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Tamir-Ostrover H, Hassin-Baer S, Fay-Karmon T, Friedman J. Quantifying Changes in Dexterity as a Result of Piano Training in People with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2024; 24:3318. [PMID: 38894110 PMCID: PMC11174779 DOI: 10.3390/s24113318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
People with Parkinson's disease often show deficits in dexterity, which, in turn, can lead to limitations in performing activities of daily life. Previous studies have suggested that training in playing the piano may improve or prevent a decline in dexterity in this population. In this pilot study, we tested three participants on a six-week, custom, piano-based training protocol, and quantified dexterity before and after the intervention using a sensor-enabled version of the nine-hole peg test, the box and block test, a test of finger synergies using unidimensional force sensors, and the Quantitative Digitography test using a digital piano, as well as selected relevant items from the motor parts of the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39) quality of life questionnaire. The participants showed improved dexterity following the training program in several of the measures used. This pilot study proposes measures that can track changes in dexterity as a result of practice in people with Parkinson's disease and describes a potential protocol that needs to be tested in a larger cohort.
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Affiliation(s)
- Hila Tamir-Ostrover
- Department of Physical Therapy, Faculty of Medical & Health Sciences, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Sharon Hassin-Baer
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 5262000, Israel; (S.H.-B.); (T.F.-K.)
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tsvia Fay-Karmon
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 5262000, Israel; (S.H.-B.); (T.F.-K.)
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jason Friedman
- Department of Physical Therapy, Faculty of Medical & Health Sciences, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
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Doskas T, Vadikolias K, Ntoskas K, Vavougios GD, Tsiptsios D, Stamati P, Liampas I, Siokas V, Messinis L, Nasios G, Dardiotis E. Neurocognitive Impairment and Social Cognition in Parkinson's Disease Patients. Neurol Int 2024; 16:432-449. [PMID: 38668129 PMCID: PMC11054167 DOI: 10.3390/neurolint16020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
In addition to motor symptoms, neurocognitive impairment (NCI) affects patients with prodromal Parkinson's disease (PD). NCI in PD ranges from subjective cognitive complaints to dementia. The purpose of this review is to present the available evidence of NCI in PD and highlight the heterogeneity of NCI phenotypes as well as the range of factors that contribute to NCI onset and progression. A review of publications related to NCI in PD up to March 2023 was performed using PubMed/Medline. There is an interconnection between the neurocognitive and motor symptoms of the disease, suggesting a common underlying pathophysiology as well as an interconnection between NCI and non-motor symptoms, such as mood disorders, which may contribute to confounding NCI. Motor and non-motor symptom evaluation could be used prognostically for NCI onset and progression in combination with imaging, laboratory, and genetic data. Additionally, the implications of NCI on the social cognition of afflicted patients warrant its prompt management. The etiology of NCI onset and its progression in PD is multifactorial and its effects are equally grave as the motor effects. This review highlights the importance of the prompt identification of subjective cognitive complaints in PD patients and NCI management.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Konstantinos Vadikolias
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | | | - George D. Vavougios
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, Faculty of Medicine, University of Cyprus, 1678 Lefkosia, Cyprus
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece
| | - Dimitrios Tsiptsios
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Polyxeni Stamati
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Vasileios Siokas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Lambros Messinis
- School of Psychology, Laboratory of Neuropsychology and Behavioural Neuroscience, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
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Novakova L, Gajdos M, Markova J, Martinkovicova A, Kosutzka Z, Svantnerova J, Valkovic P, Csefalvay Z, Rektorova I. Language impairment in Parkinson’s disease: fMRI study of sentence reading comprehension. Front Aging Neurosci 2023; 15:1117473. [PMID: 36967818 PMCID: PMC10033839 DOI: 10.3389/fnagi.2023.1117473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Parkinson’s disease (PD) affects the language processes, with a significant impact on the patients’ daily communication. We aimed to describe specific alterations in the comprehension of syntactically complex sentences in patients with PD (PwPD) as compared to healthy controls (HC) and to identify the neural underpinnings of these deficits using a functional connectivity analysis of the striatum. A total of 20 patients PwPD and 15 HC participated in the fMRI study. We analyzed their performance of a Test of sentence comprehension (ToSC) adjusted for fMRI. A task-dependent functional connectivity analysis of the striatum was conducted using the psychophysiological interaction method (PPI). On the behavioral level, the PwPD scored significantly lower (mean ± sd: 77.3 ± 12.6) in the total ToSC score than the HC did (mean ± sd: 86.6 ± 8.0), p = 0.02, and the difference was also significant specifically for sentences with a non-canonical word order (PD-mean ± sd: 69.9 ± 14.1, HC-mean ± sd: 80.2 ± 11.5, p = 0.04). Using PPI, we found a statistically significant difference between the PwPD and the HC in connectivity from the right striatum to the supplementary motor area [SMA, (4 8 53)] for non-canonical sentences. This PPI connectivity was negatively correlated with the ToSC accuracy of non-canonical sentences in the PwPD. Our results showed disturbed sentence reading comprehension in the PwPD with altered task-dependent functional connectivity from the right striatum to the SMA, which supports the synchronization of the temporal and sequential aspects of language processing. The study revealed that subcortical-cortical networks (striatal-frontal loop) in PwPD are compromised, leading to impaired comprehension of syntactically complex sentences.
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Affiliation(s)
- Lubomira Novakova
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Martin Gajdos
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Jana Markova
- Department of Communication Disorders, Faculty of Education, Comenius University, Bratislava, Slovakia
| | - Alice Martinkovicova
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Kosutzka
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jana Svantnerova
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Valkovic
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zsolt Csefalvay
- Department of Communication Disorders, Faculty of Education, Comenius University, Bratislava, Slovakia
| | - Irena Rektorova
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czechia
- *Correspondence: Irena Rektorova,
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Pintér D, Járdaházi E, Balás I, Harmat M, Makó T, Juhász A, Janszky J, Kovács N. Antiparkinsonian Drug Reduction After Directional Versus Omnidirectional Bilateral Subthalamic Deep Brain Stimulation. Neuromodulation 2023; 26:374-381. [PMID: 35190245 DOI: 10.1016/j.neurom.2022.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several pilot trials and the Clinical Evaluation of the Infinity Deep Brain Stimulation System (PROGRESS) study have found that directional stimulation can provide a wider therapeutic window and lower therapeutic current strength than omnidirectional stimulation. OBJECTIVE We conducted a single-center, open-label, registry-based, comparative trial to test the hypothesis that directional stimulation can be associated with a greater reduction in the total daily dose of antiparkinsonian medications (ApMeds) than omnidirectional stimulation. MATERIALS AND METHODS A total of 52 patients with directional and 57 subjects with omnidirectional bilateral subthalamic deep brain stimulation (STN-DBS) were enrolled. Preoperatively and 12 months postoperatively, the dose of different ApMeds, the number of tablets used daily, the severity of motor and nonmotor symptoms using the Movement Disorder Society-sponsored Unified Parkinson Disease Rating Scale, and the health-related quality of life (HRQoL) using the 39-item Parkinson's Disease Questionnaire (PDQ-39) were assessed. RESULTS According to the changes in the levodopa equivalent daily dose, directional STN-DBS led to a 13% greater reduction in the total daily dose of ApMed. The 10.3% greater reduction in the dose of levodopa was the main contributor to this difference. The number of different ApMed types also could be decreased in a greater manner with directional stimulation. The improvement in the severity of motor and nonmotor symptoms was comparable; however, we detected a 15.8% greater improvement in the global HRQoL among patients with directional stimulation according to the changes in the summary index of the PDQ-39. The total electrical energy delivered per second was comparable between the groups at 12-month postoperative visit, whereas the amplitude of stimulation was significantly lower and the impedance was significantly higher with directional leads. CONCLUSIONS Directional programming can further increase the reduction in the total daily dose of ApMed after STN-DBS. In addition, directional stimulation can have additional beneficial effects on the global HRQoL. The greater reduction of ApMed doses did not require more energy-consuming stimulation with directional stimulation.
