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Lee J, Sohn YH, Chung SJ, Kim E, Kim Y. Presentations of nonmotor symptoms by sex and onset age in people with Parkinson's disease. Int J Nurs Pract 2024; 30:e13177. [PMID: 37394896 DOI: 10.1111/ijn.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND There is growing evidence that sex and onset age are important factors of clinical features in Parkinson's disease. AIM The study aimed to identify nonmotor symptoms based on sex and onset age in people with Parkinson's disease. DESIGN This is a cross-sectional descriptive study. METHODS A total of 210 participants were recruited from the university hospital and the Parkinson's disease association. This study measured the Korean version of the nonmotor symptoms questionnaire which includes gastrointestinal, urinary, apathy/attention/memory, hallucination/delusions, depression/anxiety, sexual function, cardiovascular, sleep disorder, and miscellaneous domains. RESULTS All participants reported at least one nonmotor symptom. The most commonly reported symptoms were nocturia (65.7%) and constipation (61.9%). The male participants reported more dribbling of saliva, constipation, and impaired sexual function, whereas the female reported more weight change. Young-onset people with Parkinson's disease reported more depression than late-onset people with Parkinson's disease. CONCLUSION This study contributes to the understanding of symptom experience beyond motor-related symptomatology for those with Parkinson's disease and adds to the current literature. Individualized symptom assessment and management should be provided by prioritizing prevalent sex or onset age-specific symptoms, rather than addressing with all nonmotor symptoms.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Centre of Korea: A Joanna Briggs Institute of Excellence, College of Nursing, Yonsei University, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Eunyoung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Yielin Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
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Lenka A, Sundaravadivel P, Christopher R, Arumugham SS, Hegde S, Yadav R, Pal PK. HOMER1 Polymorphism and Parkinson's Disease-Psychosis: Is there an Association? Ann Indian Acad Neurol 2024; 27:178-182. [PMID: 38751916 PMCID: PMC11093156 DOI: 10.4103/aian.aian_1038_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 05/18/2024] Open
Abstract
Objective Homer1, a postsynaptic protein coded by the HOMER1 gene, presumably has a role in homeostatic plasticity that dampens neuronal responsiveness when the input activity is too high. HOMER1 polymorphism has been studied in major psychiatric disorders such as schizophrenia. The objective of this study is to investigate if polymorphisms of the HOMER1 gene are associated with psychosis in Parkinson's disease (PD-P). Methods One hundred patients with Parkinson's disease (PD) and 100 healthy controls were enrolled consecutively in a PD-P biomarker study at the National Institute of Mental Health and Neurosciences, Bangalore, India. Of the 100 PD patients, 50 had psychosis (PD-P) and 50 did not have psychosis (PD-NP). Two single-nucleotide polymorphisms of HOMER1 (rs4704559 and rs4704560) were analyzed from the DNA isolated from peripheral blood. The allele and genotype frequencies in the PD-P and PD-NP groups were compared. Results Analysis of HOMER1 rs4704560 revealed a significant difference in both genotype and allele levels between PD-P and PD-NP groups. There was an overrepresentation of T-allele (42% vs. 16%; P < 0.001) and TT genotype (24% vs. 6%; P < 0.001) in the PD-P group compared to PD-NP group. There was no significant difference between PD-P and PD-NP groups when various genotypes and allele frequencies related to HOMER1 rs4704559 were compared. Conclusion PD-P is probably associated with overrepresentation of T-allele of HOMER1 rs4704560, and larger studies are warranted to confirm our results.
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Affiliation(s)
- Abhishek Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Department of Neurology, Baylor College of Medicine, Houston, USA
| | - Pandarisamy Sundaravadivel
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Department of Integrative Medical Research, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Department of Integrative Medical Research, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
| | - Shyam S. Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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3
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Bayram E, Liu H, Luo S, Di Luca DG, Skipworth M, Damron Solomon L, Dahodwala N, Litvan I. Ethnoracial differences for caregiving burden in Parkinson's disease. Parkinsonism Relat Disord 2024; 118:105927. [PMID: 37952272 PMCID: PMC10911683 DOI: 10.1016/j.parkreldis.2023.105927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Caregivers play an important role in Parkinson's disease (PD) treatment, especially as the disease progresses. As the symptom profile and needs of people with PD (PwP) differ across ethnoracial groups, whether caregiving needs also differ for different ethnoracial groups should be investigated. METHODS Data were obtained from the Parkinson's Foundation funded Parkinson's Outcomes Project for PwP identifying as Hispanic (n = 495), non-Hispanic Asian (n = 170), non-Hispanic Black (n = 162), or non-Hispanic White (n = 7687). Cross-sectional and longitudinal total Multidimensional Caregiver Strain Index (MCSI) and domain-specific scores for caregiving burden were compared across the ethnoracial groups. Effect of demographics and clinical variables, interaction of these variables with ethnoracial groups for caregiver burden was assessed. RESULTS Care partners of PwP identifying as non-Hispanic Asian experienced the most burden. PwP identifying as non-Hispanic White were oldest, yet their care partners experienced the least burden. Care partners of PwP identifying as non-Hispanic Asian experienced more burden in physical and social domains, care partners of PwP identifying as Hispanic experienced more burden in financial and elder demanding/manipulative domains. Over time, burden increased similarly across the ethnoracial groups. Effect of frequency of falls, hospital admission, neuropsychiatric disorder and social support on burden over time differed across the groups. CONCLUSION PwP from different ethnoracial groups can experience different levels of caregiving burden. Predictors for caregiving burden, such as social support and falls can have different impacts based on ethnicity and race. Caregiver needs should also be assessed and culturally competent support should be provided to benefit all affected by PD.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Hongliang Liu
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
| | - Daniel G Di Luca
- Department of Neurology, Washington University in St. Louis, MO, USA.
