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Gonzalez-Latapi P, Gochanour C, Cho H, Ho Choi S, Caspell-Garcia C, Coffey C, Brumm M, Lafontant DE, Xiao Y, Tanner C, Venuto CS, Kieburtz K, Chahine LM, Poston KL, Siderowf A, Marek K, Simuni T. Eleven Years of Change: Disease Progression in Biomarker-Defined Sporadic Parkinson's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.10.09.24315191. [PMID: 39417131 PMCID: PMC11482996 DOI: 10.1101/2024.10.09.24315191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Long-term longitudinal data on outcomes in sporadic Parkinson's Disease are limited, especially from cohorts with extensive biological characterization. Recent advances in biomarkers characterization of Parkinson's Disease necessitate an updated examination of long-term progression within contemporary cohorts like the Parkinson's Progression Markers Initiative, which enrolled individuals within 2 years of clinical diagnosis of Parkinson's Disease. Our study leverages the Neuronal Synuclein Disease framework, which defines the disease based on biomarker assessed presence of neuronal alpha-synuclein and dopamine deficit, rather than based on conventional clinical diagnostic criteria. In this study we aimed to provide a comprehensive long-term description of disease progression using the integrated biological and clinical staging system framework. We analyzed data from 344 participants from the sporadic Parkinson's Disease cohort in the Parkinson's Progression Markers Initiative, who met Neuronal Synuclein Disease criteria. We assessed 11-year progression in a spectrum of clinical measures. We used Cox proportional hazards models to assess the association between baseline stage and time to key outcomes, including survival, postural instability (Hoehn & Yahr ≥ 3), loss of independence (Schwab & England < 80%), cognitive decline, and domain-based milestones such as walking and balance, motor complications, autonomic dysfunction, and activities of daily living. Additional analyses were completed to account for death and participant dropout. Biomarker analysis included dopamine transporter binding measures, as well as serum urate, neurofilament light chain and CSF amyloid-beta, phosphorylated tau and total tau. At baseline, despite the cohort consisting of individuals within 2 years of clinical diagnosis, there was clear separation of participants in Neuronal Synuclein Disease Stages (23% Stage 2b, 67% Stage 3, 10% Stage 4). At 11 years, data were available for 153 participants; 35 participants had died over the follow up period. Of retained participants, 59% presented normal cognition, 24% had evidence of postural instability and mean Schwab & England score was 78.5. Serum neurofilament light chain consistently increased over time. No other biofluids had a consistent change in trajectory. Of importance, baseline Neuronal Synuclein Disease Stage predicted progression to clinically meaningful milestones. This study provides data on longitudinal, 11-year progression in Neuronal Synuclein Disease participants within 2 years of clinical diagnosis. We observed better long-term outcomes in this contemporary observational study cohort. It highlights the heterogeneity in the early Parkinson's Disease population as defined by clinical diagnostic criteria and underscores the importance of shifting from clinical to biologically and functionally based inclusion criteria in the design of new clinical trials.
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Bazo-Alvarez JC, Nimmons D, Walters K, Petersen I, Schrag A. Risk of Parkinson's disease in people aged ≥50 years with new-onset anxiety: a retrospective cohort study in UK primary care. Br J Gen Pract 2024; 74:e482-e488. [PMID: 38514045 PMCID: PMC11221485 DOI: 10.3399/bjgp.2023.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND A history of anxiety is more common in people with Parkinson's disease (PD). The prospective risk of PD in those newly presenting with anxiety and factors that increase the risk of PD in patients with anxiety have not been investigated. AIM To investigate the incidence of PD in people with anxiety aged ≥50 years and clinical features associated with later diagnosis of PD in people with anxiety. DESIGN AND SETTING A retrospective cohort study using UK primary care data between 2008 and 2018, assessing patients with new-onset anxiety aged ≥50 years. METHOD Weibull survival regression models were fitted and hazard ratios (HRs) for modelling time-to-PD was estimated in those with and without anxiety, and when determining the risk of developing PD in those with anxiety. Results were adjusted for sociodemographic and lifestyle factors, and relevant physical and mental health conditions. RESULTS The risk of PD increased two-fold compared with the non-anxiety group after adjustment for age, sex, social deprivation, lifestyle factors, severe mental illness, head trauma, and dementia (HR 2.1, 95% confidence interval = 1.9 to 2.4). In those with anxiety, the presence of depression, hypotension, tremor, rigidity, balance impairment, constipation, sleep disturbance, fatigue, and cognitive impairment were associated with an increased risk of developing PD. CONCLUSION The risk of developing PD was at least doubled in people with anxiety compared with those without. The clinical features of those who developed PD can help identify patients presenting with anxiety who are in the prodromal phase of PD.
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Affiliation(s)
- Juan Carlos Bazo-Alvarez
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London
| | - Danielle Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London
| | - Kate Walters
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London
| | - Irene Petersen
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London
| | - Anette Schrag
- Department of Neurology, Institute of Neurology, UCL, London
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Nabizadeh F, Seyedmirzaei H, Rafiei N, Maryam Vafaei S, Shekouh D, Mehrtabar E, Mirzaaghazadeh E, Mirzaasgari Z. Global prevalence and incidence of Young Onset Parkinson's disease: A systematic review and meta-analysis. J Clin Neurosci 2024; 125:59-67. [PMID: 38754241 DOI: 10.1016/j.jocn.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/20/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND There is a lack of enough evidence regarding the epidemiology of Young-onset Parkinson's disease (YOPD) which is needed by clinicians and healthcare policymakers. AIM Herein, in this systematic review and meta-analysis, we aimed to estimate the global prevalence and incidence rates of YOPD. METHODS We searched the literature in PubMed, Scopus, and Web of Science in May 2022. We included retrospective, prospective, cross-sectional observational population-based studies that reported the prevalence or incidence of PD in individuals younger than 40 years with known diagnostic criteria. RESULTS After two-step screening, 50 studies were eligible to be included in our study. The age-standardized prevalence of YOPD was 10.2 per 100,000 persons globally while it was 14.7 per 100,000 population in European countries. Age-standardized prevalence estimates for 5-year age bands showed that the YOPD prevalence estimates varied from 6.1 per 100,000 population in the group aged 20-24 to 16.1 per 100,000 population in the group aged 35-39. Also, the age-standardized incidence of YOPD was 1.3 per 100,000 person-years population worldwide and 1.2 per 100,000 person-years in the European population. CONCLUSION Based on this systematic review and meta-analysis, the overall prevalence of YOPD is 10.2 per 100,000 population, although estimates of the prevalence and incidence in low-income countries remain scarce. To improve monitoring and certain diagnoses of YOPD, healthcare providers and policymakers should be aware that much more effective tools are required.
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Affiliation(s)
- Fardin Nabizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Homa Seyedmirzaei
- School of Medicine, Tehran University of Medical Science, Tehran, Iran; Interdisciplinary Neuroscience Research Program (INRP) , Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Rafiei
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Dorsa Shekouh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Mehrtabar
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | | | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Grotewold N, Albin RL. Update: Descriptive epidemiology of Parkinson disease. Parkinsonism Relat Disord 2024; 120:106000. [PMID: 38233324 PMCID: PMC10922566 DOI: 10.1016/j.parkreldis.2024.106000] [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: 11/08/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
We review the descriptive epidemiology of Parkinson disease (PD). PD is a prevalent neurologic disorder in high Socio-Demographic Index (SDI) nations with rising prevalence in low and middle SDI nations. PD became a prevalent disorder in high SDI nations during the 20th century. Population growth, population aging, and increased disease duration are major drivers of rising PD prevalence. Exposure to industrial toxicants may also be a contributor to rising PD prevalence. PD is an age-related disorder with incidence likely peaking in the 8th decade of life and prevalence in the 9th decade of life. PD is notable for significant sex difference in PD risk with greater risk in men. There may be ancestral differences in PD prevalence and risk. PD is associated with moderately increased mortality though this may be underestimated. Despite significant research, there is considerable uncertainty about basic features of PD epidemiology.
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Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
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Gonzalez MC, Tovar‐Rios DA, Alves G, Dalen I, Williams‐Gray CH, Camacho M, Forsgren L, Bäckström D, Lawson RA, Macleod AD, Counsell CE, Paquet C, DeLena C, D'Antonio F, Pilotto A, Padovani A, Blanc F, Falup‐Pecurariu C, Lewis SJ, Rejdak K, Papuc E, Hort J, Nedelska Z, O'Brien J, Bonanni L, Marquié M, Boada M, Pytel V, Abdelnour C, Alcolea D, Beyer K, Tysnes O, Aarsland D, Maple‐Grødem J. Cognitive and Motor Decline in Dementia with Lewy Bodies and Parkinson's Disease Dementia. Mov Disord Clin Pract 2023; 10:980-986. [PMID: 37332651 PMCID: PMC10272890 DOI: 10.1002/mdc3.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 06/20/2023] Open
Abstract
Background There is a need to better understand the rate of cognitive and motor decline of Dementia with Lewy bodies (DLB) and Parkinson's disease Dementia (PDD). Objectives To compare the rate of cognitive and motor decline in patients with DLB and PDD from the E-DLB Consortium and the Parkinson's Incidence Cohorts Collaboration (PICC) Cohorts. Methods The annual change in MMSE and MDS-UPDRS part III was estimated using linear mixed regression models in patients with at least one follow-up (DLB n = 837 and PDD n = 157). Results When adjusting for confounders, we found no difference in the annual change in MMSE between DLB and PDD (-1.8 [95% CI -2.3, -1.3] vs. -1.9 [95% CI -2.6, -1.2] [P = 0.74]). MDS-UPDRS part III showed nearly identical annual changes (DLB 4.8 [95% CI 2.1, 7.5]) (PDD 4.8 [95% CI 2.7, 6.9], [P = 0.98]). Conclusions DLB and PDD showed similar rates of cognitive and motor decline. This is relevant for future clinical trial designs.
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Affiliation(s)
- Maria Camila Gonzalez
- Department of Quality and Health Technology, Faculty of Health SciencesUniversity of StavangerStavangerNorway
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
| | - Diego Alejandro Tovar‐Rios
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
- Grupos de investigación INFERIR and PRECEC, Section of BiostatisticsUniversidad del ValleSantiago de CaliColombia
| | - Guido Alves
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
- Department of Chemistry, Bioscience and Environmental EngineeringUniversity of StavangerStavangerNorway
- Department of NeurologyStavanger University HospitalStavangerNorway
| | - Ingvild Dalen
- Department of NeurologyStavanger University HospitalStavangerNorway
| | | | - Marta Camacho
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeEngland
| | - Lars Forsgren
- Department of Clinical Science, NeurosciencesUmeå UniversityUmeåSweden
| | - David Bäckström
- Department of Clinical Science, NeurosciencesUmeå UniversityUmeåSweden
| | - Rachael A. Lawson
- Translational and Clinical Research InstituteNewcastle UniversityTyneUK
| | - Angus D. Macleod
- Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Carl E. Counsell
- Institute of Applied Health SciencesUniversity of Aberdeen, Polwarth BuildingAberdeenUK
| | - Claire Paquet
- Université de Paris, Cognitive Neurology Center, APHP, Lariboisière Fernand‐Widal HospitalParisFrance
| | - Carlo DeLena
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Frédéric Blanc
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics DepartmentUniversity Hospital of StrasbourgStrasbourg CedexFrance
| | - Cristian Falup‐Pecurariu
- Department of Neurology, County Clinic Hospital, Faculty of MedicineTransilvania UniversityBrasovRomania
| | | | - Konrad Rejdak
- Department of NeurologyMedical University of LublinLublinPoland
| | - Ewa Papuc
- Department of NeurologyMedical University of LublinLublinPoland
| | - Jakub Hort
- Memory Clinic, Department of NeurologyCharles University, 2nd Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Zuzana Nedelska
- Memory Clinic, Department of NeurologyCharles University, 2nd Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - John O'Brien
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - Laura Bonanni
- Department of Medicine and Aging SciencesUniversity Gd'Annunzio of Chieti‐PescaraChietiItaly
| | - Marta Marquié
- Ace Alzheimer Center Barcelona—Universitat Internacional de CatalunyaBarcelonaSpain
| | - Mercè Boada
- Ace Alzheimer Center Barcelona—Universitat Internacional de CatalunyaBarcelonaSpain
| | - Vanesa Pytel
- Ace Alzheimer Center Barcelona—Universitat Internacional de CatalunyaBarcelonaSpain
| | - Carla Abdelnour
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, IIB Sant Pau—Hospital de Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Katrin Beyer
- Department NeuroscienceResearch Institute Germans Trias i PujolBadalonaSpain
| | - Ole‐Bjørn Tysnes
- Department of NeurologyHaukeland University HospitalBergenNorway
| | - Dag Aarsland
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
- Department of Old Age PsychiatryInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Jodi Maple‐Grødem
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
- Department of Chemistry, Bioscience and Environmental EngineeringUniversity of StavangerStavangerNorway
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Ling Y, Zhu J, Yan F, Tse LA, Kinra S, Jiang M. Sleep behaviors and Parkinson's disease: A bidirectional Mendelian randomization analysis. Behav Brain Res 2023; 441:114281. [PMID: 36608706 DOI: 10.1016/j.bbr.2022.114281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/14/2022] [Accepted: 12/25/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Whether the quantity and quality of sleep are the risk factors for the development of Parkinson's disease remains unclear though it has now been confirmed that the quality of sleep among patients with Parkinson's disease is affected at the prodromal and clinical stages. Accordingly, this study aimed to examine the bidirectional causal relationships of multiple sleep-related phenotypes with Parkinson's disease using a two-sample Mendelian randomization (MR) method. METHODS The summary-level data collected from the published genome-wide association studies was used for analysis. Besides, the genetic relationships between different sleep-related phenotypes, including self-reported and accelerometer measured traits, were estimated for the risk and age at the onset of Parkinson's disease. To conduct MR analysis, inverse variance weighted, weight median, MR-Egger, and MR-PRESSO method were mainly used. Moreover, sensitivity analyses were carried out to examine the pleiotropic effect. RESULTS In general, there was insufficient evidence to support the causal effect of sleep-related phenotypes on risk (N cases/controls = 33,674/449,056) and age at the onset (N cases = 28,568) of Parkinson's disease. However, the results of this study indicated that the later onset age of Parkinson's disease was related to the frequent occurrence of insomnia (OR [95% CI] 1.007 [1.003, 1.011], P < 0.001) after the adjustment for multiple testing. CONCLUSIONS The results of this study suggest that insomnia-associated single nucleotide polymorphisms are more frequent in later onset Parkinson's disease patients compared to earlier onset patients. However, given the limitations of statistical power and potential bias, further validation should be still conducted through larger population research.
