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Asadpoordezaki Z, Coogan AN, Henley BM. Chronobiology of Parkinson's disease: Past, present and future. Eur J Neurosci 2023; 57:178-200. [PMID: 36342744 PMCID: PMC10099399 DOI: 10.1111/ejn.15859] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Parkinson's disease is a neurodegenerative disorder predominately affecting midbrain dopaminergic neurons that results in a broad range of motor and non-motor symptoms. Sleep complaints are among the most common non-motor symptoms, even in the prodromal period. Sleep alterations in Parkinson's disease patients may be associated with dysregulation of circadian rhythms, intrinsic 24-h cycles that control essential physiological functions, or with side effects from levodopa medication and physical and mental health challenges. The impact of circadian dysregulation on sleep disturbances in Parkinson's disease is not fully understood; as such, we review the systems, cellular and molecular mechanisms that may underlie circadian perturbations in Parkinson's disease. We also discuss the potential benefits of chronobiology-based personalized medicine in the management of Parkinson's disease both in terms of behavioural and pharmacological interventions. We propose that a fuller understanding of circadian clock function may shed important new light on the aetiology and symptomatology of the disease and may allow for improvements in the quality of life for the millions of people with Parkinson's disease.
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Affiliation(s)
- Ziba Asadpoordezaki
- Department of Psychology, Maynooth University, Maynooth, Co Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Maynooth, Co Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Beverley M Henley
- Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
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Like a Wave in Its Variable Shape, Breadth, and Depth: A Qualitative Interview Study of Experiences of Daytime Sleepiness in People with Parkinson’s Disease. PARKINSON'S DISEASE 2022; 2022:9980177. [PMID: 36204046 PMCID: PMC9532101 DOI: 10.1155/2022/9980177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 06/24/2022] [Accepted: 09/11/2022] [Indexed: 11/22/2022]
Abstract
Introduction Daytime sleepiness is a common nonmotor symptom in Parkinson's disease (PD) which is associated with decreased quality of life and perceived health. However, experiences of daytime sleepiness in people with PD have not been explored. The aim of this qualitative study was to explore experiences of daytime sleepiness in people with PD. Materials and Methods Five women and seven men (42–82 years) with PD for 1.5 to 21 years and excessive daytime sleepiness (i.e., a score of >10 on the Epworth Sleepiness Scale) participated in the study. Data were collected through individual, semistructured, face-to-face interviews and analyzed with qualitative content analysis. Results Three themes of the experience of daytime sleepiness were revealed: (1) not an isolated phenomenon, (2) something to struggle against or accept, and (3) something beyond sleepiness. Conclusion. Daytime sleepiness is a complex nonmotor symptom in PD which manifests itself in several ways. Some experiences are similar, for instance, the attribution of daytime sleepiness to PD and its medical treatment. Differences depend on how sleepiness manifests itself, affects the person, and impacts daily life, as well as whether it causes feelings of embarrassment. Some participants needed to struggle against daytime sleepiness most of the time, and others had found a way to handle it, for example, with physical activity. However, sleepiness may also be used to benefit the person, for example, if they allow themselves to take a power nap to regain energy. The health care professionals can easily underestimate or misinterpret the prevalence and burden of daytime sleepiness because people with PD may describe daytime sleepiness as tiredness, drowsiness, or feeling exhausted, not as sleepiness.
