Estimated life expectancy of Parkinson's patients compared with the UK population

Web Application to Enable Online Social Interactions in a Parkinson Disease Risk Cohort: Feasibility Study and Social Network Analysis

BACKGROUND

There is evidence that social interaction has an inverse association with the development of neurodegenerative diseases. PREDICT-Parkinson Disease (PREDICT-PD) is an online UK cohort study that stratifies participants for risk of future Parkinson disease (PD).

OBJECTIVE

This study aims to explore the methodological approach and feasibility of assessing the digital social characteristics of people at risk of developing PD and their social capital within the PREDICT-PD platform, making hypotheses about the relationship between web-based social engagement and potential predictive risk indicators of PD.

METHODS

A web-based application was built to enable social interaction through the PREDICT-PD portal. Feedback from existing members of the cohort was sought and informed the design of the pilot. Dedicated staff used weekly engagement activities, consisting of PD-related research, facts, and queries, to stimulate discussion. Data were collected by the hosting platform. We examined the pattern of connections generated over time through the cumulative number of posts and replies and ego networks using social network analysis. We used network metrics to describe the bonding, bridging, and linking of social capital among participants on the platform. Relevant demographic data and Parkinson risk scores (expressed as an odd 1:x) were analyzed using descriptive statistics. Regression analysis was conducted to estimate the relationship between risk scores (after log transformation) and network measures.

RESULTS

Overall, 219 participants took part in a 4-month pilot forum embedded in the study website. In it, 200 people (n=80, 40% male and n=113, 57% female) connected in a large group, where most pairs of users could reach one another either directly or indirectly through other users. A total of 59% (20/34) of discussions were spontaneously started by participants. Participation was asynchronous, with some individuals acting as "brokers" between groups of discussions. As more participants joined the forum and connected to one another through online posts, distinct groups of connected users started to emerge. This pilot showed that a forum application within the cohort web platform was feasible and acceptable and fostered digital social interaction. Matching participants' web-based social engagement with previously collected data at individual level in the PREDICT-PD study was feasible, showing potential for future analyses correlating online network characteristics with the risk of PD over time, as well as testing digital social engagement as an intervention to modify the risk of developing neurodegenerative diseases.

CONCLUSIONS

The results from the pilot suggest that an online forum can serve as an intervention to enhance social connectedness and investigate whether patterns of online engagement can impact the risk of developing PD through long-term follow-up. This highlights the potential of leveraging online platforms to study the role of social capital in moderating PD risk and underscores the feasibility of such approaches in future research or interventions.

Comparison of the effectiveness, safety, and costs of anti-Parkinson drugs: A multiple-center retrospective study

AIMS

This study aimed to systematically compare the effectiveness, safety, and costs of different anti-Parkinson drugs (APDs).

METHODS

This is a multi-center study that retrospectively analyzed the data of 8420 outpatients with PD from 2014 to 2019 across 30 tertiary hospitals in China. The effectiveness was evaluated by changes in total dosages of APDs, normalized by levodopa equivalent dose (LED) and presented as ΔLEDs; levodopa equivalent dose cost (LEDc) represented the daily cost of APDs; and newly added diagnostics were represented as APDs-related adverse events.

RESULTS

A total of 384 patients with eligible medical records for three consecutive years were enrolled. Patients treated with carbidopa/levodopa or levodopa/benserazide had significantly lower mean ΔLEDs than other groups (p < 0.01), followed by pramipexole and selegiline. The piribedil group had the highest ΔLEDs, with mean differences of 112.56-355.04 mg compared to other groups (p < 0.01). Meanwhile, LEDc in the levodopa/benserazide, carbidopa/levodopa, and piribedil groups were significantly lower than those in pramipexole or selegiline groups ($0.088-0.135/day for levodopa/benserazide; $0.070-0.126/day for carbidopa/levodopa; $0.112-0.138/day for piribedil; $0.290-0.332/day for pramipexole; $0.229-0.544/day for selegiline; p < 0.01). Patients with piribedil had more adverse events, with an incidence rate of 35.7%, followed by levodopa/benserazide (25.6%), selegiline (23.5%), carbidopa/levodopa (23.3%), and pramipexole (16.4%). Pramipexole showed a lower incidence rate of adverse events than piribedil, including neuropsychiatric symptoms (p = 0.006), headache/dizziness (p = 0.016), and gastrointestinal symptoms (p = 0.031).

CONCLUSIONS

Carbidopa/levodopa or levodopa/benserazide might exhibit better clinical improvement with less medical cost, while piribedil presented less clinical improvement but a higher risk of headache/dizziness, gastrointestinal, and neuropsychiatric symptoms.

Update: Descriptive epidemiology of Parkinson disease

We review the descriptive epidemiology of Parkinson disease (PD). PD is a prevalent neurologic disorder in high Socio-Demographic Index (SDI) nations with rising prevalence in low and middle SDI nations. PD became a prevalent disorder in high SDI nations during the 20th century. Population growth, population aging, and increased disease duration are major drivers of rising PD prevalence. Exposure to industrial toxicants may also be a contributor to rising PD prevalence. PD is an age-related disorder with incidence likely peaking in the 8th decade of life and prevalence in the 9th decade of life. PD is notable for significant sex difference in PD risk with greater risk in men. There may be ancestral differences in PD prevalence and risk. PD is associated with moderately increased mortality though this may be underestimated. Despite significant research, there is considerable uncertainty about basic features of PD epidemiology.

Cost-effectiveness analysis of insecticide ban aimed at preventing Parkinson's disease in Central California

BACKGROUND

Our study assessed whether banning specific insecticides to reduce the PD burden in three Central California (CA) counties is cost-effective.

METHOD

We applied a cost-effectiveness analysis using a cohort-based Markov model to estimate the impact and costs of banning seven insecticides that were previously associated with PD in these counties as well as mixture exposures to some of these pesticides. We relied for our estimations on the cohort of 65- and 66-year-olds living in these counties who were unaffected by PD at baseline in 2020 and projected their incidence, costs, and reduction in quality-adjusted-life-years (QALY) loss due to developing PD over a 20-year period. We included a shiny app for modeling different scenarios (https://sherlockli.shinyapps.io/pesticide_pd_economics_part_2/).

RESULTS

According to our scenarios, banning insecticides to reduce the occurrence of PD in three Central CA counties was cost-effective relative to not banning insecticides. In the worst-case scenario of exposure to a single pesticide, methomyl, versus none would result in an estimated 205 (95 % CI: 75, 348) additional PD cases or 12 % (95 % CI: 4 %, 20 %) increase in PD cases over a 20-year period based on residential proximity to pesticide applications. The increase in PD cases due to methomyl would increase health-related costs by $72.0 million (95 % CI: $5.5 million, $187.4 million). Each additional PD patient due to methomyl exposure would incur $109,327 (95 % CI, $5554, $347,757) in costs per QALY loss due to PD. Exposure to methomyl based on workplace proximity to pesticide applications generated similar estimates. The highest PD burden and associated costs would be incurred from exposure to multiple pesticides simultaneously.

