Analysis of the clinical features of early Parkinson's disease with comparatively integrated intestinal function

Association between autonomic dysfunction with motor and non-motor symptoms in patients with Parkinson's disease

To investigate the association between autonomic dysfunction (AutD) and motor as well as non-motor symptoms (NMS) in patients with Parkinson's disease (PD). Fifty-three PD patients were divided into two groups based on the number of domains affected by AutD: a multi-domain AutD group (AutD-M) and a single-domain AutD group (AutD-S), as evaluated using the Scale for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT), which assesses autonomic symptoms, one of the NMS. A comprehensive comparison was conducted between the two groups, including clinical measures such as clinical scales, quantitative evaluations of motor function and exercise capacity. Spearman correlation analysis was employed to investigate the relationship between AutD severity and PD symptoms. Additionally, we performed multiple linear regression model analysis to determine whether associations between SCOPA-AUT scores and clinical assessments remained significant after adjusting for Hoehn and Yahr stage, sex, and age. PD patients in the AutD-M group exhibited significantly more severe NMS and motor symptoms compared to those in the AutD-S group. In correlation analysis, SCOPA-AUT scores showed significant correlations with multiple clinical symptoms, such as most of the NMS, 10-MWT and CPET parameters. Furthermore, regression analysis also revealed that more pronounced fatigue, anxiety, depressive symptoms, worse walking speed and impaired exercise capacity were associated with higher SCOPA-AUT scores. The presence of AutD is correlated with emotional disturbances, decreased exercise endurance, and impaired gait function in patients with PD. Early management of AutD may prove beneficial in alleviating some NMS and motor symptoms in PD.

Relationship Between Sleep Quality and Constipation Severity in Patients With Parkinson Disease: A Cross-sectional Study

ABSTRACT

BACKGROUND: Constipation in patients with Parkinson disease (PD) adversely affects motor symptoms, making defecation management critical. Sleep disturbance is another common complaint in patients with PD (PWP). Associations between sleep disturbances and constipation have been reported in recent studies on PD. If improving sleep quality is useful for managing constipation in PWP, it might serve as a new method of constipation management that is less physically and mentally distressing than laxatives. This study aimed to examine the relationship between sleep quality and constipation severity in PWP. METHODS: We administered a questionnaire on sleep and constipation to 1048 PWP. Constipation severity was assessed using Constipation Assessment Scale Japanese version 2 (CAS). General sleep quality was estimated using the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale. Sleep quality due to PD-specific nighttime problems was estimated using the Parkinson's Disease Sleep Scale-2 Japanese version (PDSS-2). We conducted a multiple regression analysis using the forced entry method to identify the variables that influenced CAS. RESULTS: We analyzed 350 PWP. Overall, 94.9% of PWP had constipation symptoms. The percentages of PWP with poor sleep were as follows: PSQI, 74.7%; Athens Insomnia Scale, 69.8%; and PDSS-2, 73.8%. Furthermore, 17.6% of the patients with constipation and 35.3% with sleep problems did not consult a healthcare provider. Multivariate analysis revealed that CAS was significantly associated only with PDSS-2 (standardized partial regression coefficient, 0.217; 95% confidence interval, 0.030-0.111). CONCLUSION: Poor sleep quality, related to PD-specific nighttime problems, was found be associated with worsening constipation severity. Nursing activities that help PWP with PD-specific nighttime problems have a more comfortable night's sleep would be key to alleviating constipation severity.

Self-Reported Visual Complaints in People with Parkinson’s Disease: A Systematic Review

Background:

Scientific research increasingly focuses on visual symptoms of people with Parkinson’s disease (PD). However, this mostly involves functional measures, whereas self-reported data are equally important for guiding clinical care.

Objective:

This review provides an overview of the nature and prevalence of self-reported visual complaints by people with PD, compared to healthy controls.

Methods:

A systematic literature search was performed. Studies from three databases (PubMed, PsycInfo, and Web of Science) were screened for eligibility. Only studies that reported results of visual self-reports in people with idiopathic PD were included.

Results:

One hundred and thirty-nine eligible articles were analyzed. Visual complaints ranged from function-related complaints (e.g., blurred vision, double vision, increased sensitivity to light or changes in contrast sensitivity) to activity-related complaints (e.g., difficulty reading, reaching, or driving). Visual complaints were more prevalent in people with PD compared to healthy controls. The presence of visual complaints leads to a reduced quality of life (QoL). Increased prevalence and severity of visual complaints in people with PD are related to longer disease duration, higher disease severity, and off-state.

Conclusion:

A large proportion of people with PD have visual complaints, which negatively affect QoL. Complaints are diverse in nature, and specific and active questioning by clinicians is advised to foster timely recognition, acknowledgement, and management of these complaints.

Motor and non-motor circuit disturbances in early Parkinson disease: which happens first?

