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Du M, Liu M, Liu J. The mutual longitudinal mediating effects of psychological and physical disorders on cognitive impairment among older adults. J Affect Disord 2024; 362:477-484. [PMID: 39009315 DOI: 10.1016/j.jad.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/17/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The potential mutual effect of physical and psychological disorders on cognitive function is critical for preventing cognitive impairment among older adults. We aimed to investigate the mediating role of physical and psychological disorders in their associations with cognitive function. METHODS We conducted a prospective cohort study using the Health and Retirement Study, involving 5308 adults aged 60 years or older. Physical disorders included seven self-reported physician-diagnosed conditions. Psychological disorder and cognitive function were ascertained using the 8-item Centers for Epidemiologic Research Depression scale and the 27-point HRS cognitive scale, respectively. Multivariable linear regression models were used to assess the association of the baseline scores of physical and psychological disorders with subsequent cognitive scores. Second-order cross-lagged panel models (CLPM) were used to assess the longitudinal mediating roles, respectively. RESULTS The higher psychological disorder scores (β = -0.15; P < 0.0001) and physical disorders scores (β = -0.18; P < 0.0001) were, the worse the cognitive function was. CLPM revealed a significant longitudinal mediating effect of baseline physical disorders through changes in psychological disorder from 2002 to 2010 on the cognitive scores changes from 2002 to 2010 (β = -0.02; P < 0.0001). Meanwhile, the longitudinal mediating effect of baseline psychological disorder scores through physical disorders changes from 2002 to 2010 on the cognitive scores changes from 2002 to 2010 was significant (β = -0.004; P = 0.005). CONCLUSIONS The mutual longitudinal mediating effects of psychological disorder and physical disorder indicate that among older adults, physical and psychological disorders accelerate cognitive impairment as a whole and mutually reinforcing process.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
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2
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Du M, Tao L, Liu M, Liu J. Trajectories of health conditions and their associations with the risk of cognitive impairment among older adults: insights from a national prospective cohort study. BMC Med 2024; 22:20. [PMID: 38195549 PMCID: PMC10777570 DOI: 10.1186/s12916-024-03245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment. METHODS We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002-2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. RESULTS During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17-1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43-2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16-1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65-3.21) and those who smoked (HR = 2.77; 95% CI = 1.91-4.02) (all P for interaction < 0.05). CONCLUSIONS The results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China.
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA.
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3
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Oosterwegel MJ, Krijthe JH, den Brok MGHE, van den Heuvel L, Richard E, Heskes T, Bloem BR, Evers LJW. The effect of cardiovascular risk on disease progression in de novo Parkinson's disease patients: An observational analysis. Front Neurol 2023; 14:1138546. [PMID: 37122316 PMCID: PMC10130532 DOI: 10.3389/fneur.2023.1138546] [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: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Background Currently available treatment options for Parkinson's disease are symptomatic and do not alter the course of the disease. Recent studies have raised the possibility that cardiovascular risk management may slow the progression of the disease. Objectives We estimated the effect of baseline cardiovascular risk factors on the progression of Parkinson's disease, using measures for PD-specific motor signs and cognitive functions. Methods We used data from 424 de novo Parkinson's disease patients and 199 age-matched controls from the observational, multicenter Parkinson's Progression Markers Initiative (PPMI) study, which included follow-up of up to 9 years. The primary outcome was the severity of PD-specific motor signs, assessed with the MDS-UPDRS part III in the "OFF"-state. The secondary outcome was cognitive function, measured with the Montreal Cognitive Assessment, Symbol Digit Modalities Test, and Letter-Number Sequencing task. Exposures of interest were diabetes mellitus, hypertension, body mass index, cardiovascular event history and hypercholesterolemia, and a modified Framingham risk score, measured at baseline. The effect of each of these exposures on disease progression was modeled using linear mixed models, including adjustment for identified confounders. A secondary analysis on the Tracking Parkinson's cohort including 1,841 patients was performed to validate our findings in an independent patient cohort. Results Mean age was 61.4 years, and the average follow-up was 5.5 years. We found no statistically significant effect of any individual cardiovascular risk factor on the MDS-UPDRS part III progression (all 95% confidence intervals (CIs) included zero), with one exception: in the PD group, the estimated effect of a one-point increase in body mass index was 0.059 points on the MDS-UPDRS part III per year (95% CI: 0.017 to 0.102). We found no evidence for an effect of any of the exposures on the rate of change in cognitive functioning in the PD group. Similar results were observed for the Tracking Parkinson's cohort (all 95% CIs overlapped with PPMI), but the 95% CI of the effect of body mass index on the MDS-UPDRS part III progression included zero. Conclusions Based on this analysis of two large cohorts of de novo PD patients, we found no evidence to support clinically relevant effects of cardiovascular risk factors on the clinical progression of Parkinson's disease.