CONCLUSION

Our study provides an assessment of the cost-effectiveness of banning specific insecticides to reduce PD burden in terms of health-related QALYs and related costs. This information may help policymakers and stakeholders to make decisions concerning the regulation of pesticides.

Association of health behaviors with function and health-related quality of life among patients with Parkinson's disease

BACKGROUND

Current evidence on chronic conditions favors promotion of health behaviors as a mean to positively impact health outcomes. In Parkinson's disease, performing health behaviors is indicated as a means to fight the long-lasting burden of the disease. Understanding actual engagement in health behaviors and patient activation and their association to function and health-related quality of life is therefore important. Our objectives were, among people with Parkinson's disease: (1) to characterize health behaviors including utilization of rehabilitative treatments, physical activity, and patient activation levels, and (2) to test the associations between these health behaviors and health outcomes.

METHODS

A cross-sectional study of 88 people with Parkinson's disease (age 66.84 ± 8.8) was conducted. Participants answered questionnaires measuring health behaviors including utilization of health professions treatments, physical activity, patient activation, and health outcomes consisting of function and health-related quality of life. Linear regression models were conducted to test associations between measured health behaviors, function and health-related quality of life.

RESULTS

Participants rarely engage in rehabilitative treatments, but showed high levels of patient activation. Controlled by demographics and disease severity, physical activity and patient activation were associated with function (b = 0.41, p < .001; b = 0.2, p = .02, respectively) and physical activity but not patient activation, which was associated with health-related quality of life (b = 0.19, p = .03). There was also interaction effects of physical activity and non-motor symptoms, and physical activity and motor symptoms on health-related quality of life (b = 0.19, p = .02 and b = - 0.22, p = .01, respectively).

CONCLUSIONS

In respect to their potential health-related benefits for people with Parkinson's disease, health professionals' treatments are underutilized. Findings supported the importance of health behaviors for maintaining function and health-related quality of life among people with Parkinson's disease. They also show a differential contribution of motor and non-motor symptoms to the association between physical activity and quality of life. It is suggested that policy makers encourage opportunities for physical activity tailored for people with Parkinson's disease and adopt a proactive stance towards enhancing awareness and use of rehabilitation services. Trial registration NCT05211700, ClinicalTrials.gov ID: NCT05211700 first release 12/30/2021, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05211700.

Tinetti balance performance is associated with mortality in older adults with late-onset Parkinson's disease: a longitudinal study

BACKGROUND

Parkinson's disease (PD) is associated with a 3-fold mortality risk, which is closely related to advancing age. Evidence is lacking regarding the factors associated with the risks of mortality or nursing-home (NH) admission, in elderly patients with PD. We aimed at identifying the clinical characteristics associated with these outcomes, in older community-dwelling patients with late-onset PD.

METHODS

Retrospective, observational analysis of data from geriatric day hospital patients. Motor assessment included Unified Parkinson Disease Rating Scale (UPDRS) part III score, Tinetti Performance Oriented Mobility Assessment (POMA) balance and gait tests, and gait speed. Levodopa equivalent dose, comorbidity, cognitive performance, Activities of Daily Living performance were examined. Cox proportional hazards models were performed to identify the factors associated with mortality and NH admission rate (maximum follow-up time = 5 years).

RESULTS

We included 98 patients, mean age 79.4 (SD = 5.3) of whom 18 (18.3%) died and 19 (19.4%) were admitted into NH, over a median follow-up of 4 years. In multivariate Cox models, poor balance on the Tinetti POMA scale (HR = 0.82 95%CI (0.66-0.96), p = .023) and older age (HR = 1.12 95%CI (1.01-1.25), p = .044) were the only variables significantly associated with increased mortality risk. A Tinetti balance score below 11/16 was associated with a 6.7 hazard for mortality (p = .006). No specific factor was associated with NH admissions.

CONCLUSIONS

Age and the Tinetti POMA score were the only factors independently associated with mortality. The Tinetti POMA scale should be considered for balance assessment and as a screening tool for the most at-risk individuals, in this population.

Long-Term Outcomes of Bilateral Subthalamic Nucleus Deep Brain Stimulation for Patients With Parkinson's Disease: 10 Years and Beyond

BACKGROUND

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) represents an effective treatment for severe Parkinson's disease (PD), but little is known about the long-term benefit.

OBJECTIVE

To investigate the survival rate and long-term outcome of DBS.

METHODS

We investigated all 81 patients including 37 males and 44 females who underwent bilateral STN DBS from March 2005 to March 2008 at a single institution. The current survival status of the patients was investigated. Preoperative and postoperative follow-up assessments were analyzed.

RESULTS

The mean age at the time of surgery was 62 (range 27-82) years, and the median clinical follow-up duration was 145 months. Thirty-five patients (43%) died during the follow-up period. The mean duration from DBS surgery to death was 110.46 ± 40.8 (range 0-155) months. The cumulative survival rate is as follows: 98.8 ± 1.2% (1 year), 95.1 ± 2.4% (5 years), and 79.0 ± 4.5% (10 years). Of the 81 patients, 33 (40%) were ambulatory up to more than 11 years. The Unified Parkinson's Disease Rating Scale (UPDRS) score was significantly improved until 5 years after surgery although it showed a tendency to increase again after 10 years. The patient group with both electrodes located within the STN showed a higher rate of survival and maintained ambulation.

CONCLUSION

STN DBS is a safe and effective treatment for patients with advanced PD. This study based on the long-term follow-up of large patient populations can be used to elucidate the long-term fate of patients who underwent bilateral STN DBS for PD.

Genetic Determinants of Survival in Parkinson's Disease in the Asian Population

BACKGROUND

Patients with Parkinson's disease (PD) have reduced life expectancy compared to the general population. Genetic variation was shown to play a role in the heterogeneity of survival for patients with PD, although the underlying genetic background remains poorly studied.

OBJECTIVE

The aim was to explore the genetic determinants influencing the survival of PD.

METHODS

We performed a genome-wide association analysis using a Cox proportional hazards model in a longitudinal cohort of 1080 Chinese patients with PD. Furthermore, we built a clinical-genetic model to predict the survival of patients using clinical variables combined with polygenic risk score (PRS) of survival of PD.

RESULTS

The cohort was followed up for an average of 7.13 years, with 85 incidents of death. One locus rs12628329 (RPL3) was significantly associated with reduced survival time by ~10.8 months (P = 2.72E-08, β = 1.79, standard error = 0.32). Functional exploration suggested this variant could upregulate the expression of RPL3 and induce apoptosis and cell death. In addition, adding PRS of survival in the prediction model substantially improved survival predictability (concordance index [Cindex]: 0.936) compared with the clinical model (Cindex: 0.860).

