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Weintraub D, Espay AJ, Sharma VD, Tariot PN, Abler V, Pathak S, Stankovic S. Pimavanserin for psychosis in Parkinson's disease dementia: Subgroup analysis of the HARMONY Trial. Parkinsonism Relat Disord 2024; 119:105951. [PMID: 38113700 DOI: 10.1016/j.parkreldis.2023.105951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/15/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Pimavanserin is FDA-approved to treat Parkinson's disease (PD) psychosis. We analyzed the effect of pimavanserin on psychosis in the PD dementia (PDD) subgroup from the phase 3 HARMONY trial. METHODS This subgroup analysis included PDD patients enrolled in an international, multicenter, randomized discontinuation study of pimavanserin for dementia-related psychosis. PDD patients with moderate-to-severe psychosis, age 50-90 years, received pimavanserin 34 mg/day for 12 weeks (open-label period). Those with a sustained psychosis response to pimavanserin at weeks 8 and 12 were randomized during the double-blind period to continue pimavanserin or receive placebo. Primary efficacy endpoint was time to psychosis relapse as measured by the SAPS-H + D and CGI-I. Safety was assessed, as were effects on motor symptoms and cognitive abilities using the ESRS-A and MMSE. RESULTS 392 patients were enrolled in HARMONY (mean age: 72.6 years; 38.8 % female): 59 had PDD; 49/59 remained on pimavanserin during the open-label period (safety analysis set), and 36/49 were randomized to pimavanserin (n = 16) or placebo (n = 20) in the double-blind phase (intent-to-treat analysis set). Risk of psychosis relapse was lower with pimavanserin 34 mg compared with placebo in the double-blind phase (HR = 0.052; 95 % CI 0.016-0.166; 1-sided nominal p < 0.001). During the open-label period, 46.9 % experienced a treatment-emergent adverse event; event incidence was similar across arms in the double-blind period. Pimavanserin did not adversely affect motor or cognitive function in either treatment phase. CONCLUSIONS Pimavanserin significantly reduced risk of psychosis relapse in patients with PDD, was well tolerated, and did not worsen motor or cognitive function.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut Street, #330, Philadelphia, PA, 19104, USA.
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 3113 Bellevue Ave, Cincinnati, OH, 45219, USA.
| | - Vibhash D Sharma
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Pierre N Tariot
- Banner Alzheimer's Institute and University of Arizona College of Medicine, 901 E Willetta St, Phoenix, AZ, 85006, USA.
| | - Victor Abler
- Acadia Pharmaceuticals Inc., 12830 El Camino Real #400, San Diego, CA, 92130, USA.
| | - Sanjeev Pathak
- Acadia Pharmaceuticals Inc., 12830 El Camino Real #400, San Diego, CA, 92130, USA.
| | - Srdjan Stankovic
- Acadia Pharmaceuticals Inc., 12830 El Camino Real #400, San Diego, CA, 92130, USA.
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Pahwa R, Pagan FL, Kremens DE, Saint-Hilaire M. Clinical Use of On-Demand Therapies for Patients with Parkinson's Disease and OFF Periods. Neurol Ther 2023; 12:1033-1049. [PMID: 37221354 PMCID: PMC10310675 DOI: 10.1007/s40120-023-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
On-demand therapies for Parkinson's disease (PD) provide rapid, reliable relief for patients experiencing OFF periods; however, practical guidelines on the use of these therapies are not generally available. This paper reviews the use of on-demand treatments. Motor fluctuations occur in nearly all patients with PD after long-term use of levodopa. As the goal of PD treatment is to provide good ON time, on-demand treatments that have a more rapid reliable onset than the slower-acting oral medications provide rapid relief for OFF periods. All current on-demand treatments bypass the gastrointestinal tract, providing dopaminergic therapy directly into the blood stream by subcutaneous injection, through the buccal mucosa, or by inhalation into the pulmonary circulation. On-demand treatments are fast acting (10- to 20-min onset), with maximum, reliable, and significant responses reached within 30 min after administration. Oral medications pass through the gastrointestinal tract and thus have slower absorption owing to gastroparesis and competition with food. On-demand therapies, by providing fast-acting relief, can have a positive impact on a patient's quality of life when patients are experiencing OFF periods.
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Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd, Mailstop 2012, Kansas City, KS, 66160, USA.
| | - Fernando L Pagan
- Department of Neurology, Georgetown University Hospital, Washington, DC, USA
| | - Daniel E Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University School of Medicine, Boston, MA, USA
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DeBroff J, Omer N, Cohen B, Giladi N, Kestenbaum M, Shirvan JC, Cedarbaum JM, Gana‐Weisz M, Goldstein O, Orr‐Urtreger A, Mirelman A, Thaler A. The Influence of GBA and LRRK2 on Mood Disorders in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:606-616. [PMID: 37070047 PMCID: PMC10105114 DOI: 10.1002/mdc3.13722] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
Background Mood disorders have emerged as major non-motor comorbidities in Parkinson's disease (PD) even at the prodromal stage of the disease. Mutations in the LRRK2 and GBA genes are common among Ashkenazi Jews, with more severe phenotype reported for GBA-PD. Objective To explore the association between genetic status and mood related disorders before and after diagnosis of PD and the association between mood-related medications, phenotype, and genetic status. Methods Participants were genotyped for mutations in the LRRK2 and GBA genes. State of depression, anxiety and non-motor features were evaluated using validated questionnaires. History of mood disorders prior to diagnosis of PD and use of mood-related medications were assessed. Results The study included 105 idiopathic PD (iPD), 55 LRRK2-PD and 94 GBA-PD. Scores on mood related questionnaires and frequency of depression and anxiety before diagnosis were similar between the groups (p>0.05). However, more GBA-PD patients used mood related medications before PD diagnosis than LRRK2-PD and iPD (16.5% vs 7.1% and 8.2%, p=0.044). LRRK2-PD and GBA-PD receiving mood-related medications at time of assessment had worse motor and non-motor phenotype compared to those that did not (p<0.05). LRRK2-PD receiving mood related-medications at time of assessment, scored higher on mood-related questionnaires compared to LRRK2-PD not receiving such medications (p<0.04). Conclusions Prodromal GBA-PD are more frequently treated with mood related-medications despite equal rates of reported mood-related disorders, while LRRK2-PD with mood-related disorders experience high rates of anxiety and depression despite treatment, attesting to the need of more precise assessment and treatment of these genetic subgroups.
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Affiliation(s)
| | - Nurit Omer
- Sackler School of MedicineTel‐Aviv University
- Movement Disorders UnitNeurological Institute, Tel‐Aviv Medical Center
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
| | - Batsheva Cohen
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
| | - Nir Giladi
- Sackler School of MedicineTel‐Aviv University
- Movement Disorders UnitNeurological Institute, Tel‐Aviv Medical Center
- Sagol School of NeuroscienceTel‐Aviv University
| | - Meir Kestenbaum
- Sackler School of MedicineTel‐Aviv University
- Neurology departmentMeir HospitalKfar‐SabaIsrael
| | | | | | - Mali Gana‐Weisz
- Genomic Research Laboratory for NeurodegenerationTel‐Aviv Medical CenterTel‐AvivIsrael
| | - Orly Goldstein
- Genomic Research Laboratory for NeurodegenerationTel‐Aviv Medical CenterTel‐AvivIsrael
| | - Avi Orr‐Urtreger
- Sackler School of MedicineTel‐Aviv University
- Sagol School of NeuroscienceTel‐Aviv University
- Genomic Research Laboratory for NeurodegenerationTel‐Aviv Medical CenterTel‐AvivIsrael
| | - Anat Mirelman
- Sackler School of MedicineTel‐Aviv University
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
- Sagol School of NeuroscienceTel‐Aviv University
| | - Avner Thaler
- Sackler School of MedicineTel‐Aviv University
- Movement Disorders UnitNeurological Institute, Tel‐Aviv Medical Center
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
- Sagol School of NeuroscienceTel‐Aviv University
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Development of Small Molecules Targeting α-Synuclein Aggregation: A Promising Strategy to Treat Parkinson’s Disease. Pharmaceutics 2023; 15:pharmaceutics15030839. [PMID: 36986700 PMCID: PMC10059018 DOI: 10.3390/pharmaceutics15030839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Parkinson’s disease, the second most common neurodegenerative disorder worldwide, is characterized by the accumulation of protein deposits in the dopaminergic neurons. These deposits are primarily composed of aggregated forms of α-Synuclein (α-Syn). Despite the extensive research on this disease, only symptomatic treatments are currently available. However, in recent years, several compounds, mainly of an aromatic character, targeting α-Syn self-assembly and amyloid formation have been identified. These compounds, discovered by different approaches, are chemically diverse and exhibit a plethora of mechanisms of action. This work aims to provide a historical overview of the physiopathology and molecular aspects associated with Parkinson’s disease and the current trends in small compound development to target α-Syn aggregation. Although these molecules are still under development, they constitute an important step toward discovering effective anti-aggregational therapies for Parkinson’s disease.
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Dong-Chen X, Yong C, Yang X, Chen-Yu S, Li-Hua P. Signaling pathways in Parkinson's disease: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther 2023; 8:73. [PMID: 36810524 PMCID: PMC9944326 DOI: 10.1038/s41392-023-01353-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 01/16/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease worldwide, and its treatment remains a big challenge. The pathogenesis of PD may be related to environmental and genetic factors, and exposure to toxins and gene mutations may be the beginning of brain lesions. The identified mechanisms of PD include α-synuclein aggregation, oxidative stress, ferroptosis, mitochondrial dysfunction, neuroinflammation, and gut dysbiosis. The interactions among these molecular mechanisms complicate the pathogenesis of PD and pose great challenges to drug development. At the same time, the diagnosis and detection of PD are also one of obstacles to the treatment of PD due to its long latency and complex mechanism. Most conventional therapeutic interventions for PD possess limited effects and have serious side effects, heightening the need to develop novel treatments for this disease. In this review, we systematically summarized the pathogenesis, especially the molecular mechanisms of PD, the classical research models, clinical diagnostic criteria, and the reported drug therapy strategies, as well as the newly reported drug candidates in clinical trials. We also shed light on the components derived from medicinal plants that are newly identified for their effects in PD treatment, with the expectation to provide the summary and outlook for developing the next generation of drugs and preparations for PD therapy.
