Parkinson's disease between internal medicine and neurology

Advanced glycation end products consumption and the decline of functional capacity in patients with Parkinson's disease: Cross-sectional study

INTRODUCTION

Advanced Glycation End-Products (AGEs) are a diverse group of highly reactive molecules that play a vital role in the development of neurodegenerative disorders, such as Parkinson's Disease (PD), leading to a decline in functional and cognitive capacity. The objective of this study was to assess the intake and quantification of AGEs in individuals with PD and to correlate them with their functional and cognitive abilities.

METHODS

This was a cross-sectional study involving 20 PD patients and 20 non-PD individuals as the Control group (C). The autofluorescence reader was used to evaluate skin AGEs, while food recall was used to quantify AGEs consumed for three different days. The Montreal Cognitive Assessment, Short Physical Performance Battery, and handgrip tests were used. PD patients demonstrated greater impairment in functional capacity compared to the control group.

RESULTS

Dominant Handgrip (p = 0.02) and motor performance, in the sit and stand test (p = 0.01) and Short Physical Performance Battery (SPPB) (p = 0.01) were inferior in PD patients than the control group. Although PD patients tended to consume less AGEs than the control group, AGE intake was negatively correlated with handgrip strength in individuals with PD (r = -0.59; p < 0.05).

CONCLUSION

PD patients had lower strength and functional capacity, suggesting that the effects of AGEs might be exacerbated during chronic diseases like Parkinson's.

From zinc homeostasis to disease progression: Unveiling the neurodegenerative puzzle

Zinc is a crucial trace element in the human body, playing a role in various physiological processes such as oxidative stress, neurotransmission, protein synthesis, and DNA repair. The zinc transporters (ZnTs) family members are responsible for exporting intracellular zinc, while Zrt- and Irt-like proteins (ZIPs) are involved in importing extracellular zinc. These processes are essential for maintaining cellular zinc homeostasis. Imbalances in zinc metabolism have been linked to the development of neurodegenerative diseases. Disruptions in zinc levels can impact the survival and activity of neurons, thereby contributing to the progression of neurodegenerative diseases through mechanisms like cell apoptosis regulation, protein phase separation, ferroptosis, oxidative stress, and neuroinflammation. Therefore, conducting a systematic review of the regulatory network of zinc and investigating the relationship between zinc dysmetabolism and neurodegenerative diseases can enhance our understanding of the pathogenesis of these diseases. Additionally, it may offer new insights and approaches for the treatment of neurodegenerative diseases.

Tissue expansion for challenging DBS hardware erosions in patients with Parkinson's disease

•Consider tissue expanders for challenging DBS cases in PD patients with hardware erosion.•Placement of tissue expander is essential in planning the reconstruction.•MRI-compatibility of the tissue expander is paramount for shortening the total duration of anesthesia.•Role of routine skin biopsies to identify PD patients at additional risk for developing scalp defects should be investigated.

Association Between Parkinson's Disease and Coronary Artery Disease: A Systematic Review and Meta-Analysis

BACKGROUND

The relationship between Parkinson's disease (PD) and coronary artery disease (CAD) is unclear.

OBJECTIVE

This study aims to investigate whether PD and CAD are associated through systematic review and meta-analysis of observational studies.

METHODS

Electronic database search of PubMed, EMBASE, and Web of Science for observational studies published from 1 January 2010 to 1 August 2021 was conducted using terms related to PD and CAD. Unadjusted risk ratios (RR) and odds ratios (OR) of included cohort and case-control studies respectively were used to ascertain the association between PD and CAD. Study heterogeneity was evaluated using the I2 test.

RESULTS

Forty-one full-text studies were initially retrieved for eligibility assessment. Five studies that satisfied the inclusion criteria, consisting of three cohort and two case-control studies, were eventually included in this meta-analysis. The five studies enrolled 35,237 PD patients and 650,866 non-PD patients. PD and CAD were found to be significantly associated in cohort studies (RR = 2.23, 95% CI = 1.08-4.59, p = 0.03; Fig. 2), which held after sensitivity analysis (RR = 1.45, 95% CI = 1.31-1.60, p < 0.001; Fig. 3). Case-control studies found a trend towards association of PD and CAD approaching significance (OR = 1.47, 95% CI = 0.84-2.56, p = 0.18; Fig. 2).

CONCLUSION

Overall, this meta-analysis suggests that PD is associated with CAD. The underlying mechanisms, as well as the role of ethnicity and other comorbidities on the relationship between PD and CAD should be further explored.

