C Hommet
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - B de Toffol
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France
| | - K Mondon
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Cilia R, Cereda E, Klersy C, Canesi M, Zecchinelli AL, Mariani CB, Tesei S, Sacilotto G, Meucci N, Zini M, Ruffmann C, Isaias IU, Goldwurm S, Pezzoli G. Parkinson's disease beyond 20 years. J Neurol Neurosurg Psychiatry 2015; 86:849-55. [PMID: 25280915 DOI: 10.1136/jnnp-2014-308786] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/08/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND A very limited number of studies report data on the clinical features of Parkinson's disease (PD) 20 years after onset and beyond. OBJECTIVE To characterise PD 20 years after onset, investigating the impact of age at onset and disease duration on the clinical picture and the predictors of outcomes in patients reaching the 20-year time point. METHODS We conducted a retrospective, cross-sectional study and a longitudinal study. All case visits of patients with a disease duration ≥20 years (N=401) were stratified by disease duration (20-22, 23-25, ≥26 years) and by age at onset (cut-off, 50 years). Patients with a disease duration of 20-22 years (N=320) were prospectively followed up for a median of 45 months (IQR 23-89) for the new occurrence of fracture, percutaneous endoscopic gastrostomy, institutionalisation, confinement to a wheelchair or bed and death. RESULTS Older age at onset and longer disease duration were independently associated with a higher prevalence of major motor and non-motor milestones of disease disability (no interaction observed). In the longitudinal study, the most frequent outcomes were death (N=92), confinement to a wheelchair or bed (N=67) and fracture (N=52). Mortality was associated with the gender: male, older age, dysphagia, orthostatic hypotension, postural instability, fractures and institutionalisation. Fracture was associated with postural instability. Predictors of permanent confinement to a wheelchair or bed were older age, postural instability and institutionalisation. Comorbid dementia at the 20-year examination did not predict any of the outcomes. CONCLUSIONS Age at onset and disease duration are independent determinants of the clinical features of PD beyond 20 years. Non-motor symptoms depend more on age at onset rather than the disease duration itself. Non-levodopa-responsive axial symptoms are the main predictors of all relevant outcomes.
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Affiliation(s)
- Roberto Cilia
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Canesi
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | | | - Claudio B Mariani
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Silvana Tesei
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Giorgio Sacilotto
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Nicoletta Meucci
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Michela Zini
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Claudio Ruffmann
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Ioannis U Isaias
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Stefano Goldwurm
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
| | - Gianni Pezzoli
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy
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Abstract
BACKGROUND Several studies have compared early-onset Parkinson disease (EOPD) and late-onset Parkinson disease (LOPD) but most are not based on autopsy confirmed cases. METHODS We compared clinical and pharmacological profiles, time to reach irreversible Hoehn and Yahr (H&Y) Stage 3 and levodopa motor complications in autopsy confirmed EOPD and LOPD cases. RESULTS At first clinic visit EOPD cases were younger but had longer disease duration and they died at a younger age (all p<0.0001). Anti-Parkinsonian drug use, including levodopa, was significantly delayed in EOPD. Lifetime use of amantadine (p<0.05) and dopamine agonists (p<0.01) were higher in EOPD. While lifetime use of levodopa was similar in the two groups, levodopa was used for a significantly longer period by EOPD (p< 0.0001). EOPD had a higher cumulative incidence of dyskinesias (p<0.01), wearing-off (p<0.01), and on-off (p<0.01). However, the time to dyskinesia onset was similar in the two groups. The threshold to wearing-off was much longer in EOPD (p<0.01). H&Y stage profile at first visit was similar in the two groups. The duration from disease onset to reach irreversible H&Y stage 3 was significantly longer in EOPD. CONCLUSIONS Our observations indicate that progression of PD is slower in EOPD and suggest that the pre-clinical interval in this group is longer. These findings can be used for case selection for drug trials and studies of the pathogenesis of PD.