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Affiliation(s)
- Max J. Oosterwegel
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Data Science, Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
- *Correspondence: Max J. Oosterwegel
| | - Jesse H. Krijthe
- Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands
| | - Melina G. H. E. den Brok
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands
| | - Lieneke van den Heuvel
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands
| | - Tom Heskes
- Department of Data Science, Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - Bastiaan R. Bloem
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc J. W. Evers
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Data Science, Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
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Heng H, Liu J, Hu M, Li D, Su W, Li J. WDR43 is a potential diagnostic biomarker and therapeutic target for osteoarthritis complicated with Parkinson’s disease. Front Cell Neurosci 2022; 16:1013745. [DOI: 10.3389/fncel.2022.1013745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Osteoarthritis (OA) and Parkinson’s disease (PD) are on the rise and greatly impact the quality of individuals’ lives. Although accumulating evidence indicates a relationship between OA and PD, the particular interactions connecting the two diseases have not been thoroughly examined. Therefore, this study explored the association through genetic characterization and functional enrichment. Four datasets (GSE55235, GSE12021, GSE7621, and GSE42966) were chosen for assessment and validation from the Gene Expression Omnibus (GEO) database. Weighted Gene Co-Expression Network Analysis (WGCNA) was implemented to determine the most relevant genes for clinical features. Then, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were carried out to explore the biological processes of common genes, and to display the interrelationships between common genes, the STRING database and the application Molecular Complex Detection Algorithm (MCODE) of Cytoscape software were leveraged to get hub genes. By intersecting the common genes with the differentially expressed genes (DEGs) acquired from GSE12021 and GSE42966, the hub genes were identified. Finally, we validated the diagnostic efficacy of hub genes and explored their correlation with 22 immune infiltrating cells. As a consequence, we discovered 71 common genes, most of which were functionally enriched in antigen processing and presentation, mitochondrial translation, the mRNA surveillance pathway, and nucleocytoplasmic transport. Furthermore, WDR43 was found by intersecting eight hub genes with 28 DEGs from the two validation datasets. Receiver Operating Characteristic (ROC) implied the diagnostic role of WDR43 in OA and PD. Immune infiltration research revealed that T-cell regulatory (Tregs), monocytes, and mast cells resting were associated with the pathogenesis of OA and PD. WDR43 may provide key insights into the relationship between OA and PD.
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Meira B, Fernandes M, Salavisa M, Saraiva M, Conceição L, Borbinha C, Ladeira F, Marto JP, Barbosa R, Mendonça M, Bugalho P. Obstructive Sleep Apnea and Other Vascular Risk factors' Impact on Non‐Motor Symptoms in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:785-798. [DOI: 10.1002/mdc3.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/16/2022] [Accepted: 05/22/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bruna Meira
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Marco Fernandes
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Manuel Salavisa
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Marlene Saraiva
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Laurete Conceição
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Cláudia Borbinha
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Filipa Ladeira
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - João Pedro Marto
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Raquel Barbosa
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Marcelo Mendonça
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
- Champalimaud Research and Clinical Centre Champalimaud Foundation Lisbon Portugal
| | - Paulo Bugalho
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
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Brolin K, Bandres-Ciga S, Blauwendraat C, Widner H, Odin P, Hansson O, Puschmann A, Swanberg M. Insights on Genetic and Environmental Factors in Parkinson's Disease from a Regional Swedish Case-Control Cohort. JOURNAL OF PARKINSONS DISEASE 2021; 12:153-171. [PMID: 34776419 PMCID: PMC8842752 DOI: 10.3233/jpd-212818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Risk factors for Parkinson’s disease (PD) can be more or less relevant to a population due to population-specific genetic architecture, local lifestyle habits, and environmental exposures. Therefore, it is essential to study PD at a local, regional, and continental scale in order to increase the knowledge on disease etiology. Objective: We aimed to investigate the contribution of genetic and environmental factors to PD in a new Swedish case-control cohort. Methods: PD patients (n = 929) and matched population-based controls (n = 935) from the southernmost county in Sweden were included in the cohort. Information on environmental exposures was obtained using questionnaires at inclusion. Genetic analyses included a genome-wide association study (GWAS), haplotype assessment, and a risk profile analysis using cumulative genetic risk scores. Results: The cohort is a representative PD case-control cohort (64% men, mean age at diagnosis = 67 years, median Hoehn and Yahr score 2.0), in which previously reported associations between PD and environmental factors, such as tobacco, could be confirmed. We describe the first GWAS of PD solely composed of PD patients from Sweden, and confirm associations to well-established risk alleles in SNCA. In addition, we nominate an unconfirmed and potentially population-specific genome-wide significant association in the PLPP4 locus (rs12771445). Conclusion: This work provides an in-depth description of a new PD case-control cohort from southern Sweden, giving insights into environmental and genetic risk factors for PD in the Swedish population.
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Affiliation(s)
- Kajsa Brolin
- Lund University, Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund, Sweden
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute onAging, National Institutes of Health, Bethesda, MD, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute onAging, National Institutes of Health, Bethesda, MD, USA
| | - Håkan Widner
- Lund University, Department of Clinical SciencesLund, Neurology, Sweden.,Department of Neurology, Skåne University Hospital, Sweden
| | - Per Odin
- Lund University, Department of Clinical SciencesLund, Neurology, Sweden.,Department of Neurology, Skåne University Hospital, Sweden
| | - Oskar Hansson
- Departmentof Clinical Sciences Malmö, Clinical Memory Research Unit, LundUniversity, Sweden.,Memory Clinic, SkåneUniversity Hospital, Malmö, Sweden
| | - Andreas Puschmann
- Lund University, Department of Clinical SciencesLund, Neurology, Sweden.,Department of Neurology, Skåne University Hospital, Sweden
| | - Maria Swanberg
- Lund University, Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund, Sweden
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7
