Increased body mass index associated with autonomic dysfunction in Parkinson's disease

Peripheral immune profile in drug-naïve dementia with Lewy bodies

BACKGROUND

Accumulating evidence suggests that peripheral inflammation is associated with the pathogenesis of Parkinson's disease (PD). We examined peripheral immune profiles and their association with clinical characteristics in patients with DLB and compared these with values in patients with PD.

METHODS

We analyzed peripheral blood from 93 participants (drug-naïve DLB, 31; drug-naïve PD, 31; controls, 31). Absolute leukocyte counts, absolute counts of leukocyte subpopulations, and peripheral blood inflammatory indices such as neutrophil-to-lymphocyte ratio were examined. Associations with clinical characteristics, cardiac sympathetic denervation, and striatal 123I-2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) binding were also examined.

RESULTS

Patients with DLB had lower absolute lymphocyte and basophil counts than did age-matched controls (both; p < 0.005). Higher basophil counts were marginally associated with higher global cognition (p = 0.054) and were significantly associated with milder motor severity (p = 0.020) and higher striatal 123I-FP-CIT binding (p = 0.038). By contrast, higher basophil counts were associated with more advanced PD characterized by decreased global cognition and severe cardiac sympathetic denervation. Although lower lymphocyte counts had relevance to more advanced PD, they had little relevance to clinical characteristics in patients with DLB. Higher peripheral blood inflammatory indices were associated with lower body mass index in both DLB and PD.

CONCLUSIONS

As in patients with PD, the peripheral immune profile is altered in patients with DLB. Some peripheral immune cell counts and inflammatory indices reflect the degree of disease progression. These findings may deepen our knowledge on the role of peripheral inflammation in the pathogenesis of DLB.

Lifestyle Modulators of Neuroplasticity in Parkinson's Disease: Evidence in Human Neuroimaging Studies

Parkinson's disease (PD) is a neurodegenerative disease characterized by both motor and non-motor symptoms. A progressive neuronal loss and the consequent clinical impairment lead to deleterious effects on daily living and quality of life. Despite effective symptomatic therapeutic approaches, no disease-modifying therapies are currently available. Emerging evidence suggests that adopting a healthy lifestyle can improve the quality of life of PD patients. In addition, modulating lifestyle factors can positively affect the microstructural and macrostructural brain levels, corresponding to clinical improvement. Neuroimaging studies may help to identify the mechanisms through which physical exercise, dietary changes, cognitive enrichment, and exposure to substances modulate neuroprotection. All these factors have been associated with a modified risk of developing PD, with attenuation or exacerbation of motor and non-motor symptomatology, and possibly with structural and molecular changes. In the present work, we review the current knowledge on how lifestyle factors influence PD development and progression and the neuroimaging evidence for the brain structural, functional, and molecular changes induced by the adoption of positive or negative lifestyle behaviours.

Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review

Cardiac sympathetic denervation, as documented on 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, is relatively sensitive and specific for distinguishing Parkinson's disease (PD) from other neurodegenerative causes of parkinsonism. The present study aims to comprehensively review the literature regarding the use of cardiac MIBG in PD. MIBG is an analog to norepinephrine. They share the same uptake, storage, and release mechanisms. An abnormal result in the cardiac MIBG uptake in individuals with parkinsonism can be an additional criterion for diagnosing PD. However, a normal result of cardiac MIBG in individuals with suspicious parkinsonian syndrome does not exclude the diagnosis of PD. The findings of cardiac MIBG studies contributed to elucidating the pathophysiology of PD. We investigated the sensitivity and specificity of cardiac MIBG scintigraphy in PD. A total of 54 studies with 3114 individuals diagnosed with PD were included. The data were described as means with a Hoehn and Yahr stage of 2.5 and early and delayed registration H/M ratios of 1.70 and 1.51, respectively. The mean cutoff for the early and delayed phases were 1.89 and 1.86. The sensitivity for the early and delayed phases was 0.81 and 0.83, respectively. The specificity for the early and delayed phases were 0.86 and 0.80, respectively.