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Mehanna R, Moore S, Hou JG, Sarwar AI, Lai EC. Comparing clinical features of young onset, middle onset and late onset Parkinson's disease. Parkinsonism Relat Disord 2014; 20:530-4. [PMID: 24631501 DOI: 10.1016/j.parkreldis.2014.02.013] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Parkinson's disease (PD) affects 1-2% of the population over 65 years. There is evidence that the clinical features differ with age at symptom onset, but published information is scarce. METHODS We reviewed the charts of 593 PD patients and divided them into young onset (≤49 years), middle onset (50-69 years) and late onset (≥70 years) groups. Data collected included age at symptom onset, year of onset, family history of Parkinson's disease in first and second degree relatives, predominant first symptom, first anti parkinsonian medication prescribed, frequency of levodopa-induced dyskinesia, therapy related dystonia, therapy related gastrointestinal side effects, hallucination, dementia, depression and apathy. RESULTS The middle onset was the largest group (51%), followed by the late onset (39%) and the young onset (10%) groups. Young onset patients had a more frequent family history of Parkinson's disease and a longer survival. Symptoms other than tremor were more frequent as the initial symptom of the young onset group, and the frequency of tremor as the first symptom increased with advancing age at onset. Depression was more frequent in the young onset group. The frequency of treatment related dyskinesia or dystonia decreased with advancing age at onset. CONCLUSION We have identified specific clinical differences in Parkinson's disease related to the patient's age at onset and added to the existing knowledge of the variability of disease presentation. We suggest an age of onset of 49 years or less for the definition of young onset PD.
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Affiliation(s)
- Raja Mehanna
- University of Texas Health Science center, 6410 Fannin Street, Suite 1014, Houston, TX, USA.
| | - Suzanne Moore
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - J Gabriel Hou
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Aliya I Sarwar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Eugene C Lai
- Houston Methodist Neurological Institute, Houston, TX, USA
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Rana AQ, Siddiqui I, Yousuf MS. Challenges in diagnosis of young onset Parkinson's disease. J Neurol Sci 2012; 323:113-6. [PMID: 22989613 DOI: 10.1016/j.jns.2012.08.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/09/2012] [Accepted: 08/30/2012] [Indexed: 12/20/2022]
Abstract
Young onset Parkinson's disease patients, typically aged 21 to between 40 and 55, have symptomatology similar to regular onset patients. Despite this, we suspect that physicians take longer to diagnose young onset patients since Parkinson's disease is ruled out due to the younger age. The history prior to diagnosis of 14 young onset patients (within 21 to 45 years of age) was compared with an equivalent number of regular onset patients matched by gender, tremor presence, and Hoehn and Yahr stage. Indeed, a longer period of time was taken to diagnose younger patients with an average of additional 15 months (p<0.001). This trend of older patients being diagnosed sooner was present in the regular onset group analyzed in isolation, but not so for the younger group. The lack of age-dependent variation in time required for diagnosis suggests that Parkinson's disease is not considered at all in the diagnosis for an extended period, accounting for the large difference in prevalence of young onset group to the regular onset group. We also observed a significantly higher number of neurologist visits (p=0.002) and clinical investigations (p<0.001) prior to diagnosis of young-onset patients. Due to the impact of delayed diagnoses on young onset patients and clinical resources, we propose that Parkinson's disease be more actively considered in differential diagnoses of younger patients presenting associated symptoms.
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Ionov ID, Severtsev NN. Histamine- and haloperidol-induced catalepsy in aged mice: differential responsiveness to L-DOPA. Psychopharmacology (Berl) 2012; 223:191-7. [PMID: 22526536 DOI: 10.1007/s00213-012-2706-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/26/2012] [Indexed: 11/27/2022]
Abstract
RATIONALE In rodents and dog, histamine induces catalepsy, a dopamine-dependent phenomenon that resembles the extrapyramidal signs of Parkinson's disease (PD). Histamine was also found to damage the dopaminergic neurons in rat substantia nigra. These facts, as well as an increase in brain histamine levels in Parkinsonian patients, suggest a pathogenic role for histamine in PD. As it seems, a comparison between pattern of experimental brain histamine toxicity and signs of PD would elucidate the role of histamine in PD pathogenesis. OBJECTIVE This study aimed to examine whether mouse histamine-induced catalepsy shares such age-related traits of PD as disease aggravation and underresponsiveness to 3,4-dihydroxy-L: -phenylalanine (L: -DOPA) in aged patients. For comparison purposes, haloperidol-induced catalepsy was studied. METHODS The intensity of catalepsy was measured as the time the mouse maintained an abnormal posture. The cataleptogens, histamine or haloperidol, were administered intracerebroventricularly and subcutaneously, respectively. RESULTS The cataleptogenic activity of histamine was significantly higher in 18-19-month-old and 22-23-month-old mice than 3-4-month-old ones. Aging was found to decrease the responsiveness of the histamine-induced catalepsy to L: -DOPA. The intensity of the haloperidol-induced catalepsy and its sensitivity to L: -DOPA were found independent of the animal's age. CONCLUSIONS The mouse histamine-induced catalepsy, unlike haloperidol-induced one, displays the same pattern of age dependency as PD. These findings support an involvement of histamine in the PD pathogenesis.