| | - Michael Skipworth
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Lisa Damron Solomon
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
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4
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Lenka A, Jankovic J. How should future clinical trials be designed in the search for disease-modifying therapies for Parkinson's disease? Expert Rev Neurother 2023; 23:107-122. [PMID: 36803618 DOI: 10.1080/14737175.2023.2177535] [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: 02/22/2023]
Abstract
INTRODUCTION Although there has been substantial progress in research and innovations in symptomatic treatments, similar success has not been achieved in disease-modifying therapy (DMT) for Parkinson's disease (PD). Considering the enormous motor, psychosocial and financial burden associated with PD, safe and effective DMT is of paramount importance. AREAS COVERED One of the reasons for the lack of progress in DMT for PD is poor or inappropriate design of clinical trials. In the first part of the article, the authors focus on the plausible reasons why the previous trials have failed and in the latter part, they provide their perspectives on future DMT trials. EXPERT OPINION There are several potential reasons why previous trials have failed, including broad clinical and etiopathogenic heterogeneity of PD, poor definition and documentation of target engagement, lack of appropriate biomarkers and outcome measures, and short duration of follow-up. To address these deficiencies, future trials may consider- (i) a more customized approach to select the most suitable participants and therapeutic approaches, (ii) explore combination therapies that would target multiple pathogenetic mechanisms, and (iii) moving beyond targeting only motor symptoms to also assessing non-motor features of PD in well-designed longitudinal studies.
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Affiliation(s)
- Abhishek Lenka
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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5
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Apathy in Parkinson’s Disease: Defining the Park Apathy Subtype. Brain Sci 2022; 12:brainsci12070923. [PMID: 35884730 PMCID: PMC9313138 DOI: 10.3390/brainsci12070923] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023] Open
Abstract
Apathy is a neurobehavioural symptom affecting Parkinson’s disease patients of all disease stages. Apathy seems to be associated with a specific underlying non-motor disease subtype and reflects dysfunction of separate neural networks with distinct neurotransmitter systems. Due to the complicated neuropsychiatric aetiology of apathy, clinical assessment of this invalidating non-motor symptom remains challenging. We aim to summarize the current findings on apathy in Parkinson’s disease and highlight knowledge gaps. We will discuss the prevalence rates across the different disease stages and suggest screening tools for clinically relevant apathetic symptoms. We will approach the fundamental knowledge on the neural networks implicated in apathy in a practical manner and formulate recommendations on patient-tailored treatment. We will discuss the Park apathy phenotype in detail, shedding light on different clinical manifestations and implications for prognosis. With this review, we strive to distil the vast available theoretical knowledge into a clinical and patient-oriented perspective.
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6
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Zhou X, Liu Z, Zhou X, Xiang Y, Zhou Z, Zhao Y, Pan H, Xu Q, Chen Y, Sun Q, Wu X, Tan H, Li B, Yuan K, Xie Y, Liao W, Hu S, Zhu J, Wu X, Li J, Wang C, Lei L, Tang J, Liu Y, Wu H, Huang W, Wang T, Xue Z, Wang P, Zhang Z, Xu P, Chen L, Wang Q, Wang X, Cheng O, Shen Y, Liu W, Ye M, You Y, Li J, Yan X, Guo J, Tang B. The Chinese Parkinson's Disease Registry (CPDR): Study Design and Baseline Patient Characteristics. Mov Disord 2022; 37:1335-1345. [PMID: 35503029 DOI: 10.1002/mds.29037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of large multicenter Parkinson's disease (PD) cohort studies and limited data on the natural history of PD in China. OBJECTIVES The objective of this study was to launch the Chinese Parkinson's Disease Registry (CPDR) and to report its protocol, cross-sectional baseline data, and prospects for a comprehensive observational, longitudinal, multicenter study. METHODS The CPDR recruited PD patients from 19 clinical sites across China between January 2018 and December 2020. Clinical data were collected prospectively using at least 17 core assessment scales. Patients were followed up for clinical outcomes through face-to-face interviews biennially. RESULTS We launched the CPDR in China based on the Parkinson's Disease & Movement Disorders Multicenter Database and Collaborative Network (PD-MDCNC). A total of 3148 PD patients were enrolled comprising 1623 men (51.6%) and 1525 women (48.4%). The proportions of early-onset PD (EOPD, age at onset ≤50 years) and late-onset PD (LOPD) were 897 (28.5%) and 2251 (71.5%), respectively. Stratification by age at onset showed that EOPD manifested milder motor and nonmotor phenotypes and was related to increased probability of dyskinesia. Comparison across genders suggested a slightly older average age at PD onset, milder motor symptoms, and a higher rate of developing levodopa-induced dyskinesias in women. CONCLUSIONS The CPDR is one of the largest multicenter, observational, longitudinal, and natural history studies of PD in China. It offers an opportunity to expand the understanding of clinical features, genetic, imaging, and biological markers of PD progression. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Xiaoxia Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenhua Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Xiaoting Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yaqin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhou Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuwen Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongxu Pan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yase Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiying Sun
