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Oberholzer J, Fayolle D, Vandenbulcke A, Gaudet JG. Cardiac arrest during deep brain stimulation: A case report. Clin Case Rep 2024; 12:e9147. [PMID: 39005577 PMCID: PMC11239760 DOI: 10.1002/ccr3.9147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
We present the case of a 54-year-old male with severe Parkinson's disease and chronic, non-reversible pulmonary artery hypertension who had seizures and a cardiorespiratory arrest during surgery for deep brain stimulation, a minimally invasive procedure usually associated with a low risk of complications. This case illustrates how perioperative changes in antiparkinsonian therapy in patient with multiple comorbidities may significantly affect the risk profile.
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Affiliation(s)
- Julian Oberholzer
- Department of AnesthesiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Damien Fayolle
- Department of NeurologyHôpitaux Universitaires GenèveGenevaSwitzerland
| | - Alberto Vandenbulcke
- Department of NeurosurgeryCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - John G. Gaudet
- Department of AnesthesiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
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2
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Elendu C, Jeswani BM, Madekwe CC, Chukwuneta CP, Sidhu AK, Okorie CO, Banerjee AV, Oshin BD. Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients. Ann Med Surg (Lond) 2024; 86:4015-4034. [PMID: 38989169 PMCID: PMC11230812 DOI: 10.1097/ms9.0000000000002159] [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: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 07/12/2024] Open
Abstract
Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors' review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.
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Affiliation(s)
| | - Bijay M. Jeswani
- GCS Medical College, Hospital & Research Centre, Ahmedabad, Gujarat, India
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Bhidayasiri R, Chaisongkram A, Anan C, Phuenpathom W. User-centred design, validation and clinical testing of an anti-choking mug for people with Parkinson's disease. Sci Rep 2024; 14:14165. [PMID: 38898235 PMCID: PMC11187143 DOI: 10.1038/s41598-024-65071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024] Open
Abstract
Oropharyngeal dysphagia, or difficulty initiating swallowing, is a frequent problem in people with Parkinson's disease (PD) and can lead to aspiration pneumonia. The efficacy of pharmacological options is limited. Postural strategies, such as a chin-down manoeuvre when drinking, have had some degree of success but may be difficult for people who have other limitations such as dementia or neck rigidity, to reproduce consistently. Using a user-centred design approach and a multidisciplinary team, we developed and tested an anti-choking mug for people with PD that helps angle the head in the optimum position for drinking. The design reflected anthropometric and ergonomic aspects of user needs with features including regulation of water flow rate and sip volume, an inner slope, a thickened handle and a wide base, which promoted a chin-down posture when used. Prototype testing using digital technology to compare neck flexion angles (the primary outcome), plus clinical outcomes assessed using standard tools (Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts II and III), found significant improvements in a range of parameters related to efficient swallowing and safe drinking when using the anti-choking mug versus a sham mug.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand.
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10300, Thailand.
| | - Araya Chaisongkram
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand
| | - Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand
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Hayano E, Gon Y, Kimura Y, Zha L, Morishima T, Ohno Y, Mochizuki H, Sobue T, Miyashiro I. Risk of Parkinson's disease-related death in cancer survivors: A population-based study in Japan. Parkinsonism Relat Disord 2024; 119:105966. [PMID: 38147694 DOI: 10.1016/j.parkreldis.2023.105966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The risk of Parkinson's disease (PD)-related death in patients with cancer largely unexplored. METHODS We analyzed data from the Neoplasms ANd other causes of DEath (NANDE) study, which investigates the causes of death in patients with cancer in Japan. Standardized mortality ratios (SMRs) were calculated to compare the risk of PD-related deaths in patients with cancer to that of the general population. Poisson regression models were employed to estimate the relative risk of PD-related death in the subgroups. RESULTS The cohort included 548,485 patients with cancer, yielding 2,047,398 person-years at risk from 1995 to 2013. During the study period, 242,250 patients died and 145 deaths were attributable to PD. The SMR for PD-related death was 2.34 (95% confidence interval [CI]: 1.99-2.75). Patients who were diagnosed with cancer before 70 years of age had a high SMR (>5) for PD-related deaths. The SMR of patients with mouth-to-stomach cancers (lip, oral cavity, pharynx, esophagus, and stomach cancers) was 3.72 (95% CI: 2.84-4.86), while that of those with other cancers was 1.93 (95% CI: 1.57-2.37). The multivariate Poisson regression model revealed that patients with mouth-to-stomach cancers were more likely to die of PD than those without (relative risk 2.07, 95 % CI; 1.46-2.93). CONCLUSIONS Patients with cancer are at a high risk of PD-related death; particularly, mouth-to-stomach cancers and potentially obstructing medication for PD are attributable to a high mortality risk. Careful management, including adequate PD treatment, would benefit cancer survivors with PD and reduce the risk of PD-related death.
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Affiliation(s)
- Eri Hayano
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasufumi Gon
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan; Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, 541-8567, Japan.
| | - Yasuyoshi Kimura
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Ling Zha
- Department of Social Medicine, Environmental Medicine and Population Science, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Toshitaka Morishima
- Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, 541-8567, Japan
| | - Yuko Ohno
- Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Environmental Medicine and Population Science, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, 541-8567, Japan
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Smith-Hublou M, Herndon N, Wong JK, Ramirez-Zamora A, Wheeler-Hegland K. Impacts of Deep Brain Stimulation of the Globus Pallidus Internus on Swallowing: A Retrospective, Cross-Sectional Study. Dysphagia 2024:10.1007/s00455-023-10660-4. [PMID: 38236261 DOI: 10.1007/s00455-023-10660-4] [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: 09/17/2022] [Accepted: 12/16/2023] [Indexed: 01/19/2024]
Abstract
Deep brain stimulation (DBS) is a common treatment for motor symptoms of Parkinson disease (PD), a condition associated with increased risk of dysphagia. The effect of DBS on swallowing function has not been comprehensively evaluated using gold-standard imaging techniques, particularly for globus pallidus internus (GPi) DBS. The objective of this retrospective, cross-sectional study was to identify differences in swallowing safety and timing kinematics among PD subjects with and without GPi DBS. We investigated the effects of unilateral and bilateral GPi DBS as well as the relationship between swallowing safety and DBS stimulation parameters, using retrospective analysis of videofluoroscopy recordings (71 recordings from 36 subjects) from electronic medical records. Outcomes were analyzed by surgical status (pre-surgical, unilateral DBS, bilateral DBS). The primary outcome was percent of thin-liquid bolus trials rated as unsafe, with Penetration-Aspiration Scale scores of 3 or higher. Secondary analyses included swallowing timing measures, relationships between swallowing safety and DBS stimulation parameters, and Dynamic Imaging Grade of Swallowing Toxicity ratings. Most subjects swallowed all boluses safely (19/29 in the pre-surgical, 16/26 in the unilateral DBS, and 10/16 in the bilateral DBS conditions). Swallowing safety impairment did not differ among stimulation groups. There was no main effect of stimulation condition on timing metrics, though main effects were found for sex and bolus type. Stimulation parameters were not correlated with swallowing safety. Swallowing efficiency and overall impairment did not differ among conditions. These results provide evidence that GPi DBS does not affect pharyngeal swallowing function. Further, prospective, investigations are needed.
