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Hamedani AG, Chang AY, Chen Y, VanderBeek BL. Disparities in glaucoma and macular degeneration healthcare utilization among persons living with dementia in the United States. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06573-z. [PMID: 38995351 DOI: 10.1007/s00417-024-06573-z] [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: 02/07/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia. METHODS Optum's de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes. RESULTS POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75-0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63-0.68) and OCT (RR 0.67, 95% CI: 0.64-0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83-0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70-0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58-0.69) than those without dementia. CONCLUSIONS POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Angela Y Chang
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yineng Chen
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian L VanderBeek
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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2
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Gialluisi A, Tirozzi A, Costanzo S, De Bartolo MI, Belvisi D, Magnacca S, De Curtis A, Falciglia S, Ricci M, Cerletti C, Donati MB, Berardelli A, de Gaetano G, Iacoviello L. Blood-based biological ageing and red cell distribution width are associated with prevalent Parkinson's disease: findings from a large Italian population cohort. Front Endocrinol (Lausanne) 2024; 15:1376545. [PMID: 38660510 PMCID: PMC11041016 DOI: 10.3389/fendo.2024.1376545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Background Aging clocks tag the actual underlying age of an organism and its discrepancy with chronological age and have been reported to predict incident disease risk in the general population. However, the relationship with neurodegenerative risk and in particular with Parkinson's Disease (PD) remains unclear, with few discordant findings reporting associations with both incident and prevalent PD risk. Objective To clarify this relationship, we computed a common aging clock based on blood markers and tested the resulting discrepancy with chronological age (ΔPhenoAge) for association with both incident and prevalent PD risk. Methods In a large Italian population cohort - the Moli-sani study (N=23,437; age ≥ 35 years; 52% women) - we carried out both Cox Proportional Hazards regressions modelling ΔPhenoAge as exposure and incident PD as outcome, and linear models testing prevalent PD as exposure and ΔPhenoAge as outcome. All models were incrementally adjusted for age, sex, education level completed and other risk/protective factors previously associated with PD risk in the same cohort (prevalent dysthyroidism, hypertension, diabetes, use of oral contraceptives, exposure to paints, daily coffee intake and cigarette smoking). Results No significant association between incident PD risk (209 cases, median (IQR) follow-up time 11.19 (2.03) years) and PhenoAging was observed (Hazard Ratio [95% Confidence Interval] = 0.98 [0.71; 1.37]). However, a small but significant increase of ΔPhenoAge was observed in prevalent PD cases vs healthy subjects (β (Standard Error) = 1.39 (0.70)). An analysis of each component biomarker of PhenoAge revealed a significant positive association of prevalent PD status with red cell distribution width (RDW; β (SE) = 0.46 (0.18)). All the remaining markers did not show any significant evidence of association. Conclusion The reported evidence highlights systemic effects of prevalent PD status on biological aging and red cell distribution width. Further cohort and functional studies may help shedding a light on the related pathways altered at the organism level in prevalent PD, like red cells variability, inflammatory and oxidative stress mechanisms.
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Affiliation(s)
- Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Alfonsina Tirozzi
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | | | - Daniele Belvisi
- IRCCS NEUROMED, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Sara Magnacca
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Stefania Falciglia
- UOC Governance del Farmaco, Azienda Sanitaria Regionale del Molise –ASREM, Campobasso, Italy
| | - Moreno Ricci
- UOC Governance del Farmaco, Azienda Sanitaria Regionale del Molise –ASREM, Campobasso, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | | | - Alfredo Berardelli
- IRCCS NEUROMED, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
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3
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Wu AD, Walter BL, Brooks A, Buetow E, Amodeo K, Richard I, Mundth K, Azmi H. Standardizing default electronic health record tools to improve safety for hospitalized patients with Parkinson's disease. Front Aging Neurosci 2024; 15:1278322. [PMID: 38304735 PMCID: PMC10830808 DOI: 10.3389/fnagi.2023.1278322] [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: 08/16/2023] [Accepted: 11/22/2023] [Indexed: 02/03/2024] Open
Abstract
Electronic Health Record (EHR) systems are often configured to address challenges and improve patient safety for persons with Parkinson's disease (PWP). For example, EHR systems can help identify Parkinson's disease (PD) patients across the hospital by flagging a patient's diagnosis in their chart, preventing errors in medication and dosing through the use of clinical decision support, and supplementing staff education through care plans that provide step-by-step road maps for disease-based care of a specific patient population. However, most EHR-based solutions are locally developed and, thus, difficult to scale widely or apply uniformly across hospital systems. In 2020, the Parkinson's Foundation, a national and international leader in PD research, education, and advocacy, and Epic, a leading EHR vendor with more than 35% market share in the United States, launched a partnership to reduce risks to hospitalized PWP using standardized EHR-based solutions. This article discusses that project which included leadership from physician informaticists, movement disorders specialists, hospital quality officers, the Parkinson's Foundation and members of the Parkinson's community. We describe the best practice solutions developed through this project. We highlight those that are currently available as standard defaults or options within the Epic EHR, discuss the successes and limitations of these solutions, and consider opportunities for scalability in environments beyond a single EHR vendor. The Parkinson's Foundation and Epic launched a partnership to develop best practice solutions in the Epic EHR system to improve safety for PWP in the hospital. The goal of the partnership was to create the EHR tools that will have the greatest impact on outcomes for hospitalized PWP.
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Affiliation(s)
- Allan D. Wu
- Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Benjamin L. Walter
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland ClinicCleveland, OH, United States
| | - Anne Brooks
- Parkinson’s Foundation, New York, NY, United States
| | - Emily Buetow
- Parkinson’s Foundation, New York, NY, United States
| | - Katherine Amodeo
- Department of Neurology, Westchester Medical Center, Poughkeepsie, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Irene Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kelly Mundth
- Epic Systems Corporation, Verona, WI, United States
| | - Hooman Azmi
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
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Kannarkat JT, Kannarkat GT, Jones LK. Neurologic Alternative Payment Models-Bridging the Gap. JAMA Neurol 2024:2813358. [PMID: 38190142 DOI: 10.1001/jamaneurol.2023.5053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
This Viewpoint discusses alternative payments models and the responsibilities of health care professionals.
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Affiliation(s)
| | - George T Kannarkat
- Department of Neurology, University of Pennsylvania, Philadelphia
- Parkinson's Disease Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Lyell K Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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5
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Kluger BM, Katz M, Galifianakis NB, Pantilat SZ, Hauser JM, Khan R, Friedman C, Vaughan CL, Goto Y, Long SJ, Martin CS, Dini M, McQueen RB, Palmer L, Fairclough D, Seeberger LC, Sillau SH, Kutner JS. Patient and Family Outcomes of Community Neurologist Palliative Education and Telehealth Support in Parkinson Disease. JAMA Neurol 2024; 81:39-49. [PMID: 37955923 PMCID: PMC10644250 DOI: 10.1001/jamaneurol.2023.4260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023]
Abstract
Importance Parkinson disease and related disorders (PDRD) are the fastest growing neurodegenerative illness in terms of prevalence and mortality. As evidence builds to support palliative care (PC) for PDRD, studies are needed to guide implementation. Objective To determine whether PC training for neurologists and remote access to a PC team improves outcomes in patients with PDRD in community settings. Design, Setting, and Participants This pragmatic, stepped-wedge comparative effectiveness trial enrolled and observed participants from 19 community neurology practices supported by PC teams at 2 academic centers from March 8, 2017, to December 31, 2020. Participants were eligible if they had PDRD and moderate to high PC needs. A total of 612 persons with PDRD were referred; 253 were excluded. Patients were excluded if they had another diagnosis meriting PC, were receiving PC, or were unable or unwilling to follow study procedures. Patients received usual care or the intervention based on when their community neurologist was randomized to start the intervention. Data were analyzed from January 2021 to September 2023. Intervention The intervention included (1) PC education for community neurologists and (2) team-based PC support via telehealth. Main Outcomes and Measures The primary outcomes were differences at 6 months in patient quality of life (QOL; measured by the Quality of Life in Alzheimer Disease Scale [QOL-AD]) and caregiver burden (Zarit Burden Interview) between the intervention and usual care. Results A total of 359 patients with PDRD (233 men [64.9%]; mean [SD] age, 74.0 [8.8] years) and 300 caregivers were enrolled. At 6 months, compared with usual care, participants receiving the intervention had better QOL (QOL-AD score, 0.09 [95% CI, -0.63 to 0.82] vs -0.88 [95% CI, -1.62 to -0.13]; treatment effect estimate, 0.97; 95% CI, 0.07-1.86; P = .03). No significant difference was observed in caregiver burden (Zarit Burden Interview score, 1.19 [95% CI, 0.16 to 2.23] vs 0.55 [95%, -0.44 to 1.54]; treatment effect estimate, 0.64; 95% CI, -0.62 to 1.90; P = .32). Advance directive completion was higher under the intervention (19 of 38 [50%] vs 6 of 31 [19%] among those without directives at the beginning of the study; P = .008). There were no differences in other outcomes. Conclusions and Relevance PC education for community neurologists and provision of team-based PC via telehealth is feasible and may improve QOL and advance care planning. Overall treatment effects were small and suggest opportunities to improve both the intervention and implementation. Trial Registration ClinicalTrials.gov Identifier: NCT03076671.