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinyin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Bin Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kai Yuan
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yali Xie
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuo Hu
- Department of Nuclear Medicine (PET Center), Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jianping Zhu
- Hunan KeY Health Technology Co., Ltd, Changsha, Hunan, China
| | - Xuehong Wu
- Hunan KeY Health Technology Co., Ltd, Changsha, Hunan, China
| | - Jianhua Li
- Hunan Creator Information Technology Co., Ltd, Changsha, Hunan, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lifang Lei
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiayu Tang
- Department of Neurology, Hunan Provincial Brain Hospital, Changsha, Hunan, China
| | - Yonghong Liu
- Health Management Center, Hunan Provincial Brain Hospital, Changsha, Hunan, China
| | - Heng Wu
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Wei Huang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zheng Xue
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Puqing Wang
- Department of Neurology, Xiang Yang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, China
| | - Zhentao Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ping Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ling Chen
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xuejing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Oumei Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuefei Shen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Ye
- Department of Neurology, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong You
- Department of Neurology, The Second Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Jinchen Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
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7
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Song B, Feldmann JW, Cao S, Feitosa M, Kong Y, Kim W, Schweitzer A, Leblanc P, Schweitzer JS, Kim KS. A Pitx3-deficient developmental mouse model for fine motor, olfactory, and gastrointestinal symptoms of Parkinson's disease. Neurobiol Dis 2022; 170:105777. [PMID: 35636646 PMCID: PMC9425627 DOI: 10.1016/j.nbd.2022.105777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/01/2022] [Accepted: 05/21/2022] [Indexed: 10/26/2022] Open
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Ojo OO, Wahab KW, Bello AH, Abubakar SA, Ekeh BC, Otubogun FM, Iwuozo EU, Farombi TH, Adeniji O, Ojini FI, Imarhiagbe FA, Nyandaiti Y, Komolafe MA, Fawale MB, Onwuegbuzie GA, Zubair Y, Williams UE, Taiwo FT, Oyakhire SI, Oshinaike OO, Osemwegie N, Osaigbovo GO, Odiase FE, Odeniyi OA, Obiabo YO, Obehighe EE, Nwazor EO, Nwani PO, Kehinde AJ, Erameh CO, Ekenze OS, Dike FO, Balarabe SA, Arigbodi O, Arabambi B, Ani-Osheku I, Ali MW, Akpekpe JE, Akinyemi RO, Agulanna U, Agu CE, Agabi OP, Ademiluyi BA, Adebowale AA, Achoru CO, Abiodun OV, Rizig M, Okubadejo NU. A Cross-Sectional Comprehensive Assessment of the Profile and Burden of Non-motor Symptoms in Relation to Motor Phenotype in the Nigeria Parkinson Disease Registry Cohort. Mov Disord Clin Pract 2021; 8:1206-1215. [PMID: 34765688 DOI: 10.1002/mdc3.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background Data on non-motor symptoms (NMS) in black Africans with Parkinson's disease (PD) are sparse. Objective To describe the profile of NMS in the Nigeria PD Registry (NPDR) cohort and explore the relationship between NMS and PD motor phenotype. Methods We conducted a cross-sectional study of the frequency and burden of NMS, based on the non-motor symptoms scale (NMSS) and the Chaudhuri method respectively in our cohort. Baseline demographics, disease characteristics (Hoehn and Yahr stage, MDS-UPDRS total score and Part III motor score), motor phenotype (based on Stebbin et al's algorithm), and levodopa equivalent daily dose (LEDD) were documented. Results Data are presented for 825 PD whose mean age at study was 63.7 ± 10.1 years, female sex-221 [26.8%] while median PD duration was 36 months. PD phenotypes included tremor-dominant 466 (56.5%), postural instability and gait disorder (PIGD) 259 (31.4%), and indeterminate 100 (12.1%). 82.6% were on treatment (median LEDD of 500 mg/24 hours). 804 (97.5%) endorsed at least 1 NMS. The median NMSS score was 26.0 while subscores for urinary and sexual function domains were significantly higher in males (P < 0.05). PIGD-PD had more frequent NMS and higher frequency of severe/very severe NMSS burden (P = 0.000 for both). Nocturia and fatigue were the most prevalent NMS overall and across motor subtypes. PIGD phenotype and total UPDRS scores were the independent determinants of NMSS scores (P = 0.000). Conclusion The profile and burden of NMS, and association with motor subtype in our black African cohort is largely similar to descriptions from other populations.
