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Matsuno A, Matsushima A, Saito M, Sakurai K, Kobayashi K, Sekijima Y. Quantitative assessment of the gait improvement effect of LSVT BIG® using a wearable sensor in patients with Parkinson's disease. Heliyon 2023; 9:e16952. [PMID: 37332954 PMCID: PMC10272473 DOI: 10.1016/j.heliyon.2023.e16952] [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: 10/31/2022] [Revised: 04/15/2023] [Accepted: 06/01/2023] [Indexed: 06/20/2023] Open
Abstract
Background The main effects of Lee Silvermann Voice Treatment-BIG® therapy (LSVT-BIG) on gait function are improvements in gait speed and stride length. Considering the mechanism of this improvement, LSVT-BIG may affect joint angles of the lower extremities. Therefore, further investigation of the effect of LSVT-BIG on gait function, especially joint angles, is needed. Methods Patients with Parkinson's disease (PD) who were eligible for LSVT-BIG were recruited. We measured the following items pre- and post-LSVT-BIG: MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Functional Independence Measure (FIM), timed up and go test (TUG), and gait parameters using RehaGait®. Gait parameters included gait speed, stride duration and length, the standard deviation of stride duration and length, cadence, the ratio of the stance/swing phase, and the flexion and extension angles of the hip, knee, and ankle joints. Range of motion (ROM) was calculated as the difference of values between the maximum flexion and extension angles of each joint. Results Twenty-four participants completed the LSVT-BIG. Significant improvement was observed in the MDS-UPDRS (mean changes: Part I, -2.4 points; Part II, -3.5 points; Part III -8.9 points), TUG (-0.61 s), gait speed (+0.13 m/s), stride length (+0.12 m), flexion and extension angles and ROM of the hip joints (flexion, +2.0°; extension, +2.0; ROM, +4.0°). Enlargement in ROM of the hip joint was strongly correlated with increase in gait speed and stride length (r = 0.755, r = 0.804, respectively). Conclusions LSVT-BIG enlarged flexion and extension angles and ROM of the hip joint significantly. Change of ROM of the hip joint was directly related to the increase in stride length and gait speed observed in patients with PD after LSVT-BIG.
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Affiliation(s)
- Atsuhiro Matsuno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-0861, Japan
| | - Akira Matsushima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-0861, Japan
- Department of Neurology, JA Nagano Koseiren Kakeyu Misayama Rehabilitation Center Kakeyu Hospital, 1308 Kakeyu Onsen, Ueda 386-0396, Japan
| | - Masashi Saito
- Department of Rehabilitation, JA Nagano Koseiren Kakeyu Misayama Rehabilitation Center Kakeyu Hospital, 1308 Kakeyu Onsen, Ueda 386-0396, Japan
| | - Kazumi Sakurai
- Department of Rehabilitation, JA Nagano Koseiren Kakeyu Misayama Rehabilitation Center Kakeyu Hospital, 1308 Kakeyu Onsen, Ueda 386-0396, Japan
| | - Katsuyuki Kobayashi
- Department of Rehabilitation, JA Nagano Koseiren Kakeyu Misayama Rehabilitation Center Kakeyu Hospital, 1308 Kakeyu Onsen, Ueda 386-0396, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-0861, Japan
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Rafee S, Al-Hinai M, Douglas G, Ndukwe I, Hutchinson M. Mood symptoms in cervical dystonia: Relationship with motor symptoms and quality of life. Clin Park Relat Disord 2023; 8:100186. [PMID: 36747896 PMCID: PMC9898436 DOI: 10.1016/j.prdoa.2023.100186] [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: 08/29/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
Background Cervical dystonia (CD) has a high prevalence of anxiety and depression. The relationship between motor severity, mood symptoms and QoL is unclear and how to adequately assess these is also unknown. Instruments like the BAI, BDI and HADS are often used but items within these relating to somatic symptoms might influence the results. Methods Patients with idiopathic cervical dystonia (CD) were included. The BAI, BDI, HADS, CIDP58 and TWSTRS2- severity score were used for assessment of motor, mood and QoL symptoms. Pearson's correlations between motor and non-motor symptom scores were assessed. The psychometric properties of the psychiatric tools were measured and principal component analysis performed after identifying items that could correspond to somatic symptoms. Results 201 participants were included. 