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Hattori N, Okada Y, Kawata Y, Furusawa Y, Imai T, Yoshida H, Ota M, Arai M, Shintani A, Fernandez J. Survey on the Impact of the COVID-19 Pandemic on Patients with Parkinson's Disease and Their Caregivers in Japan. Patient Prefer Adherence 2023; 17:1221-1235. [PMID: 37187576 PMCID: PMC10179078 DOI: 10.2147/ppa.s402193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic changed the lives of patients with Parkinson's disease (PD) and their caregivers. This study aimed to investigate changes in patient behavior and PD symptoms and their effect on caregiver burden resulting from the COVID-19 pandemic in Japan. Methods This nationwide, observational, cross-sectional survey included patients with self-reported PD and caregivers (members of the Japan Parkinson's Disease Association). The primary objective was to evaluate changes in behaviors, self-assessed PD symptoms, and caregiver burden from pre-COVID-19 (February 2020) to post-national state of emergency (August 2020 and February 2021). Results Responses from 1883 patients and 1382 caregivers from 7610 distributed surveys were analyzed. Mean (standard deviation) age of patients and caregivers was 71.6 (8.2) and 68.5 (11.4) years, respectively; 41.6% of patients had a Hoehn and Yahr (HY) scale of 3. Patients (>40.0%) reported decreased frequency of going out. Most patients (>70.0%) reported no change in treatment visit frequency, voluntary training, or rehabilitation and nursing care insurance services. Symptoms worsened for approximately 7-30% of patients; the proportion with HY scale 4-5 increased from pre-COVID-19 (25.2%) to February 2021 (40.1%). Aggravated symptoms included bradykinesia, walking, gait speed, depressed mood, fatigue, and apathy. Caregivers' burden increased because of patients' worsened symptoms and reduced time going out. Conclusion Control measures during infectious disease epidemics should consider that patients' symptoms may worsen; therefore, patient and caregiver support is needed to reduce burden of care.
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Affiliation(s)
| | | | - Yayoi Kawata
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Yoshihiko Furusawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Correspondence: Yoshihiko Furusawa, Japan Medical Office, Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo City, Tokyo, 103-0023, Japan, Tel +81-3-3278-2111, Fax +81-3-3278-2000, Email
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mihoko Ota
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masaki Arai
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Dzobo K. The Role of Natural Products as Sources of Therapeutic Agents for Innovative Drug Discovery. COMPREHENSIVE PHARMACOLOGY 2022. [PMCID: PMC8016209 DOI: 10.1016/b978-0-12-820472-6.00041-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Emerging threats to human health require a concerted effort in search of both preventive and treatment strategies, placing natural products at the center of efforts to obtain new therapies and reduce disease spread and associated mortality. The therapeutic value of compounds found in plants has been known for ages, resulting in their utilization in homes and in clinics for the treatment of many ailments ranging from common headache to serious conditions such as wounds. Despite the advancement observed in the world, plant based medicines are still being used to treat many pathological conditions or are used as alternatives to modern medicines. In most cases, these natural products or plant-based medicines are used in an un-purified state as extracts. A lot of research is underway to identify and purify the active compounds responsible for the healing process. Some of the current drugs used in clinics have their origins as natural products or came from plant extracts. In addition, several synthetic analogues are natural product-based or plant-based. With the emergence of novel infectious agents such as the SARS-CoV-2 in addition to already burdensome diseases such as diabetes, cancer, tuberculosis and HIV/AIDS, there is need to come up with new drugs that can cure these conditions. Natural products offer an opportunity to discover new compounds that can be converted into drugs given their chemical structure diversity. Advances in analytical processes make drug discovery a multi-dimensional process involving computational designing and testing and eventual laboratory screening of potential drug candidates. Lead compounds will then be evaluated for safety, pharmacokinetics and efficacy. New technologies including Artificial Intelligence, better organ and tissue models such as organoids allow virtual screening, automation and high-throughput screening to be part of drug discovery. The use of bioinformatics and computation means that drug discovery can be a fast and efficient process and enable the use of natural products structures to obtain novel drugs. The removal of potential bottlenecks resulting in minimal false positive leads in drug development has enabled an efficient system of drug discovery. This review describes the biosynthesis and screening of natural products during drug discovery as well as methods used in studying natural products.