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Affiliation(s)
- Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences College of Medicine, University of Lagos Lagos Nigeria.,Neurology Unit, Department of Medicine Lagos University Teaching Hospital Lagos Nigeria
| | - Kolawole W Wahab
- Department of Medicine University of Ilorin/University of Ilorin Teaching Hospital Ilorin Nigeria
| | | | - Sani A Abubakar
- Department of Medicine Ahmadu Bello University/Ahmadu Bello University Teaching Hospital Zaria Nigeria
| | - Bertha C Ekeh
- University of Uyo Teaching Hospital/Ibom Specialist Hospital Uyo Nigeria
| | | | - Emmanuel U Iwuozo
- Neurology Unit Benue State University/Benue State University Teaching Hospital Makurdi Nigeria
| | - Temitope H Farombi
- Chief Tony Anenih Geriatrics Center, University College Hospital Ibadan, Oyo Nigeria
| | | | - Francis I Ojini
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences College of Medicine, University of Lagos Lagos Nigeria.,Neurology Unit, Department of Medicine Lagos University Teaching Hospital Lagos Nigeria
| | - Frank A Imarhiagbe
- University of Benin/University of Benin Teaching Hospital Benin City Nigeria
| | - Yakub Nyandaiti
- University of Maiduguri/University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | - Morenikeji A Komolafe
- Neurology Unit, Department of Medicine Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - Michael B Fawale
- Neurology Unit, Department of Medicine Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | | | - Yusuf Zubair
- Department of Internal Medicine National Hospital Abuja Nigeria
| | - Uduak E Williams
- Department of Internal Medicine University of Calabar/University of Calabar Teaching Hospital Calabar Nigeria
| | - Funlola T Taiwo
- Department of Medicine University College Hospital Ibadan Nigeria
| | | | - Olajumoke O Oshinaike
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences Lagos State University College of Medicine Ikeja Nigeria
| | - Nosakhare Osemwegie
- University of Port Harcourt/University of Port Harcourt Teaching Hospital Port Harcourt Nigeria
| | | | - Francis E Odiase
- University of Benin/University of Benin Teaching Hospital Benin City Nigeria
| | | | - Yahaya O Obiabo
- Department of Internal Medicine Delta State University/Delta State University Teaching Hospital Oghara Nigeria
| | | | - Ernest O Nwazor
- Department of Medicine Madonna University College of Medical Sciences/Federal Medical Center Elele/Owerri Nigeria
| | - Paul O Nwani
- Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria
| | - Abiodun J Kehinde
- Federal Medical Center, Jabi, Federal Capital Territory Abuja Nigeria
| | | | - Oluchi S Ekenze
- Neurology Unit, Department of Medicine, Faculty of Medical Sciences University of Nigeria/University of Nigeria Teaching Hospital Ituku Ozalla Nigeria
| | - Franklin O Dike
- University of Uyo Teaching Hospital/Ibom Specialist Hospital Uyo Nigeria
| | - Salisu A Balarabe
- Department of Medicine College of Health Sciences, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital Sokoto Nigeria
| | - Ohwotemu Arigbodi
- Department of Internal Medicine Delta State University Teaching Hospital Oghara Nigeria
| | | | | | | | | | - Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan Ibadan Nigeria
| | - Uchechi Agulanna
- Neurology Unit, Department of Medicine Lagos University Teaching Hospital Lagos Nigeria
| | | | - Osigwe P Agabi
- Neurology Unit, Department of Medicine Lagos University Teaching Hospital Lagos Nigeria
| | | | - Akintunde A Adebowale
- Neurology Unit, Department of Medicine Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | | | | | - Mie Rizig
- Department of Molecular Neuroscience University College London Institute of Neurology London United Kingdom
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences College of Medicine, University of Lagos Lagos Nigeria.,Neurology Unit, Department of Medicine Lagos University Teaching Hospital Lagos Nigeria
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The severity progression of non-motor symptoms in Parkinson's disease: a 6-year longitudinal study in Taiwanese patients. Sci Rep 2021; 11:14781. [PMID: 34285292 PMCID: PMC8292315 DOI: 10.1038/s41598-021-94255-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/30/2021] [Indexed: 11/08/2022] Open
Abstract
Nonmotor symptoms (NMSs) cause major burden in patients with Parkinson's disease (PD). Previous NMSs progression studies mostly focused on the prevalence. We conducted a longitudinal study to identify the progression pattern by the severity. PD patients recruited from the outpatient clinics of a tertiary medical center were evaluated by the Unified Parkinson's Disease Rating Scale and Non-Motor Symptoms Scale (NMSS). A retrospective study with three-step analysis was performed. Step 1, the NMSs severity was compared among patients stratified by disease duration every 2 years up to 10 years. Step 2, patients with repeated tests in 2 years were categorized into 4 groups by the diseased duration of every 5 years. Step 3, the NMSS score changes in 6 years follow-up were determined, and the dosage of anti-PD drugs was compared to the NMSs severity changes. 676 patients completed the step 1 analysis, which showed a trend of NMSs worsening but not significant until the disease duration longer than 4-6 years. Furthermore, the severity did not change between repeated evaluations in 2 years in all patients. The progression became apparent after 6 years. Individual symptoms had different progression patterns and the increment of medications was independent to NMSs evolution. We demonstrated the NMSs severity progression in Taiwanese PD patients and the independence of the medications and NMSs progression.
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Angelopoulou E, Nath Paudel Y, Piperi C, Mishra A. Neuroprotective potential of cinnamon and its metabolites in Parkinson's disease: Mechanistic insights, limitations, and novel therapeutic opportunities. J Biochem Mol Toxicol 2021:e22711. [PMID: 33587308 DOI: 10.1002/jbt.22711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/08/2020] [Accepted: 01/09/2021] [Indexed: 11/08/2022]
Abstract
Parkinson's disease (PD) is the most common neurodegenerative movement disorder with obscure etiology and no disease-modifying therapy to date. Hence, novel, safe, and low cost-effective approaches employing medicinal plants are currently receiving increased attention. A growing body of evidence has revealed that cinnamon, being widely used as a spice of unique flavor and aroma, may exert neuroprotective effects in several neurodegenerative diseases, including PD. In vitro evidence has indicated that the essential oils of Cinnamomum species, mainly cinnamaldehyde and sodium benzoate, may protect against oxidative stress-induced cell death, reactive oxygen species generation, and autophagy dysregulation, thus acting in a potentially neuroprotective manner. In vivo evidence has demonstrated that oral administration of cinnamon powder and sodium benzoate may protect against dopaminergic cell death, striatal neurotransmitter dysregulation, and motor deficits in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine mouse models of PD. The underlying mechanisms of its action include autophagy regulation, antioxidant effects, upregulation of Parkin, DJ-1, glial cell line-derived neurotrophic factor, as well as modulation of the Toll-like receptors/nuclear factor-κB pathway and inhibition of the excessive proinflammatory responses. In addition, in vitro and in vivo studies have shown that cinnamon extracts may affect the oligomerization process and aggregation of α-synuclein. Herein, we discuss recent evidence on the novel therapeutic opportunities of this phytochemical against PD, indicating additional mechanistic aspects that should be explored and potential obstacles/limitations that need to be overcome for its inclusion in experimental PD therapeutics.