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Feng F, Cai Y, Hou Y, Ou R, Jiang Z, Shang H. Excessive daytime sleepiness in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2021; 85:133-140. [PMID: 33637423 DOI: 10.1016/j.parkreldis.2021.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To provide a robust estimate of the prevalence of excessive daytime sleepiness (EDS) and its clinical correlates in patients with Parkinson's disease (PD). METHOD We searched the PubMed and Embase databases for studies investigating the prevalence and clinical correlates of EDS from inception to March 01, 2020. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale. Random-effects models were set to pool the risk estimates. Sensitivity analyses were performed to evaluate the stability of the outcomes. RESULTS After screening 1367 titles and abstracts, 59 studies involving 12,439 participants were included in the systematic review and meta-analysis. The pooled prevalence of EDS in PD was 35.1%, which was higher in South America, North America, Europe, and Australia than that in Asia. Compared to patients without EDS, patients with EDS had higher effect size on disease duration (0.76 years; 95% CI: 0.16-1.37, I2 = 68.8%), Hoehn and Yahr (HY) stage (0.23 grade; 95% CI: 0.11-0.34, I2 = 69.1%), Unified PD Rating Scale (UPDRS)-III (3.02 points; 95% CI: 1.53-4.51, I2: 61.2%), levodopa equivalent daily dose (LEDD) (141.46 mg; 95% CI: 64.17-218.77, I2 = 86.1%), depression symptoms (Hedges' g = 0.35; 95% CI: 0.15-0.55, I2 = 72.0%) and male sex (OR = 1.50; 95% CI: 1.30-1.72, I2 = 0). CONCLUSION Our results showed that approximately one-third of patients with PD had EDS, which may be associated with the severity of the disease, depression, and male sex, or a combination of neurodegeneration and medication.
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Affiliation(s)
- Fei Feng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - YingYing Cai
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - YanBing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Hu Y, Guo P, Lian TH, Zuo LJ, Yu SY, Liu L, Jin Z, Yu QJ, Wang RD, Li LX, Piao YS, Zhang W. Clinical Characteristics, Iron Metabolism and Neuroinflammation: New Insight into Excessive Daytime Sleepiness in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2041-2051. [PMID: 34188474 PMCID: PMC8232841 DOI: 10.2147/ndt.s272110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To investigate the clinical characteristics, iron metabolism and neuroinflammation in Parkinson's disease (PD) patients with excessive daytime sleepiness (EDS). METHODS We studied 379 patients with PD and 30 age-matched controls. All subjects were evaluated by Epworth sleepiness scale (ESS) and a series of rating scales and were divided into PD-EDS and PD-NEDS groups according to ESS score. The concentrations of iron and iron-related proteins and inflammatory cytokines in both cerebrospinal fluid (CSF) and serum were examined. RESULTS 1. The occurrence rate of EDS in total PD patients was 16.09%. 2. PD-EDS group had significantly severer disease stages, more severe motor and non-motor features of the disease. 3. In CSF, the concentrations of iron and IL-1β in the PD-EDS group were significantly higher and ferritin concentration was prominently lower when compared with the PD-NEDS group and the control group; ESS score was significantly associated with high concentrations of iron and IL-1β and low concentration of ferritin in the PD group. Iron concentration was positively correlated with IL-1β concentration in the PD-EDS group. 4. In serum, no changes were observed in iron and iron-related proteins and inflammatory cytokines among the three groups. CONCLUSION EDS was a common symptom in PD patients. PD patients with EDS had more severe motor and some non-motor symptoms. Overloaded iron-relevant inflammation in the brain might be an underlying mechanism of PD-EDS.
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Affiliation(s)
- Yang Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Peng Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Teng-Hong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Li-Jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Shu-Yang Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Li Liu
- Department of Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Zhao Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Qiu-Jin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Rui-Dan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Li-Xia Li
- Department of Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Ying-Shan Piao
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Wei Zhang
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, People's Republic of China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, 100069, People's Republic of China.,Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, 100053, People's Republic of China.,Beijing Key Laboratory on Parkinson's Disease, Beijing, 100053, People's Republic of China
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Höglund A, Hagell P, Broman JE, Pålhagen S, Sorjonen K, Fredrikson S, Svenningsson P. Associations Between Fluctuations in Daytime Sleepiness and Motor and Non-Motor Symptoms in Parkinson's Disease. Mov Disord Clin Pract 2020; 8:44-50. [PMID: 33426158 PMCID: PMC7780947 DOI: 10.1002/mdc3.13102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/27/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Non‐motor fluctuations are a major concern in Parkinson's disease (PD), and they have been categorized into neuropsychiatric, autonomic and sensory fluctuations. However, this categorization does not include sleep and sleep‐related features, and the association between daytime sleepiness and other motor and/or non‐motor fluctuations in PD remains to be elucidated. Objective To investigate the relationship between daytime sleepiness and other non‐motor and motor fluctuations in people with PD. Methods A three‐day home diary recording daytime sleepiness, mood, anxiety, and motor symptoms was used along with the Karolinska Sleepiness Scale (KSS) and 6 days of accelerometer (Parkinson's KinetiGraph™; PKG™) registration to detect motor fluctuations among people with a DaTSCAN verified clinical PD diagnosis (32 men; mean PD duration, 8.2 years). Participants were categorized as motor fluctuators or non‐fluctuators according to the UPDRS part IV and/or the presence of motor and non‐motor fluctuations. Results Fifty‐two people with PD participated. Daytime sleepiness correlated significantly with motor symptoms, mood and anxiety among those classified as motor fluctuators (n = 28). Motor fluctuators showed stronger correlations between the individual mean level of all diary variables (daytime sleepiness, anxiety, mood and motor symptoms) when compared to the non‐fluctuators (n = 24). Stronger positive within‐individual correlations were found among fluctuators in comparison to non‐fluctuators. In general, PKG data did not correlate with diary data. Conclusion Episodes of daytime sleepiness, as reported by home diaries, were associated with other self‐reported non‐motor and motor fluctuations, but were not supported by PKG data.
