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Severiano E Sousa C, Alarcão J, Pavão Martins I, Ferreira JJ. Cognitive testing in late-stage Parkinson's disease: A critical appraisal of available instruments. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:191-202. [PMID: 36027603 DOI: 10.1080/23279095.2022.2114355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE For patients with Parkinson's disease (PD), cognitive impairment is one of the most disabling non-motor symptoms, particularly in the late disease stages (LSPD). Without a common cognitive assessment battery, it is difficult to estimate its prevalence and limits comparisons across studies. In addition, some instruments traditionally used in PD may not be adequate for use in LSPD. We sought to identify instruments used to assess cognition in LSPD and to investigate their global characteristics and psychometric properties to recommend a cognitive battery for the LSPD population. METHOD We conducted a literature search of EMBASE and MEDLINE for articles reporting the use of cognitive tests in LSPD. The global characteristics and psychometric properties of the four most used cognitive tests in each cognitive domain were verified to recommend a cognitive assessment battery. RESULTS Of 60 included studies, 71.7% used screening scales to assess cognition. Of the 53 reported instruments, the Montreal Cognitive Assessment, the Digit Span, the Trail Making Test, the Semantic Fluency test, the Rey Auditory Verbal Learning Test, the Brief Visuospatial Memory Test-Revised, the Boston Naming Test, the Judgment of Line Orientation, and the Clock Drawing Test corresponded best overall to the requirements considered important for selecting instruments in LSPD. CONCLUSION Screening scales are frequently used to assess cognition in LSPD. We recommend a cognitive assessment battery that considers the special characteristics of the LSPD population, including being quick and easy to use, with minimized motor demands, and covering all relevant cognitive domains.
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Affiliation(s)
- Catarina Severiano E Sousa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Alarcão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Centro de Estudos de Medicina Baseada na Evidência, Universidade de Lisboa, Lisbon, Portugal
| | - Isabel Pavão Martins
- Faculdade de Medicina, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisbon, Portugal
- Laboratório de Estudos da Linguagem, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
- CNS-Campus Neurológico, Torres Vedras, Portugal
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Pigott JS, Davies N, Chesterman E, Read J, Nimmons D, Walters K, Armstrong M, Schrag A. Compound impact of cognitive and physical decline: A qualitative interview study of people with Parkinson's and cognitive impairment, caregivers and professionals. Health Expect 2024; 27:e13950. [PMID: 39102685 PMCID: PMC10785559 DOI: 10.1111/hex.13950] [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: 05/15/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Cognitive impairment is common in Parkinson's disease and is associated with poorer quality of life and increased caregiver distress, but little qualitative information is available on lived experiences of people with Parkinson's who also have cognitive impairment. OBJECTIVES The aim of this study was to explore the challenges of cognitive impairment in Parkinson's, triangulating the perspectives of people with Parkinson's, caregivers and healthcare professionals. METHODS Semistructured interviews were conducted with 11 people with Parkinson's and cognitive impairment, 10 family caregivers and 27 healthcare professionals, using purposive sampling in the United Kingdom (2019-2021). Cognitive impairment was identified by healthcare professionals and required subjective symptoms. Relevant cognitive diagnoses were recorded. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. RESULTS An overarching concept of the compound impact of cognitive and physical decline was developed, with six themes. Four themes describe the experience of living with cognitive impairment in Parkinson's: (1) Challenges in Daily Activities, (2) Psychological Impact and (3) Evolving Communication Difficulties together contributing to (4) Social Shift, encompassing a reduction in wider social activities but intensification of close relationships with increased dependence. A fifth theme (5) Living Well describes positive influences on these experiences, encompassing intrinsic motivation, self-management strategies and supportive relationships. Furthermore, underlying and shaping the whole experience was the sixth theme: (6) Preconceptions about Cognitive Impairment, describing fear and denial of symptoms and poor understanding of the nature of cognitive impairment in Parkinson's, with differences to other dementia pathologies. CONCLUSIONS Cognitive impairment superimposed on the existing challenges of Parkinson's has a multifaceted impact and makes living with the condition arduous. Increased understanding of the experiences of this group and employing the identified facilitators for living well may be able to improve patient and caregiver experiences. PATIENT OR PUBLIC CONTRIBUTION Two people with Parkinson's and cognitive impairment and three caregivers contributed to the study. Between them they contributed throughout the entirety of the project, giving input at conceptualisation as well as advice and review of interview questions, participant information leaflets, recruitment, interpretation of findings and summaries of the project.
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Affiliation(s)
- Jennifer S. Pigott
- Department of Clinical Neurosciences, Queen Square Institute of Neurology, University College LondonRoyal Free HospitalLondonUK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Elizabeth Chesterman
- Department of Clinical Neurosciences, Queen Square Institute of Neurology, University College LondonRoyal Free HospitalLondonUK
| | - Joy Read
- Department of Clinical Neurosciences, Queen Square Institute of Neurology, University College LondonRoyal Free HospitalLondonUK
| | - Danielle Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Kate Walters
- Research Department of Primary Care and Population Health, Centre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Megan Armstrong
- Research Department of Primary Care and Population Health, Centre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Anette Schrag
- Department of Clinical Neurosciences, Queen Square Institute of Neurology, University College LondonRoyal Free HospitalLondonUK
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Rodriguez Salgado AM, Acosta I, Kim DJ, Zitser J, Sosa AL, Acosta D, Jimenez-Velasquez IZ, Guerra M, Salas A, Valvuerdi A, Llibre-Guerra JC, Jeyachandran C, Contreras RL, Hesse H, Tanner C, Llibre Rodriguez JJ, Prina M, Llibre-Guerra JJ. Prevalence and impact of neuropsychiatric symptoms in normal aging and neurodegenerative syndromes: A population-based study from Latin America. Alzheimers Dement 2023; 19:5730-5741. [PMID: 37427840 PMCID: PMC10776811 DOI: 10.1002/alz.13384] [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: 02/07/2023] [Revised: 05/23/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) are common in neurodegenerative diseases; however, little is known about the prevalence of NPSs in Hispanic populations. METHODS Using data from community-dwelling participants age 65 years and older enrolled in the 10/66 study (N = 11,768), we aimed to estimate the prevalence of NPSs in Hispanic populations with dementia, parkinsonism, and parkinsonism-dementia (PDD) relative to healthy aging. The Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess NPSs. RESULTS NPSs were highly prevalent in Hispanic populations with neurodegenerative disease; approximately 34.3%, 56.1%, and 61.2% of the participants with parkinsonism, dementia, and PDD exhibited three or more NPSs, respectively. NPSs were the major contributor to caregiver burden. DISCUSSION Clinicians involved in the care of elderly populations should proactively screen for NPSs, especially in patients with parkinsonism, dementia, and PPD, and develop intervention plans to support families and caregivers. Highlights Neuropsychiatric symptoms (NPSs) are highly prevalent in Hispanic populations with neurodegenerative diseases. In healthy Hispanic populations, NPSs are predominantly mild and not clinically significant. The most common NPSs include depression, sleep disorders, irritability, and agitation. NPSs explain a substantial proportion of the variance in global caregiver burden.