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Affiliation(s)
- Dávid Pintér
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.
| | - Evelyn Járdaházi
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - István Balás
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Márk Harmat
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Makó
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Annamária Juhász
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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Sousa NMF, Brucki SMD. Addenbrooke's cognitive examination III: diagnostic utility for detecting mild cognitive impairment and dementia in Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:155-163. [PMID: 36863401 PMCID: PMC10033197 DOI: 10.1055/s-0042-1758448] [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] [Received: 03/22/2022] [Accepted: 07/04/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Cognitive deficit in Parkinson disease (PD) is an important cause of functional disability in these patients and early detection, with sensitive instruments, can contribute to longitudinal monitoring. OBJECTIVE To investigate the diagnostic accuracy, sensitivity, and specificity of the Addenbrooke's Cognitive Examination-III in patients with PD, using the comprehensive neuropsychological battery as reference method. METHODS Cross-sectional, observational, case-control study. SETTING rehabilitation service. A total of 150 patients and 60 healthy controls matched for age, sex, and education. For level I assessment, Addenbrooke Cognitive Examination (ACE-III) was used. Level II assessment used a comprehensive neuropsychological battery of standardized tests for this population. All patients remained in on-state during the study. The diagnostic accuracy of the battery was investigated through the receiver operating characteristic (ROC) analysis. RESULTS The clinical group was divided into 3 subgroups: normal cognition in Parkinson's disease (NC-PD-16%), mild cognitive impairment due to Parkinson's disease (MCI-PD-69.33%), and dementia due to Parkinson's disease (D-PD-14.66%). ACE-III optimal cutoff scores for detecting MCI-PD and D-PD were 85/100 (sensitivity 58.65%, specificity 60%) and 81/100 points (sensitivity 77.27%, specificity 78.33%), respectively. Age was inversely associated with the performance of the scores (totals and domains of the ACE-III), while the level of education had a significantly positive correlation in the performance of these scores. CONCLUSIONS ACE-III is a useful battery for assessing the cognitive domains and to differentiate individuals with MCI-PD and D-PD from healthy controls. Future research, in a community setting, is necessary to provide discriminatory capacity of ACE-III in the different severities of dementia.
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Affiliation(s)
- Nariana Mattos Figueiredo Sousa
- Rede SARAH de Hospitais de Reabilitação, Programa Reabilitação Neurológica, Salvador BA, Brazil.
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
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Statucka M, Cherian K, Fasano A, Munhoz RP, Cohn M. Multiculturalism: A Challenge for Cognitive Screeners in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:733-742. [PMID: 34307746 PMCID: PMC8287166 DOI: 10.1002/mdc3.13240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) and the Dementia Rating Scale-2 (DRS-2) are recommended screeners for Parkinson's disease mild cognitive impairment (PD-MCI). Cross-cultural studies examining their diagnostic precision have not addressed cultural bias in a multicultural setting. OBJECTIVES To compare DRS-2 and MoCA performance between patients born in Canada, the USA, and the UK (Anglosphere group) and immigrant patients born elsewhere (International group). To identify sources of cultural bias by comparing group characteristics, and by assessing the relationships between performance and immigration and socio-development variables. To examine the diagnostic precision of both tools in detecting PD-MCI in each group. METHODS We conducted a clinical chart review of advanced PD patients who completed cognitive screeners (MoCA: n = 288, 30% International group; DRS-2: n = 426, 31% International group). All completed a comprehensive neuropsychological assessment to apply Level II PD-MCI diagnostic criteria. RESULTS The International group performed worse than the Anglosphere group on the MoCA and DRS-2, and the only variable that accounted for some of the group difference was the Historical Index of Human Development, a societal variable, which fully mediated the group effect on the DRS-2. Diagnostic precision of the MoCA was at chance level in the International group, and was poorer than that of the DRS-II in this group and that of the MoCA in the Anglosphere group, although these were considered poor. CONCLUSIONS Our results support the recommendation to exert caution in using cognitive screeners to capture PD-MCI in all patients and particularly with first generation immigrants.
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Affiliation(s)
- Marta Statucka
- Krembil Brain InstituteToronto Western Hospital UHNTorontoOntarioCanada
| | - Kirsten Cherian
- Baycrest, Neuropsychology & Cognitive HealthTorontoOntarioCanada
- Palo Alto UniversityPalo AltoCaliforniaUSA
| | - Alfonso Fasano
- Krembil Brain InstituteToronto Western Hospital UHNTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Renato P. Munhoz
- Krembil Brain InstituteToronto Western Hospital UHNTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Melanie Cohn
- Krembil Brain InstituteToronto Western Hospital UHNTorontoOntarioCanada
- Psychology DepartmentUniversity of TorontoOntarioCanada
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Cai M, Dang G, Su X, Zhu L, Shi X, Che S, Lan X, Luo X, Guo Y. Identifying Mild Cognitive Impairment in Parkinson's Disease With Electroencephalogram Functional Connectivity. Front Aging Neurosci 2021; 13:701499. [PMID: 34276350 PMCID: PMC8281812 DOI: 10.3389/fnagi.2021.701499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Cognitive impairment occurs frequently in Parkinson’s disease (PD) and negatively impacts the patient’s quality of life. However, its pathophysiological mechanism remains unclear, hindering the development of new therapies. Changes in brain connectivity are related to cognitive impairment in patients with PD, with the dorsolateral prefrontal cortex (DLPFC) being considered the essential region related to PD cognitive impairment. Nevertheless, few studies have focused on the global connectivity responsible for communication with the DLPFC node, the posterior division of the middle frontal gyrus (PMFG) in patients with PD; this was the focus of this study. Methods We applied resting-state electroencephalography (EEG) and calculated a reliable functional connectivity measurement, the debiased weighted phase lag index (dWPLI), to examine inter-regional functional connectivity in 68 patients with PD who were classified into two groups according to their cognitive condition. Results We observed that altered left and right PMFG-based functional connectivity associated with cognitive impairment in patients with PD in the theta frequency bands under the eyes closed condition (r = −0.426, p < 0.001 and r = −0.437, p < 0.001, respectively). Exploratory results based on the MoCA subdomains indicated that poorer visuospatial function was associated with higher right PMFG-based functional connectivity (r = −0.335, p = 0.005), and poorer attention function was associated with higher left and right PMFG-based functional connectivity (r = −0.380, p = 0.001 and r = −0.256, p = 0.035, respectively). Further analysis using logistic regression and receiver operating characteristic (ROC) curves found that this abnormal functional connectivity was an independent risk factor for cognitive impairment [odds ratio (OR): 2.949, 95% confidence interval (CI): 1.294–6.725, p = 0.01 for left PMFG; OR: 11.278, 95% CI: 2.578–49.335, p = 0.001 for right PMFG, per 0.1 U], and provided moderate classification power to discriminate between cognitive abilities in patients with PD [area under the ROC curve (AUC) = 0.770 for left PMFG; AUC = 0.809 for right PMFG]. Conclusion These preliminary findings indicate that abnormal PMFG-based functional connectivity patterns associated with cognitive impairment in the theta frequency bands under the eyes closed condition and altered functional connectivity patterns have the potential to act as reliable biomarkers for identifying cognitive impairment in patients with PD.
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Affiliation(s)
- Min Cai
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ge Dang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Lin Zhu
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xue Shi
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Sixuan Che
- Department of Medical, The Fourth People's Hospital of Chengdu, Chengdu, China.,MOE Key Lab for Neuroinformation, Chengdu Mental Health Center, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoyong Lan
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xiaoguang Luo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Shenzhen Bay Laboratory, Gladstone Institute of Neurological Disease, Shenzhen, Guangdong, China
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Validation of the German Version of the New Freezing of Gait Questionnaire for People with Parkinson's Disease. PARKINSON'S DISEASE 2021; 2021:8841679. [PMID: 33520154 PMCID: PMC7817316 DOI: 10.1155/2021/8841679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 01/10/2023]
Abstract
Freezing of gait (FOG) in Parkinson's disease (PD) is a highly disabling symptom which impacts quality of life. The New FOG Questionnaire (NFOG-Q) is the most commonly used tool worldwide to characterize FOG severity in PD. This study aims to provide a German translation of the NFOG-Q and to assess its validity in people with PD. The questionnaire was translated using forward-backward translation. Validity was tested in 57 PD patients with FOG via Cronbach's alpha for internal consistency and Spearman correlations with several clinical measures to quantify disease severity, mobility, fall risk, and cognitive state for convergent and divergent validity. The German version of the NFOG-Q shows good internal consistency (Cα = 0.84). Furthermore, the NFOG-Q score was significantly correlated with the MDS-UPDRS III, H&Y stage, Timed Up and Go test, and the subjective fear of falling (FES-I). The lack of correlation with cognition (MoCA) points towards good divergent validity. This study provides a German version of the NFOG-Q which proved to be valid for the assessment of FOG severity in individuals with PD.