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Affiliation(s)
- May Smith-Hublou
- Laboratory for the Study of Upper Airway Dysfunction, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA.
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA.
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, 3009 Williston Road, Gainesville, FL, 32608, USA.
| | - Nicole Herndon
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, 3009 Williston Road, Gainesville, FL, 32608, USA
| | - Joshua K Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Karen Wheeler-Hegland
- Laboratory for the Study of Upper Airway Dysfunction, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Zeng Y, Cao S, Pang K, Tang J, Lin G. Causal Association Between Sepsis and Neurodegenerative Diseases: A Bidirectional Two-Sample Mendelian Randomization Study. J Alzheimers Dis 2024; 97:229-237. [PMID: 38189756 DOI: 10.3233/jad-230954] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Previous observational studies suggested an association between sepsis and neurodegenerative diseases, but causality remains unclear. OBJECTIVE Determining the causal association between sepsis and four neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and Lewy body dementia) through bidirectional two-sample Mendelian randomization (MR) analysis. METHODS Genome-wide association study summary statistics for all traits were obtained from publicly available databases. Inverse variance weighted (IVW) was the primary method for evaluating causal associations. In addition, three additional MR methods (MR-Egger, weighted median, and maximum likelihood method) were employed to supplement IVW. Furthermore, various sensitivity tests were conducted to assess the reliability: 1) Cochrane's Q test for assessing heterogeneity; 2) MR-Egger intercept test and MR-PRESSO global test for evaluating horizontal pleiotropy; 3) leave-one-out sensitivity test for determining the stability. RESULTS The results of IVW indicated that sepsis significantly increased the risk of Alzheimer's disease (OR = 1.11, 95% CI: 1.01-1.21, p = 0.025). In addition, three additional MR methods suggested parallel results. However, no causal effect of sepsis on the three other neurodegenerative diseases was identified. Subsequently, reverse MR analysis indicated that the four neurodegenerative diseases do not causally affect sepsis. Furthermore, sensitivity tests demonstrated the reliability of the MR analyses, suggesting no heterogeneity or horizontal pleiotropy. CONCLUSIONS The present study contributes to a deeper comprehension of the intricate interplay between sepsis and neurodegenerative disorders, thereby offering potential avenues for the development of therapeutic agents that can effectively mitigate the multifarious complications associated with sepsis.
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Affiliation(s)
- Youjie Zeng
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Si Cao
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ke Pang
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Tang
- Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoxin Lin
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Lusk S, Ward CS, Chang A, Twitchell-Heyne A, Fattig S, Allen G, Jankowsky J, Ray R. An automated respiratory data pipeline for waveform characteristic analysis. J Physiol 2023; 601:4767-4806. [PMID: 37786382 PMCID: PMC10841337 DOI: 10.1113/jp284363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/11/2023] [Indexed: 10/04/2023] Open
Abstract
Comprehensive and accurate analysis of respiratory and metabolic data is crucial to modelling congenital, pathogenic and degenerative diseases converging on autonomic control failure. A lack of tools for high-throughput analysis of respiratory datasets remains a major challenge. We present Breathe Easy, a novel open-source pipeline for processing raw recordings and associated metadata into operative outcomes, publication-worthy graphs and robust statistical analyses including QQ and residual plots for assumption queries and data transformations. This pipeline uses a facile graphical user interface for uploading data files, setting waveform feature thresholds and defining experimental variables. Breathe Easy was validated against manual selection by experts, which represents the current standard in the field. We demonstrate Breathe Easy's utility by examining a 2-year longitudinal study of an Alzheimer's disease mouse model to assess contributions of forebrain pathology in disordered breathing. Whole body plethysmography has become an important experimental outcome measure for a variety of diseases with primary and secondary respiratory indications. Respiratory dysfunction, while not an initial symptom in many of these disorders, often drives disability or death in patient outcomes. Breathe Easy provides an open-source respiratory analysis tool for all respiratory datasets and represents a necessary improvement upon current analytical methods in the field. KEY POINTS: Respiratory dysfunction is a common endpoint for disability and mortality in many disorders throughout life. Whole body plethysmography in rodents represents a high face-value method for measuring respiratory outcomes in rodent models of these diseases and disorders. Analysis of key respiratory variables remains hindered by manual annotation and analysis that leads to low throughput results that often exclude a majority of the recorded data. Here we present a software suite, Breathe Easy, that automates the process of data selection from raw recordings derived from plethysmography experiments and the analysis of these data into operative outcomes and publication-worthy graphs with statistics. We validate Breathe Easy with a terabyte-scale Alzheimer's dataset that examines the effects of forebrain pathology on respiratory function over 2 years of degeneration.