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Affiliation(s)
- Ana M Rodriguez Salgado
- Global Brain Health Institute, University of San Francisco California, San Francisco, California, USA
| | - Isaac Acosta
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Dani J Kim
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Zitser
- Department of Neurology, Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ana Luisa Sosa
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic
| | - Ivonne Z Jimenez-Velasquez
- Internal Medicine Department, Geriatrics Program, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Mariella Guerra
- Instituto de la Memoria Depresion y Enfermedades de Riesgo IMEDER, Lima, Perú
| | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | | | | | | | - Ricardo López Contreras
- Memory Clinic, Neurology Service, Salvadoran Social Security Institute, San Salvador, El Salvador
| | - Heike Hesse
- Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras
| | - Caroline Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California-San Francisco, San Francisco, California, USA
| | | | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Jorge J Llibre-Guerra
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Silva DP, Coelho M, Soares T, Vale TC, Correia Guedes L, Maciel ROH, Antunes AP, Camargos ST, Valadas A, Godinho C, Maia DP, Pita Lobo P, Maia RD, Teodoro T, Rieder CR, Velon AG, Tumas V, Barbosa ER, Teive HA, Ferraz HB, Rosas MJ, Calado A, Lampreia T, Simões R, Vila‐Chã N, Costa MM, Rodrigues AM, Caniça V, Cardoso F, Ferreira JJ. Handicap as a Measure of Perceived-Health Status in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1172-1180. [PMID: 37635780 PMCID: PMC10450228 DOI: 10.1002/mdc3.13826] [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: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Handicap is a patient-centered measure of health status that encompasses the impact of social and physical environment on daily living, having been assessed in advanced and late-stage Parkinson's Disease (PD). Objective To characterize the handicap of a broader sample of patients. Methods A cross-sectional study of 405 PD patients during the MDS-UPDRS Portuguese validation study, using the MDS-UPDRS, Unified Dyskinesias Rating Scale, Nonmotor symptoms questionnaire, PDQ-8 and EQ-5D-3L. Handicap was measured using the London Handicap Scale (LHS). Results Mean age was 64.42 (±10.3) years, mean disease duration 11.30 (±6.5) years and median HY 2 (IQR, 2-3). Mean LHS was 0.652 (±0.204); "Mobility," "Occupation" and "Physical Independence" were the most affected domains. LHS was significantly worse in patients with longer disease duration, older age and increased disability. In contrast, PDQ-8 did not differentiate age groups. Handicap was significantly correlated with disease duration (r = -0.35), nonmotor experiences of daily living (EDL) (MDS-UPDRS-I) (r = -0.51), motor EDL (MDS-UPDRS-II) (r = -0.69), motor disability (MDS-UPDRS-III) (r = -0.49), axial signs of MDS-UPDRS-III (r = -0.55), HY (r = -0.44), presence of nonmotor symptoms (r = -0.51) and PDQ-8 index (r = -0.64) (all P < 0.05). Motor EDL, MDS-UPDRS-III and PDQ-8 independently predicted Handicap (adjusted R 2 = 0.582; P = 0.007). Conclusions The LHS was easily completed by patients and caregivers. Patients were mild-moderately handicapped, which was strongly determined by motor disability and its impact on EDL, and poor QoL. Despite correlated, handicap and QoL seem to differ in what they measure, and handicap may have an added value to QoL. Handicap seems to be a good measure of perceived-health status in a broad sample of PD.
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Affiliation(s)
- Daniela Pimenta Silva
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
| | - Miguel Coelho
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | | | | | - Leonor Correia Guedes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | | | - Ana Patrícia Antunes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
| | | | - Anabela Valadas
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)
| | - Débora Palma Maia
- Movement Disorders UnitFederal University of Minas GeraisBelo HorizonteBrazil
| | - Patrícia Pita Lobo
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | - Raphael Doyle Maia
- Movement Disorders Unit, Hospital Universitário Cassiano Antônio MoraesFederal University of Espírito SantoEspírito SantoBrazil
| | - Tiago Teodoro
- Instituto de Medicina MolecularLisbonPortugal
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation TrustLondonUnited Kingdom
- Neuroscience Research Centre, Institute of Molecular and Clinical SciencesSt. George's University of LondonLondonUK
| | - Carlos R. Rieder
- Movement Disorders UnitHospital Santa Casa de Misericórdia de Porto AlegrePorto AlegreBrazil
- Federal University of Health Sciences of Porto AlegrePorto AlegreBrazil
| | - Ana Graça Velon
- Serviço de Neurologia do Centro Hospitalar de Trás‐os‐Montes e Alto DouroVila RealPortugal
| | - Vítor Tumas
- Department of Neuroscience and Behavior Sciences, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de MedicinaDepartamento de Neurologia, Centro de Distúrbios do MovimentoSão PauloBrazil
| | - Hélio A.G. Teive
- Department of NeurologyUniversidade Federal do ParanáCuritibaBrazil
| | | | | | - Ana Calado
- Serviço de Neurologia do Centro Hospitalar de Lisboa CentralLisbonPortugal
| | - Tânia Lampreia
- Serviço de NeurologiaHospital Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Rita Simões
- Serviço de NeurologiaHospital Beatriz ÂngeloLisbonPortugal
| | - Nuno Vila‐Chã
- Serviço de Neurologia do Hospital de Santo António, Centro Hospitalar Universitário do PortoPortoPortugal
| | - Maria Manuela Costa
- Serviço de NeurologiaHospital Pedro HispanoMatosinhosPortugal
- Serviço de NeurologiaHospital das Forças ArmadasPortoPortugal
| | | | | | - Francisco Cardoso
- Movement Disorders UnitFederal University of Minas GeraisBelo HorizonteBrazil
| | - Joaquim J. Ferreira
- CNS – Campus NeurológicoTorres VedrasPortugal
- Laboratory of Clinical Pharmacology, Faculty of MedicineUniversity of LisbonLisbonPortugal
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Chen Z, Zhang W, He W, Guang Y, Yu T, Du Y, Li R. Transcranial sonography with clinical and demographic characteristics to predict cognitive impairment in PD: a longitudinal study. BMC Neurol 2023; 23:15. [PMID: 36639620 PMCID: PMC9837901 DOI: 10.1186/s12883-023-03057-1] [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: 11/02/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease and is clinically characterized by a series of motor symptoms (MS) and nonmotor symptoms (NMS). NMS often appear before MS, while cognitive impairment mostly occurs within a few years after the diagnosis of PD. Therefore, we aimed to predict the risk factors for cognitive impairment (CI) in PD patients based on transcranial sonography, clinical symptoms, and demographic characteristics. METHODS Based on the occurrence time of CI, a total of 172 PD patients were divided into non-CI (N-CI, n = 48), CI at the first treatment (F-CI, n = 58), and CI at the last treatment (L-CI, n = 66) groups. Clinical data (including MS and NMS) and ultrasonic data of all patients at the first treatment and the last treatment were collected retrospectively. Independent samples t tests were used to compare continuous data, and chi-square tests were used to compare categorical data. The risk factors for CI and Parkinson's disease dementia were identified by logistic regression analysis, and an ROC curve was established to explore the diagnostic efficacy. RESULTS 1) The age of onset, first treatment and smoking history of CI patients were significantly different from those of N-CI patients. When age of first treatment ≥61 years was considered the boundary value to diagnose CI, the sensitivity and specificity were 77.40 and 66.70%, respectively. 2) The severity of depression was significantly different between F-CI and N-CI patients at the first treatment, while the cumulative and new or aggravated memory deficit was significantly different between the L-CI and N-CI patients at the last treatment. 3) There was a significant difference in TCS grading between the first and last treatment in L-CI patients. 4) Depression, sexual dysfunction, and olfactory dysfunction in NMS were independent risk factors for CI during the last treatment. 5) The sensitivity and specificity of predicting CI in PD patients were 81.80 and 64.60%, respectively. CONCLUSIONS PD patients with CI were older, and most of them had a history of smoking. Furthermore, there was good diagnostic efficiency for predicting CI in PD via TCS combined with clinical characteristics (especially NMS).