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Affiliation(s)
- Ilya D Ionov
- Centre on Theoretical Problems in Physical and Chemical Pharmacology, Russian Academy of Sciences, Leninsky Prospect 123-4-63, Moscow 117513, Russia.
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Park YS, Kim HY, Chang WS, Lee PH, Sohn YH, Chang JW. A comparison of LEDD and motor scores following STN-DBS treatment in patient with young onset vs. late onset Parkinson's disease. Neuromodulation 2012; 13:255-60. [PMID: 21992878 DOI: 10.1111/j.1525-1403.2009.00273.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We compared the role of subthalamic nucleus deep brain stimulation (STN-DBS) in the management of medically refractory idiopathic Parkinson's disease in patients with relatively young onset (<40 years of age) Parkinson's disease (YOPD) and patients with relatively late onset Parkinson's disease (≥ 56 years of age, rLOPD). METHODS A total of 33 patients with YOPD (18 patients, median age 32.5 years, range, 20-40 years) and rLOPD (15 patients, median age 58.0 years, range, 56.0-67.0 years) underwent STN-DBS between May 2000 and May 2008. We divided the patients into YOPD and rLOPD as the age of disease onset. The median follow-up period was 43 months (range, 12-95 months). We assessed Hoehn and Yahr stages, activities of daily living, and Unified Parkinson's Disease Rating Scale (UPDRS) motor scales (III) for all patients preoperatively and at six months postoperatively. We measured levodopa equivalent doses (LEDD) and stimulation parameters preoperatively, six months postoperatively, and 12 months postoperatively. RESULTS There were no significant differences in UPDRS motor scales between two groups at preoperative and six-month postoperative drug off/stim on, but UPDRS III was lower in rLOPD at six-month postoperative drug on/stim on state. A significant difference was noted in the improvement of UPDRS III between two groups for preoperative drug off and drug on conditions, but no difference was seen between two groups in a comparison of drug off/stim on vs. drug on/stim on conditions. Stimulation parameters and postoperative LEDD were not different between the two groups. Preoperative dyskinesia was more common in YOPD patients and, psychotic problems were more common in rLOPD patients. CONCLUSIONS Patients with YOPD and rLOPD exhibited comparable UPDRS motor scores and LEDD six months postoperatively. Levodopa could be prescribed at optimum doses following STN-DBS in patients with YOPD as abnormal movements are better controlled following STN-DBS implantation. Stimulation parameters were not different between the two groups. Our results suggest the age of onset does not influence response to STN-DBS Parkinson's disease patients.
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Affiliation(s)
- Young Seok Park
- Department of Neurosurgery, Severance Hospital, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Abosch A, Gupte A, Eberly LE, Tuite PJ, Nance M, Grant JE. Impulsive behavior and associated clinical variables in Parkinson's disease. PSYCHOSOMATICS 2011; 52:41-7. [PMID: 21300194 DOI: 10.1016/j.psym.2010.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a degenerative brain disorder accompanied by the loss of dopaminergic neurons and the presence of motor and non-motor symptoms. OBJECTIVE We performed a cross-sectional, questionnaire-based analysis of impulsive behavior in our PD clinic population to assess prevalence and associated characteristics. RESULTS We found a higher prevalence of impulsive behavior (29.7%) than previously reported, and found multiple, concurrent impulsive behaviors in 26% of subjects reporting impulsive behavior. CONCLUSIONS Our findings contribute to the growing awareness of impulsive behavior in PD, and support the need for longitudinal studies to assess changes in impulsive behaviors in Parkinson's patients.