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Affiliation(s)
- Arja Höglund
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
| | - Peter Hagell
- The PRO-CARE Group, Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| | - Jan-Erik Broman
- Department of Neuroscience, Psychiatry Uppsala University Uppsala Sweden
| | - Sven Pålhagen
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
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Mastering nocturnal jigsaws in Parkinson's disease: a dusk-to-dawn review of night-time symptoms. J Neural Transm (Vienna) 2020; 127:763-777. [PMID: 32172472 DOI: 10.1007/s00702-020-02170-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
Finding out about night-time symptoms from Parkinson's disease (PD) patients can be a challenge as many patients and their carers cannot recall many symptoms that occur during the night, resulting in an under-recognition or a large variability of responses from clinical interviews and scales. Moreover, technology-based assessments for most night-time symptoms are still not universally available for use in a patient's home environment. Therefore, most physicians rely on their clinical acumen to capture these night-time symptoms based on pieces of patients' history, bedpartner's reports, clinical features, associated symptoms or conditions. To capture more night-time symptoms, the authors identified common nocturnal symptoms based on how they manifest from dusk to dawn with selected features relevant to PD. While some symptoms occur in healthy individuals, in PD patients, they may impact differently. The authors intend this narrative review to provide a practical guide on how these common night-time symptoms manifest and highlight pertinent issues by focusing on prevalence, clinical symptomatology, and specific relationships to PD. It is also important to recognise that PD-specific sleep disturbances increase with advancing disease with additional contributions from ageing, comorbidities, and medication side effects. However, the relative contribution of each factor to individual symptom may be different in individual patient, necessitating clinical expertise for individual interpretation. While there are debatable issues in certain areas, they underlie the complexity of night-time symptoms. Understanding night-time symptoms in PD is like re-arranging jigsaw pieces of clinical information to create, but never complete, a picture for physicians to instigate appropriate management.
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Wang X, Wang M, Yuan Y, Li J, Shen Y, Zhang K. Altered Amplitude of Low-Frequency Fluctuations and Functional Connectivity in Excessive Daytime Sleepiness in Parkinson Disease. Front Neurosci 2020; 14:29. [PMID: 32082108 PMCID: PMC7006219 DOI: 10.3389/fnins.2020.00029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECT Excessive daytime sleepiness (EDS) is common in Parkinson disease (PD), but the neural basis of EDS in PD is unclear. We aim to analyze the neural activity changes in PD-related EDS. METHODS In the present study, 38 PD patients and 19 healthy controls underwent clinical assessments and resting state functional magnetic resonance imaging (MRI) at 3T. Patients were further classified into PD patients with EDS (n = 17) and PD patients without EDS (n = 21), according to the Epworth Sleepiness Scale (ESS) cutoff score with greater than 10 or less than 3. We evaluated all patients using PD-related motor and non-motor clinical scales. An analysis of covariance and post hoc two-sample t-tests were performed to examine between-groups differences of the amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC). RESULTS We found that, all PD-EDS subjects in our study were male. Compared with the control subjects, PD patients with EDS had decreased ALFF in the Pons and increased ALFF in the Frontal_Mid_Orb_L (p < 0.01, corrected). Moreover, PD patients with EDS showed decreased ALFF in the left posterior cingulate cortex (PCC) relative to PD without EDS, which was negatively correlated with the ESS score (p < 0.001). After that, the FC analysis with the left PCC region of interest showed reduced FC of the right PCC and right precuneus in PD with EDS compared with PD without EDS (p < 0.01, corrected). CONCLUSION We hypothesized the wake-promoting pathways and the default mode network dysfunction underlying the EDS in male PD patients.
