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Romanowska J, Bjornevik K, Cortese M, Tuominen JA, Solheim M, Abolpour Mofrad A, Igland J, Scherzer CR, Riise T. Association Between Use of Any of the Drugs Prescribed in Norway and the Subsequent Risk of Parkinson Disease: A Drug-wide Association Study. Neurology 2023; 101:e2068-e2077. [PMID: 37816645 PMCID: PMC10663041 DOI: 10.1212/wnl.0000000000207899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/17/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence rate of Parkinson disease (PD) has been increasing rapidly during the past years. Yet, no treatments exist to prevent or slow the progression of the disease. Moreover, we are unable to detect early disease stages during which intervention with disease-modifying therapies is most likely to succeed. The objective of this study was to perform an agnostic drug-wide association study estimating the association between the use of any of the drugs prescribed in Norway and the subsequent risk of PD. METHODS This registry-based cohort study use data from the entire Norwegian population between 2004 and 2019 linked to the Norwegian Prescription Registry, with more than 600 million individual prescriptions. Drug classes were screened according to Anatomical Therapeutic Chemical codes at level 2, corresponding to therapeutic subgroups. We used Cox regression models to estimate hazard ratios (HRs) and 95% CIs for the associations between drug classes and PD risk. All p values were corrected for multiple testing using the false discovery rate. In addition, we conducted sensitivity analyses of exposure definition as well as time-lag and dose-response analyses. RESULTS The study population comprised 3,223,672 individuals, 15,849 of whom developed PD during the follow-up. We identified 31 drug classes that were statistically significantly associated with PD risk in Norway during the follow-up. Drugs acting on the renin-angiotensin system (HR 0.92, 95% CI 0.89-0.95), corticosteroids for systemic use (0.88, 95% CI 0.84-0.93), and vaccines (0.89, 95% CI 0.82-0.96) were associated with a decreased risk of PD even up to 10 years before PD onset. Drug classes used to treat symptoms related to prodromal signs of PD, such as constipation, urological issues, and depression, were associated with an increased risk of subsequent diagnosis of PD with HRs of 1.6 (95% CI 1.49-1.73), 1.48 (1.42-1.53), and 1.94 (1.87-2.01), respectively. DISCUSSION This drug-wide study identified 31 drug classes that were associated with the PD risk change. It reveals the links of renin-angiotensin system medications, vaccines, and corticosteroids with PD risk and suggests that monitoring drug usage using pharmacoepidemiology may allow identifying individuals with prodromal PD.
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Affiliation(s)
- Julia Romanowska
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
| | - Kjetil Bjornevik
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Marianna Cortese
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Julia A Tuominen
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Magne Solheim
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Asieh Abolpour Mofrad
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Jannicke Igland
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Clemens R Scherzer
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Trond Riise
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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Palacios N, Wilkinson J, Bjornevik K, Schwarzschild MA, McIver L, Ascherio A, Huttenhower C. Metagenomics of the Gut Microbiome in Parkinson's Disease: Prodromal Changes. Ann Neurol 2023; 94:486-501. [PMID: 37314861 PMCID: PMC10538421 DOI: 10.1002/ana.26719] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Prior studies on the gut microbiome in Parkinson's disease (PD) have yielded conflicting results, and few studies have focused on prodromal (premotor) PD or used shotgun metagenomic profiling to assess microbial functional potential. We conducted a nested case-control study within 2 large epidemiological cohorts to examine the role of the gut microbiome in PD. METHODS We profiled the fecal metagenomes of 420 participants in the Nurses' Health Study and the Health Professionals Follow-up Study with recent onset PD (N = 75), with features of prodromal PD (N = 101), controls with constipation (N = 113), and healthy controls (N = 131) to identify microbial taxonomic and functional features associated with PD and features suggestive of prodromal PD. Omnibus and feature-wise analyses identified bacterial species and pathways associated with prodromal and recently onset PD. RESULTS We observed depletion of several strict anaerobes associated with reduced inflammation among participants with PD or features of prodromal PD. A microbiome-based classifier had moderate accuracy (area under the curve [AUC] = 0.76 for species and 0.74 for pathways) to discriminate between recently onset PD cases and controls. These taxonomic shifts corresponded with functional shifts indicative of carbohydrate source preference. Similar, but less marked, changes were observed in participants with features of prodromal PD, in both microbial features and functions. INTERPRETATION PD and features of prodromal PD were associated with similar changes in the gut microbiome. These findings suggest that changes in the microbiome could represent novel biomarkers for the earliest phases of PD. ANN NEUROL 2023;94:486-501.
