1
|
Rashid-López R, Macías-García P, Sánchez-Fernández FL, Cano-Cano F, Sarrias-Arrabal E, Sanmartino F, Méndez-Bértolo C, Lozano-Soto E, Gutiérrez-Cortés R, González-Moraleda Á, Forero L, López-Sosa F, Zuazo A, Gómez-Molinero R, Gómez-Ramírez J, Paz-Expósito J, Rubio-Esteban G, Espinosa-Rosso R, Cruz-Gómez ÁJ, González-Rosa JJ. Neuroimaging and serum biomarkers of neurodegeneration and neuroplasticity in Parkinson's disease patients treated by intermittent theta-burst stimulation over the bilateral primary motor area: a randomized, double-blind, sham-controlled, crossover trial study. Front Aging Neurosci 2023; 15:1258315. [PMID: 37869372 PMCID: PMC10585115 DOI: 10.3389/fnagi.2023.1258315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background and objectives Intermittent theta-burst stimulation (iTBS) is a patterned form of excitatory transcranial magnetic stimulation that has yielded encouraging results as an adjunctive therapeutic option to alleviate the emergence of clinical deficits in Parkinson's disease (PD) patients. Although it has been demonstrated that iTBS influences dopamine-dependent corticostriatal plasticity, little research has examined the neurobiological mechanisms underlying iTBS-induced clinical enhancement. Here, our primary goal is to verify whether iTBS bilaterally delivered over the primary motor cortex (M1) is effective as an add-on treatment at reducing scores for both motor functional impairment and nonmotor symptoms in PD. We hypothesize that these clinical improvements following bilateral M1-iTBS could be driven by endogenous dopamine release, which may rebalance cortical excitability and restore compensatory striatal volume changes, resulting in increased striato-cortico-cerebellar functional connectivity and positively impacting neuroglia and neuroplasticity. Methods A total of 24 PD patients will be assessed in a randomized, double-blind, sham-controlled crossover study involving the application of iTBS over the bilateral M1 (M1 iTBS). Patients on medication will be randomly assigned to receive real iTBS or control (sham) stimulation and will undergo 5 consecutive sessions (5 days) of iTBS over the bilateral M1 separated by a 3-month washout period. Motor evaluation will be performed at different follow-up visits along with a comprehensive neurocognitive assessment; evaluation of M1 excitability; combined structural magnetic resonance imaging (MRI), resting-state electroencephalography and functional MRI; and serum biomarker quantification of neuroaxonal damage, astrocytic reactivity, and neural plasticity prior to and after iTBS. Discussion The findings of this study will help to clarify the efficiency of M1 iTBS for the treatment of PD and further provide specific neurobiological insights into improvements in motor and nonmotor symptoms in these patients. This novel project aims to yield more detailed structural and functional brain evaluations than previous studies while using a noninvasive approach, with the potential to identify prognostic neuroprotective biomarkers and elucidate the structural and functional mechanisms of M1 iTBS-induced plasticity in the cortico-basal ganglia circuitry. Our approach may significantly optimize neuromodulation paradigms to ensure state-of-the-art and scalable rehabilitative treatment to alleviate motor and nonmotor symptoms of PD.