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Affiliation(s)
- Xu Dong-Chen
- College of Pharmaceutical Sciences, Zhejiang University, 310058, Hangzhou, P. R. China
| | - Chen Yong
- College of Pharmaceutical Sciences, Zhejiang University, 310058, Hangzhou, P. R. China
| | - Xu Yang
- College of Pharmaceutical Sciences, Zhejiang University, 310058, Hangzhou, P. R. China
| | - ShenTu Chen-Yu
- College of Pharmaceutical Sciences, Zhejiang University, 310058, Hangzhou, P. R. China
| | - Peng Li-Hua
- College of Pharmaceutical Sciences, Zhejiang University, 310058, Hangzhou, P. R. China. .,State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, P. R. China.
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Brizzi K. Outpatient neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:29-48. [PMID: 36599513 DOI: 10.1016/b978-0-12-824535-4.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Palliative care is an approach to patient care that focuses on enhancing quality of life through relief of physical, emotional, and spiritual sources of distress and patient-tailored discussions about goals of care. The palliative care approach can be delivered by any provider, and can occur alongside disease-modifying therapies. For patients with a serious neurologic illness or a neurodegenerative disease, neuropalliative care is a growing field focused on providing high-quality palliative care to neurology patients. There are three models of neuropalliative care delivery in the outpatient setting: a consultative model with a palliative care specialist, an integrated model with an embedded palliative care provider, and a primary palliative care model with the patient's neurology provider. The main components of an outpatient palliative care visit include symptom assessment and treatment, communication about serious illness, advance care planning, and assessment of caregiver needs. For patients with advanced illness, palliative care can help facilitate timely referral to hospice. Through a palliative care approach, outpatient care for patients with serious neurologic disease or neurodegenerative disease can focus on the issues most important to the patient, promote improved illness understanding and planning, and can improve the overall quality of care.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
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Rajagopalan K, Rashid N, Kumar S, Doshi D. Health care resource utilization patterns among patients with Parkinson's disease psychosis: analysis of Medicare beneficiaries treated with pimavanserin or other-atypical antipsychotics. J Med Econ 2023; 26:34-42. [PMID: 36444507 DOI: 10.1080/13696998.2022.2152600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pimavanserin (PIM) is the only FDA-approved atypical antipsychotic (AAP) for hallucinations and delusions associated with Parkinson's disease psychosis (PDP). Comparative real-world analyses demonstrating its benefits are needed. OBJECTIVES To evaluate health care resource utilization (HCRU) outcomes among PDP patients treated with PIM vs. other-AAPs. METHODS Retrospective cohort analysis of Parts A, B, and D claims from 100% Medicare sample from 01 January 2013-31 December 2019 was conducted. PDP Patients initiating (i.e. index date) continuous monotherapy (PIM vs. other-AAPs) for ≥12-months during 01 January 2014-31 December 2018 without 12-months pre-index AAP use were selected after 1:1 propensity score matching (PSM) on 31 variables (sex, race, region, age, and 27 Elixhauser comorbidities). HCRU outcomes included: annual all-cause and psychiatric hospitalization (short-term stay, long-term stay, and SNF-stay [skilled nursing facility]) rates, annual all-cause and psychiatric-ER visit rates, mean per-patient-per-year (PPPY) hospitalizations, and average length of stay (ALOS). PIM and other-AAPs were compared using generalized linear models (GLM) controlled for demographic characteristics, comorbidities, coexisting-dementia, and coexisting insomnia. RESULTS Of 12,164 PDP patients, 48.41% (n = 5,889) were female, and mean age was 77 (±8.14) years. Among 1:1 matched patients (n = 842 in each), 37.8% (n = 319) on PIM vs. 49.8% (n = 420) on other-AAPs (p < .05) reported ≥1 all-cause hospitalizations, respectively. Specifically, short-term and SNF-stay among PIM patients vs. other-AAPs were: 34% (n = 286) vs. 46.2% (n = 389) and 20.2% (n = 170) vs. 31.8% (n = 267) (p < .05), respectively. Similarly, 9.6% (n = 81) of PIM vs. 14.6% (n = 123) of other-AAPs patients had ≥1 psychiatric hospitalization (p < .05). Furthermore, ≥1 all-cause and psychiatric ER visit among PIM vs. other-AAPs were 61.6% (n = 519) vs. 69.4% (n = 584) and 5.2% (n = 43) vs. 10.2% (n = 86) (p < .05), respectively. PIM also had significantly lower ALOS, and mean PPPY short-term hospitalization and SNF-stays. CONCLUSIONS In this analysis of PDP patients, PIM monotherapy resulted in nearly 12% and 7% lower all-cause hospitalizations and ER visits vs. other-AAPs.
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Mok VWL, Chan LG, Goh JCB, Tan LCS. Psychosis in Parkinson's disease in a Southeast Asian cohort: prevalence and clinical correlates. Singapore Med J 2022; 63:702-708. [PMID: 34911181 PMCID: PMC9875879 DOI: 10.11622/smedj.2021182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction Psychosis is a prominent neuropsychiatric symptom of Parkinson's disease (PD) and is associated with negative outcomes, such as poorer quality of life and greater rate of functional impairment. Early identification of patients with PD at risk of developing psychosis facilitates appropriate management to improve outcomes. However, this phenomenon has not been examined locally. This study aimed to examine the prevalence of PD-associated psychosis in the local setting, identify any associated risk factors, as well as characterise the cognitive trajectory of patients with PD with psychosis. Methods A retrospective cohort of 336 patients with PD, who presented to the National Neuroscience Institute, Singapore, in 2006 and 2007 and attended follow-up visits through to 2013 was analysed. The data analysed included scores from clinician assessments of cognitive function, disease severity and presence of psychotic symptoms, conducted when clinically appropriate during patients' medical visits. Survival analysis and logistic and linear regression analysis were performed. Results Psychosis was diagnosed in 63 patients with PD, indicating a prevalence of 18.8% for PD-associated psychosis. Incidence of psychosis in PD was calculated to be 40 per 1,000 person-years. No significant association was found between demographic variables and the odds of developing psychosis in PD. Regression analyses found that the presence of psychosis significantly predicted greater cognitive decline and disease severity. Conclusion Psychosis has a significant presence among the PD population in Singapore, possibly serving as an indicator of more rapid cognitive decline and progression of PD severity.
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Affiliation(s)
| | - Lai Gwen Chan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Louis Chew Seng Tan
- Research; Department of Neurology, National Neuroscience Institute, Singapore
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Consonni A, Miglietti M, De Luca CMG, Cazzaniga FA, Ciullini A, Dellarole IL, Bufano G, Di Fonzo A, Giaccone G, Baggi F, Moda F. Approaching the Gut and Nasal Microbiota in Parkinson's Disease in the Era of the Seed Amplification Assays. Brain Sci 2022; 12:1579. [PMID: 36421902 PMCID: PMC9688507 DOI: 10.3390/brainsci12111579] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 10/30/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder often associated with pre-motor symptoms involving both gastrointestinal and olfactory tissues. PD patients frequently suffer from hyposmia, hyposalivation, dysphagia and gastrointestinal dysfunctions. During the last few years it has been speculated that microbial agents could play a crucial role in PD. In particular, alterations of the microbiota composition (dysbiosis) might contribute to the formation of misfolded α-synuclein, which is believed to be the leading cause of PD. However, while several findings confirmed that there might be an important link between intestinal microbiota alterations and PD onset, little is known about the potential contribution of the nasal microbiota. Here, we describe the latest findings on this topic by considering that more than 80% of patients with PD develop remarkable olfactory deficits in their prodromal disease stage. Therefore, the nasal microbiota might contribute to PD, eventually boosting the gut microbiota in promoting disease onset. Finally, we present the applications of the seed amplification assays to the study of the gut and olfactory mucosa of PD patients, and how they could be exploited to investigate whether pathogenic bacteria present in the gut and the nose might promote α-synuclein misfolding and aggregation.