42% of participants had either significant depression or anxiety symptoms or both when measured by BAI and BDI and 51% of patients met criteria on HADS. HADS-A and HADS-D, BAI and BDI were poorly correlated with TWSTRS2-S. The HADS-A and HADS-D both showed strong correlation with the sleep subdomain of CDIP58. Psychometric and principal component analysis on 149/201 participants did not reveal factor loadings consistent with the a priori somatic groupings. However mean scores were higher for somatic items. Conclusion A good score on the CDIP58, a commonly used tool, does not indicate mild disease severity or minimal mood symptoms. Minimal motor symptoms, similarly, also does not imply a positive QoL. Clinicians should be mindful on ideal methods for performing a holistic assessment of CD patients. This likely warrants a combination of motor, QoL and mood assessment tools.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Corresponding author at: Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland.
| | - Mahmood Al-Hinai
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Gillian Douglas
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Ihedinachi Ndukwe
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
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Li M, Wang K, Su W, Jia J, Wang X. The modulatory effect of 100 Hz electroacupuncture on striatal synaptic plasticity in unilateral lesioned 6-OHDA rats. Brain Res Bull 2022; 186:123-135. [PMID: 35697152 DOI: 10.1016/j.brainresbull.2022.06.004] [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: 08/25/2021] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
Recent studied have reported that impaired striatal synaptic plasticity played a crucial role in Parkinson's disease (PD). Previous studies have suggested that electroacupuncture (EA) alleviated the motor deficits in PD patients and animal models. However, the mechanisms underlying this protection need to be further elucidated. In this study, we found that EA-induced improvement of motor deficits in the 6-hydroxydopamine (6-OHDA) rat model doesn't act through dopaminergic system. EA rescued the decreased striatal long-term potentiation (LTP) in 6-OHDA rats. In addition, the declined expression of N-methyl-D-aspartic acid receptor subunit 2B (NR2B) in the striatum was remarkably up-regulated by EA. The EA-induced improvement of LTP can be eliminated by NR2B-selective inhibitor. It is indicated that EA-induced recovery of striatal LTP was correlated with the up-regulation of NR2B subunit. EA was also found to rescue the decreased dendritic arborization and the spine density in the striatum of 6-OHDA rats. Meanwhile, EA suppressed striatal glutamate content and vesicular glutamate transporter 1 which is expressed in cortico-striatal glutamatergic projections. The decrease of striatal glutamate content induced by decortication, EA treatment or a combination of both reversed the loss of striatal spine density in 6-OHDA rats. It is indicated that EA-induced reduction of cortico-striatal glutamate transmission contributes to the recovery of striatal spine density. In conclusion, the therapeutic effect of EA on the motor deficits of 6-OHDA rats was mediated by rescuing cortico-striatal glutamate transmission and striatal synaptic plasticity.
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Affiliation(s)
- Min Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ke Wang
- Beijing Institute for Brain Disorders, Beijing 100069, China; Departments of Neurobiology and Physiology, Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Capital Medical University, Beijing 100069, China
| | - Wenting Su
- Beijing Institute for Brain Disorders, Beijing 100069, China; Departments of Neurobiology and Physiology, Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Capital Medical University, Beijing 100069, China
| | - Jun Jia
- Beijing Institute for Brain Disorders, Beijing 100069, China; Departments of Neurobiology and Physiology, Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Capital Medical University, Beijing 100069, China.
| | - Xiaomin Wang
- Beijing Institute for Brain Disorders, Beijing 100069, China; Departments of Neurobiology and Physiology, Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Capital Medical University, Beijing 100069, China.