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The Impact of Trimetazidine on Disease Severity and Quality of Life in Parkinson's Disease. Sci Rep 2020; 10:10050. [PMID: 32572075 PMCID: PMC7308301 DOI: 10.1038/s41598-020-66692-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/06/2020] [Indexed: 11/08/2022] Open
Abstract
Trimetazidine is contraindicated in movement disorders, however, a not negligible part of trimetazidine users is still patients with Parkinson’s disease (PD). The present study aimed to objectively determine the impact of trimetazidine on the severity of symptoms and the health-related quality of life of patients with PD by measuring changes after its withdrawal. A consecutive series of 42 patients with PD using trimetazidine underwent detailed neurological and neuropsychological assessments at baseline and three months after the discontinuation of trimetazidine. Clinically relevant improvements were achieved with discontinuation of trimetazidine according to changes in scores of each part of the Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (Part I: −25.7%, p < 0.001; Part II: −23.8%, p < 0.001; Part III: −28.5%, p < 0.001; Part IV: −30.1%, p = 0.004) and total scores of the Non-Motor Symptoms Scale (−25.6%, p = 0.004) and the Montgomery-Asberg-Depression Rating Scale (−20.1%, p = 0.001). Benefits resulting from the withdrawal of the drug also manifested in the improvement of the health-related quality of life based on changes in the summary index of the 39-item Parkinson’s Disease Questionnaire (−18.2%, p = 0.031). Our results provide clinical rationale for strictly avoiding the use of trimetazidine in PD. Discontinuation of trimetazidin results in clinically relevant improvements in Parkinsonian symptoms.
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Pintér D, Janszky J, Kovács N. Minimal Clinically Important Differences for
Burke‐Fahn‐Marsden
Dystonia Rating Scale and
36‐Item Short‐Form
Health Survey. Mov Disord 2020; 35:1218-1223. [DOI: 10.1002/mds.28057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Dávid Pintér
- Department of Neurology, Medical SchoolUniversity of Pécs Pécs Hungary
| | - József Janszky
- Department of Neurology, Medical SchoolUniversity of Pécs Pécs Hungary
- MTA‐PTE Clinical Neuroscience MR Research Group Pécs Hungary
| | - Norbert Kovács
- Department of Neurology, Medical SchoolUniversity of Pécs Pécs Hungary
- MTA‐PTE Clinical Neuroscience MR Research Group Pécs Hungary
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Scheffels JF, Fröhlich L, Kalbe E, Kessler J. Concordance of Mini-Mental State Examination, Montreal Cognitive Assessment and Parkinson Neuropsychometric Dementia Assessment in the classification of cognitive performance in Parkinson's disease. J Neurol Sci 2020; 412:116735. [DOI: 10.1016/j.jns.2020.116735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
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Yu RL, Lee WJ, Li JY, Chang YY, Chen CC, Lin JJ, Sung YF, Lin TK, Fuh JL. Evaluating Mild Cognitive Dysfunction in Patients with Parkinson's Disease in Clinical Practice in Taiwan. Sci Rep 2020; 10:1014. [PMID: 31974411 PMCID: PMC6978523 DOI: 10.1038/s41598-020-58042-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/26/2019] [Indexed: 11/09/2022] Open
Abstract
Our study aimed to examine the contribution of commonly used tools, including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), and develop a formula for conversion of these tests in the Chinese population. We also create a predictive model for the detection of Chinese patients' mild cognitive impairment (MCI). We recruited 168 patients with Parkinson's disease (PD) from 12 medical centres or teaching hospitals in Taiwan, and each participant received a comprehensive neuropsychological assessment. Logistic regression analysis was conducted to find predictors of MCI with the help of a generalized additive model. We found that patients with an MMSE > 25 or a MoCA > 21 were less likely to have MCI. The discrimination powers of the two tests used for detecting MCI were 0.902 and 0.868, respectively, as measured by the area under the receiver operating characteristic curve (ROC). The best predictive model suggested that patients with a higher MMSE score, delayed recall scores of the 12-item Word Recall Test ≥ 5.817, and no test decline in the visuospatial index were less likely to have MCI (ROC = 0.982). Our findings have clinical utility in MCI detection in Chinese PD and need a larger sample to confirm.
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Affiliation(s)
- Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ju Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
| | - Jie-Yuan Li
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chin-Chung Chen
- Department of Neurology, Shung Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Juei-Jueng Lin
- Department of Neurology, Chushang Show-Chwan Hospital, Nantou, Taiwan.,Department of Neurology, Chung-Shan University Hospital, Taichung, Taiwan
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsu-Kung Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan. .,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
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13
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Pintér D, Forjaz MJ, Martinez-Martin P, Rodriguez-Blazquez C, Ayala A, Juhász A, Harmat M, Janszky J, Kovács N. Which Scale Best Detects Treatment Response of Tremor in Parkinsonism? JOURNAL OF PARKINSONS DISEASE 2019; 10:275-282. [PMID: 31868685 DOI: 10.3233/jpd-191800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several scales are available for rating the severity of tremor at present. However, the sensitivity to change of these instruments has remained to be clarified. OBJECTIVE To compare the sensitivity of the Fahn-Tolosa-Marin Tremor Rating Scale, the Part III of the Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the MDS-UPDRS Tremor Scale to the effects of various antitremor treatments. METHODS Enrolling subjects with parkinsonism associated with tremor, we analyzed two scenarios: (1) tremor changes associated with acute levodopa challenge (n = 287) and (2) a 12-month outcome of different treatment options (n = 512) including deep brain stimulation (n = 146), levodopa/carbidopa intestinal gel infusion (n = 30), and initiating (n = 63) or adjusting oral antiparkinsonian medication (n = 273). Changes in tremor scales were assessed by effect size values (Cohen's d and eta-square). RESULTS Part B of the Fahn-Tolosa-Marin Tremor Rating Scale was the most sensitive to acute levodopa challenge (Cohen's d = -1.04, η2 = 0.12). However, Part A of the Fahn-Tolosa-Marin Tremor Rating Scale showed the highest effect size, which was a small one (Cohen's d = -0.33, η2 = 0.03), for detecting a treatment-related change in the severity of tremor during long-term follow-up. CONCLUSIONS The Fahn-Tolosa-Marin Tremor Rating Scale has a better ability to capture changes due to levodopa challenge or antiparkinsonian treatment than MDS-UPDRS Part III or MDS-UPDRS Tremor Scale.