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Affiliation(s)
- Zhiguang Chen
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Wei Zhang
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Wen He
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Yang Guang
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Tengfei Yu
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | | | - Rui Li
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
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Should patients with Parkinson’s disease only visit a neurologist’s office? - a narrative review of neuropsychiatric disorders among people with Parkinson’s disease. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Introduction: Parkinson’s disease is a neurodegenerative disease that is often accompanied by disorders such as depression, psychotic disorders, cognitive disorders, anxiety disorders, sleep disorders, impulse control disorders. The aim of the study was to review the literature and present the characteristics of neuropsychiatric disorders occurring in people suffering from Parkinson’s disease, with the specification of the above-mentioned disorders.
Material and method: The literature available on the PubMed platform from 1986 to 2022 was reviewed using the following keywords: Parkinson’s disease, depression, anxiety disorders, psychotic disorders, sleep disorders, cognitive disorders, impulse control disorders. Original studies, reviews, meta-analyzes and internet sources were analyzed.
Results: The above-mentioned neuropsychiatric disorders appear with different frequency among people suffering from Parkinson’s disease and occur at different times of its duration or even precede its onset for many years. The non-motor symptoms in the form of depressed mood, energy loss or changes in the rhythm of the day may result in a delay of appropriate therapy and thus in complications. Neuropathological changes in the course of Parkinson’s disease as well as dopaminergic drugs used in its therapy influence the development of neuropsychiatric disorders.
Conclusions: In order to avoid misdiagnosis, practitioners should use, e.g. scales intended for patients with Parkinson’s disease. To prevent the consequences of the aforementioned disease entities, methods of early diagnosis, determination of risk factors and standardization of the treatment process must be determined. Consistent care for patients with Parkinson’s disease is significant, not only in the neurological field, but also in the psychiatric one.
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Severiano E Sousa C, Fabbri M, Godinho C, Moiron Simões R, Chendo I, Coelho M, Pavão Martins I, Ferreira JJ. Profile of cognitive impairment in late-stage Parkinson's disease. Brain Behav 2022; 12:e2537. [PMID: 35254007 PMCID: PMC9014988 DOI: 10.1002/brb3.2537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/03/2022] [Accepted: 02/06/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The profile of cognitive impairment associated with the late stages of Parkinson's disease (LSPD) is rarely reported. Its characterization is necessary to better understand the cognitive changes that occur as the disease progresses and to better contribute to its management. METHODS In this cross-sectional study, we characterized the cognitive profile of LSPD patients using the comprehensive assessment methodology proposed by the International Parkinson and Movement Disorders Society Task Force. The association of clinical and demographic variables with dementia diagnosis was also investigated using binary logistic regression analysis. RESULTS Eighty-four LSPD patients were included (age 75.4 ± 6.9; disease duration 16.9 ± 7.5). Fifty-four (64.3%) were classified as demented and presented a global impairment cognitive profile. In the nondemented group (N = 30), 25 (83.3%) LSPD patients met the diagnostic criteria for mild cognitive impairment, mostly with multiple domain impairment (96.0%) and a heterogeneous profile. Memory was the most frequent and severely impaired cognitive domain in both groups. Disease disability, orientation, complex order comprehension, verbal learning, and visuoconstructive abilities were significantly associated with dementia diagnosis (p < .05). CONCLUSIONS Cognitive impairment in multiple domains was common in LSPD patients. The most frequent and prominent deficits were in the memory domain, with a strong interference from attention impairment. Disease disability, orientation, complex order comprehension, verbal learning, and visuoconstructive abilities proved to be important determinants for dementia diagnosis.
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Affiliation(s)
- Catarina Severiano E Sousa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Margherita Fabbri
- Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal.,Department of Neurosciences, Clinical investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Almada, Portugal
| | - Rita Moiron Simões
- Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal.,Campus Neurológico, Torres Vedras, Portugal
| | - Inês Chendo
- Clínica Universitária de Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal.,Campus Neurológico, Torres Vedras, Portugal
| | - Miguel Coelho
- Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal.,Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal
| | - Isabel Pavão Martins
- Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal.,Laboratório de Estudos de Linguagem, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal.,Campus Neurológico, Torres Vedras, Portugal
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Guttuso T, Sirica D, Tosun D, Zivadinov R, Pasternak O, Weintraub D, Baglio F, Bergsland N. Thalamic Dorsomedial Nucleus Free Water Correlates with Cognitive Decline in Parkinson's Disease. Mov Disord 2022; 37:490-501. [PMID: 34936139 PMCID: PMC8940677 DOI: 10.1002/mds.28886] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Brain diffusion tensor imaging (DTI) has been shown to reflect cognitive changes in early Parkinson's disease (PD) but the diffusion-based measure free water (FW) has not been previously assessed. OBJECTIVES To assess if FW in the thalamic nuclei primarily involved with cognition (ie, the dorsomedial [DMN] and anterior [AN] nuclei), the nucleus basalis of Meynert (nbM), and the hippocampus correlates with and is associated with longitudinal cognitive decline and distinguishes cognitive status at baseline in early PD. Also, to explore how FW compares with conventional DTI, FW-corrected DTI, and volumetric assessments for these outcomes. METHODS Imaging data and Montreal Cognitive Assessment (MoCA) scores from the Parkinson's Progression Markers Initiative database were analyzed using partial correlations and ANCOVA. Primary outcome multiple comparisons were corrected for false discovery rate (q value). RESULTS Thalamic DMN FW changes over 1 year correlated with MoCA changes over both 1 and 3 years (partial correlations -0.222, q = 0.040, n = 130; and - 0.229, q = 0.040, n = 123, respectively; mean PD duration at baseline = 6.85 months). NbM FW changes over 1 year only correlated with MoCA changes over 3 years (-0.222, q = 0.040). Baseline hippocampal FW was associated with cognitive impairment at 3 years (q = 0.040) and baseline nbM FW distinguished PD-normal cognition (MoCA ≥26) from PD-cognitive impairment (MoCA ≤25), (q = 0.008). The exploratory comparisons showed FW to be the most robust assessment modality for all outcomes. CONCLUSIONS Thalamic DMN FW is a promising cognition progression biomarker in early PD that may assist in identifying cognition protective therapies in clinical trials. FW is a robust assessment modality for these outcomes. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Guttuso
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Daniel Sirica
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Duygu Tosun
- University of California, San Francisco, San Francisco, CA
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY,Center for Biomedical Imaging, Clinical and Translational Science Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA,Parkinson’s Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | | | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY,IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
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9
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Liang Y, Chen D, Ou R, Zhao B, Song W, Yi X, Yang R, Chen X. Current Status of Acceptance of Disability and the Correlation With the Life Quality in Parkinson's Disease in Southwest China. Front Med (Lausanne) 2022; 8:767215. [PMID: 35118084 PMCID: PMC8804473 DOI: 10.3389/fmed.2021.767215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Acceptance of disability (AOD) is a process that a patient must undergo to cope with altered abilities, but its effect in Parkinson's disease (PD) remains unclear. The present study aimed to determine the level of AOD, examine the influence of sociodemographic variables and disease characteristics on the AOD level, and evaluate the relation between AOD level and quality of life in a cohort of PD patients from Southwest of China. Methods A total of 336 PD patients were consecutively recruited from November 2018 to October 2020. At enrollment, demographic and clinical data were obtained using a questionnaire, and the Acceptance of Disability Scale-Revised (AODS-R) scale was used to measure the AOD level. Results The mean total score of AOD is 87.28, indicating a moderate level of disability acceptance in PD patients. Statistical analysis showed that understanding of PD, family support, and UPDRS-II score were major factors affecting AOD level, and patients with low AOD levels were more likely to have poorer quality of life. Conclusion AOD is a serious problem in PD patients in Southwest China, especially among individuals with insufficient family support and a lack of recognition of the disease. AOD was also associated with motor function and daily living ability, thus suggesting that evaluation of the AOD and promotion of the awareness may be helpful to improve the quality of life in patients with PD.