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Affiliation(s)
- Natalia Palacios
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA
- Department of Veterans Affairs, ENRM VA Hospital, Bedford, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Chan Microbiome in Public Health Center (HCMPH)
| | | | - Kjetil Bjornevik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Chan Microbiome in Public Health Center (HCMPH)
| | | | - Lauren McIver
- Harvard Chan Microbiome in Public Health Center (HCMPH)
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Alberto Ascherio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Chan Microbiome in Public Health Center (HCMPH)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Curtis Huttenhower
- Harvard Chan Microbiome in Public Health Center (HCMPH)
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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Paracha M, Herbst K, Kieburtz K, Venuto CS. Prevalence and Incidence of Nonmotor Symptoms in Individuals with and Without Parkinson's Disease. Mov Disord Clin Pract 2022; 9:961-966. [PMID: 36247906 PMCID: PMC9547141 DOI: 10.1002/mdc3.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background The prevalence ratio (PR) and incidence rate ratio (IRR) of nonmotor symptoms (NMS) were calculated for early Parkinson's disease (PD) versus non-PD from 2 observational studies. Methods NMS were assessed through the self-reported Non-Motor Symptom Questionnaire in the online Fox Insight study and through self- and clinician-rated scales in the Parkinson's Progression Marker Initiative (PPMI) study. Age- and sex-adjusted/matched PR and IRR were estimated for each NMS by PD status using Poisson regression. Results Most NMS occurred more frequently in PD. Among 15,194 Fox Insight participants, sexual dysfunction had the largest adjusted PR (12.4 [95% CI, 6.9-22.2]) and dysgeusia/hyposmia had the largest adjusted IRR over a 2-year median follow-up (17.0 [95% CI, 7.8-37.1]). Among 607 PPMI participants, anosmia had the largest PR (16.6 [95% CI, 6.1-44.8]). During the 7-year median follow-up, hallucinations had the largest IRR (13.5 [95% CI, 6.3-28.8]). Conclusion Although many NMS are more common in early PD than in non-PD, their occurrence may differ with time (hallucinations) or data collection methods (sexual dysfunction).
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Affiliation(s)
- Mariam Paracha
- Center for Health + TechnologyUniversity of RochesterRochesterNew YorkUSA
- Department of Science and MathematicsNational Technical Institute for the Deaf, Rochester Institute of TechnologyRochesterNew YorkUSA
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
| | - Konnor Herbst
- Center for Health + TechnologyUniversity of RochesterRochesterNew YorkUSA
| | - Karl Kieburtz
- Center for Health + TechnologyUniversity of RochesterRochesterNew YorkUSA
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
| | - Charles S. Venuto
- Center for Health + TechnologyUniversity of RochesterRochesterNew YorkUSA
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
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Bareeqa SB, Samar SS, Kamal S, Masood Y, Allahyar, Ahmed SI, Hayat G. Prodromal depression and subsequent risk of developing Parkinson's disease: a systematic review with meta-analysis. Neurodegener Dis Manag 2022; 12:155-164. [PMID: 35512296 DOI: 10.2217/nmt-2022-0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Parkinson's disease (PD) is a progressive neurological disorder that predominately affects dopaminergic neurons. We believe that this pooling of data will help to better understand the prodromal nature of depression in PD. Materials & methods: We conducted this study in accordance with PRISMA guidelines 2020. Fifteen eligible articles were shortlisted for final analysis. Risk of bias assessment was also conducted Results: The random-effect model revealed that the risk of subsequent Parkinson's disease in patients with prodromal depression was twice as likely (OR, 2.04; 95% CI, 1.02-4.08) as compared with a healthy population. Conclusion: Our meta-analysis concluded that the subsequent risk of PD is significantly higher in patients with depression as compared with healthy individuals.
