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Munhoz RP, Tumas V, Pedroso JL, Silveira-Moriyama L. The clinical diagnosis of Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-10. [PMID: 38325391 PMCID: PMC10849824 DOI: 10.1055/s-0043-1777775] [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: 09/14/2023] [Accepted: 11/19/2023] [Indexed: 02/09/2024]
Abstract
After more than 200 years since its initial description, the clinical diagnosis of Parkinson's disease (PD) remains an often-challenging endeavor, with broad implications that are fundamental for clinical management. Despite major developments in understanding it's pathogenesis, pathological landmarks, non-motor features and potential paraclinical clues, the most accepted diagnostic criteria remain solidly based on a combination of clinical signs. Here, we review this process, discussing its history, clinical criteria, differential diagnoses, ancillary diagnostic testing, and the role of non-motor and pre-motor signs and symptoms.
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Affiliation(s)
- Renato P. Munhoz
- University Health Network, Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto, ON, Canada.
- Krembil Research Institute, Toronto, ON, M5T 2S8, Canada.
| | - Vitor Tumas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Laura Silveira-Moriyama
- Universidade Estadual de Campinas, Campinas SP, Brazil.
- UCL Queen Square Institute of Neurology, London, United Kingdom.
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New insights from a multi-ethnic Asian progressive supranuclear palsy cohort. Parkinsonism Relat Disord 2023; 108:105296. [PMID: 36682278 DOI: 10.1016/j.parkreldis.2023.105296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare, disabling, neurodegenerative disease, with few studies done in Asian populations. METHODS We prospectively characterized the clinical features and disease burden in a consecutively-recruited multi-ethnic Asian PSP cohort. Patients were extensively phenotyped using the Movement Disorder Society (MDS-PSP) clinical diagnostic criteria and the PSP-Clinical Deficits Scale (PSP-CDS). Caregiver burden was measured using the modified Zarit Burden Interview (ZBI). Investigations (neuroimaging and genetic tests) were reviewed. RESULTS There were 104 patients (64.4% male; 67.3% Chinese, 21.2% Indians, 9.6% Malays), consisting of 48.1% Richardson syndrome (PSP-RS), 37.5% parkinsonian phenotype (PSP-P), and 10.6% progressive gait freezing phenotype (PSP-PGF). Mean age at motor onset was 66.3 ± 7.7 years, with no significant differences between the PSP phenotypes. Interestingly, REM-sleep behaviour disorder (RBD) symptoms and visual hallucinations (considered rare in PSP) were reported in 23.5% and 22.8% of patients, respectively, and a family history of possible neurodegenerative or movement disorder in 20.4%. PSP-CDS scores were highest (worst) in PSP-RS; and correlated moderately with disease duration (rs = 0.45, P < 0.001) and weakly with caregiver burden (rs = 0.22, P = 0.029) in the overall cohort. Three of 48 (6.3%) patients who had whole-exome sequencing harboured pathogenic/likely pathogenic GBA variants. CONCLUSIONS Significant heterogeneity in clinical features and disease burden, and high rates of RBD symptoms, visual hallucinations, and familial involvement were observed in this relatively large cohort. Our findings highlight important considerations when assessing Asian patients, and provide further support for the notion of overlapping neurobiology between PSP and Lewy body disorders.
