1
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Yeo MS, Hwang J, Lee HK, Kim SJ, Cho SR. Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease. Front Neurol 2024; 15:1323703. [PMID: 38628693 PMCID: PMC11018993 DOI: 10.3389/fneur.2024.1323703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background With longer life spans and medical advancements, the rising number of patients with advanced-stage Parkinson's disease (PD) warrants attention. Current literature predominantly addresses dementia and fall management in these patients. However, exploring the impact of swallowing function on patients with advanced PD is crucial. Previous research has demonstrated notable enhancements in the quality of life related to voice for participants following a group singing-intervention program. To further elucidate the effect of individual singing-induced swallowing exercises, our study aimed to investigate the quantitative and qualitative effects of therapeutic singing on swallowing function in patients with advanced PD in comparison to a matched usual care control group. The hypothesis of this study is that therapeutic singing-induced swallowing exercises can assist to maintain swallowing function in patients with advanced PD. Methods This prospective matched control study compared the effects of a 6-week therapeutic singing-based swallowing intervention on swallowing function and quality of life in patients with advanced PD. The intervention group received individual sessions with a music therapist and conventional individual physical therapy. The control group received the same standard physical therapy for 6 weeks without music intervention. The primary outcome measure was Video Fluoroscopic Dysphagia Scale (VDS). Results The study revealed that the intervention group maintained swallowing function, whereas the control group experienced deterioration, indicating significant time-dependent changes in Penetration-Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and VDS. Analysis of PAS and NIH-SSS liquid food scores in both groups showed significant time effects. However, the intervention group exhibited no significant differences between the pre- and post-tests, indicating preservation of the swallowing function. VDS of liquid food indicated an interaction effect between time and group in the pharyngeal phase and total scores. The Swallowing-Quality of Life showed significant time-effect improvement in the intervention group. Conclusion Therapeutic singing exercises may help maintain swallowing function in advanced PD patients, potentially enhancing quality of life related to swallowing in those with advanced-stage diseases. Clinical trial registration https://cris.nih.go.kr/cris/search/listDetail.do, identifier KCT0008644.
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Affiliation(s)
- Myung Sun Yeo
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Jihye Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Kyoung Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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2
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Bhansali S, Assaedi E, Yu JRT, Mandava N, Sonneborn C, Hogue O, Walter BL, Samala RV, Margolius A. End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review. Front Aging Neurosci 2023; 15:1265156. [PMID: 37744391 PMCID: PMC10511646 DOI: 10.3389/fnagi.2023.1265156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Towards the end of life (EOL), persons with parkinsonism (PwP) have complex needs and can present with unique palliative care (PC) challenges. There are no widely accepted guidelines to aid neurologists, hospitalists, or PC clinicians in managing the symptoms of PwP at EOL. We examined a population of PwP at EOL, aiming to describe trends of in-hospital management and utilization of PC services. Methods All PwP admitted to two hospitals during 2018 (N = 727) were examined retrospectively, assessing those who died in hospital or were discharged with hospice (EOL group, N = 35) and comparing them to the main cohort. Their demographics, clinical data, engagement of multidisciplinary and palliative services, code status changes, invasive care, frequency of admissions, and medication administration were assessed. Results Among the EOL group, 8 expired in hospital, and 27 were discharged to hospice. Forty-six percent of EOL patients received a PC consultation during their admission. The median interval from admission to death was 37 days. Seventy-seven percent had a full code status on admission. Compared to hospice patients, those who expired in hospital had higher rates of invasive procedures and intensive care unit transfers (41% vs. 75%, in both variables), and lower rates of PC involvement (52% vs. 25%). The transition of code status change for the EOL group from Full code to Do Not Resuscitate (DNR) occurred at a median 4-5 days from admission. For patients that passed in the hospital, the median days from transition of code status to death was 0(IQR 0-1). Levodopa dose deviations were frequent in both EOL and non-EOL group, but contraindicated medications were infrequently administered (11% in EOL group vs. 9% in non-EOL group). Conclusion Our data suggest a low utilization of PC services and delayed discussions of goals of care. More work is needed to raise awareness of inpatient teams managing PwP regarding the unique but common challenges facing PwP with advanced disease. A brief narrative review summarizing the suggested management of symptoms common to hospitalized PwP near EOL is provided.