CONCLUSIONS

These findings improve the current understanding of the genetic cause of survival of PD and provide a novel target RPL3 for further research on PD pathogenesis and potential therapeutic options. Our results also demonstrate the potential utility of PRS of survival in identifying patients with shorter survival and providing personalized clinical monitoring and treatment. © 2022 International Parkinson and Movement Disorder Society.

Curcumin-Loaded Human Serum Albumin Nanoparticles Prevent Parkinson’s Disease-like Symptoms in C. elegans

Parkinson’s disease is one of the most common degenerative disorders and is characterized by observable motor dysfunction and the loss of dopaminergic neurons. In this study, we fabricated curcumin nanoparticles using human serum albumin as a nanocarrier. Encapsulating curcumin is beneficial to improving its aqueous solubility and bioavailability. The curcumin-loaded HSA nanoparticles were acquired in the particle size and at the zeta potential of 200 nm and −10 mV, respectively. The curcumin-loaded human serum albumin nanoparticles ameliorated Parkinson’s disease features in the C. elegans model, including body movement, basal slowing response, and the degeneration of dopaminergic neurons. These results suggest that curcumin nanoparticles have potential as a medicinal nanomaterial for preventing the progression of Parkinson’s disease.

Automatic Speech Recognition in Noise for Parkinson's Disease: A Pilot Study

The sophistication of artificial intelligence (AI) technologies has significantly advanced in the past decade. However, the observed unpredictability and variability of AI behavior in noisy signals is still underexplored and represents a challenge when trying to generalize AI behavior to real-life environments, especially for people with a speech disorder, who already experience reduced speech intelligibility. In the context of developing assistive technology for people with Parkinson's disease using automatic speech recognition (ASR), this pilot study reports on the performance of Google Cloud speech-to-text technology with dysarthric and healthy speech in the presence of multi-talker babble noise at different intensity levels. Despite sensitivities and shortcomings, it is possible to control the performance of these systems with current tools in order to measure speech intelligibility in real-life conditions.

Dying with Parkinson's Disease: Healthcare Utilization and Costs in the Last Year of Life

BACKGROUND

The end-of-life period is associated with disproportionately higher health care utilization and cost at the population level but there is little data in Parkinson's disease (PD).

OBJECTIVE

The goals of this study were to 1) compare health care use and associated cost in the last year of life between decedents with and without PD, and 2) identify factors associated with palliative care consultation and death in hospital.

METHODS

Using linked administrative datasets held at ICES, we conducted a retrospective, population-based cohort study of all Ontario, Canada decedents from 2015 to 2017. We examined demographic data, rate of utilization across healthcare sectors, and cost of health care services in the last year of life.

RESULTS

We identified 291,276 decedents of whom 12,440 (4.3%) had a diagnosis of PD. Compared to decedents without PD, decedents with PD were more likely to be admitted to long-term care (52% vs. 23%, p < 0.001) and received more home care (69.0 vs. 41.8 days, p < 0.001). Receipt of palliative homecare or physician palliative home consultation were associated with lower odds of dying in hospital (OR: 0.24, 95% CI: 0.19- 0.30, and OR: 0.38, 95% CI: 0.33- 0.43, respectively). Mean cost of care in the last year of life was greater for decedents with PD ($68,391 vs. $59,244, p < 0.001).

CONCLUSION

Compared to individuals without PD, individuals with PD have higher rates of long-term care, home care and higher health care costs in the last year of life. Palliative care is associated with a lower rate of hospital death.

Sudden unexpected death in Parkinson's disease: Insights from clinical practice

Classified as the second most common neurodegenerative disorder associated with aging after Alzheimer's disease, Parkinson's disease (PD) is the most common movement disorder. In the last decade, despite advances in treatment, mortality rates linked with PD continued to reach significant figures. Available studies have shown that compared with healthy controls, patients with PD are accompanied by high rates of premature death. This is usually caused by factors such as pneumonia and cerebrovascular and cardiovascular diseases. Recently, it has been demonstrated that a significant proportion of patients with PD die suddenly. This is referred to as a sudden and unexpected death in PD (SUDPAR). Here, we focus on the magnitude of SUDPAR. Finally, it is important to learn more about SUDPAR for the implementation of effective prevention strategies.

Effectiveness of a Long-Term, Home-Based Aerobic Exercise Intervention on Slowing the Progression of Parkinson Disease: Design of the Cyclical Lower Extremity Exercise for Parkinson Disease II (CYCLE-II) Study

OBJECTIVE

Previous short duration studies have demonstrated that high-intensity aerobic exercise improves aspects of motor and non-motor function in people with Parkinson disease (PwPD); however, the effectiveness of a long-term exercise intervention on slowing disease progression is unknown. The primary aim of this study is to determine the disease-altering effects of high-intensity aerobic exercise, administered on an upright stationary cycle, on the progression of PD. A secondary aim is to develop a prognostic model for 12-month changes in the Movement Disorder Society Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III) of PwPD undergoing an aerobic exercise intervention.

METHODS

This pragmatic, multisite, single-rater blinded, randomized controlled trial will recruit PwPD from 2 large, urban, academic medical centers. Participants (N = 250 PwPD) will be randomized to (1) home-based aerobic exercise or (2) usual and customary care. Those in the aerobic exercise arm will be asked to complete in-home aerobic exercise sessions at 60% to 80% of heart rate reserve 3 times per week for 12 months utilizing a commercially available upright exercise cycle. The usual and customary care group will continue normal activity levels. Daily activity will be monitored for both groups throughout the 12-month study period. The primary outcome, both to assess disease-modifying response to aerobic exercise and for prognostic modeling in the aerobic exercise arm, is 12-month rate of change in the MDS-UPDRS III. Clinical and biomechanical measures will also be used to assess upper and lower extremity motor function as well as non-motor functions.

IMPACT

Should long-term aerobic exercise demonstrate disease-modifying capability, this study will provide evidence that "Exercise is Medicine" for PwPD. Further, the derived prognostic model will inform a patient-specific exercise prescription for PwPD and expected effects on PD progression.

Neurorescue Effects of Frondoside A and Ginsenoside Rg3 in C. elegans Model of Parkinson's Disease

Parkinson’s disease (PD) is a currently incurable neurodegenerative disorder characterized by the loss of dopaminergic (DAergic) neurons in the substantia nigra pars compacta and α-synuclein aggregation. Accumulated evidence indicates that the saponins, especially from ginseng, have neuroprotective effects against neurodegenerative disorders. Interestingly, saponin can also be found in marine organisms such as the sea cucumber, but little is known about its effect in neurodegenerative disease, including PD. In this study, we investigated the anti-Parkinson effects of frondoside A (FA) from Cucumaria frondosa and ginsenoside Rg3 (Rg3) from Panax notoginseng in C. elegans PD model. Both saponins were tested for toxicity and optimal concentration by food clearance assay and used to treat 6-OHDA-induced BZ555 and transgenic α-synuclein NL5901 strains in C. elegans. Treatment with FA and Rg3 significantly attenuated DAergic neurodegeneration induced by 6-OHDA in BZ555 strain, improved basal slowing rate, and prolonged lifespan in the 6-OHDA-induced wild-type strain with downregulation of the apoptosis mediators, egl-1 and ced-3, and upregulation of sod-3 and cat-2. Interestingly, only FA reduced α-synuclein aggregation, rescued lifespan in NL5901, and upregulated the protein degradation regulators, including ubh-4, hsf-1, hsp-16.1 and hsp-16.2. This study indicates that both FA and Rg3 possess beneficial effects in rescuing DAergic neurodegeneration in the 6-OHDA-induced C. elegans model through suppressing apoptosis mediators and stimulating antioxidant enzymes. In addition, FA could attenuate α-synuclein aggregation through the protein degradation process.