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Affiliation(s)
- Yuxiao Ling
- School of Public Health, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Jiahao Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Feng Yan
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310052, China
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, New Territories 999077, Hong Kong
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - MinMin Jiang
- Key Laboratory of Pollution Exposure and Health Intervention of Zhejiang Province, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310015, China.
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Kiesmann M, Martin RE, Sauleau E, Bulubas I, Fleury MC, Perisse J, Kaltenbach G, Schmitt E. Diagnosis of vascular parkinsonism: A new tool for gait hypokinesia occurring in older persons. Parkinsonism Relat Disord 2023; 109:105360. [PMID: 36921515 DOI: 10.1016/j.parkreldis.2023.105360] [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: 09/15/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Reliable diagnosis of vascular parkinsonism (VaP) in the presence of a gait hypokinesia is an issue that is encountered in geriatrics. The EVAMAR-AGEX study was focusing on the phenomenon of recurrent falls in older persons (OP) with this parkinsonian gait. The present study is focusing on the diagnosis of VaP-related parkinsonian gait by developing a diagnostic guidance model adapted to OP. METHODS Data from baseline and the 2-year follow-up visit were used to carry out univariate analysis and calculation of odds ratios, allowing to identify relevant variables to include in the diagnostic guidance model. To evaluate the model, confusion matrices were created, evaluating true positive, false negative, false positive and true negative incidences, sensitivity and specificity, and negative and positive predictive values. RESULTS 79 patients included 58% male; average age 81.24 years. VaP diagnosis according to Zijlmans criteria occurred in 28%; neurodegenerative parkinsonian syndromes in 72%. A 4-criteria model was established to facilitate diagnostic: lack of prior hallucinations, lack of movement disorders tremor excluded, no cognitive fluctuations, and ≥75 years of age at diagnosis. In combination of 4/4 criteria, all of them were required to disclose a specificity of 91% in the diagnosis of VaP. In combination of 3/4, in case of negative test, a negative predictive value for VaP diagnosis of 0.97 was obtained. CONCLUSION The challenge of our tool is both to be able to rule out what is probably not a VaP and to argue what makes a VaP diagnosis probable in OP.
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Affiliation(s)
- Michèle Kiesmann
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Erik Sauleau
- Biostatistical Laboratory, iCube - CNRS UMR 7357, Department of Public Health, Methods in Clinical Research, University of Strasbourg, Strasbourg, France
| | - Irina Bulubas
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Marie Céline Fleury
- Neurology Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Jérémie Perisse
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Georges Kaltenbach
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Elise Schmitt
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France; EA-3072, University of Strasbourg, Strasbourg, France.
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Caminiti SP, Boccalini C, Nicastro N, Garibotto V, Perani D. Sex differences in brain metabolic connectivity architecture in probable dementia with Lewy bodies. Neurobiol Aging 2023; 126:14-24. [PMID: 36905876 DOI: 10.1016/j.neurobiolaging.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
We investigated how sex modulates metabolic connectivity alterations in probable dementia with Lewy bodies (pDLB). We included 131 pDLB patients (males/females: 58/73) and similarly aged healthy controls (HC) (male/female: 59/75) with available (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans. We assessed (1) sex differences in the whole-brain connectivity, identifying pathological hubs, (2) connectivity alterations in functional pathways of the neurotransmitter systems, (3) Resting State Networks (RSNs) integrity. Both pDLBM (males) and pDLBF (females) shared dysfunctional hubs in the insula, Rolandic operculum, and inferior parietal lobule, but the pDLBM group showed more severe and diffuse whole-brain connectivity alterations. Neurotransmitters connectivity analysis revealed common alterations in dopaminergic and noradrenergic pathways. Sex differences emerged particularly in the Ch4-perisylvian division, with pDLBM showing more severe alterations than pDLBF. The RSNs analysis showed no sex differences, with decreased connectivity strength in the primary visual, posterior default mode, and attention networks in both groups. Extensive connectivity changes characterize both males and females in the dementia stage, with a major vulnerability of cholinergic neurotransmitter systems in males, possibly contributing to the observed different clinical phenotypes.
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Affiliation(s)
- Silvia Paola Caminiti
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Boccalini
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Nicastro
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland; Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - Daniela Perani
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Najafi F, Mansournia MA, Abdollahpour I, Rohani M, Vahid F, Nedjat S. Association between socioeconomic status and Parkinson's disease: findings from a large incident case-control study. BMJ Neurol Open 2023; 5:e000386. [PMID: 36817512 PMCID: PMC9933671 DOI: 10.1136/bmjno-2022-000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/29/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction The association between socioeconomic status (SES) and Parkinson's disease (PD) has been investigated in few studies. To our knowledge, SES measurement based on wealth index and perceived SES in PD patients has not been investigated in any study. Also, the simultaneous measurement of objective and perceived SES and their association with PD has not been conducted yet. This study aimed to determine the association between various SES indicators and PD. Methods This incident case-control study was conducted on 508 patients with PD and 1015 controls randomly selected from the general population in Iran in 2021-2022. A telephone interviewing method was used for data collection. The wealth index and educational level were used to measure objective SES. Perceived SES was also recorded. Multiple logistic regression was used to calculate the adjusted OR (AOR). Results A significant association based on the wealth index was found, where the intermediate category had lower odds of developing PD than the deprived category (AOR 0.75 (95% CI 0.58 to 0.99)). The odds of PD was significantly higher in the people with academic education compared with illiterate and primary-level education (AOR 2.17 (95% CI 1.58 to 2.99). Additionally, the odds of PD were significantly lower in the intermediate (AOR 0.26 (95% CI 0.13 to 0.52)) and affluent (AOR 0.21 (95% CI 0.11 to 0.40)), compared with the deprived categories based on perceived SES. Similar results were obtained in the analysis by sex. Conclusion This study demonstrated that lower wealth index, a lower perceived SES and academic education are associated with increased the odds of PD.
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Affiliation(s)
- Fereshteh Najafi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Ibrahim Abdollahpour
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Mohammad Rohani
- Department of Neurology, School of Medicine, Hazrat Rasool-E Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Farhad Vahid
- Department of Nutritional Sciences, School of Health, Arak University of Medical Sciences, Arak, Iran (the Islamic Republic of),Nutrition and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Kang SH, Moon SJ, Kang M, Chung SJ, Cho GJ, Koh SB. Incidence of Parkinson's disease and modifiable risk factors in Korean population: A longitudinal follow-up study of a nationwide cohort. Front Aging Neurosci 2023; 15:1094778. [PMID: 36865411 PMCID: PMC9971569 DOI: 10.3389/fnagi.2023.1094778] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction We aimed to investigate the incidence of Parkinson's disease (PD) by age and year for each sex as well as the modifiable risk factors for PD. Using data from the Korean National Health Insurance Service, 938,635 PD and dementia-free participants aged ≥40 years who underwent general health examinations were followed to December 2019. Methods We analyzed the PD incidence rates according to age, year and sex. To investigate the modifiable risk factors for PD, we used the Cox regression model. Additionally, we calculated the population-attributable fraction to measure the impact of the risk factors on PD. Results During follow-up, 9,924 of the 938,635 (1.1%) participants developed PD. The incidence of PD increased continuously from 2007 to 2018, reaching 1.34 per 1,000 person-years in 2018. The incidence of PD also increases with age, up to 80 y. Presence of hypertension (SHR = 1.09, 95% CI 1.05 to 1.14), diabetes (SHR = 1.24, 95% CI 1.17 to 1.31), dyslipidemia (SHR = 1.12, 95% CI 1.07 to 1.18), ischemic stroke (SHR = 1.26, 95% CI 1.17 to 1.36), hemorrhagic stroke (SHR = 1.26, 95% CI 1.08 to 1.47), ischemic heart disease (SHR = 1.09, 95% CI 1.02 to 1.17), depression (SHR = 1.61, 95% CI 1.53 to 1.69), osteoporosis (SHR = 1.24, 95% CI 1.18 to 1.30), and obesity (SHR = 1.06, 95% CI 1.01 to 1.10) were independently associated with a higher risk for PD. Discussion Our results highlight the effect of modifiable risk factors for PD in the Korean population, which will help establish health care policies to prevent the development of PD.
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Affiliation(s)
- Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seok-Joo Moon
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Minwoong Kang
- Department of Biomedical Research Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Chung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea,*Correspondence: Seong-Beom Koh,
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11
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Brumm MC, Siderowf A, Simuni T, Burghardt E, Choi SH, Caspell-Garcia C, Chahine LM, Mollenhauer B, Foroud T, Galasko D, Merchant K, Arnedo V, Hutten SJ, O’Grady AN, Poston KL, Tanner CM, Weintraub D, Kieburtz K, Marek K, Coffey CS. Parkinson's Progression Markers Initiative: A Milestone-Based Strategy to Monitor Parkinson's Disease Progression. JOURNAL OF PARKINSON'S DISEASE 2023; 13:899-916. [PMID: 37458046 PMCID: PMC10578214 DOI: 10.3233/jpd-223433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Identifying a meaningful progression metric for Parkinson's disease (PD) that reflects heterogeneity remains a challenge. OBJECTIVE To assess the frequency and baseline predictors of progression to clinically relevant motor and non-motor PD milestones. METHODS Using data from the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort, we monitored 25 milestones across six domains ("walking and balance"; "motor complications"; "cognition"; "autonomic dysfunction"; "functional dependence"; "activities of daily living"). Milestones were intended to be severe enough to reflect meaningful disability. We assessed the proportion of participants reaching any milestone; evaluated which occurred most frequently; and conducted a time-to-first-event analysis exploring whether baseline characteristics were associated with progression. RESULTS Half of participants reached at least one milestone within five years. Milestones within the cognitive, functional dependence, and autonomic dysfunction domains were reached most often. Among participants who reached a milestone at an annual follow-up visit and remained active in the study, 82% continued to meet criteria for any milestone at one or more subsequent annual visits and 55% did so at the next annual visit. In multivariable analysis, baseline features predicting faster time to reaching a milestone included age (p < 0.0001), greater MDS-UPDRS total scores (p < 0.0001), higher GDS-15 depression scores (p = 0.0341), lower dopamine transporter binding (p = 0.0043), and lower CSF total α-synuclein levels (p = 0.0030). Symptomatic treatment was not significantly associated with reaching a milestone (p = 0.1639). CONCLUSION Clinically relevant milestones occur frequently, even in early PD. Milestones were significantly associated with baseline clinical and biological markers, but not with symptomatic treatment. Further studies are necessary to validate these results, further assess the stability of milestones, and explore translating them into an outcome measure suitable for observational and therapeutic studies.