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Affiliation(s)
- Sakhi Bhansali
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Ekhlas Assaedi
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jeryl Ritzi T. Yu
- Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Nymisha Mandava
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Claire Sonneborn
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia Hogue
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Renato V. Samala
- Department of Palliative and Supportive Care, Cleveland Clinic, Cleveland, OH, United States
| | - Adam Margolius
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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3
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Hvisdak V, Huang AP, Kluger BM. Palliative Care of End Stage Parkinsonism: An Overview Including the Five Pillars Framework. Mov Disord Clin Pract 2023; 10:S63-S67. [PMID: 37637979 PMCID: PMC10448122 DOI: 10.1002/mdc3.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Veronica Hvisdak
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Andrew Phillip Huang
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Benzi Michael Kluger
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
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4
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Kim W, Watt CL, Enright P, Sikora L, Zwicker J. Management of Motor Symptoms for Patients with Advanced Parkinson's Disease without Safe Oral Access: A Scoping Review. J Palliat Med 2023; 26:131-141. [PMID: 36126303 DOI: 10.1089/jpm.2022.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Context: Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. Oral medications for control of motor symptoms are the mainstay of treatment. However, as the disease progresses, patients with PD may develop dysphagia that prohibits them from safely taking oral medications. Currently there are no clinical guidelines for managing distressing motor symptoms in patients with PD and severe dysphagia, which can therefore be quite challenging. Objectives: To provide an exhaustive summary of current literature on pharmacological interventions for patients with PD who do not have safe oral access in managing distressing motor symptoms. Indication, route, doses, frequency, outcome, and adverse effects will be discussed. Methods: A scoping review using Medline, Embase, CENTRAL, CINAHL, AgeLine, and PsycINFO databases (1946-2021) was conducted. Articles examining patients with PD and dysphagia who are eligible to receive palliative care or at end of life were included. Studies that included patients who were also on oral PD medications or received device-aided therapy were excluded from this review. Results: A total of 3821 articles were screened for title and abstract, 259 were selected for full-text review, and 20 articles were selected for data extraction. These included five case reports, one retrospective cohort study, one book chapter, and 13 narrative reviews. There are very few articles addressing the issue of treatment of patients with advanced PD who are unable to take oral medications. Although rotigotine patch and apormorphine injections are most frequently recommended, there are no clinical trials in this patient population to support those recommendations. Conclusion: This study highlights a need for further research examining the efficacy and dosing of nonoral medications in advanced PD with dysphagia.
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Affiliation(s)
- WooJin Kim
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine L Watt
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Paula Enright
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Jocelyn Zwicker
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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5
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Abstract
BACKGROUND Parkinson's disease is a progressive neurodegenerative disorder that negatively impacts the lives of affected people. The therapeutic benefits of treatment only decrease going forward from the time of diagnosis. Motor and non-motor symptoms alike create a heavy burden for patients and those involved in their care. Palliative care is utilized for patients with serious illnesses and when integrated into patients with Parkinson's disease, improves quality of life by addressing symptoms of discomfort, which ultimately reduces symptom burden to patients and alleviates caregiver stress. OBJECTIVE This review aims to assess the efficacy of palliative care in the management of Parkinson's disease by exploring the benefits of palliative care integration throughout multiple relevant themes to demonstrate the optimal care delivery. METHODS Comprehensive searches on the role of palliative care in Parkinson's disease patients within MEDLINE, PUBMED, CINAHL, CENTRAL, PsycINFO, Embase, and BioMed Central, considering publications between March 2010 - February 2020 were performed. A grey literature search was also performed for additional information. RESULTS Analysis of various existing literature has demonstrated promise in timely palliative care integration for patients with Parkinson's disease, which has shown improvement in the quality of life of Parkinson's disease patients. It also strives to alleviate caregivers' stress and improve their quality of life, although insufficient research exists to support this. Palliative care in Parkinson's disease is a growing area of interest, evidently demonstrating the potential to expand among the current approaches. CONCLUSION Understanding the connections between the themes surrounding palliative care is crucial for successful integration in Parkinson's disease management. It is determined that integration of palliative care in patients with Parkinson's disease help to not only improve patients' experiences but also their caregiver's experiences throughout the disease trajectory. Further research should be conducted to address how palliative care will focus on alleviating caregiver burden and establish specific prognostication tools for Parkinson's disease patients.