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Komici K, Femminella GD, Bencivenga L, Rengo G, Pagano G. Diabetes Mellitus and Parkinson's Disease: A Systematic Review and Meta-Analyses. JOURNAL OF PARKINSONS DISEASE 2021; 11:1585-1596. [PMID: 34486987 DOI: 10.3233/jpd-212725] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND A link between diabetes mellitus (DM) and Parkinson's disease (PD) have been proposed but evidence are sparse and inconsistent. OBJECTIVE Perform a systematic review of all evidence that link DM and PD characterising the prevalence of DM in PD patients, the risk of developing PD in DM patients and the influence of DM on PD severity and progression. METHODS MEDLINE, Scopus, and Cochrane Library from inception to June 30, 2021 were searched. Studies reporting prevalence, incidence, severity and disease progression of DM and PD were included. Prevalence of DM in PD and incidence of PD in DM patients, and characteristics of PD. RESULTS A total of 21 studies (n = 11,396) included data on DM prevalence in PD patients, 12 studies (n = 17,797,221) included data on incidence of PD in DM patients, and 10 studies (n = 2,482) included data on DM impact on PD severity and disease progression. The prevalence of DM in PD patients was 10.02 %, (95%C.I. 7.88 -12.16), DM patients showed a higher risk of developing PD (OR: 1.34 95%CI 1.26-1.43 p < 0.0001) compared to non-DM, and PD patients with DM showed a greater severity of motor symptoms, with higher Hoehn and Yahr stage (SMD: 0.36 95%CI 0.12-0.60; p < 0.001) and higher UPDRS (SMD 0.60 95%CI 0.28-0.92; p < 0.001) compared with PD patients without DM. CONCLUSION Although the prevalence of DM in PD patients is similar to the general population, patients with DM have a higher risk of developing PD, and the presence of DM is associated with greater PD severity and faster progression, which suggests that DM may be a facilitating factor of neurodegeneration.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Scientific Institute of Telese Terme, Telese Terme (BN), Italy
| | - Gennaro Pagano
- King's College London, London, UK.,Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center, Basel, Switzerland
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Tolosa E, Ebersbach G, Ferreira JJ, Rascol O, Antonini A, Foltynie T, Gibson R, Magalhaes D, Rocha JF, Lees A. The Parkinson's Real-World Impact Assessment (PRISM) Study: A European Survey of the Burden of Parkinson's Disease in Patients and their Carers. JOURNAL OF PARKINSONS DISEASE 2021; 11:1309-1323. [PMID: 34024784 PMCID: PMC8461669 DOI: 10.3233/jpd-212611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: A greater understanding of the everyday experiences of people with Parkinson’s disease (PD) and their carers may help improve clinical practice. Objective: The Parkinson’s Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD and their carers. Methods: PRISM is an observational cross-sectional study, in which people with PD and their carers completed an online survey using structured questionnaires, including the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQuest) and Zarit Burden Interview (ZBI). Results: Data were collected from 861 people with PD (mean age, 65.0 years; mean disease duration, 7.7 years) and 256 carers from six European countries. People with PD reported a large number of different co-morbidities, non-motor symptoms (mean NMSQuest score, 12.8), and impaired HRQoL (median PDQ-39 summary score, 29.1). Forty-five percent of people with PD reported at least one impulse control behaviour. Treatment patterns varied considerably between different European countries. Levodopa was taken in the last 12 months by 85.9% of participants, and as monotherapy by 21.8%. Carers, who were mostly female (64.8%) and the partner/spouse of the person with PD (82.1%), reported mild to moderate burden (mean ZBI total score, 26.6). Conclusions: The PRISM study sheds light on the lives of people with PD and those who care for them, re-emphasising the many challenges they face in everyday life. The study also provides insights into the current treatment of PD in Europe.
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Affiliation(s)
- Eduardo Tolosa
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Olivier Rascol
- Toulouse Parkinson Expert Center, Departments of Neurosciences and Clinical Pharmacology, Centre d'Investigation Clinique de Toulouse CIC1436, NS-Park/FCRIN Network, and NeuroToul COEN Center, University Hospital of Toulouse, INSERM, University of Toulouse, Toulouse, France
| | - Angelo Antonini
- Parkinson Disease and Movement Disorder Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | | | | | - Andrew Lees
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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9
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Roper JA, Schmitt AC, Gao H, He Y, Wu S, Schmidt P, Okun MS, Hass CJ, Cubillos F. Coexistent Osteoarthritis and Parkinson's Disease: Data from the Parkinson's Foundation Outcomes Project. JOURNAL OF PARKINSONS DISEASE 2020; 10:1601-1610. [PMID: 32925102 DOI: 10.3233/jpd-202170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson's disease is unknown. OBJECTIVE We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson's disease. METHODS In a retrospective observational longitudinal study, data from the Parkinson's Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson's disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. RESULTS More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson's disease seem to additively increase the risk of mortality (p = 0.007). CONCLUSION Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson's disease.
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Affiliation(s)
- Jaimie A Roper
- Auburn University, Auburn, School of Kinesiology, AL, USA
| | - Abigail C Schmitt
- University of Florida, Department of Applied Physiology and Kinesiology, Gainesville, FL, USA
| | - Hanzhi Gao
- University of Florida, Department of Biostatistics, Gainesville, FL, USA
| | - Ying He
- Clarkson University, Department of Mathematics, Potsdam, NY, USA
| | - Samuel Wu
- University of Florida, Department of Biostatistics, Gainesville, FL, USA
| | | | - Michael S Okun
- University of Florida, Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA.,Parkinson's Foundation, FL, USA
| | - Chris J Hass
- University of Florida, Department of Applied Physiology and Kinesiology, Gainesville, FL, USA.,University of Florida, Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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Acharya S, Salgado-Somoza A, Stefanizzi FM, Lumley AI, Zhang L, Glaab E, May P, Devaux Y. Non-Coding RNAs in the Brain-Heart Axis: The Case of Parkinson's Disease. Int J Mol Sci 2020; 21:E6513. [PMID: 32899928 PMCID: PMC7555192 DOI: 10.3390/ijms21186513] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is a complex and heterogeneous disorder involving multiple genetic and environmental influences. Although a wide range of PD risk factors and clinical markers for the symptomatic motor stage of the disease have been identified, there are still no reliable biomarkers available for the early pre-motor phase of PD and for predicting disease progression. High-throughput RNA-based biomarker profiling and modeling may provide a means to exploit the joint information content from a multitude of markers to derive diagnostic and prognostic signatures. In the field of PD biomarker research, currently, no clinically validated RNA-based biomarker models are available, but previous studies reported several significantly disease-associated changes in RNA abundances and activities in multiple human tissues and body fluids. Here, we review the current knowledge of the regulation and function of non-coding RNAs in PD, focusing on microRNAs, long non-coding RNAs, and circular RNAs. Since there is growing evidence for functional interactions between the heart and the brain, we discuss the benefits of studying the role of non-coding RNAs in organ interactions when deciphering the complex regulatory networks involved in PD progression. We finally review important concepts of harmonization and curation of high throughput datasets, and we discuss the potential of systems biomedicine to derive and evaluate RNA biomarker signatures from high-throughput expression data.
