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Camacho LO, Jahangiri L, Iseringhausen J, Goldstein GR. Parkinson's disease - The dentist's role as part of the healthcare team. J Prosthodont 2024. [PMID: 38689457 DOI: 10.1111/jopr.13862] [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: 01/11/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages, pharmacologic treatment, the effects on saliva, mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain. While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs. Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients. Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.
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Affiliation(s)
- Liliana Ortiz Camacho
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Leila Jahangiri
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Jenna Iseringhausen
- Department of Neurology and Movement Disorders, New York University Langone Health, New York, New York, USA
| | - Gary R Goldstein
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
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de la Rosa T, Scorza FA. Parkinson's disease inpatient mortality: Attention to sudden death. Clinics (Sao Paulo) 2024; 79:100366. [PMID: 38643608 PMCID: PMC11046233 DOI: 10.1016/j.clinsp.2024.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/05/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Tomás de la Rosa
- Neuroscience Department, Universidad de Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Fúlvio Alexandre Scorza
- Neurology Department, Escola Paulista de Medicina Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Shi J, Du L, He W, Zheng S, Xu X. Study on the correlation between cardiac function indices measured by velocity vector imaging and disease severity in patients with Parkinson disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1289-1297. [PMID: 37632405 DOI: 10.1002/jcu.23527] [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: 05/24/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 08/28/2023]
Abstract
AIM This study aimed to evaluate cardiac function, particularly left ventricular systolic function, in patients with Parkinson disease (PD) using velocity vector imaging (VVI), and to determine whether a correlation exists between left ventricular global systolic function and PD severity. METHODS A case-control study design was used to select 56 PD patients and 30 healthy controls from January 2019 to December 2019. The characteristics of age, sex, BMI and course of disease were collected. The Hoehn-Yahr (H-Y) score was collected to record the grading of PD. The left ventricular systolic function of all patients was evaluated by variable vapor injection (VVI). The left ventricular systolic function was compared between the case group and the control group, and the correlation between cardiac dysfunction and the severity of PD symptoms was assessed using the modified H-Y scale. RESULTS Compared with control group, left ventricular global systolic function18.22 (17.08, 19.12) vs 18.88 (18.12, 20.01) was lower in PD patients as indicated by left ventricular global longitudinal strain (GLS), and the difference was statistically significant (P = 0.039). Additionally, H-Y scores (r = -0.404) and PD duration(r = -0.323) were significantly correlated with reduced left ventricular ejection fraction (P < 0.01), GLS (P < 0.001), left ventricular global radial strain (GRS; P < 0.001), and left ventricular global circumferential strain (GCS; P < 0.001), along with their associated peak strain rates (GLSr, GRSr, and GCSr; P < 0.001). CONCLUSION Subclinical left ventricular global systolic dysfunction in patients with PD can be detected using VVI, and reduced left ventricular systolic function correlates with the modified H-Y score and duration of the disease.
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Affiliation(s)
- Jianwei Shi
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lijuan Du
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Lee B, Edling C, Ahmad S, LeBeau FEN, Tse G, Jeevaratnam K. Clinical and Non-Clinical Cardiovascular Disease Associated Pathologies in Parkinson's Disease. Int J Mol Sci 2023; 24:12601. [PMID: 37628780 PMCID: PMC10454288 DOI: 10.3390/ijms241612601] [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: 05/25/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Despite considerable breakthroughs in Parkinson's disease (PD) research, understanding of non-motor symptoms (NMS) in PD remains limited. The lack of basic level models that can properly recapitulate PD NMS either in vivo or in vitro complicates matters. Even so, recent research advances have identified cardiovascular NMS as being underestimated in PD. Considering that a cardiovascular phenotype reflects sympathetic autonomic dysregulation, cardiovascular symptoms of PD can play a pivotal role in understanding the pathogenesis of PD. In this study, we have reviewed clinical and non-clinical published papers with four key parameters: cardiovascular disease risks, electrocardiograms (ECG), neurocardiac lesions in PD, and fundamental electrophysiological studies that can be linked to the heart. We have highlighted the points and limitations that the reviewed articles have in common. ECG and pathological reports suggested that PD patients may undergo alterations in neurocardiac regulation. The pathological evidence also suggested that the hearts of PD patients were involved in alpha-synucleinopathy. Finally, there is to date little research available that addresses the electrophysiology of in vitro Parkinson's disease models. For future reference, research that can integrate cardiac electrophysiology and pathological alterations is required.