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Affiliation(s)
- Helen Senderovich
- Department of Family and Community Medicine, Division of Palliative Care, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Baycrest, Toronto, Canada
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6
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Gilbert F, Lancelot M. Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a 'new form of the disease'. JOURNAL OF MEDICAL ETHICS 2021; 47:20-25. [PMID: 32409626 DOI: 10.1136/medethics-2019-106052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Deep brain stimulation (DBS) has been regarded as an efficient and safe treatment for Parkinson's disease (PD) since being approved by the Food and Drug Administration (FDA) in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase life expectancy for most patients with PD, this medical benefit does not come without attendant negative consequences. For example, emerging forms of iatrogenic harms are sometimes induced-harms which were not initially expected when clinicians proposed neurosurgery and patients or their guardians consented to the treatment. We report and discuss the clinical case of a patient who was implanted with DBS more than 20 years ago (at the time of writing) and is now experiencing unexpected stages of PD. This case illustrates how extending the life span without improving quality of life may introduce a burden of harms for patients and families. As well, this case shows why we should prepare for the expanding numbers of PD-implanted patients experiencing a gain of longevity but with severe stages of disease leading to diminution in quality of life. This newly observed effect of DBS treatment requires us to explore ethical questions related to iatrogenic harms, informed consent, end of life and caregivers' burden.
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Affiliation(s)
- Frederic Gilbert
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
- Center for Neurotechnology, University of Washington, Seattle, U.S.A
| | - Mathilde Lancelot
- SPHERE, Paris Diderot University / University of Paris, Paris, France
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7
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Lowes H, Kurzawa-Akanbi M, Pyle A, Hudson G. Post-mortem ventricular cerebrospinal fluid cell-free-mtDNA in neurodegenerative disease. Sci Rep 2020; 10:15253. [PMID: 32943697 PMCID: PMC7499424 DOI: 10.1038/s41598-020-72190-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Cell-free mitochondrial DNA (cfmtDNA) is detectable in almost all human body fluids and has been associated with the onset and progression of several complex traits. In-life assessments indicate that reduced cfmtDNA is a feature of neurodegenerative diseases such as Parkinson's disease, Alzheimer's disease and multiple sclerosis. However, whether this feature is conserved across all neurodegenerative diseases and how it relates to the neurodegenerative processes remains unclear. In this study, we assessed the levels of ventricular cerebrospinal fluid-cfmtDNA (vCSF-cfmtDNA) in a diverse group of neurodegenerative diseases (NDDs) to determine if the in-life observations of reduced cfmtDNA seen in lumbar CSF translated to the post-mortem ventricular CSF. To investigate further, we compared vCSF-cfmtDNA levels to known protein markers of neurodegeneration, synaptic vesicles and mitochondrial integrity. Our data indicate that reduced vCSF-cfmtDNA is a feature specific to Parkinson's and appears consistent throughout the disease course. Interestingly, we observed increased vCSF-cfmtDNA in the more neuropathologically severe NDD cases, but no association to protein markers of neurodegeneration, suggesting that vCSF-cfmtDNA release is more complex than mere cellular debris produced following neuronal death. We conclude that vCSF-cfmtDNA is reduced in PD, but not other NDDs, and appears to correlate to pathology. Although its utility as a prognostic biomarker is limited, our data indicate that higher levels of vCSF-cfmtDNA is associated with more severe clinical presentations; suggesting that it is associated with the neurodegenerative process. However, as vCSF-cfmtDNA does not appear to correlate to established indicators of neurodegeneration or indeed indicators of mitochondrial mass, further work to elucidate its exact role is needed.