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Affiliation(s)
- Xixi Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junyi Li
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting Shen
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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A 10-Year Follow-Up of Excessive Daytime Sleepiness in Parkinson's Disease. PARKINSON'S DISEASE 2019; 2019:5708515. [PMID: 31583073 PMCID: PMC6748198 DOI: 10.1155/2019/5708515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/04/2019] [Indexed: 11/18/2022]
Abstract
Introduction The aim of this prospective study was to investigate excessive daytime sleepiness (EDS) over time and in relation to other PD symptoms among people with Parkinson's disease (PD). Methods Thirty participants younger than 65 years with PD were randomly selected. At inclusion, mean (SD) disease duration was 6.2 (4.8) years and median (min-max) severity of PD was classified as stage II (stages I–III) according to Hoehn and Yahr. Participants were followed annually for 10 years with clinical assessments of their PD status, medications, comorbidities, and a standardized interview about their sleep habits and occurrence of daytime sleepiness. EDS was assessed by the self-reported Epworth Sleepiness Scale (ESS). Seventeen participants completed the 10-year longitudinal follow-up. Results Fifteen of 30 persons were classified to suffer from EDS (ESS > 10) at baseline. At the group level, EDS remained stable over 10 years and did not deteriorate in parallel with worsening of motor symptoms. Furthermore, EDS was associated with sleep quality, fatigue, anxiety, depression, and axial/postural/gait impairments. Conclusions EDS did not worsen over 10 years, although other PD aspects did. EDS in PD seems to be a complex nonmotor symptom that is unrelated to deterioration of motor symptoms in PD.
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9
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Liguori C, Mercuri NB, Albanese M, Olivola E, Stefani A, Pierantozzi M. Daytime sleepiness may be an independent symptom unrelated to sleep quality in Parkinson's disease. J Neurol 2019; 266:636-641. [PMID: 30607535 DOI: 10.1007/s00415-018-09179-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022]
Abstract
Excessive daytime sleepiness (EDS) may represent a disabling non-motor symptom in patients affected by Parkinson's disease (PD). This is a secondary analysis of a previous study documenting the improvement of nocturnal sleep in PD patients treated by rotigotine vs placebo. Here we tested the supposition that EDS may represent a distinct PD non-motor symptom occurring independently of other sleep-wake disorders; moreover, we verified whether EDS can be influenced by the improvement of nocturnal sleep in PD. In the present study, we evaluated the daytime sleepiness of PD patients treated with nocturnal administration of rotigotine (PD-Rot) vs placebo (PD-Pla), as measured by both subjective (Epworth Sleepiness Scale-ESS) and objective (Multiple Sleep Latency Test-MSLT) tools. We included 21 PD-Rot compared to 21 PD-Pla patients and documented no significant changes of both ESS and MSLT data between baseline and follow-up visits in both groups. Moreover, we found no correlations between nocturnal sleep improvement and diurnal sleepiness. Therefore, these data suggest that the improvement of nocturnal sleep in PD patients does not modify the daytime sleepiness, thus suggesting that diurnal sleepiness may occur independently of nocturnal sleep disturbances in PD patients.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy. .,UOSD Parkinson, University Hospital of Rome "Tor Vergata", Rome, Italy. .,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Maria Albanese
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Enrica Olivola
- Parkinson and Movement Disorders Unit, Neurology Department, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessandro Stefani
- UOSD Parkinson, University Hospital of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mariangela Pierantozzi