The Need for Digital Health Solutions in Deep Brain Stimulation for Parkinson's Disease in the Time of COVID-19 and Beyond

OBJECTIVES

Deep brain stimulation (DBS) is a well-established therapy for the management of patients with advanced Parkinson's disease and other movement disorders. Patients implanted with DBS require life-long management of the medical device as well as medications. Patients are often challenged to frequently visit the specialized DBS centers and such challenges are aggravated depending on geography, socioeconomic factors, and support systems. We discuss the need for digital health solutions to overcome these barriers to better and safely take care of patients, especially in the current COVID-19 pandemic.

MATERIALS AND METHODS

A review of the literature was conducted for technology and logistics necessary in forming a digital health program.

RESULTS

Digital health encounters can take place in both a synchronous and asynchronous manner. Factors involving patients include cognitive capacity, physical safety, physical capacity, connectivity, and technological security. Physician factors include examining the patient, system diagnostics, and adjusting stimulation or medications. Technology is focused on bridging the gap between patient and physician through integrating the DBS lead, implantable pulse generator (IPG), programmer, novel devices/applications to grade motor function, and teleconference modalities.

CONCLUSIONS

For patients with Parkinson's disease, digital health has the potential to drastically change the landscape after DBS surgery. Furthermore, technology is fundamental in connectivity, diagnostic evaluation, and security in order to create stable and useful patient-focused care.

Autophagy and Redox Homeostasis in Parkinson's: A Crucial Balancing Act

Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are generated primarily from endogenous biochemical reactions in mitochondria, endoplasmic reticulum (ER), and peroxisomes. Typically, ROS/RNS correlate with oxidative damage and cell death; however, free radicals are also crucial for normal cellular functions, including supporting neuronal homeostasis. ROS/RNS levels influence and are influenced by antioxidant systems, including the catabolic autophagy pathways. Autophagy is an intracellular lysosomal degradation process by which invasive, damaged, or redundant cytoplasmic components, including microorganisms and defunct organelles, are removed to maintain cellular homeostasis. This process is particularly important in neurons that are required to cope with prolonged and sustained operational stress. Consequently, autophagy is a primary line of protection against neurodegenerative diseases. Parkinson's is caused by the loss of midbrain dopaminergic neurons (mDANs), resulting in progressive disruption of the nigrostriatal pathway, leading to motor, behavioural, and cognitive impairments. Mitochondrial dysfunction, with associated increases in oxidative stress, and declining proteostasis control, are key contributors during mDAN demise in Parkinson's. In this review, we analyse the crosstalk between autophagy and redoxtasis, including the molecular mechanisms involved and the detrimental effect of an imbalance in the pathogenesis of Parkinson's.

Deep Brain Stimulation in Parkinson's Disease: Still Effective After More Than 8 Years

Background

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is well established and the most effective treatment for advanced Parkinson's disease (PD). However, little is known of the long-term effects.

Objectives

The aim of this study was to examine the long-term effects of STN-DBS in PD and evaluate the effect of reprogramming after more than 8 years of treatment.

Methods

A total of 82 patients underwent surgery in Copenhagen between 2001 and 2008. Before surgery and at 8 to 15 years follow-up, the patients were rated with the Unified Parkinson's Disease Rating Scale (UPDRS) with and without stimulation and medicine. Furthermore, at long-term follow-up, the patients were offered a systemic reprogramming of the stimulation settings. Data from patients' medical records were collected. The mean (range) age at surgery was 60 (42-78) years, and the duration of disease was 13 (5-25) years. A total of 30 patients completed the long-term follow-up.

Results

The mean reduction of the motor UPDRS by medication before surgery was 52%. The improvement of motor UPDRS with stimulation alone compared with motor UPDRS with neither stimulation nor medication was 61% at 1 year and 39% at 8 to 15 years after surgery (before reprogramming). Compared with before surgery, medication was reduced by 55% after 1 year and 44% after 8 to 15 years. After reprogramming, most patients improved.

Conclusions

STN-DBS remains effective in the long run, with a sustained reduction of medication in the 30 of 82 patients available for long-term follow-up. Reprogramming is effective even in the late stages of PD and after many years of treatment.

Synergistic action of propolis with levodopa in the management of Parkinsonism in Drosophila melanogaster

Background The Phosphatase and tensin-induced putative kinase 1 (PINK1B9) mutant for Drosophila melanogaster is a key tool that has been used in assessing the pathology of Parkinsonism and its possible remedy. This research was targeted toward determining the effects of ethanolic extract of propolis, with levodopa therapy in the management of Parkinsonism. Method The PINK1B9 flies were divided into groups and fed with the different treatment doses of ethanoic extract of propolis. The treatment groups were subjected to 21 days of administration of propolis and the levodopa at different doses after which percentage climbing index, antioxidant activity and lifespan studies were done. Results Propolis alone improved motor activity, antioxidant and lifespan in Drosophila melanogaster than in PINK1 flies. Propolis in combination with levodopa significantly (P<0.05) improved physiological parameters at higher than lower concentrations in Parkinsonism Drosophila melanogaster demonstrating its importance in managing side effects associated with levodopa. Conclusion Propolis is a novel candidate as an alternative and integrative medicinal option to use in the management of Parkinsonism in both animals and humans at higher concentrations.

Effect of kaempferol on the transgenic Drosophila model of Parkinson's disease

The present study was aimed to study the effect of kaempferol, on the transgenic Drosophila model of Parkinson's disease. Kaempferol was added in the diet at final concentration of 10, 20, 30 and 40 µM and the effect was studied on various cognitive and oxidative stress markers. The results of the study showed that kaempferol, delayed the loss of climbing ability as well as the activity of PD flies in a dose dependent manner compared to unexposed PD flies. A dose-dependent reduction in oxidative stress markers was also observed. Histopathological examination of fly brains using anti-tyrosine hydroxylase immunostaining has revealed a significant dose-dependent increase in the expression of tyrosine hydroxylase in PD flies exposed to kaempferol. Molecular docking results revealed that kaempferol binds to human alpha synuclein at specific sites that might results in the inhibition of alpha synuclein aggregation and prevents the formation of Lewy bodies.

