Nonmotor symptoms and quality of life in Parkinson's disease with different motor subtypes

Motor and non-motor outcome in tremor dominant Parkinson's disease after MR-guided focused ultrasound thalamotomy

BACKGROUND AND OBJECTIVES

Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is an emerging technique for the treatment of severe, medication-refractory tremor syndromes. We here report motor and non-motor outcomes 6 and 12 months after unilateral MRgFUS thalamotomy in tremor-dominant Parkinson's disease (tdPD).

METHODS

25 patients with tdPD underwent neuropsychological evaluation including standardized questionnaires of disability, quality of life (QoL), mood, anxiety, apathy, sleep disturbances, and cognition at baseline, 6 and 12 months after MRgFUS. Motor outcome was evaluated using the Clinical Rating Scale for Tremor (CRST) and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). In addition, side effects and QoL of family caregivers were assessed.

RESULTS

12 months after MRgFUS significant improvements were evident in the tremor subscores. Patients with concomitant rest and postural tremor showed better tremor outcomes compared to patients with predominant rest tremor. There were no differences in the non-motor assessments. No cognitive decline was observed. Side effects were mostly transient (54%) and classified as mild (62%). No changes in the caregivers' QoL could be observed.

CONCLUSION

We found no changes in mood, anxiety, apathy, sleep, cognition or persistent worsening of gait disturbances after unilateral MRgFUS thalamotomy in tdPD. Concomitant postural tremors responded better to treatment than predominant rest tremors.

Reorganization of structural brain networks in Parkinson's disease with postural instability/gait difficulty

The Postural Instability/Gait Difficulty (PIGD) subtype of Parkinson's disease (PD) has a faster disease progression, a higher risk of cognitive and motor decline, yet the alterations of structural topological organization remain unknown. Diffusion Tensor Imaging (DTI) and 3D-TI scanning were conducted on 31 PD patients with PIGD (PD-PIGD), 30 PD patients without PIGD (PD-non-PIGD) and 35 Healthy Controls (HCs). Structural networks were constructed using DTI brain white matter fiber tractography. A graph theory approach was applied to characterize the topological properties of complex structural networks, and the relationships between significantly different network metrics and motor deficits were analyzed within the PD-PIGD group. PD-PIGD patients exhibited increased shortest path length compared with PD-non-PIGD and HCs (P < 0.05, respectively). Additionally, PD-PIGD patients exhibited decreased nodal properties, mainly in the cerebellar vermis, prefrontal cortex, paracentral lobule, and visual regions. Notably, the degree centrality of the cerebellar vermis was negatively correlated with the PIGD score (r = -0.390; P = 0.030) and Unified Parkinson's Disease Rating Scale Part III score (r = -0.436; P = 0.014) in PD-PIGD patients. Furthermore, network-based statistical analysis revealed decreased structural connectivity between the prefrontal lobe, putamen, supplementary motor area, insula, and cingulate gyrus in PD-PIGD patients. Our findings demonstrated that PD-PIGD patients existed abnormal structural connectomes in the cerebellar vermis, frontal-parietal cortex and visual regions. These topological differences can provide a topological perspective for understanding the potential pathophysiological mechanisms of PIGD in PD.

Clinical features of minor hallucinations in different phenotypes of Parkinson's disease: A cross-sectional study

Background

Minor hallucinations (MHs) are the most common psychiatric symptom associated with Parkinson's disease (PDPsy), but little is known about their characteristics in different motor phenotypes, especially postural instability gait difficulty (PIGD). The aim of this study was to explore the clinical features of MHs in different subtypes of PD.

Methods

In this cross-sectional study, 213 patients with Parkinson's disease (PD) were recruited, and the data obtained included comprehensive demographics, motor subtypes, clinical scale scores, and MH contents. Motor subtypes were classified as tremor-dominant (TD), PIGD or indeterminate according to Stebbins' method.

Results

A total of 213 PD patients were included: 90 (42.3%) TD patients, 98 (46.0%) PIGD patients and 25 (11.7%) indeterminate. In total, 70 (32.9%) patients experienced MHs. Compared to patients with the TD phenotype, we found that patients with the PIGD phenotype had more severe motor and nonmotor symptoms. They also had a higher incidence of visual illusions (VIs) and a shorter MH latency.

Conclusion

Our study demonstrated that compared to patients with the TD phenotype, patients with the PIGD phenotype had a higher incidence of MHs, especially VIs, which may lead to a higher incidence of visual hallucinations (VHs). They also had a shorter latency of MHs than patients with the TD phenotype, suggesting an earlier onset of MHs and a worse prognosis.