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Affiliation(s)
- Savannah Lusk
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christopher S. Ward
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Andersen Chang
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Shaun Fattig
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
| | - Genevera Allen
- Departments of Electrical and Computer Engineering, Statistics, and Computer Science, Rice University, Houston, TX 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Joanna Jankowsky
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- Departments of Neurology, Neurosurgery, and Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Russell Ray
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- McNair Medical Institute, Houston, TX 77030, USA
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Funayama M, Koreki A, Takata T, Hisamatsu T, Mizushima J, Ogino S, Kurose S, Oi H, Mimura Y, Shimizu Y, Kudo S, Nishi A, Mukai H, Wakisaka R, Nakano M. Pneumonia Risk Increased by Dementia-Related Daily Living Difficulties: Poor Oral Hygiene and Dysphagia as Contributing Factors. Am J Geriatr Psychiatry 2023; 31:877-885. [PMID: 37286391 DOI: 10.1016/j.jagp.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Although pneumonia is the leading cause of death among patients with dementia, the specific underlying causes remain unclear. In particular, the potential connection between pneumonia risk and dementia-related daily living difficulties, such as oral hygiene practice and mobility impairment, and the use of physical restraint as a management practice, has not been extensively studied. METHODS In our retrospective study, we included 454 admissions corresponding to 336 individual patients with dementia who were admitted to a neuropsychiatric unit due to behavioral and psychological symptoms. The admissions were divided into two groups: those who developed pneumonia while hospitalized (n=62) and those who did not (n=392). We investigated differences between the two groups in terms of dementia etiology, dementia severity, physical conditions, medical complications, medication, dementia-related difficulties in daily living, and physical restraint. To control potential confounding variables, we used mixed effects logistic regression analysis to identify risk factors for pneumonia in this cohort. RESULTS Our study found that the development of pneumonia in patients with dementia was associated with poor oral hygiene, dysphagia, and loss of consciousness. Physical restraint and mobility impairment showed a weaker, nonsignificant association with the development of pneumonia. CONCLUSIONS Our findings suggest that pneumonia in this population may be caused by two primary factors: increased pathogenic microorganisms in the oral cavity due to poor hygiene, and an inability to clear aspirated contents due to dysphagia and loss of consciousness. Further investigation is needed to clarify the relationship between physical restraint, mobility impairment, and pneumonia in this population.
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Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Akihiro Koreki
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Psychiatry (AK, SK), National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Taketo Takata
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Tetsuya Hisamatsu
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Psychiatry, Gunma Hospital (TH), Gunma, Japan
| | - Jin Mizushima
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Satoyuki Ogino
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Trauma and Critical Care Medicine (SO, YS), Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan; Department of Psychiatry (AK, SK), National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Hiroki Oi
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yu Mimura
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yusuke Shimizu
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Trauma and Critical Care Medicine (SO, YS), Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shun Kudo
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Akira Nishi
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan; Department of Psychiatry, Sakuragaoka Kinen Hospital (AN), Tokyo, Japan
| | - Hiroo Mukai
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Riko Wakisaka
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan; Department of Emergency and Critical Care Medicine (RW), Nippon Medical School, Tokyo, Japan
| | - Masaaki Nakano
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Jain A, Raval M, Srikanth S, Modi K, Raju AR, Garg M, Doshi R, Desai R. In-hospital Outcomes of Aspiration Pneumonia Hospitalizations With Acute Heart Failure: A Nationwide Analysis. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:191-200. [PMID: 37937201 PMCID: PMC10625882 DOI: 10.36628/ijhf.2023.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 11/09/2023]
Abstract
Background and Objectives There is a paucity of data regarding the impact of acute heart failure (AHF) on the outcomes of aspiration pneumonia (AP). Methods Using National Inpatient Sample datasets (2016 to 2019), we identified admissions for AP with AHF vs. without AHF using relevant International Classification of Diseases, Tenth Revision codes. We compared the demographics, comorbidities, and outcomes between the two groups. Results Out of the 121,097,410 weighted adult hospitalizations, 488,260 had AP, of which 13.25% (n=64,675) had AHF. The AHF cohort consisted predominantly of the elderly (mean age 80.4 vs. 71.1 years), females (47.8% vs. 42.2%), and whites (81.6% vs. 78.5%) than non-AHF cohort (all p<0.001). Complicated diabetes and hypertension, dyslipidemia, obesity, chronic pulmonary disease, and prior myocardial infarction were more frequent in AHF than in the non-AHF cohort. AP-AHF cohort had similar adjusted odds of all-cause mortality (adjusted odds ratio [AOR], 0.9; 95% confidence interval [CI], 0.78-1.03; p=0.122), acute respiratory failure (AOR, 1.0; 95% CI, 0.96-1.13; p=0.379), but higher adjusted odds of cardiogenic shock (AOR, 2.2; 95% CI, 1.30-3.64; p=0.003), and use of mechanical ventilation (MV) (AOR, 1.3; 95% CI, 1.17-1.56; p<0.001) compared to AP only cohort. AP-AHF cohort more frequently required longer durations of MV and hospital stays with a higher mean cost of the stay. Conclusions Our study from a nationally representative database demonstrates an increased morbidity burden, worsened complications, and higher hospital resource utilization, although a similar risk of all-cause mortality in AP patients with AHF vs. no AHF.
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Affiliation(s)
- Akhil Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maharshi Raval
- Internal Medicine, Landmark Medical Center, Woonsocket, RI, USA
| | | | - Karnav Modi
- Division of Research, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Athul Raj Raju
- Internal Medicine, Karuna Medical College, Kerala, India
| | | | - Rajkumar Doshi
- Cardiology, St Joseph’s University Medical Center, Paterson, NJ, USA
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10
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Zhong M, Ni R, Zhang H, Sun Y. Analysis of clinical characteristics and risk factors of community-acquired pneumonia complicated by parapneumonic pleural effusion in elderly patients. BMC Pulm Med 2023; 23:355. [PMID: 37730573 PMCID: PMC10512587 DOI: 10.1186/s12890-023-02649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) patients usually present with parapneumonic pleural effusion (PPE), which complicates the treatment of pneumonia. This study aims to investigate the clinical characteristics and risk factors of elderly CAP patients hospitalised with PPE. METHODS The clinical data of 132 elderly patients with CAP were retrospectively analysed. A total of 54 patients with PPE (PPE group) and 78 patients without PPE (NPPE group) were included in this study. Clinical data, laboratory examinations, treatments and other relevant indicators were collected. Univariate analysis and multivariate logistic regression analysis will be used to explore the possible risk factors for PPE. RESULTS The proportion of PPE in elderly patients with CAP was 40.9%. PPE patients were significantly more likely to be older, have comorbid neurological diseases, experience chest tightness, and have a lasting fever (P < 0.05). In contrast to NPPE patients, the total number of lymphocytes, serum albumin and blood sodium levels in the PPE group were significantly lower (P < 0.05). The blood D-dimer, C-reactive protein and CURB-65 score of PPE patients were significantly higher (P < 0.05) than those of NPPE patients. Multivariate logistic regression identified chest tightness (OR = 3.964, 95% CI: 1.254-12.537, P = 0.019), long duration of fever (OR = 1.108, 95%CI: 1.009-1.217, P = 0.03), low serum albumin (OR = 0.876, 95%CI: 0.790- 0.971, P = 0.012) or low blood sodium (OR = 0.896, 95%CI: 0.828-0.969, P = 0.006) as independently associated with the development of parapneumonic pleural effusion in the elderly. CONCLUSION This study has identified several clinical factors, such as chest tightness, long duration of fever, low serum albumin, and low blood sodium, as risk factors for the development of pleural effusion in elderly patients with CAP. Early identification and prompt management of these patients can prevent inappropriate treatment and reduce morbidity and mortality.