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Affiliation(s)
- Benzi M. Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Maya Katz
- Department of Neurology, Stanford University, Stanford, California
| | | | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco
| | - Joshua M. Hauser
- Division of Palliative Medicine, Department of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Ryan Khan
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora
| | - Cari Friedman
- Parkinson Association of the Rockies, University of Denver, Denver, Colorado
| | | | - Yuika Goto
- Department of Palliative Care, University of California, San Francisco
| | - S. Judith Long
- Department of Palliative Care, University of California, San Francisco
| | | | - Megan Dini
- Parkinson’s Foundation, Denver, Colorado
| | - R. Brett McQueen
- Department of Clinical Pharmacy, University of Colorado School of Medicine, Aurora
| | - Laura Palmer
- Quality and Process Improvement, University of Colorado School of Medicine, Aurora
| | - Diane Fairclough
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora
| | - Lauren C. Seeberger
- Department of Neurology, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia
| | - Stefan H. Sillau
- Department of Neurology, School of Public Health, University of Colorado, Aurora
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora
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6
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George BP, Barbosa WA, Sethi A, Richard IH. Complications and outcomes of hospitalizations for patients with and without Parkinson disease. Front Aging Neurosci 2023; 15:1276731. [PMID: 38161593 PMCID: PMC10757345 DOI: 10.3389/fnagi.2023.1276731] [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: 08/12/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective To examine complications and outcomes of hospitalizations for common indications for hospitalization among patients with Parkinson disease (PD). Methods We identified and selected the ten most common indications for hospitalization among individuals ≥65 years of age using principal diagnoses from the California State Inpatient Database, 2018-2020. Patients with comorbid PD were identified using secondary diagnosis codes and matched one-to-one to patients without PD based on principal diagnosis (exact matching), age, gender, race and ethnicity, and Elixhauser comorbidity index (coarsened exact matching). We identified potentially preventable complications based on the absence of present on admission indicators among secondary diagnoses. In the matched cohort, we compared inpatient complications, early Do-Not-Resuscitate (DNR) orders (placed within 24 h of admission), use of life-sustaining therapies, new nursing facility requirement on discharge, and death or hospice discharge for patients with and without PD. Results We identified 35,457 patients with PD among the ten leading indications for hospitalization in older adults who were matched one-to-one to patients without PD (n = 70,914 in total). Comorbid PD was associated with an increased odds of developing aspiration pneumonia (OR 1.17 95% CI 1.02-1.35) and delirium (OR 1.11 95% CI 1.02-1.22) during admission. Patients with PD had greater odds of early DNR orders [placed within 24 h of admission] (OR 1.34 95% CI 1.29-1.39). While there was no difference in the odds of mechanical ventilation (OR 1.04 95% CI 0.98-1.11), patients with PD demonstrated greater odds of tracheostomy (OR 1.41 95% CI 1.12-1.77) and gastrostomy placement (OR 2.00 95% CI 1.82-2.20). PD was associated with greater odds of new nursing facility requirement upon discharge (OR 1.58 95% CI 1.53-1.64). Patients with PD were more likely to die as a result of their hospitalization (OR 1.11 95% CI 1.06-1.16). Conclusion Patients with PD are at greater risk of developing aspiration pneumonia and delirium as a complication of their hospitalization. While patients with PD more often have early DNR orders, they have greater utilization of life-sustaining therapies and experience worse outcomes of their hospitalization including new nursing facility requirement upon discharge and greater mortality.
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Affiliation(s)
- Benjamin P. George
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - William A. Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Anish Sethi
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
- Drexel University College of Medicine, Philadelphia, PA, United States
| | - Irene H. Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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7
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McArthur JC, Augustine EF, Carmichael ST, Ferriero DM, Jensen FE, Jeste SS, Jordan LC, Llinas RH, Schlaggar BL, Sun LR, Pomeroy SL. Recognizing and Responding to the Needs of Future Child and Adult Neurology Care Through the Evolution of Residency Training. Ann Neurol 2023; 94:1005-1007. [PMID: 37755722 DOI: 10.1002/ana.26809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
Recent insights into the frequency of occurrence and the genetic and mechanistic basis of nervous system disease have demonstrated that neurologic disorders occur as a spectrum across all ages. To meet future needs of patients with neurologic disease of all ages and prepare for increasing implementaton of precision therapies, greater integration of child and adult neurology residency training is needed. ANN NEUROL 2023;94:1005-1007.
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Affiliation(s)
| | - Erika F Augustine
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Donna M Ferriero
- Departments of Neurology and Pediatrics, University of California, San Francisco, CA, USA
| | - Frances E Jensen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shafali S Jeste
- Departments of Neurology and Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rafael H Llinas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bradley L Schlaggar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott L Pomeroy
- Department of Neurology, Harvard Medical School, Boston, MA, USA
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8
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McDaniels B, Pontone GM, Keener AM, Subramanian I. A Prescription for Wellness in Early PD: Just What the Doctor Ordered. J Geriatr Psychiatry Neurol 2023; 36:461-469. [PMID: 36911924 DOI: 10.1177/08919887231164358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Being diagnosed with a neurodegenerative disease is a life-changing event and a critical time to help patients cope and move forward in a proactive way. Historically, the main focus of Parkinson's disease (PD) treatment has been on the motor features with limited attention given to non-motor and mental health sequelae, which have the most impact on quality of life. Although depression and anxiety have been described at the time of PD diagnosis, demoralization, intolerance of uncertainty, decreased self-efficacy, stigma and loneliness can also present and have negative effects on the trajectory of the disease. Hence, understanding the psychological impact of the diagnosis and how to provide better counselling at this critical time point may be the key to a better long-term trajectory and quality of life. FOCUS There has been a paradigm shift in the treatment of chronic illness moving beyond the medical model, which focuses on fighting illness with the physician being in charge of the treatment process and the patient being the passive recipient, toward a more holistic (i.e., physical, psychological, social, and spiritual health) biopsychosocial approach that emphasizes behavioral factors with the patient being an active collaborator in their treatment. Hence, we propose that fostering resilience, social support, and psychological flexibility offer promise toward attenuating negative reactions and improving overall well-being. CONCLUSION Through a proactive wellness approach incorporating lifestyle choices, people with PD (PwP) can not only achieve improved states of health, well-being, and quality of life, but actually thrive.