- UOSD Parkinson, University Hospital of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Bhidayasiri R, Sringean J, Taechalertpaisarn P, Thanawattano C. Capturing nighttime symptoms in Parkinson disease: Technical development and experimental verification of inertial sensors for nocturnal hypokinesia. ACTA ACUST UNITED AC 2018; 53:487-98. [PMID: 27533042 DOI: 10.1682/jrrd.2015.04.0062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/17/2015] [Indexed: 11/05/2022]
Abstract
Although nocturnal hypokinesia represents one of the most common nocturnal disabilities in Parkinson disease (PD), it is often a neglected problem in daily clinical practice. We have developed a portable ambulatory motion recorder (the NIGHT-Recorder), which consists of 16-bit triaxial integrated microelectromechanical system inertial sensors that are specifically designed to measure movements, register the position of the body with respect to gravity, and provide information on rotations on the longitudinal axis while lying in bed. The signal processing uses the forward derivative method to identify rolling over and getting out of bed as primary indicators. The prototype was tested on six PD pairs to measure their movements for one night. Using predetermined definitions, 134 movements were captured consisting of rolling over 115 times and getting out of bed 19 times. Patients with PD rolled over significantly fewer times than their spouses (p = 0.03), and the position change was significantly smaller in patients with PD (p = 0.03). Patients with PD rolled over at a significantly slower speed (p = 0.03) and acceleration (p = 0.03) than their spouses. In contrast, patients with PD got out of bed significantly more often than their spouses (p = 0.02). It is technically feasible to develop an easy-to-use, portable, and accurate device that can assist physicians in the assessment of nocturnal movements of patients with PD.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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11
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Lin YY, Chen RS, Lu CS, Huang YZ, Weng YH, Yeh TH, Lin WY, Hung J. Sleep disturbances in Taiwanese patients with Parkinson's disease. Brain Behav 2017; 7:e00806. [PMID: 29075566 PMCID: PMC5651390 DOI: 10.1002/brb3.806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/14/2017] [Accepted: 07/23/2017] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Sleep disturbance is a common nonmotor symptom of Parkinson's disease (PD) and strongly affects patients' quality of life. The relationship between excessive daytime sleepiness (EDS) and nighttime problems remains uncertain. Arguments persist regarding the risk factors for sleep disturbance among patients with PD. Furthermore, the prevalence of EDS appears to be lower in Asian countries. Herein, we conducted the study to describe the characteristics of sleep problems in a sample of Taiwanese PD patients and delineate the difference with reported sleep disturbances in Caucasian PD patients from the literature. METHODS Patients with PD were recruited from the outpatient clinic of a tertiary medical center and were evaluated using standardized assessment protocols, including the Parkinson's Disease Sleep Scale (PDSS), the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 39-Item Parkinson's Disease Questionnaire (PDQ-39). RESULTS A total of 225 patients with PD were recruited. The mean age of patients with PD was 65.7 years old and the mean disease duration was 8.18 years. Among the patients, 53.8% were defined as poor sleepers (PSQI > 5) and 26.3% had EDS. Seventy-one percent of the poor sleepers used hypnotic medications. The poor sleepers were worse in the scores of Unified Parkinson's Disease Rating Scale (UPDRS), PDSS, and the PDQ-39, and received higher levodopa daily dosage. A PDSS score of <126 indicate that a patient with PD was a poor sleeper. EDS was positively correlated with advanced Hoehn and Yahr stages and use of dopamine agonists but not with levodopa daily dosage and levodopa equivalent daily dosage. CONCLUSIONS Taiwanese patients with PD had a lower prevalence of EDS compared with the literatures reported in Caucasian patients. We identify and suggest that PDSS total score, rather than subcategory items, should be used to predict poor sleep among patients with PD.