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Hu WZ, Cao LX, Yin JH, Zhao XS, Piao YS, Gu WH, Ma JH, Wan ZR, Huang Y. Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson's disease and progressive supranuclear palsy. Front Neurol 2023; 13:1081219. [PMID: 36756345 PMCID: PMC9901543 DOI: 10.3389/fneur.2022.1081219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Background Non-motor symptoms (NMS) are compulsory clinical features for the clinical diagnosis of multiple system atrophy (MSA), some of which precede motor symptoms onset. To date, few studies have systematically investigated NMS in MSA and the timing of presenting NMS as the disease progresses. Clinically, MSA is difficult to be differentiated from Parkinson's disease (PD) and progressive supranuclear palsy (PSP), and the differences in NMS between MSA and PD/PSP remain unclear. The aim of this study was to compare the burden of NMS between MSA and PD/PSP and to delineate the timing of NMS presentation relative to the onset of motor symptoms in MSA. Methods A total of 61, 87, and 30 patients with MSA, PD, and PSP, respectively, were enrolled in this study. NMS was systematically assessed in all patients using the NMS scale (NMSS), and the onset of NMS relative to the onset of motor symptoms in MSA was investigated. Results MSA group had higher total NMSS scores (82.15 ± 46.10) than the PD (36.14 ± 30.78) and PSP (50.30 ± 55.05) groups (p < 0.001 overall). The number distribution pattern of the NMS was significantly different among the three parkinsonian disorders (p < 0.001 overall). In total, 85.2% of patients with MSA had more than 10 NMS, which was significantly higher than PD (28.7%) and PSP (33.3%). The frequency and scores of many NMSS subdomains and symptoms were higher in MSA than in PD and PSP (all p < 0.05). Multivariate logistic regression analysis revealed that patients with fainting, lack of motivation, swallowing, and loss of sexual interest could be attributed to MSA rather than PD or PSP, while patients with loss of concentration and forgetfulness were characteristic features of PD or PSP rather than MSA. REM-sleep behavior disorder (RBD), constipation, problems having sex, and loss of sexual interest preceded the motor symptoms onset of MSA by 2.81 ± 4.51, 1.54 ± 6.32, 1.35 ± 4.70, and 0.45 ± 3.61 years, respectively. Conclusion The NMS spectrum in MSA differs from that of PD and PSP. Patients with MSA have a higher NMS burden than patients with PD or PSP. RBD, constipation, problems having sex, and loss of sexual interest may become early diagnostic clinical markers of MSA.
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Affiliation(s)
- Wen-Zheng Hu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling-Xiao Cao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jin-Hui Yin
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue-Song Zhao
- Traditional Chinese Medical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Shan Piao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei-Hong Gu
- Neurology Department, China-Japan Friendship Hospital, Beijing, China
| | - Jing-Hong Ma
- Neurology Department, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Zhi-Rong Wan
- Department of Neurology, Aerospace Central Hospital, Beijing, China
| | - Yue Huang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Pharmacology, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia,*Correspondence: Yue Huang ✉
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Fabbri M, Foubert-Samier A, Pavy-le Traon A, Rascol O, Meissner WG. Atrofia multisistemica. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Teive HAG, Coutinho L, Ferreira Camargo CH, Munhoz RP. Reader Response: Progression of Nigrostriatal Denervation in Cerebellar Multiple System Atrophy: A Prospective Study. Neurology 2022; 98:1033-1034. [PMID: 35697518 DOI: 10.1212/wnl.0000000000200810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Choi GS, Yun JY, Hwang S, Kim SE, Kim JY, Im CH, Lee HW. Can Corticomuscular Coherence Differentiate between REM Sleep Behavior Disorder with or without Parkinsonism? J Clin Med 2021; 10:jcm10235585. [PMID: 34884285 PMCID: PMC8658120 DOI: 10.3390/jcm10235585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
REM sleep behavior disorder (RBD) could be a predictor of Parkinsonism even before development of typical motor symptoms. This study aims to characterize clinical features and corticomuscular and corticocortical coherence (CMC and CCC, respectively) during sleep in RBD patients with or without Parkinsonism. We enrolled a total of 105 subjects, including 20 controls, 54 iRBD, and 31 RBD+P patients, patients who were diagnosed as idiopathic RBD (iRBD) and RBD with Parkinsonism (RBD+P) in our neurology department. We analyzed muscle atonia index (MAI) and CMC between EEG and chin/limb muscle electromyography (EMG) and CCC during different sleep stages. Although differences in the CMC of iRBD group were observed only during REM sleep, MAI differences between groups were noted during both REM and NREM N2 stage sleep. During REM sleep, CMC was higher and MAI was reduced in iRBD patients compared to controls (p = 0.001, p < 0.001, respectively). Interestingly, MAI was more reduced in RBD+P compared to iRBD patients. In comparison, CCC was higher in iRBD patients compared to controls whereas CCC was lower in RBD+P groups compared to control and iRBD groups in various frequency bands during both NREM N2 and REM sleep stages. Among them, increased CMC during REM sleep revealed correlation between clinical severities of RBD symptoms. Our findings indicate that MAI, CMC, and CCC showed distinctive features in iRBD and RBD+P patients compared to controls, suggesting potential usefulness to understand possible links between these diseases.