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Moriarty A, Rafee S, Ndukwe I, O’Riordan S, Hutchinson M. Longitudinal follow up of mood in cervical dystonia and influence on age at onset. Mov Disord Clin Pract 2022; 9:614-618. [PMID: 35844277 PMCID: PMC9274366 DOI: 10.1002/mdc3.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/29/2022] [Accepted: 03/12/2022] [Indexed: 11/09/2022] Open
Abstract
Background Anxiety and depression are highly prevalent conditions in cervical dystonia and considered intrinsic to the disease mechanism. Psychiatric symptoms do not appear to be influenced by botulinum toxin therapy. Studies focusing on changes in mood disorder during the course of the disease are limited in this chronic, lifelong disorder. Objective To assess the longitudinal prevalence of mood disorder, pain, and quality of life in patients with cervical dystonia attending a botulinum toxin clinic. Methods Patients involved in phase I of our study were invited to be involved in reassessment using the Beck Depression Inventory, Second Revision; Beck Anxiety Index; Cervical Dystonia Impact Profile-58 (CDIP-58); and the Toronto Western Spasmodic Torticollis Rating Scale-2 Pain Scale (TWSTRS2-Pain). Results A total of 53 participants took part after a mean study interval duration of 24 months. There were no significant differences between the 2 study time points in the prevalence of anxiety (P = 0.2919) and depressive symptoms (P = 0.5). Self-reported quality of life by CDIP-58 (P = 0.96) and pain by TWSTRS2-Pain (P = 0.9321) were unchanged. Men and women with significant symptoms of mood disorder had an earlier age of onset of cervical dystonia (P = 0.008). Conclusion Anxiety and depressive symptoms persist in cervical dystonia, seem to be unrelated to pain severity, and need to be specifically targeted to improve quality of life. The relationship between mood disorder and age of onset suggest that mood disorder may be part of the disease pathophysiology.
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Affiliation(s)
- Andrew Moriarty
- Department of Neurology St Vincent’s University Hospital Dublin
- School Of Medicine University College Dublin Dublin
| | - Shameer Rafee
- Department of Neurology St Vincent’s University Hospital Dublin
- School Of Medicine University College Dublin Dublin
| | - Ihedinachi Ndukwe
- Department of Neurology St Vincent’s University Hospital Dublin
- School Of Medicine University College Dublin Dublin
| | - Sean O’Riordan
- Department of Neurology St Vincent’s University Hospital Dublin
| | - Michael Hutchinson
- Department of Neurology St Vincent’s University Hospital Dublin
- School Of Medicine University College Dublin Dublin
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Abril-Jiménez P, Merino-Barbancho B, Vera-Muñoz C, Arredondo Waldmeyer MT. Co-designing a remote rehabilitation tool for Parkinson's disease: exploratory values and challenges. BMC Neurol 2021; 21:491. [PMID: 34915855 PMCID: PMC8675517 DOI: 10.1186/s12883-021-02519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired motor function is one of the early symptoms shown in patients with Parkinson Disease (PD). For this reason, rehabilitative interventions have been used for many years to improve motor and non-motor symptoms. Among them, the use of music therapy has shown benefits in helping to overcome some of the most common motor dysfunction. Addressing the challenge of providing access to this type of therapy, this document presents the collaborative design process to develop a remote training support tool for PD based on music therapy. METHODS A qualitative study with creative co-design methods was used in which different groups of healthcare professionals, patients, and relatives participated in six iterative sessions. Workshops were designed and structured to incrementally discover requirements and needs and validate the proposed prototype ideas. RESULTS The study provided key aspects that were used for the development and validation of the proposed prototypes for the remote music-based training support tool for PD. Up to 20 factors that had a positive and/or negative influence on patient access to training were detected. These factors were classified into three common themes: daily activities and independence, participation in treatment and barriers to daily treatment, and self-management and personalization of information and telecommunication technologies (ICT). CONCLUSIONS This paper shows the results of a collaborative design process aimed at identifying the different factors, relevant to patients with PD, to improve their access to remote ICT-based training therapy and their expectations regarding alternative therapies, such as music. The participatory design methods and the iterative model used helped overcome many of the traditionally barriers that this type of technological support solutions usually have, facilitating the future participation.