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Affiliation(s)
- Yan Liang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Dezhi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojiang Yi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xueping Chen
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10
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Meinders MJ, Gentile G, Schrag AE, Konitsiotis S, Eggers C, Taba P, Lorenzl S, Odin P, Rosqvist K, Chaudhuri KR, Antonini A, Bloem BR, Groot MM. Advance Care Planning and Care Coordination for People With Parkinson's Disease and Their Family Caregivers-Study Protocol for a Multicentre, Randomized Controlled Trial. Front Neurol 2021; 12:673893. [PMID: 34434156 PMCID: PMC8382049 DOI: 10.3389/fneur.2021.673893] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parkinson's disease (PD) is a progressive neurodegenerative disease with motor- and non-motor symptoms. When the disease progresses, symptom burden increases. Consequently, additional care demands develop, the complexity of treatment increases, and the patient's quality of life is progressively threatened. To address these challenges, there is growing awareness of the potential benefits of palliative care for people with PD. This includes communication about end-of-life issues, such as Advance Care Planning (ACP), which helps to elicit patient's needs and preferences on issues related to future treatment and care. In this study, we will assess the impact and feasibility of a nurse-led palliative care intervention for people with PD across diverse European care settings. Methods: The intervention will be evaluated in a multicentre, open-label randomized controlled trial, with a parallel group design in seven European countries (Austria, Estonia, Germany, Greece, Italy, Sweden and United Kingdom). The “PD_Pal intervention” comprises (1) several consultations with a trained nurse who will perform ACP conversations and support care coordination and (2) use of a patient-directed “Parkinson Support Plan-workbook”. The primary endpoint is defined as the percentage of participants with documented ACP-decisions assessed at 6 months after baseline (t1). Secondary endpoints include patients' and family caregivers' quality of life, perceived care coordination, patients' symptom burden, and cost-effectiveness. In parallel, we will perform a process evaluation, to understand the feasibility of the intervention. Assessments are scheduled at baseline (t0), 6 months (t1), and 12 months (t2). Statistical analysis will be performed by means of Mantel–Haenszel methods and multilevel logistic regression models, correcting for multiple testing. Discussion: This study will contribute to the current knowledge gap on the application of palliative care interventions for people with Parkinson's disease aimed at ameliorating quality of life and managing end-of-life perspectives. Studying the impact and feasibility of the intervention in seven European countries, each with their own cultural and organisational characteristics, will allow us to create a broad perspective on palliative care interventions for people with Parkinson's disease across settings. Clinical Trial Registration:www.trialregister.nl, NL8180.
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Affiliation(s)
- Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Spiros Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Carsten Eggers
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Knappschaftskrankenhaus Bottrop GmbH, Department of Neurology, Bottrop, Germany
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology and Department of Palliative Care, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Parkinson's Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
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11
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Sinaeefar MJ, Saadat P, Hamidia A, Hosseini SR. Evaluation of the cognitive impairments and depressive symptoms in patients with Parkinson's disease: A case-control study from Iran. Clin Neurol Neurosurg 2021; 203:106549. [PMID: 33631508 DOI: 10.1016/j.clineuro.2021.106549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Parkinson's disease is a progressive neurodegenerative disease and the second most common neurological disease in the world, which usually affects people mainly in later years of life. Cognitive impairments and depressive symptoms are important symptoms in these patients that are associated with a poor prognosis. The study will focus on the original data regarding the cognitive impairments and depressive symptoms in patients with Parkinson's disease and control group. METHODS In a case-control study, a total of 100 Parkinson's patients who were hospitalized in Rouhani Hospital and 200 non-Parkinson's people (control group) from Amirkola Health and aging project (AHAP) Marras et al., Babol, Iran were enrolled between September 2019 to February 2020. Data were collected by simple random sampling. Data were collected using a four-part questionnaire, including demographic characteristics, Unified Parkinson Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging Scale (MHYSS), Mini-M ental State Examination (MMSE) and Geriatric Depression Scale (GDS). P-value less than 0.05 was considered as significant RESULTS: A total of 300 persons were enrolled in the study. The mean age of Parkinson's patients and non-Parkinson's people was 70.34 ± 7.76 and 70.87 ± 7.59 years, respectively. The mean MMSE score in Parkinson's and non-Parkinson's people was 24.80 ± 4.53 and 25.40 ± 3.1, respectively (p = 0.182). The mean GDS score in Parkinson's and non-Parkinson's people was 7.06 ± 4.06 and 4.31 ± 3.47, respectively (p = 0.001). There was a statistically significant relationship between depressive symptoms and cognitive impairments with disease severity (p = 0.022 and p = 0.012, respectively). In addition, variables, such as age and the education level were associated with cognitive impairments (p = 0.001 and p = 0.021, respectively), but these variables were not significantly associated with depressive symptoms (p = 0.843 and p = 0.411, respectively). There was a significant relationship between depressive symptoms and cognitive impairment in Parkinson's patients and the control group (p = 0.001 and p = 0.003, respectively). CONCLUSIONS Cognitive impairments and depressive symptoms were significantly associated with an increase in the severity of Parkinson's disease, and also, depressive symptoms in Parkinson's patients was associated with an increase in cognitive impairments.
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Affiliation(s)
| | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Angela Hamidia
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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12
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Fabbri M, Kauppila LA, Ferreira JJ, Rascol O. Challenges and Perspectives in the Management of Late-Stage Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:S75-S83. [PMID: 32568114 PMCID: PMC7592689 DOI: 10.3233/jpd-202096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disorder, with a continuously increasing prevalence. With improved clinical and therapeutic management of PD, more patients reach later stages of the disease, meaning they may face new clinical problems that were not commonly approached. This gave way to the description of a new PD stage, late-stage PD (LSPD), which is clinically discernible from the advanced-stage one. Therefore, LSPD patients have new and different needs, regarding pharmacological and non pharmacological interventions, including palliative care and multidisciplinary teams. LSPD patients constitute an‘orphan population’, who traditionally was excluded from previous studies, due to its high disability. With this manuscript, we intend to review specific management challenges of LSPD patients, covering this new concept and its clinical features, how to assess these patients, therapeutic recommendations, as well as discussing ongoing research and future perspectives.
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Affiliation(s)
- Margherita Fabbri
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Centre, NS-Park/FCRIN Network and Neuro Toul COEN Centre; Toulouse University Hospital; INSERM; University of Toulouse 3; Toulouse, France.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Avenida Professor Egas Moniz, Lisbon, Portugal
| | - Linda Azevedo Kauppila
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Avenida Professor Egas Moniz, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - Olivier Rascol
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Centre, NS-Park/FCRIN Network and Neuro Toul COEN Centre; Toulouse University Hospital; INSERM; University of Toulouse 3; Toulouse, France
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13
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Lennaerts-Kats H, Ebenau A, Steppe M, van der Steen JT, Meinders MJ, Vissers K, Munneke M, Groot M, Bloem BR. "How Long Can I Carry On?" The Need for Palliative Care in Parkinson's Disease: A Qualitative Study from the Perspective of Bereaved Family Caregivers. JOURNAL OF PARKINSONS DISEASE 2020; 10:1631-1642. [PMID: 32651330 PMCID: PMC8764597 DOI: 10.3233/jpd-191884] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Family caregivers provide the majority of care for people with Parkinson’s disease (PD) in the palliative care phase. For many this is a demanding experience, affecting their quality of life. Objective: We set out to map the experiences of bereaved family caregivers during the period of informal care in the palliative care phase as well as after the death of their loved one with PD. Methods: Ten bereaved family caregivers participated in this qualitative study. Semi-structured interviews were conducted and interpretative phenomenological analysis was used executed. Results: We identified four main themes. 1) Feeling like a professional caregiver: while caring for a person with PD, the family caregivers took over many roles and tasks of the person with PD. 2) Healthcare professionals do not always know what PD really means: most interviewees had negative experiences with knowledge and understanding of PD of, especially, (practice) nurses. 3) Being on your own: many respondents had felt highly responsible for their loved one’s care and lacked time and space for themselves. Grief and feelings of guilt were present during the caregiving period and after death. 4) Being behind the times: to provide palliative care in line with patients’ preferences and to feel prepared for the palliative care phase of PD, proactive palliative care planning was considered important. However, the interviewees told that this was most often not provided. Conclusion: These findings indicate that caring for a person with PD in the palliative care phase is a demanding experience for family caregivers. They experience psychological problems for many years before and after the death of the person with PD. Increasing healthcare professionals’ awareness of family and bereaved caregivers’ needs may mitigate these long-term detrimental effects.