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Affiliation(s)
- Gyeong Seon Choi
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
- Department of Neurology, Bundang Jesaeng General Hospital, Seongnam 13590, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul 07804, Korea;
| | - Sungeun Hwang
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
| | - Song E. Kim
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul 07804, Korea;
| | - Jeong-Yeon Kim
- Department of Biomedical Engineering, Hanyang University School of Engineering, Seoul 04763, Korea; (J.-Y.K.); (C.-H.I.)
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University School of Engineering, Seoul 04763, Korea; (J.-Y.K.); (C.-H.I.)
| | - Hyang Woon Lee
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul 07804, Korea;
- Computational Medicine, Graduate Program in System Health Science & Engineering, Ewha Womans University, Seoul 03765, Korea
- Correspondence: ; Tel.: +82-2-2650-2673
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Oliveira PD, Cardoso F. Impact of rapid eye movement sleep behavior disorder and autonomic disorders on Parkinson's disease: a review. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:156-166. [PMID: 33759983 DOI: 10.1590/0004-282x-anp-2020-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/22/2022]
Abstract
Parkinson's disease (PD) has heterogeneous clinical manifestations and prognoses. It is accompanied by a group of motor and non-motor symptoms ranging from independence to total disability, limiting work and personal care activities. Currently, disease subtype markers for informing prognosis remain elusive. However, some studies have reported an association between rapid eye movement (REM) sleep behavior disorder (RBD) and faster motor and non-motor symptom progression, including autonomic dysfunction and cognitive decline. Moreover, since autonomic dysfunction has been described in idiopathic forms of RBD, and they share some central regulatory pathways, it remains unclear whether they have a primary association or if they are more severe in patients with PD and RBD, and thus are a disease subtype marker. This article aimed at critically reviewing the literature on the controversies about the prevalence of RBD in PD, the higher incidence of PD non-motor symptoms associated with RBD, the evidence of faster motor worsening in parkinsonian patients with this parasomnia, and the main pathophysiological hypotheses that support these findings.
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Affiliation(s)
- Pérola de Oliveira
- Rede SARAH de Hospitais de Reabilitação, Departamento de Neurologia, Brasília DF, Brazil
| | - Francisco Cardoso
- Universidade Federal de Minas Gerais, Unidade de Distúrbios do Movimento, Serviço de Neurologia, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
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Overview of sleep disturbances and their management in Parkinson plus disorders. J Neurol Sci 2020; 415:116891. [DOI: 10.1016/j.jns.2020.116891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
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Jung YJ, Kim HJ, Yoo D, Choi JH, Im JH, Yang HJ, Jeon B. Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy. NEURODEGENER DIS 2020; 19:238-243. [PMID: 32348986 DOI: 10.1159/000507292] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) patients pre-sent a variety of symptoms other than autonomic dysfunctions, parkinsonism, and cerebellar ataxia. The aim of this study was to evaluate the frequency of various motor and non-motor symptoms including so-called "red flags" in patients with early MSA and to determine whether the frequency of these symptoms was different between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes. METHODS Sixty-one probable or possible MSA patients with disease duration of 3 years or less were included. Patients were classified into MSA-P, MSA-C, and MSA-PC. The frequency of 13 features including various motor and non-motor symptoms that commonly occur in MSA was assessed. RESULTS Dysarthria was the most prevalent feature (98.4%) followed by sexual dysfunction (95.1%). Probable REM sleep behavior disorder was present in 90.2%. The frequency of constipation (82.0%), dysphagia (68.9%), and snoring (70.5%) was also high. Stridor was present in 42.6% and more common in MSA-C than in MSA-P. CONCLUSIONS Increasing awareness of various motor and non-motor symptoms may assist clinicians to make an early, accurate diagnosis and to improve management of patients with MSA. We suggest that the diagnostic accuracy can be improved if these features are appropriately reflected in the new diagnostic criteria for MSA.