Collapse
Affiliation(s)
- Raúl Rashid-López
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Paloma Macías-García
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - F. Luis Sánchez-Fernández
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Fátima Cano-Cano
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - Esteban Sarrias-Arrabal
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Florencia Sanmartino
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Constantino Méndez-Bértolo
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Elena Lozano-Soto
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Remedios Gutiérrez-Cortés
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - Álvaro González-Moraleda
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Lucía Forero
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Fernando López-Sosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Amaya Zuazo
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Jaime Gómez-Ramírez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - José Paz-Expósito
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Raúl Espinosa-Rosso
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Jerez de la Frontera University Hospital, Jerez de la Frontera, Spain
| | - Álvaro J. Cruz-Gómez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Javier J. González-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| |
Collapse
|
2
|
Johnson D, Townsend L, David AS, Askey‐Jones S, Brown R, Samuel M, Okai D. Predictors of Burden in Carers of Patients with Impulse Control Behaviors in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1360-1367. [PMID: 37772283 PMCID: PMC10525061 DOI: 10.1002/mdc3.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/11/2023] [Accepted: 06/11/2023] [Indexed: 09/30/2023] Open
Abstract
Background Impulse control behaviors (ICBs) are problematic, reward-based behaviors, affecting 15% to 35% of patients with Parkinson's disease. Evidence exists of increased carer burden as a result of these behaviors; however, little is known about the variables mediating this effect and their management. Objective To identify factors predictive of carer burden in a cohort of patients with Parkinson's disease with ICBs to enable the development of targeted therapeutic interventions for carers. Methods Data were collected from 45 patients with clinically significant ICBs and their carers, including levodopa equivalent daily dosage, motor and neuropsychiatric symptoms, cognitive function, and ICB severity. Carer burden was quantified by Zarit Burden Interview (ZBI). Univariate analyses were performed using the Spearman rank correlation. Linear regression was used to create a multivariate model for predicting ZBI. Results Univariate analysis identified significant correlations between ZBI and patient total Neuropsychiatric Inventory (NPI) (r s = 0.50), 4 NPI subscores (agitation/aggression, r s = 0.41; depression/dysphoria, r s = 0.47; apathy/indifference, r s = 0.49; and irritability/lability, r s = 0.38; all P < 0.02), and the carer 28-item General Health Questionnaire (GHQ-28) (r s = 0.52, P < 0.0005). Multivariate linear regression retained total NPI and GHQ-28 scores and were collectively predictive of 36.6% of the variance in the ZBI. Conclusions Our study suggests that depressive symptoms and aspects of executive dysfunction (apathy and disinhibition) in the patient are potential drivers of carer burden in patients with ICBs. Such findings suggest the presence of executive difficulties and/or mood disturbance should point the clinician to inquire about burden in the caring role and encourage the carer to seek help for any of their own general health problems, which may compound carer burden.
Collapse
Affiliation(s)
- Daniel Johnson
- University of Oxford Medical Sciences DivisionOxfordUnited Kingdom
- West Suffolk Hospital NHS Foundation TrustBury Saint EdmundsUnited Kingdom
| | - Leigh Townsend
- University of Oxford Medical Sciences DivisionOxfordUnited Kingdom
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Anthony S. David
- Institute of Mental HealthUniversity College LondonLondonUnited Kingdom
| | - Sally Askey‐Jones
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Richard Brown
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Mike Samuel
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
- Department of NeurologyKings College Hospital NHS Foundation TrustLondonUnited Kingdom
- Department of NeurologyEast Kent Hospitals University NHS Foundation TrustCanterburyUnited Kingdom
| | - David Okai
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
- South London and Maudsley NHS Foundation TrustLondonUnited Kingdom
| |
Collapse
|
3
|
Neuropsychiatric Symptoms in Parkinson’s Disease Patients Are Associated with Reduced Health-Related Quality of Life and Increased Caregiver Burden. Brain Sci 2022; 12:brainsci12010089. [PMID: 35053832 PMCID: PMC8774188 DOI: 10.3390/brainsci12010089] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 01/11/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disorder resulting in reduced health-related quality of life (HR-QoL) of people with PD (PwP) and their caregivers. Furthermore, there is an accumulating burden on caregivers of patients in advanced stages of the disease. In previous studies, motor- and non-motor-symptoms of PwP have been identified to contribute to reduced HR-QoL and an increased caregiver burden. This cross-sectional observational study aimed to study the influence of neuropsychiatric symptoms measured with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson’s Disease (SEND-PD) questionnaire on the HR-QoL of PwP, as well as the caregiver burden. Analyses revealed a significant association between SEND-PD subscale mood/apathy and reduced HR-QoL in PwP, measured by the Parkinson’s disease quality of life questionnaire (PDQ-8) (p < 0.001). Furthermore, mood/apathy was significantly correlated with caregiver burden (p = 0.001) in the multiple linear regression analysis. Hence, neuropsychiatric symptoms were found to have a profound impact on the HR-QoL of PwP, as well as on caregiver burden. Since neuropsychiatric symptoms were one of the main predictors for caregiver burden, physicians of PwP should treat these symptoms to stabilize caregiver burden, as well as HR-QoL in PwP and their caregivers.