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Affiliation(s)
- Herma Lennaerts-Kats
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.,Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Anne Ebenau
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Maxime Steppe
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Jenny T van der Steen
- Radboud University Medical Center (Radboudumc), Nijmegen, Department of Primary and Community Care, Nijmegen, The Netherlands; and Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center (Radboudumc), Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Kris Vissers
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Marieke Groot
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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14
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Hommel ALAJ, Meinders MJ, Lorenzl S, Dodel R, Coelho M, Ferreira JJ, Laurens B, Spampinato U, Meissner W, Rosqvist K, Timpka J, Odin P, Wittenberg M, Bloem PhD BR, Koopmans RT, Schrag A. The Prevalence and Determinants of Neuropsychiatric Symptoms in Late-Stage Parkinsonism. Mov Disord Clin Pract 2020; 7:531-542. [PMID: 32626798 DOI: 10.1002/mdc3.12968] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/04/2020] [Indexed: 01/10/2023] Open
Abstract
Background Late-stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown. Objective To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD. Methods We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms. Results A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness. Conclusion Neuropsychiatric symptoms are common in late-stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late-stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized.
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Affiliation(s)
- Adrianus L A J Hommel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders Nijmegen the Netherlands.,Groenhuysen Organisation Roosendaal the Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center Radboud Institute for Health Sciences Nijmegen the Netherlands
| | - Stefan Lorenzl
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München-Klinikum Großhadern Munich Germany.,Institute of Nursing Science and Practice Salzburg Austria
| | - Richard Dodel
- Department of Geriatric Medicine University Hospital Essen Essen Germany
| | - Miguel Coelho
- University of Lisbon, Lisbon School of Medicine (FMUL), Laboratory of Clinical Pharmacology and Therapeutics, Lisbon, Portugal; and University of Lisbon Lisbon School of Medicine (FMUL), Instituto de Medicina Molecular Lisbon Portugal.,University of Lisbon Lisbon School of Medicine (FMUL), Instituto de Medicina Molecular Lisbon Portugal.,Department of Neurosciences Service of Neurology, Hospital Santa Maria Lisbon Portugal
| | - Joaquim J Ferreira
- University of Lisbon, Lisbon School of Medicine (FMUL), Laboratory of Clinical Pharmacology and Therapeutics, Lisbon, Portugal; and University of Lisbon Lisbon School of Medicine (FMUL), Instituto de Medicina Molecular Lisbon Portugal
| | - Brice Laurens
- Service de Neurologie CHU de Bordeaux 33000 Bordeaux France.,Univ. de Bordeaux, Institut des Maladies Neurodégénératives Bordeaux France
| | - Umberto Spampinato
- Service de Neurologie CHU de Bordeaux 33000 Bordeaux France.,Univ. de Bordeaux, Institut des Maladies Neurodégénératives Bordeaux France
| | - Wassilios Meissner
- Service de Neurologie CHU de Bordeaux 33000 Bordeaux France.,Univ. de Bordeaux, Institut des Maladies Neurodégénératives Bordeaux France.,Department of Medicine University of Otago Christchurch New Zealand.,New Zealand Brain Research Institute Christchurch New Zealand
| | - Kristina Rosqvist
- Department of Neurology, Department of Clinical Sciences Lund University Lund Sweden
| | - Jonathan Timpka
- Department of Neurology, Department of Clinical Sciences Lund University Lund Sweden
| | - Per Odin
- Department of Neurology, Department of Clinical Sciences Lund University Lund Sweden
| | - Michael Wittenberg
- Coordinating Centre for Clinical Trials Philipps University Marburg Marburg Germany
| | - Bas R Bloem PhD
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders Nijmegen the Netherlands
| | - Raymond T Koopmans
- Radboud University Medical Center Department of Primary and Community Care Nijmegen The Netherlands.,Joachim en Anna, Center for Specialized Geriatric Care Nijmegen The Netherlands
| | - Anette Schrag
- University College London, Queen Square Institute of Neurology, University College London London United Kingdom
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15
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Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson's Disease Patients. PARKINSONS DISEASE 2020; 2020:5184084. [PMID: 32184980 PMCID: PMC7060449 DOI: 10.1155/2020/5184084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
Parkinson's disease (PD) is a chronic progressive movement disorder with severe reduction in patients' health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients' HR-QoL. However, the relationship of these symptoms to caregiver burden is relatively unclear. Influence of the Montreal Cognitive Assessment scale (MoCA) as a cognitive screening tool and Movement Disorders Society Unified Parkinson's disease Rating Scale MDS-UPDRS symptoms in relation to patients' HR-QoL and caregivers` burden was analyzed. PD patients (n = 124) completed MDS-UPDRS, MoCA, and the PD questionnaire 8 (PDQ-8) as a measure of quality of life. Caregivers (n = 78) were assessed by the PD caregiver burden inventory (PDCB). PDQ-8 and PDCB scores were regressed on MDS-UPDRS subscales and MoCA subscores. PDQ-8 correlated with attention (R2 0.1282; p < 0.001) and executive (R2 0.0882; p 0.001) MoCA subscores and all parts of the MDS-UPDRS. PDCB correlated most strongly with MDS-UPDRS part III motor symptoms (R2 0.2070; p < 0.001) and the MoCA attention subscore (R2 0.1815; p < 0.001). While all facets of PD symptoms assessed by the MDS-UPDRS relate to PD patients' quality of life, motor symptoms are the most relevant factor for the prediction of caregiver burden. In addition, patients' attentional symptoms seem to affect not only them, but also their caregivers. These findings show the potential of a detailed analysis of MDS-UPDRS and MoCA performance in PD patients.
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16
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Chen CH, Lee BC, Lin CH. Integrated Plasma and Neuroimaging Biomarkers Associated with Motor and Cognition Severity in Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:77-88. [DOI: 10.3233/jpd-191766] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Chih-Hao Chen
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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17
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Drexel SC, Klietz M, Kollewe K, Paracka L, Kutschenko A, Kopp B, Lange F, Wegner F, Dressler D. Caregiver burden and health-related quality of life in idiopathic dystonia patients under botulinum toxin treatment: a cross-sectional study. J Neural Transm (Vienna) 2020; 127:61-70. [PMID: 31802240 PMCID: PMC6942568 DOI: 10.1007/s00702-019-02109-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Dystonia is a chronic movement disorder that is associated with a reduction in health-related quality of life (HR-QoL) and restriction of activities of daily living. Botulinum neurotoxin (BT) improves disease-specific HR-QoL by reducing abnormal movements, postures, and pain. We examined the burden of the corresponding primary caregiver as a potential important factor for disease management and HR-QoL of dystonia patients under treatment with BT. 114 patients with focal, segmental, or generalized dystonia were recruited, together with 93 corresponding caregivers, whose burden was investigated using the Caregiver Burden Inventory. In addition, all participants were assessed for cognitive impairment, depression, anxiety, alexithymia, and HR-QoL. Only a small proportion of caregivers suffered from caregiver burden. Despite BT therapy, patients' HR-QoL was decreased compared to the age-matched general German population. Psychological symptoms, notably anxiety, and depression correlated significantly with reduced HR-QoL. Our data imply that caregiver burden emerged to be an issue in subgroups of dystonia patients. Furthermore, HR-QoL of dystonia patients is reduced even under optimized BT treatment in a specialized center.