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Affiliation(s)
- Hannah Lowes
- Biosciences Institute, 4th Floor Cookson Building, Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Marzena Kurzawa-Akanbi
- Biosciences Institute, 4th Floor Cookson Building, Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Angela Pyle
- Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Gavin Hudson
- Biosciences Institute, 4th Floor Cookson Building, Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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8
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Huang X, Lewis MM, Van Scoy LJ, De Jesus S, Eslinger PJ, Arnold AC, Miller AJ, Fernandez-Mendoza J, Snyder B, Harrington W, Kong L, Wang X, Sun D, Delnomdedieu M, Duvvuri S, Mahoney SE, Gray D, Mailman R. The D1/D5 Dopamine Partial Agonist PF-06412562 in Advanced-Stage Parkinson's Disease: A Feasibility Study. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1515-1527. [PMID: 32986682 PMCID: PMC8640973 DOI: 10.3233/jpd-202188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current drug treatments have little efficacy in advanced-to-end-stage Parkinson's disease (advPD), yet there are no reports of interventional trials in advPD. D1 dopamine agonists have the potential to provide benefit. OBJECTIVE To determine the feasibility and safety of the selective D1/D5 dopamine partial agonist PF 06412562 in advPD. METHODS A two-week, randomized, double blind, crossover phase Ib study in advPD patients compared standard-of-care (SoC) carbidopa/levodopa with PF 06412562. Each week, there was a Day 1 baseline evaluation with overnight levodopa washout, then treatment on Days 2 and 3 with either SoC or PF-06412562 (split dose 25 + 20 mg), followed by discharge on Day 4. Primary endpoints were safety and tolerability. Secondary endpoints were global clinical impression of change (GCI-C) rated by clinicians and caregivers. RESULTS Eight advPD patients and their caregivers consented to participate and six were randomized (average disease duration: 22 y). None withdrew voluntarily. One participant with baseline Day 1 dehydration, pre-renal kidney injury, and autonomic dysfunction experienced symptomatic and serious hypotension after receiving PF-06412562 in Week 1 and was discontinued from the study. All other adverse events were rated mild (PF-06412562: n = 1, SoC: n = 0), moderate (PF-06412562: n = 1, SoC: n = 1), or severe but non-serious (PF-06412562: n = 3, SoC: n = 2). No clinically meaningful laboratory changes were observed. Among the five participants who completed the study, GCI-C favored PF-06412562 in two per clinicians' and four participants per caregivers' rating. CONCLUSION PF-06412562 was tolerated in advPD patients. This study provides the feasibility for future safety and efficacy studies in this population with unmet needs.
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Affiliation(s)
- Xuemei Huang
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Pharmacology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Kinesiology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Translational Brain Research Center, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Mechelle M. Lewis
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Pharmacology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Translational Brain Research Center, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Lauren Jodi Van Scoy
- Department of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Humanities, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Psychiatry, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Sol De Jesus
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Translational Brain Research Center, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Paul J. Eslinger
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Neural and Behavioral Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Translational Brain Research Center, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Amy C. Arnold
- Department of Neural and Behavioral Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Amanda J. Miller
- Department of Neural and Behavioral Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Julio Fernandez-Mendoza
- Department of Neural and Behavioral Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Bethany Snyder
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - William Harrington
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Xi Wang
- Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | - Dongxiao Sun
- Department of Pharmacology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
| | | | | | | | - David Gray
- Cerevel Neurosciences LLC., Boston, MA, 02116 USA
| | - Richard Mailman
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Department of Pharmacology, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
- Translational Brain Research Center, Penn State Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA 17033 USA
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Guo Y, Wang L, Li Y, Guo L, Meng F. The Detection of Freezing of Gait in Parkinson's Disease Using Asymmetric Basis Function TV-ARMA Time-Frequency Spectral Estimation Method. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2077-2086. [PMID: 31478865 DOI: 10.1109/tnsre.2019.2938301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Freezing of gait (FOG) is an episodic gait disturbance affecting locomotion in Parkinson's disease. As a biomarker to detect FOG, the Freeze index (FI), which is defined as the ratio of the areas under power spectra in 'freeze' band and in 'locomotion' band, can negatively be affected by poor time and frequency resolution of time-frequency spectrum estimate when short-time Fourier transform (STFT) or Wavelet transform (WT) is used. In this study, a novel high-resolution parametric time-frequency spectral estimation method is proposed to improve the accuracy of FI. A time-varying autoregressive moving average model (TV-ARMA) is first identified where the time-varying parameters are estimated using an asymmetric basis function expansion method. The TV-ARMA model is then transformed into frequency domain to estimate the time-frequency spectrum and calculate the FI. Results evaluated on the Daphnet Freezing of Gait Dataset show that the new method improves the time and frequency resolutions of the time-frequency spectrum and the associate FI has better performance in the detection of FOG than its counterparts based on STFT and WT methods do. Moreover, FOGs can be predicted in advance of its occurrence in most cases using the new method.
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10
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Sankary LR, Ford PJ, Machado AG, Hoeksema LJ, Samala RV, Harris DJ. Deep Brain Stimulation at End of Life: Clinical and Ethical Considerations. J Palliat Med 2019; 23:582-585. [PMID: 31403368 DOI: 10.1089/jpm.2019.0129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Deep brain stimulation (DBS) is an implanted neurological device effective in treating motor symptoms of Parkinson disease (PD), such as tremor, rigidity, and bradykinesia. More than 150,000 patients worldwide have been implanted with DBS devices. Questions arise at the end of life concerning how to provide best care for patients with DBS, including its continued benefit or potential complications, yet, no published articles provide guidance for hospice providers regarding the management of DBS devices in end-of-life care. With contributions from hospice physicians, a neurosurgeon, and ethicists, this article provides recommendations to address clinical and ethical challenges in optimizing DBS for patients with PD nearing the end of life.