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Affiliation(s)
- Bonn Lee
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
| | - Charlotte Edling
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
| | - Shiraz Ahmad
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
| | - Fiona E. N. LeBeau
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK;
| | - Gary Tse
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury CT2 7FS, UK
| | - Kamalan Jeevaratnam
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
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5
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Nabizadeh F, Valizadeh P, Sharifi P, Zafari R, Mirmosayyeb O. Risk of myocardial infarction in Parkinson's disease: A systematic review and meta-analysis. Eur J Neurol 2023; 30:2557-2569. [PMID: 37151196 DOI: 10.1111/ene.15838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies investigating cardiovascular disorders in patients with Parkinson's disease (PD) showed heterogeneous results regarding whether there is a higher or lower risk of myocardial infarction (MI) in these patients compared to the general population. Because of the inconsistency in findings, herein the aim was to perform a systematic review and meta-analysis to investigate the risk of MI in patients with PD. METHODS A comprehensive literature search was performed using four databases, PubMed, Web of Science, Scopus and Embase, in June 2022. Peer-reviewed observational studies comprising case-controls, cohort, cross-sectional and longitudinal studies that reported MI in the PD population were included. RESULTS After the screening, 20 studies with a total of 80,441 patients with PD and 802,857 controls were included in our qualitative and quantitative synthesis. The pooled estimated odds ratio for MI in PD patients compared to controls was 0.80 (95% confidence interval [CI] 0.56-1.05) which indicates that there is no association. The pooled prevalence of MI was 5% (95% CI 3%-7%) with a range of 1%-20% amongst patients with PD. The men (6%, 95% CI 1%-13%) and women (6%, 95% CI 1%-14%, Q = 29.27, I2 = 98.50%, p < 0.001) had similar MI prevalence. CONCLUSION This comprehensive systematic review and meta-analysis provide compelling evidence that PD is associated with a reduced risk of MI. Whilst the exact mechanism underlying this association remains to be fully elucidated, it is clear that certain risk factors for cardiac events appear to be less present in PD patients, which may serve as a protective factor. However, given the reports of increased risk for cerebrovascular events in PD patients, it is possible that the major risk factors for MI and cardiovascular accidents in this population differ. These findings have important implications for clinical management and further research in this area is warranted.
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Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Parisa Sharifi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasa Zafari
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Javanshiri K, Drakenberg T, Haglund M, Englund E. Sudden cardiac death in synucleinopathies. J Neuropathol Exp Neurol 2023; 82:242-249. [PMID: 36668680 PMCID: PMC9941831 DOI: 10.1093/jnen/nlad001] [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] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to investigate the cause of death in subjects with α-synucleinopathies (ASs) and the confirmed presence of cardiac α-synuclein (α-syn), compared to non-AS disorders in a neuropathologically confirmed cohort. In total, 78 neuropathologically confirmed AS cases positive for cardiac α-syn were included in the study. Individuals with other neurocognitive diseases, having no α-syn in the brainstem or above, nor in cardiac nerves, served as controls (n = 53). Data regarding the cause of death, cardiac α-syn, pathological cardiac findings, and cardio- and cerebrovascular disease were assembled from autopsy reports and medical records. In the AS group, there was a significantly higher prevalence of sudden cardiac death ([SCD]; n = 40, 51.3%) compared to the control group (n = 12, 22.6%, p < 0.001). No statistically significant differences between the groups were reported regarding other cardiac conditions on autopsy or regarding cardio- and cerebrovascular disease from the medical records. The most prevalent cause of death in the AS group was SCD, which differed significantly from the control group. This suggests that α-syn deposits in cardiac nerves may cause lethal alterations in cardiac function, warranting further research.
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Affiliation(s)
- Keivan Javanshiri
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Tove Drakenberg
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mattias Haglund
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Mörz M. A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against COVID-19. Vaccines (Basel) 2022; 10:vaccines10101651. [PMID: 36298516 PMCID: PMC9611676 DOI: 10.3390/vaccines10101651] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The current report presents the case of a 76-year-old man with Parkinson’s disease (PD) who died three weeks after receiving his third COVID-19 vaccination. The patient was first vaccinated in May 2021 with the ChAdOx1 nCov-19 vector vaccine, followed by two doses of the BNT162b2 mRNA vaccine in July and December 2021. The family of the deceased requested an autopsy due to ambiguous clinical signs before death. PD was confirmed by post-mortem examinations. Furthermore, signs of aspiration pneumonia and systemic arteriosclerosis were evident. However, histopathological analyses of the brain uncovered previously unsuspected findings, including acute vasculitis (predominantly lymphocytic) as well as multifocal necrotizing encephalitis of unknown etiology with pronounced inflammation including glial and lymphocytic reaction. In the heart, signs of chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and vasculitis were present. Although there was no history of COVID-19 for this patient, immunohistochemistry for SARS-CoV-2 antigens (spike and nucleocapsid proteins) was performed. Surprisingly, only spike protein but no nucleocapsid protein could be detected within the foci of inflammation in both the brain and the heart, particularly in the endothelial cells of small blood vessels. Since no nucleocapsid protein could be detected, the presence of spike protein must be ascribed to vaccination rather than to viral infection. The findings corroborate previous reports of encephalitis and myocarditis caused by gene-based COVID-19 vaccines.
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Affiliation(s)
- Michael Mörz
- Institute of Pathology 'Georg Schmorl', The Municipal Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany
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8
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Ling A, Herbert F, Wright B, Richfield E. Terminal Choking in Parkinson's Disease. J Pain Symptom Manage 2022; 63:e757-e764. [PMID: 35081446 DOI: 10.1016/j.jpainsymman.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Ling
- ST5 Palliative Medicine (Specialist Trainee) (A.L.), Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Infirmary, Bristol, United Kingdom.