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Affiliation(s)
- Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
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Pereira JB, Kumar A, Hall S, Palmqvist S, Stomrud E, Bali D, Parchi P, Mattsson-Carlgren N, Janelidze S, Hansson O. DOPA decarboxylase is an emerging biomarker for Parkinsonian disorders including preclinical Lewy body disease. NATURE AGING 2023; 3:1201-1209. [PMID: 37723208 PMCID: PMC10570139 DOI: 10.1038/s43587-023-00478-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/01/2023] [Indexed: 09/20/2023]
Abstract
The diagnosis of Parkinsonian disorders is currently based on clinical criteria, which have limited sensitivity until most dopaminergic neurons are lost. Here we show that cerebrospinal fluid levels of DOPA decarboxylase (DDC) (also known as aromatic L-amino acid decarboxylase) can accurately identify patients with Lewy body disease (LBD) (area under the curve (AUC) = 0.89; PFDR = 2.6 × 10-13) and are associated with worse cognitive performance (P < 0.05). We also found that DDC can detect preclinical LBD stages in clinically unimpaired individuals with a positive seed amplification α-synuclein assay (AUC = 0.81, P = 1.0 × 10-5) and that this biomarker could predict progression to clinical LBD over a 3-year period in preclinical cases (hazard ratio = 3.7 per s.d. change, confidence interval = 1.1-12.7). Moreover, DDC levels were also increased in atypical Parkinsonian disorders but not in non-Parkinsonian neurodegenerative disorders. These cerebrospinal fluid results were replicated in an independent cohort, where we also found that DDC levels in plasma could identify both LBD and atypical Parkinsonian disorders (AUC = 0.92, P = 1.3 × 10-14). Our results show that DDC might have a future role in clinical practice as a biomarker of dopaminergic dysfunction to detect Parkinsonian disorders even during the preclinical disease stages and predict their progression to clinical LBD.
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Affiliation(s)
- Joana B Pereira
- Division of Neuro, Department of Clinical Neutaroscience, Karolinska Institutet, Solna, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Atul Kumar
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sara Hall
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Divya Bali
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Piero Parchi
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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10
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Liu X, Ding Y, Jiang C, Ma X, Xin Y, Li Y, Zhang S, Shao B. Astragaloside IV ameliorates radiation-induced nerve cell damage by activating the BDNF/TrkB signaling pathway. Phytother Res 2023; 37:4102-4116. [PMID: 37226643 DOI: 10.1002/ptr.7872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/23/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
Radiation can induce nerve cell damage. Synapse connectivity and functionality are thought to be the essential foundation of all cognitive functions. Therefore, treating and preventing damage to synaptic structure and function is an urgent challenge. Astragaloside IV (AS-IV) is a glycoside extracted from Astragalus membranaceus (Fisch.). Bunge is a widely used traditional Chinese medicine in China with various pharmacological properties, including protective effects on the central nervous system (CNS). In this study, the effect of AS-IV on synapse damage and BDNF/TrkB signaling pathway in radiated C57BL/6 mice with X-rays was investigated. PC12 cells and primary cortical neurons were exposed to UVA in vitro. Open field test and rotarod test were used to observe the effects of AS-IV on the motor and explore the abilities of radiated mice. The pathological changes in the brain were observed by hematoxylin and eosin and Nissl staining. Immunofluorescence analysis was used to detect the synapse damage. The expressions of the BDNF/TrkB pathway and neuroprotection-related molecules were detected by Western blotting and Quantitative-RTPCR, respectively. The results showed that AS-IV could improve the motor and explore abilities of radiated mice, reduce pathological damage to the cortex, enhance neuroprotection functions, and activate BDNF/TrkB pathway. In conclusion, AS-IV could relieve radiation-induced synapse damage, at least partly through the BDNF/TrkB pathway.
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Affiliation(s)
- Xin Liu
- Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Yanping Ding
- School of Life Sciences, Northwest Normal University, Lanzhou, China
| | - Chenxin Jiang
- Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Xin Ma
- Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Yuanyuan Xin
- Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Yingdong Li
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Shengxiang Zhang
- Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Baoping Shao
- Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
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11
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Uchitomi H, Ming X, Zhao C, Ogata T, Miyake Y. Classification of mild Parkinson's disease: data augmentation of time-series gait data obtained via inertial measurement units. Sci Rep 2023; 13:12638. [PMID: 37537260 PMCID: PMC10400620 DOI: 10.1038/s41598-023-39862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023] Open
Abstract
Data-augmentation methods have emerged as a viable approach for improving the state-of-the-art performances for classifying mild Parkinson's disease using deep learning with time-series data from an inertial measurement unit, considering the limited amount of training datasets available in the medical field. This study investigated effective data-augmentation methods to classify mild Parkinson's disease and healthy participants with deep learning using a time-series gait dataset recorded via a shank-worn inertial measurement unit. Four magnitude-domain-transformation and three time-domain-transformation data-augmentation methods, and four methods involving mixtures of the aforementioned methods were applied to a representative convolutional neural network for the classification, and their performances were compared. In terms of data-augmentation, compared with baseline classification accuracy without data-augmentation, the magnitude-domain transformation performed better than the time-domain transformation and mixed-data augmentation. In the magnitude-domain transformation, the rotation method significantly contributed to the best performance improvement, yielding accuracy and F1-score improvements of 5.5 and 5.9%, respectively. The augmented data could be varied while maintaining the features of the time-series data obtained via the sensor for detecting mild Parkinson's in gait; this data attribute may have caused the aforementioned trend. Notably, the selection of appropriate data extensions will help improve the classification performance for mild Parkinson's disease.
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Affiliation(s)
- Hirotaka Uchitomi
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Yokohama, 226-8502, Japan.
| | - Xianwen Ming
- Department of Systems and Control Engineering, School of Engineering, Tokyo Institute of Technology, Yokohama, 226-8502, Japan
| | - Changyu Zhao
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Yokohama, 226-8502, Japan
| | - Taiki Ogata
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Yokohama, 226-8502, Japan
| | - Yoshihiro Miyake
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Yokohama, 226-8502, Japan
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12
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Kundrick A, Hogue O, Namrow S, Samala R, Walter E, Walter B, Fernandez H, Margolius A. Adopting a palliative care mindset is an unmet need in Parkinson's disease. Clin Park Relat Disord 2023; 9:100206. [PMID: 37448833 PMCID: PMC10336662 DOI: 10.1016/j.prdoa.2023.100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Parkinson's disease (PD) affects multiple facets of patients' lives, many of which may not be recognized or addressed by their healthcare team. A growing body of evidence has shown that palliative care improves patients' quality of life with PD; however, little is currently known about how patients with PD perceive palliative care. Methods An 8-question multiple choice survey was created and given to patients with established care for PD at a movement disorders clinic in a quaternary care center. Patients with less than two years of follow-up or that had atypical features of PD were excluded from the survey. Results There were 106 respondents to the survey. A third of patients reported having never heard of palliative care and an additional 25% had heard of it but did not know what it was. Eighty-eight percent reported being familiar with or very knowledgeable about hospice, though 50% of respondents did not know the difference between hospice and palliative care. 93% had never been offered either service. 37.7% thought their neurologist should discuss advance care planning early in the course of their disease. Conclusion Even among established patients with Parkinson's disease in a quaternary center, over half were not familiar with palliative care, and the majority had never been offered palliative or hospice services despite growing evidence that it could improve their quality of life. Additionally, patients would like to be introduced to advanced care planning early in the course of their disease.