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Affiliation(s)
- Shubhra Acharya
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg; (S.A.); (A.S.-S.); (F.M.S.); (A.I.L.); (L.Z.)
- Faculty of Science, Technology and Medicine, University of Luxembourg, L-4365 Esch-sur-Alzette, Luxembourg
| | - Antonio Salgado-Somoza
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg; (S.A.); (A.S.-S.); (F.M.S.); (A.I.L.); (L.Z.)
| | - Francesca Maria Stefanizzi
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg; (S.A.); (A.S.-S.); (F.M.S.); (A.I.L.); (L.Z.)
| | - Andrew I. Lumley
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg; (S.A.); (A.S.-S.); (F.M.S.); (A.I.L.); (L.Z.)
| | - Lu Zhang
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg; (S.A.); (A.S.-S.); (F.M.S.); (A.I.L.); (L.Z.)
| | - Enrico Glaab
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, L-4365 Esch-sur-Alzette, Luxembourg; (E.G.); (P.M.)
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, L-4365 Esch-sur-Alzette, Luxembourg; (E.G.); (P.M.)
| | - Yvan Devaux
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg; (S.A.); (A.S.-S.); (F.M.S.); (A.I.L.); (L.Z.)
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11
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Jones JD, Rahmani E, Garcia E, Jacobs JP. Gastrointestinal symptoms are predictive of trajectories of cognitive functioning in de novo Parkinson's disease. Parkinsonism Relat Disord 2020; 72:7-12. [PMID: 32058266 PMCID: PMC7179075 DOI: 10.1016/j.parkreldis.2020.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Non-motor symptoms such as cognitive and gastrointestinal (GI) symptoms are common in Parkinson's disease (PD). In PD, GI-symptoms often present prior to motor symptoms. It is hypothesized that GI-symptoms reflect disruptions of the microbiome-gut-brain axis, which leads to altered immune functioning, chronic neuroinflammation, and subsequent neurodegeneration. Initial evidence links gut-dysbiosis to PD pathology and motor symptom severity. The present study examines the longitudinal relationship between severity of GI-symptoms and cognitive impairment in newly diagnosed PD patients. METHODS A secondary data analysis of the Parkinson's Progression Markers Initiative (PPMI) included 423 newly diagnosed PD patients who were followed for up to 5 years. Participants underwent neuropsychological tests of processing speed, attention, visuospatial functioning, verbal learning and verbal delayed recall. Participant were classified as cognitive intact, mild cognitive impairment or Parkinson's disease dementia. Frequency of GI-symptoms were assessed with the Scales for Outcomes in Parkinson's Disease Autonomic (SCOPA-AUT). Multi-level models (MLM) examined the longitudinal relationship between GI symptoms and cognitive impairment. RESULTS All cognitive outcomes were predicted by the main effect of GI symptoms, or the GI-symptom X Occasion interaction term. Specifically, more severe GI-symptoms were predictive of a less favorable trajectory of performance on tests of letter fluency, visuospatial, learning and memory. Cognitive performance was uniquely associated with GI-symptoms and unrelated to non-GI autonomic symptoms. CONCLUSIONS The presence of GI symptoms may serve as an early marker of cognitive impairment in PD. Future studies should examine specific mechanisms underlying the relationship between gut-dysbiosis and cognitive impairment.
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Affiliation(s)
- Jacob D Jones
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA.
| | - Elizabeth Rahmani
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Erik Garcia
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Jonathan P Jacobs
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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12
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Kotagal V, Albin RL, Müller MLTM, Bohnen NI. Cardiovascular Risk Factor Burden in Veterans and Non-Veterans with Parkinson Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:153-160. [PMID: 29480230 DOI: 10.3233/jpd-171271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical comorbidities, including cardiovascular risk factors such as hypertension and diabetes, influence disease progression in Parkinson disease (PD) and may be variably present in different clinical populations. OBJECTIVE/METHODS We conducted a retrospective nested case-control study of 29 Veterans with PD and 29 non-Veteran PD controls. The groups were matched for age, gender, and disease duration. Both groups underwent clinical and imaging testing as part of their participation in a larger cross-sectional PD observational study at our research center. Veterans were recruited primarily from movement disorders neurology clinics at the Ann Arbor Veterans Affairs (VA) Health System. Non-Veterans were recruited primarily from analogous clinics at the University of Michigan Health System. We explored differences in cardiovascular risks factor burden between the groups. RESULTS Veterans with PD showed higher scores on the simplified Framingham 10-year general cardiovascular disease risk calculator (FR score; 27.3% (11.5) vs. 20.7% (6.8); t = -2.66, p = 0.011) and fewer years of self-reported education (14.5 (2.5) vs. 16.7 (2.6); t = 3.33, p = 0.002). After adjusting for age, disease duration, education, and the use of antihypertensive medications, Veterans showed higher FR scores (t = 2.95, p = 0.005) and a higher intra-subject ratio of FR score to age-and-gender normalized FR score (t = 2.49, p = 0.016), representing an elevated component of modifiable cardiovascular risk factor burden. CONCLUSION Cardiovascular comorbidities are common in Veterans with PD and may be more severe than in non-Veteran PD populations. These findings merit replication in other representative cohorts. Veterans may be a preferred population for clinical trials evaluating cardiovascular risk factor management on PD progression.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA
| | - Martijn L T M Müller
- University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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13