Collapse
|
4
|
Martinez‐Martin P, Wan YM, Ray Chaudhuri K, Schrag AE, Weintraub D. Impulse control and related behaviors in Parkinson’s disease with dementia. Eur J Neurol 2020; 27:944-950. [DOI: 10.1111/ene.14169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- P. Martinez‐Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health Madrid Spain
| | - Y. M. Wan
- Department of Basic and Clinical Neuroscience Institute of Psychiatry Psychology and Neuroscience at King's College London London UK
- Parkinson Foundation Centre of Excellence at King's College Hospital London UK
- Department of Psychiatry Ng Teng Fong General Hospital Singapore
| | - K. Ray Chaudhuri
- Department of Basic and Clinical Neuroscience Institute of Psychiatry Psychology and Neuroscience at King's College London London UK
- Parkinson Foundation Centre of Excellence at King's College Hospital London UK
| | - A. E. Schrag
- Department of Clinical Neurosciences Royal Free Campus UCL Institute of Neurology London UK
| | - D. Weintraub
- Departments of Psychiatry and Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA
- Parkinson’s Disease Research Education and Clinical Center (PADRECC) Philadelphia Veterans Affairs Medical Center Philadelphia PA USA
| |
Collapse
|
5
|
Carrozzino D. Clinimetric approach to rating scales for the assessment of apathy in Parkinson's disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109641. [PMID: 31059722 DOI: 10.1016/j.pnpbp.2019.109641] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 02/09/2023]
Abstract
A number of rating scales for the assessment of apathy in Parkinson's disease (PD) were developed. Unfortunately, previous studies focused mainly on psychometric criteria rather than on clinimetric principles to develop these assessment instruments. In the clinimetric approach, the clinical validity of a rating scale, rather than its statistical significance, has the priority. The aim of the present systematic review was to capture the clinimetric properties of these rating scales and to identify the measures, which display clinical validity for the assessment of apathy in PD. The systematic search was conducted on Scopus, PsycINFO, PubMed, Web of Science, ScienceDirect, and Medline following the PRISMA guidelines. A total of 44 studies were included and analyzed in this systematic review. The apathy rating scales, which were found to be psychometrically robust and reliable, were actually clinically questionable. The apathy measures, which displayed clinimetric properties, were the Starkstein Apathy Scale (SAS), the 5-item version of the World Health Organization Well-Being Index (WHO-5), the Neurasthenia Scale and the Lille Apathy Rating Scale (LARS). The SAS was found to be clinically valid at a macro-analytic level, particularly when used either to exclude the presence of symptoms of apathy or to evaluate the side effects of medications. The WHO-5 and the Neurasthenia Scale were found to be clinically valid only at a micro-analytic level and can be used as screening measures for the assessment of the severity of symptoms of apathy. The LARS was a clinically valid instrument to be used for the diagnosis of apathy.
Collapse
Affiliation(s)
- Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini no. 31, 66100 Chieti, Italy.
| |
Collapse
|
6
|
Evans AH, Okai D, Weintraub D, Lim SY, O'Sullivan SS, Voon V, Krack P, Sampaio C, Post B, Leentjens AFG, Martinez-Martin P, Stebbins GT, Goetz CG, Schrag A. Scales to assess impulsive and compulsive behaviors in Parkinson's disease: Critique and recommendations. Mov Disord 2019; 34:791-798. [PMID: 31136681 DOI: 10.1002/mds.27689] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
Impulse control disorders (ICDs) and related impulsive and compulsive behaviors (together called ICBs) have been increasingly recognized in the context of Parkinson's disease (PD) and treatment. The International Parkinson's and Movement Disorder Society commissioned a task force to assess available clinical screening instruments and rating scales, including their clinimetric properties, make recommendations regarding their utility, and suggest future directions in scale development and validation. The literature was systematically searched for scales measuring a range of reported ICBs in PD. A scale was designated "recommended" if the scale had been employed in PD studies, been used beyond the group that developed