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Affiliation(s)
- Mingmei Zhong
- The Third Affiliated Hospital of Anhui Medical University, Hefei, 230061, China.
| | - Ruiqin Ni
- Bengbu Medical College, Bengbu, 233030, China
| | - Huizhen Zhang
- The Third Affiliated Hospital of Anhui Medical University, Hefei, 230061, China
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11
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Huff A, Karlen-Amarante M, Oliveira LM, Ramirez JM. Role of the postinspiratory complex in regulating swallow-breathing coordination and other laryngeal behaviors. eLife 2023; 12:e86103. [PMID: 37272425 PMCID: PMC10264072 DOI: 10.7554/elife.86103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023] Open
Abstract
Breathing needs to be tightly coordinated with upper airway behaviors, such as swallowing. Discoordination leads to aspiration pneumonia, the leading cause of death in neurodegenerative disease. Here, we study the role of the postinspiratory complex (PiCo) in coordinating breathing and swallowing. Using optogenetic approaches in freely breathing anesthetized ChATcre:Ai32, Vglut2cre:Ai32 and intersectional recombination of ChATcre:Vglut2FlpO:ChR2 mice reveals PiCo mediates airway protective behaviors. Activation of PiCo during inspiration or the beginning of postinspiration triggers swallow behavior in an all-or-nothing manner, while there is a higher probability for stimulating only laryngeal activation when activated further into expiration. Laryngeal activation is dependent on stimulation duration. Sufficient bilateral PiCo activation is necessary for preserving the physiological swallow motor sequence since activation of only a few PiCo neurons or unilateral activation leads to blurred upper airway behavioral responses. We believe PiCo acts as an interface between the swallow pattern generator and the preBötzinger complex to coordinate swallow and breathing. Investigating PiCo's role in swallow and laryngeal coordination will aid in understanding discoordination with breathing in neurological diseases.
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Affiliation(s)
- Alyssa Huff
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Luiz M Oliveira
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological Surgery, University of Washington School of MedicineSeattleUnited States
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12
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Kershenbaum AD, Price AC, Cardinal RN, Chen S, Fitzgerald JM, Lewis J, Moylett S, O’Brien JT. Mortality rates and proximal causes of death in patients with Lewy body dementia versus Alzheimer's disease: A longitudinal study using secondary care mental health records. Int J Geriatr Psychiatry 2023; 38:e5937. [PMID: 37208979 PMCID: PMC10946736 DOI: 10.1002/gps.5937] [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: 01/14/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous studies have shown reduced survival in Lewy body dementia (LBD) compared to Alzheimer's disease (AD), but the reasons for this are not known. We identified cause of death categories accounting for the reduced survival in LBD. METHODS We linked cohorts of patients with dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD) and AD, with proximal cause of death data. We examined mortality by dementia group and hazard ratios for each death category by dementia group in males and females separately. In a specific focus on the dementia group with the highest mortality rate versus reference, we examined cumulative incidence to identify the main causes of death accounting for the excess deaths. RESULTS Hazard ratios for death were higher in PDD and DLB compared to AD, for both males and females. PDD males had the highest hazard ratio for death across the dementia comparison groups (HR 2.7, 95% CI 2.2-3.3). Compared with AD, hazard ratios for "nervous system" causes of death were significantly elevated in all LBD groups. Additional significant cause-of-death categories included aspiration pneumonia, genitourinary causes, other respiratory causes, circulatory and a "symptoms and signs" category in PDD males; other respiratory causes in DLB males; mental disorders in PDD females; and aspiration pneumonia, genitourinary and other respiratory causes in DLB females. CONCLUSION Further research and cohort development is required to investigate differences by age group, to extend cohort follow-up to the whole population and to investigate the risk-balance of interventions which may differ by dementia group.