For the last two decades, pathogenic concepts in Parkinson disease (PD) have revolved around the toxicity and spread of α-synuclein. Thus, α-synuclein would follow caudo-rostral propagation from the periphery to the central nervous system, first producing non-motor manifestations (such as constipation, sleep disorders and hyposmia), and subsequently impinging upon the mesencephalon to account for the cardinal motor features before reaching the neocortex as the disease evolves towards dementia. This model is the prevailing theory of the principal neurobiological mechanism of disease. Here, we scrutinize the temporal evolution of motor and non-motor manifestations in PD and suggest that, even though the postulated bottom-up mechanisms are likely to be involved, early involvement of the nigrostriatal system is a key and prominent pathophysiological mechanism. Upcoming studies of detailed clinical manifestations with newer neuroimaging techniques will allow us to more closely define, in vivo, the role of α-synuclein aggregates with respect to neuronal loss during the onset and progression of PD.

Impact of motor subtype on non-motor symptoms and fall-related features in patients with early Parkinson's disease

AIM

Clinical implications for motor phenotypes of Parkinson's disease (PD) remain to be further elucidated, particularly at the early stages of the disease. We aimed to compare the non-motor and fall-related features between tremor-dominant (TD) and postural instability-gait difficulty (PIGD) subtypes in patients with early PD.

METHODS

PD was categorized into TD, intermediate and PIGD types, according to the literature. Not only motor symptoms, but also non-motor symptoms for global cognition, depression, anxiety, fatigue and dysautonomia, were measured in detail. In addition, fall-related features, including a previous history of falls, fear of fall measurement and gait freezing were assessed.

RESULTS

In patients with early PD (disease duration no more than 5 years), 35 patients with TD-type PD and 31 patients with PIGD-type PD were finally evaluated for the study. Compared with the TD group, the PIGD group showed higher fatigue, gastrointestinal dysfunction and fall-related parameter scores. Moreover, the PIGD scores were significantly correlated with all of those symptoms.

CONCLUSIONS

Our findings suggest that PIGD is significantly linked to fatigue, gastrointestinal dysfunction and fall-related features during the early stages of PD. Geriatr Gerontol Int 2021; 21: 416-420.

The relationship between attention and static balance disturbance in patients with Parkinson's disease

OBJECTIVE

Balance disturbance is one of the main complications of the Parkinson's disease (PD). As studies have shown that impairments in some cognitive processes can lead to balance problems, we investigated the relationship between focused and divided attention and static balance in patients with PD and a healthy control group.

METHODS

We included 111 patients with PD (M age = 49.41, SD = 6.33 years) and 142 healthy individuals (M age = 50.62, SD = 6.07 years). All participants were evaluated with the Trails Making Test A and B (TMT), and all participants' balance was evaluated with a Wii Balance Board, from which we measured the antero-posterior (AP), medio-lateral (ML), and total center of pressure (COP) velocity. We compared the two groups in terms of TMT-A, TMT-B, and COP velocity tests in both eyes-open and eyes-closed conditions with independent t-tests, and we calculated Pearson's correlation coefficients between the balance board-derived outcomes and the TMT scores.

RESULTS

The two groups differed significantly on TMT-A and TMT-B scores, in total and ML COP velocity in both eyes-closed and eyes-open conditions, and in AP COP velocity only in eyes-open condition. Among patients with PD, TMT-A and TMT-B scores were positively correlated with total, ML, and AP COP velocity, in both eyes-open and eyes-closed conditions.

CONCLUSIONS

Associated attention deficits may be among the causes of balance disturbances in patients with PD, though both attention and balance may have a common root in brain circuitry.

Association of fall risk factors and non-motor symptoms in patients with early Parkinson's disease

The association of non-motor symptoms (NMSs) with fall-related factors in patients with Parkinson’s disease (PD) remains to be further elucidated in the early stages of the disease. Eighty-six patients with less than 5 years of the onset of PD were retrospectively enrolled in the study. We assessed potential fall-related risk factors including (1) a history of falls during the past year (faller versus non-faller), (2) the fear of falling (FoF), and (3) the freezing of gait (FoG). Different types of NMSs were measured using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Parkinson’s disease Fatigue Scale (PFS), and the Scales for Outcomes in Parkinson’s disease—Autonomic dysfunction (SCOPA-AUT). The faller group (37.2%) showed higher scores for BDI, BAI, PFS, and SCOPA-AUT, compared to the non-faller group. From logistic regression analyses, the prior history of falls was related to the gastrointestinal domain of SCOPA-AUT, FoF was associated with BAI, and gastrointestinal and urinary domains of SCOPA-AUT, and FoG was linked to BAI and gastrointestinal domain of SCOPA-AUT. In conclusion, we found that fall-related risk factors in patients with early PD were highly connected with gastrointestinal dysautonomia.