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Affiliation(s)
- Patricia Abril-Jiménez
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, Avda Complutense 30, D108, 28040 Madrid, Spain
| | - Beatriz Merino-Barbancho
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, Avda Complutense 30, D108, 28040 Madrid, Spain
| | - Cecilia Vera-Muñoz
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, Avda Complutense 30, D108, 28040 Madrid, Spain
| | - María Teresa Arredondo Waldmeyer
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, Avda Complutense 30, D108, 28040 Madrid, Spain
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Rutten S, van Wegen EE, Ghielen I, Schoon B, van den Heuvel OA. Symptom dimensions of anxiety in Parkinson's disease: Replication study in a neuropsychiatric patient population. Clin Park Relat Disord 2021; 5:100117. [PMID: 34825163 PMCID: PMC8605274 DOI: 10.1016/j.prdoa.2021.100117] [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: 06/30/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Anxiety disorders occur in approximately one third of people with Parkinson's disease (PD), and have a major impact on patient and caregiver wellbeing. In order to better understand and diagnose anxiety in PD patients, we investigated the generalizability of the results of a previous factor analysis on anxiety symptoms to a sample of PD patients with neuropsychiatric symptoms. METHODS In this cross-sectional study, anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) in 123 PD patients who were referred for neuropsychiatric diagnostics and treatment. Subscales of anxiety were analyzed through principal component analysis of BAI items. The associations between BAI subscales and symptoms of motor and cognitive function and depression were assessed through regression analyses. RESULTS Similar to the previous factor analysis, we found one psychological (affective) and four somatic subscales of anxiety in the BAI. The affective subscale was the principal component explaining 35.9% of the variance. The scores on the total BAI and the affective subscale were significantly associated with depressive symptoms. In a post-hoc analysis, the affective subscale had equal power as compared to the total BAI in predicting whether or not participants were diagnosed with an anxiety disorder after psychiatric evaluation. CONCLUSION In this study, we replicated our previous findings of one affective and multiple somatic subscales of the BAI. The 7-item affective subscale of the BAI shows potential as a screening tool for non-episodic anxiety in PD. However, in clinical practice, we recommend evaluating anxiety symptoms in the context of other PD symptoms, including motor, autonomic, and other (neuro)psychiatric symptoms.
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Affiliation(s)
- Sonja Rutten
- Amsterdam University Medical Centers (Amsterdam UMC), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ Amsterdam, Netherlands
| | - Erwin E.H. van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Ires Ghielen
- Amsterdam University Medical Centers (Amsterdam UMC), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ Amsterdam, Netherlands
| | - Bridget Schoon
- Amsterdam University Medical Centers (Amsterdam UMC), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ Amsterdam, Netherlands
| | - Odile A. van den Heuvel
- Amsterdam University Medical Centers (Amsterdam UMC), Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ Amsterdam, Netherlands
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The contribution of cognitive behavioural factors to social anxiety in Parkinson's disease. Behav Cogn Psychother 2021; 50:57-73. [PMID: 34488922 DOI: 10.1017/s1352465821000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Social anxiety is prevalent in idiopathic Parkinson's disease but why this is, is not yet well understood. Social cognitions, safety-seeking behaviours and internally focused attention are all known to predict social anxiety in the general population. These associated factors have not yet been explored in idiopathic Parkinson's disease, where disease severity and motor symptoms might also influence the experience of social anxiety. AIMS This study aimed to explore the relationship between cognitive behavioural factors and social anxiety in Parkinson's disease. METHOD Using a cross-sectional design, 124 people with Parkinson's disease completed self-report questionnaires including measures of Parkinson's disease severity, social anxiety, negative social cognitions, safety-seeking behaviours, internally focused attention, anxiety and depression. RESULTS The final regression model accounted for 71.6% of variance in social anxiety. Cognitive behavioural variables accounted for the largest magnitude of unique variance (43.5%). Sex, anxiety and depression accounted for 23.4%, and Parkinson non-motor symptom severity for 4.7%. Negative social cognitions and safety-seeking behaviours were statistically significant predictors, while an internal focus of attention was not. CONCLUSIONS Social anxiety in Parkinson's disease is associated with negative social cognitions and safety-seeking behaviours. Findings indicate the need for further research into cognitive behavioural approaches to social anxiety in Parkinson's disease.