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Affiliation(s)
| | - Annabel C. Price
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
- University of CambridgeFulbournUK
| | - Rudolf N. Cardinal
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
- University of CambridgeFulbournUK
| | | | | | - Jonathan Lewis
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
| | | | - John T. O’Brien
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
- University of CambridgeFulbournUK
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Metta V, Chung-Faye G, Ts Benamer H, Mrudula R, Goyal V, Falup-Pecurariu C, Muralidharan N, Deepak D, Abdulraheem M, Borgohain R, Chaudhuri KR. Hiccups, Hypersalivation, Hallucinations in Parkinson's Disease: New Insights, Mechanisms, Pathophysiology, and Management. J Pers Med 2023; 13:jpm13050711. [PMID: 37240881 DOI: 10.3390/jpm13050711] [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: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD-hiccups, hypersalivation, and hallucinations-in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32-74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32-63% in PD, and a 55-78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson's disease.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Guy Chung-Faye
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Hani Ts Benamer
- Department of Movement Disorders & Parkinson's Centre of Excellence, Mohammed Bin Rashid University, Dubai 263267, United Arab Emirates
| | - Rukmini Mrudula
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Vinay Goyal
- Institute of Movement Disorders, Medanta Hospitals, India
| | | | | | - Desh Deepak
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | | | - Rupam Borgohain
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
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Lidetu T, Muluneh EK, Wassie GT. Incidence and Predictors of Aspiration Pneumonia Among Stroke Patients in Western Amhara Region, North-West Ethiopia: A Retrospective Follow Up Study. Int J Gen Med 2023; 16:1303-1315. [PMID: 37089139 PMCID: PMC10115200 DOI: 10.2147/ijgm.s400420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background Aspiration pneumonia is one of the major complications among hospitalized stroke patients, with global incidence ranging from 5-83% and hospital mortality rate of up to 70%. This study aimed to assess the incidence and identify predictors of aspiration pneumonia among stroke patients in Western Amhara region, North-West Ethiopia. Methods An institution-based retrospective follow-up study was conducted on a simple random sample of 568 stroke patients in Western Amhara region admitted at Felege Hiwot Referral Hospital. Log binomial regression model, a generalized linear model with log link, was applied to identify significant predictors of aspiration pneumonia. Results Cumulative incidence of aspiration pneumonia among the 568 sampled patients was 23.06%. Males were 1.71 times more at risk to acquire aspiration pneumonia than females (ARR = 1.71, 95% CI 1.07-2.74). Patients with vomiting and dysphagia were at more risk of acquiring aspiration pneumonia as compared with patients without vomiting and dysphagia (ARR = 1.81, 95% CI 1.04-3.14 and ARR = 1.95, 95% CI 1.10-3.48, respectively). Patients who received antibiotic prophylaxis and patients with Glasgow Coma Scale greater than 12 had less risk of acquiring aspiration pneumonia as compared with those who did not receive antibiotic prophylaxis and patients with Glasgow Coma Scale less than 8 (ARR = 0.10, 95% CI 0.04-0.28 and ARR = 0.45, 95% CI 0.22-0.94, respectively). Conclusion The cumulative incidence of aspiration pneumonia among sampled patients was 23.06%. Vomiting, dysphagia, antibiotic treatment and Glasgow Coma Scale showed significant correlation with the acquiring of aspiration pneumonia. Therefore, we recommend health-care providers should give special attention for patients with these risk factors to prevent aspiration pneumonia.
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Affiliation(s)
- Tadios Lidetu
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
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15
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Rinaldi D, Imbalzano G, Galli S, Bianchini E, Ledda C, De Carolis L, Zibetti M, Lopiano L, Pontieri FE, Artusi CA. The impact of dysphagia in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel. Parkinsonism Relat Disord 2023; 109:105368. [PMID: 36933499 DOI: 10.1016/j.parkreldis.2023.105368] [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] [Received: 01/21/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dysphagia is common in advanced phases of Parkinson disease (PD), and is a risk factor for aspiration pneumonia. Nonetheless, dysphagia has been poorly investigated in PD patients treated with levodopa-carbidopa intestinal gel (LCIG). We aimed to analyze the impact of dysphagia on mortality in LCIG treated patients and its relationship with other PD disability milestones. METHODS We retrospectively evaluated 95 consecutive PD patients treated with LCIG. Kaplan-Meier and log-rank test were used to compare mortality in patients with dysphagia from others. Cox regression was used to estimate the impact of dysphagia, age, disease duration, and Hoehn and Yahr (H&Y) on mortality in the entire cohort. Finally, univariate and multivariate regression analyses were used to estimate the association between dysphagia and age, disease duration, H&Y, hallucinations, and dementia. RESULTS A significantly higher mortality rate was observed in patients with dysphagia. In the Cox model, dysphagia was the only feature significantly associated with mortality (95%CI 2.780-20.609; p < 0.001). Univariate analyses showed a significant correlation between dysphagia and dementia (OR: 0.387; p:0.033), hallucinations (OR: 0.283; p:0.009), and H&Y score (OR: 2.680; p < 0.001); in the multivariate analysis, only the H&Y stage was associated with the presence of dysphagia (OR: 2.357; p:0.003). CONCLUSION Dysphagia significantly increased the risk of death in our cohort of LCIG-treated patients, independently from other relevant features such as age, disease duration, dementia, and hallucinations. These findings support the management of this symptom as a priority in the advanced PD stages, even in people treated with LCIG.
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Affiliation(s)
- Domiziana Rinaldi
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Silvia Galli
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Edoardo Bianchini
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Lanfranco De Carolis
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Francesco Ernesto Pontieri
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy.
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Cho SW, Kim JH, Choi HS, Ahn HY, Kim MK, Rhee EJ. Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database. Endocrinol Metab (Seoul) 2023; 38:10-24. [PMID: 36758542 PMCID: PMC10008661 DOI: 10.3803/enm.2023.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
The Korean National Health Information Database (NHID) contains big data combining information obtained from the National Health Insurance Service and health examinations. Data are provided in the form of a cohort, and the NHID can be used to conduct longitudinal studies and research on rare diseases. Moreover, data on the cause and date of death are provided by Statistics Korea. Research and publications based on the NHID have increased explosively in the field of endocrine disorders. However, because the data were not collected for research purposes, studies using the NHID have limitations, particularly the need for the operational definition of diseases. In this review, we describe the characteristics of the Korean NHID, operational definitions of endocrine diseases used for research, and an overview of recent studies in endocrinology using the Korean NHID.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Eun Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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A nationwide cohort study on diabetes severity and risk of Parkinson disease. NPJ Parkinsons Dis 2023; 9:11. [PMID: 36707543 PMCID: PMC9883517 DOI: 10.1038/s41531-023-00462-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
There is growing evidence that patients with type 2 diabetes mellitus (DM) have an increased risk of developing Parkinson's disease (PD) and share similar dysregulated pathways. We aimed to determine whether the risk of PD increases as diabetes progresses among patients with type 2 DM. Using a nationally representative database from the Korean National Health Insurance System, 2,362,072 individuals (≥40 years of age) with type 2 DM who underwent regular health checkups during 2009-2012 were followed up until the end of 2018. The diabetes severity score parameters included the number of oral hypoglycemic agents, diabetes duration, insulin use, or presence of chronic kidney disease, diabetic retinopathy, or cardiovascular disease. Each of these characteristics was scored as one unit of diabetes severity and their sum was defined as a diabetes severity score from 0-6. We identified 17,046 incident PD cases during the follow-up. Each component of the diabetes severity score showed a similar intensity for the risk of PD. Compared with subjects with no parameters, HR values (95% confidence intervals) of PD were 1.09 (1.04-1.15) in subjects with one diabetes severity score parameter, 1.28 (1.22-1.35) in subjects with two parameters, 1.55 (1.46-1.65) in subjects with three parameters, 1.96 (1.82-2.11) in subjects with four parameters, 2.08 (1.83-2.36) in subjects with five parameters, and 2.78 (2.05-3.79) in subjects with six parameters. Diabetes severity was associated with an increased risk of developing PD. Severe diabetes may be a risk factor for the development of PD.