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Affiliation(s)
- Michael C. Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elliot Burghardt
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Seung Ho Choi
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Samantha J. Hutten
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Alyssa N. O’Grady
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Kathleen L. Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, SanFrancisco, CA, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Departmentof Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - on behalf of the Parkinson’s Progression Markers Initiative
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, University of California, San Diego, CA, USA
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, SanFrancisco, CA, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Departmentof Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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12
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Rahimpour A, Heidarzadehpilehrood R, Abdollahi S, Ranjbari H, Shams Z, Ghasemi SA, Najmaei S, Pirhoushiaran M. A comprehensive bioinformatic analysis revealed novel MicroRNA biomarkers of Parkinson's disease. Cell Biol Int 2022; 46:1841-1851. [PMID: 36098337 DOI: 10.1002/cbin.11869] [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: 03/02/2022] [Revised: 06/18/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022]
Abstract
Parkinson's disease (PD) is categorized as a neurodegenerative disorder. Different studies have focused on the role of microRNAs (miRNAs) on PD progression. Due to its complexity in initiation and progression, a considerable requirement has arisen to identify novel miRNA biomarkers in a noninvasive manner. In silico analysis has been used to select differentially expressed miRNAs (DE-miRNAs) and key pathways in this disease. In this manner, several data sets of different neurodegenerative diseases have been analyzed to purify the findings of the present study. Totally, 15 DE miRNAs showed significant changes compared to healthy controls and other neurodegenerative diseases. Then, the targets of the miRNAs were predicted through miRTarBase and TargetScan databases. Besides, enrichment analysis was implemented for predicted target genes. Most of the target genes were enriched in the TRAIL signaling pathway, Regulation of nucleobase, nucleoside, nucleotide and nucleic acid metabolism, protein serine/threonine kinase activity, and Cytoplasm. Moreover, a protein-protein interaction network was constructed to find the most key DE miRNAs and targets in this disease. The results of the present study may help researchers shed light on the discovery of novel biomarkers for PD.
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Affiliation(s)
- Alireza Rahimpour
- Islamic Azad University of science and research branch Tehran, Tehran, Iran
| | - Roozbeh Heidarzadehpilehrood
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sepideh Abdollahi
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Haidar Ranjbari
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Zinat Shams
- Department of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Seyed Abbas Ghasemi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Shima Najmaei
- University of Rostock, Institute of Biological Sciences, Division of Microbiology, A.-Einstein-Str. 3, Rostock, Germany
| | - Maryam Pirhoushiaran
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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13
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Szwedo AA, Dalen I, Pedersen KF, Camacho M, Bäckström D, Forsgren L, Tzoulis C, Winder-Rhodes S, Hudson G, Liu G, Scherzer CR, Lawson RA, Yarnall AJ, Williams-Gray CH, Macleod AD, Counsell CE, Tysnes OB, Alves G, Maple-Grødem J. GBA and APOE Impact Cognitive Decline in Parkinson's Disease: A 10-Year Population-Based Study. Mov Disord 2022; 37:1016-1027. [PMID: 35106798 PMCID: PMC9362732 DOI: 10.1002/mds.28932] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Common genetic variance in apolipoprotein E (APOE), β-glucocerebrosidase (GBA), microtubule-associated protein tau (MAPT), and α-synuclein (SNCA) has been linked to cognitive decline in Parkinson's disease (PD), although studies have yielded mixed results. OBJECTIVES To evaluate the effect of genetic variants in APOE, GBA, MAPT, and SNCA on cognitive decline and risk of dementia in a pooled analysis of six longitudinal, non-selective, population-based cohorts of newly diagnosed PD patients. METHODS 1002 PD patients, followed for up to 10 years (median 7.2 years), were genotyped for at least one of APOE-ε4, GBA mutations, MAPT H1/H2, or SNCA rs356219. We evaluated the effect of genotype on the rate of cognitive decline (Mini-Mental State Examanation, MMSE) using linear mixed models and the development of dementia (diagnosed using standardized criteria) using Cox regression; multiple comparisons were accounted for using Benjamini-Hochberg corrections. RESULTS Carriers of APOE-ε4 (n = 281, 29.7%) and GBA mutations (n = 100, 10.3%) had faster cognitive decline and were at higher risk of progression to dementia (APOE-ε4, HR 3.57, P < 0.001; GBA mutations, HR 1.76, P = 0.001) than non-carriers. The risk of cognitive decline and dementia (HR 5.19, P < 0.001) was further increased in carriers of both risk genotypes (n = 23). No significant effects were observed for MAPT or SNCA rs356219. CONCLUSIONS GBA and APOE genotyping could improve the prediction of cognitive decline in PD, which is important to inform the clinical trial selection and potentially to enable personalized treatment © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Aleksandra A. Szwedo
- The Norwegian Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Kenn Freddy Pedersen
- The Norwegian Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Marta Camacho
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David Bäckström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
- Department of Neurology, and Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Charalampos Tzoulis
- Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Gavin Hudson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ganqiang Liu
- Neurobiology Research Center, School of Medicine, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Clemens R. Scherzer
- Center for Advanced Parkinson Research, Harvard Medical School, Brigham and Women’s Hospital, Boston, USA
| | - Rachael A. Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Angus D. Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Carl E. Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Guido Alves
- The Norwegian Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jodi Maple-Grødem
- The Norwegian Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
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14
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The incidence, baseline predictors, and outcomes of dementia in an incident cohort of Parkinson's disease and controls. J Neurol 2022; 269:4288-4298. [PMID: 35307754 PMCID: PMC9294013 DOI: 10.1007/s00415-022-11058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are few long-term data on the incidence, baseline predictors, and outcomes of dementia in Parkinson's disease (PD) from prospective community-based incident cohorts. METHODS The PINE study prospectively identified all incident PD patients in Aberdeen along with age-sex-matched, community-based controls who consented to standardized annual life-long follow-up. Each year, a clinical expert reviewed the diagnosis of PD and the presence of dementia according to DSM-IV-based criteria. Age-sex stratified incidence rates for dementia in PD and controls were calculated and compared with hazard ratios (HR) adjusted for age, sex, education, and socioeconomic status. Cox proportional-hazard modelling was used to assess baseline predictors for PD dementia and the influence of dementia on survival and institutionalization. RESULTS 201 patients (mean age 72.6yrs) and 260 controls (mean age 75.4yrs) were followed for median 9.5 years. The incidence of dementia was 7.4 (PD) versus 2.1 (controls) per 100 person-years (adjusted HR 6.0, 95%CI 4.1-8.7), with a sixfold increase from under 60 to over 80 years in PD but no sex difference. Independent baseline predictors of PD dementia were older age at diagnosis, self-reported cognitive symptoms, dream enactment, lower MMSE scores, worse motor UPDRS scores, and the ApoE genotype. PD dementia increased the rates of subsequent death and institutionalization (32.0 and 26.9 per 100 person-years, respectively). CONCLUSION The incidence of dementia in PD is high, increases markedly with age, is increased in those with baseline subjective cognitive symptoms as well as other established risk factors, and is associated with high rates of death and institutionalization.
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15
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Virameteekul S, Phokaewvarangkul O, Bhidayasiri R. Profiling the most elderly parkinson's disease patients: Does age or disease duration matter? PLoS One 2021; 16:e0261302. [PMID: 34937068 PMCID: PMC8694485 DOI: 10.1371/journal.pone.0261302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite our ageing populations, elderly patients are underrepresented in clinical research, and ageing research is often separate from that of Parkinson's disease (PD). To our knowledge, no previous study has focused on the most elderly ('old-old', age ≥ 85 years) patients with PD to reveal how age directly influences PD clinical progression. OBJECTIVE We compared the clinical characteristics and pharmacological profiles, including complications of levodopa treatment, disease progression, disabilities, and comorbidities of the old-old with those of comparable younger ('young-old', age 60-75 years) PD patients. In addition, within the old-old group, we compared those with a short disease duration (< 10 years at the time of diagnosis) to those with a long disease duration ≥10 years to investigate whether prognosis was related to disease progression or aging. METHODS This single-centre, case-control study compared 60 old-old to 92 young-old PD patients, matched for disease duration. Patients in the old-old group were also divided equally (30:30) into two subgroups (short and long disease duration) with the same mean age. We compared the groups based on several clinical measures using a conditional logistic regression. RESULTS By study design, there were no differences between age groups when comparing disease duration, however, the proportion of men decreased with age (p = 0.002). At a comparable length of PD duration of 10 years, the old-old PD patients predominantly had significantly greater postural instability and gait disturbance (p = 0.006), higher motor scope of the Unified Parkinson's Disease Rating Scale (UPDRS-III, p<0.0001), and more advanced Hoehn & Yahr (H&Y) stage (p<0.0001). The Non-Motor Symptoms Questionnaire (NMSQuest) score was also significantly higher among the old-old (p<0.0001) compared to the young-old patients. Moreover, the distribution of NMS also differed between ages, with features of gastrointestinal problems (p<0.0001), urinary problems (p = 0.004), sleep disturbances and fatigue (p = 0.032), and cognitive impairment (p<0.0001) significantly more common in the old-old group, whereas sexual problems (p = 0.012), depression, and anxiety (p = 0.032) were more common in the young-old. No differences were found in visual hallucinations, cerebrovascular disease, and miscellaneous domains. While young-old PD patients received higher levodopa equivalent daily doses (p<0.0001) and developed a significant greater rate of dyskinesia (p = 0.002), no significant difference was observed in the rate of wearing-off (p = 0.378). Old-old patients also had greater disability, as measured by the Schwab and England scale (p<0.0001) and had greater milestone frequency specifically for dementia (p<0.0001), wheelchair placement (p<0.0001), nursing home placement (p = 0.019), and hospitalisation in the past 1 year (p = 0.05). Neither recurrent falls (p = 0.443) nor visual hallucinations (p = 0.607) were documented significantly more often in the old-old patients. CONCLUSIONS Age and disease duration were independently associated with clinical presentation, course, and progression of PD. Age was the main predictor, but disease duration also had a strong effect, suggesting that factors of the ageing process beyond the disease process itself cause PD in the most elderly to be more severe.
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Affiliation(s)
- Sasivimol Virameteekul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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16
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Green S, Perrott SL, McCleary A, Sleeman I, Maple-Grødem J, Counsell CE, Macleod AD. First delirium episode in Parkinson's disease and parkinsonism: incidence, predictors, and outcomes. NPJ PARKINSONS DISEASE 2021; 7:92. [PMID: 34635668 PMCID: PMC8505483 DOI: 10.1038/s41531-021-00234-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson’s disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.1 (95% confidence interval [CI] 6.6–9.9) in PD and 18.5 (95% CI 13.9–24.7) in AP. Independent predictors of delirium were atypical parkinsonism (Hazard ratio [HR] vs PD = 2.83 [95% CI 1.60–5.03], age in PD but not in AP (HR for 10-year increase 2.29 [95% CI 1.74–3.02]), baseline MMSE (HR = 0.94 [95% CI 0.89–0.99]), APOE ε4 in PD (HR 2.16 [95% CI 1.15–4.08]), and MAPT H1/H1 in PD (HR 2.08 [95% CI 1.08–4.00]). Hazards of dementia and death after delirium vs before delirium were increased (dementia: HR = 6.93 [95% CI 4.18–11.48] in parkinsonism; death: HR = 3.76 [95% CI 2.65–5.35] in PD, 1.59 [95% CI 1.04–2.42] in AP). Delirium is a common non-motor feature of PD and AP and is associated with increased hazards of dementia and mortality. Whether interventions for early identification and treatment improve outcomes requires investigation.