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Affiliation(s)
| | - Syeda Sana Samar
- Medical Student, Jinnah Sindh Medical University, Karachi, Sindh, 75510, Pakistan
| | - Sufiyan Kamal
- Medical Student, Jinnah Sindh Medical University, Karachi, Sindh, 75510, Pakistan
| | - Yasir Masood
- Washington University in Saint Louis, MO 63130, USA
| | - Allahyar
- Bolan Medical Complex Hospital, Quetta, Balochistan, 87300, Pakistan
| | - Syed Ijlal Ahmed
- Department of Neurology, Neurology Resident, Saint Louis University, MO 63103, USA
| | - Ghazala Hayat
- Department of Neurology, Professor of Neurology, Saint Louis University, MO 63103, USA
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Abstract
Age-related olfactory dysfunction, or presbyosmia, is a common sensory impairment in aging adults. People in this demographic group with comorbid conditions or exposure to viral, traumatic, or environmental insults remain at the greatest risk for impairment. Several methods for assessing olfaction exist, but they are only available in special settings and require consideration of age, sex, ancestry, and cognition. Perhaps most importantly, olfactory dysfunction has been suggested as an early sign of Alzheimer's and Parkinson's disease and therefore may serve as a tool in the diagnosis and prognosis of these neurodegenerative conditions. Outside of this context, olfactory loss also impacts nutrition, safety, and social relationships, and even predicts mortality itself. This review covers the detection and manifestations of olfactory decline in aging individuals and the myriad ways in which olfactory impairment is connected to their health and well-being.
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Affiliation(s)
- Emily J Papazian
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
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Invalid Self-Assessment of Olfactory Functioning in Parkinson's Disease Patients May Mislead the Neurologist. PARKINSONS DISEASE 2020; 2020:7548394. [PMID: 33274040 PMCID: PMC7683170 DOI: 10.1155/2020/7548394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Olfactory dysfunction (OD) is a prominent nonmotor symptom in Parkinson's disease (PD), and OD is a supportive diagnostic criterion for PD. Physicians often ask their patients if they have noticed a smell disorder. This study evaluates the diagnostic validity of OD self-assessment in PD. To this end, 64 PD patients and 33 age-matched healthy controls were enrolled in a study assessing subjective and objective olfactory functioning. To examine subjective olfactory abilities, first, patients and controls had to classify their olfactory sense as “impaired” or “unimpaired,” comparable to a realistic situation in an outpatient setting. Second, to evaluate subjective olfactory acuity, a visual analogue scale (VAS) was used. Third, the Sniffin' Sticks test battery was used as an objective instrument to diagnose OD. Categorical olfactory self-assessment predicts the classification normosmic versus hyposmic based on the global Sniffin' Sticks score (TDI) with a sensitivity of 0.79 and a specificity of 0.45. TDI correlated significantly with the VAS (r = 0.297, p = 0.017). The ROC curve analysis, using the VAS rating as a predictor for objective olfaction, revealed 42 as the best possible cutoff score with an area under the curve of 0.63. These results demonstrate that olfactory self-assessments show a low accuracy and are not suitable for the diagnosis of a smell disorder in PD. Objective measures are necessary to evaluate olfactory sense in clinical and research settings.