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Chen L, Wang L, Zhuo Q, Zhang Q, Chen F, Li L, Lin L. Effect of Shenmai injection on cognitive function after cardiopulmonary bypass in cardiac surgical patients: a randomized controlled trial. BMC Anesthesiol 2018; 18:142. [PMID: 30309327 PMCID: PMC6182819 DOI: 10.1186/s12871-018-0604-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients. This study aimed to evaluate the effects of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve replacement under cardiopulmonary bypass (CPB). METHODS This prospective, randomized, controlled trial was conducted from September 2014 to January 2017. Eighty-eight patients receiving cardiac valve replacement under CPB were randomized into the control (C) or the SMI (S) group. SMI (0.6 mL/kg) was administered intravenously from the time of anesthesia induction to the beginning of CPB. Cognitive function was assessed at 3 days before surgery and 3 days, 7 days, and 1 month after surgery using the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) score. The serum levels of neuroglobin (Ngb), hypoxia-inducible factor-1α (HIF-1α), and neuron-specific enolase (NSE) were measured at 30 min after induction (T0), immediately after the endonasal temperature rewarmed to 36 °C (T1), and 1 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after CPB. RESULTS Compared with the baseline values at T0, the serum Ngb levels in group C were significantly decreased at T1-2 and then increased at T3-6, while the levels in group S were decreased at T1-2 and increased at T4-6, compared to group C (p < 0.05). The serum HIF-1α levels at T1-4 and the serum NSE levels at T1-6 were significantly increased in both groups (p < 0.05). The serum levels of Ngb at T3, HIF-1α at T1-3, and NSE at T3-4,6 were lower in group S, compared to group C (p < 0.01). The MoCA-BJ scores were decreased at 3 and 7 days after surgery in both groups, and the MoCA-BJ scores in group S were higher than those in group C at 3 and 7 days after surgery (p < 0.01). CONCLUSION Cognitive function is impaired postoperatively in patients who have undergone cardiac valve replacement under CPB. In addition, treatment with the traditional Chinese medicine SMI decreases the serum levels of Ngb, HIF-1α, and NSE as well as attenuates cognitive dysfunction. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov as ChiCTR-TRC-14004373 on March 11, 2014.
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Affiliation(s)
- Lei Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Liangrong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qian Zhuo
- Wenzhou People's Hospital, Wenzhou, Zhejiang Province, China
| | - Qiong Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Feifei Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Liling Li
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Lina Lin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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14
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Crosta F, Desideri G, Marini C. Obstructive sleep apnea syndrome in Parkinson's disease and other parkinsonisms. FUNCTIONAL NEUROLOGY 2018; 32:137-141. [PMID: 29042002 PMCID: PMC5726349 DOI: 10.11138/fneur/2017.32.3.137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An association of obstructive sleep apnea syndrome (OSAS) and other sleep-disordered breathing (SDB) with Parkinson's disease (PD) has been reported in some small studies. In the present study we investigated the occurrence of SDB in a large consecutive outpatient series. This is a case-control study in subjects attending a neurological clinic where all patients were screened for SDB by means of sleep-wake history, Epworth Sleepiness Scale, and full-night polysomnography, when indicated. 3194 patients were recruited. Of these, 194 were affected by PD and 77 by other parkinsonisms. Snoring, excessive daytime sleepiness and OSAS were more common in patients with PD or parkinsonisms (40.59, 5.9, and 4.06%) than in controls (35.58, 2.19, and 2.09%). Our study suggests an increased frequency of OSAS and other SDB in PD and parkinsonisms. Early detection and management of these disorders may have a substantial impact on quality of life and survival in these patients.
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Affiliation(s)
- Francesca Crosta
- Geriatric Unit, Department of Medicine, Health and Environment Sciences, L’Aquila, Italy
| | | | - Carmine Marini
- Neurology Unit, Department of Medicine, Health and Environment Sciences, L’Aquila, Italy
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15
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Pagano G, Polychronis S, Wilson H, Giordano B, Ferrara N, Niccolini F, Politis M. Diabetes mellitus and Parkinson disease. Neurology 2018; 90:e1654-e1662. [PMID: 29626177 DOI: 10.1212/wnl.0000000000005475] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/08/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate whether diabetes mellitus is associated with Parkinson-like pathology in people without Parkinson disease and to evaluate the effect of diabetes mellitus on markers of Parkinson pathology and clinical progression in drug-naive patients with early-stage Parkinson disease. METHODS We compared 25 patients with Parkinson disease and diabetes mellitus to 25 without diabetes mellitus, and 14 patients with diabetes mellitus and no Parkinson disease to 14 healthy controls (people with no diabetes mellitus or Parkinson disease). The clinical diagnosis of diabetes mellitus was confirmed by 2 consecutive fasting measurements of serum glucose levels >126 mL/dL. Over a 36-month follow-up period, we then investigated in the population with Parkinson disease whether the presence of diabetes mellitus was associated with faster motor progression or cognitive decline. RESULTS The presence of diabetes mellitus was associated with higher motor scores (p < 0.01), lower striatal dopamine transporter binding (p < 0.05), and higher tau CSF levels (p < 0.05) in patients with Parkinson disease. In patients with diabetes but without Parkinson disease, the presence of diabetes mellitus was associated with lower striatal dopamine transporter binding (p < 0.05) and higher tau (p < 0.05) and α-synuclein (p < 0.05) CSF levels compared to healthy controls. At the Cox survival analysis in the population of patients with Parkinson disease, the presence of diabetes mellitus was associated with faster motor progression (hazard ratio = 4.521, 95% confidence interval = 1.468-13.926; p < 0.01) and cognitive decline (hazard ratio = 9.314, 95% confidence interval = 1.164-74.519; p < 0.05). CONCLUSIONS Diabetes mellitus may predispose toward a Parkinson-like pathology, and when present in patients with Parkinson disease, can induce a more aggressive phenotype.