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Affiliation(s)
- Efthalia Angelopoulou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yam Nath Paudel
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Awanish Mishra
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
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11
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Angelopoulou E, Paudel YN, Piperi C, Mishra A. Neuroprotective potential of cinnamon and its metabolites in Parkinson's disease: Mechanistic insights, limitations, and novel therapeutic opportunities. J Biochem Mol Toxicol 2021; 35:e22720. [PMID: 33491302 DOI: 10.1002/jbt.22720] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) is the most common neurodegenerative movement disorder with obscure etiology and no disease-modifying therapy to date. Hence, novel, safe, and low cost-effective approaches employing medicinal plants are currently receiving increased attention. A growing body of evidence has revealed that cinnamon, being widely used as a spice of unique flavor and aroma, may exert neuroprotective effects in several neurodegenerative diseases, including PD. In vitro evidence has indicated that the essential oils of Cinnamomum species, mainly cinnamaldehyde and sodium benzoate may protect against oxidative stress-induced cell death, reactive oxygen species generation, and autophagy dysregulation, thus acting in a potentially neuroprotective manner. In vivo evidence has demonstrated that oral administration of cinnamon powder and sodium benzoate may protect against dopaminergic cell death, striatal neurotransmitter dysregulation, and motor deficits in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine mouse models of PD. The underlying mechanisms of its action include autophagy regulation, antioxidant effects, upregulation of Parkin, DJ-1, glial cell line-derived neurotrophic factor, as well as modulation of the TLR/NF-κB pathway and inhibition of the excessive proinflammatory responses. In addition, in vitro and in vivo studies have shown that cinnamon extracts may affect the oligomerization process and aggregation of α-synuclein. Herein, we discuss recent evidence on the novel therapeutic opportunities of this phytochemical against PD, indicating additional mechanistic aspects that should be explored, and potential obstacles/limitations that need to be overcome, for its inclusion in experimental PD therapeutics.
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Affiliation(s)
- Efthalia Angelopoulou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yam N Paudel
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Awanish Mishra
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
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12
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Abraham DS, Pham Nguyen TP, Hennessy S, Gray SL, Xie D, Weintraub D, Willis AW. Annual Prevalence of Use of Potentially Inappropriate Medications for Treatment of Affective Disorders in Parkinson's Disease. Am J Geriatr Psychiatry 2021; 29:35-47. [PMID: 32553997 PMCID: PMC7671949 DOI: 10.1016/j.jagp.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the national prevalence of pharmacological treatment of affective disorders in older adults with Parkinson's disease (PD), and determine the prevalence and risk factors for receipt of an American Geriatrics Society Beers Criteria® defined potentially inappropriate medication (PIM) for affective disorder treatment. DESIGN Cross-sectional analysis of 2014 Medicare data. SETTING Research Identifiable File data from the Centers for Medicare and Medicaid Services. PARTICIPANTS Individuals ≥65 years of age with PD whose inpatient, outpatient, and prescription care is administered through the U.S. Medicare Program. MEASUREMENTS The 2014 prevalence of affective (i.e., depressive and anxiety) disorders was calculated. We assessed prescription fills for affective disorder treatment and classified prescriptions according to PIM status. Patient and clinician factors associated with PIM prescriptions were determined. RESULTS Of 84,323 beneficiaries with PD, 15.1% had prevalent depression only, 7.5% had anxiety only, and 8.5% had comorbid depression and anxiety. Among those with depression only, 80.7% were treated in 2014 (12.8% of treated received at least one PIM). The annual treatment prevalence was 62.9% (75.9% PIM) and 93.1% (63.9% PIM) in the anxiety only and comorbid group, respectively. In most groups, PIM use was less likely among men and those with dementia; geriatricians were less likely to prescribe PIMs. CONCLUSION Treatment of affective disorders in persons diagnosed with PD is high. PIM use is also common, particularly in persons with anxiety. Future research will quantify the potential effects of these PIMs on clinical and patient outcomes.
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Affiliation(s)
- Danielle S Abraham
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, DW, AWW), Philadelphia, PA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, AWW), Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA; Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA.