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Affiliation(s)
- Alessandra Consonni
- Division of Neurology 4-Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Martina Miglietti
- Division of Neurology 4-Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Chiara Maria Giulia De Luca
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Federico Angelo Cazzaniga
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Arianna Ciullini
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ilaria Linda Dellarole
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giuseppe Bufano
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alessio Di Fonzo
- Division of Neurology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giorgio Giaccone
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Fulvio Baggi
- Division of Neurology 4-Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Fabio Moda
- Division of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Beserra-Filho JIA, Maria-Macêdo A, Silva-Martins S, Custódio-Silva AC, Soares-Silva B, Silva SP, Lambertucci RH, de Souza Araújo AA, Lucchese AM, Quintans-Júnior LJ, Santos JR, Silva RH, Ribeiro AM. Lippia grata essential oil complexed with β-cyclodextrin ameliorates biochemical and behavioral deficits in an animal model of progressive parkinsonism. Metab Brain Dis 2022; 37:2331-2347. [PMID: 35779151 DOI: 10.1007/s11011-022-01032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Parkinson's disease (PD) is identified by the loss of dopaminergic neurons in the Substantia Nigra pars compacta (SNpc), and is correlated to aggregates of proteins such as α-synuclein, Lewy's bodies. Although the PD etiology remains poorly understood, evidence suggests a main role of oxidative stress on this process. Lippia grata Schauer, known as "alecrim-do-mato", "alecrim-de-vaqueiro", "alecrim-da-chapada", is a native bush from tropical areas mainly distributed throughout the Central and South America. This plant species is commonly used in traditional medicine for relief of pain and inflammation conditions, and that has proven antioxidant effects. We evaluated the effects of essential oil of the L. grata after its complexed with β-cyclodextrin (LIP) on PD animal model induced by reserpine (RES). Behavioral assessments were performed across the treatment. Upon completion the treatment, the animals were euthanized, afterwards their brains were isolated and processed for immunohistochemical and oxidative stress analysis. The LIP treatment delayed the onset of the behavior of catalepsy, decreased the number of oral movements and prevented the memory impairment on the novel object recognition task. In addition, the treatment with LIP protected against dopaminergic depletion in the SNpc and dorsal striatum (STRd), and decreased the α-syn immunoreactivity in the SNpc and hippocampus (HIP). Moreover, there was reduction of the oxidative stability index. These findings demonstrated that the LIP treatment has neuroprotective effect in a progressive parkinsonism model, suggesting that LIP could be an important source for novel treatment approaches in PD.
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Affiliation(s)
- Jose Ivo A Beserra-Filho
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Amanda Maria-Macêdo
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | - Suellen Silva-Martins
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | | | - Beatriz Soares-Silva
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | - Sara Pereira Silva
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | | | | | - Angélica Maria Lucchese
- Graduate Programm in Biotechnology, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brazil
| | | | - José Ronaldo Santos
- Department of Biosciences, Universidade Federal de Sergipe, Itabaiana, Sergipe, Brazil
| | - Regina H Silva
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alessandra M Ribeiro
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil.
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Neuropathology of the Basal Ganglia in SNCA Transgenic Rat Model of Parkinson's Disease: Involvement of Parvalbuminergic Interneurons and Glial-Derived Neurotropic Factor. Int J Mol Sci 2022; 23:ijms231710126. [PMID: 36077524 PMCID: PMC9456397 DOI: 10.3390/ijms231710126] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disease characterized by the accumulation of alpha-synuclein, encoded by the SNCA gene. The main neuropathological hallmark of PD is the degeneration of dopaminergic neurons leading to striatal dopamine depletion. Trophic support by a neurotrophin called glial-derived neurotrophic factor (GDNF) is also lacking in PD. We performed immunohistochemical studies to investigate neuropathological changes in the basal ganglia of a rat transgenic model of PD overexpressing alfa-synuclein. We observed that neuronal loss also occurs in the dorsolateral part of the striatum in the advanced stages of the disease. Moreover, along with the degeneration of the medium spiny projection neurons, we found a dramatic loss of parvalbumin interneurons. A marked decrease in GDNF, which is produced by parvalbumin interneurons, was observed in the striatum and in the substantia nigra of these animals. This confirmed the involvement of the striatum in the pathophysiology of PD and the importance of GDNF in maintaining the health of the substantia nigra.
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Rodin I, Sung JH, Appel-Cresswell S, Chauhan H, Smith K, Vila-Rodriguez F, Ainsworth NJ. Psychiatric, Motor, and Autonomic Effects of Bifrontal ECT in Depressed Parkinson's Disease Patients. J Neuropsychiatry Clin Neurosci 2022; 33:161-166. [PMID: 33626885 DOI: 10.1176/appi.neuropsych.20050133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressive symptoms are a source of significant morbidity in Parkinson's disease (PD). Electroconvulsive therapy (ECT) is a promising treatment for depression in PD (dPD); however, data remain limited, including data on optimal electrode placement. In this retrospective study, the investigators aimed to characterize the effects of bifrontal ECT for dPD on psychiatric and motor symptoms, as well as autonomic response. METHODS Clinical data were retrieved from a university-affiliated ECT service in Vancouver, British Columbia, for patients with dPD receiving bifrontal ECT between 2014 and 2018. Clinical Global Impression (depressive symptoms) and Unified Parkinson's Disease Rating Scale (motor symptoms) scores and cardiovascular measurements during ECT, as well as doses of dopaminergic medications, were recorded. RESULTS Eight patients met criteria for inclusion. Six patients (75%) met response criteria for improvement of depressive symptoms, including 83% of patients who completed a full ECT course. Five patients went on to receive maintenance ECT, with only one patient relapsing by the 1-year follow-up (20%). For patients with motor scales reported, 60% showed a clinically significant improvement in motor symptoms. Among patients who completed ECT, a reduction in the median dopaminergic medication dose was also observed (-350 mg). Two patients discontinued ECT as a result of tolerability concerns. Participants demonstrated a relatively typical pattern of autonomic response to ECT, with low incidence of bradycardic events. CONCLUSIONS The results provide preliminary evidence of the benefit of bifrontal ECT in dPD for both depressive and motor symptoms. The autonomic data suggest that most patients with dPD respond in a typical physiological manner to ECT stimulus; however, further investigation is needed.
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Affiliation(s)
- Isaac Rodin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Je Hun Sung
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Silke Appel-Cresswell
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Harpreet Chauhan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Kevin Smith
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Fidel Vila-Rodriguez
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Nicholas J Ainsworth
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
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Structural Plasticity of the Hippocampus in Neurodegenerative Diseases. Int J Mol Sci 2022; 23:ijms23063349. [PMID: 35328770 PMCID: PMC8955928 DOI: 10.3390/ijms23063349] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
Neuroplasticity is the capacity of neural networks in the brain to alter through development and rearrangement. It can be classified as structural and functional plasticity. The hippocampus is more susceptible to neuroplasticity as compared to other brain regions. Structural modifications in the hippocampus underpin several neurodegenerative diseases that exhibit cognitive and emotional dysregulation. This article reviews the findings of several preclinical and clinical studies about the role of structural plasticity in the hippocampus in neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and multiple sclerosis. In this study, literature was surveyed using Google Scholar, PubMed, Web of Science, and Scopus, to review the mechanisms that underlie the alterations in the structural plasticity of the hippocampus in neurodegenerative diseases. This review summarizes the role of structural plasticity in the hippocampus for the etiopathogenesis of neurodegenerative diseases and identifies the current focus and gaps in knowledge about hippocampal dysfunctions. Ultimately, this information will be useful to propel future mechanistic and therapeutic research in neurodegenerative diseases.
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Siddique Y. Neurodegenerative Disorders and the Current State, Pathophysiology, and Management of Parkinson's Disease. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:574-595. [PMID: 34477534 DOI: 10.2174/1871527320666210903101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/14/2020] [Accepted: 02/13/2021] [Indexed: 06/13/2023]
Abstract
In the last few decades, major knowledge has been gained about pathophysiological aspects and molecular pathways behind Parkinson's Disease (PD). Based on neurotoxicological studies and postmortem investigations, there is a general concept of how environmental toxicants (neurotoxins, pesticides, insecticides) and genetic factors (genetic mutations in PD-associated proteins) cause depletion of dopamine from substantia nigra pars compacta region of the midbrain and modulate cellular processes leading to the pathogenesis of PD. α-Synuclein, a neuronal protein accumulation in oligomeric form, called protofibrils, is associated with cellular dysfunction and neuronal death, thus possibly contributing to PD propagation. With advances made in identifying loci that contribute to PD, molecular pathways involved in disease pathogenesis are now clear, and introducing therapeutic strategy at the right time may delay the progression. Biomarkers for PD have helped monitor PD progression; therefore, personalized therapeutic strategies can be facilitated. In order to further improve PD diagnostic and prognostic accuracy, independent validation of biomarkers is required.
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Affiliation(s)
- Yasir Siddique
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, 202002, Uttar Pradesh, India
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15
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Yang T, Liu Y, Li J, Xu H, Li S, Xiong L, Wang T. Advances in clinical basic research: Performance, treatments, and mechanisms of Parkinson disease. IBRAIN 2021; 7:362-378. [PMID: 37786563 PMCID: PMC10529016 DOI: 10.1002/ibra.12011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/05/2021] [Accepted: 12/05/2021] [Indexed: 02/05/2023]
Abstract
The loss of neuronal in the substantia nigra of the elderly contributes to striatal damage and plays a critical part in the common forms of neurodegenerative diseases such as Parkinson disease (PD). The deficit of dopamine is one of the most familiar neuropathological features of PD as well as α-Synuclein aggregation. The peripheral autonomic nervous system is also affected negatively during the course of the disease, although the subsistent of dyskinesias and else major motor characteristic deficits take significant role in the diagnostic methods during clinical practice, which is related to a number of non-motor symptoms that might increase aggregate risks. Multiple pathways and mechanisms are involved in the molecular pathogenesis: α-Synuclein, neuronal homeostasis, mitochondrial function, oxidative stress, as well as neuroinflammation. Investigations in the last few years for diagnostic biomarkers used neuroimaging, including single photon emission computed tomography as well as cutting-edge magnetic resonance imaging techniques, which has been presented to facilitate discrepant diagnosis. Pharmacological treatment is also important and efficient in equal measure. In addition to reliance on striatal dopamine replacement therapy, many solutions that are used for motor or nonmotor symptoms in these patients are available.