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Shaibdat NS, Ahmad N, Azmin S, Ibrahim NM. Causes, factors, and complications associated with hospital admissions among patients with Parkinson's disease. Front Neurol 2023; 14:1136858. [PMID: 36959822 PMCID: PMC10027758 DOI: 10.3389/fneur.2023.1136858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Patients with Parkinson's disease (PD) are at a higher risk of hospital admissions compared to the general population. We studied the causes and factors associated with admissions among patients with PD over 6 years. Methods We included all PD admissions between 1 January 2016 and 31 December 2021. Other causes of parkinsonism were excluded. Causes of admissions were divided into PD-related (direct or indirect) or non-PD-related. The type of admission was categorized into emergency or elective. Results We identified 605 hospital admissions (259 patients with PD); 345 (57.0%) were PD-related and 260 (43%) were non-PD-related. Emergency PD admissions contributed to 50.4% of all admissions, most commonly from respiratory infection (23%). PD admissions in comparison to non-PD admissions were associated with worse disease severity (HY ≥ 3; p < 0.001), longer disease duration [8.71 (SD 6.23) vs. 6.60 (SD 5.39) years; p < 0.001], and longer hospital stay [7.70 (SD 5.89) vs. 6.42 (SD 7.63) days; p = 0.020]. Non-PD admissions were associated with more comorbidities (97.3%; p = 0.013). There were 124 (20.5%) complications and 31 deaths (5.1%). A total of 29 deaths were due to respiratory infection and 3 deaths were due to COVID-19 pneumonia. Emergency admission (PD- and non-PD-related; p = 0.001) and respiratory-related causes (p < 0.001) were predictors of unfavorable hospital admission outcomes (death and complications). Conclusion Respiratory infection was the leading cause of hospital admission and a significant independent predictor of unfavorable hospital admission outcomes (death and complications). PD-related admissions were associated with disease severity and led to more complications and longer hospital stays. Non-PD-related admissions were associated with comorbidities.
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Affiliation(s)
- Navena Sharma Shaibdat
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shahrul Azmin
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- *Correspondence: Norlinah Mohamed Ibrahim ;
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Mörz M. A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against COVID-19. Vaccines (Basel) 2022; 10:vaccines10101651. [PMID: 36298516 PMCID: PMC9611676 DOI: 10.3390/vaccines10101651] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The current report presents the case of a 76-year-old man with Parkinson’s disease (PD) who died three weeks after receiving his third COVID-19 vaccination. The patient was first vaccinated in May 2021 with the ChAdOx1 nCov-19 vector vaccine, followed by two doses of the BNT162b2 mRNA vaccine in July and December 2021. The family of the deceased requested an autopsy due to ambiguous clinical signs before death. PD was confirmed by post-mortem examinations. Furthermore, signs of aspiration pneumonia and systemic arteriosclerosis were evident. However, histopathological analyses of the brain uncovered previously unsuspected findings, including acute vasculitis (predominantly lymphocytic) as well as multifocal necrotizing encephalitis of unknown etiology with pronounced inflammation including glial and lymphocytic reaction. In the heart, signs of chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and vasculitis were present. Although there was no history of COVID-19 for this patient, immunohistochemistry for SARS-CoV-2 antigens (spike and nucleocapsid proteins) was performed. Surprisingly, only spike protein but no nucleocapsid protein could be detected within the foci of inflammation in both the brain and the heart, particularly in the endothelial cells of small blood vessels. Since no nucleocapsid protein could be detected, the presence of spike protein must be ascribed to vaccination rather than to viral infection. The findings corroborate previous reports of encephalitis and myocarditis caused by gene-based COVID-19 vaccines.
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Affiliation(s)
- Michael Mörz
- Institute of Pathology 'Georg Schmorl', The Municipal Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany
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Henry KA, Singh R, Zhang N, Lyons MK, McNett K, Neal MT, Mehta SH. Effect of STN/GPi DBS on swallowing function in Parkinson's disease as assessed by Video fluoroscopy: A retrospective study. Parkinsonism Relat Disord 2022; 103:136-140. [PMID: 36115199 DOI: 10.1016/j.parkreldis.2022.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The goal of the study is to objectively assess changes in swallowing (using "gold standard" video fluoroscopy (VFS)) following Deep Brain Stimulation (DBS) surgery in Parkinson's disease (PD) patients. There are few studies on the effect of DBS on swallowing in PD. We use VFS to assess swallowing function pre- and post-DBS. METHODS Our study participants underwent pre- and post-DBS VFS (6 months later) in the practically defined on state. We converted VFS reports into an objective numerical scale. Higher scores denote more severe dysphagia. We used non-parametric test (Wilcoxon signed rank test) to test if the difference between pre- and post-DBS swallow score is significantly different from 0. RESULTS Fifty-four PD patients completed pre- and post-DBS evaluations. Twenty-five patients had bilateral GPi DBS (46.3%) and 29 had bilateral STN DBS (53.7%). The mean (SD) post-DBS swallow score is 1.9 (2.0) and pre-DBS swallow score is 1.6 (1.3). The difference is not significantly different from 0 (p = 0.16). In our study, swallow scores for majority of the patients (39 out of 54) did not change after DBS regardless of lead location. Six (11.1%) PD patients had post-DBS swallow score decrease on average by 1 (SD: 0) points. 9 (16.7%) patients had post-DBS swallow score increase on average by 2.7 (SD: 2.3) points. CONCLUSION There was no statistically significant change in the swallow scores pre-and 6 months post-DBS with VFS when assessed in the practically defined on state, regardless of the site of bilateral lead implantation. Hence, we believe that DBS does not improve or reduce swallow function in a clinically meaningful way in PD.