Parkinson's disease and cancer: a systematic review and meta-analysis on the influence of lifestyle habits, genetic variants, and gender

PURPOSE

The relationship between Parkinson's disease (PD) and cancer has been debated. Gender and genetic influences on cancer development in PD is unclear.

METHODS

Using QUOROM guidelines, we conducted a systematic review and meta-analysis on potential clinical and genetic factors influencing the PD and subsequent cancer relationship. English articles published in PubMed, Web of Science, and SCOPUS from 2010 to 30 August 2020 were considered for suitability.

RESULTS

Of 46 studies identified, fourteen satisfied the inclusion criteria and were further analysed. Unadjusted risk ratios (RR) and 95% confidence intervals were computed to determine the PD and cancer relationship. PD patients have decreased subsequent cancer risks (RR = 0.87, 95% CI = 0.81-0.93), reduced risks of colon, rectal, and colorectal cancer (RR = 0.77, 95% CI = 0.63-0.94), lung cancer (RR = 0.62, 95% CI = 0.48-0.80), and increased brain cancer (R = 1.48, 95% CI = 1.02-2.13) and melanoma risk (R = 1.76, 95% CI = 1.23-2.50). Compared to idiopathic PD, LRRK2-G2019S carriers had increased general cancer risks (RR = 1.26, 95% CI = 1.09-1.46), particularly brain (RR = 2.41, 95% CI = 1.06-5.50), breast (RR = 2.57, 95% CI = 1.19-5.58), colon (RR = 1.83, 95% CI = 1.13-2.99), and haematological cancers (RR = 2.05, 95% CI = 1.07-3.92). Female PD patients have decreased general cancer risks compared to male PD patients in this analysis (RR = 0.83, 95% CI = 0.69-0.98).

CONCLUSION

PD patients have reduced risks of colon, rectal, colorectal cancer and lung cancers and increased risks of brain cancer and melanoma. LRRK2-G2019S carriers have increased cancer risks, particularly brain, breast, colon and blood cancers. Female gender was associated with reduced risks. The role of ethnicity, comorbidities, and lifestyle habits on PD patients' subsequent cancer risk should be further investigated.

Transition and Sustainability of an Online Care Model for People With Parkinson's Disease in Response to the COVID-19 Pandemic

INTRODUCTION

CoronaVirus Disease-2019 (COVID-19) led to social distancing and the need for alternative care models. Telehealth programs for people with Parkinson's (PWP) disease may ensure continuity of care. The goal of this observational survey study was to determine the practicability, satisfaction, and barriers to online programs, their relationship to perceived symptoms, mood, and quality of life, and program sustainability beyond the immediate pandemic.

METHODS

In-person Parkinson's programs at New York Institute of Technology College of Osteopathic Medicine transitioned online at the start of the pandemic to include Rock Steady Boxing, Support Groups, and Rock Steady Buddies. A custom online survey sent to 150 participants investigated PD history, symptomatology, level of exercise before and during the pandemic, depression (PHQ-9), quality of life (PDQ-39), and practicability and perceived satisfaction related to these online programs. Descriptive statistics were reported.

RESULTS

Of 69 respondents [mean age of 70.2y (SD 8.4 yrs)], >75% were satisfied with the transition to online programs. Consistent attendance and minimal barriers to programs indicated practicability, with increased adherence to exercise. Of 66 completed PHQ-9s, 22.7% had scores ≥9 (moderate to severe depression); of 61 completed PDQ-39s, scores averaged 21.4; better quality of life than national averages for PWP. Self-perceived physical and mental wellbeing were positively affected.

CONCLUSIONS

Results suggest the transition to online programs met the needs of the Parkinson's community in a practicable and sustainable manner during the pandemic. With COVID-19 still prevalent, the current model of blending synchronous online and in-person classes provides a more flexible, sustainable format compared to in-person alone. Institutions may consider including online components to existing programs to promote continuity of care for aging populations as part of best practices.

Outcomes of Patients With Parkinson Disease Undergoing Cervical Spine Surgery for Radiculopathy and Myelopathy With Minimum 2-Year Follow-up

STUDY DESIGN

This was a retrospective cohort analysis.

OBJECTIVE

To identify the impact of Parkinson disease (PD) on 2-year postoperative outcomes following cervical spine surgery (CSS).

SUMMARY OF BACKGROUND DATA

(PD) patients are prone to spine malalignment and surgical interventions, yet little is known regarding outcomes of CSS among PD patients.

MATERIALS AND METHODS

All patients from the Statewide Planning and Research Cooperative System with cervical radiculopathy or myelopathy who underwent CSS were included; among these, those with PD were identified. PD and non-PD patients (n=64 each) were 1:1 propensity score-matched by age, sex, race, surgical approach, and Deyo-Charlson Comorbidity Index (DCCI). Demographics, hospital-related parameters, and adverse postoperative outcomes were compared between cohorts. Logistic regression identified predictive factors for outcomes.