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Affiliation(s)
- Ting‐Ting Yang
- Department of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Yu‐Cong Liu
- Department of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Jing Li
- Department of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Hui‐Chan Xu
- Department of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Shun‐Lian Li
- Department of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Liu‐Lin Xiong
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Ting‐Hua Wang
- Department of Anesthesiology, Translational Neuroscience Center, Institute of Neurological Disease, West China HospitalSichuan UniversityChengduChina
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Pagonabarraga J, Tinazzi M, Caccia C, Jost WH. The role of glutamatergic neurotransmission in the motor and non-motor symptoms in Parkinson's disease: Clinical cases and a review of the literature. J Clin Neurosci 2021; 90:178-183. [PMID: 34275546 DOI: 10.1016/j.jocn.2021.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022]
Abstract
Glutamate is the major excitatory neurotransmitter in the central nervous system and, as such, many brain regions, including the basal ganglia, are rich in glutamatergic neurons. The importance of the basal ganglia in the control of voluntary movement has long been recognised, with the effect of dysfunction of the region exemplified by the motor symptoms seen in Parkinson's disease (PD). However, the basal ganglia and the associated glutamatergic system also play a role in the modulation of emotion, nociception and cognition, dysregulation of which result in some of the non-motor symptoms of PD (depression/anxiety, pain and cognitive deficits). Thus, while the treatment of PD has traditionally been approached from the perspective of dopaminergic replacement, using agents such as levodopa and dopamine receptor agonists, the glutamatergic system offers a novel treatment target for the disease. Safinamide has been approved in over 20 countries globally for fluctuating PD as add-on therapy to levodopa regimens for the management of 'off' episodes. The drug has both dopaminergic and non-dopaminergic pharmacological effects, the latter including inhibition of abnormal glutamate release. The effect of safinamide on the glutamatergic system might present some advantages over dopamine-based therapies for PD by providing efficacy for motor (levodopa-induced dyskinesia) as well as non-motor (anxiety, mood disorders, pain) symptoms. In this article, we discuss the potential role of glutamatergic inhibition on these symptoms, using illustrative real-world examples of patients we have treated with safinamide.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Michele Tinazzi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.
| | - Carla Caccia
- CNS Preclinical Pharmacology, Independent Advisor, Milan, Italy.
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Pimavanserin Treatment for Parkinson's Disease Psychosis in Clinical Practice. PARKINSONS DISEASE 2021; 2021:2603641. [PMID: 33489083 PMCID: PMC7801085 DOI: 10.1155/2021/2603641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023]
Abstract
Background Parkinson's disease psychosis (PDP) is a common, nonmotor symptom of Parkinson's disease (PD), which may affect up to 60% of patients and is associated with impaired quality of life, increased healthcare costs, and nursing home placement, among other adverse outcomes. Characteristic symptoms of PDP include illusions; visual, auditory, tactile, and olfactory hallucinations; and delusions. PDP symptoms typically progress over its course from being mild, infrequent, and often untroubling to complex, sometimes constant, and potentially highly disturbing. PDP has traditionally been treated with atypical antipsychotics (e.g., clozapine and quetiapine) although these are not approved for this indication and clozapine requires frequent white blood cell count monitoring due to the risk of agranulocytosis. Pimavanserin is a newer atypical antipsychotic with highly selective binding to serotonergic receptors, no evidence for worsening motor symptoms in PD, and no need for white blood cell count monitoring. It is currently the only approved medication indicated for PDP treatment. However, because it was approved relatively recently (2016), clinical experience with pimavanserin is limited. Case Presentations. A wide variety of representative clinical scenarios are presented, each with distinct variables and complications. Issues addressed include distinguishing PDP from similar symptoms caused by other disorders such as dementia, coordinating pimavanserin with other PD medications and with deep brain stimulation, adapting pimavanserin dosing for optimal benefit and tolerability, and recognizing variability of PDP symptoms due to patients' changing life circumstances. Conclusions These scenarios provide multiple insights regarding PDP management and the role of pimavanserin. Effective treatment of PDP may reduce disturbing symptoms of psychosis, thus improving patient function and quality of life. In addition, effective pharmacotherapy for PDP may also facilitate the use of other medications needed to treat neurological symptoms of PD (e.g., tremor, bradykinesia, and dyskinesia), although they may also have adverse effects that contribute to symptoms of PDP.
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Abstract
Essential tremor is one of the most common tremor syndromes. According to the recent tremor classification, tremor as a symptom is defined as an involuntary, rhythmic, oscillatory movement of a body part and is classified along two axes: axis 1-defining syndromes based on the clinical features such as historical features, tremor characteristics, associated signs, and laboratory tests; and axis 2-classifying the etiology (Bhatia et al., Mov Disord 33:75-87, 2018). The management of this condition has two major approaches. The first is to exclude treatable etiologies, as particularly during the onset of this condition the presentation of a variety of etiologies can be with monosymptomatic tremor. Once the few etiologies with causal treatments are excluded, all further treatment is symptomatic. Shared decision-making with enabling the patient to knowledgeably choose treatment options is needed to customize the management. Mild to moderate tremor severity can sometimes be controlled with occupational treatment, speech therapy of psychotherapy, or adaptation of coping strategy. First-line pharmacological treatments include symptomatic treatment with propranolol, primidone, and topiramate. Botulinum toxin is for selected cases. Invasive treatments for essential tremor should be considered for severe tremors. They are generally accepted as the most powerful interventions and provide not only improvement of tremor but also a significant improvement of life quality. The current standard is deep brain stimulation (DBS) of the thalamic and subthalamic region. Focused ultrasound thalamotomy is a new therapy attracting increasing interest. Radiofrequency lesioning is only rarely done if DBS or focused ultrasound is not possible. Radiosurgery is not well established. We present our treatment algorithm.
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Affiliation(s)
- Franziska Hopfner
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Rosalind-Fraenklinstr. 10, 24105, Kiel, Germany
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Rosalind-Fraenklinstr. 10, 24105, Kiel, Germany.
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Bogosian A, Rixon L, Hurt CS. Prioritising target non-pharmacological interventions for research in Parkinson's disease: achieving consensus from key stakeholders. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:35. [PMID: 32595982 PMCID: PMC7315468 DOI: 10.1186/s40900-020-00212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In 2014 Parkinson's UK conducted a research prioritisation exercise with stakeholders highlighting important clinical research questions. The exercise highlighted the need for effective interventions to be developed and tested to tackle a range of non-motor symptoms including: sleep quality, stress and anxiety, mild cognitive impairment, dementia and urinary problems. The present work set out to build on this exercise by prioritising types of non-pharmacological interventions to be tested to treat the identified non-motor symptoms. METHODS A Patient and Public Involvement exercise was used to reach consensus on intervention priorities for the treatment of non-motor symptoms. A Delphi structure was used to support the feedback collected. A first-round prioritisation survey was conducted followed by a panel discussion. Nineteen panellists completed the first-round survey (9 people with Parkinson's and 10 professionals working in Parkinson's) and 16 participated in the panel discussion (8 people with Parkinson's and 8 professionals working in Parkinson's). A second-round prioritization survey was conducted after the panel discussion with 13 people with Parkinson's. RESULTS Physical activity, third wave cognitive therapies and cognitive training were rated as priority interventions for the treatment of a range of non-motor symptoms. There was broad agreement on intervention priorities between health care professionals and people with Parkinson's. A consensus was reached that research should focus on therapies which could be used to treat several different non-motor symptoms. In the context of increasing digitisation, the need for human interaction as an intervention component was highlighted. CONCLUSION Bringing together Parkinson's professionals and people with Parkinson's resulted in a final treatment priority list which should be both feasible to carry out in routine clinical practice and acceptable to both professionals and people with Parkinson's. The workshop further specified research priorities in Parkinson's disease based on the current evidence base, stakeholder preferences, and feasibility. Research should focus on developing and testing non-pharmacological treatments which could be effective across a range of symptoms but specifically focusing on tailored physical activity interventions, cognitive therapies and cognitive training.
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Affiliation(s)
- Angeliki Bogosian
- Division of Health Services Research and Management, City, University of London, London, UK
| | - Lorna Rixon
- Division of Health Services Research and Management, City, University of London, London, UK
| | - Catherine S. Hurt
- Division of Health Services Research and Management, City, University of London, London, UK
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20
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Seritan AL, Rienas C, Duong T, Delucchi K, Ostrem JL. Ages at Onset of Anxiety and Depressive Disorders in Parkinson's Disease. J Neuropsychiatry Clin Neurosci 2020; 31:346-352. [PMID: 31117906 DOI: 10.1176/appi.neuropsych.18090201] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) is a quintessential neuropsychiatric condition in which anxiety and depressive symptoms are common and may precede motor manifestations. The authors explored the ages at onset of anxiety and depressive disorders among patients with PD evaluated by psychiatrists at a deep brain stimulation center. METHODS Psychiatric diagnoses and ages at onset were collected via clinical interviews. The ages at PD diagnosis were ascertained by chart review. Onset ages for anxiety and depressive disorders (overall and for specific disorders) were compared with patients' ages at PD diagnosis by using t tests. Onset ages for major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder were compared with typical onset ages in the general population by using the sign test. A total of 108 patients (66.7% men; age 63.7 years [SD=8.9]) were included in the analysis. RESULTS Anxiety and depressive disorders occurred significantly earlier than PD diagnoses. Among patients whose anxiety and depression predated motor symptoms, the mean age at onset of anxiety disorders was 25.6 years earlier, and the mean age at onset of depressive disorders was 17.6 years earlier compared with the mean age at PD diagnosis (both p values <0.0001). Median onset ages for MDD (p<0.0001), GAD (p=0.0002), and panic disorder (p=0.0005) were significantly higher than typical median onset ages in the general population. CONCLUSIONS These results may indicate that neurodegenerative changes are present in parts of the brainstem reticular core and limbic system before motor circuits are affected to a degree that causes motor symptoms. Psychiatrists should be mindful that onset of MDD, GAD, and panic disorder after age 45 might signal a neurodegenerative movement disorder such as PD.