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Affiliation(s)
- Dávid Pintér
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Neurosciences, University of Pécs, Pécs, Hungary
| | - Maria João Forjaz
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Spain
| | | | | | - Alba Ayala
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Spain
| | - Annamária Juhász
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Neurosciences, University of Pécs, Pécs, Hungary
| | - Márk Harmat
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Neurosciences, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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14
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Rodriguez-Sabate C, Morales I, Puertas-Avendaño R, Rodriguez M. The dynamic of basal ganglia activity with a multiple covariance method: influences of Parkinson's disease. Brain Commun 2019; 2:fcz044. [PMID: 32954313 PMCID: PMC7425309 DOI: 10.1093/braincomms/fcz044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/31/2019] [Accepted: 11/17/2019] [Indexed: 11/26/2022] Open
Abstract
The closed-loop cortico-subcortical pathways of basal ganglia have been extensively used to describe the physiology of these centres and to justify the functional disorders of basal ganglia diseases. This approach justifies some experimental and clinical data but not others, and furthermore, it does not include a number of subcortical circuits that may produce a more complex basal ganglia dynamic than that expected for closed-loop linear networks. This work studied the functional connectivity of the main regions of the basal ganglia motor circuit with magnetic resonance imaging and a new method (functional profile method), which can analyse the multiple covariant activity of human basal ganglia. The functional profile method identified the most frequent covariant functional status (profiles) of the basal ganglia motor circuit, ordering them according to their relative frequency and identifying the most frequent successions between profiles (profile transitions). The functional profile method classified profiles as input profiles that accept the information coming from other networks, output profiles involved in the output of processed information to other networks and highly interconnected internal profiles that accept transitions from input profiles and send transitions to output profiles. Profile transitions showed a previously unobserved functional dynamic of human basal ganglia, suggesting that the basal ganglia motor circuit may work as a dynamic multiple covariance network. The number of internal profiles and internal transitions showed a striking decrease in patients with Parkinson’s disease, a fact not observed for input and output profiles. This suggests that basal ganglia of patients with Parkinson’s disease respond to requirements coming from other neuronal networks, but because the internal processing of information is drastically weakened, its response will be insufficient and perhaps also self-defeating. These marked effects were found in patients with few motor disorders, suggesting that the functional profile method may be an early procedure to detect the first stages of the Parkinson’s disease when the motor disorders are not very evident. The multiple covariance activity found presents a complementary point of view to the cortico-subcortical closed-loop model of basal ganglia. The functional profile method may be easily applied to other brain networks, and it may provide additional explanations for the clinical manifestations of other basal ganglia disorders.
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Affiliation(s)
- Clara Rodriguez-Sabate
- Laboratory of Neurobiology and Experimental Neurology, Department of Physiology, Faculty of Medicine, University of La Laguna, Tenerife, Canary Islands 28907, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid 28031, Spain.,Department of Psychiatry, Getafe University Hospital, Madrid 28031, Spain
| | - Ingrid Morales
- Laboratory of Neurobiology and Experimental Neurology, Department of Physiology, Faculty of Medicine, University of La Laguna, Tenerife, Canary Islands 28907, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid 28031, Spain
| | - Ricardo Puertas-Avendaño
- Laboratory of Neurobiology and Experimental Neurology, Department of Physiology, Faculty of Medicine, University of La Laguna, Tenerife, Canary Islands 28907, Spain
| | - Manuel Rodriguez
- Laboratory of Neurobiology and Experimental Neurology, Department of Physiology, Faculty of Medicine, University of La Laguna, Tenerife, Canary Islands 28907, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid 28031, Spain
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15
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Prediction of cognitive progression in Parkinson's disease using three cognitive screening measures. Clin Park Relat Disord 2019; 1:91-97. [PMID: 32368733 PMCID: PMC7197868 DOI: 10.1016/j.prdoa.2019.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Cognitive impairment is a common complication of Parkinson's disease (PD) and identifying risk factors for progression to Parkinson's disease dementia (PDD) is important. However, little research has been done comparing the utility of commonly used cognitive screening tests in predicting cognitive progression in PD. Methods We retrospectively reviewed data from patients with PD enrolled in the Pacific Udall Center who had baseline and longitudinal neuropsychological and global cognitive screening tests. The diagnostic accuracies of 3 common screening tests were compared: Montreal Cognitive Assessment (MoCA), Mattis Dementia Rating Scale (DRS-2), and Mini Mental Status Examination (MMSE). Cognitive diagnoses of PD with mild cognitive impairment (PD-MCI) and PDD were based on full neuropsychological testing and established Movement Disorder Society criteria. Logistic regression and Cox proportional hazards regression models were used to examine predictors of cognitive decline. Results Four hundred seventy patients for whom scores on all 3 screening tests were available from the same assessment were included in a cross-sectional analysis. The MoCA demonstrated the best overall diagnostic accuracy for PD-MCI (AUC = 0.79, sensitivity = 76.4%) and for PDD (AUC = 0.89, sensitivity = 81.0%) compared to the DRS-2 and MMSE. A longitudinal analysis was performed on the subset of patients (316/470; 67.2%) who were nondemented at baseline and had undergone two or more assessments. After controlling for covariates, the MoCA was the only test associated with progression to PDD (OR = 1.27 95% CI 1.1–1.5, p = 0.001) and faster time to dementia (HR = 1.3, 95% CI 1.1–1.4, p < 0.0001). Conclusions This study provides additional support for the use of the MoCA as a primary screening tool for cognitive impairment in PD and is the first to show that the MoCA is a predictor of conversion to PDD.
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16
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The Parkinson's Disease Composite Scale Is Adequately Responsive to Acute Levodopa Challenge. PARKINSONS DISEASE 2019; 2019:1412984. [PMID: 31583072 PMCID: PMC6754945 DOI: 10.1155/2019/1412984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/29/2019] [Indexed: 01/10/2023]
Abstract
Background The Parkinson's Disease Composite Scale (PDCS) is a recently developed easy-to-use tool enabling a timely but comprehensive assessment of Parkinson's disease (PD)-related symptoms. Although the PDCS has been extensively validated, its responsiveness to acute levodopa challenge has not been demonstrated yet. Objective To investigate the correlation between changes in the motor examination part of the Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the PDCS motor scores during acute levodopa challenge and calculate a cutoff range on the PDCS indicating clinically relevant improvement. Methods A consecutive series of 100 patients with parkinsonism were assessed using the motor examination sections of the MDS-UPDRS and the PDCS at least 12 hours after the last levodopa dose and after the administration of a single dose of a suprathreshold immediate formulation of levodopa/benserazide reaching the "best ON." Results. There was a high correlation between changes in the MDS-UPDRS and the PDCS motor scores (Spearman's rho = 0.73, p < 0.001). Receiver operating characteristic analysis revealed that a 14.6%-18.5% improvement in the PDCS motor scores corresponds to a 20-30% improvement in the MDS-UPDRS motor examination. Conclusions The PDCS can reliably and adequately respond to an acute levodopa challenge. Any improvements in PDCS motor scores exceeding the 14.6-18.5% threshold could represent a clinically relevant response to levodopa.
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17
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Saredakis D, Collins-Praino LE, Gutteridge DS, Stephan BC, Keage HA. Conversion to MCI and dementia in Parkinson's disease: a systematic review and meta-analysis. Parkinsonism Relat Disord 2019; 65:20-31. [DOI: 10.1016/j.parkreldis.2019.04.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/15/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022]
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18
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Bloem BR, Marks WJ, Silva de Lima AL, Kuijf ML, van Laar T, Jacobs BPF, Verbeek MM, Helmich RC, van de Warrenburg BP, Evers LJW, intHout J, van de Zande T, Snyder TM, Kapur R, Meinders MJ. The Personalized Parkinson Project: examining disease progression through broad biomarkers in early Parkinson's disease. BMC Neurol 2019; 19:160. [PMID: 31315608 PMCID: PMC6636112 DOI: 10.1186/s12883-019-1394-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our understanding of the etiology, pathophysiology, phenotypic diversity, and progression of Parkinson's disease has stagnated. Consequently, patients do not receive the best care, leading to unnecessary disability, and to mounting costs for society. The Personalized Parkinson Project (PPP) proposes an unbiased approach to biomarker development with multiple biomarkers measured longitudinally. Our main aims are: (a) to perform a set of hypothesis-driven analyses on the comprehensive dataset, correlating established and novel biomarkers to the rate of disease progression and to treatment response; and (b) to create a widely accessible dataset for discovery of novel biomarkers and new targets for therapeutic interventions in Parkinson's disease. METHODS/DESIGN This is a prospective, longitudinal, single-center cohort study. The cohort will comprise 650 persons with Parkinson's disease. The inclusion criteria are purposely broad: age ≥ 18 years; and disease duration ≤5 years. Participants are followed for 2 years, with three annual assessments at the study center. Outcomes include a clinical assessment (including motor and neuro-psychological tests), collection of biospecimens (stool, whole blood, and cerebrospinal fluid), magnetic resonance imaging (both structural and functional), and ECG recordings (both 12-lead and Holter). Additionally, collection of physiological and environmental data in daily life over 2 years will be enabled through the Verily Study Watch. All data are stored with polymorphic encryptions and pseudonyms, to guarantee the participants' privacy on the one hand, and to enable data sharing on the other. The data and biospecimens will become available for scientists to address Parkinson's disease-related research questions. DISCUSSION The PPP has several distinguishing elements: all assessments are done in a single center; inclusion of "real life" subjects; deep and repeated multi-dimensional phenotyping; and continuous monitoring with a wearable device for 2 years. Also, the PPP is powered by privacy and security by design, allowing for data sharing with scientists worldwide respecting participants' privacy. The data are expected to open the way for important new insights, including identification of biomarkers to predict differences in prognosis and treatment response between patients. Our long-term aim is to improve existing treatments, develop new therapeutic approaches, and offer Parkinson's disease patients a more personalized disease management approach. TRIAL REGISTRATION Clinical Trials NCT03364894 . Registered December 6, 2017 (retrospectively registered).