| | - Fiona Herbert
- ST5 Geriatric Medicine (Specialist Trainee) (F.H.), Care of the Elderly, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Bethany Wright
- Consultant in Palliative Medicine (B.W.), St Peter's Hospice, Brentry, Bristol, United Kingdom
| | - Edward Richfield
- Consultant in Geriatric Medicine (E.R.), Medicine for Older People, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
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A New Therapeutic Approach for Dystussia and Atussia in Neurogenic Dysphagia: Effect of Aerosolized Capsaicin on Peak Cough Flow. Dysphagia 2022; 37:1814-1821. [PMID: 35430718 PMCID: PMC9643184 DOI: 10.1007/s00455-022-10439-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
Swallowing and cough are crucial components of airway protection. In patients with neurogenic dysphagia (ND), there is a high prevalence of dystussia (impaired cough) and atussia (absence of cough). As a result, the ability to detect and remove aspirated material from the airway decreases, exacerbating the sequelae associated with ND, including aspiration pneumonia, a leading cause of mortality in ND. This controlled intervention study aimed to quantify the cough response to aerosolized capsaicin (AC) in patients with ND and assess the potential of AC as a therapeutic tool in treating ND-related dystussia and atussia. Furthermore, we propose a novel application method that enables AC treatment to be performed at home. Spirometry was used to measure peak cough flow (PCF) of voluntary cough (cough on command) and reflexive cough (cough secondary to pharyngeal exposure to AC) in 30 subjects with and 30 without ND. The capsaicin aerosol was generated by adding 1-10 drops of liquid cayenne extract (1.5-2% capsaicin) to 100 mL carbonated water (0.00075-0.001% to 0.0075-0.01% capsaicin). Voluntary PCF in the ND group was significantly lower than in the control group (p < 0.001), while there was no significant difference in reflexive PCF (p = 0.225). Within the ND group, reflexive PCF was significantly higher than voluntary PCF (p = 0.001), while in healthy controls, reflexive PCF was significantly lower (p < 0.001). The data show that AC increased the tracheobronchial clearance efficacy in ND patients with dystussia and atussia, as it enabled subjects to access their individual cough potential, which is present, but inaccessible, due to neurological disorder.
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Scorza FA, Guimarães-Marques M, Nejm M, de Almeida ACG, Scorza CA, Fiorini AC, Finsterer J. Sudden unexpected death in Parkinson's disease: Insights from clinical practice. Clinics (Sao Paulo) 2022; 77:100001. [PMID: 35152167 PMCID: PMC8900653 DOI: 10.1016/j.clinsp.2021.100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/04/2021] [Indexed: 01/21/2023] Open
Abstract
Classified as the second most common neurodegenerative disorder associated with aging after Alzheimer's disease, Parkinson's disease (PD) is the most common movement disorder. In the last decade, despite advances in treatment, mortality rates linked with PD continued to reach significant figures. Available studies have shown that compared with healthy controls, patients with PD are accompanied by high rates of premature death. This is usually caused by factors such as pneumonia and cerebrovascular and cardiovascular diseases. Recently, it has been demonstrated that a significant proportion of patients with PD die suddenly. This is referred to as a sudden and unexpected death in PD (SUDPAR). Here, we focus on the magnitude of SUDPAR. Finally, it is important to learn more about SUDPAR for the implementation of effective prevention strategies.
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Affiliation(s)
- Fulvio A Scorza
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Neuroscience Center of the Woman Health "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Marcia Guimarães-Marques
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Mariana Nejm
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Antônio Carlos G de Almeida
- Neuroscience Center of the Woman Health "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Laboratory of Experimental and Computational Neuroscience, Department of Biosystems Engineering, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Carla A Scorza
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Neuroscience Center of the Woman Health "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ana C Fiorini
- Neuroscience Center of the Woman Health "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Phonoaudiology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Phonoaudiology Post graduation Program, Pontifícia Universidade Católica de São Paulo (PUC-SP), São Paulo, SP, Brazil
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de la Rosa T, Calvo VS, Gonçalves VC, Scerni DA, Scorza FA. 6-hydroxydopamine and ovariectomy has no effect on heart rate variability parameters of females. Clinics (Sao Paulo) 2021; 76:e3175. [PMID: 34644736 PMCID: PMC8478141 DOI: 10.6061/clinics/2021/e3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In addition to the classic motor symptoms of Parkinson's disease (PD), patients also present with non-motor symptoms, such as autonomic dysfunction, which is present in almost 90% of patients with PD, affecting the quality of life and mortality. Regarding sex differences in prevalence and presentation, there is increasing concern about how sex affects autonomic dysfunction. However, there are no previous data on autonomic cardiac function in females after 6-hydroxydopamine (6-OHDA) striatal injection. METHODS Wistar female rats were ovariectomized. After 20 days, the animals received bilateral injections of 6-OHDA (total dose per animal: 48 µg) or a vehicle solution in the striatum. Thirty days after 6-OHDA injection, subcutaneous electrodes were implanted for electrocardiogram (ECG) recording. Ten days after electrode implantation, ECG signals were recorded. Analyses of heart rate variability (HRV) parameters were performed, and the 6-OHDA lesion was confirmed by analyzing the number of tyrosine hydroxylase-positive neurons in the substantia nigra pars compacta (SNpc). RESULTS A high dose of 6-OHDA did not affect HRV of females, independent of ovariectomy. As expected, ovariectomy did not affect HRV or lesions in the SNpc after 6-OHDA injection. CONCLUSIONS We suggest that females with 6-OHDA present with cardioprotection, independent of ovarian hormones, which could be related to female vagal predominance.