it, and had adequate clinimetric data published for PD. Numerous diagnostic screening tools and severity rating scales were identified for a range of ICBs, including compulsive medication use, punding/hobbyism, walkabout, pathological gambling, hypersexuality, compulsive or binge eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction. For screening across the range of ICBs (except compulsive medication use), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) and QUIP-Rating Scale (QUIP-RS) are recommended, and for severity rating across the range of ICBs the QUIP-RS and the Ardouin Scale of Behavior in Parkinson's Disease are recommended. The Scale for Outcomes in Parkinson's Disease-Psychiatric Complications is recommended for rating of hypersexuality and the compulsive behaviors gambling/shopping. Further testing of established scales against gold standard diagnostic criteria is urgently required for all other individual ICBs in PD. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Andrew H Evans
- Department of Neurology, the Royal Melbourne Hospital, Parkville, Australia
| | - David Okai
- Kings College London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, London, UK
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (Philadelphia Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Mental Illness Research Education Clinical, Centers of Excellence (MIRECC)), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sean S O'Sullivan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Neurology, Bon Secours Hospital, Cork, Ireland
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Krack
- Movement Disorders Center, Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern Switzerland
| | - Cristina Sampaio
- Cure Huntington's Disease InitiativeEl (CHDI) Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Bart Post
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Anette Schrag
- Department of Clinical Neurosciences, Institute of Neurology, University College London, London, UK
| | | |
Collapse
|
7
|
Ragab OA, Elheneedy YA, Bahnasy WS. Non-motor symptoms in newly diagnosed Parkinson’s disease patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0070-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
8
|
Catalan MJ, Molina-Arjona JA, Mir P, Cubo E, Arbelo JM, Martinez-Martin P. Improvement of impulse control disorders associated with levodopa-carbidopa intestinal gel treatment in advanced Parkinson's disease. J Neurol 2018; 265:1279-1287. [PMID: 29557989 DOI: 10.1007/s00415-018-8803-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 12/01/2022]
Abstract
Impulse control behaviors are a frequent comorbidity for patients with Parkinson's disease (PD). The objective of the present study was to evaluate the effectiveness levodopa-carbidopa intestinal gel (LCIG) therapy on impulse control disorders (ICDs) in patients with advanced PD. We conducted a multicenter, observational, and prospective (6 months follow-up) study that included consecutive PD patients assigned to LCIG through routine medical practice. Patients completed visits at baseline, 1, 3, and 6 months after percutaneous endoscopic gastrostomy procedure. The following outcomes were evaluated: presence and severity of ICDs and other neuropsychiatric disorders, sleep disturbances, patients' quality of life, and caregivers' burden. Sixty-two patients were included at baseline: mean age 72.2 years (SD ± 7.0), 42% women. Median duration of PD symptoms was 13.5 years (IQR 5.5-21.5) and median time with motor fluctuations was 5.0 years (IQR 1.0-9.0). Treatment with LCIG infusion was associated with progressive and significant improvements in ICDs symptoms over the study period (64.4% reduction in the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease-Rating Scale score). Psychotic and other neuropsychiatric symptoms were also significantly reduced, and patients' sleep quality and psychosocial function improved. Caregivers' burden remained unchanged. There was a significant improvement in the daily "Off" time [7.4 h (SD ± 4.0) vs 1.5 h (SD ± 1.8); p < 0.0001] at the end of follow-up, whereas duration of dyskinesias was not affected. ICDs significantly improved after 6-month LCIG treatment in a group of PD patients with mild-to-moderate neuropsychiatric disturbances.
Collapse
Affiliation(s)
- Maria Jose Catalan
- Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain.