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Affiliation(s)
- Yi-Ying Lin
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Rou-Shayn Chen
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Chin-Song Lu
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Ying-Zu Huang
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Yi-Hsin Weng
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Tu-Hsueh Yeh
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Wey-Yil Lin
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
| | - June Hung
- Department of Neurology LinKou Chang Gung Memorial Hospital Taoyuan Taiwan
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12
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Kang SY, Ryu HS, Sunwoo MK, Kim SJ, Baik JS, Park MY, Park HE, Kim JS, Kwon KY, Koh SB, Kim YE, Lee MK, Kim JM, Chung SJ, Sohn YH. Sleepiness and Depression in Parkinson's Disease Patients Treated with Ropinirole and Levodopa. J Mov Disord 2017; 10:123-129. [PMID: 28950686 PMCID: PMC5615177 DOI: 10.14802/jmd.17048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 12/21/2022] Open
Abstract
Objective
We aimed to investigate the effect of ropinirole on excessive daytime sleepiness (EDS) and depression in Parkinson’s disease (PD) with a large population. Methods
We conducted a cross-sectional observational study at nine hospitals in Korea between April 24, 2013, and April 22, 2015. We analyzed the demographic and clinical features, other medical history, history of antiparkinsonian medication within 6 months, Hoehn and Yahr stage (HY stage), Unified Parkinson’s Disease Rating Scale (UPDRS) part II and III, Epworth Sleepiness Scale (ESS), and 30-item Geriatric Depression Scale (GDS-30). Results
Four-hundred-thirteen patients with PD (mean age: 65.2 ± 9.0 years; men: 227 patients) were analyzed. Multivariate logistic regression analysis showed that age at examination, UPDRS II, and GDS-30 were independent risk factors for EDS and that sex, UPDRS II, and ESS were independent risk factors for depression. Conclusion
Our large group study did not find any significant associations of ropinirole with EDS and depression in Korean PD patients.
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Affiliation(s)
- Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ho-Sung Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mun-Kyung Sunwoo
- Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sang-Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan, Korea
| | - Jong-Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Mee-Young Park
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Hyung-Eun Park
- Department of Neurology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young-Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Mi-Kyong Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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13
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Wen MC, Chan LL, Tan LCS, Tan EK. Mood and neural correlates of excessive daytime sleepiness in Parkinson's disease. Acta Neurol Scand 2017; 136:84-96. [PMID: 28670700 DOI: 10.1111/ane.12704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 01/18/2023]
Abstract
For patients with Parkinson's disease (PD), excessive daytime sleepiness (PD-EDS) is a debilitating non-motor symptom and may be affected by mood symptoms, especially depression and anxiety. Few neuroimaging works have attempted to identify the neural features of PD-EDS, but various findings were reported. The purpose of this study was to systematically review the literature on mood and neuroimaging correlates of PD-EDS. A MEDLINE, PubMed, EMBASE, and PsycInfo search for peer-reviewed original research articles on depression, anxiety, and neuroimaging in PD-EDS identified 26 studies on depression, nine on anxiety, and eight on neuroimaging. Half of the studies reported greater depression in PD-EDS-positive patients compared with PD-EDS-negative patients. There was a significantly positive correlation between depression and PD-EDS. Limited studies on anxiety in PD-EDS suggested a weak correlation between anxiety and EDS. For depression and anxiety, the effect sizes were medium when EDS was subjectively measured, but became small when EDS was objective measured. Current neuroimaging studies generally suggested diminished neural structural and functional features (eg, brain volume, white matter integrity as indicated by fractional anisotropy, and cerebral metabolism) in patients with PD-EDS. Future studies should apply objective and subjective measures of mood symptoms and EDS and improve the neuroimaging methodology via using multimodal techniques and whole-brain analysis to provide new clues on the mood and neural correlates of PD-EDS.