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Affiliation(s)
- Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea,
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ji-Hyun Choi
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin Hee Im
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Paramanandam V, Olszewska DA, Shakya B, Chalissery AJ, O'Connell M, Farrell M, Lynch T. A 57-Year-Old Woman With Progressive Left Hand Clumsiness and Falls. Mov Disord Clin Pract 2019; 6:656-660. [PMID: 31745473 DOI: 10.1002/mdc3.12825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/11/2022] Open
Abstract
Clinical History A 57-year old woman presented with left hand pain, periodic leg movement during sleep, gradual onset of stiffness, clumsiness, and falls. Neurological examination showed: generalized rigidity and bradykinesia. There was left hand dystonic posturing and ideomotor apraxia, as well as mirror movements of upper limbs and stimulus-sensitive myoclonus. The patient had a high-pitched voice and hypophonia (Video S1). Discussion Experts discuss localization and the syndromic diagnosis and predict the underlying pathology. The pathological diagnosis is then provided and clinical learning points are considered.
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Affiliation(s)
- Vijayashankar Paramanandam
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | - Diana Angelika Olszewska
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | | | - Albi Jose Chalissery
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | - Martin O'Connell
- Department of Radiology Mater Misericordiae University Hospital Dublin Ireland
| | - Michael Farrell
- Department of Neuropathology Beaumont Hospital Dublin Ireland
| | - Tim Lynch
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
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McCarter SJ, Feemster JC, Tabatabai GM, Sandness DJ, Timm PC, McCarter AR, Talley HN, Junna MR, Savica R, Singer W, Coon EA, Benarroch EE, Josephs KA, Boeve BF, Silber MH, St. Louis EK. Submentalis Rapid Eye Movement Sleep Muscle Activity: A Potential Biomarker for Synucleinopathy. Ann Neurol 2019; 86:969-974. [DOI: 10.1002/ana.25622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Stuart J. McCarter
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
- Department of MedicineMayo Clinic College of Medicine and Science Rochester MN
| | - John C. Feemster
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Grace M. Tabatabai
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - David J. Sandness
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Paul C. Timm
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Allison R. McCarter
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Heather N. Talley
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Mithri R. Junna
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
- Department of MedicineMayo Clinic College of Medicine and Science Rochester MN
| | - Rodolfo Savica
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of Health Science ResearchMayo Clinic College of Medicine and Science Rochester MN
| | - Wolfgang Singer
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Elizabeth A. Coon
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | | | - Keith A. Josephs
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Erik K. St. Louis
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
- Department of MedicineMayo Clinic College of Medicine and Science Rochester MN
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Mainka T, Balint B, Gövert F, Kurvits L, van Riesen C, Kühn AA, Tijssen MAJ, Lees AJ, Müller-Vahl K, Bhatia KP, Ganos C. The spectrum of involuntary vocalizations in humans: A video atlas. Mov Disord 2019; 34:1774-1791. [PMID: 31651053 DOI: 10.1002/mds.27855] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/22/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Lille Kurvits
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Christoph van Riesen
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL, Institute of Neurology, London, UK
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
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Barone DA, Henchcliffe C. Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol 2018; 129:1551-1564. [PMID: 29883833 DOI: 10.1016/j.clinph.2018.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) involves REM sleep without atonia in conjunction with a recurrent nocturnal dream enactment behavior, with vocalizations such as shouting and screaming, and motor behaviors such as punching and kicking. Secondary RBD is well described in association with neurological disorders including Parkinson's disease (PD), multiple system atrophy (MSA), and other conditions involving brainstem structures such as tumors. However, RBD alone is now considered to be a potential harbinger of later development of neurodegenerative disorders, in particular PD, MSA, dementia with Lewy bodies (DLB), and pure autonomic failure. These conditions are linked by their underpinning pathology of alpha-synuclein protein aggregation. In RBD, it is therefore important to recognize the potential risk for later development of an alpha-synucleinopathy, and to investigate for other potential causes such as medications. Other signs and symptoms have been described in RBD, such as orthostatic hypotension, or depression. While it is important to recognize these features to improve patient management, they may ultimately provide clinical clues that will lead to risk stratification for phenoconversion. A critical need is to improve our ability to counsel patients, particularly with regard to prognosis. The ability to identify who, of those with RBD, is at high risk for later neurodegenerative disorders will be paramount, and would in addition advance our understanding of the prodromal stages of the alpha-synucleinopathies. Moreover, recognition of at-risk individuals for neurodegenerative disorders may ultimately provide a platform for the testing of possible neuroprotective agents for these neurodegenerative disorders.