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Affiliation(s)
- Gennaro Pagano
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Sotirios Polychronis
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Heather Wilson
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Beniamino Giordano
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Nicola Ferrara
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Flavia Niccolini
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Marios Politis
- From the Neurodegeneration Imaging Group (G.P., S.P., H.W., B.G., F.N., M.P.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Division of Geriatrics (B.G., N.F.), Department of Translational Medical Sciences, University of Naples Federico II, Italy.
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16
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Doiron M, Langlois M, Dupré N, Simard M. The influence of vascular risk factors on cognitive function in early Parkinson's disease. Int J Geriatr Psychiatry 2018; 33:288-297. [PMID: 28509343 DOI: 10.1002/gps.4735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/10/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Hypertension, dyslipidemia, diabetes, and obesity are well-established risk factors for cognitive impairment and dementia in older adults. In contrast, previous studies that have assessed the impact of vascular risk factors (VRFs) on cognition in Parkinson's disease (PD) have had methodological limitations and reported conflicting findings. We address this question in a large well-characterized cohort of de novo PD patients. METHODS A total of 367 untreated and non-demented patients aged 50 years and older with early PD (H&Y = 1.0-2.0) underwent a comprehensive clinical and neuropsychological assessment at baseline and 24 months later. A series of linear mixed models were used to determine the effects of VRFs on cognition while controlling for patient and disease characteristics. The outcomes included norm-referenced Z-scores of global cognition, visuospatial skills, verbal episodic memory, semantic verbal fluency, attention, and working memory tests. RESULTS A longer history of hypertension and a higher pulse pressure were significant predictors of lower Z-scores on immediate and delayed free recall, recognition, and verbal fluency tests. On average, every 10 mmHg increase in pulse pressure was associated with a 0.08 reduction on the cognitive Z-scores. The effects were independent of age, education, disease duration, motor impairment, medication, and depressive symptoms. Other VRFs were not associated with cognitive outcomes. CONCLUSIONS Our results are consistent with previous studies suggesting that hypertension exerts a detrimental effect on memory and verbal fluency in early PD. Management of blood pressure and cardiovascular health may be important to reduce risk of cognitive decline in PD. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Maxime Doiron
- School of Psychology, Laval University, Quebec City, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada.,Faculty of Medicine, Laval University, Quebec City, Canada
| | - Mélanie Langlois
- Faculty of Medicine, Laval University, Quebec City, Canada.,Department of Neurological Sciences, CHU de Québec (Enfant-Jésus), Quebec City, Canada
| | - Nicolas Dupré
- Faculty of Medicine, Laval University, Quebec City, Canada.,Department of Neurological Sciences, CHU de Québec (Enfant-Jésus), Quebec City, Canada
| | - Martine Simard
- School of Psychology, Laval University, Quebec City, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada
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17
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Yarnall AJ, Sayer AA, Clegg A, Rockwood K, Parker S, Hindle JV. New horizons in multimorbidity in older adults. Age Ageing 2017; 46:882-888. [PMID: 28985248 DOI: 10.1093/ageing/afx150] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/02/2017] [Indexed: 12/21/2022] Open
Abstract
The concept of multimorbidity has attracted growing interest over recent years, and more latterly with the publication of specific guidelines on multimorbidity by the National Institute for Health and Care Excellence (NICE). Increasingly it is recognised that this is of particular relevance to practitioners caring for older adults, where multimorbidity may be more complex due to the overlap of physical and mental health disorders, frailty and polypharmacy. The overlap of frailty and multimorbidity in particular is likely to be due to the widespread health deficit accumulation, leading in some cases to functional impairment. The NICE guidelines identify 'target groups' who may benefit from a tailored approach to care that takes their multimorbidity into account, and make a number of research recommendations. Management includes a proactive individualised assessment and care plan, which improves quality of life by reducing treatment burden, adverse events, and unplanned or uncoordinated care.
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Affiliation(s)
- Alison J Yarnall
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care & Rehabilitation, University of Leeds, Leeds, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Stuart Parker
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John V Hindle
- School of Psychology, Bangor University, Bangor, UK
- Llandudno Hospital, Betsi Cadwaladr University Health Board, Llandudno, UK
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18
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Haaksma ML, Vilela LR, Marengoni A, Calderón-Larrañaga A, Leoutsakos JMS, Olde Rikkert MGM, Melis RJF. Comorbidity and progression of late onset Alzheimer's disease: A systematic review. PLoS One 2017; 12:e0177044. [PMID: 28472200 PMCID: PMC5417646 DOI: 10.1371/journal.pone.0177044] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/23/2017] [Indexed: 01/18/2023] Open
Abstract
Background Alzheimer’s disease is a neurodegenerative syndrome characterized by multiple dimensions including cognitive decline, decreased daily functioning and psychiatric symptoms. This systematic review aims to investigate the relation between somatic comorbidity burden and progression in late-onset Alzheimer’s disease (LOAD). Methods We searched four databases for observational studies that examined cross-sectional or longitudinal associations of cognitive or functional or neuropsychiatric outcomes with comorbidity in individuals with LOAD. From the 7966 articles identified originally, 11 studies were included in this review. The Newcastle-Ottawa quality assessment was used. The large variation in progression measures, comorbidity indexes and study designs hampered the ability to perform a meta-analysis. This review was registered with PROSPERO under DIO: 10.15124/CRD42015027046. Results Nine studies indicated that comorbidity burden was associated with deterioration in at least one of the three dimensions of LOAD examined. Seven out of ten studies investigating cognition found comorbidities to be related to decreased cognitive performance. Five out of the seven studies investigating daily functioning showed an association between comorbidity burden and decreased daily functioning. Neuropsychiatric symptoms (NPS) increased with increasing comorbidity burden in two out of three studies investigating NPS. Associations were predominantly found in studies analyzing the association cross-sectionally, in a time-varying manner or across short follow-up (≤2 years). Rarely baseline comorbidity burden appeared to be associated with outcomes in studies analyzing progression over longer follow-up periods (>2 years). Conclusion This review provides evidence of an association between somatic comorbidities and multifaceted LOAD progression. Given that time-varying comorbidity burden, but much less so baseline comorbidity burden, was associated with the three dimensions prospectively, this relationship cannot be reduced to a simple cause-effect relation and is more likely to be dynamic. Therefore, both future studies and clinical practice may benefit from regarding comorbidity as a modifiable factor with a possibly fluctuating influence on LOAD.