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Affiliation(s)
- Katharine A Henry
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Nan Zhang
- Department of Biostatics, Mayo Clinic, Scottsdale, AZ, USA
| | - Mark K Lyons
- Department of Neurosurgery, Mayo Clinic, Scottsdale, AZ, USA
| | - Karen McNett
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Matthew T Neal
- Department of Neurosurgery, Mayo Clinic, Scottsdale, AZ, USA
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21
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Ablat N, Ablimit M, Sun Y, Zhao X, Pu X. Application of new imaging methods in the development of Chinese medicine. Biomed Pharmacother 2022; 153:113470. [DOI: 10.1016/j.biopha.2022.113470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/27/2022] Open
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22
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Complications During the Hospital Stay, Length of Stay, and Cost of Care in Parkinson Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Database Study. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202207000-00009. [PMID: 35802778 PMCID: PMC9273370 DOI: 10.5435/jaaosglobal-d-22-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
Abstract
Patients with Parkinson disease (PD) undergoing total knee arthroplasty (TKA) can present with a unique subset of challenges during their hospital stay. The literature is limited to single-center studies with a small number of patients. This study was aimed to analyze the inpatient complications, length of stay (LOS), and cost of care (COC) associated after TKA with PD over 4 years (2016 to 2019).
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23
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Zhuang J, Jia J. Effects of Respiratory Muscle Strength Training on Respiratory-Related Impairments of Parkinson's Disease. Front Aging Neurosci 2022; 14:929923. [PMID: 35847666 PMCID: PMC9281879 DOI: 10.3389/fnagi.2022.929923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
In addition to typical motor dysfunction, Parkinson's disease is also characterized by respiratory-related dysfunction. As a means of rehabilitation, respiratory muscle strength training (RMST) has been applied to restore Parkinson's disease (PD) functions. However, the current clinical value of RMST in the application for PD has not been widely established. This article aims to review the research progress of the application of RMST in PD rehabilitation to provide new sight into respiratory-related impairments management in people with PD.
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Affiliation(s)
- Jinyang Zhuang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- *Correspondence: Jie Jia
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Poovieng J, Sakboonyarat B, Nasomsong W. Bacterial etiology and mortality rate in community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia in Thai university hospital. Sci Rep 2022; 12:9004. [PMID: 35637232 PMCID: PMC9150030 DOI: 10.1038/s41598-022-12904-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/18/2022] [Indexed: 02/08/2023] Open
Abstract
Pneumonia is caused by infection at the pulmonary parenchyma which constitutes a crucial risk factor for morbidity and mortality. We aimed to determine the mortality rate and its risk factors as well as etiology among inpatients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and healthcare-associated pneumonia (HCAP). A hospital-based retrospective cohort study was conducted in a university hospital located in Bangkok, Thailand. A total of 250 inpatients with pneumonia was included in the present study. The inhospital mortality rate was 1.25 (95% CI 0.99–1.56) per 100 person-days. The present study reported that overall pneumonia caused by gram-negative pathogens accounted for 60.5%. P. aeruginosa was a frequent gram-negative pathogen among these participants, especially among patients with HCAP and HAP. Adjusted hazard ratio (AHR) of inhospital mortality among patients with HAP was 1.75 (95% CI 1.01–3.03) times that of those among patients with CAP, while AHR for 28-day mortality among patients with HAP compared with those with CAP was 2.81 (95% CI 1.38–5.75). Individual risks factors including cardiomyopathy, active-smoker and insulin use were potential risk factors for mortality. Initial qSOFA and acid-based disturbance should be assessed to improve proper management and outcomes.
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25
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Ebina J, Ebihara S, Kano O. Similarities, differences and overlaps between frailty and Parkinson's disease. Geriatr Gerontol Int 2022; 22:259-270. [PMID: 35243739 DOI: 10.1111/ggi.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
Parkinson's disease is a neurodegenerative disorder clinically characterized by bradykinesia, rest tremor, rigidity, and postural and gait disturbances, which are frequently observed in older people. It also shows non-motor symptoms, such as depression, anxiety, cognitive impairment and dementia. The number of patients is gradually increasing worldwide. Aging is a risk factor for the onset of Parkinson's disease, and various physiological effects of aging influence its progression. Frailty is a geriatric syndrome in which the reversible and vulnerable status between robustness and disability is affected by various physiological stressors with aging. Frailty consists of physical, psychological and social aspects. Furthermore, sarcopenia, a syndrome characterized by the loss of muscle mass, strength and function, is also significantly associated with frailty. To maintain the quality of life of older people, frailty, including sarcopenia, should be quickly and appropriately managed. Polypharmacy is an important factor causing the progression of frailty in geriatric syndrome. Although Parkinson's disease and frailty have similar symptoms, and are considered to affect each other, the clinical features and mechanisms of both largely remain unclear. Nevertheless, little literature on the relationship between frailty and Parkinson's disease is currently available. This narrative review aims to clarify the relationships between Parkinson's disease and frailty, not only on the physical, but also on the mental, cognitive, and social aspects and issues regarding polypharmacy in Parkinson's disease explored by previous studies. Geriatr Gerontol Int 2022; 22: 259-270.
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Affiliation(s)
- Junya Ebina
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
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Halhouli O, Zhang Q, Aldridge GM. Caring for patients with cognitive dysfunction, fluctuations and dementia caused by Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:407-434. [PMID: 35248204 DOI: 10.1016/bs.pbr.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive dysfunction is one of the most prevalent non-motor symptoms in patients with Parkinson's disease (PD). While it tends to worsen in the later stages of disease, it can occur at any time, with 15-20% of patients exhibiting cognitive deficits at diagnosis (Aarsland et al., 2010; Goldman and Sieg, 2020). The characteristic features of cognitive dysfunction include impairment in executive function, visuospatial abilities, and attention, which vary in severity from subtle impairment to overt dementia (Martinez-Horta and Kulisevsky, 2019). To complicate matters, cognitive dysfunction is prone to fluctuate in PD patients, impacting diagnosis and the ability to assess progression and decision-making capacity. The diagnosis of cognitive impairment or dementia has a huge impact on patient independence, quality of life, life expectancy and caregiver burden (Corallo et al., 2017; Lawson et al., 2016; Leroi et al., 2012). It is therefore essential that physicians caring for patients with PD provide education, screening and treatment for this aspect of the disease. In this chapter, we provide a practical guide for the assessment and management of various degrees of cognitive dysfunction in patients with PD by approaching the disease at different stages. We address risk factors for cognitive dysfunction, prevention strategies prior to making the diagnosis, available tools for screening. Lastly, we review aspects of care, management and considerations, including decision-making capacity, that occur after the patient has been diagnosed with cognitive dysfunction or dementia.