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Affiliation(s)
- Tomás de la Rosa
- Departamento de Neurologia, Escola Paulista de Medicina/Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
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12
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Short-term deceleration capacity of heart rate: a sensitive marker of cardiac autonomic dysfunction in idiopathic Parkinson's disease. Clin Auton Res 2021; 31:729-736. [PMID: 34251546 DOI: 10.1007/s10286-021-00815-4] [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: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cardiac autonomic dysfunction in idiopathic Parkinson's disease (PD) manifests as reduced heart rate variability (HRV). In the present study, we explored the deceleration capacity of heart rate (DC) in patients with idiopathic PD, an advanced HRV marker that has proven clinical utility. METHODS Standard and advanced HRV measures derived from 7-min electrocardiograms in 20 idiopathic PD patients and 27 healthy controls were analyzed. HRV measures were compared using regression analysis, controlling for age, sex, and mean heart rate. RESULTS Significantly reduced HRV was found only in the subcohort of PD patients older than 60 years. Low- frequency power and global HRV measures were lower in patients than in controls, but standard beat-to-beat HRV markers (i.e., rMSSD and high-frequency power) were not significantly different between groups. DC was significantly reduced in the subcohort of PD patients older than 60 years compared to controls. CONCLUSIONS Deceleration-related oscillations of HRV were significantly reduced in the older PD patients compared to healthy controls, suggesting that short-term DC may be a sensitive marker of cardiac autonomic dysfunction in PD. DC may be complementary to traditional markers of short-term HRV for the evaluation of autonomic modulation in PD. Further study to examine the association between DC and cardiac adverse events in PD is needed to clarify the clinical relevance of DC in this population.
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Rossi M, Wainsztein N, Merello M. Cardiac Involvement in Movement Disorders. Mov Disord Clin Pract 2021; 8:651-668. [PMID: 34307738 DOI: 10.1002/mdc3.13188] [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: 05/16/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Several conditions represented mainly by movement disorders are associated with cardiac disease, which can be overlooked in clinical practice in the context of a prominent primary neurological disorder. Objectives To review neurological conditions that combine movement disorders and primary cardiac involvement. Methods A comprehensive and structured literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was conducted to identify disorders combining movement disorders and cardiac disease. Results Some movement disorders are commonly or prominently associated with cardiac disease. Neurological and cardiac symptoms may share underlying physiopathological mechanisms in diseases, such as Friedreich's ataxia and Wilson's disease, and in certain metabolic disorders, including Refsum disease, Gaucher disease, a congenital disorder of glycosylation, or cerebrotendinous xanthomatosis. In certain conditions, such as Sydenham's chorea or dilated cardiomyopathy with ataxia syndrome (ATX-DNAJC19), heart involvement can present early in the course of disease, whereas in others such as Friedreich's ataxia or Refsum disease, cardiac symptoms tend to present in later stages. In another 68 acquired or inherited conditions, cardiac involvement or movement disorders are seldom reported. Conclusions As cardiac disease is part of the phenotypic spectrum of several movement disorders, heart involvement should be carefully investigated and increased awareness of this association encouraged as it may represent a leading cause of morbidity and mortality.
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Affiliation(s)
- Malco Rossi
- Sección Movimientos Anormales, Departamento de Neurociencias Instituto de Investigaciones Neurológicas Raúl Carrea, Fleni Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council Buenos Aires Argentina
| | - Nestor Wainsztein
- Departamento de Medicina Interna Unidad de Cuidados Críticos, Fleni Buenos Aires Argentina
| | - Marcelo Merello
- Sección Movimientos Anormales, Departamento de Neurociencias Instituto de Investigaciones Neurológicas Raúl Carrea, Fleni Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council Buenos Aires Argentina.,Pontificia Universidad Católica Argentina Buenos Aires Argentina
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Han S, Moon I, Choi EK, Han KD, Cho HC, Lee SY, Yang S, Kwon S, Choi YJ, Lee HJ, Lee E, Lee SR, Oh S. Increased atrial fibrillation risk in Parkinson's disease: A nationwide population-based study. Ann Clin Transl Neurol 2021; 8:238-246. [PMID: 33389803 PMCID: PMC7818085 DOI: 10.1002/acn3.51279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is the second most common neurodegenerative disorder associated with various morbidities. Although the relationship between cardiovascular disease and PD has been studied, a paucity of information on PD and atrial fibrillation (AF) association exists. Thus, we aimed to investigate whether patients with PD have an increased risk of AF. METHODS This study included 57,585 patients with newly diagnosed PD (≥40-year-old, mean age 69.7 years, men 40.2%) and without a history of AF from the Korean National Health Insurance Service (NHIS) database between 2010 and 2015. Furthermore, an equal number of age- and sex-matched subjects without PD were selected for comparison. The primary outcome was new-onset AF. RESULTS During the mean follow-up period of 3.4 ± 1.8 years, AF was newly diagnosed in 3,665 patients. A significantly higher incidence rate of AF was noted among patients with PD than among patients without PD (10.75 and 7.86 per 1000 person-year, respectively). Multivariate Cox-regression analysis revealed that PD was an independent risk factor for AF (hazard ratio [HR]: 1.27, 95% confidence interval [CI]: 1.18-1.36). Furthermore, subgroup analyses revealed that AF risk was higher in the younger age subgroups, and compared with the non-PD group, the youngest PD group (age: 40-49 years) had a threefold increased risk of AF (HR: 3.06, 95% CI: 1.20-7.77). INTERPRETATION Patients with PD, especially the younger age subgroups, have an increased risk of AF. Active surveillance and management of AF should be considered to prevent further complications.