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Affiliation(s)
- Avery Kundrick
- Center for Neurological Restoration, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, United States
| | - Olivia Hogue
- Center for Neurological Restoration, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, United States
| | | | - Renato Samala
- Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Ellen Walter
- Center for Neurological Restoration, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, United States
| | - Benjamin Walter
- Center for Neurological Restoration, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, United States
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, United States
| | - Adam Margolius
- Center for Neurological Restoration, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, United States
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13
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Homolak J. Targeting the microbiota-mitochondria crosstalk in neurodegeneration with senotherapeutics. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2023; 136:339-383. [PMID: 37437983 DOI: 10.1016/bs.apcsb.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Neurodegenerative diseases are a group of age-related disorders characterized by a chronic and progressive loss of function and/or structure of synapses, neurons, and glial cells. The etiopathogenesis of neurodegenerative diseases is characterized by a complex network of intricately intertwined pathophysiological processes that are still not fully understood. Safe and effective disease-modifying treatments are urgently needed, but still not available. Accumulating evidence suggests that gastrointestinal dyshomeostasis and microbial dysbiosis might play an important role in neurodegeneration by acting as either primary or secondary pathophysiological factors. The research on the role of microbiota in neurodegeneration is in its early phase; however, accumulating evidence suggests that dysbiosis might promote neurodegenerative diseases by disrupting mitochondrial function and inducing mitochondrial dysfunction-associated senescence (MiDAS), possibly due to bidirectional crosstalk based on the common evolutionary origin of mitochondria and bacteria. Cellular senescence is an onco-supressive homeostatic mechanism that results in an irreversible cell cycle arrest upon exposure to noxious stimuli. Senescent cells resist apoptosis via senescent cell anti-apoptotic pathways (SCAPs) and transition into a state known as senescence-associated secretory phenotype (SASP) that generates a cytotoxic proinflammatory microenvironment. Cellular senescence results in the adoption of a detrimental vicious cycle driven by dysbiosis, mitochondrial dysfunction, inflammation, and oxidative stress - a pathophysiological positive feedback loop that results in neuroinflammation and neurodegeneration. Detrimental effects of MiDAS might be prevented and abolished by mitochondria-targeted senotherapeutics, a group of drugs specifically designed to alleviate senescence by inhibiting SCAPs (senolytics), or inhibiting SASP (senomorphics).
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Affiliation(s)
- Jan Homolak
- Department of Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia; Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.
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14
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O'Shea N, Lyons S, Higgins S, O'Dowd S. Neurological update: the palliative care landscape for atypical parkinsonian syndromes. J Neurol 2023; 270:2333-2341. [PMID: 36688987 DOI: 10.1007/s00415-023-11574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
Atypical parkinsonian syndromes are neurodegenerative conditions, characterised by rapid disease progression and shorter life expectancy compared to idiopathic Parkinson's disease. These conditions inflict substantial physical and psychosocial burden on patients and their families; hence, there is a clear rationale for a palliative care approach from diagnosis. An interdisciplinary care model has been shown to improve symptom burden, quality of life and engagement with advance care planning, in a heterogeneous group of neurodegenerative conditions. In this update, we summarise how the landscape for treating these patients has changed and the questions that still need to be resolved.
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Affiliation(s)
- Noreen O'Shea
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6WRY72, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
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15
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Tang X, Xing S, Ma M, Xu Z, Guan Q, Chen Y, Feng F, Liu W, Chen T, Chen Y, Sun H. The Development and Design Strategy of Leucine-Rich Repeat Kinase 2 Inhibitors: Promising Therapeutic Agents for Parkinson's Disease. J Med Chem 2023; 66:2282-2307. [PMID: 36758171 DOI: 10.1021/acs.jmedchem.2c01552] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder affecting millions of people worldwide. Mutations in the gene encoding leucine-rich repeat kinase 2 (LRRK2) are the most common genetic risk factor for PD. Elevated LRRK2 kinase activity is found in idiopathic and familial PD cases. LRRK2 mutations are involved in multiple PD pathogeneses, including dysregulation of mitochondrial homeostasis, ciliogenesis, etc. Here, we provide a comprehensive overview of the biological function, structure, and mutations of LRRK2. We also examine recent advances and challenges in developing LRRK2 inhibitors and address prospective protein-based targeting strategies. The binding mechanisms, structure-activity relationships, and pharmacokinetic features of inhibitors are emphasized to provide a comprehensive compendium on the rational design of LRRK2 inhibitors. We hope that this publication can serve as a guide for designing novel LRRK2 inhibitors based on the summarized facts and perspectives.
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Affiliation(s)
- Xu Tang
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Shuaishuai Xing
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Mingkang Ma
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Ziwei Xu
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Qianwen Guan
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Yuting Chen
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Feng Feng
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing 211198, People's Republic of China
- Jiangsu Food and Pharmaceuticals Science College, Institute of Food and Pharmaceuticals Research, Huai'an 223005, People's Republic of China
| | - Wenyuan Liu
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Tingkai Chen
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Yao Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Haopeng Sun
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
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16
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Contaldi E, Magistrelli L, Comi C. Disease mechanisms as subtypes: Immune dysfunction in Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:67-93. [PMID: 36803824 DOI: 10.1016/b978-0-323-85555-6.00008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In recent years, the contraposition between inflammatory and neurodegenerative processes has been increasingly challenged. Inflammation has been emphasized as a key player in the onset and progression of Parkinson disease (PD) and other neurodegenerative disorders. The strongest indicators of the involvement of the immune system derived from evidence of microglial activation, profound imbalance in phenotype and composition of peripheral immune cells, and impaired humoral immune responses. Moreover, peripheral inflammatory mechanisms (e.g., involving the gut-brain axis) and immunogenetic factors are likely to be implicated. Even though several lines of preclinical and clinical studies are supporting and defining the complex relationship between the immune system and PD, the exact mechanisms are currently unknown. Similarly, the temporal and causal connections between innate and adaptive immune responses and neurodegeneration are unsettled, challenging our ambition to define an integrated and holistic model of the disease. Despite these difficulties, current evidence is providing the unique opportunity to develop immune-targeted approaches for PD, thus enriching our therapeutic armamentarium. This chapter aims to provide an extensive overview of past and present studies that explored the implication of the immune system in neurodegeneration, thus paving the road for the concept of disease modification in PD.
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Affiliation(s)
- Elena Contaldi
- Movement Disorders Centre, "Maggiore della Carità" University Hospital, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, "Maggiore della Carità" University Hospital, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Cristoforo Comi
- Neurology Unit, S.Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Vercelli, Italy.
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17
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Mahajan A, Shih LC. Introduction to Diagnostic Challenges in Movement Disorders. Semin Neurol 2023; 43:2-3. [PMID: 36807281 DOI: 10.1055/s-0043-1762913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Ludy C Shih
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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18
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Mahajan A, Shih LC. Introduction to Diagnostic Challenges in Movement Disorders. Semin Neurol 2023; 43:2-3. [PMID: 37011664 DOI: 10.1055/s-0043-1764291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Ludy C Shih
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
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19
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Fleisher JE, Suresh M, Klostermann EC, Lee J, Hess SP, Myrick E, Mitchem D, Woo K, Sennott BJ, Witek NP, Chen SM, Beck JC, Ouyang B, Wilkinson JR, Hall DA, Chodosh J. IN-HOME-PDCaregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease. Parkinsonism Relat Disord 2023; 106:105222. [PMID: 36446676 PMCID: PMC9825655 DOI: 10.1016/j.parkreldis.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Family caregivers of people with advanced Parkinson's Disease (PD) are at high risk of caregiver strain, which independently predicts adverse patient outcomes. We tested the effects of one year of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) with 16 weeks of peer mentoring on caregiver strain compared with usual care. METHODS We enrolled homebound people with advanced PD (PWPD) and their primary caregiver as IN-HOME-PD dyads. We trained experienced PD family caregivers as peer mentors. Dyads received four structured home visits focused on advanced symptom management, home safety, medications, and psychosocial needs. Starting at approximately four months, caregivers spoke weekly with a peer mentor for 16 weeks. We compared one-year change in caregiver strain (MCSI, range 0-72) with historical controls, analyzed intervention acceptability, and measured change in anxiety, depression, and self-efficacy. RESULTS Longitudinally, IN-HOME-PD caregiver strain was unchanged (n = 51, 23.34 (SD 9.43) vs. 24.32 (9.72), p = 0.51) while that of controls worsened slightly (n = 154, 16.45 (10.33) vs. 17.97 (10.88), p = 0.01). Retention in peer mentoring was 88.2%. Both mentors and mentees rated 100% of mentoring calls useful, with mean satisfaction of 91/100 and 90/100, respectively. There were no clinically significant improvements in anxiety, depression, or self-efficacy. CONCLUSIONS Interdisciplinary telehealth-enhanced home visits combined with peer mentoring mitigated the worsening strain observed in caregivers of less advanced individuals. Mentoring was met with high satisfaction. Future caregiver-led peer mentoring interventions are warranted given the growing, unmet needs of PD family caregivers. TRIAL REGISTRATION NCT03189459.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Madhuvanthi Suresh
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Ellen C Klostermann
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Serena P Hess
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Brianna J Sennott
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie P Witek
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Sarah Mitchell Chen
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - James C Beck
- Parkinson's Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA.