| | - Thanh Phuong Pham Nguyen
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, DW, AWW), Philadelphia, PA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, AWW), Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA; Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA; Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA
| | - Shelly L Gray
- Department of Pharmacy, University of Washington School of Pharmacy, (SLG), Seattle, WA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA; Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, DW, AWW), Philadelphia, PA; Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, (DW), Philadelphia, PA; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, (DW), Philadelphia, PA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, DW, AWW), Philadelphia, PA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, AWW), Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA; Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, (DSA, TPPN, SH, DX, AWW), Philadelphia, PA
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13
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Woo YR, Kim HS, Lee SH, Ju HJ, Bae JM, Cho SH, Lee JD. Systemic Comorbidities in Korean Patients with Rosacea: Results from a Multi-Institutional Case-Control Study. J Clin Med 2020; 9:jcm9103336. [PMID: 33080929 PMCID: PMC7603220 DOI: 10.3390/jcm9103336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022] Open
Abstract
Recent evidence links rosacea to systemic disease, but there are not enough methodologic studies addressing this association in Asians. Our aim was to identify rosacea comorbidities in Koreans and establish a reference database. A multi-center, case-control study was performed where a total of 12,936 rosacea patients and 12,936 age- and sex-matched control subjects were identified from 2007 to 2018. Logistic regression was performed to find significant association between rosacea and Sjögren syndrome (odds ratio [OR] 2.05; 95% confidence interval, 1.40–3.00), systemic sclerosis (OR 6.56; 95% CI, 1.50–28.7), rheumatoid arthritis (OR 1.72; 95% CI, 1.50–1.98), ankylosing spondylitis (OR 2.32; 95% CI, 1.42–3.84), autoimmune thyroiditis (OR 1.96; 95% CI, 1.40–2.73), alopecia areata (OR 1.77; 95% CI, 1.27–2.45), vitiligo (OR 1.90; 95% CI, 1.30–2.77), lung cancer (OR 1.54; 95% CI, 1.06–2.21), hepatobiliary cancer (OR 1.38; 95% CI, 1.06–1.77), alcohol abuse (OR 1.59; 95% CI, 1.05–2.39), diabetes mellitus (OR 1.11; 95% 1.02–1.19), obesity (OR 1.72; 95% CI, 1.22–2.41), allergic rhinitis (OR 1.65; 95% CI, 1.54–1.76), allergic conjunctivitis (OR 1.57; 95% CI, 1.27–1.94), chronic rhinosinusitis (OR 1.28; 95% CI, 1.14–1.42), herpes infection (OR 1.69; 95% CI, 1.53–1.86), and human papillomavirus infection (OR 2.50; 95% CI, 2.06–3.02). Higher odds for Sjogren syndrome, systemic sclerosis, ankylosing spondylitis, thyroiditis, vitiligo, hepatobiliary cancer, and obesity was exclusive in female subjects with rosacea, whereas increased prevalence of alopecia areata and alcohol abuse was confined to men. Only those who were 50 years and older exhibited higher odds for vitiligo, lung cancer, and gastroesophageal reflux disease while individuals younger than 50 were exclusively associated with hepatobiliary cancer, allergic conjunctivitis, and irritable bowel syndrome. Our study suggests that Koreans with rosacea are more likely to experience systemic comorbidity. Clinicians should acknowledge these interrelations and employ comprehensive care with an individual-based approach.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (H.S.K.); (S.H.L.); (S.H.C.)
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (H.S.K.); (S.H.L.); (S.H.C.)
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Se Hoon Lee
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (H.S.K.); (S.H.L.); (S.H.C.)
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (H.J.J.); (J.M.B.)
| | - Jung Min Bae
- Department of Dermatology, St. Vincent’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (H.J.J.); (J.M.B.)
- Heal House Skin Clinic, Mesanro 24, Paldal-gu, Suwon 16461, Korea
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (H.S.K.); (S.H.L.); (S.H.C.)
| | - Jeong Deuk Lee
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (H.S.K.); (S.H.L.); (S.H.C.)
- Correspondence: ; Tel.: +82-32-280-5100
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14
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Abraham DS, Pham Nguyen TP, Hennessy S, Weintraub D, Gray SL, Xie D, Willis AW. Frequency of and risk factors for potentially inappropriate medication use in Parkinson's disease. Age Ageing 2020; 49:786-792. [PMID: 32255485 DOI: 10.1093/ageing/afaa033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/16/2019] [Accepted: 01/01/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND impairments in neurotransmitter pathways put Parkinson's disease (PD) patients at risk for drug-disease interactions and adverse medication events. OBJECTIVE to determine the prevalence and risk factors for potentially inappropriate medication (PIM) prescriptions, as defined by the 2015 Beers List, in PD. METHODS cross-sectional analysis was conducted on 2014 Medicare beneficiaries with PD who had parts A, B and D coverage. The prevalence of PIM prescriptions for older adults was determined overall, and specifically for medications that can exacerbate motor symptoms or cognitive impairment in PD. Logistic regression models were constructed to determine the association between age, sex, race, geography and poverty with PIM prescriptions. RESULTS the final sample included 458,086 beneficiaries. In 2014, 35.8% of beneficiaries with PD filled a prescription for at least one PIM for older adults. In total, 8.7% of beneficiaries received a PIM that could exacerbate motor symptoms and 29.0% received a PIM that could worsen cognitive impairment. After adjustment, in all models, beneficiaries who were younger, female, white, urban-dwelling and eligible for Medicaid benefits were more likely to receive a PIM. CONCLUSION PIM prescriptions are not uncommon in PD, particularly for medications that can exacerbate cognitive impairment. Future research will examine underlying drivers of sex and other disparities in PIM prescribing. Additional studies are needed to understand the impact of PIMs on disease symptoms, healthcare utilisation and patient outcomes.