High-accuracy Automated Diagnosis of Parkinson's Disease

PURPOSE

Parkinson's disease (PD), which is the second most common neurodegenerative disease following Alzheimer's disease, can be diagnosed clinically when about 70% of the dopaminergic neurons are lost and symptoms are noticed. Neuroimaging methods such as single photon emission computed tomography have become useful tools in vivo to assess dopamine transporters (DATs) in the striatal region. However, inter- and intra-reader variability of construing the images might result in misdiagnosis. To overcome the challenges posed by classification of the disease, image preparation techniques and a back propagation neural network (BPNN) have been proposed. The aim of this study is to show that the proposed method can be used for the classification of PD with high accuracy.

METHODS

In this study, we used basic image preparation techniques and a BPNN on DAT imaging datasets from the Parkinson's Progression Markers Initiative. 1,334 PD and 212 normal control (NC) subjects were included. In the image preparation phase, adaptive histogram equalization was applied to the cropped images, followed by image binarization. Then, the mass-difference method was applied to separate the regions of interest with similar values. Finally, the binarized images were subtracted from the original images, and the average pixel per node approach was applied to the images to minimize the inputs. In the BPNN phase, 400 input neurons and 2 output neurons were used. The dataset was divided into three sets: training, validation, and test. The BPNN was trained several times in order to obtain the optimum values.

RESULTS

The use of 40 hidden neurons, a learning rate of 0.00079, and a momentum factor of 0.90 produced superior results and were applied in the final BPNN architecture. The tolerance value used was 0.80. Uniquely, we found the sensitivity, specificity, and accuracy for PD vs. NC classification to be 99.7%, 99.2%, 99.6%, respectively. To the best of our knowledge, this is the highest accuracy value achieved in the existing literature. Our method increases computational speed together with improved performance.

CONCLUSION

We have shown that effective image processing methods and the use of BPNN can successfully be applied to PD datasets to accurately determine any abnormalities in DATs. Using the shallow neural network, this procedure requires less processing time compared to other methods, and its accuracy, sensitivity, and specificity are reliable. However, further studies are needed to establish a prediction method for the preclinical and prodromal stages of the disease.

Proactive and Integrated Management and Empowerment in Parkinson's Disease: Designing a New Model of Care

Parkinson's disease is the second most common neurodegenerative condition after Alzheimer's disease. The number of patients will rise dramatically due to ageing of the population and possibly also due to environmental issues. It is widely recognised that the current models of care for people with Parkinson's disease or a form of atypical parkinsonism lack continuity, are reactive to problems rather than proactive, and do not adequately support individuals to self-manage. Integrated models of care have been developed for other chronic conditions, with a range of positive effects. A multidisciplinary team of professionals in the United Kingdom and the Netherlands, all with a long history of caring for patients with movement disorders, used knowledge of deficiencies with the current model of care, an understanding of integrated care in chronic disease and the process of logic modelling, to develop a novel approach to the care of patients with Parkinson's disease. We propose a new model, termed PRIME Parkinson (Proactive and Integrated Management and Empowerment in Parkinson's Disease), which is designed to manage problems proactively, deliver integrated, multidisciplinary care, and empower patients and their carers. It has five main components: (1) personalised care management, (2) education and empowerment of patients and carers, (3) empowerment of healthcare professionals, (4) a population health approach, and (5) support of the previous four components by patient- and professional-friendly technology. Having mapped the processes required for the success of this initiative, there is now a requirement to assess its effect on health-related and quality of life outcomes as well as determining its cost-effectiveness. In the next phase of the project, we will implement PRIME Parkinson in selected areas of the United Kingdom and the Netherlands.

Is It Possible to Conduct a Multi-Arm Multi-Stage Platform Trial in Parkinson's Disease: Lessons Learned from Other Neurodegenerative Disorders and Cancer

Many potential disease modifying therapies have been identified as suitable for clinical evaluation in Parkinson's disease (PD). Currently, the evaluation of compounds in phase II and phase III clinical trials in PD are set up in isolation, a process that is lengthy, costly and lacks efficiency. This review will introduce the concept of a multi-arm, multi-stage (MAMS) trial platform which allows for the assessment of several potential therapies at once, transitioning seamlessly from a phase II safety and efficacy study to a phase III trial by means of an interim analysis. At the interim checkpoint, ineffective arms are dropped and replaced by new treatment arms, thereby allowing for the continuous evaluation of interventions. MAMS trial platforms already exist for prostate, renal and oropharyngeal cancer and are currently being developed for progressive multiple sclerosis (PMS) and motor neuron disease (MND) within the UK. As a MAMS trial will evaluate many potential treatments it is of critical importance that a widely endorsed core protocol is developed which will investigate outcomes and objectives meaningful to patients. This review will discuss the challenges of drug selection, trial design, stratification and outcome measures and will share strategies implemented in the planned MAMS trials for MND and PMS that may be of interest to the PD field.

Phonetic relevance and phonemic grouping of speech in the automatic detection of Parkinson's Disease

Literature documents the impact of Parkinson’s Disease (PD) on speech but no study has analyzed in detail the importance of the distinct phonemic groups for the automatic identification of the disease. This study presents new approaches that are evaluated in three different corpora containing speakers suffering from PD with two main objectives: to investigate the influence of the different phonemic groups in the detection of PD and to propose more accurate detection schemes employing speech. The proposed methodology uses GMM-UBM classifiers combined with a technique introduced in this paper called phonemic grouping, that permits observation of the differences in accuracy depending on the manner of articulation. Cross-validation results reach accuracies between 85% and 94% with AUC ranging from 0.91 to 0.98, while cross-corpora trials yield accuracies between 75% and 82% with AUC between 0.84 and 0.95, depending on the corpus. This is the first work analyzing the generalization properties of the proposed approaches employing cross-corpora trials and reaching high accuracies. Among the different phonemic groups, results suggest that plosives, vowels and fricatives are the most relevant acoustic segments for the detection of PD with the proposed schemes. In addition, the use of text-dependent utterances leads to more consistent and accurate models.

Deep brain stimulation in Parkinson's disease: A multicentric, long-term, observational pilot study

BACKGROUND

The impact of deep brain stimulation (DBS) on cognitive and urinary disorders, falls, and eventually hospitalizations and mortality in Parkinson's disease (PD) is still debated.

OBJECTIVE

We compared the rates of dementia, mild cognitive impairment (MCI), urinary incontinence, nocturia, falls, hospitalizations, and mortality in a cohort of PD patients undergoing DBS with a cohort of medically-treated patients chosen as controls.

METHODS

We conducted a retrospective pilot study in six Italian DBS centers. 91 PD patients receiving DBS and 91 age- and gender-matched controls receiving the best medical treatment alone with a minimum follow-up of one year were enrolled. Clinical data were collected from baseline to the last follow-up visit using an ad-hoc developed web-based system.

RESULTS

The risk of dementia was similar in the two groups while patients in the surgical cohort had lower rates of MCI, urinary incontinence, nocturia, and falls. In contrast, the risk of hospital admissions related to PD was higher in the surgical cohort. However, when excluding hospitalizations related to DBS surgery, the difference between the two cohorts was not significant. The surgical cohort had a lower number of hospitalizations not related to PD. The risk of death was similar in the two groups.