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Draoui A, El Hiba O, Aimrane A, El Khiat A, Gamrani H. Parkinson's disease: From bench to bedside. Rev Neurol (Paris) 2020; 176:543-559. [DOI: 10.1016/j.neurol.2019.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/12/2023]
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Molsberry S, Bjornevik K, Hughes KC, Healy B, Schwarzschild M, Ascherio A. Diet pattern and prodromal features of Parkinson disease. Neurology 2020; 95:e2095-e2108. [PMID: 32817391 DOI: 10.1212/wnl.0000000000010523] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the relationship between diet pattern and prodromal Parkinson disease (PD) features. METHODS These analyses include 47,679 participants from the Nurses' Health Study and the Health Professionals Follow-up Study. Since 1986, both cohorts have collected dietary information every 4 years and calculated scores for adherence to different diet patterns, including the alternate Mediterranean diet (aMED) and the Alternative Healthy Eating Index (AHEI). In 2012, participants responded to questions regarding constipation and probable REM sleep behavior disorder. For a subset of 17,400 respondents to the 2012 questionnaire, 5 additional prodromal features of PD were assessed in 2014 to 2015. We used multinomial logistic regression to estimate the association between baseline (1986) diet pattern score quintiles and number of prodromal features (0, 1, 2, or ≥3) in 2012 to 2015. Additional analyses investigated the association between long-term adherence to these dietary patterns over 20 years and prodromal features suggestive of PD. RESULTS In a comparison of extreme aMED diet quintiles, the odds ratio for ≥3 vs 0 features was 0.82 (95% confidence interval [CI] 0.68-1.00, false discovery rate [FDR]-adjusted p trend = 0.03) at baseline and 0.67 (95% CI 0.54-0.83, FDR-p trend < 0.001) for long-term diet; results were equally strong for the association with AHEI scores. Higher adherence to these diets was inversely associated with individual features, including constipation, excessive daytime sleepiness, and depression. CONCLUSIONS The inverse association between these diet patterns and prodromal PD features is consistent with previous findings and suggests that adherence to a healthy diet may reduce the occurrence of nonmotor symptoms that often precede PD diagnosis.
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Affiliation(s)
- Samantha Molsberry
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Kjetil Bjornevik
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Katherine C Hughes
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brian Healy
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael Schwarzschild
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Schrag A, Zhelev S, Hotham S, Merritt R, Khan K, Graham L. Heterogeneity in progression of prodromal features in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:275-279. [DOI: 10.1016/j.parkreldis.2019.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/10/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Durcan R, Wiblin L, Lawson RA, Khoo TK, Yarnall AJ, Duncan GW, Brooks DJ, Pavese N, Burn DJ. Prevalence and duration of non-motor symptoms in prodromal Parkinson's disease. Eur J Neurol 2019; 26:979-985. [PMID: 30706593 PMCID: PMC6563450 DOI: 10.1111/ene.13919] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
Background and purpose The prevalence and duration of non‐motor symptoms (NMS) in prodromal Parkinson's disease (PD) has not been extensively studied. The aim of this study was to determine the prevalence and duration of prodromal NMS (pNMS) in a cohort of patients with recently diagnosed PD. Methods We evaluated the prevalence and duration of pNMS in patients with early PD (n = 154). NMS were screened for using the Non‐Motor Symptom Questionnaire (NMSQuest). We subtracted the duration of the presence of each individual NMS reported from the duration of the earliest motor symptom. NMS whose duration preceded the duration of motor symptoms were considered a pNMS. Individual pNMS were then grouped into relevant pNMS clusters based on the NMSQuest domains. Motor subtypes were defined as tremor dominant, postural instability gait difficulty (PIGD) and indeterminate type according to the Movement Disorder Society Unified Parkinson's Disease Rating Scale revision. Results Prodromal NMS were experienced by 90.3% of patients with PD and the median number experienced was 4 (interquartile range, 2–7). A gender difference existed in the pNMS experienced, with males reporting more sexual dysfunction, forgetfulness and dream re‐enactment, whereas females reported more unexplained weight change and anxiety. There was a significant association between any prodromal gastrointestinal symptoms [odds ratio (OR), 2.30; 95% confidence interval (CI), 1.08–4.89, P = 0.03] and urinary symptoms (OR, 2.54; 95% CI, 1.19–5.35, P = 0.016) and the PIGD phenotype. Further analysis revealed that total pNMS were not significantly associated with the PIGD phenotype (OR, 1.10; 95% CI, 0.99–1.21, P = 0.068). Conclusions Prodromal NMS are common and a gender difference in pNMS experienced in prodromal PD may exist. The PIGD phenotype had a higher prevalence of prodromal gastrointestinal and urinary tract symptoms.