| | - Bichun Ouyang
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jayne R Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Deborah A Hall
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
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20
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A new scheme for the development of IMU-based activity recognition systems for telerehabilitation. Med Eng Phys 2022; 108:103876. [DOI: 10.1016/j.medengphy.2022.103876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/10/2022] [Accepted: 08/21/2022] [Indexed: 11/24/2022]
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21
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Elyasi L, Rosenholm JM, Jesmi F, Jahanshahi M. The Antioxidative Effects of Picein and Its Neuroprotective Potential: A Review of the Literature. Molecules 2022; 27:molecules27196189. [PMID: 36234724 PMCID: PMC9571929 DOI: 10.3390/molecules27196189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Neurodegenerative diseases (NDDs) are the main cause of dementia in the elderly, having no cure to date, as the currently available therapies focus on symptom remission. Most NDDs will progress despite treatment and eventually result in the death of the patient after several years of a burden on both the patient and the caregivers. Therefore, it is necessary to investigate agents that tackle the disease pathogenesis and can efficiently slow down or halt disease progression, with the hope of curing the patients and preventing further burden and mortality. Accordingly, recent research has focused on disease-modifying treatments with neuroregenerative or neuroprotective effects. For this purpose, it is necessary to understand the pathogenesis of NDDs. It has been shown that oxidative stress plays an important role in the damage to the central nervous system and the progression of neurodegenerative disorders. Furthermore, mitochondrial dysfunction and the accumulation of unfolded proteins, including beta-amyloid (Aβ), tau proteins, and α-synuclein, have been suggested. Accordingly, cellular and molecular studies have investigated the efficacy of several natural compounds (herbs and nutritional agents) for their neuroprotective and antioxidative properties. The most popular herbs suggested for the treatment and/or prevention of NDDs include Withania somnifera (ashwagandha), ginseng, curcumin, resveratrol, Baccopa monnieri, and Ginkgo biloba. In some herbs, such as ginseng, preclinical and clinical evidence are available for supporting its effectiveness; however, in some others, only cellular and animal studies are available. In line with the scant literature in terms of the effectiveness of herbal compounds on NDDs, there are also other herbal agents that have been disregarded. Picein is one of the herbal agents that has been investigated in only a few studies. Picein is the active ingredient of several herbs and can be thus extracted from different types of herbs, which makes it more available. It has shown to have anti-inflammatory properties in cellular and plant studies; however, to date, only one study has suggested its neuroprotective properties. Furthermore, some cellular studies have shown no anti-inflammatory effect of picein. Therefore, a review of the available literature is required to summarize the results of studies on picein. To date, no review study seems to have addressed this issue. Thus, in the present study, we gather the available information about the antioxidative and potential neuroprotective properties of picein and its possible effectiveness in treating NDDs. We also summarize the plants from which picein can be extracted in order to guide researchers for future investigations.
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Affiliation(s)
- Leila Elyasi
- Neuroscience Research Center, Department of Anatomy, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan 4917955315, Iran
- Correspondence: ; Tel./Fax: +98-17-32453515
| | - Jessica M. Rosenholm
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, 20500 Turku, Finland
| | - Fatemeh Jesmi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran 1415944911, Iran
| | - Mehrdad Jahanshahi
- Neuroscience Research Center, Department of Anatomy, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan 4917955315, Iran
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22
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Ratliff JB, Schaefer SM, Chitnis S, Cooney JW, Hess CW, Okubadejo N, Shalash A, Moro E, Sue C, Pandey S, Pal PK, Yang L. Viewpoint on Milestones for Fellowship Training in Movement Disorders. Mov Disord 2022; 37:1605-1609. [PMID: 35816077 PMCID: PMC9543200 DOI: 10.1002/mds.29146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jeffrey B Ratliff
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sara M Schaefer
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Shilpa Chitnis
- Department of Neurology, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey W Cooney
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Christopher W Hess
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Elena Moro
- Grenoble Alpes University, CHU de Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Carolyn Sue
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Laurice Yang
- Department of Neurology, Stanford University, Palo Alto, California, USA
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23
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Mora Pinzon M, Krainer J, LeCaire T, Houston S, Green‐Harris G, Norris N, Barnes S, Clark LR, Gleason CE, Hermann BP, Ramon H, Buckingham W, Chin NA, Asthana S, Johnson SC, Walaszek A, Carlsson CM. The Wisconsin Alzheimer's Institute Dementia Diagnostic Clinic Network: A community of practice to improve dementia care. J Am Geriatr Soc 2022; 70:2121-2133. [PMID: 35362093 PMCID: PMC9542133 DOI: 10.1111/jgs.17768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/05/2022] [Accepted: 03/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Wisconsin Alzheimer's Institute (WAI) Dementia Diagnostic Clinic Network is a community of practice formed in 1998 as a collaboration of community-based clinics from various healthcare systems throughout the state. Its purpose is to promote the use of evidence-based strategies to provide high quality care throughout Wisconsin for people with dementia. The purpose of this study is to describe the use of a community of practice to facilitate education of healthcare providers on best practices in dementia care, and the implementation of an interprofessional approach to diagnose and manage dementia and related disorders. METHODS Cross-sectional study of the members of the WAI's Dementia Diagnosis Clinic Network. Characteristics of clinics and healthcare teams, learners' participation in educational events and educational outcomes were collected from evaluation forms. Number and characteristics of patients seen in the memory clinics were collected from de-identified data forms submitted by members to a centralized location for data analysis. RESULTS The clinic network currently has 38 clinics affiliated with 26 different healthcare systems or independent medical groups in 21 of 72 Wisconsin counties. Most (56%) are based in primary care, 15% in psychiatry, and 29% in neurology. Between 2018 and 2021, we received data on 4710 patients; 92% were ≥65 years old, 60% were female, and 92% were white. Network members meet in-person twice a year to learn about innovations in the field of dementia care and to share best practices. Educational events associated with the network are shown to be relevant, useful, and improve knowledge and skills of participants. CONCLUSION Communities of practice provide added value via shared best practices and educational resources, continuing education of the health workforce, continuous quality improvement of clinical practices, and adoption of new diagnostic and management approaches in dementia care.