| | | | - Pablo Mir
- Movement Disorders Unit, Neurology and Clinical Neurophysiology Service, Seville Biomedicine Institute (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Esther Cubo
- Department of Neurology, Hospital General Yagüe, Burgos, Spain
| | - Jose Matias Arbelo
- Department of Neurology, University Hospital Insular de Gran Canaria, Las Palmas, Gran Canaria, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | | |
Collapse
|
9
|
Stocchi F, Radicati FG, Chaudhuri KR, Johansson A, Padmakumar C, Falup‐Pecurariu C, Martinez‐Martin P. The Parkinson's Disease Composite Scale: results of the first validation study. Eur J Neurol 2018; 25:503-511. [DOI: 10.1111/ene.13529] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
- F. Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele Roma Italy
| | - F. G. Radicati
- University and Institute for Research and Medical Care IRCCS San Raffaele Roma Italy
| | - K. R. Chaudhuri
- National Parkinson Foundation Centre of Excellence King's College London UK
| | - A. Johansson
- Department of Neurology Karolinska University Hospital Stockholm Sweden
| | - C. Padmakumar
- Rankin Park Centre John Hunter Hospital Newcastle Australia
| | - C. Falup‐Pecurariu
- Department of Neurology County Emergency Clinic Hospital Brasov and Faculty of Medicine Transilvania University Brasov Brasov Romania
| | | |
Collapse
|
10
|
Heller S, Steinberg A, Sedler M. Validation of the English Version of the Multimodal Assessment of Capacities in Severe Dementia (MAC-SD): A Cognitive and Functional Scale for Use in Severe Dementia. J Alzheimers Dis Rep 2017; 1:249-262. [PMID: 30480242 PMCID: PMC6159650 DOI: 10.3233/adr-170038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Most existing screening instruments that assess cognition and functioning in dementia suffer from floor effects, limiting their utility in severely demented patients. In 2015, the first author devised a new instrument, The Multimodal Assessment of Capacities in Severe Dementia (MAC-SD), to address this need. The MAC-SD Spanish version proved reliable, valid, and useful for evaluating patients with severe dementia. OBJECTIVE This report presents the results of a field trial of the English version of the MAC-SD in a U.S. population. METHODS The MAC-SD was administered to 40 participants with severe dementia along with gold standard measures of cognition and functioning in dementia (the Severe Mini-Mental State Exam, the Severe Impairment Battery, the Global Deterioration Scale, and the Barthel Index of Activities of Daily Living). Data analysis was performed to determine floor effects, reliability, validity, sensitivity to change, and clinical usefulness. RESULTS The MAC-SD showed no significant floor effects, acceptable reliability, convergent validity with control measures, internal validity, and known groups validity. Of participants who scored the lowest possible on control measures, MAC-SD scores ranged widely. The MAC-SD was highly sensitive to change, and was able to detect changes not seen on control measures. CONCLUSIONS The MAC-SD English version is reliable and valid for use in the cognitive and functional assessment of patients with severe dementia. It gives more detailed information than control instruments about the cognitive and functional abilities of patients with the most severe dementia, and is able to detect changes in these patients not shown by control measures.
Collapse
Affiliation(s)
- Sloane Heller
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
- Current address: Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - Alan Steinberg
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Mark Sedler
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| |
Collapse
|
11
|
Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, Kurtis MM, Skorvanek M. Measurement of Nonmotor Symptoms in Clinical Practice. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:291-345. [PMID: 28802923 DOI: 10.1016/bs.irn.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonmotor symptoms constitute a prominent part of Parkinson's disease manifestations. They are present since the first phases of the disease, increase their number and severity with disease progression, and importantly impact on patients' health and quality of life, caregivers' burden, and social resources. Research on Parkinson's disease has traditionally focused on the motor aspects of the disease, but an increasing interest in the nonmotor manifestations has risen in the past decade. The availability of assessment instruments for detecting and measuring these symptoms has allowed understanding of their importance and course over time, as well as estimation of therapeutic effects on them. In this chapter, a review of the basic characteristics of nonmotor symptom assessments used in clinical practice and research are presented.
Collapse
Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain.
| | | | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M Kurtis
- Movement Disorders Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Matej Skorvanek
- P.J. Safarik University, Kosice, Slovakia; University Hospital of L. Pasteur, Kosice, Slovakia
| |
Collapse
|
12
|
Balestrino R, Martinez-Martin P. Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson's disease. J Neurol Sci 2017; 373:173-178. [DOI: 10.1016/j.jns.2016.12.060] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/27/2016] [Indexed: 02/09/2023]
|
13
|
Balestrino R, Martinez-Martin P. Reprint of "Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson's disease". J Neurol Sci 2017; 374:3-8. [PMID: 28109579 DOI: 10.1016/j.jns.2017.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/27/2016] [Indexed: 02/05/2023]
Abstract
Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient' life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used.