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Affiliation(s)
- Andreea L Seritan
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Christopher Rienas
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Tammy Duong
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Kevin Delucchi
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
| | - Jill L Ostrem
- The Department of Psychiatry, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi); the Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Rienas, Duong, Delucchi, Ostrem); and the Department of Neurology, University of California, San Francisco (Ostrem)
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21
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Lyons KE, Pahwa R, Hermanowicz N, Davis T, Pagan F, Isaacson S. Changing the treatment paradigm for Parkinson’s disease psychosis with pimavanserin. Expert Rev Clin Pharmacol 2019; 12:681-691. [DOI: 10.1080/17512433.2019.1623669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly E. Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Neal Hermanowicz
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Thomas Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fernando Pagan
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Stuart Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
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22
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Nackaerts E, D'Cruz N, Dijkstra BW, Gilat M, Kramer T, Nieuwboer A. Towards understanding neural network signatures of motor skill learning in Parkinson's disease and healthy aging. Br J Radiol 2019; 92:20190071. [PMID: 30982328 DOI: 10.1259/bjr.20190071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In the past decade, neurorehabilitation has been shown to be an effective therapeutic supplement for patients with Parkinson's disease (PD). However, patients still experience severe problems with the consolidation of learned motor skills. Knowledge on the neural correlates underlying this process is thus essential to optimize rehabilitation for PD. This review investigates the existing studies on neural network connectivity changes in relation to motor learning in healthy aging and PD and critically evaluates the imaging methods used from a methodological point of view. The results indicate that despite neurodegeneration there is still potential to modify connectivity within and between motor and cognitive networks in response to motor training, although these alterations largely bypass the most affected regions in PD. However, so far training-related changes are inferred and possible relationships are not substantiated by brain-behavior correlations. Furthermore, the studies included suffer from many methodological drawbacks. This review also highlights the potential for using neural network measures as predictors for the response to rehabilitation, mainly based on work in young healthy adults. We speculate that future approaches, including graph theory and multimodal neuroimaging, may be more sensitive than brain activation patterns and model-based connectivity maps to capture the effects of motor learning. Overall, this review suggests that methodological developments in neuroimaging will eventually provide more detailed knowledge on how neural networks are modified by training, thereby paving the way for optimized neurorehabilitation for patients.
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Affiliation(s)
| | - Nicholas D'Cruz
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bauke W Dijkstra
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Moran Gilat
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Thomas Kramer
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Reynolds GO, Saint-Hilaire M, Thomas CA, Barlow DH, Cronin-Golomb A. Cognitive-Behavioral Therapy for Anxiety in Parkinson's Disease. Behav Modif 2019; 44:552-579. [PMID: 30931594 DOI: 10.1177/0145445519838828] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Parkinson's disease (PD) is characterized by motor symptoms, but nonmotor symptoms also significantly impair daily functioning and reduce quality of life. Anxiety is prevalent and debilitating in PD, but remains understudied and undertreated. Much affective research in PD focuses on depression rather than anxiety, and as such, there are no evidence-based treatments for anxiety in this population. Cognitive-behavioral therapy (CBT) has shown promise for treating depression in PD and may be efficacious for anxiety. This exploratory study implemented a multiple-baseline single-case experimental design to evaluate the utility and feasibility of CBT for individuals with PD who also met criteria for a DSM-5 anxiety disorder (n = 9). Participants were randomized to a 2-, 4-, or 6-week baseline phase, followed by 12 CBT sessions, and two post treatment assessments (immediately post treatment and 6-week follow-up). Multiple outcome measures of anxiety and depression were administered weekly during baseline and intervention. Weekly CBT sessions were conducted in-person (n = 5) or via secure videoconferencing (n = 4). At post treatment, seven of the nine participants showed significant reductions in anxiety and/or depression, with changes functionally related to treatment and most improvements maintained at 6-week follow-up. Effects of CBT on secondary outcomes varied across participants, with preliminary evidence for reduction in fear of falling. Adherence and retention were high, as were treatment satisfaction and acceptability. The findings of this pilot study provide preliminary evidence for the utility of CBT as a feasible treatment for anxiety and comorbid depressive symptoms in PD and highlight the potential of telehealth interventions for mood in this population.
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Current treatment of behavioral and cognitive symptoms of Parkinson's disease. Parkinsonism Relat Disord 2019; 59:65-73. [PMID: 30852149 DOI: 10.1016/j.parkreldis.2019.02.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/19/2022]
Abstract
Cognitive and behavioral symptoms are common in Parkinson's disease, may occur even in the prodromal stages of the disease, worsen with disease progression, and surpass motor symptoms as the major factors affecting patient quality of life and caregiver burden. The symptoms may be caused by the disease pathology or they may represent adverse effects of treatment, or both etiological factors may contribute. Although many of these symptoms are related to dopaminergic dysfunction or dopaminergic medication, other neurotransmitters are involved as well. Behavioral symptoms including impulse control disorders, apathy, psychosis, as well as mild cognitive impairment and dementia are reviewed with a special focus on current treatment approaches.
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Meyer GM, Spay C, Laurencin C, Ballanger B, Sescousse G, Boulinguez P. Functional imaging studies of Impulse Control Disorders in Parkinson's disease need a stronger neurocognitive footing. Neurosci Biobehav Rev 2019; 98:164-176. [PMID: 30639672 DOI: 10.1016/j.neubiorev.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/22/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023]
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) are associated with dopaminergic dysfunction and treatment, but have no satisfactory therapeutic solution. While studies assessing the neurofunctional bases of ICDs are important for advancing our understanding and management of ICDs, they remain sparse and inconsistent. Based on a systematic analysis of the neuroimaging literature, the present review pinpoints various abnormalities beyond the mesocorticolimbic circuit that supports reward processing, suggesting possible dysfunction at the sensorimotor, executive and affective levels. We advocate that: 1) Future studies should use more sophisticated psychological models and behavioral designs that take into account the potentially multifaceted aspect of ICDs; this would allow a more accurate assessment of the underlying neurocognitive processes, which are not all dependent on the dopaminergic system. 2) Future neuroimaging studies should rely more strongly on task-based, event-related analyses to disentangle the various mechanisms that can be dysfunctional in ICDs. We believe these guidelines constitute a prerequisite towards distinguishing causes, correlates and individual susceptibility factors of PD patients with ICDs.
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Affiliation(s)
- Garance M Meyer
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon Neuroscience Research Center, INSERM, U 1028, CNRS, UMR 5292, Action Control and Related Disorders team, F-69000, Lyon, France
| | - Charlotte Spay
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon Neuroscience Research Center, INSERM, U 1028, CNRS, UMR 5292, Action Control and Related Disorders team, F-69000, Lyon, France
| | - Chloé Laurencin
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon Neuroscience Research Center, INSERM, U 1028, CNRS, UMR 5292, Neuroplasticity and Neuropathology of Olfactory Perception team, F-69000, Lyon, France; Service de Neurologie C, Centre Expert Parkinson, Hôpital Neurologique Pierre, Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte Ballanger
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon Neuroscience Research Center, INSERM, U 1028, CNRS, UMR 5292, Neuroplasticity and Neuropathology of Olfactory Perception team, F-69000, Lyon, France
| | - Guillaume Sescousse
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon Neuroscience Research Center, INSERM, U 1028, CNRS, UMR 5292, PsyR2 team, F-69000, Lyon, France
| | - Philippe Boulinguez
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon Neuroscience Research Center, INSERM, U 1028, CNRS, UMR 5292, Action Control and Related Disorders team, F-69000, Lyon, France.
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Boot E, Bassett AS, Marras C. 22q11.2 Deletion Syndrome-Associated Parkinson's Disease. Mov Disord Clin Pract 2019; 6:11-16. [PMID: 30746410 PMCID: PMC6335527 DOI: 10.1002/mdc3.12687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2DS) is a multisystem condition associated with an increased risk of early-onset Parkinson's disease (PD). METHODS We review the clinical, neuroimaging, and neuropathological observations, as well as diagnostic challenges, of PD in 22q11.2DS. We conducted a search of PubMed up until June 1, 2018 and personal files to identify relevant publications. RESULTS 22q11.2DS-associated PD is responsible for approximately 0.5% of early-onset PD. The hallmark motor symptoms and neuropathology of PD, and typical findings of reduced striatal dopamine transporter binding with molecular imaging, are present in 22q11.2DS-associated PD. Mean age at PD onset in 22q11.2DS is relatively young (∼40 years). Patients with 22q11.2DS-associated PD show a good response to levodopa. CONCLUSIONS Further recognition of 22q11.2DS and study of PD in people with 22q11.2DS could provide insights into the mechanisms that cause PD in the general population. 22q11.2DS may serve as an identifiable PD model to study prodromal PD and disease-modifying treatments.
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Affiliation(s)
- Erik Boot
- The Dalglish Family 22q Clinic for Adults, and Department of PsychiatryUniversity Health NetworkTorontoOntarioCanada
- ‘s Heeren Loo ZorggroepAmersfoortThe Netherlands
- Department of Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Anne S. Bassett
- The Dalglish Family 22q Clinic for Adults, and Department of PsychiatryUniversity Health NetworkTorontoOntarioCanada
- Toronto General Hospital Research Institute and Division of Cardiology, Department of MedicineUniversity Health NetworkTorontoOntarioCanada
- Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease ResearchToronto Western Hospital and University of TorontoTorontoOntarioCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
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Cozac VV. [Modern approaches to treatment of psychosis in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018. [PMID: 28635863 DOI: 10.17116/jnevro2016116101103-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychotic disorders in Parkinson's disease (PDPD) are common and significantly influence the quality of life and disability level. The pathogenesis of PDPD is complex and not yet fully understood. Taking into consideration the features of the Parkinson's disease (usually older patients with a risk of cognitive decline), and the pharmacodynamics of the antiparkinsonian and traditional antipsychotic drugs, the management of PDPD is a challenging issue of clinical neurology and psychiatry. In this systematic review, scientific publications for the period 2014-2016 were analyzed within two bibliographic databases: MEDLINE/PubMed and eLIBRARY.RU. Additionally, the guidelines of the International Parkinson and Movement Disorders Society, American Academy of Neurology and European Academy of Neurology were included in the analysis. Clozapine is recommended to use in the treatment of PDPD, quetiapine is possible to use, pimavanserin will probably become a remedy of choice. Nonpharmacological approaches have positive effects on the general condition of the patients with PDPD, however the efficacy of such approaches to treat psychosis is unclear.