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Affiliation(s)
- B. R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W. J. Marks
- Verily Life Sciences, South San Francisco, CA USA
| | - A. L. Silva de Lima
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- CAPES Foundation, Ministry of Education of Brazil, Brasília/DF, Brazil
| | - M. L. Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T. van Laar
- Department of Neurology, Universtity Medical Center Groningen, Groningen, The Netherlands
| | - B. P. F. Jacobs
- Faculty of Science, University of Nijmegen, Nijmegen, The Netherlands
| | - M. M. Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. C. Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B. P. van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L. J. W. Evers
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - J. intHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T. van de Zande
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T. M. Snyder
- Verily Life Sciences, South San Francisco, CA USA
| | - R. Kapur
- Neurology Platform, Verily Life Sciences, South San Francisco, CA USA
| | - M. J. Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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19
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Badrkhahan SZ, Sikaroodi H, Sharifi F, Kouti L, Noroozian M. Validity and reliability of the Persian version of the Montreal Cognitive Assessment (MoCA-P) scale among subjects with Parkinson's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:431-439. [PMID: 30821505 DOI: 10.1080/23279095.2019.1565762] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parkinson's disease (PD) is a progressive multifactorial degenerative disorder that has both motor and nonmotor features. Among the nonmotor features of PD, cognitive impairment; Mild Cognitive Impairment (MCI) and dementia, poses one of the most significant implications for disability. Because of the high possibility of developing Dementia in PD, it is essential to obtain a reliable cognitive screen. Two commonly used cognitive measures include the Mini Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The MoCA is a more sensitive tool for the detection of MCI in compared to the MMSE. Because of the cultural differences, in this study, we evaluated the psychometric properties of the Persian version of the MoCA (MoCA-P) in a group of participants with PD in Iran. Participants were assessed by MMSE, Geriatric Depression Scale (GDS), and Functional Assessment Staging Test (FAST). If they met study eligibility, the MoCA-P scale was administered. Receiver Operating Characteristic (ROC) curve analyses showed that the MoCA-P scale produced significant discrimination of PD with Dementia (PDD) from PD with MCI (PD-MCI). It seems that the MoCA-P has adequate psychometric properties as a screening instrument for the detection of PD-MCI and PDD in Iranian patients. As near to 30% of patients with PD go on to develop dementia, the MoCA-P can be useful in the detection of cognitive impairment in patients with PD and is suitable for executive function assessment.
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Affiliation(s)
- Seyedeh Zahra Badrkhahan
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hajir Sikaroodi
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Kouti
- Clinical Pharmacy Department, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Maryam Noroozian
- Cognitive Neurology & Neuropsychiatry Division, Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Markaki I, Klironomos S, Svenningsson P. Decreased Cerebrospinal Fluid Aβ42 in Patients with Idiopathic Parkinson's Disease and White Matter Lesions. JOURNAL OF PARKINSONS DISEASE 2019; 9:361-367. [PMID: 30714972 DOI: 10.3233/jpd-181486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cerebral small vessel disease (SVD), often manifesting as white matter lesions (WMLs), and Parkinson's disease (PD) are common disorders whose prevalence increases with age. Vascular risk factors contribute to SVD, but their role in PD is less clear. OBJECTIVES The study objective was to investigate the frequency and grade of WMLs in PD, and their association with clinical and biochemical parameters. METHODS In total, 100 consecutive patients with available magnetic resonance imaging were included. Vascular risk factors including smoking, hypertension, diabetes type 2, atrial fibrillation, heart insufficiency and hypercholesterolemia were assessed. In 50 patients that had underwent lumbar puncture, cerebrospinal fluid (csf) levels of beta-amyloid1-42, tau and phospho-tau were measured. RESULTS WMLs were present in 86 of 100 patients. Increasing WML severity was independently associated with increased age and lower csf beta-amyloid1-42. CONCLUSIONS In our study, WMLs were very common in patients with PD, and were associated with low levels of csf beta-amyloid1-42. Longitudinal studies would increase understanding of the interplay between WMLs and amyloid pathology in PD.
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Affiliation(s)
- Ioanna Markaki
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Neurology, Academic Specialist Center, Stockholm, Sweden
| | - Stefanos Klironomos
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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21
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Screening for Problematic Internet Use May Help Identify Impulse Control Disorders in Parkinson's Disease. Behav Neurol 2019; 2019:4925015. [PMID: 30863462 PMCID: PMC6378069 DOI: 10.1155/2019/4925015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/18/2018] [Accepted: 12/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background Impulse control disorders in Parkinson's disease (PD) represent emerging problems with potentially devastating consequences. The standard screening methods for impulse control disorders are clinically imperfect. Although it is rarely reported, many patients utilize the Internet to fulfill their compulsive behaviors because of its easy accessibility. We designed a study to test the hypothesis that an active screening for excessive Internet use and Internet addiction might improve the sensitivity of identification of impulse control disorders. Methods The standard screening method included the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease and the modified Minnesota Impulsive Disorders Interview. In the second round, the Problematic Internet Use Questionnaire was also assessed for detecting excessive Internet use. Results While the standard approach identified 19 patients out of 106 (17.9%) with any type of impulse control disorders, screening for the problematic Internet use detected 29 patients with impulse control disorders (27.4%) having significantly better efficacy over the standard method (p = 0.004, the McNemar test). Conclusions Our study suggests that the screening for problematic Internet use by the Problematic Internet Use Questionnaire is an effective, feasible, and easy-to-use add-on method for identifying PD patients with impulse control disorders more efficiently and probably at earlier stages.
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22
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Pintér D, Kovács M, Harmat M, Juhász A, Janszky J, Kovács N. Trimetazidine and parkinsonism: A prospective study. Parkinsonism Relat Disord 2019; 62:117-121. [PMID: 30638818 DOI: 10.1016/j.parkreldis.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although trimetazidine may induce parkinsonian symptoms in some patients, no systematic characterization has been reported on parkinsonism occurring during trimetazidine treatment since the first case reports. OBJECTIVE To systematically investigate parkinsonism occurring during trimetazidine use. METHODS Thirty-three consecutive patients on trimetazidine treatment with previously unrecognized parkinsonian symptoms were enrolled. Detailed neurological and neuropsychological examinations were performed at baseline and 1 and 12 months after trimetazidine withdrawal. In cases with persisting parkinsonian symptoms and suspected de novo Parkinson's disease, antiparkinsonian treatment was initiated. Twenty of the 33 patients underwent DaTSCAN imaging. RESULTS After trimetazidine withdrawal, parkinsonism was completely resolved in 11 cases. The comparison of baseline data of patients with reversible and persisting parkinsonism showed that trimetazidine-induced reversible parkinsonism was mainly characterized by akinesia, rigidity, postural instability and gait disturbances (PIGD; PIGD scores: 5.3 ± 3.8 vs. 2.0 ± 1.6 points, p = 0.006) rather than tremors (tremor scores: 1.5 ± 2.2 vs. 7.7 ± 4.6 points, p = 0.000). Trimetazidine-induced reversible parkinsonism was also more symmetrical (asymmetry index: 3.1 ± 3.6 vs. 40.1 ± 22.2, p = 0.000) and milder in severity (MDS-UPDRS Part III. scores: 10.5 ± 19. vs. 30.5 ± 11.3, p = 0.040) than nonreversible parkinsonism. DaTSCAN images were normal in all trimetazidine-induced reversible parkinsonism patients, while these images were abnormal in every patient with nonreversible parkinsonism. In cases of nonreversible parkinsonism, preexisting, incipient Parkinson's disease was suspected by clinical appearance and a good response to antiparkinsonian medication. CONCLUSIONS Mild and symmetrical appearance of parkinsonism with normal DaTSCAN results can indicate drug-induced parkinsonism. Trimetazidine discontinuation generally results in permanent remission in such cases.