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Affiliation(s)
- Aviva Abosch
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
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Wickremaratchi MM, Knipe MDW, Sastry BSD, Morgan E, Jones A, Salmon R, Weiser R, Moran M, Davies D, Ebenezer L, Raha S, Robertson NP, Butler CC, Ben-Shlomo Y, Morris HR. The motor phenotype of Parkinson's disease in relation to age at onset. Mov Disord 2011; 26:457-63. [PMID: 21229621 DOI: 10.1002/mds.23469] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/03/2010] [Accepted: 09/14/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is heterogeneous and age at onset may define variation in clinical phenotype. Most previous studies have used various age cut-offs and have been based on clinical case series. METHODS We have studied the association between clinical features and age of onset in 358 community-based and regional patients with PD. RESULTS Tremor at presentation is twice as common in those with onset over 64 years as compared to those with onset under 45 (early onset PD - EOPD) and becomes more common with increasing age at onset (p values for trend ≤ 0.004). Dystonia affects 60% of those with EOPD, shows a curvilinear relationship with age at onset (cubic versus linear p=0.01) with highest risk in patients whose disease began before 48 years. In this study age at onset was a strong predictor of the development of dyskinesias, with younger age associated with a higher risk of dyskinesias. Following multivariable analysis, allowing for possibly confounding factors (disease duration, L-DOPA dosage, L-DOPA treatment duration) younger age at onset, (less than 55 years) predicted the development of L-DOPA induced dyskinesia (odds ratio <45 years 2.1, 95% CI 1.0, 4.8; odds ratio < 55 years 3.8, 95% CI 1.8, 8.0). Only 2/70 (2.9%) EOPD patients carried pathogenic parkin or PINK1 mutations and the clinical differences between early and late onset disease were not explained by the presence of mutations in these genes. DISCUSSION This study highlights the clinical differences between early and late onset PD, which have important implications for diagnosis and management.
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Hughes LE, Barker RA, Owen AM, Rowe JB. Parkinson's disease and healthy aging: independent and interacting effects on action selection. Hum Brain Mapp 2010; 31:1886-99. [PMID: 20162604 PMCID: PMC3353319 DOI: 10.1002/hbm.20979] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Functional reorganization of the motor system occurs in response to both aging and Parkinson's disease (PD). Since PD typically develops in older adults, disease progression and the effects of treatment may interact with normal aging. Using event-related functional magnetic resonance imaging, we studied patients "on" and "off" their normal dopaminergic medication, age-matched controls and younger adults on tasks of action and action selection. For manual movements, aging increased activity in bilateral motor, premotor and cingulate cortex. Activation in the premotor regions of "on" patients was higher relative to age-matched controls. However, in contrast to controls and "off" patients, the activations for patients when "on" decreased with age. Voluntary selection of actions was associated with activation in a bilateral network of fronto-parietal cortex. Within this network, advancing severity of PD was associated with decreased activity particularly in premotor and ventrolateral prefrontal cortex. Together, these results reveal very different patterns of age-related changes in health and PD. Younger patients are able to exert greater compensatory activity in premotor cortex than older patients, even after correction for disease severity. This effect is dopamine dependant, and may in part explain the clinical observation of reduced dopamine responsiveness in older patients with PD.
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Affiliation(s)
- Laura E. Hughes
- Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, United Kingdom,Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, United Kingdom
| | - Roger A. Barker
- Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, United Kingdom,Cambridge Centre for Brain Repair, University of Cambridge, CB2 OPY, United Kingdom
| | - Adrian M. Owen
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, United Kingdom,Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EB, United Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, United Kingdom,Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, United Kingdom,Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EB, United Kingdom
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Abstract
For mostly arbitrary reasons, the term "juvenile parkinsonism" is restricted to patients aged 20 years or younger, and "young-onset PD" (YOPD) is onset between ages 21 and 40 years. Previous studies suggest that YOPD has a slower disease progression and a greater incidence and earlier appearance of L-dopa-induced dyskinesias and motor fluctuations. Therefore, our therapeutic strategies have to respect the fact that YOPD patients face many years of gradual progression of disease and disability, a greater probability for developing various adverse effects of treatment, and worsening of quality of life. As an individually tailored treatment should be our primary goal, we must bear in mind that the needs and expectations of YOPD patients are different from those of their older counterparts. The therapeutic strategy for YOPD patients should include a relatively low threshold for initiation of treatment, and initiating treatment with a dopamine receptor agonist while maintaining an individually adjusted, moderately high threshold for switching to or adding L-dopa in cases where treatment response is suboptimal or if problematic adverse effects develop. It has been shown that some dopamine receptor agonists may also have antidepressive efficacy, thus potentially managing an additional problem associated with PD.