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Affiliation(s)
- R Durcan
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - L Wiblin
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - R A Lawson
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - T K Khoo
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia.,School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - A J Yarnall
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - G W Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - D J Brooks
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - N Pavese
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - D J Burn
- Faculty of Medical Science, Newcastle University, Newcastle Upon Tyne, UK
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Schrag A, Anastasiou Z, Ambler G, Noyce A, Walters K. Predicting diagnosis of Parkinson's disease: A risk algorithm based on primary care presentations. Mov Disord 2019; 34:480-486. [PMID: 30735573 PMCID: PMC6518931 DOI: 10.1002/mds.27616] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diagnosis of Parkinson's disease (PD) is typically preceded by nonspecific presentations in primary care. OBJECTIVES The objective of this study was to develop and validate a prediction model for diagnosis of PD based on presentations in primary care. SETTING The settings were general practices providing data for The Health Improvement Network UK primary care database. METHODS Data from 8,166 patients aged older than age 50 years with incident diagnosis of PD and 46,755 controls were analyzed. Likelihood ratios, sensitivity, specificity, and positive and negative predictive values for individual symptoms and combinations of presentations were calculated. An algorithm for risk of diagnosis of PD within 5 years was calculated using multivariate logistic regression analysis. Split sample analysis was used for model validation with a 70% development sample and a 30% validation sample. RESULTS Presentations independently and significantly associated with later diagnosis of PD in multivariate analysis were tremor, constipation, depression or anxiety, fatigue, dizziness, urinary dysfunction, balance problems, memory problems and cognitive decline, hypotension, rigidity, and hypersalivation. The discrimination and calibration of the risk algorithm were good with an area under the curve of 0.80 (95% confidence interval 0.78-0.81). At a threshold of 5%, 37% of those classified as high risk would be diagnosed with PD within 5 years and 99% of those who were not classified as high risk would not be diagnosed with PD. CONCLUSION This risk algorithm applied to routine primary care presentations can identify individuals at increased risk of diagnosis of PD within 5 years to allow for monitoring and earlier diagnosis of PD. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anette Schrag
- University College London Institute of Neurology, University College London, London, UK
| | - Zacharias Anastasiou
- University College London Institute of Neurology, University College London, London, UK
| | - Gareth Ambler
- University College London Department of Statistical Science, University College London, London, UK
| | - Alastair Noyce
- University College London Institute of Neurology, University College London, London, UK
| | - Kate Walters
- University College London Department of Primary Care & Population Health, University College London, London, UK
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12
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Reduced workforce participation 5 years prior to first Parkinson's disease sick-leave. NPJ PARKINSONS DISEASE 2018; 4:36. [PMID: 30564630 PMCID: PMC6290795 DOI: 10.1038/s41531-018-0072-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Abstract
The importance of understanding the prodromal phase of Parkinson’s disease (PD) by systematic recording of prediagnostic symptoms and reductions in body functions has been highlighted. The aim of this study was to investigate whether persons later diagnosed with PD exhibit increased physician-certified sickness absence 1, 2, and 5 years prior to a first sick-leave episode attributed to PD. A case-control study was performed to analyze data from all nontrivial (exceeding 14 days) sick-leave episodes in Sweden between 2008 and 2014. The 537 incident PD sick-leave episodes were identified as PD sick-leave cases and compared to 537 sick-leave controls identified by matching age, sex, and date of the first day of the sick-leave episode. The total sickness absence and sickness absence due to musculoskeletal diagnoses were found to be increased among the PD sick-leave cases from 5 years prior to the first sick-leave episode ascribed to PD when compared to the controls. No differences between PD sick-leave cases and sick-leave controls were found with regard to mental and behavioral diagnoses. We conclude that the capacity to participate in working life is reduced already at the early prediagnostic stages of PD. This finding can be used as a basis for further research into the process of identifying individuals at risk for developing PD, particularly in combination with further investigation into biochemical, genetic, and imaging biomarkers. A Swedish study shows that Parkinson’s disease (PD) patients had more sick-leave episodes in the years before diagnosis than matched controls not diagnosed with PD. There is growing evidence that prior PD diagnosis, patients experience a variety of nonmotor symptoms and subtle motor signs. Further understanding these symptoms could prompt earlier therapeutic intervention and increase the likelihood of slowing down or even halting disease progression. A study led by Jonathan Timpka at Lund University examined the sickness leave history of 537 workers 1, 2 and 5 years before a first sick-leave episode due to PD. These workers took more sick-leave due to musculoskeletal symptoms, but not due to mental or behavioral issues, than the control group. These findings highlight a potential effect of preclinical PD on patients’ ability to work.