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Aldridge GM, Birnschein A, Denburg NL, Narayanan NS. Parkinson's Disease Dementia and Dementia with Lewy Bodies Have Similar Neuropsychological Profiles. Front Neurol 2018; 9:123. [PMID: 29593630 PMCID: PMC5857567 DOI: 10.3389/fneur.2018.00123] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/19/2018] [Indexed: 12/21/2022] Open
Abstract
Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) are common causes of dementia worldwide. Although considered separate entities based on the relative temporal onset of motor symptoms vs. diagnosis of dementia, it is unknown if these diseases truly have distinct cognitive profiles. We hypothesized that patients divided into PDD and DLB categories strictly by temporal criteria would have different neuropsychological profiles. We investigated this question via neuropsychological testing of PDD and DLB patients at the University of Iowa. We performed retrospective chart analysis and review of neuropsychological testing of clinically diagnosed patients with PDD or DLB, who had presented to University of Iowa’s dementia and movement disorder clinics. Forty-seven patients diagnosed by the treating neurologist as PDD or DLB were included. Neuropsychological performance was compared between groups, and as a function of the relative timing of the motor diagnosis vs. diagnosis of dementia. We found that both PDD and DLB patients showed severe deficits in executive function, visual–spatial processing, and verbal learning. However, we found no significant differences in neuropsychological performance between groups, and neuropsychological performance could not reliably account for the relative timing of motor diagnosis vs. diagnosis of dementia. Our data support the idea that DLB and PDD are on a neuropsychological spectrum.
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Affiliation(s)
| | - Allison Birnschein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Natalie L Denburg
- Department of Neurology, University of Iowa, Iowa City, IA, United States
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Shen Y, Dai YP, Wang Y, Li J, Xiong KP, Mao CJ, Huang JY, Luo WF, Liu CF. Two polysomnographic features of REM sleep behavior disorder: Clinical variations insight for Parkinson's disease. Parkinsonism Relat Disord 2017; 44:66-72. [DOI: 10.1016/j.parkreldis.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/06/2017] [Accepted: 09/02/2017] [Indexed: 11/25/2022]
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16
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Zhang X, Sun X, Wang J, Tang L, Xie A. Prevalence of rapid eye movement sleep behavior disorder (RBD) in Parkinson’s disease: a meta and meta-regression analysis. Neurol Sci 2016; 38:163-170. [DOI: 10.1007/s10072-016-2744-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
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17
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Jiang H, Huang J, Shen Y, Guo S, Wang L, Han C, Liu L, Ma K, Xia Y, Li J, Xu X, Xiong N, Wang T. RBD and Neurodegenerative Diseases. Mol Neurobiol 2016; 54:2997-3006. [PMID: 27032389 DOI: 10.1007/s12035-016-9831-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/04/2016] [Indexed: 01/08/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder characterized by enacting one's dreams during the REM sleep, with most of the dreams being violent or aggressive, so that patients often come to see the doctor complaining hurting themselves or bed partners during sleep. Prevalence of RBD, based on population, is 0.38-2.01 %, but much higher in patients with neurodegenerative diseases, especially synucleinopathies. RBD may herald the emergence of synucleinopathies by decades, such that it may be used as an effective early marker of neurodegenerative diseases. Pharmaceutical treatment of RBD includes clonazepam, melatonin, pramipexole, and some newly reported medications. In this review, we summarized the clinical and PSG features of RBD, the pathophysiology and the therapy of it, focusing on the correlation between neurodegenerative diseases and RBD, in order to emphasize the significance of RBD as an early marker of neurodegenerative diseases.
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Affiliation(s)
- Haiyang Jiang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Yan Shen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Shiyi Guo
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Luxi Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Chao Han
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Ling Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Kai Ma
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Yun Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Jie Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Xiaoyun Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China.