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Affiliation(s)
- Miriam L. Haaksma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Lara R. Vilela
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute, IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Carlos III Health Institute, Madrid, Spain
| | - Jeannie-Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Marcel G. M. Olde Rikkert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - René J. F. Melis
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- * E-mail:
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Are Parkinson's Patients More Vulnerable to the Effects of Cardiovascular Risk: A Neuroimaging and Neuropsychological Study. J Int Neuropsychol Soc 2017; 23:322-331. [PMID: 28162137 PMCID: PMC5729910 DOI: 10.1017/s1355617717000017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study examined whether individuals with Parkinson's disease (PD) are at increased vulnerability for vascular-related cognitive impairment relative to controls. The underlying assumption behind this hypothesis relates to brain reserve and that both PD and vascular risk factors impair similar fronto-executive cognitive systems. METHODS The sample included 67 PD patients and 61 older controls (total N=128). Participants completed neuropsychological measures of executive functioning, processing speed, verbal delayed recall/memory, language, and auditory attention. Cardiovascular risk was assessed with the Framingham Cardiovascular Risk index. Participants underwent brain imaging (T1 and T2 FLAIR). Trained raters measured total and regional leukoaraiosis (periventricular, deep subcortical, and infracortical). RESULTS Hierarchical regressions revealed that more severe cardiovascular risk was related to worse executive functioning, processing speed, and delayed verbal recall in both Parkinson patients and controls. More severe cardiovascular risk was related to worse language functioning in the PD group, but not controls. In contrast, leukoaraiosis related to both cardiovascular risk and executive functioning for controls, but not the PD group. CONCLUSIONS Overall, results revealed that PD and cardiovascular risk factors are independent risk factors for cognitive impairment. Generally, the influence of cardiovascular risk factors on cognition is similar in PD patients and controls. (JINS, 2017, 23, 322-331).
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Umotong E. Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit. J Nerv Ment Dis 2016; 204:950-954. [PMID: 27893528 PMCID: PMC5142359 DOI: 10.1097/nmd.0000000000000622] [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] [Indexed: 11/26/2022]
Abstract
The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.
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Affiliation(s)
- Eno Umotong
- Imperial College London, School of Medicine, London; and Heart of England NHS Foundation Trusts, Heartlands Hospital, Birmingham, United Kingdom
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Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson's Disease: Results of a Controlled Study. J Int Neuropsychol Soc 2016; 22:878-889. [PMID: 27655232 DOI: 10.1017/s135561771600076x] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. METHODS This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. RESULTS Depressive symptoms increased only in the control group (p<.02). Executive function improved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (p<.02). CONCLUSIONS Aerobic exercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878-889).
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Moriarty H, Bunting-Perry L, Robinson JP, Bradway CW. The Experience of Women Who Care for Spouses With Parkinson's Disease and Lower Urinary Tract Symptoms. J Obstet Gynecol Neonatal Nurs 2016; 45:737-48. [DOI: 10.1016/j.jogn.2016.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 12/29/2022] Open
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Csoti I, Jost WH, Reichmann H. Parkinson's disease between internal medicine and neurology. J Neural Transm (Vienna) 2016; 123:3-17. [PMID: 26298728 PMCID: PMC4713462 DOI: 10.1007/s00702-015-1443-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Abstract
General medical problems and complications have a major impact on the quality of life in all stages of Parkinson's disease. To introduce an effective treatment, a comprehensive analysis of the various clinical symptoms must be undertaken. One must distinguish between (1) diseases which arise independently of Parkinson's disease, and (2) diseases which are a direct or indirect consequence of Parkinson's disease. Medical comorbidity may induce additional limitations to physical strength and coping strategies, and may thus restrict the efficacy of the physical therapy which is essential for treating hypokinetic-rigid symptoms. In selecting the appropriate medication for the treatment of any additional medical symptoms, which may arise, its limitations, contraindications and interactions with dopaminergic substances have to be taken into consideration. General medical symptoms and organ manifestations may also arise as a direct consequence of the autonomic dysfunction associated with Parkinson's disease. As the disease progresses, additional non-parkinsonian symptoms can be of concern. Furthermore, the side effects of Parkinson medications may necessitate the involvement of other medical specialists. In this review, we will discuss the various general medical aspects of Parkinson's disease.
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Affiliation(s)
- Ilona Csoti
- Gertrudis-Clinic Parkinson-Center, Karl-Ferdinand-Broll-Str. 2-4, 35638, Leun, Germany.
| | - Wolfgang H Jost
- Parkinson-Klinik Wolfach, Kreuzbergstr.12-24, 77709, Wolfach, Germany.
| | - Heinz Reichmann
- Department of Neurology, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Caregiver-identified needs and barriers to care in Parkinson's disease. Geriatr Nurs 2015; 36:197-201. [PMID: 25744557 DOI: 10.1016/j.gerinurse.2015.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/23/2022]
Abstract
Perceptions of service needs and barriers to care among caregivers of individuals with Parkinson's disease have not been well explored. The purpose of this study was to assess caregiver perceptions of their own and patients' medical and supportive service needs. An online and paper survey was disseminated to a sample of caregivers (n = 66) of individuals with Parkinson's disease. Although caregivers reported positive quality of life and adjustment to caregiving, nearly half of the sample endorsed feeling stressed about caregiving. Caregivers reported that services for symptom management, coping with changes in lifestyle, future planning, relationships, and cognition, and wellness strategies were most needed. Reported barriers to patients accessing care included limited service availability and a lack of insurance coverage for services. These findings suggest a need to improve access to services for patients and increased efforts to promote caregiver wellness at movement disorder specialty clinics.