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Affiliation(s)
- Seokmoon Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Inki Moon
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hae-Chan Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seokhun Yang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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15
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Abstract
Patients with Parkinson's disease (PD) may undergo several elective and emergency surgeries. Motor fluctuations, the presence of a wide range of non-motor symptoms (NMS), and the use of several medications, often not limited to dopaminergic agents, make the perioperative management of PD challenging. However, the literature on perioperative management of PD is sparse. In this descriptive review article, we comprehensively discuss the issues in the pre-, intra-, and postoperative phases which may negatively affect the PD patients and discuss the approach to their prevention and management. The major preoperative challenges include accurate medication reconciliation and administration of the dopaminergic medications during the nil per os (NPO) state. While the former can be addressed with staff education and PD-specific admission protocols, knowledge of non-oral formulations of dopaminergic agents (apomorphine, inhalational levodopa, and rotigotine transdermal patch) is the key to the management of the Parkinsonian symptoms in NPO state. Deep brain stimulation (DBS) devices should be turned off to avert potential electromagnetic interference with surgical appliances. Choosing the appropriate anesthesia and avoiding and managing respiratory issues and dysautonomia are the major intraoperative challenges. Timely reinitiation of dopaminergic medications, adequate management of pain, nausea, and vomiting, and prevention of postoperative infections and delirium are the postoperative challenges. Overall, a multidisciplinary approach is pivotal to prevent and manage the perioperative complications in PD. Administration of anti-Parkinson medications during NPO state, prevention of anesthesia-related complications, and timely rehabilitation remain the key to healthy surgical outcomes.
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16
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Sringean J, Anan C, Bhidayasiri R. Impaired ability to turn in bed in parkinson’s disease as a potential rare cause of positional asphyxia: a sensor-based analysis. Clin Neurol Neurosurg 2020; 192:105713. [DOI: 10.1016/j.clineuro.2020.105713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 01/24/2020] [Accepted: 02/02/2020] [Indexed: 11/25/2022]
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17
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Pitz V, Malek N, Tobias ES, Grosset KA, Gentleman S, Grosset DG. The Levodopa Response Varies in Pathologically Confirmed Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2020; 7:218-222. [PMID: 32071945 DOI: 10.1002/mdc3.12885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/11/2019] [Accepted: 12/02/2019] [Indexed: 01/18/2023] Open
Abstract
Background A good response to levodopa is a key feature of Parkinson's disease (PD), and a poor response suggests an alternative diagnosis, but the extent of variation in the levodopa response in definite PD is not well defined. Literature Review A systematic review of articles reporting pathologically confirmed PD and levodopa responsiveness from 1971 to 2018 was performed using the medical subheadings "postmortem," "Parkinson's disease," "levodopa," and "l-dopa" in PubMed, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) databases. Cases A total of 12 articles described 445 PD cases: 61.7% male, age at disease onset 64.0 years (SD 9.6), age at death 77.1 years (SD 7.2). Levodopa responsiveness was reported in 399 cases (89.7%) either as a graded or a binary response. In the 280 cases (70.2%) describing a graded response, it was excellent in 37.5%, good in 45.7%, moderate in 12.1%, and poor in 4.6%. In the 119 cases describing a binary response (29.8%), 73.1% were levodopa responsive, and 26.9% were nonresponsive. Comorbid brain pathology was present in 137 of 235 cases assessed, being cerebrovascular in 46.0% and Alzheimer's disease in 37.2% of these, but its contribution to levodopa responsiveness was unclear. Conclusions The levodopa motor response varies in definite PD. Explanations other than diagnostic inaccuracy should be explored.
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Affiliation(s)
- Vanessa Pitz
- Institute of Neuroscience and Psychology University of Glasgow Glasgow United Kingdom
| | - Naveed Malek
- Department of Neurology Ipswich Hospital NHS Trust Ipswich United Kingdom
| | - Edward S Tobias
- School of Medicine, Dentistry and Nursing University of Glasgow Glasgow United Kingdom.,Department of Clinical Genetics Queen Elizabeth University Hospital Glasgow United Kingdom
| | - Katherine A Grosset
- Institute of Neuroscience and Psychology University of Glasgow Glasgow United Kingdom.,Department of Neurology Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow United Kingdom
| | - Steve Gentleman
- Department of Medicine Imperial College London London United Kingdom
| | - Donald G Grosset
- Institute of Neuroscience and Psychology University of Glasgow Glasgow United Kingdom.,Department of Neurology Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow United Kingdom
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18
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Scorza FA, Menezes-Rodrigues FS, Olszewer E, Errante PR, Tavares JGP, Scorza CA, Ferraz HB, Finsterer J, Caricati-Neto A. The mitochondrial calcium uniporter: a new therapeutic target for Parkinson's disease-related cardiac dysfunctions? Clinics (Sao Paulo) 2020; 75:e1299. [PMID: 31939558 PMCID: PMC6945289 DOI: 10.6061/clinics/2020/e1299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/18/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fúlvio Alexandre Scorza
- Disciplina de Neurociencia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | | | - Efraín Olszewer
- Fundacao de Apoio a Pesquisa e Estudos na Area de Saude (FAPES), Sao Paulo, SP, BR
| | - Paolo Ruggero Errante
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - José Gustavo Patrão Tavares
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Carla Alessandra Scorza
- Disciplina de Neurociencia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Henrique Ballalai Ferraz
- Departamento de Neurologia. Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - Afonso Caricati-Neto
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Corresponding author. E-mail:
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19
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Menezes-Rodrigues FS, Scorza CS, Fiorini AC, Caricati-Neto A, Scorza CA, Finsterer J, Scorza FA. Sudden unexpected death in Parkinson’s disease: why is drinking water important? Neurodegener Dis Manag 2019; 9:241-246. [DOI: 10.2217/nmt-2019-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Parkinson’s disease (PD) is one of the most common age-related neurodegenerative disorders. Several studies over the last few years have shown that PD is accompanied by high rates of premature death compared with healthy controls. Death in PD patients is usually caused by determinant factors such as pneumonia, and cerebrovascular and cardiovascular diseases. During recent years it has emerged that dehydration may also contribute to mortality in PD. Interestingly, it has been documented that a substantial proportion of patients with PD die suddenly (known as sudden and unexpected death in PD). In this article, we focus on the magnitude of the problem of sudden and unexpected death in PD, with special reference to the daily water consumption of PD patients.