Deep Learning Algorithm of 12-Lead Electrocardiogram for Parkinson Disease Screening

BACKGROUND

Although idiopathic Parkinson's disease (IPD) is increasing with the aging population, there is no adequate screening test for early diagnosis of IPD. Cardiac autonomic dysfunction begins in the early stages of IPD, and an electrocardiogram (ECG) contains precise information on the heart.

OBJECTIVE

This study is to develop an ECG deep learning algorithm that can efficiently screen for IPD.

METHODS

Data were collected from 751 IPD patients (2,138 ECGs), 751 age and sex-matched non-IPD patients (2,673 ECGs) as a control group, and 297 drug-induced Parkinsonism (DPD) patients (875 ECGs) as a disease control group. ECG data were randomly divided into training set, validation set, and test set at a ratio of 6:2:2. We developed a deep-convolutional neural network (CNN) consisting of 16 layers with Bayesian optimization that classified IPD patients by ECG data. The robustness of the deep learning model was verified through 5-fold cross-validation.

RESULTS

The AUROC of the model for detection of IPD was 0.924 (95% CI, 0.913-0.936) in the test set. That for detecting DPD was 0.473 (95% CI, 0.453-0.504). The sensitivities of the model according to Unified Parkinson's Disease Rating Scale III and Hoehn & Yahr scale were also similar.

CONCLUSION

In conclusion, the CNN-based deep learning model using ECG data showed quite good performance in identifying IPD patients. Standardized 12-lead ECG test could be one of the clinically feasible candidate methods for early screening of IPD in the future.

Association of general and abdominal adiposity with postural changes in systolic blood pressure: results from the NAKO pretest and MetScan studies

The association between anthropometric measurements and postural changes in systolic blood pressure (SBP) has not been frequently reported. This study aimed to investigate the association of body mass index (BMI) and waist circumference (WC) with postural changes in SBP in two German cross-sectional studies. Data were derived from 506 participants of the population-based German National Cohort (NAKO) pretest and from 511 participants of the convenience sample-based MetScan studies. Linear regression models were used to estimate the association between BMI and WC with the difference between standing and sitting SBP (dSBP). Odds ratios (ORs) for an increase (dSBP > 10 mmHg) or decrease (dSBP ≤ -10 mmHg) in dSBP were calculated using logistic regression. The results were pooled by meta-analysis using an inverse variance model. In pooled analysis, a 5 kg/m² higher BMI was associated with a 1.46 mmHg (95% confidence interval (CI) 0.98-1.94) higher dSBP, while a 5 cm higher WC was associated with a 0.51 mmHg (95% CI 0.32-0.69) higher dSBP. BMI or WC were associated with a higher odds of an increase in dSBP (adjusted OR, 1.71; 95% CI 1.36-2.14 per 5 kg/m² higher BMI and 1.22; 95% CI 1.05-1.40 per 5 cm higher WC) but with a reduced odds of a decline in dSBP (adjusted OR, 0.67; 95% CI 0.44-1.00 per 5 kg/m² higher BMI and 0.84; 95% CI 0.72-0.99 per 5 cm higher WC). The associations between WC and dSBP were no longer statistically significant after BMI adjustments. In conclusion, higher BMI and higher WC were associated with higher postural increases in SBP; however, WC was not related to postural changes in SBP once adjusted for BMI.

Nutritional status and dynapenia in people living with Parkinson's disease: a cross-sectional study

OBJECTIVE

This study aimed to evaluate the nutritional status and handgrip strength (HS) in patients with Parkinson's disease (PD).

METHODOLOGY

This is a cross-sectional study with outpatients in two treatment centers in the state of Pernambuco. Sociodemographic data, body mass index (BMI), waist circumference (WC), and calf circumference (CC) were collected. Body fat (BF) was assessed using electrical bioimpedance. Dynapenia was assessed using HS and dynapenic obesity was defined as very high WC associated with low HS. The Hoehn-Yahr scale was used for the staging of PD and the disease's severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS).