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Knudsen K, Krogh K, Østergaard K, Borghammer P. Constipation in parkinson's disease: Subjective symptoms, objective markers, and new perspectives. Mov Disord 2016; 32:94-105. [PMID: 27873359 DOI: 10.1002/mds.26866] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 12/16/2022] Open
Abstract
Constipation is among the first nonmotor symptoms to develop in the prodromal phase of PD. Pathological alpha-synuclein deposition is present throughout the gastrointestinal tract up to 20 years preceding diagnosis. Nevertheless, constipation in the context of PD remains ill defined and poorly understood. In this review, we summarize current knowledge of subjective symptoms and objective measures of constipation in PD. More than 10 different definitions of constipation have been used in the PD literature, making generalizations difficult. When pooling results from the most homogeneous studies in PD, a median constipation prevalence of 40% to 50% emerges, but with large variation across individual studies. Also, constipation prevalence tends to increase with disease progression. A similar prevalence is observed among patients with idiopathic rapid eye movement sleep behavior disorder. Interestingly, we detected a correlation between constipation prevalence in PD patients and healthy control groups in individual studies, raising concerns about how various constipation questionnaires are implemented across study populations. More than 80% of PD patients exhibit prolonged colonic transit time, and the same is probably true for de novo PD patients. Thus, the prevalence of objective colonic dysfunction exceeds the prevalence of subjective constipation. Colonic transit time measures are simple, widely available, and hold promise as a useful biomarker in manifest PD. More research is needed to elucidate the role of gastrointestinal dysfunction in disease progression of PD. Moreover, colonic transit measures may have utility as a more accurate risk factor for predicting PD in the prodromal phase. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Karen Østergaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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14
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Tudor KI, Sakakibara R, Panicker JN. Neurogenic lower urinary tract dysfunction: evaluation and management. J Neurol 2016; 263:2555-2564. [DOI: 10.1007/s00415-016-8212-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/20/2022]
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15
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Walter U, Heilmann E, Voss J, Riedel K, Zhivov A, Schäd SG, Gross GE, Benecke R, Trcka J. Frequency and profile of Parkinson's disease prodromi in patients with malignant melanoma. J Neurol Neurosurg Psychiatry 2016; 87:302-10. [PMID: 25817520 DOI: 10.1136/jnnp-2014-310239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The results of register studies suggest an association between Parkinson's disease (PD) and melanoma. We studied the frequency and profile of early markers of PD in patients with malignant melanoma. METHODS 100 participants were enrolled in a prospective observational study, of whom 65 had a history of high-risk cutaneous (n=53) or uveal (n=12) melanoma (31 women; age, 61.2±14.9 years) and another 35 served as control participants (19 women; 54.6±20.5 years). Participants underwent assessments of motor function (Unified PD Rating Scale; keyboard tapping test), olfactory function, colour vision, depressive symptoms, the Non-Motor Symptoms Questionnaire, and transcranial brain sonography. Raters were blinded to the diagnosis and clinical data of study participants. RESULTS Patients with melanoma showed increased frequency of substantia nigra hyperechogenicity and prodromal motor and non-motor features of PD, especially asymmetric motor slowing and apathy. Hyposmia and colour vision disturbance were, however, infrequent. Larger echogenicity of substantia nigra correlated with lower serum iron in patients with melanoma, similar to previously reported findings in PD, and independently from the earlier findings, with lighter skin pigmentation. Substantia nigra hyperechogenicity, combined with motor asymmetry or hyposmia, was present at baseline in all participants with mild or definite parkinsonism diagnosed after 1 year. Parkinsonism was specifically related to melanoma location at the sun-exposed skin of the head or neck. CONCLUSIONS History of melanoma was associated with increased prevalence of prodromal markers of PD. Their predictive value needs to be established in long-term investigations. The similarity of serum iron characteristics found in patients with melanoma and PD deserves further research.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Elise Heilmann