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18
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Christensen JAE, Jennum P, Koch H, Frandsen R, Zoetmulder M, Arvastson L, Christensen SR, Sorensen HBD. Sleep stability and transitions in patients with idiopathic REM sleep behavior disorder and patients with Parkinson’s disease. Clin Neurophysiol 2016; 127:537-543. [DOI: 10.1016/j.clinph.2015.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/05/2015] [Accepted: 03/10/2015] [Indexed: 11/26/2022]
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19
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Abstract
The older patient population is growing rapidly around the world and in the USA. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation all of which may be misinterpreted as dementia. The key sleep disorders impacting patients with dementia include insomnia, hypersomnolence, circadian rhythm misalignment, sleep disordered breathing, motor disturbances of sleep such as periodic leg movement disorder of sleep and restless leg syndrome, and parasomnias, mostly in the form of rapid eye movement (REM) sleep behavior disorder (RBD). RBD is a pre-clinical marker for a class of neurodegenerative diseases, the "synucleinopathies", and requires formal polysomnographic evaluation. Untreated sleep disorders may exacerbate cognitive and behavioral symptoms in patients with dementia and are a source of considerable stress for bed partners and family members. When left untreated, sleep disturbances may also increase the risk of injury at night, compromise health-related quality of life, and precipitate and accelerate social and economic burdens for caregivers.
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Affiliation(s)
- Verna R Porter
- Department of Neurology, UCLA Mary S. Easton Center for Alzheimer's Disease Research, David Geffen School of Medicine at UCLA, 10911 Weyburn Ave., Suite 200, Los Angeles, CA, 90095-7226, USA.
| | - William G Buxton
- Department of Neurology, David Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza, Suite B200, Los Angeles, CA, 90095-6975, USA.
| | - Alon Y Avidan
- Department of Neurology, UCLA Sleep Disorders Center, David Geffen School of Medicine at UCLA, 710 Westwood Blvd., Room 1-145 RNRC, Los Angeles, CA, 90095-1769, USA.
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Chung EJ, Kim SJ. (123)I-Metaiodobenzylguanidine Myocardial Scintigraphy in Lewy Body-Related Disorders: A Literature Review. J Mov Disord 2015; 8:55-66. [PMID: 26090077 PMCID: PMC4460541 DOI: 10.14802/jmd.15015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 01/18/2023] Open
Abstract
Lewy body-related disorders are characterized by the presence of Lewy bodies and Lewy neurites, which have abnormal aggregations of α-synuclein in the nigral and extranigral areas, including in the heart. 123I-metaiodobenzylguanidine (MIBG) scintigraphy is a well-known tool to evaluate cardiac sympathetic denervation in the Lewy body-related disorders. MIBG scintigraphy showed low uptake of MIBG in the Lewy body-related disorders, including Parkinson’s disease, dementia with Lewy bodies, pure autonomic failure and rapid eye movement sleep behavior disorder. This review summarizes previous results on the diagnostic applications of MIBG scintigraphy in Lewy body-related disorders.
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Affiliation(s)
- Eun Joo Chung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Jin Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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21
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Munhoz RP, Moro A, Silveira-Moriyama L, Teive HA. Non-motor signs in Parkinson's disease: a review. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:454-62. [PMID: 26017214 DOI: 10.1590/0004-282x20150029] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/09/2015] [Indexed: 12/16/2022]
Abstract
During the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem process with diverse non-motor signs (NMS). In addition to been extremely common, these NMS play a major role in undermining functionality and quality of life. On the other hand, NMS are under recognized by physicians and neglected by patients. Here, we review the most common NMS in PD, including cognitive, psychiatric, sleep, metabolic, and sensory disturbances, discuss the current knowledge from biological, epidemiological, clinical, and prognostic standpoints, highlighting the need for early recognition and management.
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Affiliation(s)
- Renato P Munhoz
- Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Adriana Moro
- Unidade de Distúrbios do Movimento, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Helio A Teive
- Unidade de Distúrbios do Movimento, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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22
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Lyashenko ЕА, Levin OS, Poluektov MG. Melatonin in correction of REM-sleep behavior disorders in Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2015. [PMID: 28635783 DOI: 10.17116/jnevro20151156240-43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Е А Lyashenko
- Russian Medical Academy of Postgraduate Education, Center for Movement Disorders, Moscow
| | - O S Levin
- Russian Medical Academy of Postgraduate Education, Center for Movement Disorders, Moscow
| | - M G Poluektov
- Sechenov First Moscow State Medical University, Moscow
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