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Affiliation(s)
- Danielle S Abraham
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Thanh Phuong Pham Nguyen
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Shelly L Gray
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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15
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Lenka A, Ingalhalikar M, Shah A, Saini J, Arumugham SS, Hegde S, George L, Yadav R, Pal PK. Abnormalities in the white matter tracts in patients with Parkinson disease and psychosis. Neurology 2020; 94:e1876-e1884. [PMID: 32317347 DOI: 10.1212/wnl.0000000000009363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/15/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The objective of the current study was to compare the microstructural integrity of the white matter (WM) tracts in patients having Parkinson disease (PD) with and without psychosis (PD-P and PD-NP) through diffusion tensor imaging (DTI). METHODS This cross-sectional study involved 48 PD-NP and 42 PD-P who were matched for age, sex, and education. Tract-based spatial statistics (TBSS) was used to compare several DTI metrics from the diffusion-weighted MRIs obtained through a 3-Tesla scanner. A set of neuropsychological tests was used for the cognitive evaluation of all patients. RESULTS The severity and stage of PD were not statistically different between the groups. The PD-P group performed poorly in all the neuropsychological domains compared with the PD-NP group. TBSS analysis revealed widespread patterns of abnormality in the fractional anisotropy (FA) in the PD-P group, which also correlated with some of the cognitive scores. These tracts include inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, right parieto-occipital WM, body of the corpus callosum, and corticospinal tract. CONCLUSION This study provides novel insights into the putative role of WM tract abnormalities in the pathogenesis of PD-P by demonstrating significant alterations in several WM tracts. Additional longitudinal studies are warranted to confirm the findings of our research.
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Affiliation(s)
- Abhishek Lenka
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Madhura Ingalhalikar
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Apurva Shah
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Jitender Saini
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shyam Sundar Arumugham
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shantala Hegde
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Lija George
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Ravi Yadav
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Pramod Kumar Pal
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC.
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16
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Petkus AJ, Filoteo JV, Schiehser DM, Gomez ME, Hui JS, Jarrahi B, McEwen S, Jakowec MW, Petzinger GM. Mild cognitive impairment, psychiatric symptoms, and executive functioning in patients with Parkinson's disease. Int J Geriatr Psychiatry 2020; 35:396-404. [PMID: 31894601 DOI: 10.1002/gps.5255] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/21/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) and psychiatric symptoms (anxiety, depression, and apathy) are common in Parkinson's disease (PD). While studies have supported the association between psychiatric symptoms and cognitive performance in PD, it is unclear if the magnitude of link between psychiatric symptoms and cognitive health is stronger by MCI status. The purpose of this study was to examine the association between cognitive performance and psychiatric symptoms in PD and whether MCI status moderates this association. METHODS/DESIGN Participants (N = 187) completed a comprehensive neuropsychological assessment that included measures of attention, language, executive function (EF), visuospatial ability, episodic memory, and psychiatric symptoms. Participants were classified as PD-MCI (N = 73) or PD-normal cognition (NC; N = 114). Linear regression analyses were conducted to examine the association between psychiatric symptoms and cognitive performance and the moderating effect of PD-MCI status. RESULTS There were no differences in mean psychiatric symptoms between PD-MCI and PD-NC. Psychiatric symptoms were predominantly associated with worse EF. The magnitude of the association between anxiety and worse EF was larger in participants with PD-MCI compared with PD-NC. A multivariable regression analysis examining the independent contributions of each symptom demonstrated the most robust association between EF and anxiety. CONCLUSIONS Symptoms of anxiety, depression, and apathy are associated with worse executive functioning in individuals with PD. PD-MCI may be important in moderating the association between cognitive performance, specifically anxiety, and EF. Factors that promote cognitive resilience may serve as key therapeutic modalities in managing neuropsychiatric symptoms in PD.
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Affiliation(s)
- Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles, California
| | - J Vincent Filoteo
- Psychology Service, Veterans Administration San Diego Healthcare System (VA/SDHS), San Diego, California.,Department of Psychiatry, University of California, San Diego, California.,Department of Neuroscience, University of California, San Diego, California
| | - Dawn M Schiehser
- Psychology Service, Veterans Administration San Diego Healthcare System (VA/SDHS), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Megan E Gomez
- Veterans Administration Long Beach Healthcare System (VA/LBHS), Long Beach, California
| | - Jennifer S Hui
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Behnaz Jarrahi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
| | - Sarah McEwen
- Pacific Neuroscience Institute, Santa Monica, California
| | - Michael W Jakowec
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, California
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Nonmotor symptoms of 820 Taiwanese patients with Parkinson's disease: an exploratory-comparative study. J Neurol 2020; 267:1499-1507. [PMID: 32025799 DOI: 10.1007/s00415-020-09708-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Nonmotor symptoms (NMSs) severely affect the daily quality of life of patients with Parkinson's disease (PD). Although many studies have documented the clinical characteristics of NMSs in PD patients, some issues remain unaddressed. The severity and gender distribution of NMSs in Asian and the Western patients differ. The correlations between clinical characteristics and NMS manifestations remain unclear. We studied these relationships in a large cohort of Taiwanese PD patients. METHODS Patients with PD were recruited from the outpatient clinic of a tertiary medical center and evaluated with standardized assessment protocols, including the NonMotor Symptoms Scale (NMSS), Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) scale, Mini-Mental Status Examination, and Montreal Cognitive Assessment. RESULTS Among 820 patients enrolled, 41.8% were female. The prevalence of the NMSs was 96.5%, with attention/memory (79.51%) being the most frequently involved domain. The mean severity score on the NMSS was 36.48 ± 34.30. Male patients reported higher NMS prevalence and severity than female patients, mostly in the gastrointestinal tract and urinary domains. We found that the severity of NMSs was correlated with disease duration, UPDRS Part III score, and H&Y stage. CONCLUSION Although they exhibited similar NMS prevalence, Taiwanese PD patients reported less intense NMSs compared with those reported by Western patients. Furthermore, the NMS items our patients emphasized and gender discrepancies were distinct from those in Western studies.
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Abstract
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.