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Affiliation(s)
- Dávid Pintér
- Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary; Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Márk Harmat
- Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary; Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Annamária Juhász
- Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary; Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.
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Comparing Sensitivity and Specificity of Addenbrooke's Cognitive Examination-I, III and Mini-Addenbrooke's Cognitive Examination in Parkinson's Disease. Behav Neurol 2018; 2018:5932028. [PMID: 30369997 PMCID: PMC6189663 DOI: 10.1155/2018/5932028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/01/2018] [Accepted: 08/19/2018] [Indexed: 12/29/2022] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative disorder characterized by numerous motor and nonmotor symptoms. Neurocognitive disorders (NCD) are one of the most troublesome problems and their diagnosis is often challenging. Methods We compared the sensitivity and specificity of several versions of Addenbrooke Cognitive Examination (ACE, ACE-III, and Mini-ACE) on 552 subjects with PD. Normal cognition, mild and major NCD were judged in accordance with the respective criteria of the Diagnostic and Statistical Manual of Mental Disorders 5th edition. Subsequently, we applied the receiver operation characteristic (ROC) analysis in comparison of different education levels. Results For subjects with education level 0–8 and 9–12 years, the ACE-III had the best discriminating capabilities for mild NCD (cut-off scores: 83.5 and 85.5 points, respectively), while Mini-ACE was the best for subjects having education > 12 years (cut-off score: 25.5 points). For detecting major NCD, ACE-III had the best diagnostic accuracy in all levels of education (cut-off scores: 70.5, 77.5, and 78.5 points for subjects having education level 0–8, 9–12, and >12 years, respectively). Conclusion ACE-III and its nested version, the Mini-ACE, had the best screening abilities for detecting mild and major NCD in PD.
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Makkos A, Kovács M, Pintér D, Janszky J, Kovács N. Minimal clinically important difference for the historic parts of the Unified Dyskinesia Rating Scale. Parkinsonism Relat Disord 2018; 58:79-82. [PMID: 30174275 DOI: 10.1016/j.parkreldis.2018.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/08/2018] [Accepted: 08/24/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Motor complications represent an important clinical problem in the treatment of Parkinson's disease (PD). The Motor Complications Part of the Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS Part IV) and the Unified Dyskinesia Rating Scale (UDysRS) are among the most reliable instruments to evaluate these problems. The minimal clinically important difference thresholds are the smallest changes in the outcome measures that are clinically meaningful. AIMS The aim of our study was to calculate the minimal clinically important difference thresholds for the MDS-UPDRS Part IV and the historic parts of the UDysRS. METHODS A total of 1044 paired investigations of 436 patients were analyzed. Changes in the respective outcome measures (MDS-UPDRS Part IV, UDysRS Parts I and II) were compared to the Patient-rated Global Impression of Improvement scores (anchors). Subsequently, we applied receiver-operating characteristic analysis to ascertain the MCID thresholds with optimal sensitivity and specificity. RESULTS Any improvement greater than 2.1 points or any worsening greater than 1.8 points on UDysRS Part I represents a minimal, yet clinically meaningful change. In reference to UDysRS Part II, the smallest changes considered clinically relevant are 1.8 and 1.7 points for improvement and deterioration, respectively. The thresholds for the MDS-UPDRS Part IV are 0.9 points for improvement and 0.8 points for worsening. CONCLUSIONS Our estimates may allow the judgment of the clinical relevance of numeric changes in the dyskinesia scales.
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Affiliation(s)
- Attila Makkos
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary; Department of Neurology, University of Pécs, Pécs, Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary; Department of Neurology, University of Pécs, Pécs, Hungary
| | - Dávid Pintér
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.
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Tröster AI. Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:810-828. [PMID: 29077802 PMCID: PMC5860398 DOI: 10.1093/arclin/acx090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/06/2017] [Indexed: 12/02/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective (but non-curative) treatment for some of the motor symptoms and treatment complications associated with dopaminergic agents in Parkinson's disease (PD). DBS can be done relatively safely and is associated with quality of life gains. In most DBS centers, neuropsychological evaluations are performed routinely before surgery, and sometimes after surgery. The purpose of such evaluation is not to decide solely on its results whether or not to offer DBS to a given candidate, but to provide the patient and treatment team with the best available information to make reasonable risk-benefit assessments. This review provides information relevant to the questions often asked by patients and their carepartners, neurologists, and neurosurgeons about neuropsychological outcomes of DBS, including neuropsychological adverse event rates, magnitude of cognitive changes, outcomes after unilateral versus bilateral surgery directed at various targets, impact of mild cognitive impairment (MCI) on outcome, factors implicated in neurobehavioral outcomes, and safety of newer interventions or techniques such as asleep surgery and current steering.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ, USA
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Makkos A, Kovács M, Aschermann Z, Harmat M, Janszky J, Karádi K, Kovács N. Are the MDS-UPDRS-Based Composite Scores Clinically Applicable? Mov Disord 2018; 33:835-839. [DOI: 10.1002/mds.27303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Attila Makkos
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | | | - Márk Harmat
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - Kázmér Karádi
- Institute of Behavioural Sciences; University of Pécs; Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
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Skorvanek M, Goldman JG, Jahanshahi M, Marras C, Rektorova I, Schmand B, van Duijn E, Goetz CG, Weintraub D, Stebbins GT, Martinez-Martin P. Global scales for cognitive screening in Parkinson's disease: Critique and recommendations. Mov Disord 2017; 33:208-218. [PMID: 29168899 DOI: 10.1002/mds.27233] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cognitive impairment is a common nonmotor manifestation of Parkinson's disease, with deficits ranging from mild cognitive difficulties in 1 or more of the cognitive domains to severe dementia. The International Parkinson and Movement Disorder Society commissioned the assessment of the clinimetric properties of cognitive rating scales measuring global cognitive performance in PD to make recommendations regarding their use. METHODS A systematic literature search was conducted to identify the scales used to assess global cognitive performance in PD, and the identified scales were reviewed and rated as "recommended," "recommended with caveats," "suggested," or "listed" by the panel using previously established criteria. RESULTS A total of 12 cognitive scales were included in this review. Three scales, the Montreal Cognitive Assessment, the Mattis Dementia Rating Scale Second Edition, and the Parkinson's Disease-Cognitive Rating Scale, were classified as "recommended." Two scales were classified as "recommended with caveats": the Mini-Mental Parkinson, because of limited coverage of executive abilities, and the Scales for Outcomes in Parkinson's Disease-Cognition, which has limited data on sensitivity to change. Six other scales were classified as "suggested" and 1 scale as "listed." CONCLUSIONS Because of the existence of "recommended" scales for assessment of global cognitive performance in PD, this task force suggests that the development of a new scale for this purpose is not needed at this time. However, global cognitive scales are not a substitute for comprehensive neuropsychological testing. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Matej Skorvanek
- Department of Neurology, Safarik University, Kosice, Slovakia.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Chicago, Illinois, USA
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience & Movement Disorders and the National Hospital for Neurology & Neurosurgery, London, UK
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University, Brno, Czech Republic
| | - Ben Schmand
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik van Duijn
- Department of Psychiatry, Leiden University Medical Centre, Leiden, and Centre of Mental Health Care Delfland, Delft, Netherlands
| | - Christopher G Goetz
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Chicago, Illinois, USA
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania and Parkinson's Disease and Mental Health Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Glenn T Stebbins
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Chicago, Illinois, USA
| | - Pablo Martinez-Martin
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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Prevalence of Anxiety among Hungarian Subjects with Parkinson's Disease. Behav Neurol 2017; 2017:1470149. [PMID: 29081598 PMCID: PMC5634583 DOI: 10.1155/2017/1470149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 12/28/2022] Open
Abstract
Although anxiety is one of the most frequent symptoms of Parkinson's disease (PD), only a few clinical tools can efficiently and reliably detect its presence. The aim of the present study was to validate the Hungarian patient-rated version of Parkinson Anxiety Scale (PAS). A total of 190 PD patients were enrolled into the clinimetric validation phase of the study and another 590 participated in the cross-sectional screening phase. The presence of anxiety disorder was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders criteria. The cutoff value for PAS which best discriminated the presence of anxiety from the absence was 12.5 points (sensitivity of 88.6%, specificity of 79.9). The area under the curve was 0.847 whereas the ROC analysis yielded the statistical significance level (p < 0.001). The optimal threshold values for mild (Hoehn and Yahr Stage, HYS 1 and 2), moderate (HYS 3), and severe (HYS 4 and 5) disease stages were 10.5, 12.5, and 13.5 points, respectively. Based on the general threshold anxiety occurred in 35.8% of the patients (persistent anxiety: 29.2%, episodic anxiety: 20.7%, and avoidant anxiety disorder: 16.8%). We demonstrate that the PAS is a valid, highly reliable, and sensitive tool for assessing anxiety.