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Affiliation(s)
- Oday Halhouli
- University of Iowa, Department of Neurology, Iowa City, IA, United States
| | - Qiang Zhang
- University of Iowa, Department of Neurology, Iowa City, IA, United States
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27
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Plaza E, Ruviaro Busanello-Stella A. Effects of a tongue training program in Parkinson's disease: analysis of electrical activity and strength of suprahyoid muscles. J Electromyogr Kinesiol 2022; 63:102642. [DOI: 10.1016/j.jelekin.2022.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022] Open
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28
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Aquino YC, Cabral LM, Miranda NC, Naccarato MC, Falquetto B, Moreira TS, Takakura AC. Respiratory disorders of Parkinson's disease. J Neurophysiol 2022; 127:1-15. [PMID: 34817281 DOI: 10.1152/jn.00363.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease (PD) is characterized by the progressive loss of dopaminergic neurons in the substantia nigra, mainly affecting people over 60 yr of age. Patients develop both classic symptoms (tremors, muscle rigidity, bradykinesia, and postural instability) and nonclassical symptoms (orthostatic hypotension, neuropsychiatric deficiency, sleep disturbances, and respiratory disorders). Thus, patients with PD can have a significantly impaired quality of life, especially when they do not have multimodality therapeutic follow-up. The respiratory alterations associated with this syndrome are the main cause of mortality in PD. They can be classified as peripheral when caused by disorders of the upper airways or muscles involved in breathing and as central when triggered by functional deficits of important neurons located in the brainstem involved in respiratory control. Currently, there is little research describing these disorders, and therefore, there is no well-established knowledge about the subject, making the treatment of patients with respiratory symptoms difficult. In this review, the history of the pathology and data about the respiratory changes in PD obtained thus far will be addressed.
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Affiliation(s)
- Yasmin C Aquino
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Laís M Cabral
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Nicole C Miranda
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Monique C Naccarato
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Bárbara Falquetto
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Thiago S Moreira
- Department of Physiology and Biophysics, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana C Takakura
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
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Treatment paradigms in Parkinson's Disease and Covid-19. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:135-171. [PMID: 36208898 PMCID: PMC9148185 DOI: 10.1016/bs.irn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
People with Parkinson's Disease (PwP) may be at higher risk for complications from the Coronavirus Disease 2019 (Covid-19) due to older age and to the multi-faceted nature of Parkinson's Disease (PD) per se, presenting with a variety of motor and non-motor symptoms. Those on advanced therapies may be particularly vulnerable. Taking the above into consideration, along with the potential multi-systemic impact of Covid-19 on affected patients and the complications of hospitalization, we are providing an evidence-based guidance to ensure a high standard of care for PwP affected by Covid-19 with varying severity of the condition. Adherence to the dopaminergic medication of PwP, without abrupt modifications in dosage and frequency, is of utmost importance, while potential interactions with newly introduced drugs should always be considered. Treating physicians should be cautious to acknowledge and timely address any potential complications, while consultation by a neurologist, preferably with special knowledge on movement disorders, is advised for patients admitted in non-neurological wards. Non-pharmacological approaches, including the patient's mobilization, falls prevention, good sleep hygiene, emotional support, and adequate nutritional and fluid intake, are essential and the role of telemedicine services should be strengthened and encouraged.
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Santos García D, Álvarez Sauco M, Calopa M, Carrillo F, Escamilla Sevilla F, Freire E, García Ramos R, Kulisevsky J, Gómez Esteban JC, Legarda I, Luquín MRI, Castrillo JCM, Martínez-Martin P, Martínez-Torres I, Mir P, Ignacio ÁS. MNCD: A New Tool for Classifying Parkinson’s Disease in Daily Clinical Practice. Diagnostics (Basel) 2021; 12:diagnostics12010055. [PMID: 35054222 PMCID: PMC8774369 DOI: 10.3390/diagnostics12010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective: Parkinson’s disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.
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Affiliation(s)
- Diego Santos García
- Unidad de Trastornos de Movimiento, Servicio de Neurología, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15009 A Coruña, Spain
- Neurología, Hospital San Rafael, 15009 A Coruña, Spain
- Correspondence: ; Tel.: +34-646173341
| | - María Álvarez Sauco
- Departamento de Neurología, Hospital General Universitario de Elche, 03203 Elche, Spain; (M.Á.S.); (E.F.)
| | - Matilde Calopa
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Fátima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (F.C.); (P.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Francisco Escamilla Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria (ibs.Granada), 18013 Granada, Spain;
| | - Eric Freire
- Departamento de Neurología, Hospital General Universitario de Elche, 03203 Elche, Spain; (M.Á.S.); (E.F.)
- Departamento de Neurología, Hospital IMED Elche, 03203 Elche, Spain
| | - Rocío García Ramos
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Jaime Kulisevsky
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
- Departamento de Neurología, Unidad de Trastornos del Movimiento, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | | | - Inés Legarda
- Hospital Universitario Son Espases, 07120 Palma, Spain;
| | - María Rosario Isabel Luquín
- Departamento de Neurología, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain;
| | | | - Pablo Martínez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Irene Martínez-Torres
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario y Politècnico La Fe, 46026 Valencia, Spain;
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (F.C.); (P.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Ángel Sesar Ignacio
- Unidad de Trastornos del Movimiento, Servicio de Neurología, CHUS (Complejo Hospitalario Universitario de Santiago de Compostela), 15706 A Coruña, Spain;
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