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Affiliation(s)
- Samantha Green
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sarah L Perrott
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Isobel Sleeman
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Carl E Counsell
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Angus D Macleod
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
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17
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Maple-Grødem J, Paul KC, Dalen I, Ngo KJ, Wong D, Macleod AD, Counsell CE, Bäckström D, Forsgren L, Tysnes OB, Kusters CDJ, Fogel BL, Bronstein JM, Ritz B, Alves G. Lack of Association Between GBA Mutations and Motor Complications in European and American Parkinson's Disease Cohorts. JOURNAL OF PARKINSONS DISEASE 2021; 11:1569-1578. [PMID: 34275908 PMCID: PMC8609705 DOI: 10.3233/jpd-212657] [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: 01/20/2023]
Abstract
Background: Motor complications are a consequence of the chronic dopaminergic treatment of Parkinson’s disease (PD) and include levodopa-induced dyskinesia (LIDs) and motor fluctuations (MF). Currently, evidence is on lacking whether patients with GBA-associated PD differ in their risk of developing motor complications compared to the general PD population. Objective: To evaluate the association of GBA carrier status with the development of LIDS and MFs from early PD. Methods: Motor complications were recorded prospectively in 884 patients with PD from four longitudinal cohorts using part IV of the UPDRS or MDS-UPDRS. Subjects were followed for up to 11 years and the associations of GBA mutations with the development of motor complications were assessed using parametric accelerated failure time models. Results: In 439 patients from Europe, GBA mutations were detected in 53 (12.1%) patients and a total of 168 cases of LIDs and 258 cases of MF were observed. GBA carrier status was not associated with the time to develop LIDs (HR 0.78, 95%CI 0.47 to 1.26, p = 0.30) or MF (HR 1.19, 95%CI 0.84 to 1.70, p = 0.33). In the American cohorts, GBA mutations were detected in 36 (8.1%) patients and GBA carrier status was also not associated with the progression to LIDs (HR 1.08, 95%CI 0.55 to 2.14, p = 0.82) or MF (HR 1.22, 95%CI 0.74 to 2.04, p = 0.43). Conclusion: This study does not provide evidence that GBA-carrier status is associated with a higher risk of developing motor complications. Publication of studies with null results is vital to develop an accurate summary of the clinical features that impact patients with GBA-associated PD.
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Affiliation(s)
- Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Kathie J Ngo
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Darice Wong
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.,Clinical Neurogenomics Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David Bäckström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.,Department of Neurology, and Department of Neuroscience, Yale University School of Medicine, CT, USA
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Cynthia D J Kusters
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - Brent L Fogel
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.,Clinical Neurogenomics Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeff M Bronstein
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
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McIntosh E, Kent S, Gray A, Clarke CE, Williams A, Jenkinson C, Ives N, Patel S, Rick C, Wheatley K, Gray R. Cost-Effectiveness of Dopamine Agonists and Monoamine Oxidase B Inhibitors in Early Parkinson's Disease. Mov Disord 2021; 36:2136-2143. [PMID: 33960511 DOI: 10.1002/mds.28623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The PD MED study reported small but persistent benefits in patient-rated mobility scores and quality of life from initiating therapy with levodopa compared with levodopa-sparing therapies in early Parkinson's disease (PD). OBJECTIVES The objective was to estimate the cost-effectiveness of levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors compared with levodopa alone. METHODS PD MED is a pragmatic, open-label randomized, controlled trial in which patients newly diagnosed with PD were randomly assigned between levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors ) and levodopa alone. Mean quality-adjusted life-years and costs were calculated for each participant. Differences in mean quality-adjusted life-years and costs between levodopa and levodopa-sparing therapies and between dopamine agonists and monoamine oxidase type B inhibitors were estimated using linear regression. RESULTS Over a mean observation period of 4 years, levodopa was associated with significantly higher quality-adjusted life-years (difference, 0.18; 95% CI, 0.05-0.30; P < 0.01) and lower mean costs (£3390; £2671-£4109; P < 0.01) than levodopa-sparing therapies, the difference in costs driven by the higher costs of levodopa-sparing therapies. There were no significant differences in the costs of inpatient, social care, and institutional care between arms. There was no significant difference in quality-adjusted life-years between those allocated dopamine agonists and monoamine oxidase type B inhibitors (0.02; -0.17 to 0.13 in favor of dopamine agonists; P = 0.81); however costs were significantly lower for those allocated monoamine oxidase type B inhibitors (£2321; £1628-£3015; P < 0.01) because of the higher costs of dopamine agonists. There were no significant differences between arms for other costs. CONCLUSIONS Initial treatment with levodopa is highly cost-effective compared with levodopa-sparing therapies. Monoamine oxidase type B inhibitors, as initial levodopa-sparing therapy was more cost-effective, with similar quality-adjusted life-years but lower costs than dopamine agonists. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Seamus Kent
- University of Oxford, Oxford, United Kingdom
| | | | - Carl E Clarke
- University of Birmingham, Birmingham, United Kingdom.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Adrian Williams
- University of Birmingham, Birmingham, United Kingdom.,Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | | | - Natalie Ives
- University of Birmingham, Birmingham, United Kingdom
| | - Smitaa Patel
- University of Birmingham, Birmingham, United Kingdom
| | - Caroline Rick
- University of Nottingham, Nottingham, United Kingdom
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Carlin T, Hansen C, Vuillerme N. Objective Measurement of Walking Activity Using Wearable Technologies in People with Parkinson Disease: A Systematic Review Protocol. Biomed Hub 2021; 6:64-68. [PMID: 34616747 PMCID: PMC8460917 DOI: 10.1159/000516819] [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: 02/22/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a complex neurodegenerative disease with motor and nonmotor symptoms with a multitude of disease variations and severity. Physical activity can improve the management of disease symptoms and increase patients' quality of life. Technological development of small wearable devices allows objective activity measurement such as daily step count. OBJECTIVE To synthesize ongoing and past research on objective walking activity measurements using wearable devices in patients with PD. METHODS PubMed, Cochrane, Web of Science, and PEDro database are systematically searched with no limitation on publication date. Keywords are relative to (1) the population, (2) the measurement tool, and (3) the measured outcomes. Only full-text English articles published in a peer-reviewed journal will be included. Participants do not have to undergo any type of intervention. Included studies must report an objective measurement of walking activity using wearable devices in PD patients. After an independent screening process done by 2 reviewers, data will be extracted from the articles according to the following 5 set of data: (1) the study metrics, (2) the population characteristics, (3) the measurement tools, (4) the experimental procedure, and (5) the reported outcomes. RESULTS The results will contain inter alia summaries of the wearables' specifications, wearing location, and recommendations for feasible methodologies to capture daily walking activity. DISCUSSION This review aims to synthesize the evidence of objective walking activity assessment with wearable devices in patients with PD. It will also provide recommendations with regard to device selection and suggest key points when monitoring walking activity in this specific population.
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Affiliation(s)
- Thomas Carlin
- Laboratory AGEIS, Universitaire Grenoble Alpes, Grenoble, France
- LabCom Telecom4Health, Universitaire Grenoble Alpes, Grenoble, France
| | - Clint Hansen
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nicolas Vuillerme
- Laboratory AGEIS, Universitaire Grenoble Alpes, Grenoble, France
- LabCom Telecom4Health, Universitaire Grenoble Alpes, Grenoble, France
- Institut Universitaire de France, Paris, France
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20
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Disparities in diagnosis, treatment and survival between Black and White Parkinson patients. Parkinsonism Relat Disord 2021; 87:7-12. [PMID: 33905958 DOI: 10.1016/j.parkreldis.2021.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 03/13/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Racial disparities in diagnosis, treatment and survival in Black patients with Parkinson's disease (PD) compared to White patients have not been well studied, largely due to limited number of studies and information on Black patients in healthcare systems. Studying racial disparities and identifying underlying factors in large populations are important to understand PD and improve care. METHODS We retrospectively identified PD patients on both races from 1/1/2006 to 10/31/2017 and compared demographics, socioeconomic status (educations, incomes and insurances), comorbidities (all categories, including mood, cognition and psychosis), treatment (medications for parkinsonism and major non-motor symptoms, and frequency and locations of healthcare) and survival, and identified factors associated with medication usage and survival. RESULTS We retrospectively studied 2033 PD patients, of whom 725 were Black. Black patients lacked male predominance, were 4 years older at first diagnosis here, more likely to smoke and live in a low education and income community, and possessed limited insurances compared to White patients. Black patients also had more comorbidities and were more likely to receive care through emergency or inpatient service, but less likely to be on medications for parkinsonism and mood disorders. Race, age, smoking status, insurance type, frequency and locations of healthcare and comorbidities were associated with medication usage. Black race, older age, inpatient admission and malignancy were associated with increased risk of death. CONCLUSION We revealed racial disparities in diagnosis, treatment and survival, and factors associated with medication usage and survival in the largest reported Black PD cohort from a single center.
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21
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Gan J, Liu S, Wang X, Shi Z, Shen L, Li X, Guo Q, Yuan J, Zhang N, You Y, Lv Y, Zheng D, Ji Y. Clinical characteristics of Lewy body dementia in Chinese memory clinics. BMC Neurol 2021; 21:144. [PMID: 33789600 PMCID: PMC8010972 DOI: 10.1186/s12883-021-02169-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Background Lewy body dementia (LBD), consisting of dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), is the second most common type of neurodegenerative dementia in older people. The current study aimed to investigate the clinical characteristics of LBD in Chinese memory clinics. Methods A total of 8405 dementia medical records were reviewed, revealing 455 patients with LBD. Demographic data, neuropsychological scores, and the scale for Medial Temporal lobe Atrophy (MTA) were then analyzed from nine memory clinics in the China Lewy Body Disease Collaborative Alliance. Results The clinical proportion of LBD among the subjects and among all dementia types was 5.4% (4.9–5.9%) and 7.3% (6.7–8.0%), respectively, with a mean onset age of 68.6 ± 8.4 years. Patients with DLB comprised 5.6% (n = 348, age of onset 69.1 ± 8.3), while PDD comprised 1.7% (n = 107, age of onset 66.7 ± 8.8) of all dementia cases. There were slightly more males than females with DLB (n = 177, 50.9%) and PDD (n = 62, 57.9%). Patients with DLB had a poorer performance compared to those with PDD on the MMSE (16.8 ± 7.1 vs. 19.5 ± 5.7, p = 0.001), the MoCA (11.4 ± 6.6 vs. 14.0 ± 5.8, p<0.001), the CDR (1.8 ± 0.7 vs. 1.6 ± 0.7, p = 0.002), and the MTA (1.8 ± 0.7 vs. 1.2 ± 0.6, p = 0.002). Diagnostic differences for LBD exist among the centers; their reported proportions of those with DLB ranged from 0.7 to 11.4 and those with PDD ranged from 0.0 to 2.9%. Conclusions Variations of diagnoses exists in different regions and the clinical proportion of LBD is likely to be underestimated in China and other regions.
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Affiliation(s)
- Jinghuan Gan
- Department of neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Xiaodan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xudong Li
- Department of neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junliang Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong You
- Department of Neurology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yang Lv
- Department of Geriatrics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongming Zheng
- Department of Neurology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China
| | - Yong Ji
- Department of neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.
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22
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Miyasaki JM, Lim TT, Bhidayasiri R. Editorial: Inclusion, equity, diversity and social justice in movement disorders research. Parkinsonism Relat Disord 2021; 85:114-116. [PMID: 33840573 DOI: 10.1016/j.parkreldis.2021.03.022] [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: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Janis M Miyasaki
- Department of Medicine, Division Neurology, University of Alberta, Edmonton, Canada.
| | | | - Roongroj Bhidayasiri
- Chulalongkorn Centre 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, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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23
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Szwedo AA, Pedersen CC, Ushakova A, Forsgren L, Tysnes OB, Counsell CE, Alves G, Lange J, Macleod AD, Maple-Grødem J. Association of SNCA Parkinson's Disease Risk Polymorphisms With Disease Progression in Newly Diagnosed Patients. Front Neurol 2021; 11:620585. [PMID: 33643180 PMCID: PMC7902914 DOI: 10.3389/fneur.2020.620585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/22/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: To evaluate the impact of SNCA polymorphisms originally identified as risk factors for Parkinson's disease (PD) on the clinical presentation and progression of the disease in a large cohort of population-based patients with incident PD. Methods: Four hundred thirty-three patients and 417 controls from three longitudinal cohorts were included in the study. Disease progression was recorded annually for up to 9 years using the Unified Parkinson's Disease Rating Scale (UPDRS) or Mini-Mental State Examination. Genotypes for five variants within the SNCA locus (rs2870004, rs356182, rs5019538, rs356219, and rs763443) were determined. We studied the association between each variant and disease progression using linear mixed-effects regression models. Results: The clinical profile of the patients with PD at the point of diagnosis was highly uniform between genotype groups. The rs356219-GG genotype was associated with a higher UPDRS II score than A-allele carriers (β = 1.52; 95% confidence interval 0.10–2.95; p = 0.036), but no differences were observed in the rate of progression of the UPDRS II scores. rs356219-GG was also associated with a faster annual change in Mini-Mental State Examination score compared with A-carriers (β = 0.03; 95% confidence interval 0.00–0.06; p = 0.043). Conclusions: We show that the known PD-risk variant rs356219 has a minor effect on modifying disease progression, whereas no differences were associated with rs2870004, rs356182, rs5019538, and rs763443. These findings suggest that SNCA variants associated with PD risk may not be major driving factors to the clinical heterogeneity observed for PD.