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Affiliation(s)
- S C Drexel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - K Kollewe
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - L Paracka
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Kutschenko
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F Lange
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000, Leuven, Belgium
| | - F Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - D Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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18
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Plasma homocysteine, folate and vitamin B12 levels in Parkinson’s disease in China: A meta-analysis. Clin Neurol Neurosurg 2020; 188:105587. [DOI: 10.1016/j.clineuro.2019.105587] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 01/08/2023]
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19
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Storch A, Rosqvist K, Ebersbach G, Odin P. Disease stage dependency of motor and non-motor fluctuations in Parkinson’s disease. J Neural Transm (Vienna) 2019; 126:841-851. [DOI: 10.1007/s00702-019-02033-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022]
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20
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Novak P, Pimentel Maldonado DA, Novak V. Safety and preliminary efficacy of intranasal insulin for cognitive impairment in Parkinson disease and multiple system atrophy: A double-blinded placebo-controlled pilot study. PLoS One 2019; 14:e0214364. [PMID: 31022213 PMCID: PMC6483338 DOI: 10.1371/journal.pone.0214364] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 03/12/2019] [Indexed: 12/14/2022] Open
Abstract
Parkinson disease (PD) is associated with cognitive impairment. We aimed to determine the effects of intranasal insulin (INI) on cognition and motor performance in PD. This was a proof of concept, randomized, double-blinded, placebo-controlled trial evaluating the effects of 40 international units (IU) of insulin or saline once daily for four weeks on cognitive and functional performance. Of 16 subjects enrolled, eight in the INI group and six in the placebo group completed verbal fluency (FAS), Unified Parkinson Disease Scale (UPDRS), and modified Hoehn and Yahr scale (HY, PD severity) at baseline and post-treatment and were included in the analyses. After treatment, the INI group had a better total FAS score (p = 0.02) (41 ± 8.2 vs. 30.8 ± 7.1, mean ±SD, p = 0.02) compared to the placebo group. The INI group also had improved HY (p = 0.04) and UPDRS-Motor (Part III) (p = 0.02) scores when compared to baseline. One INI treated patient with multiple system atrophy (MSA) remained stable and did not show disease progression. The placebo group had no change. INI administration was well tolerated and there were no hypoglycemic episodes or serious study related adverse events or medications interactions. INI is safe in PD and MSA patients and may provide clinically relevant functional improvement. Larger studies are warranted to determine the INI effect in treatment of cognitive and motor impairment in Parkinson disease. Trial Registration: ClinicalTrial.gov NCT02064166.
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Affiliation(s)
- Peter Novak
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, University of Massachusetts, Worcester, Massachusetts, United States of America
- * E-mail:
| | | | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Validation of a simple screening tool for early diagnosis of advanced Parkinson's disease in daily practice: the CDEPA questionnaire. NPJ PARKINSONS DISEASE 2018; 4:20. [PMID: 29978014 PMCID: PMC6028449 DOI: 10.1038/s41531-018-0056-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 12/03/2022]
Abstract
Early clinical diagnosis of advanced Parkinson’s disease (APD) may be difficult. This study aimed to validate a simple screening tool, the CDEPA questionnaire (“Cuestionario De Enfermedad de Parkinson Avanzada” [Questionnaire for Advanced Parkinson’s Disease]), for the identification of APD in daily practice. The study included 173 consecutively selected patients with PD (40% were women, mean age was 68.4 ± 10.5 years), stratified according to the Hoehn and Yahr (HY) scale. The CDEPA questionnaire defined APD as the presence of severe disability requiring help for activities of daily living (ADL), motor fluctuations with limitation or inability to perform ADL, severe dysphagia, recurrent falls, or dementia. The diagnostic performance of the questionnaire was assessed against the gold standard criterion based on clinical judgment. PD was categorized as advanced in 65 (38%) patients when using the gold standard and in 109 (63%) patients when the CDEPA questionnaire was used. The CDEPA questionnaire and the gold standard agreed moderately (kappa statistic of 0.48, P < 0.001). The CDEPA classified APD with a sensitivity of 97%; specificity of 57%; total accuracy of 72.3%; and area under the curve (for a binary classifier) of 77.2%. Significant differences were found between the groups created by the CDEPA in several usual PD evaluations (HY Scale, SCOPA Motor Scale, Non-motor Symptoms Scale for PD, Clinical Impression of Severity Index for PD, Clinical Global Impression–Severity Scale, and Patient Global Impression–Severity Scale). CDEPA showed satisfactory inter-rater agreement (kappa = 0.88) and test–retest concordance (kappa 0.83). In conclusion, the CDEPA questionnaire is a valid, reliable, and useful instrument for easily screening APD. A Spanish questionnaire for advanced Parkinson’s disease, CDEPA, is a reliable tool for identifying patients with late-stage PD. Patients with advanced PD have severe motor and non-motor symptoms, and show poor response to conventional therapies. Early diagnosis is the key to determine which patients will benefit from the alternative treatment options such as deep brain stimulation. A study led by Pablo Martinez-Martin at the Carlos III Institute of Health in Madrid compared the accuracy of advanced PD diagnosis using the CDEPA questionnaire and a neurologist’s clinical judgment. The diagnostic accuracy of the questionnaire was >70% and the questionnaire results agreed with the diagnosis of advanced PD based on clinical judgment in 97% of cases. This quick and easy-to-administer questionnaire could be highly valuable for detecting advanced PD in outpatient clinics.
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Bouça-Machado R, Lennaerts-Kats H, Bloem B, Ferreira JJ. Why Palliative Care Applies to Parkinson's Disease. Mov Disord 2018; 33:750-753. [DOI: 10.1002/mds.27309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/04/2017] [Accepted: 12/22/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Raquel Bouça-Machado
- Instituto de Medicina Molecular; Lisbon Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
| | - Herma Lennaerts-Kats
- Radboud University Medical Center, Department of Neurology, Department of Anaesthesiology, Pain and Palliative Care; Nijmegen The Netherlands
| | - Bastiaan Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology; Nijmegen The Netherlands
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular; Lisbon Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine; University of Lisbon; Portugal
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23
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Mosley PE, Moodie R, Dissanayaka N. Caregiver Burden in Parkinson Disease: A Critical Review of Recent Literature. J Geriatr Psychiatry Neurol 2017; 30:235-252. [PMID: 28743212 DOI: 10.1177/0891988717720302] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Burden is a negative psychological state induced in caregivers by the demands of providing care to a person with an illness or a disability. Managing caregiver burden in Parkinson disease (PD) is significant because informal caregivers make a substantial contribution to the well-being of persons with PD, incurring financial, social, and personal losses. Failure to recognize and manage caregiver burden may lead to burnout and premature institutionalization of the person with PD. We conducted a comprehensive literature review to identify and summarize factors that may amplify burden, including motor and nonmotor symptoms of PD, caregiver psychiatric symptoms, and caregiver coping style. We review instruments designed to sample the construct of burden among caregivers and evaluate interventions that may reduce burden, either by directly targeting caregivers or by treating PD symptoms associated with burden. We aim to provide a concise synopsis of these issues for the clinician or researcher working with this population in order to facilitate recognition of caregiver burden, provide accurate assessment, administer appropriate interventions, and stimulate further research in this area.