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Affiliation(s)
- V V Cozac
- Hospital of the University of Basel, Basel, Switzerland
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Litwin T, Dusek P, Szafrański T, Dzieżyc K, Członkowska A, Rybakowski JK. Psychiatric manifestations in Wilson's disease: possibilities and difficulties for treatment. Ther Adv Psychopharmacol 2018; 8:199-211. [PMID: 29977520 PMCID: PMC6022881 DOI: 10.1177/2045125318759461] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/02/2018] [Indexed: 12/14/2022] Open
Abstract
Wilson's disease (WD) is an inherited metabolic disorder related to disturbances of copper metabolism, and predominantly presents with liver and neuropsychiatric symptoms. In most cases it can be successfully treated with anti-copper agents, and both liver function and neuropsychiatric symptoms typically improve. Treatment guidelines for WD include recommendations for anti-copper treatment as well as for the treatment of liver failure symptoms. Recently, recommendations for treatment of the neurological symptoms of WD have also been proposed. Although most WD patients present with psychiatric symptoms at some stage of the disease, currently there are no guidelines for the treatment of the psychiatric manifestations. Treatment of the psychiatric symptoms of WD is often guided by general psychiatric experience, which typically glosses over the specificity of WD, and can result in severe neurological and/or hepatic complications. Here we review and discuss the possible treatments available for the mood disturbances, psychosis, behavioral and cognitive disorders that can occur in WD, as well as their efficacy.
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Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Polandc
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- Department of Radiology, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | | | - Karolina Dzieżyc
- Second Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Janusz K. Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
Parkinson disease (PD) is a progressive neurodegenerative disease that affects one million people in the United States. This article reviews the etiology and pathophysiology of PD, risk factors, clinical manifestations, diagnostic criteria, and treatment of this common disease. Implications for home care clinicians are included.
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Morbus Parkinson im Alter. Z Gerontol Geriatr 2017; 50:547-559. [DOI: 10.1007/s00391-017-1284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 12/15/2022]
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Phillips KA, Ross CN, Spross J, Cheng CJ, Izquierdo A, Biju KC, Chen C, Li S, Tardif SD. Behavioral phenotypes associated with MPTP induction of partial lesions in common marmosets (Callithrix jacchus). Behav Brain Res 2017; 325:51-62. [PMID: 28219749 PMCID: PMC5410665 DOI: 10.1016/j.bbr.2017.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 11/23/2022]
Abstract
Parkinson's disease is a chronic neurodegenerative disorder with the core motor features of resting tremor, bradykinesia, rigidity, and postural instability. Non-motor symptoms also occur, and include cognitive dysfunction, mood disorders, anosmia (loss of smell), and REM sleep disturbances. As the development of medications and other therapies for treatment of non-motor symptoms is ongoing, it is essential to have animal models that aid in understanding the neural changes underlying non-motor PD symptoms and serve as a testing ground for potential therapeutics. We investigated several non-motor symptoms in 10 adult male marmosets using the MPTP model, with both the full (n=5) and partial (n=5) MPTP dosing regimens. Baseline data in numerous domains were collected prior to dosing; assessments in these same domains occurred post-dosing for 12 weeks. Marmosets given the partial MPTP dose (designed to mimic the early stages of the disease) differed significantly from marmosets given the full MPTP dose in several ways, including behavior, olfactory discrimination, cognitive performance, and social responses. Importantly, while spontaneous recovery of PD motor symptoms has been previously reported in studies of MPTP monkeys and cats, we did not observe recovery of any non-motor symptoms. This suggests that the neurochemical mechanisms behind the non-motor symptoms of PD, which appear years before the onset of symptoms, are independent of the striatal dopaminergic transmission. We demonstrate the value of assessing a broad range of behavioral change to detect non-motor impairment, anosmia, and differences in socially appropriate responses, in the marmoset MPTP model of early PD.
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Affiliation(s)
- Kimberley A Phillips
- Department of Psychology, Trinity University, San Antonio TX, United States; Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States.
| | - Corinna N Ross
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States; Department of Science and Mathematics, Texas A&M University San Antonio, San Antonio, TX, United States; Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Jennifer Spross
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Catherine J Cheng
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, San Antonio, TX, United States; Department of Cell Systems and Anatomy, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Alyssa Izquierdo
- Department of Psychology, Trinity University, San Antonio TX, United States
| | - K C Biju
- Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Cang Chen
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, San Antonio, TX, United States; Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, United States; South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX, United States
| | - Senlin Li
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, San Antonio, TX, United States; Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, United States; South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX, United States
| | - Suzette D Tardif
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States; Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
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Dissanayaka NNW, Pye D, Mitchell LK, Byrne GJ, O'Sullivan JD, Marsh R, Pachana NA. Cognitive Behavior Therapy for Anxiety in Parkinson's Disease: Outcomes for Patients and Caregivers. Clin Gerontol 2017; 40:159-171. [PMID: 28452666 DOI: 10.1080/07317115.2016.1240131] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Anxiety negatively impacts the quality of life of Parkinson's disease (PD) patients and caregivers. Despite high prevalence, there is a paucity of trials investigating effective treatments for anxiety in PD. This uncontrolled study investigated the use of a manualized and tailored Cognitive Behavior Therapy (CBT) for anxiety in PD. METHODS Participants completed 6 weekly CBT sessions. Pre-, post- and follow-up (3 and 6 months) assessments were made. Change in outcomes were analysed using t-tests and Reliability Change Index. Of 17 PD patients who agreed to CBT, 12 completed the intervention. RESULTS This study showed a significant reduction in Hamilton Anxiety Rating Scale scores in PD immediately post CBT (t(11) = 3.59, p < .01), maintained at 3-month (t(8) = 2.83, p = .02) and 6-month (t(7) = 2.07, p = .04) follow-up. A reduction in caregiver burden (t(11) = 2.68, p = .03) was observed post intervention. Improvements in motor disability (t(11) = 2.41, p = .04) and cognitive scores (t(11) = -2.92, p = .01) were also observed post intervention and at follow-up. CONCLUSIONS Tailored CBT can be used to treat anxiety in PD. CLINICAL IMPLICATIONS This study provides preliminary evidence suggesting that tailored CBT reduces anxiety in PD with persisting benefits, and lowers caregiver burden.
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Affiliation(s)
- Nadeeka N W Dissanayaka
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - Deidre Pye
- a The University of Queensland , Brisbane , Australia
| | | | - Gerard J Byrne
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - John D O'Sullivan
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - Rodney Marsh
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
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Williams NR, Bentzley BS, Sahlem GL, Pannu J, Korte JE, Revuelta G, Short EB, George MS. Unilateral ultra-brief pulse electroconvulsive therapy for depression in Parkinson's disease. Acta Neurol Scand 2017; 135:407-411. [PMID: 27241213 DOI: 10.1111/ane.12614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) has demonstrated efficacy in treating core symptoms of Parkinson's disease (PD); however, widespread use of ECT in PD has been limited due to concern over cognitive burden. We investigated the use of a newer ECT technology known to have fewer cognitive side effects (right unilateral [RUL] ultra-brief pulse [UBP]) for the treatment of medically refractory psychiatric dysfunction in PD. MATERIALS AND METHODS This open-label pilot study included 6 patients who were assessed in the motoric, cognitive, and neuropsychiatric domains prior to and after RUL UBP ECT. Primary endpoints were changes in total score on the HAM-D-17 and GDS-30 rating scales. RESULTS Patients were found to improve in motoric and psychiatric domains following RUL UBP ECT without cognitive side effects, both immediately following ECT and at 1-month follow-up. CONCLUSIONS This study demonstrates that RUL UBP ECT is safe, feasible, and potentially efficacious in treating multiple domains of PD, including motor and mood, without clear cognitive side effects.
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Affiliation(s)
- N. R. Williams
- Department of Psychiatry & Behavioral Sciences; Stanford University; Stanford CA USA
| | - B. S. Bentzley
- Department of Psychiatry & Behavioral Sciences; Stanford University; Stanford CA USA
| | - G. L. Sahlem
- Department of Psychiatry; Medical University of South Carolina; Charleston SC USA
| | - J. Pannu
- Department of Psychiatry & Behavioral Sciences; Stanford University; Stanford CA USA
| | - J. E. Korte
- Department of Public Health Sciences; Medical University of South Carolina; Charleston SC USA
| | - G. Revuelta
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
| | - E. B. Short
- Department of Psychiatry; Medical University of South Carolina; Charleston SC USA
| | - M. S. George
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
- Department of Psychiatry; Medical University of South Carolina; Charleston SC USA
- Ralph H. Johnson VA Medical Center; Charleston SC USA
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Abstract
Parkinson disease is the second-most common neurodegenerative disorder that affects 2-3% of the population ≥65 years of age. Neuronal loss in the substantia nigra, which causes striatal dopamine deficiency, and intracellular inclusions containing aggregates of α-synuclein are the neuropathological hallmarks of Parkinson disease. Multiple other cell types throughout the central and peripheral autonomic nervous system are also involved, probably from early disease onwards. Although clinical diagnosis relies on the presence of bradykinesia and other cardinal motor features, Parkinson disease is associated with many non-motor symptoms that add to overall disability. The underlying molecular pathogenesis involves multiple pathways and mechanisms: α-synuclein proteostasis, mitochondrial function, oxidative stress, calcium homeostasis, axonal transport and neuroinflammation. Recent research into diagnostic biomarkers has taken advantage of neuroimaging in which several modalities, including PET, single-photon emission CT (SPECT) and novel MRI techniques, have been shown to aid early and differential diagnosis. Treatment of Parkinson disease is anchored on pharmacological substitution of striatal dopamine, in addition to non-dopaminergic approaches to address both motor and non-motor symptoms and deep brain stimulation for those developing intractable L-DOPA-related motor complications. Experimental therapies have tried to restore striatal dopamine by gene-based and cell-based approaches, and most recently, aggregation and cellular transport of α-synuclein have become therapeutic targets. One of the greatest current challenges is to identify markers for prodromal disease stages, which would allow novel disease-modifying therapies to be started earlier.