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Affiliation(s)
- Francisco S Menezes-Rodrigues
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
- Departamento de Farmacologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Cristiane S Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Ana C Fiorini
- Departamento de Fonoaudiologia, Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Afonso Caricati-Neto
- Departamento de Farmacologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | | | - Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
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20
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Rodrigues LD, Oliveira LF, Shinoda L, Scorza CA, Faber J, Ferraz HB, Britto LRG, Scorza FA. Cardiovascular alterations in rats with Parkinsonism induced by 6-OHDA and treated with Domperidone. Sci Rep 2019; 9:8965. [PMID: 31222185 PMCID: PMC6586896 DOI: 10.1038/s41598-019-45518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/10/2019] [Indexed: 01/10/2023] Open
Abstract
After Alzheimer, Parkinson disease (PD) is the most frequently occurring progressive, degenerative neurological disease. It affects both sympathetic and parasympathetic nervous systems in a variable fashion. Cardiovascular symptoms are present in almost all stages of PD and narrower heart rate variability is the earliest sign. Administration of Levodopa to PD patients has proven to provide some degree of neurological protection. This drug, however, causes side effects including nausea and vomiting, lessened by the administration of domperidone. Autopsies in PD patients led some researchers to suggest the involvement of the ventricular arrhythmia induced by domperidone. The aim of the present study was to determine the impact of the adjusted human maximal dose of domperidone, on cardiological features of Wistar rats. domperidone was administered to both 6-hydroxydopamine Parkinsonism models and regular Wistar rats. Quantitative analysis of ranges of heart beat variation showed significant abnormal distribution in both groups receiving domperidone as compared with respective sham counterparts. However, qualitative analysis of Poincaré plots showed that 6-hydroxydopamine Parkinsonism models receiving domperidone had the narrowest full range of heart beat and the worst distribution heart beat ranges as compared with all study groups corroborating with previous suggestion that domperidone administration to PD patients is likely to play a role in sudden unexpected death in this group of patients.
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Affiliation(s)
- Laís D Rodrigues
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil.
| | - Leandro F Oliveira
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil.
| | - Lucas Shinoda
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Carla A Scorza
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Jean Faber
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Henrique B Ferraz
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Luiz R G Britto
- Laboratory of Cellular Neurobiology, Department of Physiology and Biophysics -University of São Paulo, São Paulo, Brazil
| | - Fulvio A Scorza
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
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21
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Zhang Y, Wang G. Response to: Sudden death in Parkinson's disease: Unjustifiably forgotten. Parkinsonism Relat Disord 2019; 58:87. [DOI: 10.1016/j.parkreldis.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/24/2018] [Indexed: 11/16/2022]
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22
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Nejm MB, Andersen ML, Tufik S, Finsterer J, Scorza FA. Sudden unexpected death in Parkinson’s disease: why do neuroscientists still ignore this condition? Neurol Sci 2018; 40:413-414. [DOI: 10.1007/s10072-018-3581-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
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23
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Scorza FA, Fiorini AC, de Almeida ACG, Scorza CA, Finsterer J. In brief: Sudden unexpected death in Parkinson's disease. Acta Neurol Scand 2018; 138:264-265. [PMID: 29926907 DOI: 10.1111/ane.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F. A. Scorza
- Disciplina de Neurociência; Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP); São Paulo Brasil
| | - A. C. Fiorini
- Programa de Estudos Pós-Graduado em Fonoaudiologia; Pontifícia Universidade Católica de São Paulo (PUC-SP); Departamento de Fonoaudiologia; Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP); São Paulo Brasil
| | - A.-C. G. de Almeida
- Laboratório de Neurociência Experimental e Computacional; Departamento de Engenharia de Biossistemas; Universidade Federal de São João del-Rei (UFSJ); Minas Gerais Brasil
| | - C. A. Scorza
- Disciplina de Neurociência; Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP); São Paulo Brasil
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Xue F, Wang FY, Mao CJ, Guo SP, Chen J, Li J, Wang QJ, Bei HZ, Yu Q, Liu CF. Analysis of nocturnal hypokinesia and sleep quality in Parkinson's disease. J Clin Neurosci 2018; 54:96-101. [PMID: 29908717 DOI: 10.1016/j.jocn.2018.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 04/02/2018] [Accepted: 06/04/2018] [Indexed: 11/24/2022]
Abstract
Nocturnal hypokinesia/akinesia and sleep disorder are believed to be common in Parkinson's disease (PD), but are often underestimated. To date, only a few studies have focused on nocturnal symptoms related to motor function and sleep quality in PD patients, and the assessments were based mainly on the subjective descriptions of the patients. In this study, we assessed the relationships between motor symptoms and sleep quality in 29 PD patients (17 PD patients reporting impaired bed mobility (IBM) and 12 patients without IBM). All the participants were monitored using multisite inertial sensors and polysomnography in sleep-monitoring rooms for whole night. Compared with PD-IBM patients, PD+IBM patients tended to have fewer turning-over episodes and smaller degree turns. Meanwhile, PD+IBM patients had worse Pittsburgh Sleep Quality Index (PSQI) and Parkinson's Disease Sleep Scale (PDSS) scores, and less total sleep time (TST) than PD-IBM patients. Spearman correlation analyses found that the number of turning-over events showed negative correlations with disease duration (r = -0.378, P < 0.05) and Unified Parkinson's Disease Rating Scale (UPDRS) axial scores (r = -0.370, P < 0.05). Moreover, TST (r = 0.505, p < 0.05) and sleep efficiency (SE) (r = 0.473, p < 0.05) positively correlated with the number of turns in bed. Multivariate linear regression analyses showed that UPDRS axial scores and the number of turns were significantly associated with TST (both p < 0.05). In conclusion, the number of turns in bed and UPDRS axial scores were two significant factors affecting sleep quality. Multisite inertial sensors can be used to quantitatively evaluate nocturnal motor functions in PD patients.