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Juhász A, Deli G, Aschermann Z, Janszky J, Harmat M, Makkos A, Kovács M, Komoly S, Balás I, Dóczi T, Büki A, Kovács N. How Efficient Is Subthalamic Deep Brain Stimulation in Reducing Dyskinesia in Parkinson's Disease? Eur Neurol 2017; 77:281-287. [DOI: 10.1159/000455208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
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Horváth K, Aschermann Z, Kovács M, Makkos A, Harmat M, Janszky J, Komoly S, Karádi K, Kovács N. Minimal clinically important differences for the experiences of daily living parts of movement disorder society-sponsored unified Parkinson's disease rating scale. Mov Disord 2017; 32:789-793. [DOI: 10.1002/mds.26960] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Krisztina Horváth
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
| | - Zsuzsanna Aschermann
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Attila Makkos
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márk Harmat
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - Sámuel Komoly
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Kázmér Karádi
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Behavioral Sciences, Universiyt of Pecs, Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
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Makkos A, Pál E, Aschermann Z, Janszky J, Balázs É, Takács K, Karádi K, Komoly S, Kovács N. High-Frequency Repetitive Transcranial Magnetic Stimulation Can Improve Depression in Parkinson's Disease: A Randomized, Double-Blind, Placebo-Controlled Study. Neuropsychobiology 2017; 73:169-77. [PMID: 27093063 DOI: 10.1159/000445296] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 03/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A recent evidence-based guideline demonstrated that bilateral repetitive transcranial magnetic stimulation (rTMS) over the motor cortex (M1) can improve motor symptoms of Parkinson's disease (PD). We conducted a randomized, double-blind, placebo-controlled study to evaluate the impact of bilateral M1 rTMS on depression in PD. METHODS Forty-six patients with PD and mild-to-moderate depression were randomly assigned to active (n = 23) and sham (n = 23) rTMS. Two patients in the sham group did not complete the protocol because of reasons unrelated to the study. High-frequency rTMS was applied over the primary motor cortex bilaterally for 10 days. An investigator blinded to the treatment performed three video-taped examinations on each patient: before stimulation (baseline), and 1 day (short-term effect) and 30 days after the treatment session ended (long-term effect). The primary end point was the changes in depression, while secondary end points included health-related quality of life scales and Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS In the actively treated group, not only did the severity of depression improve (from 17 to 7 points, Montgomery-Åsberg Depression Rating Scale, median values, p < 0.001), but also the health-related quality of life (from 25.4 to 16.9 points, PDQ-39 summary index, median values, p < 0.001). Besides, we could also demonstrate an improvement in MDS-UPDRS Motor Examination (from 26 to 20 points, median values, p < 0.05). In the sham-treated group, none of the examined tests and scales improved significantly after treatment. CONCLUSIONS Our results demonstrate the beneficial effects of high-frequency bilateral M1 rTMS on depression and health-related quality of life in PD. However, this effect of rTMS should also be confirmed in patients with severe depression by further clinical trials.
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Affiliation(s)
- Attila Makkos
- Doctoral School of Clinical Neuroscience, University of Px00E9;cs, Px00E9;cs, Hungary
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Horváth K, Aschermann Z, Kovács M, Makkos A, Harmat M, Janszky J, Komoly S, Karádi K, Kovács N. Changes in Quality of Life in Parkinson's Disease: How Large Must They Be to Be Relevant? Neuroepidemiology 2017; 48:1-8. [PMID: 28161701 DOI: 10.1159/000455863] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Minimal clinically important difference (MCID) is the smallest change in an outcome, which a patient identifies as meaningful. Although the 2 most frequently applied Parkinson's disease (PD) "quality of life" questionnaires (the PDQ-39 and PDQ-8) provide encouragingly similar results, their MCID thresholds appear to be vastly different. Our aim was to calculate the MCID estimates for both PDQ-39 and PDQ-8 Summary Indices (PDQ-39-SI and PDQ-8-SI) by the utilization of both anchor- and distribution-based techniques. METHODS Nine hundred eighty-five paired investigations of 365 patients were included. Three different techniques were used simultaneously to calculate the MCID values. RESULTS First, we replicated the previously published results demonstrating how both PDQ-39-SI and PDQ-8-SI provide similar values and respond in a similar way to changes. Subsequently, we calculated the MCID thresholds. The most optimal estimates for MCID thresholds for PDQ-39-SI were -4.72 and +4.22 for detecting minimal clinically important improvement and worsening. For PDQ-8-SI, these estimates were -5.94 and +4.91 points for detecting minimal clinically important improvement and worsening respectively. CONCLUSIONS Our study is the first one that directly compared the MCID estimates for both PDQ-39-SI and PDQ-8-SI on a large pool of patients including all disease severity stages. These MICD estimates varied across PD severity.
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Affiliation(s)
- Krisztina Horváth
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary
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Juhász A, Aschermann Z, Ács P, Janszky J, Kovács M, Makkos A, Harmat M, Tényi D, Karádi K, Komoly S, Takáts A, Tóth A, Nagy H, Klivényi P, Dibó G, Dézsi L, Zádori D, Annus Á, Vécsei L, Varannai L, Kovács N. Levodopa/carbidopa intestinal gel can improve both motor and non-motor experiences of daily living in Parkinson's disease: An open-label study. Parkinsonism Relat Disord 2017; 37:79-86. [PMID: 28185758 DOI: 10.1016/j.parkreldis.2017.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/09/2017] [Accepted: 02/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Levodopa/carbidopa intestinal gel therapy (LCIG) can efficiently improve several motor and non-motor symptoms of advanced Parkinson's disease (PD). The recently developed Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) improved the original UPDRS making it a more robust tool to evaluate therapeutic changes. However, previous studies have not used the MDS-UPDRS and the Unified Dyskinesia Rating Scale (UDysRS) to assess the efficacy of LCIG. OBJECTIVES Our aim was to determine if the MDS-UPDRS and UDysRS could detect improvement in the experiences of daily living following 1-year LCIG treatment. METHODS In this prospective, multicenter, open-label study, 34 consecutive patients undergoing LCIG treatment were enrolled. Patients were examined twice: prior to LCIG initiation and 12 months later. Impact of PD-related symptoms and dyskinesia was assessed by the MDS-UPDRS and UDysRS. RESULTS Non-motor Experiences of Daily Living part of MDS-UPDRS improved from 20 (median, interquartile-range, IQR:14-23) to 16 points (median, IQR:12-20, p = 0.044) and the Motor Experiences of Daily Living ameliorated from 24 (median, IQR:20-29) to 18 points (median, IQR:13-25, p = 0.025). Health-related quality of life, measured by PDQ-39, also improved from 35.4 (median, IQR:26.9-50.3) to 27.0 (median, IQR:21.3-31.4) points (p = 0.003). The total score of UDysRS decreased from 47 (median, IQR:36-54) to 34 (median, IQR:21-45) points (p = 0.003). CONCLUSIONS As far as the authors are aware of, our paper is the first to evaluate the impact of LCIG on dyskinesia by the means of UDysRS. Changes in MDS-UPDRS and UDysRS confirm that LCIG treatment can efficiently improve experiences of daily living in advanced PD.