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Affiliation(s)
- Aleksandra A Szwedo
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Camilla Christina Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Anastasia Ushakova
- Section of Biostatistics, Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Johannes Lange
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
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24
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Maple-Grødem J, Dalen I, Tysnes OB, Macleod AD, Forsgren L, Counsell CE, Alves G. Association of GBA Genotype With Motor and Functional Decline in Patients With Newly Diagnosed Parkinson Disease. Neurology 2020; 96:e1036-e1044. [PMID: 33443131 PMCID: PMC8055329 DOI: 10.1212/wnl.0000000000011411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To establish the significance of glucocerebrosidase gene (GBA) carrier status on motor impairment in a large cohort of patients with incident Parkinson disease (PD). Methods Three European population-based studies followed 528 patients with PD from diagnosis. A total of 440 with genomic DNA from baseline were assessed for GBA variants. We evaluated motor and functional impairment annually using the Unified Parkinson’s Disease Rating Scale (UPDRS) motor and activities of daily living (ADL) sections. Differential effects of classes of GBA variants on disease progression were evaluated using mixed random and fixed effects models. Results A total of 387 patients with idiopathic disease (age at baseline 70.3 ± 9.5 years; 60.2% male) and 53 GBA carriers (age at baseline 66.8 ± 10.1 years; 64.2% male) were included. The motor profile of the groups was clinically indistinguishable at diagnosis. GBA carriers showed faster annual increase in UPDRS scores measuring ADL (1.5 point per year, 95% confidence interval [CI] 1.1–2.0) and motor symptoms (2.2 points per year, 95% CI 1.3–3.1) compared to noncarriers (ADL, 1.0 point per year, 95% CI 0.9–1.1, p = 0.003; motor, 1.3 point per year, 95% CI 1.1–1.6, p = 0.007). Simulations of clinical trial designs showed that recruiting only GBA carriers can reduce trial size by up to 65% compared to a trial recruiting all patients with PD. Conclusion GBA variants are linked to a more aggressive motor disease course over 7 years from diagnosis in patients with PD. A better understanding of PD progression in genetic subpopulations may improve disease management and has direct implications for improving the design of clinical trials.
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Affiliation(s)
- Jodi Maple-Grødem
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden.
| | - Ingvild Dalen
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden
| | - Ole-Bjørn Tysnes
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden
| | - Angus D Macleod
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden
| | - Lars Forsgren
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden
| | - Carl E Counsell
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden
| | - Guido Alves
- From The Norwegian Centre for Movement Disorders (J.M.-G., G.A.), Department of Research, Section of Biostatistics (I.D.), and Department of Neurology (G.A.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (J.M.-G., G.A.), University of Stavanger; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Department of Clinical Medicine (O.-B.T.), University of Bergen, Norway; Institute of Applied Health Sciences (A.D.M., C.E.C.), University of Aberdeen, UK; and Department of Clinical Science, Neurosciences (L.F.), Umeå University, Sweden
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25
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Accuracy of death certificates for recording parkinsonian syndromes and associated dementia. J Neurol 2020; 268:140-146. [PMID: 32737654 DOI: 10.1007/s00415-020-10113-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Death certification is often used to identify patients with certain diseases in epidemiologic research. There have been few studies looking at the accuracy of recording of parkinsonian diagnoses, any associated dementia and the cause of death on death certificates in people with parkinsonian conditions. This study aimed to assess this. METHODS Data for these analyses were derived from a prospective incident cohort of degenerative/vascular parkinsonian syndromes with lifelong follow-up from Scotland, UK (the PINE study). In those who died, the available research and clinical care records were reviewed to establish the cause for each patient's death. The sensitivity of death certificates was calculated to detect any parkinsonian diagnosis mentioned on the death certificate, the correct specific diagnosis and the presence of dementia. The causes of death were compared between clinical records and death certificates. RESULTS Two hundred and seventy-seven patients had died (180 men), mean age at diagnosis and death 76.9 years and 81.9 years respectively. 66.8% of death certificates mentioned any parkinsonian syndrome but only 49.5% had the correct diagnosis. Sensitivity was highest for Parkinson's disease, those who had parkinsonian-related deaths, had longer disease durations and died out of hospital. Death certificates detected 51.2% of those with dementia. The commonest causes of death were pneumonia, end-stage Parkinsonism and vascular disease with moderate agreement between case-note review and death certification. CONCLUSION Deaths certificates often do not mention underlying Parkinsonism or associated dementia and so epidemiological studies should not rely on this as a sole method of identifying cases or studying mortality.
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Gervasi F, Murtas R, Decarli A, Russo AG. Residential distance from high-voltage overhead power lines and risk of Alzheimer's dementia and Parkinson's disease: a population-based case-control study in a metropolitan area of Northern Italy. Int J Epidemiol 2020; 48:1949-1957. [PMID: 31280302 PMCID: PMC6929536 DOI: 10.1093/ije/dyz139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/17/2022] Open
Abstract
Background The association between the extremely low-frequency magnetic field generated by overhead power lines and neurodegenerative disease is still a matter of debate. Methods A population-based case-control study was carried out on the residents in the Milan metropolitan area between 2011 and 2016 to evaluate the possible association between exposure to extremely low-frequency magnetic fields generated by high-voltage overhead power lines and Alzheimer's dementia and Parkinson's disease. A statistical analysis was performed on cases and controls matched by sex, year of birth and municipality of residence (with a case to controls ratio of 1 : 4) using conditional logistic regression models adjusted for socio-economic deprivation and distance from the major road network as potential confounders. Results Odds ratios for residents <50 m from the source of exposure compared with residents at ≥600 m turned out to be 1.11 (95% confidence interval: 0.95–1.30) for Alzheimer's dementia and 1.09 (95% confidence interval: 0.92–1.30) for Parkinson's disease. Conclusions The finding of a weak association between exposure to the extremely low-frequency magnetic field and neurodegenerative diseases suggests the continuation of research on this topic. Moreover, the low consistency between the results of the already existing studies emphasises the importance of increasingly refined study designs.
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Affiliation(s)
- Federico Gervasi
- Epidemiology Unit, Agency for Health Protection of Milan, 20122 Milan, Italy.,Laboratory of Medical Statistics, Biometrics, and Epidemiology "G A Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rossella Murtas
- Epidemiology Unit, Agency for Health Protection of Milan, 20122 Milan, Italy
| | - Adriano Decarli
- Epidemiology Unit, Agency for Health Protection of Milan, 20122 Milan, Italy
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Ramsay N, Macleod AD, Alves G, Camacho M, Forsgren L, Lawson RA, Maple-Grødem J, Tysnes OB, Williams-Gray CH, Yarnall AJ, Counsell CE. Validation of a UPDRS-/MDS-UPDRS-based definition of functional dependency for Parkinson's disease. Parkinsonism Relat Disord 2020; 76:49-53. [PMID: 32645619 DOI: 10.1016/j.parkreldis.2020.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Functional dependency in basic activities of daily living (ADLs) is a key outcome in Parkinson's disease (PD). We aimed to define dependency in PD, using the original and MDS versions of the Unified Parkinson's Disease Rating Scale (UPDRS). METHODS We developed two algorithms to define dependency from items of UPDRS Part 2 and MDS-UPDRS Part 2 relating to basic ADLs (feeding, dressing, hygiene and walking, and getting out of a chair). We validated both algorithms using data from 1110 patients from six community-based PD incidence cohorts, testing concurrent validity, convergent validity, and predictive validity. RESULTS Our optimal algorithm showed high specificity and moderate to high sensitivity versus Schwab & England <80% (specificity 95% [95% confidence interval (CI) 93-97] and sensitivity 65% [95% CI 55-73] at baseline; 88% [95% CI 85-91] and 85% [95% CI 79-97] respectively at five-years follow-up). Convergent validity was demonstrated by strong associations between dependency defined by the algorithm and cognition (MMSE), quality of life (PDQ39), and impairment (UPDRS part 3) (all p < 0.001). Algorithm-defined dependency status also predicted mortality: HR for mortality in those dependent vs independent at baseline was 1.6 (95%CI 1.2-2.1) and in those dependent vs independent at five-years' follow-up was 2.2 (1.6-3.0). DISCUSSION We have demonstrated the concurrent validity, convergent validity, and predictive validity of a UPDRS-/MDS-UPDRS-based algorithm to define functional dependency in PD. This can be used for studying dependency in any study where UPDRS or MDS-UPDRS part 2 data have been collected.
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Affiliation(s)
- Neil Ramsay
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway; Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Norway.
| | - Marta Camacho
- Department of Clinical Neurosciences, University of Cambridge, UK.
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Sweden.
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway; Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Norway.
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, University of Bergen, Norway.
| | | | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
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Godoi BB, Amorim GD, Quiroga DG, Holanda VM, Júlio T, Tournier MB. Parkinson's disease and wearable devices, new perspectives for a public health issue: an integrative literature review. ACTA ACUST UNITED AC 2020; 65:1413-1420. [PMID: 31800906 DOI: 10.1590/1806-9282.65.11.1413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/31/2019] [Indexed: 11/22/2022]
Abstract
Parkinson's disease is the second most common neurodegenerative disease, with an estimated prevalence of 41/100,000 individuals affected aged between 40 and 49 years old and 1,900/100,000 aged 80 and over. Based on the essentiality of ascertaining which wearable devices have clinical literary evidence and with the purpose of analyzing the information revealed by such technologies, we conducted this scientific article of integrative review. It is an integrative review, whose main objective is to carry out a summary of the state of the art of wearable devices used in patients with Parkinson's disease. After the review, we retrieved 8 papers. Of the selected articles, only 3 were not systematic reviews; one was a series of cases and two prospective longitudinal studies. These technologies have a very rich field of application; however, research is still necessary to make such evaluations reliable and crucial to the well-being of these patients.
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Affiliation(s)
- Bruno Bastos Godoi
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Diamantina, MG, Brasil
| | - Gabriel Donato Amorim
- Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, ES. Brasil
| | | | - Vanessa Milanesi Holanda
- Centro de Neurologia e Neurocirurgia Associados (NeuroCenna), BP - A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Thiago Júlio
- Dasa - Diagnósticos da América, Barueri, SP, Brasil
| | - Marcelo Benedet Tournier
- Hult International Business School. Campus & Enrollment Office. Hult International Business School, Cambridge, MA, USA
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ADAPTATION OF POLYMERASE CHAIN REACTION-RESTRICTION FRAGMENT LENGTH POLYMORPHISM METHOD FOR POLYMORPHISM (RS2583988) ANALYSIS IN ALPHA-SYNUCLEIN GENE. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-3-73-130-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Macleod AD, Counsell CE. Treatment Responsiveness of Motor Features in Parkinson's Disease: A Matched Case-Control Analysis. Mov Disord Clin Pract 2020; 7:45-51. [PMID: 31970211 PMCID: PMC6962676 DOI: 10.1002/mdc3.12856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment response in PD is important clinically and for research diagnostic criteria, but few objective data show treatment-responsiveness of PD motor features. OBJECTIVES To evaluate the treatment response of motor features to moderate treatment doses in a "real-world" PD cohort. METHODS We analyzed data from a community-based incident cohort of PD in North-East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (1) patients with an increase of at least 300 mg of levodopa-equivalent dose (LED) and (2) patients without treatment change, matched for age, sex, and disease duration. RESULTS We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300 to 375 mg/day. Forty-two percent with treatment increase had ≥30% improvement in overall UPDRS motor score, a further 35% had substantial subjective improvement, but only 1 had an objective excellent (>70%) treatment response. Women responded better than men by 5.4 points (95% confidence interval [CI]: 2.7-8.1). All motor features improved with treatment, but after adjustment for age, sex, and initial score, only rest tremor (P < 0.001), rigidity (P = 0.01), bradykinesia (<0.001), posture (P = 0.01), and gait (P = 0.03) had significant improvements, compared to those with no treatment change. Dopa-less-responsive motor items, taken together, had small statistically significant relative improvements (1.1-point difference [95% CI: 0.4-1.8]; P = 0.004). CONCLUSIONS Motor items sometimes previously considered dopa unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.