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Affiliation(s)
- Maria Mora Pinzon
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA,Department of Family Medicine and Community HealthUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Jody Krainer
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Tamara LeCaire
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Stephanie Houston
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Gina Green‐Harris
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Nia Norris
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Stacy Barnes
- College of NursingMarquette UniversityMilwaukeeWisconsinUSA
| | - Lindsay R. Clark
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Carey E. Gleason
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Bruce P. Hermann
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | | | - Will Buckingham
- Center for Health Disparities Research (CHDR), School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sanjay Asthana
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Art Walaszek
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA,Department of PsychiatryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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24
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Minen MT, George A, Camacho E, Yao L, Sahu A, Campbell M, Soviero M, Hossain Q, Verma D, Torous J. Assessment of Smartphone Apps for Common Neurologic Conditions (Headache, Insomnia, and Pain): Cross-sectional Study. JMIR Mhealth Uhealth 2022; 10:e36761. [PMID: 35727625 PMCID: PMC9257611 DOI: 10.2196/36761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are thousands of apps for individuals struggling with headache, insomnia, and pain, but it is difficult to establish which of these apps are best suited for patients' specific needs. If clinicians were to have access to a platform that would allow them to make an informed decision on the efficacy and feasibility of smartphone apps for patient care, they would feel confident in prescribing specific apps. OBJECTIVE We sought to evaluate the quality of apps for some of the top common, disabling neurologic conditions (headache, insomnia, and pain) based on principles derived from the American Psychiatric Association's (APA) app evaluation model. METHODS We used the Mobile Health Index and Navigation database and expanded upon the database's current supported conditions by adding 177 new app entries. Each app was rated for consistency with the APA's app evaluation model, which includes 105 objective questions based on the following 5 major classes of consideration: (1) accessibility, (2) privacy and security, (3) clinical foundation, (4) engagement style, and (5) interoperability. These characteristics were evaluated to gain a broader understanding of the significant features of each app category in comparison against a control group. RESULTS Approximately 90% (187/201) of all apps evaluated were free to download, but only 50% (63/201) of headache- and pain-related apps were truly free. Most (87/106, 81%) sleep apps were not truly free to use. The apps had similar limitations with limited privacy, accessibility, and crisis management resources. For example, only 17% (35/201) of the apps were available in Spanish. The apps offered mostly self-help tools with little tailoring; symptom tracking was the most common feature in headache- (32/48, 67%) and pain-related apps (21/47, 45%), whereas mindfulness was the most common feature in sleep-related apps (73/106, 69%). CONCLUSIONS Although there are many apps for headache, pain, and insomnia, all 3 types of apps have room for improvement around accessibility and privacy. Pain and headache apps share many common features, whereas insomnia apps offer mostly mindfulness-based resources. Given the many available apps to pick from, clinicians and patients should seek apps that offer the highest-quality features, such as complete privacy, remedial features, and the ability to download the app at no cost. These results suggest that there are many opportunities for the improvement of apps centered on headache, insomnia, and pain.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Alexis George
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Erica Camacho
- Department of Psychiatry, Beth Israel Deaconess Medical Center, New York, NY, United States
| | - Leslie Yao
- Barnard College, New York, NY, United States
| | - Ananya Sahu
- Barnard College, New York, NY, United States
| | | | - Mia Soviero
- Barnard College, New York, NY, United States
| | - Quazi Hossain
- The City College of New York, New York, NY, United States
| | - Deepti Verma
- The City College of New York, New York, NY, United States
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, New York, NY, United States
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25
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Culig L, Chu X, Bohr VA. Neurogenesis in aging and age-related neurodegenerative diseases. Ageing Res Rev 2022; 78:101636. [PMID: 35490966 PMCID: PMC9168971 DOI: 10.1016/j.arr.2022.101636] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
Abstract
Adult neurogenesis, the process by which neurons are generated in certain areas of the adult brain, declines in an age-dependent manner and is one potential target for extending cognitive healthspan. Aging is a major risk factor for neurodegenerative diseases and, as lifespans are increasing, these health challenges are becoming more prevalent. An age-associated loss in neural stem cell number and/or activity could cause this decline in brain function, so interventions that reverse aging in stem cells might increase the human cognitive healthspan. In this review, we describe the involvement of adult neurogenesis in neurodegenerative diseases and address the molecular mechanistic aspects of neurogenesis that involve some of the key aggregation-prone proteins in the brain (i.e., tau, Aβ, α-synuclein, …). We summarize the research pertaining to interventions that increase neurogenesis and regulate known targets in aging research, such as mTOR and sirtuins. Lastly, we share our outlook on restoring the levels of neurogenesis to physiological levels in elderly individuals and those with neurodegeneration. We suggest that modulating neurogenesis represents a potential target for interventions that could help in the fight against neurodegeneration and cognitive decline.
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Affiliation(s)
- Luka Culig
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Xixia Chu
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Vilhelm A Bohr
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
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26
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Nie P, Zhang J, Yang X, Shao Y, Zhang X, Liu W, Fu K, Chen J, Zhang J. Remote Programming in Patients With Parkinson's Disease After Deep Brain Stimulation: Safe, Effective, and Economical. Front Neurol 2022; 13:879250. [PMID: 35592473 PMCID: PMC9111520 DOI: 10.3389/fneur.2022.879250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to evaluate the safety, efficiency, and cost expenditure of remote programming in patients with Parkinson's disease (PD) after deep brain stimulation (DBS). Methods A total of 74 patients who underwent DBS at the Department of Neurosurgery, Zhongnan Hospital of Wuhan University between June 2018 and June 2020 were enrolled in this study. There were 27 patients in the remote programming group and 47 patients in the outpatient programming group. Clinical data, programming efficiency, adverse events, expenditure, and satisfaction were compared between the two groups. Results A total of 36 times of remote programming were performed on the 27 patients in the remote programming group, and four had mild adverse events during programming, and the adverse events disappeared within 1 week. The satisfaction questionnaire showed that 97.3% of the patients were satisfied with the surgical effect. The patients in the remote programming group (88.9%) were more likely to receive long-term programming after DBS than the patients in the outpatient programming group (74.5%). The Parkinsonism symptoms improved in both programming groups. The majority (18/27) of patients in the remote programming group lived away from the programming center, while the majority (27/47) of patients in the outpatient programming group lived in Wuhan, where the programming center was located (P = 0.046). The cost per patient per programming was US$ 43.5 in the remote programming group and $59.5 (56–82.7) in the outpatient programming group (P < 0.001). The median time cost for each visit was 30 min (25–30) in the remote programming group and 150 min (135–270.0) in the outpatient programming group (P < 0.001). Conclusion Remote programming is safe and effective after DBS in patients with Parkinson's disease. Moreover, it reduces expenditure and time costs for patients and achieves high satisfaction, particularly for patients living far from programming centers.
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Affiliation(s)
- Pan Nie
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuyang Shao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiuming Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kai Fu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Jie Zhang
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27
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Zhuo W, Lundquist AJ, Donahue EK, Guo Y, Phillips D, Petzinger GM, Jakowec MW, Holschneider DP. A mind in motion: Exercise improves cognitive flexibility, impulsivity and alters dopamine receptor gene expression in a Parkinsonian rat model. CURRENT RESEARCH IN NEUROBIOLOGY 2022; 3:100039. [DOI: 10.1016/j.crneur.2022.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/06/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022] Open
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28
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Rehman RZU, Guan Y, Shi JQ, Alcock L, Yarnall AJ, Rochester L, Del Din S. Investigating the Impact of Environment and Data Aggregation by Walking Bout Duration on Parkinson's Disease Classification Using Machine Learning. Front Aging Neurosci 2022; 14:808518. [PMID: 35391750 PMCID: PMC8981298 DOI: 10.3389/fnagi.2022.808518] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease. PD misdiagnosis can occur in early stages. Gait impairment in PD is typical and is linked with an increased fall risk and poorer quality of life. Applying machine learning (ML) models to real-world gait has the potential to be more sensitive to classify PD compared to laboratory data. Real-world gait yields multiple walking bouts (WBs), and selecting the optimal method to aggregate the data (e.g., different WB durations) is essential as this may influence classification performance. The objective of this study was to investigate the impact of environment (laboratory vs. real world) and data aggregation on ML performance for optimizing sensitivity of PD classification. Gait assessment was performed on 47 people with PD (age: 68 ± 9 years) and 52 controls [Healthy controls (HCs), age: 70 ± 7 years]. In the laboratory, participants walked at their normal pace for 2 min, while in the real world, participants were assessed over 7 days. In both environments, 14 gait characteristics were evaluated from one tri-axial accelerometer attached to the lower back. The ability of individual gait characteristics to differentiate PD from HC was evaluated using the Area Under the Curve (AUC). ML models (i.e., support vector machine, random forest, and ensemble models) applied to real-world gait showed better classification performance compared to laboratory data. Real-world gait characteristics aggregated over longer WBs (WB 30-60 s, WB > 60 s, WB > 120 s) resulted in superior discriminative performance (PD vs. HC) compared to laboratory gait characteristics (0.51 ≤ AUC ≤ 0.77). Real-world gait speed showed the highest AUC of 0.77. Overall, random forest trained on 14 gait characteristics aggregated over WBs > 60 s gave better performance (F1 score = 77.20 ± 5.51%) as compared to laboratory results (F1 Score = 68.75 ± 12.80%). Findings from this study suggest that the choice of environment and data aggregation are important to achieve maximum discrimination performance and have direct impact on ML performance for PD classification. This study highlights the importance of a harmonized approach to data analysis in order to drive future implementation and clinical use. Clinical Trial Registration [09/H0906/82].