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Hackney ME, Bay AA, Jackson JM, Nocera JR, Krishnamurthy V, Crosson B, Evatt ML, Langley J, Cui X, McKay JL, Huddleston DE. Rationale and Design of the PAIRED Trial: Partnered Dance Aerobic Exercise as a Neuroprotective, Motor, and Cognitive Intervention in Parkinson's Disease. Front Neurol 2020; 11:943. [PMID: 33162925 PMCID: PMC7581698 DOI: 10.3389/fneur.2020.00943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD), an intractable condition impairing motor and cognitive function, is imperfectly treated by drugs and surgery. Two priority issues for many people with PD are OFF-time and cognitive impairment. Even under best medical management, three-fourths of people with PD experience “OFF-time” related to medication-related motor fluctuations, which severely impacts both quality of life and cognition. Cognitive deficits are found even in newly diagnosed people with PD and are often intractable. Our data suggest that partnered dance aerobic exercise (PDAE) reduces OFF-time on the Movement Disorders Society Unified Parkinson Disease Rating Scale-IV (MDS-UPDRS-IV) and ameliorates other disease features, which motivate the PAIRED trial. PDAE provides AE during an improvisational, cognitively engaging rehabilitative physical activity. Although exercise benefits motor and cognitive symptoms and may be neuroprotective for PD, studies using robust biomarkers of neuroprotection in humans are rare. We propose to perform a randomized, controlled trial in individuals with diagnosed mild–moderate PD to compare the efficacy of PDAE vs. walking aerobic exercise (WALK) for OFF-time, cognition, and neuroprotection. We will assess neuroprotection with neuromelanin-sensitive MRI (NM-MRI) and iron-sensitive (R2*) MRI sequences to quantify neuromelanin loss and iron accumulation in substantia nigra pars compacta (SNc). We will use these biomarkers, neuromelanin loss, and iron accumulation, as tools to chart the course of neurodegeneration in patients with PD who have undergone long-term (16 months) intervention. We will randomly assign 102 individuals with mild–moderate PD to 16 months of PDAE or WALK. The 16-month intervention period will consist of Training (3 months of biweekly sessions) and Maintenance (13 months of weekly sessions) phases. We will assess participants at baseline, 3 months (immediately post-Training), and 16 months (immediately post-Maintenance) for OFF-time and behaviorally and physiologically measured cognition. We will acquire NM-MRI and R2* imaging data at baseline and 16 months to assess neuroprotection. We will (1) examine effects of Training and Maintenance phases of PDAE vs. WALK on OFF-time, (2) compare PDAE vs. WALK at 3 and 16 months on behavioral and functional MRI (fMRI) measures of spatial cognition, and (3) compare PDAE vs. WALK for effects on rates of neurodegeneration.
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Affiliation(s)
- Madeleine E Hackney
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Nursing, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jordan M Jackson
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Joe R Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Bruce Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Georgia State University Department of Psychology, Atlanta, GA, United States.,Health and Rehabilitation Science, University of Queensland, Brisbane, QLD, Australia
| | - Marian L Evatt
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Jason Langley
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
| | - Xiangqin Cui
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - J Lucas McKay
- Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel E Huddleston
- Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
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Bay AA, Hart AR, Michael Caudle W, Corcos DM, Hackney ME. The association between Parkinson's disease symptom side-of-onset and performance on the MDS-UPDRS scale part IV: Motor complications. J Neurol Sci 2018; 396:262-265. [PMID: 30537631 DOI: 10.1016/j.jns.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/18/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative condition associated with aging characterized by loss of dopamine-producing neurons in the substantia nigra pars compacta and a reduction in dopamine levels in the striatum. PD is commonly treated using dopamine-replacement medication called levodopa. Levodopa has decreasing efficacy over time. Periods when levodopa is not effective at controlling symptoms of PD are called "OFF-time" or "medication-related motor fluctuations," (MRMF). One characteristic of PD is unilateral side of symptom onset. Previous studies have found that side of onset was associated with differential motor and cognitive PD-related symptoms. The main study objective was to examine differences in left and right onset PD patients and OFF-time as measured by the Movement Disorders Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part IV Sum Score and Part IV item scores. METHODS 64 individuals with mild-moderate PD (age: M(SD) = 68.72 (8.88)), years with PD: M(SD) = 6.61 (5.05); Hoehn and Yahr stage Med (1st, 3rd quartile) = 2.0 (2.0, 3.0) were assessed with the MDS-UPDRS parts I-IV. We conducted two-tailed independent sample t-tests to examine the differences between PD patients with left versus right onset. RESULTS Right onset PD was significantly associated with more overall MRMF (p = 0.01), more OFF-time (p = 0.04), greater impact of motor fluctuations on daily life (p = 0.02) and more complex (unpredictable) MRMF (p = 0.01). CONCLUSION People with right onset PD have more complications with levodopa treatment. Alternative and/or adjuvant treatments to levodopa may be particularly beneficial for those with right onset PD.
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Affiliation(s)
- Allison A Bay
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA
| | - Ariel R Hart
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA
| | - W Michael Caudle
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Daniel M Corcos
- Physical Therapy and Human Movement Science, Northwestern University, 633 Clark St., Evanston, IL 60208, USA
| | - Madeleine E Hackney
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA; Atlanta VA Center for Visual and Neurocognitive Rehabilitation, 1670 Clairmont Rd., Decatur, GA 30033, USA; Department of Rehabilitation Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA.