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Affiliation(s)
- Fei Xue
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Emergency Department, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi 214400, China
| | - Fu-Yu Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Cheng-Jie Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Si-Ping Guo
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Jing Chen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Jie Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Qiao-Jun Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Hong-Zhe Bei
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Qian Yu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China.
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25
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Scorza FA, de Almeida ACG, Fiorini AC, Scorza CA, Finsterer J. Parkinson's disease, epileptic seizures, and sudden death: Three faces of the same coin. Epilepsy Behav 2018; 83:239-241. [PMID: 29631863 DOI: 10.1016/j.yebeh.2018.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Antonio-Carlos G de Almeida
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Minas Gerais, Brazil.
| | - Ana C Fiorini
- Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Departamento de Fonoaudiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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26
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Scorza FA, Fiorini AC, Scorza CA, Finsterer J. Cardiac abnormalities in Parkinson's disease and Parkinsonism. J Clin Neurosci 2018; 53:1-5. [PMID: 29706419 DOI: 10.1016/j.jocn.2018.04.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Though there is increasing evidence for primary cardiac disease in Parkinson's disease (PD) and Parkinsonism (PS), this evidence is hardly included in the general management of these patients. METHODS Literature review. RESULTS PD is one of the most common age-related neurodegenerative disorders. Epidemiological studies have shown that PD is accompanied by high rates of premature death compared with the general population. In general, death in PD/PS is usually caused by determinant factors such as pneumonia, cerebrovascular, and cardiovascular disease. There is a significant body of literature demonstrating involvement of the heart in PD/PS. Cardiac involvement in PD/PS includes cardiac autonomic dysfunction, cardiomyopathy, coronary heart disease, arrhythmias, conduction defects, and sudden cardiac death (SCD), and sudden unexpected death in Parkinson's disease (SUDPAR). CONCLUSIONS Cardiac abnormalities found in PD/PS are manifold but the most prominent is cardiac autonomic dysfunction. The frequency of coronary heart disease in PD is a matter of debate. Only rarely reported in PD/PS are cardiomyopathies, arrhythmias, and sudden cardiac death, and SUDPAR. It is particularly recommended that PD/PS patients are more intensively investigated cardiologically as soon as the diagnosis is established. Early recognition of cardiac involvement is important for preventing SCD and SUDPAR.
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Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Ana C Fiorini
- Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Brazil; Departamento de Fonoaudiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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Scorza FA, Scorza CA, Finsterer J. The heart in Parkinson's disease: Opening Pandora's box. Auton Neurosci 2017; 216:91-92. [PMID: 29102382 DOI: 10.1016/j.autneu.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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28
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Scorza FA, do Carmo AC, Fiorini AC, Nejm MB, Scorza CA, Finsterer J, Ferraz HB. Sudden unexpected death in Parkinson's disease (SUDPAR): a review of publications since the decade of the brain. Clinics (Sao Paulo) 2017; 72:649-651. [PMID: 29236909 PMCID: PMC5706063 DOI: 10.6061/clinics/2017(11)01] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Fulvio A. Scorza
- Disciplina de Neurociencia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Andrea C. do Carmo
- Biblioteca do Campus Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Ana C. Fiorini
- Programa de Estudos Pos-Graduados em Fonoaudiologia, Pontificia Universidade Catolica de Sao Paulo (PUC-SP), Sao Paulo, SP, BR
- Departamento de Fonoaudiologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
| | - Mariana B. Nejm
- Disciplina de Neurociencia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
| | - Carla A. Scorza
- Disciplina de Neurociencia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
| | - Josef Finsterer
- Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Henrique B. Ferraz
- Departamento de Neurologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/UNIFESP, Sao Paulo, SP, BR
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Nishida N, Yoshida K, Hata Y. Sudden unexpected death in early Parkinson's disease: neurogenic or cardiac death? Cardiovasc Pathol 2017; 30:19-22. [DOI: 10.1016/j.carpath.2017.06.001] [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: 05/25/2017] [Accepted: 06/05/2017] [Indexed: 01/29/2023] Open
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Bhidayasiri R, Sringean J, Anan C, Boonpang K, Thanawattano C, Ray Chaudhuri K. Quantitative demonstration of the efficacy of night-time apomorphine infusion to treat nocturnal hypokinesia in Parkinson's disease using wearable sensors. Parkinsonism Relat Disord 2016; 33 Suppl 1:S36-S41. [PMID: 27939326 DOI: 10.1016/j.parkreldis.2016.