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Affiliation(s)
- Rana Zia Ur Rehman
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yu Guan
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jian Qing Shi
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China
| | - Lisa Alcock
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Silvia Del Din
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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29
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Leeper H, Cooper D, Armstrong T. Palliative Care Intervention Trials for Adults Living With Progressive Central Nervous System Diseases and Their Caregivers: A Systematic Review. J Pain Symptom Manage 2022; 63:e88-e110. [PMID: 34147576 PMCID: PMC8683574 DOI: 10.1016/j.jpainsymman.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Interest in implementing palliative care for adults living with progressive central nervous system diseases (PCNSD) and their caregivers is increasing. OBJECTIVES To inform evidence-based practice and future research by critically evaluating randomized clinical trials (RCTs) investigating palliative care interventions (PCIs) for adults living with PCNSD and their caregivers using self-reported outcomes and the patient- and caregiver-reported outcome measures employed. METHODS A systematic search using PRISMA methods of EMBASE, PubMed, Scopus, Web of Science databases using index and keyword methods for articles published from inception through February 28, 2021 was performed. RCTs investigating PCI as their primary aim using patient- and/or caregiver-reported outcomes to assess PCI effectiveness in adults living with PCNSD and their caregivers were included for qualitative synthesis. RESULTS Five RCTs met criteria and used 21 unique outcome measures. Pooled patient diagnoses included multiple sclerosis, motor neuron disease and movement disorders, primarily Parkinson's Disease. All five RCTs assessed PCI effectiveness on patient symptom burden and caregiver burden, and three RCTs used patient QOL as a primary outcome. Overall risk of bias was low. Pooled positive findings were limited to very modest changes in patient QOL, specific physical symptoms and caregiver burden. Most outcome measures lacked clinimetric responsiveness to detect change whether caused by disease or an intervention to the patient or caregiver. CONCLUSION Sparse, low-certainty evidence for PCI impact on patient QOL, symptom burden and caregiver burden indicate future research should consider refining study populations, interventions, outcomes assessed and outcome measures to detect any change due to PCI.
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Affiliation(s)
- HeatherE Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland.
| | - Diane Cooper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
| | - TerriS Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
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Subramanian I, Hinkle JT, Chaudhuri KR, Mari Z, Fernandez H, Pontone GM. Mind the gap: Inequalities in mental health care and lack of social support in Parkinson disease. Parkinsonism Relat Disord 2021; 93:97-102. [PMID: 34887173 PMCID: PMC9664995 DOI: 10.1016/j.parkreldis.2021.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.
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Affiliation(s)
- Indu Subramanian
- Dept of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Southwest Parkinson's Disease Research, Education and Clinical Centers, Veterans Administration, Los Angeles, CA, USA.
| | - Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, King's College London, London, UK; Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Zoltan Mari
- Parkinson's and Movement Disorders Program, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory M Pontone
- Dept. of Neurology & Dept. of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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31
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Chepke C, Shaughnessy LW, Brunton S, Farmer JG, Rosenzweig AS, Grossberg GT, Wright WL. Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease. Int J Gen Med 2021; 14:10271-10280. [PMID: 34992442 PMCID: PMC8711560 DOI: 10.2147/ijgm.s335739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson’s disease psychosis or dementia-related psychosis.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
- Atrium Health, Charlotte, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Correspondence: Craig Chepke Email
| | - Lynn W Shaughnessy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA
- Department of Family Medicine, Touro University, Vallejo, CA, USA
| | - Jill G Farmer
- Parkinson’s Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA
- Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA
| | | | - George T Grossberg
- Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Wendy L Wright
- Wright & Associates Family Health Care, Concord and Amherst, NH, USA
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32
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Sun M, Bao W, Huang C, Xia Z, Zhang C, Wang G, Wang R, Li J, Roux S, Li Q, Zou D, Ma K, Bao X. A Novel Probiotic Formula, BIOCG, Protects Against Alzheimer's-Related Cognitive Deficits via Regulation of Dendritic Spine Dynamics. Curr Alzheimer Res 2021; 18:558-572. [PMID: 34674621 DOI: 10.2174/1567205018666211022091110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/27/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The brain-gut-microbiome axis has emerged as an important pathway through which perturbations in the gut and/or microbial microenvironment can impact neurological function. Such alterations have been implicated in a variety of neuropsychiatric disorders, includ- ing depression, anxiety, and Alzheimer's Disease (AD) and the use of probiotics as therapy for th- ese diseases remains promising. However, the mechanisms underlying the gut microenvironment's influence on disease pathogenesis and therapy remain unclear. OBJECTIVE The objective of this study is to investigate the effect of a novel probiotic formula, BIOCG, on cognitive function and pathobiological mechanisms, including amyloid processing and dendritic spine dynamics, in a mouse model of AD. METHODS BIOCG was administered for 3 months to 3xTg or 3xTg; Thy1-YFP AD mice and func- tional outcomes were assessed via behavioral testing and electrophysiology. Mechanisms relevant to AD pathogenesis including dendritic spine morphology and turnover, Amyloid Precursor Pro- tein (APP) processing and microglial phenotype were also evaluated. Finally, we sequenced fecal samples following probiotic treatment to assess the impact on gut microbial composition and corre- late the changes with the above described measures. RESULTS Mice treated with BIOCG demonstrated preserved cognitive abilities and stronger Long- Term Potentiation (LTP), spontaneous Excitatory Postsynaptic Currents (sEPSC), and glutamate-in- duced LTPs, indicative of functional and electrophysiological effects. Moreover, we observed atten- uated AD pathogenesis, including reduced Amyloid Beta (Aβ) burden, as well as more mature den- dritic spines in the BIOCG-treated. Our finding of changes in microglial number and phenotype in the treatment group suggests that this formulation may mediate its effects via attenuation of neu- roinflammation. Sequencing data confirmed that the gut microbiome in treated mice was more varied and harbored a greater proportion of "beneficial" bacteria. CONCLUSION Overall, our results indicate that treatment with BIOCG enhances microbial diversity and, through gut-brain axis interactions, attenuates neuroinflammation to produce histologic and functional improvement in AD pathogenesis.