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Johannes Voss
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Katrin Riedel
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Andrey Zhivov
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Susanne G Schäd
- Department of Dermatology and Venerology, University of Rostock, Rostock, Germany
| | - Gerd E Gross
- Department of Dermatology and Venerology, University of Rostock, Rostock, Germany
| | - Reiner Benecke
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jiri Trcka
- Department of Dermatology and Venerology, University of Rostock, Rostock, Germany
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16
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Plouvier AOA, Olde Hartman TC, Boots LPW, Bloem BR, van Weel C, Lagro-Janssen ALM. Time intervals in diagnosing Parkinson's disease: The patients' views. PATIENT EDUCATION AND COUNSELING 2015; 98:777-782. [PMID: 25770049 DOI: 10.1016/j.pec.2015.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/22/2014] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore patients' views on their pathway to the diagnosis of Parkinson's disease (PD). METHODS A qualitative study of 52 essays written by patients with PD, using comparative content analysis. RESULTS Patients divide their diagnostic pathway into three time intervals: recognition of the symptoms; the decision to seek help; and the process of diagnosing PD. Patients have difficulties recognizing the prodromal symptoms of PD (their knowledge is based on public figures with advanced PD) and mention their general practitioners do as well. The decision to seek help is influenced by the patient's attitude toward health care and by their significant others. More than half of the patients believe their diagnosis was delayed. However, the majority of all patients are satisfied with their diagnostic trajectory. CONCLUSION The pathway to diagnosing PD is an iterative process influenced by patient-, health care provider- and disease-related factors. Despite possible delay in diagnosis, patients are content with their pathway. PRACTICE IMPLICATIONS In order to facilitate earlier diagnosis and timely therapeutic intervention (in particular with regard to future possibilities for disease modifying therapy), effort is required to increase the recognition of prodromal symptoms of PD by patients, their significant others and health care providers.
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Affiliation(s)
- Annette O A Plouvier
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands.
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands
| | - Leontien P W Boots
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology and Parkinson Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands
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Schrag A, Horsfall L, Walters K, Noyce A, Petersen I. Prediagnostic presentations of Parkinson's disease in primary care: a case-control study. Lancet Neurol 2015; 14:57-64. [PMID: 25435387 DOI: 10.1016/s1474-4422(14)70287-x] [Citation(s) in RCA: 408] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parkinson's disease has an insidious onset and is diagnosed when typical motor features occur. Several motor and non-motor features can occur before diagnosis, early in the disease process. We aimed to assess the association between first presentation of several prediagnostic features in primary care and a subsequent diagnosis of Parkinson's disease, and to chart the timeline of these first presentations before diagnosis. METHODS We identified individuals with a first diagnosis of Parkinson's disease and those without Parkinson's disease from Jan 1, 1996, to Dec 31, 2012, from The Health Improvement Network UK primary care database. Codes were extracted for a range of possible prediagnostic or early symptoms, comprising motor features (tremor, rigidity, balance impairments, neck pain or stiffness, and shoulder pain or stiffness), autonomic features (constipation, hypotension, erectile dysfunction, urinary dysfunction, and dizziness), neuropsychiatric disturbances (memory problems, late-onset anxiety or depression, cognitive decline, and apathy), and additional features (fatigue, insomnia, anosmia, hypersalivation and rapid-eye-movement sleep behaviour disorder) in the years before diagnosis. We report the incidence of symptoms recorded in more than 1% of cases per 1000 person-years and incidence risk ratios (RRs) for individuals with and without Parkinson's disease at 2, 5, and 