Collapse
Affiliation(s)
- Roberta Balestrino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
| |
Collapse
|
14
|
Alvarado-Bolaños A, Cervantes-Arriaga A, Rodríguez-Violante M, Llorens-Arenas R, Calderón-Fajardo H, Millán-Cepeda R, Leal-Ortega R, Estrada-Bellmann I, Zuñiga-Ramírez C. Impact of Neuropsychiatric Symptoms on the Quality of Life of Subjects with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:541-8. [PMID: 26406134 DOI: 10.3233/jpd-150597] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms in Parkinson's disease (PD) are frequent. Impact of neuropsychiatric symptoms on quality of life has recently become a relevant topic of research due to its potential to develop targeted therapies to improve quality of life. OBJECTIVE To determine the impact of neuropsychiatric symptoms in patients with PD using the Parkinson's Disease Questionnaire Short Form (PDQ-8). METHODS Consecutive patients with PD were evaluated with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's disease (SEND-PD) and PDQ-8 scales separately. Association between neuropsychiatric symptoms and quality of life was explored using, means comparisons, correlation coefficients and multiple regression models. RESULTS A total of 492 patients were included for the study. Overall, 44.5% had psychotic symptoms, 76.5% had alterations on mood/apathy domains, and 27% had an impulse control disorder. All neuropsychiatric symptoms had an effect on the PDQ-8 with a moderate to large effect size. Correlation coefficients ranged from 0.17 to 0.63 between neuropsychiatric symptoms and quality of life (p < 0.001, in all cases). The regression model showed that mood/apathy alterations and impulse control disorders, along with MDS-UPDRS III accounted for 49.8% of variance in the PDQ-8 simplified index (F = 122.98; p < 0.001). Mood/apathy alterations showed the highest correlation coefficient (0.63, p < 0.001) and β (0.53, p < 0.001). CONCLUSIONS Both the presence and severity of neuropsychiatric symptoms, in particular mood/apathy alterations,had a significant impact on quality of life in subjects with PD.
Collapse
Affiliation(s)
- Alonso Alvarado-Bolaños
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rodrigo Llorens-Arenas
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Humberto Calderón-Fajardo
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | |
Collapse
|
15
|
Cubo E, Mariscal N, Solano B, Becerra V, Armesto D, Calvo S, Arribas J, Seco J, Martinez A, Zorrilla L, Heldman D. Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease. J Telemed Telecare 2016; 23:328-338. [PMID: 27000142 DOI: 10.1177/1357633x16638971] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.
Collapse
Affiliation(s)
- E Cubo
- 1 Neurology Department, Hospital Universitario of Burgos, Burgos, Spain
| | - N Mariscal
- 1 Neurology Department, Hospital Universitario of Burgos, Burgos, Spain
| | - B Solano
- 1 Neurology Department, Hospital Universitario of Burgos, Burgos, Spain
| | - V Becerra
- 2 Health Econometric Consultant, Hospital Universitario, Burgos, Spain
| | - D Armesto
- 3 Statistical Consultant, Neurology Department, Hospital Universitario Burgos, Spain
| | - S Calvo
- 4 Research Unit, Hospital Universitario of Burgos, Burgos, Spain
| | - J Arribas
- 4 Research Unit, Hospital Universitario of Burgos, Burgos, Spain
| | - J Seco
- 5 Centro Servicios Avanzados, Burgos, Spain
| | - A Martinez
- 5 Centro Servicios Avanzados, Burgos, Spain
| | - L Zorrilla
- 5 Centro Servicios Avanzados, Burgos, Spain
| | - D Heldman
- 6 Great Lakes NeuroTechnologies, Cleveland, USA
| |
Collapse
|
16
|
Rieu I, Martinez-Martin P, Pereira B, De Chazeron I, Verhagen Metman L, Jahanshahi M, Ardouin C, Chéreau I, Brefel-Courbon C, Ory-Magne F, Klinger H, Peyrol F, Schupbach M, Dujardin K, Tison F, Houeto JL, Krack P, Durif F. International validation of a behavioral scale in Parkinson's disease without dementia. Mov Disord 2015; 30:705-13. [PMID: 25809278 DOI: 10.1002/mds.26223] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 12/08/2014] [Accepted: 12/14/2014] [Indexed: 12/16/2022] Open
Abstract
The "Ardouin Scale of Behavior in Parkinson's Disease" is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview. Patients (n=260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test-retest reliability, the kappa coefficient for items was higher than 0.4. For inter-rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ=0.82); anxiety with the Hospital Anxiety and Depression Scale-anxiety (ρ=0.56); apathy with the Lille Apathy Rating Scale (ρ=0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia.