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nocturnal hypokinesia/akinesia is one of the common night-time symptoms in patients with Parkinson's disease (PD), negatively affecting quality of life of patients and caregivers. The recognition of this problem and treatment options are limited in clinical practice. OBJECTIVES To evaluate the efficacy of nocturnal apomorphine infusion, using a wearable sensor, in patients who are already on daytime continuous subcutaneous apomorphine infusion and still suffer from nocturnal hypokinesia. METHODS Nocturnal parameters in 10 PD patients before and during nocturnal infusion were assessed over two nights at their homes, using a wearable sensor (trunk). Nocturnal parameters included number, velocity, acceleration, degree, and duration of rolling over, and number of times they got out of bed. Correlations with validated clinical rating scales were performed. RESULTS Following nocturnal apomorphine infusion (34.8 ± 6.5 mg per night), there were significant improvements in the number of turns in bed (p = 0.027), turning velocity (p = 0.046), and the degree of turning (p = 0.028) in PD patients. Significant improvements of Modified Parkinson's Disease Sleep Scale (p = 0.005), the axial score of Unified Parkinson's Disease Rating Scale (p = 0.013), and Nocturnal Akinesia Dystonia and Cramp Scale (p = 0.014) were also observed. CONCLUSION Our study was able to demonstrate quantitatively the efficacy of nocturnal apomorphine infusion in PD patients with nocturnal hypokinesia and demonstrated the feasibility of using wearable sensors to yield objective and quantifiable outcomes in a clinical trial setting. More studies are needed to determine the long-term efficacy of this treatment in a large prospective cohort of PD patients.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chusak Thanawattano
- Biomedical Signal Processing Laboratory, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
| | - K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
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Scorza FA, Cavalheiro EA, Scorza CA, Ferraz HB. Sudden unexpected death in Parkinson's disease: Perspectives on what we have learned about sudden unexpected death in epilepsy (SUDEP). Epilepsy Behav 2016; 57:124-125. [PMID: 26949153 DOI: 10.1016/j.yebeh.2016.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Esper A Cavalheiro
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Henrique B Ferraz
- Departamento de Neurologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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Sringean J, Taechalertpaisarn P, Thanawattano C, Bhidayasiri R. How well do Parkinson's disease patients turn in bed? Quantitative analysis of nocturnal hypokinesia using multisite wearable inertial sensors. Parkinsonism Relat Disord 2016; 23:10-6. [DOI: 10.1016/j.parkreldis.2015.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/17/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022]
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Scorza FA, Scorza CA, Ferraz HB. Domperidone, Parkinson disease and sudden cardiac death: Mice and men show the way. Clinics (Sao Paulo) 2016; 71:59-61. [PMID: 26934232 PMCID: PMC4760361 DOI: 10.6061/clinics/2016(02)01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Fulvio A Scorza
- Universidade Federal de São Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Disciplina de Neurociência, São Paulo/SP, Brazil
| | - Carla A Scorza
- Universidade Federal de São Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Disciplina de Neurociência, São Paulo/SP, Brazil
| | - Henrique B Ferraz
- Universidade Federal de São Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Disciplina de Neurologia, São Paulo/SP, Brazil
- E-mail:
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Association of depressive symptoms with circadian blood pressure alterations in Parkinson’s disease. J Neurol 2015; 262:2564-71. [DOI: 10.1007/s00415-015-7887-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022]
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Sawada H, Oeda T, Umemura A, Tomita S, Kohsaka M, Park K, Yamamoto K, Sugiyama H. Baseline C-Reactive Protein Levels and Life Prognosis in Parkinson Disease. PLoS One 2015. [PMID: 26218286 PMCID: PMC4517917 DOI: 10.1371/journal.pone.0134118] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background C-reactive protein (CRP) is a biomarker of inflammation, and high levels of CRP correlate with vascular death. Chronic inflammation is considered to be involved in neurodegeneration, although there is no evidence linking it with the process of neurodegenerative diseases. Objective To determine the role of baseline CRP levels in the prognosis of patients with Parkinson disease (PD). Methods A cohort of 313 patients with a mean age of 69.1 and mean PD duration of 7.9 years was retrospectively followed for a mean observation time of 1,753 days. CRP was measured when patients were not diagnosed with any infections, and levels were repetitively measured to investigate a tendency of “regression to mean.” The primary outcome measure was a survival time from study enrollment to death. Results During the observation period 56 patients died. Baseline CRP was log-linearly associated with a risk of death in PD. Mean survival time was 3,149 (95% confidence interval; 3,009-3,289) days in patients with CRP ≤ 0.8mg/L (lower two thirds) and 2,620 (2,343-2,897) days in those with CRP > 0.8 mg/L (top third, p < 0.001, log-rank test). The adjusted hazard ratio (HR) per two-fold higher CRP concentration for all deaths was 1.29 (1.10-1.52), and after excluding PD-unrelated deaths, such as cancer or stroke, HR was 1.23 (1.01-1.49) (adjusted for age, sex, PD duration, modified Hohen-Yahr stages, MMSE scores, and serum albumin). Conclusions Baseline CRP concentrations were associated with the risk of death and predicted life prognosis of patients with PD. The associations were independent from PD duration, PD severity, cognitive function, ages, and nutritional conditions, suggesting the possibility that subclinical chronic inflammation is associated with a neurodegenerative process in PD.
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Affiliation(s)
- Hideyuki Sawada
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
- * E-mail:
| | - Tomoko Oeda
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
| | - Atsushi Umemura
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
| | - Satoshi Tomita
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
| | - Masayuki Kohsaka
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
| | - Kwiyoung Park
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
| | - Kenji Yamamoto
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
| | - Hiroshi Sugiyama
- Department of Neurology and Clinical Research Center, National Hospital of Utano, National Hospital Organization, Kyoto, Japan
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