10 years before diagnosis. FINDINGS 8166 individuals with and 46,755 individuals without Parkinson's disease were included in the study. Apathy, REM sleep behaviour disorder, anosmia, hypersalivation, and cognitive decline were all reported in less than 1% of people per 1000 person-years and were excluded from further analyses. At 2 years before Parkinson's disease diagnosis, the incidence of all studied prediagnostic features except neck pain or stiffness was higher in patients who went on to develop Parkinson's disease (n=7232) than in controls (n=40,541). At 5 years before diagnosis, compared with controls (n=25,544), patients who went on to develop Parkinson's disease (n=4769) had a higher incidence of tremor (RR 13·70, 95% CI 7·82-24·31), balance impairments (2·19, 1·09-4·16), constipation (2·24, 2·04-2·46), hypotension (3·23, 1·85-5·52), erectile dysfunction (1·30, 1·11-1·51), urinary dysfunction (1·96, 1·34-2·80), dizziness (1·99, 1·67-2·37), fatigue (1·56, 1·27-1·91), depression (1·76, 1·41-2·17), and anxiety (1·41, 1·09-1·79). At 10 years before diagnosis of Parkinson's disease, the incidence of tremor (RR 7·59, 95% CI 1·11-44·83) and constipation (2·01, 1·62-2·49) was higher in those who went on to develop Parkinson's disease (n=1680) than in controls (n=8305). INTERPRETATION A range of prediagnostic features can be detected several years before diagnosis of Parkinson's disease in primary care. These data can be incorporated into ongoing efforts to identify individuals at the earliest stages of the disease for inclusion in future trials and to help understand progression in the earliest phase of Parkinson's disease. FUNDING Parkinson's UK.
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Affiliation(s)
- Anette Schrag
- UCL Institute of Neurology, University College London, London, UK.
| | - Laura Horsfall
- UCL Department of Primary Care and Population Sciences, University College London, London, UK
| | - Kate Walters
- UCL Department of Primary Care and Population Sciences, University College London, London, UK
| | - Alastair Noyce
- UCL Institute of Neurology, University College London, London, UK
| | - Irene Petersen
- UCL Department of Primary Care and Population Sciences, University College London, London, UK
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Walter U, Heilmann R, Kaulitz L, Just T, Krause BJ, Benecke R, Höppner J. Prediction of Parkinson's disease subsequent to severe depression: a ten-year follow-up study. J Neural Transm (Vienna) 2014; 122:789-97. [PMID: 25217967 DOI: 10.1007/s00702-014-1313-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
Major depressive disorder (MDD) has been associated with an increased risk of subsequent Parkinson's disease (PD) in case-control and cohort studies. However, depression alone is unlikely to be a useful marker of prodromal PD due to its low specificity. In this longitudinal observational study, we assessed whether the presence of other potential markers of prodromal PD predicts the subsequent development of PD in MDD patients. Of 57 patients with severe MDD but no diagnosis of PD who underwent a structured interview, olfactory and motor investigation and transcranial sonography at baseline, 46 (36 women; mean age 54.9 ± 11.7 years) could be followed for up to 11 (median, 10) years. Three patients (2 women; age 64, 65 and 70 years) developed definite PD after 1, 7, and 9 years, respectively. The combined finding of mild asymmetric motor slowing, idiopathic hyposmia, and substantia nigra hyperechogenicity predicted subsequent PD in all patients who could be followed for longer than 1 year. Out of the whole study cohort, only the subjects with subsequent PD presented with the triad of asymmetric motor slowing, idiopathic hyposmia, and substantia nigra hyperechogenicity in combination with at least two out of four reportable risk factors (family history of PD, current non-smoker, non-coffee drinker, constipation) at baseline investigation. Post-hoc analysis revealed that additional rating of eye and eye-lid motor abnormalities might further improve the prediction of PD in larger cohorts. Findings of this pilot-study suggest that MDD patients at risk of subsequent PD can be identified using an inexpensive non-invasive diagnostic battery.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany,
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Is elevated norepinephrine an etiological factor in some cases of Parkinson’s disease? Med Hypotheses 2014; 82:462-9. [DOI: 10.1016/j.mehy.2014.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/12/2014] [Accepted: 01/22/2014] [Indexed: 11/19/2022]
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