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Affiliation(s)
- Angus D. Macleod
- Institute of Applied Health Sciences, University of AberdeenAberdeenUnited Kingdom
| | - Carl E. Counsell
- Institute of Applied Health Sciences, University of AberdeenAberdeenUnited Kingdom
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Kim A, Kim A, Kim Y, Kim YE, Kim HJ, Jeon B. Musculoskeletal problems in PD patients have no association with socioeconomic status. J Clin Neurosci 2019; 70:229-233. [DOI: 10.1016/j.jocn.2019.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
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Gumber A, Ramaswamy B, Thongchundee O. Effects of Parkinson's on employment, cost of care, and quality of life of people with condition and family caregivers in the UK: a systematic literature review. Patient Relat Outcome Meas 2019; 10:321-333. [PMID: 31695537 PMCID: PMC6816078 DOI: 10.2147/prom.s160843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background Parkinson’s is an incurable, neuro-degenerative condition with multiple symptoms substantially impacting on living conditions and quality of life (QoL) for people with Parkinson’s (PwP), most whom are older adults, and their families. The study aimed to undertake a literature review of studies conducted in the UK that quantify the direct or indirect impact of Parkinson’s on people with the condition, their families, and society in terms of out-of-pocket payments and financial consequences. Methods Literature was searched for Parkinson’s-related terms plus condition impact (eg, financial, employment, pension, housing, health care costs, and QoL) in the UK setting. The strategy probed several electronic databases with all retrieved papers screened for relevancy. The instruments used to measure patient-related outcomes were then examined for their relevancy in justifying the results. Results The initial search retrieved 2,143 papers of which 79 were shortlisted through title and abstract screening. A full-text reading indicated 38 papers met the inclusion and quality criteria. Summary data extracted from the articles on focus, design, sample size, and questionnaires/instruments used were presented in four themes: (a) QoL and wellbeing of PwP, (b) QoL and wellbeing of caregivers and family members, (c) employment and living conditions, and (d) direct and indirect health care and societal cost. Conclusion UK results substantiated global evidence regarding the deterioration of QoL of PwP as the condition progressed, utilizing numerous measures to demonstrate change. Many spouses and family accept care responsibilities, affecting their QoL and finances too. The review highlighted increased health care and privately borne costs with condition progression, although UK evidence was limited on societal costs of Parkinson’s in terms of loss of employment, reduced work hours, premature retirement of PwP and caregivers that directly affected their household budget.
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Affiliation(s)
- Anil Gumber
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Bhanu Ramaswamy
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Oranuch Thongchundee
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
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Lee JY, Lim NG, Chung CK, Lee JY, Kim HJ, Park SB. Parkinson's Disease as Risk Factor in Osteoporosis and Osteoporotic Vertebral Fracture : Prevalence Study Using National Inpatient Sample Database in Korea. J Korean Neurosurg Soc 2018; 62:71-82. [PMID: 30630295 PMCID: PMC6328797 DOI: 10.3340/jkns.2018.0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/17/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the prevalence of osteoporosis (OP) and osteoporotic vertebral fracture (OVF) in people with Parkinson's disease (PD) in Korea and its association with socioeconomic status. METHODS Using Health Insurance Review and Assessment Service-National Inpatient Sample (HIRA-NIS) data from 2009 to 2013, we estimated the annual prevalence of PD, OP, and OVF and investigated its association with socioeconomic status using data from National Health Insurance (NHI) beneficiaries and Medical Aid (MA) recipients. This study was supported by research funding from Korean Society for Bone and Mineral Research 2015. There were no study-specific biases related to conflicts of interest. RESULTS The number of PD patients in the HIRA-NIS increased each year from 2009 to 2013. Among patients with PD, the standardized prevalence rates of OP and OVF increased from 2009 to 2013; from 23.2 to 27.8 and from 2.8 to 4.2, respectively. Among patients with PD with OP, the prevalence of OVF were 12.2% and 15.1% in 2009 and 2013, respectively. The standardized prevalence rates of PD with OP and PD with OVF were significantly higher in MA recipients than in NHI beneficiaries. CONCLUSION The prevalence of PD both with OP and with OVF increased and the prevalence was higher in MA recipients than in NHI beneficiaries. These findings may suggest that age over 65 years, female and low income may be a significant factor related to PD occurring with OP and OVF.
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Affiliation(s)
- Jin Yong Lee
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Nam Gu Lim
- Department of Medical Administration and Information, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea
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Mouton A, Blanc F, Gros A, Manera V, Fabre R, Sauleau E, Gomez-Luporsi I, Tifratene K, Friedman L, Thümmler S, Pradier C, Robert PH, David R. Sex ratio in dementia with Lewy bodies balanced between Alzheimer's disease and Parkinson's disease dementia: a cross-sectional study. ALZHEIMERS RESEARCH & THERAPY 2018; 10:92. [PMID: 30208961 PMCID: PMC6136211 DOI: 10.1186/s13195-018-0417-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023]
Abstract
Background Gender distribution varies across neurodegenerative disorders, with, traditionally, a higher female frequency reported in Alzheimer’s disease (AD) and a higher male frequency in Parkinson’s disease (PD). Conflicting results on gender distribution are reported concerning dementia with Lewy bodies (DLB), usually considered as an intermediate disease between AD and PD. The aim of the present study was to investigate gender differences in DLB in French specialized memory settings using data from the French national database spanning from 2010 to 2015 and to compare sex ratio in DLB with that in AD, Parkinson’s disease dementia (PDD), and PD. Our hypothesis was that there is a balanced sex ratio in DLB, different from that found in AD and PD. Methods We conducted a repeated cross-sectional study. The study population comprised individuals with a DLB, AD, PDD, or PD diagnosis according to the International Classification of Diseases, Tenth Revision, in the French National Alzheimer Database between 2010 and 2015. Sex ratio and demographic data were compared using multinomial logistic regression and a Bayesian statistical model. Results From 2010 to 2015 in French specialized memory settings, sex ratios (female percent/male percent) were found as follows: 1.21 (54.7%/45.3%) for DLB (n = 10,309), 2.34 (70.1%/29.9%) for AD (n = 135,664), 0.76 (43.1%/56.9%) for PD (n = 8744), and 0.83 (45.4%/54.6%) for PDD (n = 3198). Significant differences were found between each group, but not between PDD and PD, which had a similar sex ratio. Conclusions This large-sample prevalence study confirms the balanced gender distribution in the DLB population compared with AD and PD-PDD. Gender distribution and general demographic characteristics differed between DLB and PDD. This is consistent with the hypothesis that DLB is a distinct disease with characteristics intermediate between AD and PD, as well as with the hypothesis that DLB could have at least partially distinct neuropathological correlates.
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Affiliation(s)
- A Mouton
- Université Côte d'Azur, CobTeK lab, Nice, France. .,Centre Mémoire de Ressources et de Recherche, Institut Claude Pompidou, 10 rue Molière, 06100, Nice, France.
| | - F Blanc
- Geriatrics Department, University Hospitals of Strasbourg, CMRR (Research and Resources Memory Centre), Geriatric Day Hospital, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto, Strasbourg, France
| | - A Gros
- Université Côte d'Azur, CobTeK lab, Nice, France
| | - V Manera
- Université Côte d'Azur, CobTeK lab, Nice, France
| | - R Fabre
- Université Côte d'Azur, CobTeK lab, Nice, France.,Centre Hospitalier Universitaire de Nice, Department of Public Health, L'Archet Hospital, Nice University Hospital, EA 6312, Nice, France
| | - E Sauleau
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357, Strasbourg, France
| | | | - K Tifratene
- Université Côte d'Azur, CobTeK lab, Nice, France.,Antibes Hospital, Memory Center, Antibes, France
| | - L Friedman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - S Thümmler
- Université Côte d'Azur, CobTeK lab, Nice, France.,Centre Hospitalier Universitaire de Nice, University Department of Child and Adolescent Psychiatry, Children's Hospitals CHU-Lenval, Nice, France
| | - C Pradier
- Centre Hospitalier Universitaire de Nice, Department of Public Health, L'Archet Hospital, Nice University Hospital, EA 6312, Nice, France
| | - P H Robert
- Université Côte d'Azur, CobTeK lab, Nice, France
| | - R David
- Université Côte d'Azur, CobTeK lab, Nice, France
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Jurado-Coronel JC, Cabezas R, Ávila Rodríguez MF, Echeverria V, García-Segura LM, Barreto GE. Sex differences in Parkinson's disease: Features on clinical symptoms, treatment outcome, sexual hormones and genetics. Front Neuroendocrinol 2018; 50:18-30. [PMID: 28974386 DOI: 10.1016/j.yfrne.2017.09.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/12/2017] [Accepted: 09/29/2017] [Indexed: 01/14/2023]
Abstract
Parkinson's disease (PD) is the second most frequent age-related neurodegenerative disorder. Sex is an important factor in the development of PD, as reflected by the fact that it is more common in men than in women by an approximate ratio of 2:1. Our hypothesis is that differences in PD among men and women are highly determined by sex-dependent differences in the nigrostriatal dopaminergic system, which arise from environmental, hormonal and genetic influences. Sex hormones, specifically estrogens, influence PD pathogenesis and might play an important role in PD differences between men and women. The objective of this review was to discuss the PD physiopathology and point out sex differences in nigrostriatal degeneration, symptoms, genetics, responsiveness to treatments and biochemical and molecular mechanisms among patients suffering from this disease. Finally, we discuss the role estrogens may have on PD sex differences.
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Affiliation(s)
- Juan Camilo Jurado-Coronel
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Ricardo Cabezas
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | | | - Valentina Echeverria
- Universidad San Sebastián, Fac. Cs de la Salud, Lientur 1457, Concepción, 4080871, Chile; Research & Development Service, Bay Pines VA Healthcare System, Bay Pines, FL 33744, USA
| | - Luis Miguel García-Segura
- Instituto Cajal, CSIC, Madrid, Spain; CIBER de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile.
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Lunde KA, Chung J, Dalen I, Pedersen KF, Linder J, Domellöf ME, Elgh E, Macleod AD, Tzoulis C, Larsen JP, Tysnes OB, Forsgren L, Counsell CE, Alves G, Maple-Grødem J. Association of glucocerebrosidase polymorphisms and mutations with dementia in incident Parkinson's disease. Alzheimers Dement 2018; 14:1293-1301. [PMID: 29792872 DOI: 10.1016/j.jalz.2018.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/24/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Both polymorphisms and mutations in glucocerebrosidase (GBA) may influence the development of dementia in patients with Parkinson's disease. METHODS Four hundred forty-two patients and 419 controls were followed for 7 years. Dementia was diagnosed using established criteria. Participants were analyzed for GBA genetic variants, including E326K, T369M, and L444P. Associations between GBA carrier status and dementia were assessed with Cox survival analysis. RESULTS A total of 12.0% of patients with Parkinson's disease carried a GBA variant, and nearly half (22/53) of them progressed to dementia during follow-up. Carriers of deleterious GBA mutations (adjusted hazard ratio 3.81, 95% confidence interval 1.35 to 10.72; P = .011) or polymorphisms (adjusted hazard ratio 1.79; 95% confidence interval 1.07 to 3.00; P = .028) progressed to dementia more rapidly than noncarriers. DISCUSSION GBA variants are of great clinical relevance for the development of dementia in Parkinson's disease, especially due to the relatively higher frequency of these alleles compared with other risk alleles.
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Affiliation(s)
- Kristin Aaser Lunde
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Centre for Organelle Research, University of Stavanger, Stavanger, Norway
| | - Janete Chung
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Ingvild Dalen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Kenn Freddy Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Linder
- Department of Pharmacology and Clinical Neuroscience, Neurology, Umeå University, Umeå, Sweden
| | - Magdalena E Domellöf
- Department of Pharmacology and Clinical Neuroscience, Neurology, Umeå University, Umeå, Sweden; Department of Psychology, Umeå University, Umeå, Sweden
| | - Eva Elgh
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Angus D Macleod
- Institute of Applied Health Sciences, Polwarth Building, University of Aberdeen, Aberdeen, UK
| | - Charalampos Tzoulis
- Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Petter Larsen
- Network for Medical Sciences, University of Stavanger, Bergen, Norway
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience, Neurology, Umeå University, Umeå, Sweden
| | - Carl E Counsell
- Institute of Applied Health Sciences, Polwarth Building, University of Aberdeen, Aberdeen, UK
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Department of Neurology, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Centre for Organelle Research, University of Stavanger, Stavanger, Norway.