RESULTS

Overall, patient demographics were comparable between cohorts, except that DCCI was higher in PD patients (1.28 vs. 0.67, P=0.028). PD patients had lengthier mean hospital stays than non-PD patients (6.4 vs. 4.1 d, P=0.046). PD patients also incurred comparable total hospital expenses ($69,565 vs. $57,388, P=0.248). Individual medical complication rates were comparable between cohorts; though PD patients had higher rates of postoperative altered mental status (4.7% vs. 0%, P=0.08) and acute renal failure (10.9% vs. 3.1%, P=0.084), these differences were not significant. Yet, PD patients experienced higher rates of overall medical complications (35.9% vs. 18.8%, P=0.029). PD patients had comparable rates of individual and overall surgical complications. The PD cohort underwent higher reoperation rates (15.6% vs. 7.8%, P=0.169) compared with non-PD patients, though this difference was not significant. Of note, PD was not a significant predictor of overall 2-year complications (odds ratio=1.57, P=0.268) or reoperations (odds ratio=2.03, P=0.251).

CONCLUSION

Overall medical complication rates were higher in patients with PD, while individual medical complications as well as surgical complication and reoperation rates after elective CSS were similar in patients with and without PD, though PD patients required longer hospital stays. Importantly, a baseline diagnosis of PD was not significantly associated with adverse two-year medical and surgical complications. This data may improve counseling and risk-stratification for PD patients before CSS.

LEVEL OF EVIDENCE

Level III.

Oral Health Disorders in Parkinson's Disease: More than Meets the Eye

Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.

Visual function changes in a Parkinson's Disease cohort - preliminary data

The prevalence of Parkinson's disease (PD), the second most common neurodegenerative disorder, has dramatically increased worldwide from 2,5 million in 1990, to 6,1 million in 2016. This condition continues to unfold its complexity, being nowadays recognized more as a syndrome rather than a disease. Beside the motor symptoms, the non-motor features, which can appear as early as twenty years before the classic onset, are now included in the diagnostic criteria. Increased public awareness, early recognition, and intervention (mostly neuroprotective) could highly increase the quality of life of people suffering from PD. We believe that these measures must be taken without delay, in order to counteract the increasing prevalence of PD worldwide. Abbreviations: PD = Parkinson's disease, GBD = Global Burden of Diseases, HY = Hoehn-Yahr scale, SD = standard deviation.

A Novel Management Platform Based on Personalized Home Care Pathways for Medicine Management and Rehabilitation of Persons With Parkinson's Disease-Requirements and Implementation Plan of the Care-PD Program

As the percentage of the aging population increases, the incidence of Parkinson's disease (PD) in China is increasing year by year. PD is both a public health and social problem facing the government and society as a whole. Persons with PD need reasonable medication management and rehabilitation strategies after a clear diagnosis. A proper home care plan can effectively slow the progression of PD. However, people with PD lack an effective way to manage their illnesses and cannot achieve the recommended clinical path in a family environment. Medication management, condition monitoring, and rehabilitation training are important components of the home care plan for PD. Persons with PD require strategies that delay the development of the disease and to adhere to treatment, which would contribute to improving their quality of life. Thus, we developed a small program called Care-PD to build a medicine management and service platform for PD. The development of Care-PD is a multi-dimensional model designed for PD, which is funded by the National Key R&D Program of China (No. 2018YFC1314700), and includes services such as medication management, symptom monitoring, professional counseling, home life, and community communication. Care-PD can become a key technology that increases the compliance of persons with PD with home care plans and improve measures to control the disease. In this article, we describe the medication management and services for PD based on the Care-PD program and its structure. The small program will improve the adverse conditions faced by persons with PD by combining the latest technology and clinical approaches. Meanwhile, we describe a verification strategy to evaluate the effectiveness of the Care-PD program as a comprehensive management strategy for PD.

The influences of behavioral and psychological interventions on the neurological function and MMSE scores in Parkinson's disease patients

OBJECTIVE

To analyze the effects of behavioral and psychological interventions on the neurological function in Parkinson's disease (PD) patients.

METHODS

A total of 103 patients with PD admitted to our hospital were randomly divided into the observation group (OG, n=52) or the control group (CNG, n=51). The CNG was treated with routine nursing, while the OG was treated with behavioral and psychological interventions.