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Affiliation(s)
| | | | - Péter Ács
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroimaging MR Research Group, Pécs, Hungary
| | - Márton Kovács
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Attila Makkos
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Márk Harmat
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Dalma Tényi
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Kázmér Karádi
- Institute of Behavioral Sciences, University of Pécs, Pécs, Hungary
| | - Sámuel Komoly
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Annamária Takáts
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Adrián Tóth
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Helga Nagy
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - György Dibó
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Lívia Dézsi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Dénes Zádori
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Ádám Annus
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, University of Szeged, Szeged, Hungary; MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | | | - Norbert Kovács
- Department of Neurology, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroimaging MR Research Group, Pécs, Hungary.
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Speech prosody impairment predicts cognitive decline in Parkinson’s disease. Parkinsonism Relat Disord 2016; 29:90-5. [DOI: 10.1016/j.parkreldis.2016.05.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/02/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
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Qiao J, Wang X, Lu W, Cao H, Qin X. Validation of Neuropsychological Tests to Screen for Dementia in Chinese Patients With Parkinson's Disease. Am J Alzheimers Dis Other Demen 2016; 31:368-74. [PMID: 26646116 PMCID: PMC10852760 DOI: 10.1177/1533317515619478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To compare the accuracy of different neuropsychological tests and their combinations for deriving reliable cognitive indices for dementia diagnosis in Parkinson's disease (PD). One hundred forty consecutive patients with PD were recruited and administrated an extensive battery of neuropsychological tests. Discriminant analysis and receiver-operator characteristic curve were used to evaluate their correct classifications and validity. Patients with PD having dementia (PDD; 23.5%) performed significantly worse in all tests than patients without dementia. Age of onset, disease duration, Hoehn-Yahr grade, Unified Parkinson's Disease Rating Scale part III scores, and education were associated with dementia in patients with PD. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment, and Block Design (BD) showed better specificity and sensitivity when used alone, and combined use of MMSE and BD further increased the validity. Our results indicated that the accuracy of MMSE was better in dementia diagnosis of Chinese patients with PD, and combined use of MMSE and BD could further increase the validity of dementia diagnosis.
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Affiliation(s)
- Jin Qiao
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyan Wang
- Department of Medical Administration, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenhui Lu
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hongmei Cao
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xing Qin
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Impact of Sex on the Nonmotor Symptoms and the Health-Related Quality of Life in Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:7951840. [PMID: 27293959 PMCID: PMC4884810 DOI: 10.1155/2016/7951840] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/27/2016] [Accepted: 04/12/2016] [Indexed: 12/30/2022]
Abstract
Background. Female Parkinson's disease (PD) patients seem to experience not only more severe motor complications and postural instability but also more pronounced depression, anxiety, pain, and sleep disturbances. Objective. The aim of the present study was to evaluate the role of sex as a possible independent predictor of HRQoL in PD. Methods. In this cross-sectional study, 621 consecutive patients treated at the University of Pécs were enrolled. Severity of PD symptoms was assessed by MDS-UPDRS, UDysRS, Non-Motor Symptoms Scale, PDSS-2, Hamilton Anxiety Scale, Montgomery-Asberg Depression Rating Scale, Lille Apathy Rating Scale, and Addenbrooke Cognitive Examination. HRQoL was assessed by PDQ-39 and EQ-5D. Multiple regression analysis was performed to estimate the PDQ-39 and EQ-5D index values based on various clinical factors. Results. Although females received significantly lower dosage of levodopa, they had significantly more disabling dyskinesia and worse postural instability. Anxiety, pain, sleep disturbances, and orthostatic symptoms were more frequent among females while sexual dysfunction, apathy, and daytime sleepiness were more severe among males. Women had worse HRQoL than men (EQ-5D index value: 0.620 ± 0.240 versus 0.663 ± 0.229, p = 0.025, and PDQ-39 SI: 27.1 ± 17.0 versus 23.5 ± 15.9, p = 0.010). Based on multiple regression analysis, sex was an independent predictor for HRQoL in PD. Conclusions. Based on our results, female sex is an independent predictor for having worse HRQoL in PD.
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Kovács N, Horváth K, Aschermann Z, Ács P, Bosnyák E, Deli G, Pál E, Janszky J, Faludi B, Karádi K, Késmárki I, Bokor M, Rigó E, Lajtos J, Klivényi P, Dibó G, Vécsei L, Takáts A, Tóth A, Imre P, Nagy F, Herceg M, Kamondi A, Hidasi E, Komoly S. Independent validation of Parkinson’s disease Sleep Scale 2nd version (PDSS-2). Sleep Biol Rhythms 2015. [DOI: 10.1007/s41105-015-0024-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Horváth K, Aschermann Z, Ács P, Deli G, Janszky J, Komoly S, Balázs É, Takács K, Karádi K, Kovács N. Minimal clinically important difference on the Motor Examination part of MDS-UPDRS. Parkinsonism Relat Disord 2015; 21:1421-6. [DOI: 10.1016/j.parkreldis.2015.10.006] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/24/2015] [Accepted: 10/05/2015] [Indexed: 01/31/2023]
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Minimal Clinically Important Difference on Parkinson's Disease Sleep Scale 2nd Version. PARKINSONS DISEASE 2015; 2015:970534. [PMID: 26539303 PMCID: PMC4619979 DOI: 10.1155/2015/970534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/10/2015] [Indexed: 11/30/2022]
Abstract
Background and Aims. The aim of the present study was to determine the estimates of minimal clinically important difference for Parkinson's Disease Sleep Scale 2nd version (PDSS-2) total score and dimensions. Methods. The subject population consisted of 413 PD patients. At baseline, MDS-UPDRS, Hoehn-Yahr Scale, Mattis Dementia Rating Scale, and PDSS-2 were assessed. Nine months later the PDSS-2 was reevaluated with the Patient-Reported Global Impression Improvement Scale. Both anchor-based techniques (within patients' score change method and sensitivity- and specificity-based method by receiver operating characteristic analysis) and distribution-based approaches (effect size calculations) were utilized to determine the magnitude of minimal clinically important difference. Results. According to our results, any improvements larger than −3.44 points or worsening larger than 2.07 points can represent clinically important changes for the patients. These thresholds have the effect size of 0.21 and −0.21, respectively. Conclusions. Minimal clinically important differences are the smallest change of scores that are subjectively meaningful to patients. Studies using the PDSS-2 as outcome measure should utilize the threshold of −3.44 points for detecting improvement or the threshold of 2.07 points for observing worsening.
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Addenbrooke's Cognitive Examination and Individual Domain Cut-Off Scores for Discriminating between Different Cognitive Subtypes of Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:579417. [PMID: 26351616 PMCID: PMC4553334 DOI: 10.1155/2015/579417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
Abstract
Objective. The main aim of this study was to verify the sensitivity and specificity of Addenbrooke's Cognitive Examination-Revised (ACE-R) in discriminating between Parkinson's disease (PD) with normal cognition (PD-NC) and PD with mild cognitive impairment (PD-MCI) and between PD-MCI and PD with dementia (PD-D). We also evaluated how ACE-R correlates with neuropsychological cognitive tests in PD. Methods. We examined three age-matched groups of PD patients diagnosed according to the Movement Disorder Society Task Force criteria: PD-NC, PD-MCI, and PD-D. ROC analysis was used to establish specific cut-off scores of ACE-R and its domains. Correlation analyses were performed between ACE-R and its subtests with relevant neuropsychological tests. Results. Statistically significant differences between groups were demonstrated in global ACE-R scores and subscores, except in the language domain. ACE-R cut-off score of 88.5 points discriminated best between PD-MCI and PD-NC (sensitivity 0.68, specificity 0.91); ACE-R of 82.5 points distinguished best between PD-MCI and PD-D (sensitivity 0.70, specificity 0.73). The verbal fluency domain of ACE-R demonstrated the best discrimination between PD-NC and PD-MCI (cut-off score 11.5; sensitivity 0.70, specificity 0.73) while the orientation/attention subscore was best between PD-MCI and PD-D (cut-off score 15.5; sensitivity 0.90, specificity 0.97). ACE-R scores except for ACE-R language correlated with specific cognitive tests of interest.
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