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Macleod AD, Dalen I, Tysnes O, Larsen JP, Counsell CE. Development and validation of prognostic survival models in newly diagnosed Parkinson's disease. Mov Disord 2018; 33:108-116. [PMID: 28976022 PMCID: PMC5813201 DOI: 10.1002/mds.27177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop valid prognostic models to predict mortality, dependency, and "death or dependency" for use in newly diagnosed Parkinson's disease (PD). METHODS The models were developed in the Parkinsonism Incidence in North-East Scotland study (UK, 198 patients) and validated in the ParkWest study (Norway, 192 patients), cohorts that attempted to identify and follow-up all new PD cases in the study area. Dependency was defined using the Schwab & England scale. We selected variables measured at time of diagnosis to include in the models. Internal validation and external validation were performed by calculating C-statistics (discrimination) and plotting observed versus predicted risk in quantiles of predicted risk (calibration). RESULTS Older age, male sex, increased severity of axial features, and Charlson comorbidity index were independent prognostic factors in the mortality model. Increasing age, higher smoking history, increased severity of axial features, and lower MMSE score were independent predictors in the models of dependency and "death or dependency." Each model had very good internal calibration and very good or good discrimination (internal and external C-statistics for the models were 0.73-0.75 and 0.68-0.78, respectively). Although each model clearly separated patients into groups according to risk, they tended to overestimate risk in ParkWest. The models were recalibrated to the baseline risk in the ParkWest study and then calibrated well in this cohort. CONCLUSIONS We have developed prognostic models for predicting medium-term risk of important clinical outcomes in newly diagnosed PD. These models have validity for use for stratification of randomization, confounder adjustment, and case-mix correction, but they are inadequate for individualized prognostication. © 2017. The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Angus D. Macleod
- Division of Applied Health SciencesUniversity of AberdeenForesterhillAberdeenUK
| | - Ingvild Dalen
- Department of Research, Section of BiostatisticsStavanger University HospitalStavangerNorway
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
| | - Ole‐Bjørn Tysnes
- Institute of Clinical MedicineUniversity of BergenBergenNorway
- Department of NeurologyHaukeland University HospitalBergenNorway
| | | | - Carl E. Counsell
- Division of Applied Health SciencesUniversity of AberdeenForesterhillAberdeenUK
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Parkinson’s Disease: Contemporary Concepts and Clinical Management. NEURODEGENER DIS 2018. [DOI: 10.1007/978-3-319-72938-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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39
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Macleod AD, Counsell CE. Predictors of functional dependency in Parkinson's disease. Mov Disord 2017; 31:1482-1488. [PMID: 27548693 PMCID: PMC5082567 DOI: 10.1002/mds.26751] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/19/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Functional dependency, the need for help in basic activities of daily living, is an important patient-oriented outcome. We aimed to describe the development of dependency in Parkinson's disease (PD) and identify independent prognostic factors for this outcome. METHODS We analyzed data from the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective, community-based incident cohort of PD with ongoing follow-up. We described the development of dependency defined by a Schwab & England score of < 80% and a Barthel Index of <19. We identified the baseline predictors of dependency using multivariable Cox regression. RESULTS In 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio for 10-year increase 2.23 [95% confidence interval 1.66-2.98]), greater smoking history (hazard ratio for 10-pack-year increase, 1.15 [1.04-1.26]), more severe axial impairment (hazard ratio for 5-point increase in sum of axial items from UPDRS scale, 1.78 [1.30-2.44]), and lower MMSE score (hazard ratio 0.88 [0.79-0.98]) were independently associated with a higher risk of dependency as defined by Schwab & England. Only older age (hazard ratio for 10-year increase 1.35 [1.04-1.76]) and severity of axial impairment (hazard ratio for 5-point increase 1.85 [1.31-2.62]) were associated with a higher risk of dependency as defined by the Barthel Index. Sex, deprivation, comorbidity, overall UPDRS motor score, and disease stage were not independently associated with dependency. CONCLUSION This is the first community-based study of dependency in PD. There was a high rate of dependency development. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
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Nerius M, Fink A, Doblhammer G. Parkinson's disease in Germany: prevalence and incidence based on health claims data. Acta Neurol Scand 2017; 136:386-392. [PMID: 27726128 PMCID: PMC5655709 DOI: 10.1111/ane.12694] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Germany, epidemiological information on Parkinson's disease (PD) is rare and outdated. Considering aging populations, current prevalences and incidence rates about this age-related disease would be important for adequate public health planning. METHODS We used newly available health claims data sets from the largest German health insurer dating 2004-2007 and 2007-2010 with an analysis population in the base years of 491 038 persons aged 50 and older. Quarter-specific information about ICD-10 diagnoses and PD drug prescriptions from the inpatient and outpatient sectors was used to validate PD cases. Estimations were presented for two validation strategies relying on repeated PD diagnoses (SIa) and on one PD diagnosis followed by at least one PD drug prescription (SIb). RESULTS The standardized prevalence was 797 (SIb) to 961/100 000 persons (SIa), showing an age-specific increase up to category 85-89 and a decline thereafter. The standardized incidence rate was 192 to 229/100 000 person-years with a similar age-specific shape. Prevalences and incidences rates were higher for men compared to women in regard to age. CONCLUSIONS Health claims data are found to be suitable for PD assessment using the repeated diagnoses or PD drug prescriptions as necessary criteria.
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Affiliation(s)
- M. Nerius
- German Center for Neurodegenerative Diseases (DZNE); Bonn Germany
- Rostock Center for the Study of Demographic Change; Rostock Germany
- Institute for Sociology and Demography; University of Rostock; Rostock Germany
| | - A. Fink
- German Center for Neurodegenerative Diseases (DZNE); Bonn Germany
- Rostock Center for the Study of Demographic Change; Rostock Germany
| | - G. Doblhammer
- German Center for Neurodegenerative Diseases (DZNE); Bonn Germany
- Rostock Center for the Study of Demographic Change; Rostock Germany
- Institute for Sociology and Demography; University of Rostock; Rostock Germany
- Max Planck Institute for Demographic Research; Rostock Germany
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Cumming K, Macleod AD, Myint PK, Counsell CE. Early weight loss in parkinsonism predicts poor outcomes: Evidence from an incident cohort study. Neurology 2017; 89:2254-2261. [PMID: 29079685 PMCID: PMC5705250 DOI: 10.1212/wnl.0000000000004691] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 09/11/2017] [Indexed: 01/27/2023] Open
Abstract
Objective: To compare weight change over time in patients with Parkinson disease (PD), those with atypical parkinsonism, and matched controls; to identify baseline factors that influence weight loss in parkinsonism; and to examine whether it predicts poor outcome. Methods: We analyzed data from the Parkinsonism Incidence in North-East Scotland (PINE) study, an incident, population-based prospective cohort of parkinsonian patients and age- and sex-matched controls with annual follow-up. Mixed-model analysis described weight change in patients with PD, those with atypical parkinsonism, and controls. Baseline determinants of sustained clinically significant weight loss (>5% loss from baseline) and associations between early sustained weight loss and death, dementia, and dependency in parkinsonism were studied with Cox regression. Results: A total of 515 participants (240 controls, 187 with PD, 88 with atypical parkinsonism) were followed up for a median of 5 years. At diagnosis, atypical parkinsonian patients had lower body weights than patients with PD, who were lighter than controls. Patients with PD lost weight more rapidly than controls, and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (hazard ratio [HR] for 10-year age increase 1.83, 95% confidence interval [CI] 1.44–2.32). Weight loss occurring within 1 year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95% CI 1.00–4.42), dementia (HR 3.23, 95% CI 1.40–7.44), and death (HR 2.23, 95% CI 1.46–3.41). Conclusion: Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance, and targeted dietary interventions to prevent it may improve long-term outcomes.
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Affiliation(s)
- Kirsten Cumming
- From the School of Medicine (K.C.), Medical Sciences & Nutrition, and Chronic Disease Research Group (A.D.M., C.E.C.) and Ageing Clinical & Experimental Research Team (P.K.M.), Institute of Applied Health Sciences, University of Aberdeen, Scotland
| | - Angus D Macleod
- From the School of Medicine (K.C.), Medical Sciences & Nutrition, and Chronic Disease Research Group (A.D.M., C.E.C.) and Ageing Clinical & Experimental Research Team (P.K.M.), Institute of Applied Health Sciences, University of Aberdeen, Scotland.
| | - Phyo K Myint
- From the School of Medicine (K.C.), Medical Sciences & Nutrition, and Chronic Disease Research Group (A.D.M., C.E.C.) and Ageing Clinical & Experimental Research Team (P.K.M.), Institute of Applied Health Sciences, University of Aberdeen, Scotland
| | - Carl E Counsell
- From the School of Medicine (K.C.), Medical Sciences & Nutrition, and Chronic Disease Research Group (A.D.M., C.E.C.) and Ageing Clinical & Experimental Research Team (P.K.M.), Institute of Applied Health Sciences, University of Aberdeen, Scotland
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Lee JE, Choi JK, Lim HS, Kim JH, Cho JH, Kim GS, Lee PH, Sohn YH, Lee JH. The Prevalence and Incidence of Parkinson′s Disease in South Korea: A 10-Year Nationwide Population–Based Study. ACTA ACUST UNITED AC 2017. [DOI: 10.17340/jkna.2017.4.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rovini E, Maremmani C, Cavallo F. How Wearable Sensors Can Support Parkinson's Disease Diagnosis and Treatment: A Systematic Review. Front Neurosci 2017; 11:555. [PMID: 29056899 PMCID: PMC5635326 DOI: 10.3389/fnins.2017.00555] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/21/2017] [Indexed: 01/15/2023] Open
Abstract
Background: Parkinson's disease (PD) is a common and disabling pathology that is characterized by both motor and non-motor symptoms and affects millions of people worldwide. The disease significantly affects quality of life of those affected. Many works in literature discuss the effects of the disease. The most promising trends involve sensor devices, which are low cost, low power, unobtrusive, and accurate in the measurements, for monitoring and managing the pathology. OBJECTIVES This review focuses on wearable devices for PD applications and identifies five main fields: early diagnosis, tremor, body motion analysis, motor fluctuations (ON-OFF phases), and home and long-term monitoring. The concept is to obtain an overview of the pathology at each stage of development, from the beginning of the disease to consider early symptoms, during disease progression with analysis of the most common disorders, and including management of the most complicated situations (i.e., motor fluctuations and long-term remote monitoring). DATA SOURCES The research was conducted within three databases: IEEE Xplore®, Science Direct®, and PubMed Central®, between January 2006 and December 2016. STUDY ELIGIBILITY CRITERIA Since 1,429 articles were found, accurate definition of the exclusion criteria and selection strategy allowed identification of the most relevant papers. RESULTS Finally, 136 papers were fully evaluated and included in this review, allowing a wide overview of wearable devices for the management of Parkinson's disease.
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Affiliation(s)
- Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Carlo Maremmani
- U.O. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Massa, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
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Yang YW, Hsieh TF, Li CI, Liu CS, Lin WY, Chiang JH, Li TC, Lin CC. Increased risk of Parkinson disease with diabetes mellitus in a population-based study. Medicine (Baltimore) 2017; 96:e5921. [PMID: 28099356 PMCID: PMC5279101 DOI: 10.1097/md.0000000000005921] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This nationwide population-based study investigated the risk of Parkinson disease (PD) in relation to diabetes mellitus (DM) through the National Health Insurance Research Database in Taiwan.A retrospective study was conducted, consisting of 36,294 patients who were newly diagnosed with DM between January 1, 2000 and December 31, 2006 and 108,882 individuals without DM as healthy controls from insurance claims data from Taiwan's National Health Research Institutes Dataset. The subjects were followed up until December 31, 2011 or until the first manifestation of PD. The hazard ratio (HR) of DM for PD incidence was estimated by Cox proportional hazard regression model.Compared with the non-DM cohort, the incidence density rate of PD was 1.36-fold higher in the DM cohort (1.53 vs 2.08 per 1000 person-years) with an adjusted HR of 1.19 (95% confidence interval = 1.08-1.32) after adjusting for age, sex, comorbidities, and medication use. The adjusted HR of PD for DM with a larger magnitude was observed in females (1.29, 1.12-1.49); individuals age 65 years and older (1.20, 1.06-1.35); those without schizophrenia (1.20, 1.08-1.33), bipolar disorder (1.20, 1.08-1.33), hypertension (1.18, 1.06-1.32), hyperlipidemia (1.21, 1.09-1.34), chronic obstructive pulmonary disease (1.19, 1.06-1.32), coronary artery disease (1.22, 1.09-1.36), stroke (1.23, 1.10-1.37), asthma (1.20, 1.08-1.34), flunarizine use (1.21, 1.08-1.35), zolpidem use (1.16, 1.04-1.30), Charlson comorbidity index score of 0 (1.23, 1.08-1.40), and those using metoclopramide (1.35, 1.14-1.60) and zolpidem (1.46, 1.12-1.90).DM increased the risk of PD during a mean follow-up of 7.3 years. Further mechanistic research on the effect of DM on PD is needed.