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Dietary Variations in a Multiethnic Parkinson's Disease Cohort and Possible Influences on Nonmotor Aspects: A Cross-Sectional Multicentre Study. PARKINSONS DISEASE 2018; 2018:7274085. [PMID: 30662706 PMCID: PMC6312592 DOI: 10.1155/2018/7274085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/21/2018] [Indexed: 12/27/2022]
Abstract
Dietary habits may differ between Parkinson's disease (PD) patients of different ethnicities. The primary aim of this cross-sectional analysis was to compare dietary habits in a multiethnic PD population and investigate potential nonmotor differences. All patients completed a dietary habits questionnaire. Besides basic demographics, patients' motor involvement (Hoehn and Yahr (HY)) and nonmotor symptoms (Nonmotor Symptoms Scale; Hospital Anxiety and Depression Scale) were assessed. 139 PD patients were included (mean age 66.8 ± 11.6 years; 61.2% male; mean disease duration 6.2 ± 5.2 years; median HY 3): 47.5% were White, 24.5% Asian, and 28.0% Black African and Caribbean (BAC). We found dietary differences between the groups, including a greater frequency of vegetarians and greater consumption of cumin, turmeric, and cinnamon as well as lower consumption of beef in Asian patients than in White and BAC and greater consumption of chili than in White patients and higher consumption of pork in White than Asian and BAC patients. There were no significant differences in dietary supplement consumption after correction for multiple comparisons. None of the dietary factors examined were associated with differences in nonmotor symptoms. Diet and supplement use vary in PD patients across ethnicities, this is both a problem and opportunity for nutritional medicine research. These data support the importance of considering ethnic diversity as part of recruitment strategy in nutrition and clinical studies.
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Sauerbier A, Aris A, Lim EW, Bhattacharya K, Ray Chaudhuri K. Impact of ethnicity on the natural history of Parkinson disease. Med J Aust 2018; 208:410-414. [DOI: 10.5694/mja17.01074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/16/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Sauerbier
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Azman Aris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Ee Wei Lim
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
- National Neuroscience Institute, Singapore
| | | | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
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Predictors of onset of psychosis in patients with Parkinson's disease: Who gets it early? Parkinsonism Relat Disord 2017; 44:91-94. [PMID: 28928050 DOI: 10.1016/j.parkreldis.2017.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Psychosis is one of the common non-motor symptoms of PD, which substantially worsens the quality of life. Hence, it is important to identify factors that are associated with early onset of psychosis in PD. In order to identify those factors, the current study aims to compare various demographic and clinical features of PD patients with early and late onset psychosis. METHODOLOGY In this prospective case-control study, 51 consecutive patients with PD having psychosis (PDP) were recruited. Median of the latency of onset of psychotic symptoms from the onset of motor symptoms was calculated (5.5 years) and after doing a median split, the cohort of PDP was divided into early onset PDP (EOP, n = 25) and late onset PDP (LOP, n = 26). Both the groups were compared for several demographic and clinical characteristics. RESULTS Compared to those with LOP, patients with EOP had poor scores on frontal assessment battery (13.8 ± 2.0 vs 15.3 ± 1.8, p = 0.007), more frequently had Rapid Eye movement sleep Behavior Disorder (RBD) (80% vs 46.2%, p = 0.02), Postural Instability with Gait Difficulty (PIGD) phenotype (72% vs 26.9%, p = 0.002), and excessive daytime sleepiness (Epworth Sleepiness Scale: 8.04 ± 3.7 vs 3.9 ± 3.1). Patients with LOP were older (63.4 ± 7.0 years vs 56.5 ± 8.1 years, p = 0.002) and had higher Levodopa equivalent dose/day (LEDD: 819.1 ± 365.8 vs 608.5 ± 356.3, p = 0.04) compared to those with EOP. CONCLUSION Presence of RBD, excessive daytime sleepiness, frontal lobe dysfunction, and PIGD phenotype of PD may be associated with early onset of psychosis in PD. Higher LEDD may not trigger early occurrence of psychosis in PD.
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Sauerbier A, Jitkritsadakul O, Titova N, Klingelhoefer L, Tsuboi Y, Carr H, Kumar H, Banerjee R, Erro R, Bhidayasiri R, Schrag A, Zis P, Lim SY, Al-Hashel J, Kamel WA, Martinez-Martin P, Ray Chaudhuri K. Non-Motor Symptoms Assessed by Non-Motor Symptoms Questionnaire and Non-Motor Symptoms Scale in Parkinson's Disease in Selected Asian Populations. Neuroepidemiology 2017; 49:1-17. [DOI: 10.1159/000478702] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Ethnic variations have been described in medical conditions, such as hypertension, diabetes, and multiple sclerosis. Whether ethnicity plays a role in Parkinson's disease (PD), particularly with regard to non-motor symptoms (NMS), remains unclear. Existing literature is diverse, controversial, and inadequately documented. This review aims to analyse and report the currently available literature on NMS, specifically in Asian PD patients. Summary: We conducted a literature review using PubMed, searching for articles and currently available publications that reference and assess NMS in PD patients living in Asia using the validated NMS Questionnaire (NMS Quest) and NMS Scale (NMSS). In total, 24 articles were included: 12 using the NMS Quest and 12 using the NMSS. Symptoms of constipation, memory impairment, and nocturia were the most frequently self-reported symptoms (NMS Quest) in selected Asian populations, while symptoms within the domains sleep/fatigue, attention/memory, and mood/apathy were most prevalent when applying the health-professional completed NMSS. Key Messages: NMS are generally prevalent and highly burdensome within selected Asian PD populations living in countries included in this review. Our review suggests that NMS-driven phenotypic heterogeneity is present in Asian patients, and compared to Western PD populations there might be variations in assessed NMS.
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