CONCLUSION

Despite a higher risk of hospitalization, patients receiving DBS had a lower rate of MCI, urinary incontinence, nocturia and falls, without evidence of an increased risk of dementia and mortality. Although these findings need to be confirmed in prospective studies, they seem to suggest that DBS may play a significant role in the management of non-motor symptoms and common complications of advanced PD.

Mortality and cause of death in South Korean patients with Parkinson's disease: a longitudinal follow-up study using a national sample cohort

OBJECTIVE

The incidence rate of Parkinson's disease (PD) is growing rapidly owing to the ageing population. We investigated the mortality rates and causes of death in South Korean patients with PD.

DESIGN

We investigated a national cohort using the nationwide insurance database.

SETTING

Korean Health Insurance Review and Assessment Service-National Sample Cohort database.

PARTICIPANTS

We included 3510 participants ≥60 years of age who were diagnosed with PD between 2002 and 2013, as well as 14 040 matched controls.

INTERVENTIONS

None PRIMARY AND SECONDARY OUTCOME MEASURES: A stratified Cox proportional hazards model was used to evaluate patients with PD who were matched 1:4 with non-PD control subjects adjusted for age, sex, income and region of residence. The causes of death were grouped into 12 classifications.

RESULTS

The adjusted HR for mortality in the PD group was 2.09 (95% CI 1.94 to 2.24, p<0.001). Subgroup analysis according to age (<70 years, 70-79 years, and ≥80 years) and sex revealed that patients with PD showed higher adjusted HRs for mortality across all subgroups. Mortalities caused by metabolic, mental, neurologic, circulatory, respiratory, and genitourinary diseases, as well as trauma, were more common in the PD group than in the control group, with the highest OR observed in patients with neurologic disease.

CONCLUSIONS

We demonstrated that PD in South Korean patients ≥60 years of age was associated with increased mortality in both sexes regardless of age.

Treatment Patterns in Patients with Incident Parkinson's Disease in the United States

BACKGROUND

Treatment patterns in Parkinson's disease (PD) have not been extensively studied for nearly two decades. Insurance claims are appropriate for such analysis.

OBJECTIVE

To understand the standard of care use of symptomatic treatments in new cases of PD and factors associated with treatment choice.

METHODS

Retrospective cohort study using claims data from the United States between 2008 and 2016. We used Kaplan-Meier methodology to estimate time to treatment start and switch or add-on therapy and Cox proportional hazards models to identify predictors.

RESULTS

We identified 68,532 patients eligible for treatment pattern analyses. Median time from diagnosis until first treatment was 37 days (95% confidence interval: 36-38). Two distinct patterns of treatment initiation were identified: fast initiators and patients with delayed treatment start (or no recorded treatment). Levodopa therapies were the most commonly prescribed treatment class (52.6%). Increased age was associated with shorter time to start of treatment with levodopa. Younger age was associated with shorter time to initiation of dopamine agonists and other symptomatic treatments. Patients that initiated treatment with levodopa/combinations had the fewest switches/add-ons [30.4%; median time 7.29 (6.71, 8.13) years]. Older patients had fewer switch/add-on therapies, but only in the group that started with levodopa/combination therapy.

CONCLUSIONS

Time from diagnosis to treatment start was relatively short, suggesting that PD diagnosis, as reflected in the database, is closely linked to start of symptomatic treatment. Levodopa treatment remains the most common treatment, especially for older patients. Delayed treatment start was associated with increased age and comorbidity.

Amelioration of the nigrostriatal pathway facilitated by ultrasound-mediated neurotrophic delivery in early Parkinson's disease

The blood-brain barrier (BBB) prevents most drugs from gaining access to the brain parenchyma, which is a recognized impediment to the treatment of neurodegenerative disorders like Parkinson's disease (PD). Focused ultrasound (FUS), in conjunction with systemically administered microbubbles, opens the BBB locally, reversibly and non-invasively. Herein, we show that neither FUS applied over both the striatum and the ventral midbrain, without neurotrophic factors, nor intravenous administration of neurotrophic factors (either through protein or gene delivery) without FUS, ameliorates the damage to the nigrostriatal dopaminergic pathway in the sub-acute MPTP mouse model of early-stage PD. Conversely, the combination of FUS and intravenous neurotrophic (protein or gene) delivery attenuates the damage to the nigrostriatal dopaminergic pathway, by allowing the entry of these agents into the brain parenchyma. Our findings provide evidence that the application of FUS at the early stages of PD facilitates critical neurotrophic delivery that can curb the rapid progression of neurodegeneration while improving the neuronal function, seemingly opening new therapeutic avenues for the early treatment of diseases of the central nervous system.

Is Parkinson's Disease Associated with Increased Mortality, Poorer Outcomes Scores, and Revision Risk After THA? Findings from the Swedish Hip Arthroplasty Register

BACKGROUND

Neurological conditions such as Parkinson's disease are commonly accepted as a risk factor for an increased likelihood of undergoing revision surgery or death after THA. However, the available evidence for an association between Parkinson's disease and serious complications or poorer patient-reported outcomes after THA is limited and contradictory.

QUESTIONS/PURPOSES

(1) Do patients with a preoperative diagnosis of Parkinson's disease have an increased risk of death after elective THA compared with a matched control group of patients? (2) After matching for patient- and surgery-related factors, do revision rates differ between the patients with Parkinson's disease and the matched control group? (3) Are there any differences in patient-reported outcome measures for patients with Parkinson's disease compared with the matched control group?

METHODS

Data were derived from a merged database with information from the Swedish Hip Arthroplasty Register and administrative health databases. We identified all patients with Parkinson's disease who underwent THA for primary osteoarthritis between January 1, 1999 and December 31, 2012 (n = 490 after exclusion criteria applied). A control group was generated through exact one-to-one matching for age, sex, Charlson comorbidity index, surgical approach, and fixation method. Risk of death and revision were compared between the groups using Kaplan-Meier and log-rank testing. Patient-reported outcome measures (PROMs), routinely recorded as EQ-5D, EQ VAS, and pain VAS, were measured at the preoperative visit and at 1-year postoperatively; mean absolute values for PROM scores and change in scores over time were compared between the two groups.