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Maltête D, Edouard T, Mihout B, Costentin J. Increased erythrocyte catechol-O-methyltransferase activity in elderly: relationship to clinical peculiarities in Parkinson's disease? Int J Geriatr Psychiatry 2010; 25:323-4. [PMID: 20148410 DOI: 10.1002/gps.2311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wickremaratchi MM, Ben-Shlomo Y, Morris HR. The effect of onset age on the clinical features of Parkinson's disease. Eur J Neurol 2009; 16:450-6. [PMID: 19187262 DOI: 10.1111/j.1468-1331.2008.02514.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Many clinicians view age at onset as an important determinant of clinical phenotype in Parkinson's disease (PD) and this has been reinforced by the identification of Mendelian genes that account for some cases of younger onset PD. A systematic review of OVID Medline for articles relevant to the relationship between clinical features and age at onset in PD published in English between 1950-2007 was performed. There are very few prospective community based studies which focus on the relationship between age at onset and the features of PD and a variety of case definitions are used in the literature. Most studies of young onset PD are based on specialist clinic referral series. The available evidence suggests that PD patients with a younger age at onset have: (i) a slower disease progression, (ii) an increased rate of dystonia at onset and during treatment, (iii) a lower rate of dementia and (iv) an increased rate of dyskinesias in response to L-DOPA treatment. The majority of the available studies do not report patient genotype data, but it is probably that the clinical heterogeneity of PD will be further refined with detailed clinico-genetic studies.
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Affiliation(s)
- M M Wickremaratchi
- Department of Psychological Medicine, Cardiff University School of Medicine, Cardiff, Wales, UK
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40
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Linazasoro G. A global view of Parkinson's disease pathogenesis: Implications for natural history and neuroprotection. Parkinsonism Relat Disord 2009; 15:401-5. [DOI: 10.1016/j.parkreldis.2009.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 01/17/2009] [Accepted: 02/04/2009] [Indexed: 01/07/2023]
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41
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Ha DE, Legendre G, Colau JC. Maladie de Parkinson juvénile et prématurité récidivante. À propos d'un cas. ACTA ACUST UNITED AC 2007; 35:224-7. [PMID: 17293151 DOI: 10.1016/j.gyobfe.2006.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 12/22/2006] [Indexed: 11/24/2022]
Abstract
The association of Parkinson's disease and pregnancy is very rare. Some thirty cases are found in the literature. We report the case of a pregnancy in a 30-year-old patient with juvenile Parkinson's disease. During this pregnancy treated by levodopa and bromocriptine, no aggravation of the symptoms was been observed. However, the pregnancy was complicated by a premature delivery at 31 weeks of amenorrhoea.
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Affiliation(s)
- D-E Ha
- Service de Gynécologie-Obstétrique, Hôpital Foch, 40, rue Worth, BP 36, 92151 Suresnes cedex, France.
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42
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Shih MC, Franco de Andrade LA, Amaro E, Felicio AC, Ferraz HB, Wagner J, Hoexter MQ, Lin LF, Fu YK, Mari JJ, Tufik S, Bressan RA. Higher nigrostriatal dopamine neuron loss in early than late onset Parkinson's disease?—A [99mTc]-TRODAT-1 SPECT study. Mov Disord 2007; 22:863-6. [PMID: 17290452 DOI: 10.1002/mds.21315] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Early-onset Parkinson's disease (EOPD) is distinct from the classic late-onset PD (LOPD) because of its slower disease progression. The aim of this study was to compare dopamine neuronal loss in EOPD with that of LOPD with the same disease duration, through dopamine transporter (DAT) estimation. Fourteen patients, seven EOPD (<50 years) and seven LOPD, matched for disease duration were scanned with [(99m)Tc]-TRODAT-1-SPECT (INER-Taiwan), and were assessed with standard PD scales. EOPD patients had 34% lower striatal DAT binding potential (BP) compared with that of LOPD patients (BP = 0.29 +/- 0.12, BP = 0.44 +/- 0.12, P < 0.02) with similar PD severity. These results suggest that EOPD patients have greater dopamine density loss than LOPD patients without motor-symptom worsening.