RESULTS

At 1, 2, and 3 months after the nursing, the National Institutes of Health Stroke Scale (NIHSS) scores, the unified PD disease rating scale III (UPDRS-III) scores, and the Pittsburgh Sleep Quality Index (PSQI) scores in both groups were lower than they were before the nursing, the NIHSS, UPDRS-III, and PSQI scores in the OG were lower than they were in the CNG, the General Self-efficacy Scale (GSES) and Mini-Mental State Examination (MMSE) scores and the Barthel scores in both groups were higher than they were before the nursing, and the GSES, MMSE, and Barthel scores in the OG were higher than they were in the CNG (P < 0.05).

CONCLUSION

Behavioral and psychological interventions can improve PD patients' impaired neurological function, self-efficacy, cognitive function, motor dysfunction, sleep quality, and quality of life.

[The high blood pressure in patients with Parkinson's disease]

OBJECTIVE

To evaluate the relationships between blood pressure (BP), duration of the high BP, reaction of the cardiovascular system on the physical load with the duration of Parkinson's disease (PD) and motor disorders in PD patients.

MATERIAL AND METHODS

Fifty-six women with PD and high BP in the anamnesis and 91 women with arterial hypertension, stage 1 were included in the study. The groups of the patients did not differ by age (67.14±7.75 vs. 67.24±5.70 years; p>0.05). The patients were asked about the duration of high BP, the maximal systolic and diastolic BP (SBP and DBP) and presence of antihypertensive therapy, the patients with PD were additionally asked about the duration of the disease, the medicine for PD treatment, the vegetative dysfunction features. The assessment of the orthostatic reaction was determined by transition of the patient from the supine position to the sitting position. Three types of the reaction were isolated: normal, orthostatic hypotension and hypertension. The assessment of motor function in patients with PD was performed using MDS UPDRS, part III.

RESULTS

Before and after the orthostatic test, patients with PD and history of arterial hypertension showed normal SBP and DBP levels, while those with isolated hypertension had elevated mean BP corresponding to the high-normal level: the difference in BP levels between the two groups was significant (134.89±17.19 vs. 124.64±18.19 mm Hg; p<0.05; 130.43±19.88 vs. 122.80±19.08 mm Hg; p<0.05). Patients with isolated hypertension were less likely to receive BP-lowering treatment - 30 (32.61%) vs. 10 (18.87%); p=0.04. There were no differences in the frequency of hypertensive and orthostatic reactions between the groups. The total score of motor disorders in patients with PD was correlated with the duration of high BP (R= -0.26; p=0.04). Among the patients with PD, 37 had hypertension prior to the neurologic disorder, 7 were diagnosed with two diseases simultaneously, while the remaining 12 had PD as the initial diagnosis, developing hypertension later in life. The score of the points of the motor disturbances was greater in patients who had developed two diseases simultaneously with the simultaneous developing of the illnesses (15.88±9.36 vs. 19.84±8.01 vs. 26.14±9.68; p<0.05, χ²=10.47, df=2).

CONCLUSION

The development of arterial hypertension in patients with PD aggravates the disease.

Heart Matters: Cardiac Dysfunction and Other Autonomic Changes in Parkinson's Disease

It has been more than 200 years since James Parkinson made the first descriptions of the disease that bears his name. Since then, knowledge about Parkinson's disease has been improved, and its pathophysiology, diagnosis, and treatments are well described in the scientific and medical literature. However, there is no way to prevent the disease from its progressive nature yet and only its symptoms can be minimized. It is known that the process of neurodegeneration begins before the onset of motor signs and symptoms of the disease, when diagnosis is usually made. Therefore, recognizing manifested non-motor symptoms can make an early diagnosis possible and lead to a better understanding of the disease. Autonomic dysfunctions are important non-motor manifestations of Parkinson's disease and affect the majority of patients. Importantly, heart failure is the third leading cause of death in people suffering from Parkinson's disease. Several evidences have shown the correlation between Parkinson's disease and the preexistence of cardiovascular diseases. Therefore, cardiovascular monitoring and identification of its dysfunctions can have a prodromal role for Parkinson's disease. This review presents studies of the literature that can lead to a better understanding of Parkinson's disease with special attention to its relation to heart and cardiovascular parameters.

Cardiovascular Disorders Mediated by Autonomic Nervous System Dysfunction

Cardiovascular disorders, such as orthostatic hypotension and supine hypertension, are common in patients with neurodegenerative synucleinopathies such as Parkinson disease (PD), and may also occur in other conditions, such as peripheral neuropathies, that result in autonomic nervous system (ANS) dysfunction. Dysfunction and degeneration of the ANS are implicated in the development of orthostatic and postprandial hypotension and impaired thermoregulation. Neurogenic orthostatic hypotension (nOH) results from sympathetic failure and is a common autonomic disorder in PD. Supine hypertension may also occur as a result of both sympathetic and parasympathetic dysfunction in conjunction with nOH in the majority of patients with PD. Management of supine hypertension in the setting of nOH can be counterintuitive and challenging. Additionally, the presence of other noncardiovascular comorbidities, such as diabetes mellitus and peripheral edema, may further contribute to the burden of disease. ANS dysfunction thus presents major healthcare implications and challenges for neurology and cardiovascular practices, necessitating an integrated neurology and cardiology management approach.