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The Relationship Between Anxiety Disorders and Parkinson's Disease: Clinical and Therapeutic Issues. Curr Psychiatry Rep 2021; 23:20. [PMID: 33660146 DOI: 10.1007/s11920-021-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to describe anxiety's different symptomatologic presentations in Parkinson's disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities. RECENT FINDINGS In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.
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Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:175-196. [PMID: 34389117 DOI: 10.1016/b978-0-12-822290-4.00015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.
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Kurihara K, Nakagawa R, Ishido M, Yoshinaga Y, Watanabe J, Hayashi Y, Mishima T, Fujioka S, Tsuboi Y. Impact of motor and nonmotor symptoms in Parkinson disease for the quality of life: The Japanese Quality-of-Life Survey of Parkinson Disease (JAQPAD) study. J Neurol Sci 2020; 419:117172. [PMID: 33065494 DOI: 10.1016/j.jns.2020.117172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is characterized by a range of classic motor symptoms and heterogeneous nonmotor symptoms that affect patients' quality of life (QoL). Studies have individually reported the effect of either motor or nonmotor symptoms on patients' QoL; however, a thorough assessment of the symptoms that have the greatest influence on QoL is limited. This JAQPAD study examined the effect of both motor and nonmotor symptoms and patient demographics on QoL in a large population of patients with PD in Japan. METHODS All members of the Japan Parkinson's Disease Association were invited to participate in the study. Questionnaires assessing wearing-off symptoms (the 9-item Wearing-Off Questionnaire [WOQ-9]), nonmotor symptoms (Non-Motor Symptoms Questionnaire [NMSQ]) and QoL (the 8-item Parkinson's Disease Questionnaire [PDQ-8]) were included. Multiple regression analyses assessed the effect of clinical factors on the PDQ-8 Summary Index (PDQ-8 SI). Spearman rank correlation coefficient (r) estimated the correlation between each subdomain score of nine NMSQ domains and the PDQ-8 SI. RESULTS A total of 3022 patients were included in the analysis. The PDQ-8 SI score correlated with off-time, age, duration of PD, work status, and the NMSQ total score and subdomain scores. Memory problems correlated most strongly with the PDQ-8 SI score (r = 0.4419), followed by mood (r = 0.4387) and digestive problems (r = 0.4341; p < 0.0001). CONCLUSIONS Physicians tend to focus on motor symptoms, while nonmotor symptoms often go under-recognized in clinical practice. This JAQPAD study highlights the importance of recognition and management of both motor and nonmotor symptoms, which together significantly affect patient QoL.
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Affiliation(s)
- Kanako Kurihara
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Ryoko Nakagawa
- AbbVie GK, Medical, 3-1-21 Shibaura, Minato-ku, Tokyo, 108-0023, Japan
| | - Miwako Ishido
- AbbVie GK, Medical, 3-1-21 Shibaura, Minato-ku, Tokyo, 108-0023, Japan
| | - Yoko Yoshinaga
- AbbVie GK, Medical, 3-1-21 Shibaura, Minato-ku, Tokyo, 108-0023, Japan
| | - Jun Watanabe
- AbbVie GK, Medical, 3-1-21 Shibaura, Minato-ku, Tokyo, 108-0023, Japan
| | - Yuka Hayashi
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan.