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Yamabe K, Liebert R, Flores N, Pashos C. Health-related quality-of-life, work productivity, and economic burden among patients with Parkinson's disease in Japan. J Med Econ 2018; 21:1206-1212. [PMID: 30200795 DOI: 10.1080/13696998.2018.1522638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS This study aimed to characterize the burden of Parkinson's disease (PD) by examining health-related quality-of-life (HRQoL), impairments to work productivity and daily activities, healthcare resource use, and associated costs among Japanese patients with PD. MATERIALS AND METHODS This retrospective cross-sectional study used data from the 2009-2014 Japan National Health and Wellness Survey (NHWS) (n = 144,692). HRQoL (Short Form 36-Item Health Survey version 2), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire), healthcare resource utilization, and annual costs were compared between respondents with PD (n = 133) and controls without PD (n = 144,559). The effect of PD on outcomes was estimated using propensity score weighting and multivariable regression models. RESULTS HRQoL was lower in patients with PD compared to the control group, with reduced physical (41.3 vs 51.3) and mental (35.7 vs 45.4) component summary scores and health state utility scores (0.62 vs 0.77; p < .001 for all). Patients with PD also reported higher levels of absenteeism (19.3% vs 3.3%), presenteeism (45.2% vs 18.5%), overall work impairment (52.8% vs 20.3%), and activity impairment (49.6% vs 20.8%) than controls without PD (p < .001 for all). In addition, patients with PD had higher healthcare resource utilization, direct (¥3,856,921/$37,994 vs ¥715,289/$7,046), and indirect (¥2,573,938/$25,356 vs ¥902,534/$8,891) costs compared with controls without PD (p < .001 for both). LIMITATIONS Data were cross-sectional and did not allow for causal inferences. Although the NHWS demographically represents the Japanese adult population, it is unclear whether it adequately represents the adult population with PD in Japan. CONCLUSIONS PD was associated with poorer HRQoL, greater work productivity loss, and higher direct and indirect costs. The findings suggest that an unmet need exists among patients with PD in Japan. Improving PD treatment and management could benefit both patients and society.
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Affiliation(s)
- Kaoru Yamabe
- a Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | | | | | - Chris Pashos
- c Takeda Pharmaceuticals International Co. , Cambridge , MA , USA
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Thomford NE, Senthebane DA, Rowe A, Munro D, Seele P, Maroyi A, Dzobo K. Natural Products for Drug Discovery in the 21st Century: Innovations for Novel Drug Discovery. Int J Mol Sci 2018; 19:E1578. [PMID: 29799486 PMCID: PMC6032166 DOI: 10.3390/ijms19061578] [Citation(s) in RCA: 566] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022] Open
Abstract
The therapeutic properties of plants have been recognised since time immemorial. Many pathological conditions have been treated using plant-derived medicines. These medicines are used as concoctions or concentrated plant extracts without isolation of active compounds. Modern medicine however, requires the isolation and purification of one or two active compounds. There are however a lot of global health challenges with diseases such as cancer, degenerative diseases, HIV/AIDS and diabetes, of which modern medicine is struggling to provide cures. Many times the isolation of "active compound" has made the compound ineffective. Drug discovery is a multidimensional problem requiring several parameters of both natural and synthetic compounds such as safety, pharmacokinetics and efficacy to be evaluated during drug candidate selection. The advent of latest technologies that enhance drug design hypotheses such as Artificial Intelligence, the use of 'organ-on chip' and microfluidics technologies, means that automation has become part of drug discovery. This has resulted in increased speed in drug discovery and evaluation of the safety, pharmacokinetics and efficacy of candidate compounds whilst allowing novel ways of drug design and synthesis based on natural compounds. Recent advances in analytical and computational techniques have opened new avenues to process complex natural products and to use their structures to derive new and innovative drugs. Indeed, we are in the era of computational molecular design, as applied to natural products. Predictive computational softwares have contributed to the discovery of molecular targets of natural products and their derivatives. In future the use of quantum computing, computational softwares and databases in modelling molecular interactions and predicting features and parameters needed for drug development, such as pharmacokinetic and pharmacodynamics, will result in few false positive leads in drug development. This review discusses plant-based natural product drug discovery and how innovative technologies play a role in next-generation drug discovery.
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Affiliation(s)
- Nicholas Ekow Thomford
- Pharmacogenomics and Drug Metabolism Group, Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
- School of Medical Sciences, University of Cape Coast, PMB, Cape Coast, Ghana.
| | - Dimakatso Alice Senthebane
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Wernher and Beit Building (South), University of Cape Town Medical Campus, Anzio Road, Observatory, Cape Town 7925, South Africa.
- Division of Medical Biochemistry and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
| | - Arielle Rowe
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Wernher and Beit Building (South), University of Cape Town Medical Campus, Anzio Road, Observatory, Cape Town 7925, South Africa.
| | - Daniella Munro
- Pharmacogenomics and Drug Metabolism Group, Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
| | - Palesa Seele
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
| | - Alfred Maroyi
- Department of Botany, University of Fort Hare, Private Bag, Alice X1314, South Africa.
| | - Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Wernher and Beit Building (South), University of Cape Town Medical Campus, Anzio Road, Observatory, Cape Town 7925, South Africa.
- Division of Medical Biochemistry and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
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Onozawa R, Tsugawa J, Tsuboi Y, Fukae J, Mishima T, Fujioka S. The impact of early morning off in Parkinson's disease on patient quality of life and caregiver burden. J Neurol Sci 2016; 364:1-5. [DOI: 10.1016/j.jns.2016.02.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/03/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
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