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Affiliation(s)
- M.-C. Wen
- Department of Research; National Neuroscience Institute; Singapore Singapore
- Department of Neurology; National Neuroscience Institute; Singapore Singapore
| | - L. L. Chan
- Department of Diagnostic Radiology; Singapore General Hospital; Singapore Singapore
| | - L. C. S. Tan
- Department of Neurology; National Neuroscience Institute; Singapore Singapore
- Duke-National University of Singapore Graduate Medical School; Singapore Singapore
| | - E. K. Tan
- Department of Research; National Neuroscience Institute; Singapore Singapore
- Department of Neurology; National Neuroscience Institute; Singapore Singapore
- Duke-National University of Singapore Graduate Medical School; Singapore Singapore
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14
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Ylikoski A, Martikainen K, Sieminski M, Partinen M. Sleeping difficulties and health-related quality of life in Parkinson's disease. Acta Neurol Scand 2017; 135:459-468. [PMID: 27282092 DOI: 10.1111/ane.12620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Various sleep-related symptoms occur in Parkinson's disease (PD). Their occurrence with health-related quality of life (HRQL), comorbid sleep disorders, and other comorbidities was studied. METHODS Altogether, 1447 randomly selected patients with Parkinson's disease, aged 43-89 years, participated in a questionnaire study. A structured questionnaire with 207 items was based on the Basic Nordic Sleep Questionnaire. Questions on demographics, PD, sleep disorders, and comorbidities were included. RESULTS The response rate was 59.0%, and of these, 80% had answered to all questions that were used in the analyses (N=684). Occurrence of long sleep was found in 26.2% of the subjects, short sleep in 32.5%, poor sleep in 21.2%, sleep deprivation in 33.8%, disrupted sleep in 47.4%, and difficulties to fall asleep in 12.2%, respectively. Poor self-rated health and poor quality of life occurred in 44.4% and in 43.3% of all participants. In the logistic regression, age and gender differentially predicted long sleep and sleep deprivation, such that older age and being male were positively associated with long sleep but negatively associated with the report of sleep deprivation. Depression, subjective negative stress, and fatigue occurred with long sleep. On the other hand, poor sleep and excessive daytime sleepiness occurred with short sleep and sleep deprivation. CONCLUSIONS The sleep difficulties in PD are frequent. The long sleeping patients have depression, stress, and fatigue.
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Affiliation(s)
- A. Ylikoski
- Vitalmed Research Center; Helsinki Sleep Clinic; Helsinki Finland
- Department of Neurology; Hospital of Laakso; Helsinki Finland
| | | | - M. Sieminski
- Department of Adult Neurology; Medical University of Gdansk; Gdansk Poland
| | - M. Partinen
- Vitalmed Research Center; Helsinki Sleep Clinic; Helsinki Finland
- Department of Clinical Neurosciences; Institute of Clinical Medicine; University of Helsinki; Helsinki Finland
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15
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Tessitore A, Giordano A, De Micco R, Caiazzo G, Russo A, Cirillo M, Esposito F, Tedeschi G. Functional connectivity underpinnings of fatigue in “Drug-Naïve” patients with Parkinson's disease. Mov Disord 2016; 31:1497-1505. [DOI: 10.1002/mds.26650] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 03/13/2016] [Accepted: 03/16/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alessandro Tessitore
- Department of Medical; Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples; Naples Italy
| | - Alfonso Giordano
- Department of Medical; Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples; Naples Italy
- IDC Hermitage Capodimonte; Naples Italy
| | - Rosa De Micco
- Department of Medical; Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples; Naples Italy
| | | | - Antonio Russo
- Department of Medical; Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples; Naples Italy
| | - Mario Cirillo
- Neuroradiology Service, Second University of Naples; Naples Italy
| | - Fabrizio Esposito
- Department of Medicine and Surgery; University of Salerno; Baronissi Salerno Italy
- Department of Cognitive Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Gioacchino Tedeschi
- Department of Medical; Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples; Naples Italy
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Yu RL, Wu RM, Chan AYY, Mok V, Wu YR, Tilley BC, Luo S, Wang L, LaPelle NR, Stebbins GT, Goetz CG. Cross-Cultural Differences of the Non-Motor Symptoms Studied by the Traditional Chinese Version of the International Parkinson and Movement Disorder Society- Unified Parkinson's Disease Rating Scale. Mov Disord Clin Pract 2016; 4:68-77. [PMID: 28345011 DOI: 10.1002/mdc3.12349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Given the importance of ethnic differences in the evaluation of various aspects of symptoms in patients with Parkinson's disease (PD), we present the formal procedure for completing the traditional Chinese translation of the International and Parkinson and Movement Disorder Society/UPDRS (MDS-UPDRS) and highlight the discrepancy in nonmotor symptoms (NMS) between patients in Eastern and Western countries. METHODS A total of 350 native Chinese-speaking PD patients were recruited from multiple hospitals in Eastern countries; they completed the MDS-UPDRS. The translation process was executed and factor analysis was performed to determine the structure of the scale. Chi-squared and t tests were used to compare frequency and severity of PD symptoms between the Chinese-speaking and English-speaking groups (n = 876). RESULTS NMS and motor symptoms were more severe in the Western population (Part I: t(1205) = 5.36, P < 0.0001; and Part III: t(1205) = 7.64, P < 0.0001); however, the prevalence of cognitive dysfunction and impairments in activities of daily living were more frequent in the Eastern patients. The comparative fit index was 0.93 or greater, and the exploratory factor analysis revealed compatible results between the translated scale and the original version. CONCLUSION The traditional Chinese version of the MDS-UPDRS can be designated as an official translation of the original scale, and it is now available for use. Moreover, NMS in PD constitute a major issue worldwide, and the pattern of NMS among the Chinese population is more marked in terms of cognition-based symptoms and activities of daily living.