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Cernera S, Eisinger RS, Wong JK, Ho KWD, Lopes JL, To K, Carbunaru S, Ramirez-Zamora A, Almeida L, Foote KD, Okun MS, Gunduz A. Long-term Parkinson's disease quality of life after staged DBS: STN vs GPi and first vs second lead. NPJ Parkinsons Dis 2020; 6:13. [PMID: 32656315 PMCID: PMC7338364 DOI: 10.1038/s41531-020-0115-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
Deep brain stimulation (DBS) for Parkinson's disease (PD) improves quality of life (QoL), but longitudinal follow-up data are scarce. We sought to quantify long-term benefits of subthalamic nucleus (STN) vs globus pallidus internus (GPi), and unilateral vs staged bilateral PD-DBS on postoperative QoL. This is a retrospective, longitudinal, non-randomized study using the PD QoL questionnaire (PDQ)-39 in patients with STN- or GPi-DBS, and with unilateral (N = 191) or staged bilateral (an additional contralateral lead implant) surgery (N = 127 and 156 for the first and second lead, respectively). Changes in PDQ-39 summary index (PDQ-39SI) and subscores throughout 60 months of follow-up were used as the primary analysis. We applied mixed models that included levodopa and covariates that differed at baseline across groups. For unilateral implantation, we observed an initial improvement in PDQ-39SI of 15.55 ± 3.29% (µ ± SE) across both brain targets at 4 months postoperatively. Unilateral STN patients demonstrated greater improvement in PDQ-39SI than GPi patients at 4 and 18 months postoperatively. Analysis of patients with staged bilateral leads revealed an initial 25.34 ± 2.74% (µ ± SE) improvement in PDQ-39SI at 4 months after the first lead with further improvement until 18 months, with no difference across targets. Scores did not improve after the second lead with gradual worsening starting at 18 months postoperatively. STN-DBS provided greater short-term QoL improvement than GPi-DBS for unilateral surgery. For staged bilateral DBS, overall QoL improvement was explained primarily by the first lead. Decision-making for patients considering DBS should include a discussion surrounding the potential risks and benefits from a second DBS lead.
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Affiliation(s)
- Stephanie Cernera
- J. Crayton Pruitt Department of Biomedical Engineering, Gainesville, FL USA
| | - Robert S. Eisinger
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kwo Wei David Ho
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Janine Lobo Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kevin To
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Samuel Carbunaru
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Leonardo Almeida
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kelly D. Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Michael S. Okun
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Department of Biomedical Engineering, Gainesville, FL USA
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
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Kosutzka Z, Kusnirova A, Hajduk M, Straka I, Minar M, Valkovic P. Gait Disorders Questionnaire-Promising Tool for Virtual Reality Designing in Patients With Parkinson's Disease. Front Neurol 2019; 10:1024. [PMID: 31611840 PMCID: PMC6768968 DOI: 10.3389/fneur.2019.01024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Gait disorders (GD) are frequent and disabling symptoms in patients with Parkinson's disease, mostly because they significantly limit mobility and often lead to fear of falls or actual falls. Nowadays, rehabilitation is considered to be the most effective nonpharmacological approach to reduce risk of falls. Using paradigms in virtual reality (VR) is a promising tool in neurorehabilitation because of the potential improvement in motor learning and improvement in daily functioning by replicating everyday real-life scenarios. Objective: To identify the most prevalent everyday situations which impair gait in PD that could be simulated in virtual reality (VR) environment. Methods: A newly developed self-report questionnaire consisting of 15 binary response items (YES/NO) encompassing everyday walking situations was administered to 62 patients diagnosed with idiopathic PD according to MDS Clinical Diagnostic Criteria. We included patients able to walk unassisted for at least 10 min and without significant cognitive impairment. Mokken Scale Analysis was used to evaluate psychometric properties of the scale. Results: Questionnaires from 58 patients were analyzed (31 men, age = 63 ± 9.9 y, disease duration = 7.02 ± 4.03 y, LEDD = 1115 ± 549.4 mg, H&Y = 2.4 ± 0.6). Only 10 items (out of 15) were identified as scalable and these were included in Gait Disorders Questionnaire (GDQ). The most prevalent trigger of gait disorders was walking under time pressure, followed by gait in crowded places and walking while dual-tasking. The total score of GDQ significantly correlated with the disease duration (r s = 0.347, p = 0.008) and modified H&Y staging (r s = 0.288, p = 0.028). Conclusion: With the use of GDQ we identified the most prevalent everyday transition activities that provoke gait disorders in patients with PD. The results may be useful for further development and systematic application of VR paradigms for physiotherapy of PD patients.