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Affiliation(s)
- Yu-Wan Yang
- Department of Neurology, China Medical University Hospital
- School of Medicine, China Medical University
| | - Teng-Fu Hsieh
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung
- School of Medicine, Tzu Chi University, Hualian
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University
- Department of Medical Research, China Medical University Hospital
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University
- Department of Medical Research, China Medical University Hospital
- Department of Family Medicine, China Medical University Hospital
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University
- Department of Family Medicine, China Medical University Hospital
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital
- Research Center for Chinese Medicine and Acupuncture, China Medical University
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University
- Department of Medical Research, China Medical University Hospital
- Department of Family Medicine, China Medical University Hospital
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Fielding S, Macleod AD, Counsell CE. Medium-term prognosis of an incident cohort of parkinsonian patients compared to controls. Parkinsonism Relat Disord 2016; 32:36-41. [PMID: 27553511 PMCID: PMC5110002 DOI: 10.1016/j.parkreldis.2016.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/15/2016] [Accepted: 08/10/2016] [Indexed: 12/13/2022]
Abstract
Background The best data on prognosis comes from population-based incident cohorts but few such cohorts exist for Parkinson's disease and atypical parkinsonism. Methods The PINE study is a prospective follow-up study of an incident cohort of people with degenerative or vascular parkinsonism and age-sex matched controls. Participants have annual follow-up from diagnosis until death with review of primary/secondary care records and linkage to the UK death register. Data are collected on survival, disability (dependency on others for activities of daily living) and institutionalization. Research criteria are used to guide the clinical diagnosis, which is updated annually. We compared all-cause mortality, disability and institutionalization in patients (subdivided by diagnosis) and controls, adjusted for important confounders. Results 323 incident parkinsonian patients (199 Parkinson's disease, 124 atypical parkinsonism, mean age at diagnosis 75yrs) and 262 controls (mean age 75yrs) had 1349 and 1334 person-years follow-up respectively (maximum follow-up 10 years). All outcomes were worse in parkinsonian patients than controls, especially in atypical parkinsonism (adjusted mortality hazards ratios Parkinson's disease 2.49, 95%CI 1.72–3.58, atypical parkinsonism, 6.85, 95%CI 4.78–9.81). Median survival times for Parkinson's disease and atypical parkinsonism were 7.8 and 2.7 years respectively but were very age-dependent. At three years the rates of death or dependency were controls 21%, Parkinson's disease 46%, atypical parkinsonism 96% whilst overall institutionalization rates were 5%, 15% and 55% respectively. Conclusion The prognosis of Parkinson's disease and atypical parkinsonism in this unselected incident cohort was significantly worse than previously reported. This has important implications for patient management. 323 incident parkinsonian patients were followed for up to 10 years. Mortality was 2.5–6.8 times higher in patients compared to controls. After 3 years 46% (PD) and 96% (atypical parkinsonism) were dead or dependent. 14% (PD) and 55% (atypical parkinsonism) were institutionalized during follow-up. Prognosis was significantly worse than in previous non-incident younger cohorts.
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Affiliation(s)
- S Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - A D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - C E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Sleeman I, Che ZC, Counsell C. Risk of fracture amongst patients with Parkinson’s disease and other forms of parkinsonism. Parkinsonism Relat Disord 2016; 29:60-5. [DOI: 10.1016/j.parkreldis.2016.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for idiopathic Parkinson's disease. Cochrane Database Syst Rev 2016; 7:CD010916. [PMID: 27425786 PMCID: PMC6457946 DOI: 10.1002/14651858.cd010916.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Idiopathic Parkinson's disease (IPD) is a neurodegenerative disorder, with the severity of the disability usually increasing with disease duration. IPD affects patients' health-related quality of life, disability, and impairment. Current rehabilitation approaches have limited effectiveness in improving outcomes in patients with IPD, but a possible adjunct to rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in IPD. OBJECTIVES To assess the effectiveness of tDCS in improving motor and non-motor symptoms in people with IPD. SEARCH METHODS We searched the following databases (until February 2016): the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library ; 2016 , Issue 2), MEDLINE, EMBASE, CINAHL, AMED, Science Citation Index, the Physiotherapy Evidence Database (PEDro), Rehabdata, and Inspec. In an effort to identify further published, unpublished, and ongoing trials, we searched trial registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers. SELECTION CRITERIA We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials that compared tDCS versus control in patients with IPD for improving health-related quality of life , disability, and impairment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality (JM and MP) and extracted data (BE and JM). If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports. MAIN RESULTS We included six trials with a total of 137 participants. We found two studies with 45 participants examining the effects of tDCS compared to control (sham tDCS) on our primary outcome measure, impairment, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). There was very low quality evidence for no effect of tDCS on change in global UPDRS score ( mean difference (MD) -7.10 %, 95% confidence interval (CI -19.18 to 4.97; P = 0.25, I² = 21%, random-effects model). However, there was evidence of an effect on UPDRS part III motor subsection score at the end of the intervention phase (MD -14.43%, 95% CI -24.68 to -4.18; P = 0.006, I² = 2%, random-effects model; very low quality evidence). One study with 25 participants measured the reduction in off and on time with dyskinesia, but there was no evidence of an effect (MD 0.10 hours, 95% CI -0.14 to 0.34; P = 0.41, I² = 0%, random-effects model; and MD 0.00 hours, 95% CI -0.12 to 0.12; P = 1, I² = 0%, random- effects model, respectively; very low quality evidence).Two trials with a total of 41 participants measured gait speed using measures of timed gait at the end of the intervention phase, revealing no evidence of an effect ( standardised mean difference (SMD) 0.50, 95% CI -0.17 to 1.18; P = 0.14, I² = 11%, random-effects model; very low quality evidence). Another secondary outcome was health-related quality of life and we found one study with 25 participants reporting on the physical health and mental health aspects of health-related quality of life (MD 1.00 SF-12 score, 95% CI -5.20 to 7.20; I² = 0%, inverse variance method with random-effects model; very low quality evidence; and MD 1.60 SF-12 score, 95% CI -5.08 to 8.28; I² = 0%, inverse variance method with random-effects model; very low quality evidence, respectively). We found no study examining the effects of tDCS for improving activities of daily living. In two of six studies, dropouts , adverse events, or deaths occurring during the intervention phase were reported. There was insufficient evidence that dropouts , adverse effects, or deaths were higher with intervention (risk difference (RD) 0.04, 95% CI -0.05 to 0.12; P = 0.40, I² = 0%, random-effects model; very low quality evidence).We found one trial with a total of 16 participants examining the effects of tDCS plus movement therapy compared to control (sham tDCS) plus movement therapy on our secondary outcome, gait speed at the end of the intervention phase, revealing no evidence of an effect (MD 0.05 m/s, 95% CI -0.15 to 0.25; inverse variance method with random-effects model; very low quality evidence). We found no evidence of an effect regarding differences in dropouts and adverse effects between intervention and control groups (RD 0.00, 95% CI -0.21 to 0.21; Mantel-Haenszel method with random-effects model; very low quality evidence). AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effects of tDCS for reducing off time ( when the symptoms are not controlled by the medication) and on time with dyskinesia ( time that symptoms are controlled but the person still experiences involuntary muscle movements ) , and for improving health- related quality of life, disability, and impairment in patients with IPD. Evidence of very low quality indicates no difference in dropouts and adverse events between tDCS and control groups.
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Affiliation(s)
- Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
- SRH Fachhochschule für Gesundheit Gera gGmbHDepartment of PhysiotherapyNeue Str. 28‐3007548 GeraThüringenGermany07548
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolLöscherstr. 18DresdenGermanyD‐01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
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Yang F, Johansson ALV, Pedersen NL, Fang F, Gatz M, Wirdefeldt K. Socioeconomic status in relation to Parkinson's disease risk and mortality: A population-based prospective study. Medicine (Baltimore) 2016; 95:e4337. [PMID: 27472716 PMCID: PMC5265853 DOI: 10.1097/md.0000000000004337] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Little is known about the role of socioeconomic status in relation to Parkinson's disease (PD) risk, and no study has investigated whether the impact of socioeconomic status on all-cause mortality differs between individuals with and without PD.In this population-based prospective study, over 4.6 million Swedish inhabitants who participated in the Swedish census in 1980 were followed from 1981 to 2010. The incidence rate of PD and incidence rate ratio were estimated for the association between socioeconomic status and PD risk. Age-standardized mortality rate and hazard ratio (HR) were estimated for the association between socioeconomic status and all-cause mortality for individuals with and without PD.During follow-up, 66,332 incident PD cases at a mean age of 76.0 years were recorded. Compared to individuals with the highest socioeconomic status (high nonmanual workers), all other socioeconomic groups (manual or nonmanual and self-employed workers) had a lower PD risk. All-cause mortality rates were higher in individuals with lower socioeconomic status compared with high nonmanual workers, but relative risks for all-cause mortality were lower in PD patients than in non-PD individuals (e.g., for low manual workers, HR: 1.12, 95% confidence interval [CI]: 1.09-1.15 for PD patients; HR: 1.36, 95% CI: 1.35-1.36 for non-PD individuals).Individuals with lower socioeconomic status had a lower PD incidence compared to the highest socioeconomic group. Lower socioeconomic status was associated with higher all-cause mortality among individuals with and without PD, but such impact was weaker among PD patients.
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Affiliation(s)
- Fei Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden Department of Psychology, University of Southern California, Los Angeles, CA, USA Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
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Macleod AD, Goddard H, Counsell CE. Co-morbidity burden in Parkinson's disease: Comparison with controls and its influence on prognosis. Parkinsonism Relat Disord 2016; 28:124-9. [PMID: 27210815 PMCID: PMC4925465 DOI: 10.1016/j.parkreldis.2016.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/07/2016] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Abstract
Background Many aspects of co-morbidity burden in Parkinson’s disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies. Objectives To determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes. Methods Data from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling. Results The CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08–1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94). Conclusions The CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later. The Charlson Index was a reliable and valid way to measure co-morbidity burden in PD. There was no difference in co-morbidity burden between PD and matched controls. Higher co-morbidity at diagnosis was associated with higher early mortality.
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Affiliation(s)
- Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Hannah Goddard
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Shephard F, Greville-Heygate O, Liddell S, Emes R, Chakrabarti L. Analysis of Mitochondrial haemoglobin in Parkinson's disease brain. Mitochondrion 2016; 29:45-52. [PMID: 27181046 PMCID: PMC4940210 DOI: 10.1016/j.mito.2016.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 01/14/2023]
Abstract
Mitochondrial dysfunction is an early feature of neurodegeneration. We have shown there are mitochondrial haemoglobin changes with age and neurodegeneration. We hypothesised that altered physiological processes are associated with recruitment and localisation of haemoglobin to these organelles. To confirm a dynamic localisation of haemoglobin we exposed Drosophila melanogaster to cyclical hypoxia with recovery. With a single cycle of hypoxia and recovery we found a relative accumulation of haemoglobin in the mitochondria compared with the cytosol. An additional cycle of hypoxia and recovery led to a significant increase of mitochondrial haemoglobin (p<0.05). We quantified ratios of human mitochondrial haemoglobin in 30 Parkinson's and matched control human post-mortem brains. Relative mitochondrial/cytosolic quantities of haemoglobin were obtained for the cortical region, substantia nigra and cerebellum. In age matched post-mortem brain mitochondrial haemoglobin ratios change, decreasing with disease duration in female cerebellum samples (n=7). The change is less discernible in male cerebellum (n=18). In cerebellar mitochondria, haemoglobin localisation in males with long disease duration shifts from the intermembrane space to the outer membrane of the organelle. These new data illustrate dynamic localisation of mitochondrial haemoglobin within the cell. Mitochondrial haemoglobin should be considered in the context of gender differences characterised in Parkinson's disease. It has been postulated that cerebellar circuitry may be activated to play a protective role in individuals with Parkinson's. The changing localisation of intracellular haemoglobin in response to hypoxia presents a novel pathway to delineate the role of the cerebellum in Parkinson's disease.
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Affiliation(s)
- Freya Shephard
- University of Nottingham, Faculty of Medicine, SVMS, Sutton Bonington Campus, LE12 5RD, England, UK
| | - Oliver Greville-Heygate
- University of Nottingham, Faculty of Medicine, SVMS, Sutton Bonington Campus, LE12 5RD, England, UK
| | - Susan Liddell
- Division of Animal Sciences, School of Biosciences, Sutton Bonington Campus, LE12 5RD, England, UK
| | - Richard Emes
- University of Nottingham, Faculty of Medicine, SVMS, Sutton Bonington Campus, LE12 5RD, England, UK
| | - Lisa Chakrabarti
- University of Nottingham, Faculty of Medicine, SVMS, Sutton Bonington Campus, LE12 5RD, England, UK.
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