Collapse
Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Neurology Department; CHU Gabriel Montpied, Clermont-Ferrand, France; Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Heller S, Mendoza Rebolledo C, Rodríguez Blázquez C, Carrasco Chillón L, Pérez Muñoz A, Rodríguez Pérez I, Martínez-Martín P. Validation of the multimodal assessment of capacities in severe dementia: a novel cognitive and functional scale for use in severe dementia. J Neurol 2015; 262:1198-208. [PMID: 25740664 DOI: 10.1007/s00415-015-7692-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 11/30/2022]
Abstract
The multimodal assessment of capacities in severe dementia (MAC-SD), a novel cognitive and functional assessment, was developed for use with patients with severe dementia. Its psychometric attributes were examined in a unicenter, open, observational study. The MAC-SD along with the Spanish language Severe Mini Mental Exam were administered to 103 patients with a diagnosis of severe dementia. Psychometric analyses were performed to determine acceptability, reliability, validity, and responsiveness. As a whole, the MAC-SD sections showed no floor effects, satisfactory internal consistency, reproducibility, construct validity, precision, and sensitivity to change. The MAC-SD performed as a useful, valid, and potentially responsive tool to measure cognition and functioning in the most advanced stages of dementia.
Collapse
Affiliation(s)
- Sloane Heller
- Alzheimer Disease Research Unit, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain,
| | | | | | | | | | | | | |
Collapse
|
18
|
Starkstein SE. Anosognosia in Alzheimer's disease: Diagnosis, frequency, mechanism and clinical correlates. Cortex 2014; 61:64-73. [DOI: 10.1016/j.cortex.2014.07.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/13/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
|
19
|
Dujardin K, Langlois C, Plomhause L, Carette AS, Delliaux M, Duhamel A, Defebvre L. Apathy in untreated early-stage Parkinson disease: Relationship with other non-motor symptoms. Mov Disord 2014; 29:1796-801. [DOI: 10.1002/mds.26058] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/05/2014] [Accepted: 09/28/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kathy Dujardin
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Carole Langlois
- Department of Biostatistics; Lille University Medical Center; Lille France
| | - Lucie Plomhause
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Anne-Sophie Carette
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Marie Delliaux
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| | - Alain Duhamel
- Department of Biostatistics; Lille University Medical Center; Lille France
| | - Luc Defebvre
- Neurology and Movement Disorders Department; Lille University Medical Center; Lille France
| |
Collapse
|
20
|
Independent Validation of the SEND-PD and Correlation with the MDS-UPDRS Part IA. PARKINSONS DISEASE 2014; 2014:260485. [PMID: 25400976 PMCID: PMC4226183 DOI: 10.1155/2014/260485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 11/17/2022]
Abstract
Introduction. Neuropsychiatric symptoms in Parkinson's disease can be assessed by the MDS-UPDRS part IA. The Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's disease (SEND-PD) has been recently developed to assess the severity of some neuropsychiatric symptoms. The objective of this study is to compare the performance of the SEND-PD with the corresponding items of the MDS-UPDRS part IA. Methods. Patients with Parkinson's disease were evaluated using the MDS-UPDRS and the SEND-PD by independent raters. Partial SEND-PD and neuropsychiatric MDS-UPDRS part IA were constructed with equivalent items for comparison. Results. A total of 260 consecutive patients were included. Overall, 61.2% of the patients did not report any psychotic symptom and 83.5% did not report any ICD symptom. On the other hand, 78.5% of the patients did report at least one symptom related to apathy, depression, or anxiety. The partial SEND-PD score was 2.9 ± 3.1 (range from 0 to 16). The neuropsychiatric MDS-UPDRS part IA score was 2.9 ± 3 (range from 0 to 14). The correlation coefficient between corresponding items ranged from 0.67 to 0.98 and between both summary indexes was r s = 0.93 (all, P < 0.001). Conclusion. A high association between equivalent items of the SEND-PD and the MDS-UPDRS was found.