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Affiliation(s)
| | - Paul J Ford
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Laura J Hoeksema
- Department of Palliative Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Renato V Samala
- Department of Palliative Medicine, Cleveland Clinic, Cleveland, Ohio
| | - David J Harris
- Department of Palliative Medicine, Cleveland Clinic, Cleveland, Ohio
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11
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Wright J. Addressing sexuality and intimacy in people living with Parkinson's during palliative care and at the end of life. ACTA ACUST UNITED AC 2019; 28:772-779. [PMID: 31242112 DOI: 10.12968/bjon.2019.28.12.772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sexuality and intimacy are poorly researched in both people living with Parkinson's and in older people. Triggers for discussion usually centre on sexual dysfunction and hypersexuality in relation to Parkinson's. However, there are many more factors that impact on physical and emotional connectedness. Despite highlighting this unmet need there are limited tools or comprehensive assessments available to help improve quality of life. Further research is required within this field, with emphasis on health professionals' education and on highlighting to patients that they have permission for this topic to be discussed and actioned.
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Affiliation(s)
- Jenny Wright
- Parkinson's Disease Nurse Specialist, Nottingham University Hospitals NHS Trust, Nottingham
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12
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Rajiah K, Maharajan MK, Yeen SJ, Lew S. Quality of Life and Caregivers' Burden of Parkinson's Disease. Neuroepidemiology 2017; 48:131-137. [PMID: 28728161 DOI: 10.1159/000479031] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/25/2017] [Indexed: 11/19/2022] Open
Abstract
AIM This study focused on the impact of the clinical features on the quality of life (QoL) of Parkinson's disease (PD) patients and of their caregivers. METHODS This study included PD patients along with their caregivers and was undertaken at the Malaysian Parkinson's Disease Association from June 2016 to November 2016. Clinical features of PD patients were assessed using the Movement Disorder Society revised Unified Parkinson Disease Rating Scale; the Hoehn and Yahr stage and the Schwab and England Activities of Daily Living Scale were used to assess the severity and the ability of PD patients respectively. QoL of PD patients was measured using the Parkinson's Disease Questionnaire-39 (PDQ-39). The revised version of the Zarit Burden Interview assessed caregiver burden. RESULTS At least one of the clinical features affected PD patients' QoL, and at least one of the QoL domains affected the caregivers' burden. Clinical features "saliva and drooling" and "dyskinesia" explained 29% of variance in QoL of PD patients. The QoL domains "stigma," along with "emotional well-being" explained 48.6% of variance in caregivers' burden. CONCLUSIONS The clinical features "saliva and drooling" and "dyskinesia" impacted the QoL of PD patients, and the QoL domains "stigma" and "emotional well-being" of PD patients impacted their caregivers' burden.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
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Budini M, Buratti E, Morselli E, Criollo A. Autophagy and Its Impact on Neurodegenerative Diseases: New Roles for TDP-43 and C9orf72. Front Mol Neurosci 2017; 10:170. [PMID: 28611593 PMCID: PMC5447761 DOI: 10.3389/fnmol.2017.00170] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022] Open
Abstract
Autophagy is a catabolic mechanism where intracellular material is degraded by vesicular structures called autophagolysosomes. Autophagy is necessary to maintain the normal function of the central nervous system (CNS), avoiding the accumulation of misfolded and aggregated proteins. Consistently, impaired autophagy has been associated with the pathogenesis of various neurodegenerative diseases. The proteins TAR DNA-binding protein-43 (TDP-43), which regulates RNA processing at different levels, and chromosome 9 open reading frame 72 (C9orf72), probably involved in membrane trafficking, are crucial in the development of neurodegenerative diseases such as Amyotrophic lateral sclerosis (ALS) and Frontotemporal Lobar Degeneration (FTLD). Additionally, recent studies have identified a role for these proteins in the control of autophagy. In this manuscript, we review what is known regarding the autophagic mechanism and discuss the involvement of TDP-43 and C9orf72 in autophagy and their impact on neurodegenerative diseases.