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Diabetes mellitus is independently associated with more severe cognitive impairment in Parkinson disease. Parkinsonism Relat Disord 2014; 20:1394-8. [PMID: 25454317 DOI: 10.1016/j.parkreldis.2014.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/28/2014] [Accepted: 10/07/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is increasing interest in interactions between metabolic syndromes and neurodegeneration. Diabetes mellitus (DM) contributes to cognitive impairment in the elderly but its effect in Parkinson disease (PD) is not well studied. OBJECTIVE To investigate effects of comorbid DM on cognition in PD independent from PD-specific primary neurodegenerations. METHODS Cross-sectional study. Patients with PD (n = 148); age 65.6 ± 7.4 years, Hoehn and Yahr stage 2.4 ± 0.6, with (n = 15) and without (n = 133) comorbid type II DM, underwent [(11)C]methyl-4-piperidinyl propionate (PMP) acetylcholinesterase (AChE) PET imaging to assess cortical cholinergic denervation, [(11)C]dihydrotetrabenazine (DTBZ) PET imaging to assess nigrostriatal denervation, and neuropsychological assessments. A global cognitive Z-score was calculated based on normative data. Analysis of covariance was performed to determine cognitive differences between subjects with and without DM while controlling for nigrostriatal denervation, cortical cholinergic denervation, levodopa equivalent dose and education covariates. RESULTS There were no significant differences in age, gender, Hoehn and Yahr stage or duration of disease between diabetic and non-diabetic PD subjects. There was a non-significant trend toward lower years of education in the diabetic PD subjects compared with non-diabetic PD subjects. PD diabetics had significantly lower mean (±SD) global cognitive Z-scores (-0.98 ± 1.01) compared to the non-diabetics (-0.36 ± 0.91; F = 7.78, P = 0.006) when controlling for covariate effects of education, striatal dopaminergic denervation, and cortical cholinergic denervation (total model F = 8.39, P < 0.0001). CONCLUSION Diabetes mellitus is independently associated with more severe cognitive impairment in PD likely through mechanisms other than disease-specific neurodegenerations.
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Influence of hypertension on neurocognitive domains in nondemented Parkinson's disease patients. PARKINSONS DISEASE 2014; 2014:507529. [PMID: 24587937 PMCID: PMC3920751 DOI: 10.1155/2014/507529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/07/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022]
Abstract
Objective. Health comorbidities, particularly cardiovascular risk factors, are well known to pose risks for cognitive decline in older adults. To date, little attention has focused on the impact of these comorbidities on Parkinson's disease (PD). This study examined the prevalence and contribution of comorbidities on cognitive status in PD patients, above and beyond the effects of disease severity. Methods. A cross sectional design was used, including neuropsychological data on 341 PD patients without severe cognitive decline. Comorbidity data were collected via medical chart review. Data were analyzed using a series of multiple hierarchical regressions, controlling for PD-related disease variables. Results. Overall sample characteristics are 69% male, disease duration 9.7 years, Unified Parkinson's Disease Rating Scale 26.4, and age 64.7 years. Hypercholesterolemia (41.6%), hypertension (38.1%), and hypotension (30.2%) were the most reported comorbidities. The presence of hypertension significantly contributed to domains of executive function and verbal memory. The cooccurrence of orthostatic hypotension moderated the relationship between hypertension and executive function. Conclusions. This study on a large cohort of PD patients provides evidence for a detrimental influence of health comorbidities, particularly hypertension, on cognitive domains that have traditionally been conceptualized as being frontally and/or temporally mediated.
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Yao SC, Hart AD, Terzella MJ. An evidence-based osteopathic approach to Parkinson disease. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.osfp.2013.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Kotagal V, Albin RL, Müller MLTM, Koeppe RA, Frey KA, Bohnen NI. Diabetes is associated with postural instability and gait difficulty in Parkinson disease. Parkinsonism Relat Disord 2013; 19:522-6. [PMID: 23462483 DOI: 10.1016/j.parkreldis.2013.01.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/11/2012] [Accepted: 01/22/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Comorbid diabetes may be associated with more severe motor impairment in Parkinson disease. In normal elderly individuals, diabetes is associated with parkinsonian features, including gait difficulty and rigidity, though not tremor. Whether diabetes contributes to increased motor dysfunction in Parkinson disease by exacerbating nigrostriatal dopaminergic denervation or through intensification of extranigral pathology is unknown. METHODS We performed a case-control study (n = 39) involving 13 Parkinson disease subjects (age 66.4yrs ± 5.5; duration of disease 6.9yrs ± 4.4) with diabetes and 26 age, gender, and duration-of-disease-matched Parkinson disease controls without diabetes. All subjects underwent [(11)C]dihydrotetrabenazine vesicular monoamine transporter type-2 positron emission tomography imaging to assess striatal dihydrotetrabenazine distribution volume ratio and Unified Parkinson disease rating scale motor examination to determine rigidity, bradykinesia, tremor, and postural instability and gait difficulty subscores. Magnetic resonance imaging scans were analyzed to assess leukoaraiosis burden. RESULTS After controlling for nigrostriatal dopaminergic denervation, Parkinson disease subjects with diabetes displayed greater postural instability and gait difficulty subscores (t = 3.81, p = 0.0005). There were no differences in bradykinesia, rigidity, or tremor subscores between cases and controls. The association between diabetes and postural instability and gait difficulty persisted after controlling for comorbid hypertension and body mass index. Leukoaraiosis, distal vibratory sense, and levodopa dose equivalents did not differ significantly between cases and controls. CONCLUSIONS Diabetes may contribute to postural instability and gait difficulty in Parkinson disease through mechanisms other than nigrostriatal dopaminergic denervation.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
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