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Affiliation(s)
- Ming Chi Shih
- Laboratório Interdiciplinar de Neuroimagem e Cognição (LiNC), Universidade Federal de São Paulo, Sao Paulo, Brazil.
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Mazzella L, Yahr MD, Marinelli L, Huang N, Moshier E, Di Rocco A. Dyskinesias predict the onset of motor response fluctuations in patients with Parkinson's disease on L-dopa monotherapy. Parkinsonism Relat Disord 2005; 11:151-5. [PMID: 15823479 DOI: 10.1016/j.parkreldis.2004.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Revised: 10/06/2004] [Accepted: 10/13/2004] [Indexed: 11/26/2022]
Abstract
The aim of the study was to investigate the relationship between dyskinesias and motor fluctuations in patients with Parkinson's disease on l-dopa monotherapy. We identified 116 patients on l-dopa monotherapy treated between 1965 and 1992 and followed until death. Dyskinesias occurred in 102 patients. Of these, 48 only developed dyskinesias while 54 had both dyskinesias and motor fluctuations. Among patients with both complications, 49 developed dyskinesias before fluctuations, and only five had dyskinesias after the onset of fluctuations. Our findings suggest that dyskinesias predict the onset of motor fluctuations, and may share a common pathophysiological mechanism.
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Affiliation(s)
- L Mazzella
- Department of Neurology, Beth Israel Medical Center-Albert Einstein College of Medicine, PACC-10 Union Square East #5K, New York, NY 10003, USA
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Holmberg B, Johnels B, Ingvarsson P, Eriksson B, Rosengren L. CSF-neurofilament and levodopa tests combined with discriminant analysis may contribute to the differential diagnosis of Parkinsonian syndromes. Parkinsonism Relat Disord 2001; 8:23-31. [PMID: 11472877 DOI: 10.1016/s1353-8020(00)00083-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The differentiation between Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) is important for prognostic and therapeutic purposes. In order to evaluate the diagnostic capability of two tests reflecting these items, patients fulfilling strict clinical criteria for PD (n=35), MSA (n=36) and PSP (n=14), were consecutively included. An analysis of neurofilament protein (NFL), a marker of axonal degeneration in the cerebrospinal fluid (CSF) and a levodopa test, recorded with optoelectronic technique were performed. Using discriminant analyses, the test's abilities to predict the clinical PD or non-PD (MSA and PSP) diagnoses were compared. Whereas the CSF-NFL and levodopa tests predicted 79 and 85% correct diagnoses respectively, the combined test predicted 90% correct diagnoses. We conclude that the CSF-NFL and levodopa tests provide detailed information of clinical variables on which the clinical diagnostic criteria are based. As they are pathologically unrelated, the diagnostic precision increases compared to clinical diagnoses when they are combined.
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Affiliation(s)
- B Holmberg
- Institute of Clinical Neuroscience, Department of Neurology, University of Göteborg, Sahlgrenska University Hospital, 413 45, Sweden.