Multimorbidity Predicts Quality of Life but not Motor Severity in Early Parkinson's Disease

Recent guidance by the National Institute for Health and Care Excellence (NICE) focuses on the management of people with multimorbidity, including Parkinson's disease (PD). To date there has been little exploration of this in neurodegenerative diseases. This study aimed to explore the associations between multimorbidity, motor severity and quality of life (QoL) in early PD. Regression analyses determined whether multimorbidity was significantly associated with disease severity and QoL. Multimorbidity was a small but significant predictor of QoL in people with incident PD, but not motor severity, suggesting that they may benefit from a tailored multidisciplinary approach to care.

[A multiple linear model of help-seeking behavior in patients with depressive and neurotic disorders]

AIM

To find out the factors effecting time from onset of symptoms of psychiatric disorders to help-seeking.

MATERIAL AND METHODS

The sample included 166 inpatients with affective or neurotic, stress-related and somatoform disorders. Clinical, psychometric, anamnestic methods were used.

RESULTS AND CONCLUSION

The multiple regression model of help-seeking by inpatients with depressive and neurotic disorders is characterized by the high level of multiple correlation (r=0.85). This model allows the prediction of the time of help-seeking in the group of inpatients or individually, which can be used as a basis for programs of prevention of delayed help-seeking behavior.

Exploring the Effect of Rotenone-A Known Inducer of Parkinson's Disease-On Mitochondrial Dynamics in Dictyostelium discoideum

Current treatments for Parkinson's disease (PD) only alleviate symptoms doing little to inhibit the onset and progression of the disease, thus we must research the mechanism of Parkinson's. Rotenone is a known inducer of parkinsonian conditions in rats; we use rotenone to induce parkinsonian cellular conditions in Dictyostelium discoideum. In our model we primarily focus on mitochondrial dynamics. We found that rotenone disrupts the actin and microtubule cytoskeleton but mitochondrial morphology remains intact. Rotenone stimulates mitochondrial velocity while inhibiting mitochondrial fusion, increases reactive oxygen species (ROS) but has no effect on ATP levels. Antioxidants have been shown to decrease some PD symptoms thus we added ascorbic acid to our rotenone treated cells. Ascorbic acid administration suggests that rotenone effects may be specific to the disruption of the cytoskeleton rather than the increase in ROS. Our results imply that D. discoideum may be a valid cellular PD model and that the rotenone induced velocity increase and loss of fusion could prevent mitochondria from effectively providing energy and other mitochondrial products in high demand areas. The combination of these defects in mitochondrial dynamics and increased ROS could result in degeneration of neurons in PD.

The self-management balancing act of spousal care partners in the case of Parkinson's disease

BACKGROUND

Living with and caring for someone with chronic illness can lead to limitations in activity and social participation for the care partner. Past research emphasizes the importance of care partners taking care of themselves physically and emotionally so they can stay healthy to support the care recipient. There is little information regarding how the care partner takes care of their own social lives. The purpose of this study was to explore the concept of social self-management from the perspective of spousal care partners of people with Parkinson's disease.

METHOD

Twenty spousal care partners of people with Parkinson's disease were interviewed three times. A grounded theory approach informed data analysis.

RESULTS

Findings that emerged from the data focused on balance in activities, support, and emotions and were summarized into three main themes: (1) Activities: Caregiving and beyond; (2) Strategies to support self and spouse; and (3) Emotional impact: Burden and compassion.

CONCLUSION

This research shows that care partners want to retain social participation and provides support for the importance of addressing the socio-emotional needs of care partners of people with a chronic disease. Interventions that guide care partners to take care of their spectrum of needs may lead to healthier, positive relationships. Implications for rehabilitation The focus of rehabilitation is often on the person diagnosed with the chronic condition. Living with and caring for someone with a chronic illness, such as Parkinson's disease, can lead to limitations in activity and social participation for the care partner. Including care partners in the rehabilitation process is key to helping maintain their health and well-being. Learning caregiving and self-management strategies may help care partners support their loved ones while staying socially engaged.

Classification of advanced stages of Parkinson's disease: translation into stratified treatments

Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.