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Stievenard A, Méquinion M, Andrews ZB, Destée A, Chartier-Harlin MC, Viltart O, Vanbesien-Mailliot CC. Is there a role for ghrelin in central dopaminergic systems? Focus on nigrostriatal and mesocorticolimbic pathways. Neurosci Biobehav Rev 2017; 73:255-275. [DOI: 10.1016/j.neubiorev.2016.11.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 12/21/2022]
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Salazar RD, Le AM, Neargarder S, Cronin-Golomb A. The impact of motor symptoms on self-reported anxiety in Parkinson's disease. Parkinsonism Relat Disord 2017; 38:26-30. [PMID: 28256435 DOI: 10.1016/j.parkreldis.2017.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anxiety is commonly endorsed in Parkinson's disease (PD) and significantly affects quality of life. The Beck Anxiety Inventory (BAI) is often used but contains items that overlap with common PD motor symptoms (e.g., "hands trembling"). Because of these overlapping items, we hypothesized that PD motor symptoms would significantly affect BAI scores. METHODS One hundred non-demented individuals with PD and 74 healthy control participants completed the BAI. PD motor symptoms were assessed by the Unified Parkinson's Disease Rating Scale (UPDRS). Factor analysis of the BAI assessed for a PD motor factor, and further analyses assessed how this factor affected BAI scores. RESULTS BAI scores were significantly higher for PD than NC. A five-item PD motor factor correlated with UPDRS observer-rated motor severity and mediated the PD-control difference on BAI total scores. An interaction occurred, whereby removal of the PD motor factor resulted in a significant reduction in BAI scores for PD relative to NC. The correlation between the BAI and UPDRS significantly declined when controlling for the PD motor factor. CONCLUSIONS The results indicate that commonly endorsed BAI items may reflect motor symptoms such as tremor instead of, or in addition to, genuine mood symptoms. These findings highlight the importance of considering motor symptoms in the assessment of anxiety in PD and point to the need for selecting anxiety measures that are less subject to contamination by the motor effects of movement disorders.
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Affiliation(s)
- Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Asher M Le
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, USA; Department of Psychology, Bridgewater State University, USA
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Perović Z, Cukić M. Depression in patients with Parkinson's disease with dementia. SANAMED 2017. [DOI: 10.24125/sanamed.v1i1.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Parkinson's disease is a multisystem disorder which is characterized by a combination of motor and non-motor symptoms. Non-motor symptoms include: depression, cognitive impairment, autonomic and sensor symptoms. It is difficult to detect and treat depression symptoms in patients with Parkinson's disease with dementia. Early identification and treatment of depression symptoms can greatly improve the quality of life in these patients, as well as facilitate the quality of caregivers' lives. Goal of the paper: The aim of our research was to evaluate frequency of depression occurrence in patients with Parkinson's disease with cognitive impairment. Patients and methods: We did a prospective study which included 59 PD patients, who came for a regular check-up to Neurological infirmary of the General Hospital in Niksic, in the interval from 1st January 2016to 31st December 2016, all of whom were previously diagnosed with Parkinson's disease. We tested their cognitive status using the Mini Mental State Examination scale. Out of 59 patients, 32 displayed cognitive deficit and were included in further research. We gave directions about testing to guardians or caregivers of the patients who displayed moderate or distinct cognitive impairment. The testing was done on the next check-up, with Cornell's depression scale. Results: Research showed that out of 32 patients, 5 (15.6%) didn't suffer from depression, 8 (25%) probably suffered from major depression, while 19 (59.4%) definitely suffered from major depression. On the cognitive scale, 6 (18.8%) patients had mild, 11 (34.4%) moderate and 15 (46.9%) distinct cognitive deficit. Out of 8 patients with probable depression 3 (9.4%) had mild, 3 (9.4%) had moderate and 2 (6.2%) distinct cognitive deficit. We can also: conclude that out of 19 (59.4%) with certain depression, 1 (3.1%) had mild, 5 (15.6%) had medium severe, and 13 (40.6%) had severe cognitive deficit. Conclusion: Prevalence of depression and dementia in Parkinson's diseasepatients is high. Our patients have moderate cognitive deficit in 34.4% of the cases, and distinct cognitive deficit in 46.9% of the cases; while 59.4% definitely suffers from major depression at some point of their illness. Their early detection is of great importance for treatment and quality of life of these patients.
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Babayeva M, Assefa H, Basu P, Chumki S, Loewy Z. Marijuana Compounds: A Nonconventional Approach to Parkinson's Disease Therapy. PARKINSON'S DISEASE 2016; 2016:1279042. [PMID: 28050308 PMCID: PMC5165161 DOI: 10.1155/2016/1279042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD), a neurodegenerative disorder, is the second most common neurological illness in United States. Neurologically, it is characterized by the selective degeneration of a unique population of cells, the nigrostriatal dopamine neurons. The current treatment is symptomatic and mainly involves replacement of dopamine deficiency. This therapy improves only motor symptoms of Parkinson's disease and is associated with a number of adverse effects including dyskinesia. Therefore, there is unmet need for more comprehensive approach in the management of PD. Cannabis and related compounds have created significant research interest as a promising therapy in neurodegenerative and movement disorders. In this review we examine the potential benefits of medical marijuana and related compounds in the treatment of both motor and nonmotor symptoms as well as in slowing the progression of the disease. The potential for cannabis to enhance the quality of life of Parkinson's patients is explored.
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Affiliation(s)
- Mariana Babayeva
- Touro College of Pharmacy, 230 West 125th Street, Room 530, New York, NY 10027, USA
| | - Haregewein Assefa
- Touro College of Pharmacy, 230 West 125th Street, Room 530, New York, NY 10027, USA
| | - Paramita Basu
- Touro College of Pharmacy, 230 West 125th Street, Room 530, New York, NY 10027, USA
| | - Sanjeda Chumki
- Touro College of Pharmacy, 230 West 125th Street, Room 530, New York, NY 10027, USA
| | - Zvi Loewy
- Touro College of Pharmacy, 230 West 125th Street, Room 530, New York, NY 10027, USA
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Abstract
Cognitive and neuropsychiatric symptoms are common in Parkinson's Disease and may surpass motor symptoms as the major factors impacting patient quality of life. The symptoms may be broadly separated into those associated with the disease process and those that represent adverse effects of treatment. Symptoms attributed to the disease arise from pathologic changes within multiple brain regions and are not restricted to dysfunction in the dopaminergic system. Mood symptoms such as depression, anxiety, and apathy are common and may precede the development of motor symptoms by years, while other neuropsychiatric symptoms such as cognitive impairment, dementia, and psychosis are more common in later stages of the disease. Neuropsychiatric symptoms attributed to treatment include impulse control disorders, pathologic use of dopaminergic medications, and psychosis. This manuscript will review the current understanding of neuropsychiatric symptoms in Parkinson's Disease.
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Affiliation(s)
- Jeffrey W Cooney
- Duke University School of Medicine, 932 Morreene Rd., Durham, NC, 27705, USA
| | - Mark Stacy
- Duke University School of Medicine, 120a Davison, Durham, NC, 27705, USA.
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Martinez-Ramirez D, Okun MS, Jaffee MS. Parkinson's disease psychosis: therapy tips and the importance of communication between neurologists and psychiatrists. Neurodegener Dis Manag 2016; 6:319-30. [PMID: 27408981 PMCID: PMC5066136 DOI: 10.2217/nmt-2016-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/03/2016] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a chronic and complex neurodegenerative disorder resulting in a mixture of motor and nonmotor symptoms. Psychosis develops in around 60% of PD patients during and can be one of the most challenging nonmotor symptoms. PD psychosis is considered the single greatest precipitant for nursing home placement. PD psychosis is an independent predictor of increased mortality, and there is no 'ideal' or universal treatment strategy. The treatment approach to PD psychosis should be tailored and individualized for each patient. In this review, we will discuss PD psychosis and provide practical treatment considerations for neurologists, psychiatrists and other healthcare professionals. We stress the importance of real-time communication between members of the healthcare team.
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Affiliation(s)
- Daniel Martinez-Ramirez
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA
| | - Michael S Okun
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA
| | - Michael S Jaffee
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA
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Belin J, Houéto JL, Constans T, Hommet C, de Toffol B, Mondon K. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects]. Rev Neurol (Paris) 2015; 171:841-52. [PMID: 26573332 DOI: 10.1016/j.neurol.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022]
Abstract
Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects.