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Affiliation(s)
- Mauricio Budini
- Dentistry Faculty, Institute in Dentistry Sciences, University of ChileSantiago, Chile
| | - Emanuele Buratti
- International Centre for Genetic Engineering and BiotechnologyTrieste, Italy
| | - Eugenia Morselli
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Alfredo Criollo
- Dentistry Faculty, Institute in Dentistry Sciences, University of ChileSantiago, Chile.,Advanced Center for Chronic DiseasesSantiago, Chile
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14
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Need for palliative care for neurological diseases. Neurol Sci 2016; 37:1581-7. [DOI: 10.1007/s10072-016-2614-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
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Bloem BR, Stocchi F. Move for Change Part III: a European survey evaluating the impact of the EPDA Charter for People with Parkinson's Disease. Eur J Neurol 2014; 22:133-41, e8-9. [PMID: 25196038 DOI: 10.1111/ene.12544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Move for Change is an online pan-European patient survey based on the European Parkinson's Disease Association (EPDA) Charter for People with Parkinson's Disease (PD), which states that all PD patients have the right to: be referred to a doctor with a specialist interest in PD; receive an accurate diagnosis; have access to support services; receive continuous care; and take part in managing their illness. METHODS This part of the survey focuses on the final two elements of the Charter. It was administered online through the EPDA website and through affiliated patient associations' websites. A total of 1591 questionnaires were received and 1546 were analysed (97.2%). RESULTS Approximately half of the patients (53.0%) consulted a neurologist regularly (every 4-6 months). Consultations were usually arranged as part of a follow-up process (65.5%) and lasted for 15-30 min (63.2%), with 16.1% lasting <10 min and 17.9% lasting >30 min. Patients were largely satisfied with the attention they received (63.2%) but just 11.6% of patients were involved in treatment decisions, and 39.1% prepared a list of symptom changes for discussion. Two hundred caregivers also took part in the survey, and 71.4% felt included in the treatment plan by the doctor. CONCLUSIONS These results highlight that PD disease-management is driven by the clinician; he/she arranges consultations and makes the majority of management decisions, rather than patients being included in the process. This survey can be used to raise awareness for PD patients, encouraging greater involvement in the management of PD.
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Affiliation(s)
- B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Goy ER, Bohlig A, Carter J, Ganzini L. Identifying Predictors of Hospice Eligibility in Patients With Parkinson Disease. Am J Hosp Palliat Care 2013; 32:29-33. [DOI: 10.1177/1049909113502119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aims to improve recognition of hospice eligibility for patients with Parkinson disease (PD) by ascertaining which variables have a higher probability of occurring uniquely in 6 to 12 months before death when compared to 18 to 24 months before death. Participants were 339 patients who died who were diagnosed with PD or Parkinsonism and treated with dopaminergic prescriptions for at least 3 years in northwestern US Veterans Affairs medical centers. A range of indicators were compared across 3 time periods (30-36 months, 24-18 months, and 12-6 months before death) using within-subjects repeated measures design. Results indicate that body mass index less than 18, alone or combined with a shift in prescribing (when benefits of dopaminergic medications no longer outweigh their risk of side effects), may signal appropriate timing for hospice referral.
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Affiliation(s)
- Elizabeth R. Goy
- Mental Health Division, Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Amanda Bohlig
- Mental Health Division, Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Julie Carter
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Linda Ganzini
- Mental Health Division, Portland Veterans Affairs Medical Center, Portland, OR, USA
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Lökk J, Fereshtehnejad SM. Managing palliative care in Parkinson’s disease from diagnosis to end-stage disease: what the clinician should know. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
SUMMARY Progression of Parkinson’s disease (PD) is followed by aggravation of both motor and non-motor symptoms, which calls for more prominent palliative care towards the end stage of the disease. These palliative services should include multidisciplinary teamwork, in addition to taking into account treatment side effects, dose readjustment, and add-on nonpharmaceutical and pharmaceutical approaches. The treatment protocols in the advanced stage of PD are quite different from the ones in the early stages. The focus is shifted from symptom relief strategies to providing the patient with comfort and support during the palliative stage. In this review, some specific palliative approaches for dealing with motor and non-motor complications of end-stage PD are provided, as well as some general knowledge on palliation.
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Affiliation(s)
- Johan Lökk
- Department of Neurobiology, Care Sciences & Society (NVS), Karolinska Institutet, Blickagången 1, 141 86 Stockholm, Sweden.
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences & Society (NVS), Karolinska Institutet, Blickagången 1, 141 86 Stockholm, Sweden
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