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45
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Metz GA, Farr T, Ballermann M, Whishaw IQ. Chronic levodopa therapy does not improve skilled reach accuracy or reach range on a pasta matrix reaching task in 6-OHDA dopamine-depleted (hemi-Parkinson analogue) rats. Eur J Neurosci 2001; 14:27-37. [PMID: 11488946 DOI: 10.1046/j.0953-816x.2001.01615.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L-dopa therapy reverses some but not all of the motor deficits in human Parkinson patients. Although a number rat analogues of human Parkinson's disease have been developed for evaluating the efficacy of drug therapies, it is not known whether L-dopa has a similar selective action on the motor symptoms in the rat models. To examine the effectiveness of L-dopa in reversing the motor deficits in rats, we administered 6-OHDA unilaterally to produce hemi-Parkinson rats, which were then trained to reach for food using either their impaired (contralateral to the lesion) limb or their good (ipsilateral to the lesion) limb. To assess the skill, accuracy and range of limb movement, rats reached for pasta from a horizontal array of 260 vertically orientated pieces of pasta. The number and location of pasta pieces taken from this matrix was calculated and the qualitative aspects of the reaching movements were rated. The quantitative data on pasta sticks retrieved indicated that forelimb extension and movement radius around the shoulder joint was reduced by 6-OHDA treatment and did not improve after chronic L-dopa treatment. The qualitative analysis showed that grasping patterns, paw movements and body movements impaired by the lesion were also not improved by L-dopa treatment. These findings are the first in the rat to suggest that whereas L-dopa has a general activating effect on the rat's whole-body movements, as displayed in contralateral rotation, its effectiveness does not extend to skilled forelimb movements. The results are discussed in relationship to the idea that the restoration of some skilled movements may require normal synaptic function.
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Affiliation(s)
- G A Metz
- Department of Psychology and Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada, T1K 3M4.
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46
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Jacobs H, Heberlein I, Vieregge A, Vieregge P. Personality traits in young patients with Parkinson's disease. Acta Neurol Scand 2001; 103:82-7. [PMID: 11227136 DOI: 10.1034/j.1600-0404.2001.103002082.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES It has been hypothesized that the dopaminergic deficit of older patients with Parkinson's disease (PD) is associated with a reduction in the dopamine-dependent personality trait "novelty seeking". It is unknown whether this may also be found in younger patients with PD whose dopaminergic deficit is considered to be purely motor. MATERIAL AND METHODS We interviewed 122 patients below 51 years of age and 122 age- and sex-matched healthy controls with regard to clinical and sociodemographic data. Both groups had to fill out the Tridimensional Personality Questionnaire (TPQ) of Cloninger. Neuropsychological testing of formal intelligence and depression was also applied. RESULTS "Novelty seeking" was not different between both groups. Patients were more often depressed than controls, explaining their difference in "harm avoidance" on the TPQ. "Persistence", a sub-scale of the third TPQ dimension "reward dependence", was significantly higher in patients. Neither sex, nor age, nor educational status were correlated with one of the three personality traits. CONCLUSIONS The higher rate of depression explains our finding of more "harm avoidance" among young PD patients. According to a literature review the choice and performance of controls is crucial whether personality traits in PD patients may be assessed as abnormal.
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Affiliation(s)
- H Jacobs
- Department of Neurology, Medical University of Lübeck, Germany
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47
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Ondo W, Hunter C, Almaguer M, Jankovic J. A novel sublingual apomorphine treatment for patients with fluctuating Parkinson's disease. Mov Disord 1999; 14:664-8. [PMID: 10435505 DOI: 10.1002/1531-8257(199907)14:4<664::aid-mds1017>3.0.co;2-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We tested a novel preparation of a sublingual apomorphine hydrochloride tablet (APO) in 10 patients with advanced Parkinson's disease complicated by motor fluctuations. After a dose titration, patients took either 40 mg APO three times per day alternating with levodopa doses (eight patients) or six doses of 20 mg APO taken concurrently with levodopa doses (two patients) for 3 months. Assessments included timed tapping and ambulation tests, Unified Parkinson's Disease Rating Scale (UPDRS), and patient diaries. Tapping speed while taking only APO (12 hours after stopping levodopa) was faster than while taking only levodopa (p <0.05). The daily levodopa dose decreased by 32.1% (p <0.01), yet the total "on" time increased from 73.5% +/- 10.2% to 81.5% +/- 7.5% of the day (p <0.01) after starting APO. "On" UPDRS part II scores (p <0.05) and "on" UPDRS part III (motor examination) scores (p <0.05) also improved. Adverse events such as nausea, orthostatic hypotension, and disagreeable taste did not limit the dose of APO in any case. The short-term benefit and tolerability demonstrated in this study warrant further study of this new APO preparation.
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Affiliation(s)
- W Ondo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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