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Affiliation(s)
- Philip E Mosley
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,2 Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,3 Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,4 School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Rebecca Moodie
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nadeeka Dissanayaka
- 5 UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.,6 School of Psychology, University of Queensland, St Lucia, Queensland, Australia.,7 Department of Neurology, Royal Brisbane & Woman's Hospital, Herston, Queensland, Australia
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24
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Bouça-Machado R, Titova N, Chaudhuri KR, Bloem BR, Ferreira JJ. Palliative Care for Patients and Families With Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:475-509. [PMID: 28554419 DOI: 10.1016/bs.irn.2017.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is the second most common neurodegenerative disease worldwide. There is widespread consensus that Parkinson patients, their carers, and clinicians involved in their care would benefit from a fully integrated, need-based provision of palliative care. However, the concept of palliative care in Parkinson's disease is still poorly defined and, consequently, poorly implemented into daily clinical practice. A particular challenge is the gradually progressive nature of Parkinson's disease-with insidiously increasing disability-making it challenging to clearly define the onset of palliative care needs for Parkinson patients. As people with Parkinson's disease are now living longer than in the past, future research needs to develop a more robust evidence-based approach to clarify the disease events associated with increased palliative care needs, and to examine these, prospectively, in an integrated palliative care service. The modern palliative care outlook, termed "simultaneous care,",is no longer restricted to the final stage of disease. It involves incorporating a continuity of care, effective management of the chronic-palliative interface, and a multidisciplinary network of professionals working both in the community and in specialized clinics, with active involvement of caregivers. Although promising, there is still a need to demonstrate the effectiveness of palliative care for patients with Parkinson's disease.
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Affiliation(s)
- Raquel Bouça-Machado
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Bas R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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25
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Coelho M, Abreu D, Correia-Guedes L, Lobo PP, Fabbri M, Godinho C, Domingos J, Albuquerque L, Freitas V, Pereira JM, Cattoni B, Carvalho H, Reimão S, Rosa MM, Ferreira AG, Ferreira JJ. Disability in Activities of Daily Living and Severity of Dyskinesias Determine the Handicap of Parkinson's Disease Patients in Advanced Stage Selected to DBS. JOURNAL OF PARKINSONS DISEASE 2017; 7:255-261. [PMID: 28157106 DOI: 10.3233/jpd-160848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is scarce data on the level of handicap in Parkinson's disease (PD) and none in advanced stage PD. OBJECTIVE To assess the handicap in advanced stage PD patients with disabling levodopa-induced motor complications selected to deep brain stimulation (DBS). METHODS Data was prospectively recorded during routine evaluation for DBS. Handicap was measured using London Handicap Scale (LHS) (0 = maximal handicap; 1 = no handicap). Disease severity was evaluated using the Hoehn & Yahr scale and the UPDRS/MDS-UPDRS, during off and on after a supra-maximal dose of levodopa. Schwab and England Scale (S&E) was scored in off and on. Dyskinesias were scored using the modified Abnormal Involuntary Movement Scale (mAIMS). Results concern cross-sectional assessment before DBS. RESULTS 100 PD patients (mean age 61 (±7.6); mean disease duration 12.20 (±4.6) years) were included. Median score of motor MDS-UPDRS was 54 in off and 25 in on. Mean total LHS score was 0.56 (±0.14). Patients were handicapped in several domains with a wide range of severity. Physical Independence and Social Integration were the most affected domains. Determinants of total LHS score were MDS-UPDRS part II off (β= -0.271; p = 0.020), S&E on (β= 0.264; p = 0.005) and off (β= 0.226; p = 0.020), and mAIMS on (β= -0.183; p = 0.042) scores (R2 = 29.6%). CONCLUSIONS We were able to use handicap to measure overall health condition in advanced stage PD. Patients were moderately to highly handicapped and this was strongly determined by disability in ADL and dyskinesias. Change in handicap may be a good patient-centred outcome to assess efficiency of DBS.
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Affiliation(s)
- Miguel Coelho
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Daisy Abreu
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Leonor Correia-Guedes
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Patricia Pita Lobo
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Margherita Fabbri
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Catarina Godinho
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Josefa Domingos
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Luisa Albuquerque
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Language Research Laboratory, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Vanda Freitas
- Language Research Laboratory, Instituto de Medicina Molecular, Lisbon, Portugal
| | - João Miguel Pereira
- Department of Neurosciences, Service of Psychiatry and Mental Health, Hospital Santa Maria, Lisbon, Portugal
| | - Begona Cattoni
- Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal
| | - Herculano Carvalho
- Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal
| | - Sofia Reimão
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Department of Neurosciences, Service of Neurological Imaging, Hospital Santa Maria, Lisbon, Portugal
| | - Mário M Rosa
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Joaquim J Ferreira
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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26
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Consensus on the Definition of Advanced Parkinson's Disease: A Neurologists-Based Delphi Study (CEPA Study). PARKINSONS DISEASE 2017; 2017:4047392. [PMID: 28239501 PMCID: PMC5292396 DOI: 10.1155/2017/4047392] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/23/2016] [Accepted: 01/05/2017] [Indexed: 11/29/2022]
Abstract
To date, no consensus exists on the key factors for diagnosing advanced Parkinson disease (APD). To obtain consensus on the definition of APD, we performed a prospective, multicenter, Spanish nationwide, 3-round Delphi study (CEPA study). An ad hoc questionnaire was designed with 33 questions concerning the relevance of several clinical features for APD diagnosis. In the first-round, 240 neurologists of the Spanish Movement Disorders Group participated in the study. The results obtained were incorporated into the questionnaire and both, results and questionnaire, were sent out to and fulfilled by 26 experts in Movement Disorders. Review of results from the second-round led to a classification of symptoms as indicative of “definitive,” “probable,” and “possible” APD. This classification was confirmed by 149 previous participating neurologists in a third-round, where 92% completely or very much agreed with the classification. Definitive symptoms of APD included disability requiring help for the activities of daily living, presence of motor fluctuations with limitations to perform basic activities of daily living without help, severe dysphagia, recurrent falls, and dementia. These results will help neurologists to identify some key factors in APD diagnosis, thus allowing users to categorize the patients for a homogeneous recognition of this condition.
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27
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Titova N, Chaudhuri KR. Palliative Care and Nonmotor Symptoms in Parkinson's Disease and Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1239-1255. [DOI: 10.1016/bs.irn.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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28
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Schrag A, Siddiqui UF, Anastasiou Z, Weintraub D, Schott JM. Clinical variables and biomarkers in prediction of cognitive impairment in patients with newly diagnosed Parkinson's disease: a cohort study. Lancet Neurol 2017; 16:66-75. [PMID: 27866858 PMCID: PMC5377592 DOI: 10.1016/s1474-4422(16)30328-3] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Parkinson's disease is associated with an increased incidence of cognitive impairment and dementia. Predicting who is at risk of cognitive decline early in the disease course has implications for clinical prognosis and for stratification of participants in clinical trials. We assessed the use of clinical information and biomarkers as predictive factors for cognitive decline in patients with newly diagnosed Parkinson's disease. METHODS The Parkinson's Progression Markers Initiative (PPMI) study is a cohort study in patients with newly diagnosed Parkinson's disease. We evaluated cognitive performance (Montreal Cognitive Assessment [MoCA] scores), demographic and clinical data, APOE status, and biomarkers (CSF and dopamine transporter [DAT] imaging results). Using change in MoCA scores over 2 years, MoCA scores at 2 years' follow-up, and a diagnosis of cognitive impairment (combined mild cognitive impairment or dementia) at 2 years as outcome measures, we assessed the predictive values of baseline clinical variables and separate or combined additions of APOE status, DAT imaging, and CSF biomarkers. We did univariate and multivariate linear analyses with MoCA change scores between baseline and 2 years, and with MoCA scores at 2 years as dependent variables, using backwards linear regression analysis. Additionally, we constructed a prediction model for diagnosis of cognitive impairment using logistic regression analysis. FINDINGS 390 patients with Parkinson's disease recruited between July 1, 2010, and May 31, 2013, and for whom data on MoCA scores at baseline and 2 years were available. In multivariate analyses, baseline age, University of Pennsylvania Smell Inventory Test (UPSIT) scores, CSF amyloid - (Aβ42) to t-tau ratio, and APOE status were associated with change in MoCA scores over time. Baseline age, MoCA and UPSIT scores, and CSF Aβ42 to t-tau ratio were associated with MoCA score at 2 years (using a backwards p-removal threshold of 0·1). Accuracy of prediction of cognitive impairment using age alone (area under the curve 0·68, 95% CI 0·60-0·76) significantly improved by addition of clinical scores (UPSIT, Rapid Eye Movement Sleep Behaviour Disorder Screening Questionnaire [RBDSQ], Geriatric Depression Scale, and Movement Disorder Society Unified Parkinson's Disease Rating Scale motor scores; 0·76, 0·68-0·83), CSF variables (0·74, 0·68-0·81), or DAT imaging results (0·76, 0·68-0·83). In combination, the five variables showing the most significant associations with cognitive impairment (age, UPSIT, RBDSQ, CSF Aβ42, and caudate uptake on DAT imaging) allowed prediction of cognitive impairment at 2 years (0·80, 0·74-0·87; p=0·0003 compared to age alone). INTERPRETATION In newly diagnosed Parkinson's disease, the occurrence of cognitive impairment at 2 year follow-up can be predicted with good accuracy using a model combining information on age, non-motor assessments, DAT imaging, and CSF biomarkers. FUNDING None.