RESULTS

The risk of death did not differ at 90 days (control group risk = 0.61%; 95% CI = 0.00-1.3; Parkinson's disease group risk = 0.62%; 95% CI = 0.00-1.31; p = 0.998) or 1 year (control group = 2.11%; 95% CI = 0.81-3.39; Parkinson's disease group = 2.56%, 95% CI = 1.12-3.97; p = 0.670). At 9 years, the risk of death was increased for patients with Parkinson's disease (control group = 28.05%; 95% CI = 22.29-33.38; Parkinson's disease group = 54.35%; 95% CI = 46.72-60.88; p < 0.001). The risk of revision did not differ at 90 days (control group = 0.41%; 95% CI = 0.00-0.98; Parkinson's disease group = 1.03%; 95% CI = 0.13-1.92; p = 0.256). At 1 year, the risk of revision was higher for patients with Parkinson's disease (control group = 0.41%; 95% CI = 0.00-0.98; Parkinson's disease group = 2.10%; 95% CIs = 0.80-3.38; p = 0.021). This difference was more pronounced at 9 years (control group = 1.75%; 95% CI = 0.11-3.36; Parkinson's disease group = 5.44%; 95% CI = 2.89-7.91; p = 0.001) when using the Kaplan-Meier method. There was no difference between the control and Parkinson's disease groups for level of pain relief at 1 year postoperatively (mean reduction in pain VAS score for control group = 48.85, SD = 20.46; Parkinson's disease group = 47.18, SD = 23.96; p = 0.510). Mean change in scores for quality of life and overall health from preoperative measures to 1 year postoperatively were smaller for patients in the Parkinson's disease group compared with controls (mean change in EQ-5D scores for control group = 0.42, SD = 0.32; Parkinson's disease group = 0.30, SD = 0.37; p 0.003; mean change in EQ VAS scores for control group = 20.94, SD = 23.63; Parkinson's disease = 15.04, SD = 23.00; p = 0.027).

CONCLUSIONS

Parkinson's disease is associated with an increased revision risk but not with short-term mortality rates relevant to assessing risk versus benefit before undergoing THR. The traditional reluctance to perform THR in patients with Parkinson's disease may be too conservative given that the higher long-term risk of death is more likely due to the progressive neurological disorder and not THR itself, and patients with Parkinson's disease report comparable outcomes to controls. Further research on outcomes in THR for patients with other neurological conditions is needed to better address the broader assumptions underlying this traditional teaching.Level of Evidence Level III, therapeutic study.

Estimated Residential Exposure to Agricultural Chemicals and Premature Mortality by Parkinson's Disease in Washington State

The aim of this study was to examine the relationship between estimated residential exposure to agricultural chemical application and premature mortality from Parkinson’s disease (PD) in Washington State. Washington State mortality records for 2011–2015 were geocoded using residential addresses, and classified as having exposure to agricultural land-use within 1000 meters. Generalized linear models were used to explore the association between land-use associated with agricultural chemical application and premature mortality from PD. Individuals exposed to land-use associated with glyphosate had 33% higher odds of premature mortality than those that were not exposed (Odds Ratio (OR) = 1.33, 95% Confidence Intervals (CI) = 1.06–1.67). Exposure to cropland associated with all pesticide application (OR = 1.19, 95% CI = 0.98–1.44) or Paraquat application (OR = 1.22, 95% CI = 0.99–1.51) was not significantly associated with premature mortality from PD, but the effect size was in the hypothesized direction. No significant associations were observed between exposure to Atrazine (OR = 1.21, 95% CI = 0.84–1.74) or Diazinon (OR = 1.07, 95% CI = 0.85–1.34), and premature mortality from PD. The relationship between pesticide exposure and premature mortality aligns with previous biological, toxicological, and epidemiological findings. Glyphosate, the world’s most heavily applied herbicide, and an active ingredient in Roundup^® and Paraquat, a toxic herbicide, has shown to be associated with the odds of premature mortality from PD.

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

BACKGROUND

Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures.

METHODS

A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75-84, 85-90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed.

RESULTS

The age ranges did not show any statistically-significant differences (P<.05; R2=.000-.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011-.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson's disease, aortic stenosis, surgery type, ASA-score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000-.010).

CONCLUSION

Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

The genetic landscape of Parkinson's disease

The cause of Parkinson's disease (PD) remains unknown in most patients. Since 1997, with the first genetic mutation known to cause PD described in SNCA gene, many other genes with Mendelian inheritance have been identified. We summarize genetic, clinical and neuropathological findings related to the 27 genes reported in the literature since 1997, associated either with autosomal dominant (AD): LRRK2, SNCA, VPS35, GCH1, ATXN2, DNAJC13, TMEM230, GIGYF2, HTRA2, RIC3, EIF4G1, UCHL1, CHCHD2, and GBA; or autosomal recessive (AR) inheritance: PRKN, PINK1, DJ1, ATP13A2, PLA2G6, FBXO7, DNAJC6, SYNJ1, SPG11, VPS13C, PODXL, and PTRHD1; or an X-linked transmission: RAB39B. Clinical and neuropathological variability among genes is great. LRRK2 mutation carriers present a phenotype similar to those with idiopathic PD whereas, depending on the SNCA mutations, the phenotype ranges from early onset typical PD to dementia with Lewy bodies, including many other atypical forms. DNAJC6 nonsense mutations lead to a very severe phenotype whereas DNAJC6 missense mutations cause a more typical form. PRKN, PINK1 and DJ1 cases present with typical early onset PD with slow progression, whereas other AR genes present severe atypical Parkinsonism. RAB39B is responsible for a typical phenotype in women and a variable phenotype in men. GBA is a major PD risk factor often associated with dementia. A growing number of reported genes described as causal genes (DNAJC13, TMEM230, GIGYF2, HTRA2, RIC3, EIF4G1, UCHL1, and CHCHD2) are still awaiting replication or indeed have not been replicated, thus raising questions as to their pathogenicity. Phenotypic data collection and next generation sequencing of large numbers of cases and controls are needed to differentiate pathogenic dominant mutations with incomplete penetrance from rare, non-pathogenic variants. Although known genes cause a minority of PD cases, their identification will lead to a better understanding their pathological mechanisms, and may contribute to patient care, genetic counselling, prognosis determination and finding new therapeutic targets.

An early diagnosis is not the same as a timely diagnosis of Parkinson's disease

Parkinson’s disease is a common neurodegenerative condition that has significant costs to the individual patient and to society. The pathology starts up to a decade before symptoms are severe enough to allow a diagnosis using current criteria. Although the search for disease-modifying treatment continues, it is vital to understand what the right time is for diagnosis. Diagnosis of Parkinson’s disease is based on the classic clinical criteria, but the presence of other clinical features and disease biomarkers may allow earlier diagnosis, at least in a research setting. In this review, we identify the benefits of an early diagnosis, including before the classic clinical features occur. However, picking the right point for a “timely” diagnosis will vary depending on the preferences of the individual patient, efficacy (or existence) of disease-modifying treatment, and the ability for health systems to provide support and management for individuals at every stage of the disease. Good evidence for the quality-of-life benefits of existing symptomatic treatment supports the argument for earlier diagnosis at a time when symptoms are already present. This argument would be significantly bolstered by the development of disease-modifying treatments. Benefits of early diagnosis and treatment would affect not only the individual (and their families) but also the wider society and the research community. Ultimately, however, shared decision-making and the principles of autonomy, beneficence, and non-maleficence will need to be applied on an individual basis when considering a “timely” diagnosis.