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Affiliation(s)
- Zuzana Kosutzka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alice Kusnirova
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Hajduk
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Igor Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Minar
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Valkovic
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
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Reynolds GO, Saint-Hilaire M, Thomas CA, Barlow DH, Cronin-Golomb A. Cognitive-Behavioral Therapy for Anxiety in Parkinson's Disease. Behav Modif 2019; 44:552-579. [PMID: 30931594 DOI: 10.1177/0145445519838828] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Parkinson's disease (PD) is characterized by motor symptoms, but nonmotor symptoms also significantly impair daily functioning and reduce quality of life. Anxiety is prevalent and debilitating in PD, but remains understudied and undertreated. Much affective research in PD focuses on depression rather than anxiety, and as such, there are no evidence-based treatments for anxiety in this population. Cognitive-behavioral therapy (CBT) has shown promise for treating depression in PD and may be efficacious for anxiety. This exploratory study implemented a multiple-baseline single-case experimental design to evaluate the utility and feasibility of CBT for individuals with PD who also met criteria for a DSM-5 anxiety disorder (n = 9). Participants were randomized to a 2-, 4-, or 6-week baseline phase, followed by 12 CBT sessions, and two post treatment assessments (immediately post treatment and 6-week follow-up). Multiple outcome measures of anxiety and depression were administered weekly during baseline and intervention. Weekly CBT sessions were conducted in-person (n = 5) or via secure videoconferencing (n = 4). At post treatment, seven of the nine participants showed significant reductions in anxiety and/or depression, with changes functionally related to treatment and most improvements maintained at 6-week follow-up. Effects of CBT on secondary outcomes varied across participants, with preliminary evidence for reduction in fear of falling. Adherence and retention were high, as were treatment satisfaction and acceptability. The findings of this pilot study provide preliminary evidence for the utility of CBT as a feasible treatment for anxiety and comorbid depressive symptoms in PD and highlight the potential of telehealth interventions for mood in this population.
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Stress Management Training (SMT) Improves Coping of Tremor-Boosting Psychosocial Stressors and Depression in Patients with Parkinson's Disease: A Controlled Prospective Study. PARKINSONS DISEASE 2018; 2018:4240178. [PMID: 30510675 PMCID: PMC6230397 DOI: 10.1155/2018/4240178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/19/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
Background Stress reduction and relaxation exercises are therapeutically suggested to patients with Parkinson's disease (PD) and tremor, but data regarding efficacy or preferential methods are missing. Objective To investigate the effect of a standardized stress management training (SMT) according to Kaluza on coping with tremor-boosting psychosocial stress factors. Methods 8-week SMT was applied to 82 PD patients with tremor and 30 controls. Changes in stress-associated factors were measured applying four scales: Kaluza's “warning signs for stress” and “stress-amplifying thoughts” and Beck Depression Inventory (BDI) and quality of life (PDQ-8). Short-term outcome (8 weeks) was evaluated in both groups, and long-term outcome (3–6 months) was evaluated only in PD patients. Results At baseline, PDQ-8 was worse in PD patients compared to controls. PD patients improved significantly regarding short- and long-term outcome scores of “warning signs for stress,” “stress-amplifying thoughts,” and BDI scores, independently of disease severity or duration. Younger and male PD patients showed the best benefit. Controls improved comparably to PD patients but significantly only with respect to “stress-amplifying thoughts.” Retrospectively, 88% (29/33) of PD patients were rated SMT as helpful 12–18 months later. Self-practicing SMT exercises correlated significantly with subjectively better coping with tremor-related daily impairment and subjective short-term and long-term tremor reduction. Conclusion SMT should be a part of therapy of PD patients with tremor.