RESULTS

The results showed that 77.2% were elderly, which were at II and III stages of UPDRS scale. Overweight and obesity were present in 44.3% and 27.8%. Dynapenia was found in 50.6%. A negative correlation was observed between HS with age, UPDRS II and III, and BF percentage. Dynapenic obesity in men was lower 37.5% compared to women 63.6%.

CONCLUSION

It is relevant to identify the functional capacity such as dynapenia and also the nutritional status in people living with neurodegenerative diseases of early onset, such as PD, so it is possible to develop strategies in prevention and treatment that can improve these conditions, considering its negative impact in PD.

Prevalence, risk factors, and clinical correlations of underweight in Chinese newly diagnosed and drug-naïve patients with Parkinson's disease

OBJECTIVE

Studies have shown that patients with Parkinson's disease (PD) will experience weight loss during the progression of the illness, which suggests an increased rate of underweight. However, few studies have addressed underweight in early de novo population. This study aimed to examine the prevalence, risk factors, and clinical correlations of underweight in Chinese newly diagnosed and drug-naïve patients with PD.

METHODS

A total of 245 inpatients with newly diagnosed PD and 213 age-, sex-, and education-matched healthy controls were enrolled in Ningbo. BMI, demographics, supine and upright blood pressure, Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) together with fasting blood glucose, low-density lipoprotein, total cholesterol, uric acid (UA), and homocysteine were collected in all subjects. Hoehn and Yahr (HY) rating and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores were also measured in patients.

RESULTS

Overall, 35 (14.3%) patients were underweight and 14 (6.6%) controls were underweight. Binary regression analyses showed that low MoCA (p = 0.035), ΔSBP and ΔDBP values (both p < 0.001) were risk factors for underweight. Furthermore, correlation analysis indicated that BMI was associated with HY grade, UPDRS motor, HAMA, HAMD, MoCA, ΔSBP, ΔDBP, and UA values, stepwise multiple regression revealed significant correlations between BMI and ΔSBP (p < 0.001), ΔDBP (p = 0.001), MoCA (p = 0.002), UPDRS motor (p = 0.005), and HAMD scores (p = 0.014).

CONCLUSIONS

Our study showed that the prevalence of underweight was significantly higher in Chinese newly diagnosed and drug-naïve patients with PD than in the healthy population, and several clinical variables were risk factors for underweight.

Untangling the relationship between fat distribution, nutritional status and Parkinson's disease severity

Background

Parkinson’s disease (PD) is responsible for significant changes in body composition.

Aims

We aimed to test the association between PD severity and fat distribution patterns, and to investigate the potential modifier effect of nutritional status in this association.

Methods

We enrolled 195 PD subjects consecutively admitted to a university geriatric day hospital. All participants underwent comprehensive clinical evaluation, including assessment of total and regional body composition (dual-energy X-ray absorptiometry, DXA), body mass index, nutritional status (Mini-Nutritional Assessment, MNA), motor disease severity (UPDRS III), comorbidities, and pharmacotherapy.

Results

The fully adjusted linear regression model showed a negative association between UPDRS III and total body fat in kg and percentage (respectively, B − 0.79; 95% CI − 1.54 to − 0.05 and B − 0.55; 95% CI − 1.04 to − 0.05), percentage android fat (B − 1.07; 95% CI − 1.75 to − 0.39), trunk–leg fat ratio (B − 0.02; 95% CI − 0.04 to − 0.01), trunk–limb fat ratio (B − 0.01; 95% CI − 0.06 to − 0.01) and android–gynoid fat ratio (B − 0.01; 95% CI − 0.03 to − 0.01). After stratification by MNA score, all the parameters of android-like fat distribution resulted negatively associated (p < 0.001 for all) with UPDRS III, but only among subjects with a MNA < 23.5 (risk of malnutrition or malnutrition).