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Affiliation(s)
- Rwei-Ling Yu
- National Cheng Kung University, Institute of Behavioral Medicine, College of Medicine, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, The Chinese University of Hong Kong, Shatin, China
| | - Vincent Mok
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, The Chinese University of Hong Kong, Shatin, China
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital-Linkou branch, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Barbara C Tilley
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sheng Luo
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lu Wang
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nancy R LaPelle
- Division of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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17
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Wen MC, Ng SYE, Heng HSE, Chao YX, Chan LL, Tan EK, Tan LCS. Neural substrates of excessive daytime sleepiness in early drug naïve Parkinson's disease: A resting state functional MRI study. Parkinsonism Relat Disord 2016; 24:63-8. [PMID: 26810915 DOI: 10.1016/j.parkreldis.2016.01.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/05/2015] [Accepted: 01/11/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Excessive daytime sleepiness (EDS) is a common non-motor symptom in Parkinson's disease (PD), but its neuropathology remains elusive due to the limited studies and the inclusion of medicated patients. This current study examined the neural substrates of EDS in drug naïve PD patients. METHODS A total of 76 PD patients in the early disease stages were recruited; 16 of them had EDS, while the remaining 60 did not. Resting state functional magnetic resonance imaging (rs-fMRI) was used to determine group differences (patients with EDS vs. patients without EDS) in spontaneous neural activity indicated by regional homogeneity (ReHo). Additionally, functional connectivity (FC) of the regions showing group differences in ReHo with the entire brain was performed. RESULTS ReHo analysis controlling for gray matter volume, age, gender, general cognition, depression, postural instability gait difficulty, and rapid eye movement sleep behavior disorder showed decreased ReHo in the left cerebellum and inferior frontal gyrus, but increased ReHo in the left paracentral lobule in PD-EDS patients, compared with patients without EDS. FC analysis controlling for the same variables as in the analysis of ReHo revealed that the three regions showing ReHo differences had decreased FC with regions in the frontal, temporal, insular and limbic lobes and cerebellum in PDs with EDS. CONCLUSION While decreases in ReHo and FC were found, increases in ReHo were also noted, implying both neural downregulation and compensatory mechanisms in early PD patients with EDS. Longitudinal studies are warranted to clarify the long-term impact of EDS in PD.
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Affiliation(s)
- Ming-Ching Wen
- Department of Research, National Neuroscience Institute, Singapore
| | - Samuel Y E Ng
- Department of Research, National Neuroscience Institute, Singapore
| | - Hannah S E Heng
- Department of Research, National Neuroscience Institute, Singapore
| | - Yin Xia Chao
- Department of Research, National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Ling Ling Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Eng King Tan
- Department of Research, National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore; Department of Neurology, National Neuroscience Institute, Singapore
| | - Louis C S Tan
- Duke-NUS Graduate Medical School, Singapore; Department of Neurology, National Neuroscience Institute, Singapore.
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