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Diagnostic Overshadowing of Anxiety in Parkinson Disease: Psychosocial Factors and a Cognitive-Behavioral Model. Cogn Behav Neurol 2018; 31:123-132. [DOI: 10.1097/wnn.0000000000000161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Revisiting the Paraquat-Induced Sporadic Parkinson's Disease-Like Model. Mol Neurobiol 2018; 56:1044-1055. [PMID: 29862459 DOI: 10.1007/s12035-018-1148-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/23/2018] [Indexed: 02/05/2023]
Abstract
Parkinson's disease (PD) is a major neurodegenerative disorder that affects 1-2% of the total global population. Despite its high prevalence and publication of several studies focused on understanding its pathology, an effective treatment that stops and/or reverses the damage to dopaminergic neurons is unavailable. Similar to other neurodegenerative disorders, PD etiology may be linked to several factors, including genetic susceptibility and environmental elements. Regarding environmental factors, several neurotoxic pollutants, including 6-hydroxydopamine (6-OHDA) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), have been identified. Moreover, some pesticides/herbicides, such as rotenone, paraquat (PQ), maneb (MB), and mancozeb (MZ), cause neurotoxicity and induce a PD-like pathology. Based on these findings, several in vitro and in vivo PD-like models have been developed to understand the pathophysiology of PD and evaluate different therapeutic strategies to fight dopaminergic neurodegeneration. 6-OHDA and MPTP are common models used in PD research, and pesticide-based approaches have become secondary models of study. However, some herbicides, such as PQ, are commonly used by farming laborers in developing countries. Thus, the present review summarizes the relevant scientific background regarding the use and effects of chronic exposure to PQ in the context of PD. Similarly, we discuss the relevance of PD-like models developed using this agrochemical compound.
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Objective Measurement and Monitoring of Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017. [PMID: 28802925 DOI: 10.1016/bs.irn.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
The comprehensive evaluation of nonmotor symptoms (NMS) in Parkinson's disease (PD) starts with the awareness of physicians, patients, and caregivers on their nature, clinical presentation, and effect on patient's daily activities and quality of life. This awareness can be better achieved if the symptoms can be visualized, measured, and monitored. As NMS are largely subjective in nature, a majority of them cannot be visualized (unlike tremor, which is easily seen), making their identification and quantification difficult. While symptoms are nonmotor, it does not mean that they are not measurable, as many NMS are integral to motor symptoms of Parkinson's, yet often neglected. In this review, we attempt to provide the most up-to-date and comprehensive literature review on the objective measurement and monitoring of NMS in PD. The aim is to make it clinically relevant by approaching NMS by domains as identified in the NMS Questionnaire. A section on the assessment of nonmotor fluctuations is also included, providing prospects for future objective monitoring. With the advances of technology, it is likely that many NMS will have objective outcomes, thus making these symptoms easily measurable and hopefully lead to future clinical trials that incorporate nonmotor outcomes. Nevertheless, it still requires a physician's judgment to determine which method, scales, objective measures, or monitoring devices or a combination of these is most appropriate to the individual patient in order to answer a particular clinical question.
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