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Affiliation(s)
- J Belin
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France.
| | - J L Houéto
- Service de neurologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - T Constans
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - C Hommet
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - B de Toffol
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France
| | - K Mondon
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Temporal Dissociation of Striatum and Prefrontal Cortex Uncouples Anhedonia and Defense Behaviors Relevant to Depression in 6-OHDA-Lesioned Rats. Mol Neurobiol 2015; 53:3891-3899. [DOI: 10.1007/s12035-015-9330-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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Berardelli I, Pasquini M, Roselli V, Biondi M, Berardelli A, Fabbrini G. Cognitive Behavioral Therapy in Movement Disorders: A Review. Mov Disord Clin Pract 2015; 2:107-115. [PMID: 30363949 DOI: 10.1002/mdc3.12160] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/13/2015] [Accepted: 01/21/2015] [Indexed: 12/20/2022] Open
Abstract
In addition to motor symptoms, patients with movement disorders often complain of psychiatric disturbances, including mood, anxiety, and impulse-control disorders and psychosis. These abnormalities are often misdiagnosed and left untreated, thus resulting in a worse prognosis and lower quality of life. Besides the use of standard pharmacological treatments, psychiatric abnormalities can be treated by means of nonpharmacological approaches. These approaches include various types of psychological therapies, the most widely used being cognitive behavioral therapy (CBT). We reviewed all articles, conducted until 2014, that contained primary data derived from clinical trials and case reports on the effect of CBT in the most common movement disorders. One randomized, controlled study and several uncontrolled studies on the efficacy of CBT in Parkinson's disease (PD) have shown a short-term benefit of depression and anxiety. In Tourette's syndrome (TS), CBT has been assessed in a number of large controlled clinical trials that have demonstrated an improvement in psychiatric disturbances and tics. There are no controlled studies on the efficacy of CBT in other types of movement disorders, such as dystonia, Huntington's disease, and essential tremor. Only a limited number of studies have evaluated the efficacy of CBT in the management of psychiatric disorders in movement disorders. The evidence available suggests that CBT is useful in TS and probably useful in PD. We recommend the planning of randomized, controlled clinical trials to investigate the effects of CBT and group CBT in the treatment of psychiatric disturbances in movement disorders.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Massimo Pasquini
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Valentina Roselli
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy.,IRCSS Neuromed Pozzilli (IS) Italy
| | - Giovanni Fabbrini
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy.,IRCSS Neuromed Pozzilli (IS) Italy
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Dissanayaka NN, White E, O'Sullivan JD, Marsh R, Silburn PA, Copland DA, Mellick GD, Byrne GJ. Characteristics and Treatment of Anxiety Disorders in Parkinson's Disease. Mov Disord Clin Pract 2015; 2:155-162. [PMID: 30363816 PMCID: PMC6183244 DOI: 10.1002/mdc3.12157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/12/2015] [Accepted: 12/14/2014] [Indexed: 01/18/2023] Open
Abstract
Background: Anxiety disorders are common in Parkinson's disease (PD) and are undertreated. The current study investigates demographic and PD-specific factors associated with Diagnostic and Statistical Manual (DSM-IV) anxiety disorders and subsyndromal anxiety in PD. It also examines the use of pharmacological and nonpharmacological treatments for anxiety in PD. Methods: Ninety nondemented PD patients completed a semistructured interview. Logistic regression models were constructed examining associations between several demographic, disease-specific, and treatment factors, as well as both current syndromal, DSM-IV anxiety disorders, and subsyndromal anxiety. Results: Associations were found between current DSM-IV anxiety disorder, as well as female gender, younger age, more severe stages of PD, and poor activities of daily living. Subsyndromal anxiety was related to a younger onset age of PD. Relationships were also found between both anxiety groups and more complications of PD therapy, as well as higher depression scores. There were no associations between anxiety and levodopa equivalent daily dosage, motor disability, and cognition. In our sample, 57% of patients with current DSM-IV anxiety disorders or subsyndromal anxiety were not currently treated with pharmacotherapy. Of those who currently received such treatment, 83% still experienced current anxiety disorders. Results suggest that anxiety is poorly recognized and treated in PD. Conclusions: Clinical trials investigating the efficacy of pharmacotherapy, tailored psychotherapy, and combination therapy primarily focusing on anxiety are much needed, with the aim of establishing novel targeted treatment protocols for the management of subtypes of anxiety disorders in PD.
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Affiliation(s)
- Nadeeka N.W. Dissanayaka
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Elizabeth White
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - John D. O'Sullivan
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - Rodney Marsh
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
| | - Peter A. Silburn
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - David A. Copland
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of Health & Rehabilitation SciencesUniversity of QueenslandSt LuciaBrisbaneQueenslandAustralia
| | - George D. Mellick
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- Eskitis Institute for Drug DiscoveryGriffith UniversityNathanBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
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Jenner P. Treatment of the later stages of Parkinson's disease - pharmacological approaches now and in the future. Transl Neurodegener 2015; 4:3. [PMID: 25973178 PMCID: PMC4429454 DOI: 10.1186/2047-9158-4-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/01/2015] [Indexed: 11/10/2022] Open
Abstract
The problems associated with the pharmacological treatment of the later stages of Parkinson's disease (PD) remain those seen over many years. These centre on a loss of drug effect ('wearing off') with disease progression, the occurrence of dyskinesia, notably with L-dopa use and the appearance of non-motor symptoms that are largely refractory to dopaminergic medication. Treatment strategies in late PD have been dominated by the use of drug combinations and the subtle manipulation of drug dosage. However, change is occurring as the understanding of the basis of motor complications and fluctuations and non-motor symptoms improves. New pharmacological options are expanding with the advent of longer acting versions of existing dopaminergic drugs, new drug delivery systems and the introduction of non-dopaminergic agents able to manipulate motor function both within the basal ganglia and in other brain regions. Non-dopaminergic agents are also being investigated for the treatment of dyskinesia and for the relief of non-motor symptoms. However, while therapy continues to improve, the treatment of late stage PD remains problematic with non-motor symptoms dominating the unmet need in this patient group.
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Affiliation(s)
- Peter Jenner
- Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Sciences, Faculty of Health Sciences and Medicine, King's College, London, SE1 1UL UK
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Samuel M, Rodriguez-Oroz M, Antonini A, Brotchie JM, Ray Chaudhuri K, Brown RG, Galpern WR, Nirenberg MJ, Okun MS, Lang AE. Management of impulse control disorders in Parkinson's disease: Controversies and future approaches. Mov Disord 2015; 30:150-9. [PMID: 25607799 PMCID: PMC5077247 DOI: 10.1002/mds.26099] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 10/28/2014] [Accepted: 11/02/2014] [Indexed: 02/01/2023] Open
Abstract
Impulse control disorders in Parkinson's disease are a group of impulsive behaviors most often associated with dopaminergic treatment. Presently, there is a lack of high quality evidence available to guide their management. This manuscript reviews current management strategies, before concentrating on the concept of dopamine agonist withdrawal syndrome and its implications for the management of impulse control disorders. Further, we focus on controversies, including the role of more recently available anti-parkinsonian drugs, and potential future approaches involving routes of drug delivery, nonpharmacological treatments (such as cognitive behavioral therapy and deep brain stimulation), and other as yet experimental strategies.
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Affiliation(s)
- Michael Samuel
- Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital, King's Health Partners, London, UK
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Broadstock M, Ballard C, Corbett A. Novel pharmaceuticals in the treatment of psychosis in Parkinson’s disease. Expert Rev Clin Pharmacol 2014; 7:779-86. [DOI: 10.1586/17512433.2014.966814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Coakeley S, Martens KE, Almeida QJ. Management of anxiety and motor symptoms in Parkinson’s disease. Expert Rev Neurother 2014; 14:937-46. [DOI: 10.1586/14737175.2014.936388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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L'Episcopo F, Tirolo C, Caniglia S, Testa N, Morale MC, Serapide MF, Pluchino S, Marchetti B. Targeting Wnt signaling at the neuroimmune interface for dopaminergic neuroprotection/repair in Parkinson's disease. J Mol Cell Biol 2014; 6:13-26. [PMID: 24431301 DOI: 10.1093/jmcb/mjt053] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
During the past three decades, the Wingless-type MMTV integration site (Wnt) signaling cascade has emerged as an essential system regulating multiple processes in developing and adult brain. Accumulating evidence points to a dysregulation of Wnt signaling in major neurodegenerative pathologies including Parkinson's disease (PD), a common neurodegenerative disorder characterized by the progressive loss of midbrain dopaminergic (mDA) neurons and deregulated activation of astrocytes and microglia. This review highlights the emerging link between Wnt signaling and key inflammatory pathways during mDA neuron damage/repair in PD progression. In particular, we summarize recent evidence documenting that aging and neurotoxicant exposure strongly antagonize Wnt/β-catenin signaling in mDA neurons and subventricular zone (SVZ) neuroprogenitors via astrocyte-microglial interactions. Dysregulation of the crosstalk between Wnt/β-catenin signaling and anti-oxidant/anti-inflammatory pathways delineate novel mechanisms driving the decline of SVZ plasticity with age and the limited nigrostriatal dopaminergic self-repair in PD. These findings hold a promise in developing therapies that target Wnt/β-catenin signaling to enhance endogenous restoration and neuronal outcome in age-dependent diseases, such as PD.
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Affiliation(s)
- Francesca L'Episcopo
- OASI Institute for Research and Care on Mental Retardation and Brain Aging (IRCCS), Neuropharmacology Section, Via Conte Ruggero 73, 94018 Troina, Italy
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Factor SA, Jankovic J. Editorial: Neurotherapeutics of movement disorders. Neurotherapeutics 2014; 11:3-5. [PMID: 24366609 PMCID: PMC3899485 DOI: 10.1007/s13311-013-0241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Stewart A Factor
- Department of Neurology, Emory University School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30329, USA,
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