Region-Based Analysis of Prevalence and Incidence of Parkinson's Disease: Analysis of the National Sample Cohort in South Korea

Background and Purpose

The rapid increases in the elderly population and urbanization in South Korea have influenced both demographics and the environment. This study investigated trends in the prevalence and incidence of Parkinson's disease (PD), and the associations of PD with the urban and rural environments in South Korea.

Methods

This study examined subjects aged 40 years or older in a cohort constructed using the National Sample Cohort data set in South Korea during 2002–2013. We estimated the age-standardized prevalence and incidence of PD based on the 2002 population, and estimated their trends. We analyzed regional differences in these rates by dividing South Korea into three regions based on geographic characteristics and two regions based on the degree of urbanization.

Results

The standardized prevalence rates of PD per 100,000 increased significantly from 75.8 in 2003 to 136.8 in 2012 (p<0.0001), especially in older subjects. The standardized prevalence of PD was highest in metropolitan Seoul. The standardized incidence of PD per 100,000 was 13.9 in 2003 and 10.3 in 2012, with no significant trend (p>0.05). The standardized incidence of PD in younger subjects was lower in eastern Korea than in the other two regions, while in the older subjects it was lower in western Korea than in metropolitan Seoul over almost the entire analyzed period. The standardized incidence of PD did not differ significantly between metropolitan and nonmetropolitan areas.

Conclusions

The standardized prevalence of PD increased steadily from 2003 to 2012 in South Korea, while its standardized incidence has remained constant. There were regional differences in the prevalence and incidence of PD based on the degree of urbanization and the area of agricultural land.

Outcomes of Primary Total Knee Arthroplasty in Patients With Parkinson's Disease

BACKGROUND

Parkinson's disease is a degenerative disorder causing rigidity, bradykinesia, and tremor of the motor system. There is significant paucity of evidence regarding whether total knee arthroplasty (TKA) is of benefit in patients with both Parkinson's disease and osteoarthritis. We aimed to compare outcomes and complications of TKA between patients with Parkinson's disease and those without.

METHODS

A cohort of 43 knees from 35 patients with Parkinson's disease who received a primary TKA between January 2004 and December 2015 were retrospectively extracted from a private clinical database held by 2 surgeons and compared to an age and gender-matched control group of 50 knees from 41 patients. TKAs were performed by 2 surgeons at 1 tertiary private hospital.The indication for TKA in both groups was osteoarthritis. Difference between preoperative and 1-year range of movement (ROM) and 12-point Oxford Knee Score (OKS) was assessed using Student's unpaired t-test. Postoperative complications and revision procedures were also recorded during the follow-up period. The minimal clinically important difference for OKS at 1-year follow-up, defined as improvement of ≥6, was also assessed.

RESULTS

In the Parkinson's group, mean ROM improvement was 14° (100° preoperatively to 114° at 12 months), compared to 12° in the control group (102°-114°, respectively). Mean OKS improvement was 15 in the Parkinson's group (23 preoperatively to 38 at 12 months) compared to 17 in the control group (23 and 40, respectively.) No significant difference was identified between the 2 groups for either ROM (P = .96) or OKS (P = .45.) All Parkinson's patients achieved the minimal clinically important difference at 1-year follow-up. There were no mortalities during the study follow-up period and no significant difference in complication rates between the 2 groups (P = .41).

CONCLUSION

Parkinson's disease was not associated with poorer functional outcomes or increased complications compared to controls in our study. We suggest that Parkinson's disease is not an absolute contraindication to TKA.

Costs of informal nursing care for patients with neurologic disorders: A systematic review

OBJECTIVE

To systematically review the economic burden of informal nursing care (INC), often called informal care, caused by multiple sclerosis (MS), Parkinson disease (PD), and epilepsy, with special attention to disease severity.

METHODS

We systematically searched MEDLINE, PsycINFO, and NHS Economic Evaluation Database for articles on the cost of illness of the diseases specified. Title, abstract, and full-text review were conducted in duplicate by 2 researchers. The distribution of hours and costs of INC were extracted and used to compare the relevance of INC across included diseases and disease severity.

RESULTS

Seventy-one studies were included (44 on MS, 17 on PD, and 10 on epilepsy). Studies on epilepsy reported an average of 2.3-54.5 monthly hours of INC per patient. For PD, average values of 42.9-145.9 hours and for MS average values of 9.2-249 hours per patient per month were found. In line with utilized hours, costs of INC were lowest for epilepsy (interquartile range [IQR] 229-1,466 purchasing power parity US dollars [PPP-USD]) and similar for MS (IQR 4,454-11,222 PPP-USD) and PD (IQR 1,440-7,117 PPP-USD). In addition, costs of INC increased with disease severity and accounted for 38% of total health care costs in severe MS stages on average.

CONCLUSIONS

The course of diseases and disease severity matter for the amount of INC used by patients. For each of the neurologic disorders, an increase in the costs of INC, due to increasing disease severity, considerably contributes to the rise in total health care costs.

Current understanding of the molecular mechanisms in Parkinson's disease: Targets for potential treatments

Gradual degeneration and loss of dopaminergic neurons in the substantia nigra, pars compacta and subsequent reduction of dopamine levels in striatum are associated with motor deficits that characterize Parkinson’s disease (PD). In addition, half of the PD patients also exhibit frontostriatal-mediated executive dysfunction, including deficits in attention, short-term working memory, speed of mental processing, and impulsivity. The most commonly used treatments for PD are only partially or transiently effective and are available or applicable to a minority of patients. Because, these therapies neither restore the lost or degenerated dopaminergic neurons, nor prevent or delay the disease progression, the need for more effective therapeutics is critical. In this review, we provide a comprehensive overview of the current understanding of the molecular signaling pathways involved in PD, particularly within the context of how genetic and environmental factors contribute to the initiation and progression of this disease. The involvement of molecular chaperones, autophagy-lysosomal pathways, and proteasome systems in PD are also highlighted. In addition, emerging therapies, including pharmacological manipulations, surgical procedures, stem cell transplantation, gene therapy, as well as complementary, supportive and rehabilitation therapies to prevent or delay the progression of this complex disease are reviewed.

Recent developments in circulating biomarkers in Parkinson’s disease: the potential use of miRNAs in a clinical setting

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, affecting 5% of the elderly population. PD diagnosis is still based on the identification of neuromotor symptoms although nonmotor manifestations emerge years prior to diagnosis. The discovery of biomarkers at the earliest stages of PD is of extreme interest. miRNAs have been considered potential biomarkers for neurodegenerative diseases, but only a limited number have been found to be PD related. This review focuses on the current findings in the field of circulating miRNAs in PD and the challenges surrounding clinical utility and validation. We briefly describe the more established circulating biomarkers in PD and provide a more thorough review of miRNAs differentially expressed in PD. We highlight their potential for being considered as biomarkers for diagnosis while emphasizing the challenges for adequate validation of the findings and how miRNAs can be envisioned in a clinical setting satisfying regulatory bodies.