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Affiliation(s)
- Anette Schrag
- Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, London, UK.
| | - Uzma Faisal Siddiqui
- Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, London, UK
| | - Zacharias Anastasiou
- Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, London, UK
| | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
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29
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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30
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Fabbri M, Coelho M, Abreu D, Guedes LC, Rosa MM, Costa N, Antonini A, Ferreira JJ. Do patients with late-stage Parkinson's disease still respond to levodopa? Parkinsonism Relat Disord 2016; 26:10-6. [DOI: 10.1016/j.parkreldis.2016.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
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Albuquerque L, Martins M, Coelho M, Guedes L, Ferreira JJ, Rosa M, Martins IP. Advanced Parkinson disease patients have impairment in prosody processing. J Clin Exp Neuropsychol 2015; 38:208-16. [PMID: 26595435 DOI: 10.1080/13803395.2015.1100279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The ability to recognize and interpret emotions in others is a crucial prerequisite of adequate social behavior. Impairments in emotion processing have been reported from the early stages of Parkinson's disease (PD). This study aims to characterize emotion recognition in advanced Parkinson's disease (APD) candidates for deep-brain stimulation and to compare emotion recognition abilities in visual and auditory domains. METHOD APD patients, defined as those with levodopa-induced motor complications (N = 42), and healthy controls (N = 43) matched by gender, age, and educational level, undertook the Comprehensive Affect Testing System (CATS), a battery that evaluates recognition of seven basic emotions (happiness, sadness, anger, fear, surprise, disgust, and neutral) on facial expressions and four emotions on prosody (happiness, sadness, anger, and fear). APD patients were assessed during the "ON" state. Group performance was compared with independent-samples t tests. RESULTS Compared to controls, APD had significantly lower scores on the discrimination and naming of emotions in prosody, and visual discrimination of neutral faces, but no significant differences in visual emotional tasks. CONCLUSION The contrasting performance in emotional processing between visual and auditory stimuli suggests that APD candidates for surgery have either a selective difficulty in recognizing emotions in prosody or a general defect in prosody processing. Studies investigating early-stage PD, and the effect of subcortical lesions in prosody processing, favor the latter interpretation. Further research is needed to understand these deficits in emotional prosody recognition and their possible contribution to later behavioral or neuropsychiatric manifestations of PD.
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Affiliation(s)
- Luisa Albuquerque
- a Language Research Laboratory, University of Lisbon , Lisbon , Portugal.,b Institute of Molecular Medicine, University of Lisbon , Lisbon , Portugal.,c Faculty of Medicine , University of Lisbon , Lisbon , Portugal.,d Department of Clinical Neurosciences , Santa Maria Hospital , Lisbon , Portugal
| | - Maurício Martins
- a Language Research Laboratory, University of Lisbon , Lisbon , Portugal.,b Institute of Molecular Medicine, University of Lisbon , Lisbon , Portugal.,c Faculty of Medicine , University of Lisbon , Lisbon , Portugal.,e Berlin School of Mind and Brain, Humboldt-Universität zu Berlin , Berlin.,f Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig , Germany
| | - Miguel Coelho
- d Department of Clinical Neurosciences , Santa Maria Hospital , Lisbon , Portugal.,g Clinical Pharmacology Unit, Instituto de Medicina Molecular , Lisbon , Portugal
| | - Leonor Guedes
- d Department of Clinical Neurosciences , Santa Maria Hospital , Lisbon , Portugal.,g Clinical Pharmacology Unit, Instituto de Medicina Molecular , Lisbon , Portugal
| | - Joaquim J Ferreira
- g Clinical Pharmacology Unit, Instituto de Medicina Molecular , Lisbon , Portugal
| | - Mário Rosa
- g Clinical Pharmacology Unit, Instituto de Medicina Molecular , Lisbon , Portugal
| | - Isabel Pavão Martins
- a Language Research Laboratory, University of Lisbon , Lisbon , Portugal.,b Institute of Molecular Medicine, University of Lisbon , Lisbon , Portugal.,c Faculty of Medicine , University of Lisbon , Lisbon , Portugal.,d Department of Clinical Neurosciences , Santa Maria Hospital , Lisbon , Portugal
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32
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Leão AH, Sarmento‐Silva AJ, Santos JR, Ribeiro AM, Silva RH. Molecular, Neurochemical, and Behavioral Hallmarks of Reserpine as a Model for Parkinson's Disease: New Perspectives to a Long-Standing Model. Brain Pathol 2015; 25:377-90. [PMID: 25726735 PMCID: PMC8029054 DOI: 10.1111/bpa.12253] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
The administration of reserpine to rodents was one of the first models used to investigate the pathophysiology and screening for potential treatments of Parkinson's disease (PD). The reserpine model was critical to the understanding of the role of monoamine system in the regulation of motor and affective disorders, as well as the efficacy of current PD treatments, such as L-DOPA and dopamine agonists. Nevertheless, with the introduction of toxin-induced and genetic models of PD, reserpine became underused. The main rationale to this drawback was the supposed absence of reserpine construct validity with PD. Here, we highlight classical and recent experimental findings that support the face, pharmacological, and construct validity of reserpine PD model and reason against the current rationale for its underuse. We also aim to shed a new perspective upon the model by discussing the main challenges and potentials for the reserpine model of PD.
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Affiliation(s)
- Anderson H.F.F. Leão
- Memory Studies LaboratoryDepartment of PhysiologyUniversidade Federal do Rio Grande do NorteNatalRNBrazil
| | - Aldair J. Sarmento‐Silva
- Memory Studies LaboratoryDepartment of PhysiologyUniversidade Federal do Rio Grande do NorteNatalRNBrazil
| | - José R. Santos
- Biology DepartmentUniversidade Federal de SergipeSão CristóvãoSEBrazil
| | - Alessandra M. Ribeiro
- Memory Studies LaboratoryDepartment of PhysiologyUniversidade Federal do Rio Grande do NorteNatalRNBrazil
- Department of BiosciencesUniversidade Federal de São PauloSantosSPBrazil
| | - Regina H. Silva
- Memory Studies LaboratoryDepartment of PhysiologyUniversidade Federal do Rio Grande do NorteNatalRNBrazil
- Behavioral Neuroscience LaboratoryDepartment of PharmacologyUniversidade Federal de São PauloSão PauloSPBrazil
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