Conclusion

We found a negative association between severity of motor impairment and total fat mass in PD, more specific with respect to an android pattern of fat distribution. This association seems to be driven by nutritional status, and is significant only among patients at risk of malnutrition or with overt malnutrition.

Clinical features and electrocardiogram parameters in Parkinson's disease

We investigated the relation between clinical features and electrocardiogram (ECG) parameters in patients with Parkinson's disease (PD). One hundred and fifty-six PD patients were enrolled. Their clinical features [body mass index (BMI), age, disease duration, and disease stage] and ECG parameters [RR, PR, QRS, and QT intervals, and heart rate-corrected QT (QTc)] were analyzed. BMI was positively correlated with the PR and QRS intervals in patients with PD. The QRS interval was positively correlated with disease duration and Hoehn and Yahr stage, and the QT interval and QTc were positively correlated with age. Clinical features and ECG parameters are likely to be closely associated with each other. Several ECG parameters reflect autonomic dysfunction or disease progression. Clinicians should pay more attention to ECG parameters in the treatment of PD patients.

Body weight and dysautonomia in early Parkinson's disease

OBJECTIVES

Patients with Parkinson's disease (PD) begin to lose weight several years before diagnosis, which suggests weight variation is associated with some factor(s) that precede the onset of motor symptoms. This study aimed to investigate the association of autonomic nervous system with body weight in patients with PD.

MATERIALS AND METHODS

The subjects were 90 patients with early de novo PD. We examined the associations of body mass index (BMI) with sympathetic nervous activity reflected in orthostatic intolerance or cardiac uptake of ¹²³ I-metaiodobenzylguanidine and parasympathetic nervous activity reflected in constipation or heart rate variability (HRV).

RESULTS

Twelve patients (13.3%) were overweight (BMI>25 kg/m² ), 62 patients (68.9%) were normal-weight (18.5≦BMI<25 kg/m² ), and 16 patients (17.8%) were underweight (BMI<18.5 kg/m² ). Underweight patients had greater disease severity and decrease in blood pressure on head-up tilt-table testing, higher cardiac washout ratio of ¹²³ I-metaiodobenzylguanidine, and lower HRV and complained of constipation more often than those with normal-weight or overweight patients. On multiple regression analyses, the correlation of these variables with BMI maintained statistical significance after adjustment for age, sex, symptom duration, and motor subtype.

CONCLUSIONS

Dysautonomia and disease severity are closely related to body weight independently of age, sex, symptom duration, and motor subtype. Dysautonomia may play a partial role on weight variation in the early stage of PD.

Lower body mass index is associated with orthostatic hypotension in Parkinson's disease

INTRODUCTION

Lower body mass index (BMI) is associated with orthostatic hypotension (OH) in the general population, especially in the elderly; however, no studies have addressed this issue in Parkinson's disease (PD).

METHODS

We investigated the results of the head-up tilt test and BMI of patients with PD, and evaluated whether BMI is related to orthostatic systolic blood pressure (SBP) change during the head-up tilt test. PD patients were divided into male and female groups, and further divided into middle-aged (age<65years) and elderly (age≥65years) subgroups in each sex.

RESULTS

OH was observed in 13 of 64 male and 12 of 75 female patients with PD. BMI was lower in patients with OH than in those without, in both men and women. In the elderly group, a significant correlation between BMI and orthostatic SBP change was found (men, r=0.47, p=0.006; women, r=0.43, p=0.005), and a BMI below mean-0.5 standard deviation increased OH odds (men: BMI<20.5; odds ratio, 6.79; 95% CI, 1.06-43.36; women: BMI<18.5; odds ratio, 5.11; 95% CI, 1.05-24.96).

CONCLUSION

Lower BMI is a predisposing factor of OH in elderly patients with PD.