Psychiatric symptoms in Parkinson's disease: a comparison between patients with and without "on-off" symptoms

Comorbidities in Neurology: Is adenosine the common link?

Comorbidities in Neurology represent a major conceptual and therapeutic challenge. For example, temporal lobe epilepsy (TLE) is a syndrome comprised of epileptic seizures and comorbid symptoms including memory and psychiatric impairment, depression, and sleep dysfunction. Similarly, Alzheimer's disease (AD), Parkinson's disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are accompanied by various degrees of memory dysfunction. Patients with AD have an increased likelihood for seizures, whereas all four conditions share certain aspects of psychosis, depression, and sleep dysfunction. This remarkable overlap suggests common pathophysiological mechanisms, which include synaptic dysfunction and synaptotoxicity, as well as glial activation and astrogliosis. Astrogliosis is linked to synapse function via the tripartite synapse, but astrocytes also control the availability of gliotransmitters and adenosine. Here we will specifically focus on the 'adenosine hypothesis of comorbidities' implying that astrocyte activation, via overexpression of adenosine kinase (ADK), induces a deficiency in the homeostatic tone of adenosine. We present evidence from patient-derived samples showing astrogliosis and overexpression of ADK as common pathological hallmark of epilepsy, AD, PD, and ALS. We discuss a transgenic 'comorbidity model', in which brain-wide overexpression of ADK and resulting adenosine deficiency produces a comorbid spectrum of seizures, altered dopaminergic function, attentional impairment, and deficits in cognitive domains and sleep regulation. We conclude that dysfunction of adenosine signaling is common in neurological conditions, that adenosine dysfunction can explain co-morbid phenotypes, and that therapeutic adenosine augmentation might be effective for the treatment of comorbid symptoms in multiple neurological conditions.

Changes in vocal intensity in Parkinson's disease following pallidotomy surgery

The present study was designed to examine changes in vocal intensity following unilateral posteroventral pallidotomy (PVP) in a large sample of speakers with Parkinson's disease (PD) that exhibited a range of hypokinetic dysarthria. Twenty-five persons with PD were recorded using a variety of speech tasks, once prior to and once following PVP. The pre-PVP vocal SPL was subtracted from the post-PVP vocal SPL to derive a relative change in vocal SPL. Mildly dysarthric participants had significantly greater relative increases in vocal SPL following PVP than either moderately or severely dysarthric participants who had reduced vocal SPL following PVP. If future results follow those observed in the present data, mildly dysarthric Parkinson's patients may benefit most from unilateral PVP perhaps due to less overall destruction of the basal ganglia sensorimotor control circuits involved in oral facial functions, thus increasing the chances to observe improvements postsurgery.