Collapse
|
21
|
Amar BR, Yadav R, Janardhan Reddy YC, Pal PK. A clinical profile of patients with Parkinson's disease and psychosis. Ann Indian Acad Neurol 2014; 17:187-92. [PMID: 25024570 PMCID: PMC4090845 DOI: 10.4103/0972-2327.132625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 10/25/2013] [Accepted: 12/03/2013] [Indexed: 11/04/2022] Open
Abstract
AIMS The aim of the study was to study the clinical profile of the patients with Parkinson's disease (PD) and psychosis. SETTINGS AND DESIGN This was a prospective, cross sectional, hospital-based study done at the Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India from September 2009 to January 2011. All patients with PD, diagnosed by United Kingdom PD Society Brain Bank criteria, having with features of psychosis as diagnosed by the neuropsychiatric inventory (NPI) were included. Patients without a caregiver who could validate the patient's symptoms were excluded. RESULTS A total of 40 patients (5 women, 35 men) with PD with psychosis (mean age: 54.2 ± 11.5 years, mean duration of illness: 6.5 ± 4.5 years, and mean duration of psychosis: 4.3 ± 4.3 years) were included in the study. The Global NPI score was 19.1 ± 11.5. Majority of the patients had pure hallucinations (85%), while the rest had either pure delusions (7.5%) or a combination of delusions and hallucinations (7.5%). In those with hallucinations, visual hallucinations were the commonest (60%) (pure only in 22.5%), followed by auditory (45%), minor hallucinations (45%), and tactile (20%). Only one person reported having olfactory hallucinations (2.5%). Loss of insight was most often observed during the visual hallucinations (52%), followed by tactile (44.4%), auditory (38.9 %), and minor hallucinations (33.3%). CONCLUSIONS In patients with PD and psychosis, pure hallucinations are common and visual hallucinations are the commonest among the hallucinations. A large proportion of patients have minor hallucinations, which need to be recognized early for effective and early management. The limitations of the study were small sample size, use of a single scale to assess psychosis and subjective assessment of insight.
Collapse
Affiliation(s)
- B R Amar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| |
Collapse
|
22
|
Martinez-Martin P. Dementia in Parkinson's disease: Usefulness of the pill questionnaire. Mov Disord 2013; 28:1832-7. [DOI: 10.1002/mds.25649] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Pablo Martinez-Martin
- Research Unit, Alzheimer Centre Reina Sofia Foundation; and CIBERNED, CIEN Foundation. Carlos III Institute of Health; Madrid Spain
| |
Collapse
|
23
|
Unveiling relevant non-motor Parkinson's disease severity symptoms using a machine learning approach. Artif Intell Med 2013; 58:195-202. [PMID: 23711400 DOI: 10.1016/j.artmed.2013.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 03/12/2013] [Accepted: 04/07/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Is it possible to predict the severity staging of a Parkinson's disease (PD) patient using scores of non-motor symptoms? This is the kickoff question for a machine learning approach to classify two widely known PD severity indexes using individual tests from a broad set of non-motor PD clinical scales only. METHODS The Hoehn & Yahr index and clinical impression of severity index are global measures of PD severity. They constitute the labels to be assigned in two supervised classification problems using only non-motor symptom tests as predictor variables. Such predictors come from a wide range of PD symptoms, such as cognitive impairment, psychiatric complications, autonomic dysfunction or sleep disturbance. The classification was coupled with a feature subset selection task using an advanced evolutionary algorithm, namely an estimation of distribution algorithm. RESULTS Results show how five different classification paradigms using a wrapper feature selection scheme are capable of predicting each of the class variables with estimated accuracy in the range of 72-92%. In addition, classification into the main three severity categories (mild, moderate and severe) was split into dichotomic problems where binary classifiers perform better and select different subsets of non-motor symptoms. The number of jointly selected symptoms throughout the whole process was low, suggesting a link between the selected non-motor symptoms and the general severity of the disease. CONCLUSION Quantitative results are discussed from a medical point of view, reflecting a clear translation to the clinical manifestations of PD. Moreover, results include a brief panel of non-motor symptoms that could help clinical practitioners to identify patients who are at different stages of the disease from a limited set of symptoms, such as hallucinations, fainting, inability to control body sphincters or believing in unlikely facts.
Collapse
|