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Affiliation(s)
- Miao Sun
- Department of Pharmacology, School of Pharmacy, Nantong University, #19 Qixiu Road, Nantong 226001, Jiangsu. China
| | - Wenchenyang Bao
- Department of Pharmacology, School of Pharmacy, Nantong University, #19 Qixiu Road, Nantong 226001, Jiangsu. China
| | - Chengyu Huang
- Department of Pharmacology, School of Pharmacy, Nantong University, #19 Qixiu Road, Nantong 226001, Jiangsu. China
| | - Ziyue Xia
- Department of Pharmacology, School of Pharmacy, Nantong University, #19 Qixiu Road, Nantong 226001, Jiangsu. China
| | - Changliang Zhang
- Jiangsu Biodep Biotechnology, 6-C2 Dongsheng West Road, Jiangyin 214400, Jiangsu. China
| | - Guangxian Wang
- Jiangsu Biodep Biotechnology, 6-C2 Dongsheng West Road, Jiangyin 214400, Jiangsu. China
| | - Runxin Wang
- Jiangsu Biodep Biotechnology, 6-C2 Dongsheng West Road, Jiangyin 214400, Jiangsu. China
| | - Jiangyu Li
- Admera Health, South Plainfield, NJ07080. United States
| | - Shaun Roux
- Probiotics Australia, 24-30 Blanck Street, Ormeau, QLD, 4208. Australia
| | - Qian Li
- Department of biology, College of Staten Island, Staten Island, NY 10314 . United States
| | - Dongmei Zou
- Department of Pharmacology, School of Pharmacy, Nantong University, #19 Qixiu Road, Nantong 226001, Jiangsu. China
| | - Kai Ma
- Jiangsu Biodep Biotechnology, 6-C2 Dongsheng West Road, Jiangyin 214400, Jiangsu. China
| | - Xiaofeng Bao
- Department of Pharmacology, School of Pharmacy, Nantong University, #19 Qixiu Road, Nantong 226001, Jiangsu. China
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Technology-based therapy-response and prognostic biomarkers in a prospective study of a de novo Parkinson's disease cohort. NPJ Parkinsons Dis 2021; 7:82. [PMID: 34535672 PMCID: PMC8448861 DOI: 10.1038/s41531-021-00227-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022] Open
Abstract
Early noninvasive reliable biomarkers are among the major unmet needs in Parkinson's disease (PD) to monitor therapy response and disease progression. Objective measures of motor performances could allow phenotyping of subtle, undetectable, early stage motor impairments of PD patients. This work aims at identifying prognostic biomarkers in newly diagnosed PD patients and quantifying therapy-response. Forty de novo PD patients underwent clinical and technology-based kinematic assessments performing motor tasks (MDS-UPDRS part III) to assess tremor, bradykinesia, gait, and postural stability (T0). A visit after 6 months (T1) and a clinical and kinematic assessment after 12 months (T2) where scheduled. A clinical follow-up was provided between 30 and 36 months after the diagnosis (T3). We performed an ANOVA for repeated measures to compare patients' kinematic features at baseline and at T2 to assess therapy response. Pearson correlation test was run between baseline kinematic features and UPDRS III score variation between T0 and T3, to select candidate kinematic prognostic biomarkers. A multiple linear regression model was created to predict the long-term motor outcome using T0 kinematic measures. All motor tasks significantly improved after the dopamine replacement therapy. A significant correlation was found between UPDRS scores variation and some baseline bradykinesia (toe tapping amplitude decrement, p = 0.009) and gait features (velocity of arms and legs, sit-to-stand time, p = 0.007; p = 0.009; p = 0.01, respectively). A linear regression model including four baseline kinematic features could significantly predict the motor outcome (p = 0.000214). Technology-based objective measures represent possible early and reproducible therapy-response and prognostic biomarkers.
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Poonja S, Miyasaki J, Fu X, Camicioli R, Sang T, Yuan Y, Ba F. The Trajectory of Motor Deterioration to Death in Parkinson's Disease. Front Neurol 2021; 12:670567. [PMID: 34484095 PMCID: PMC8416311 DOI: 10.3389/fneur.2021.670567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/26/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Motor progression varies even among those with a single diagnosis such as Parkinson's disease (PD) and little is known about the trajectory of motor signs prior to death. Understanding deterioration patterns may help clinicians counsel patients and proactively plan interdisciplinary care, including palliative care. The objective of this study was to examine and describe Unified Parkinson's Disease Rating Scale motor score (UPDRS-III) trajectories at the end of life in PD. Methods: A retrospective chart review was performed for deceased PD patients who attended the Parkinson and Movement Disorders Program at the University of Alberta for at least 5 years between 1999 and 2018. UPDRS-III scores were recorded for all visits. Trajectory patterns were visualized with Loess curves stratified by sex and age at diagnosis. Piecewise linear models were used to individually model the UPDRS-III scores, and the trajectories obtained were clustered based on their features. Results: Among the 202 charts reviewed, 84 meeting inclusion criteria were analyzed. The UPDRS-III increased over time regardless of sex and age. Distinct trajectory variations present in PD (e.g., Consistent Deterioration, Stability-Deterioration, Improvement-Deterioration, Deterioration-Improvement-Deterioration) were identified. Twenty-five percent of the patients were classified as Undetermined/Irregular trajectories. In addition, regardless of trajectory type, many patients experienced a steep increase in UPDRS-III approaching death. Those with disease diagnosis after age 65 years had a shorter survival time, compared to PD patients with a younger age of onset. Conclusion: Our study identified dominant types of motor trajectory in PD that can help clinicians understand their patients' course of illness. This information can help counsel patients regarding the variability in motor deterioration and should alert physicians to recognize a terminal decline. Age of disease onset was correlated with survival time.
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Affiliation(s)
- Sabrina Poonja
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janis Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Xilai Fu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tina Sang
- Department of Science, University of Alberta, Edmonton, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Singh A, Dawson TM, Kulkarni S. Neurodegenerative disorders and gut-brain interactions. J Clin Invest 2021; 131:e143775. [PMID: 34196307 DOI: 10.1172/jci143775] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Neurodegenerative disorders (NDs) affect essential functions not only in the CNS, but also cause persistent gut dysfunctions, suggesting that they have an impact on both CNS and gut-innervating neurons. Although the CNS biology of NDs continues to be well studied, how gut-innervating neurons, including those that connect the gut to the brain, are affected by or involved in the etiology of these debilitating and progressive disorders has been understudied. Studies in recent years have shown how CNS and gut biology, aided by the gut-brain connecting neurons, modulate each other's functions. These studies underscore the importance of exploring the gut-innervating and gut-brain connecting neurons of the CNS and gut function in health, as well as the etiology and progression of dysfunction in NDs. In this Review, we discuss our current understanding of how the various gut-innervating neurons and gut physiology are involved in the etiology of NDs, including Parkinson's disease, Alzheimer's disease, Huntington's disease, and amyotrophic lateral sclerosis, to cause progressive CNS and persistent gut dysfunction.
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Affiliation(s)
- Alpana Singh
- Center for Neurogastroenterology, Division of Gastroenterology and Hepatology, Department of Medicine
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering.,Department of Neurology.,Solomon H. Snyder Department of Neuroscience, and.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana, USA
| | - Subhash Kulkarni
- Center for Neurogastroenterology, Division of Gastroenterology and Hepatology, Department of Medicine
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Mahajan A, Davalos L, Schneider L, Bailey M, Khan J, London Z. The impact of student debt on neurological practice. J Neurol Sci 2021; 427:117536. [PMID: 34139451 DOI: 10.1016/j.jns.2021.117536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
The median cost of attending medical school is rising annually, and with it, student debt. Neurology residents have stepped up during the pandemic to answer the call of a health system at its breaking point. In this article, we outline how this escalating problem of student debt affects the neurology pipeline, the wellbeing and career decisions of current neurology trainees and practicing neurologists and through it, and the gap in healthcare. We describe currently available options for loan repayment and call for advocacy and legislation to address this mounting burden as a means to improve neurological care in the United States.
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Affiliation(s)
- Abhimanyu Mahajan
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| | - Long Davalos
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Logan Schneider
- Stanford University/Palo Alto VA Alzheimer's center, Palo Alto, CA, United States
| | - Meagan Bailey
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| | - Jaffar Khan
- Department of Neurology, Emory University, Atlanta, GA, United States.
| | - Zachary London
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
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Houston E, Kennedy AG, O'Malley D, Rabinowitz T, Rose GL, Boyd J. Telemedicine in Neurology: A Scoping Review of Key Outcomes in Movement Disorders. Telemed J E Health 2021; 28:295-308. [PMID: 34101518 DOI: 10.1089/tmj.2021.0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Telemedicine for neurological care has been researched and practiced in various ways over the past three decades, but the recent COVID-19 pandemic has rapidly expanded its use and highlighted the need for a synthesis of the existing literature. We aimed to review the methodology and outcomes of previous studies that have evaluated the use of telemedicine in movement disorders. Methods: This scoping review was performed by searching PubMed, Ovid MEDLINE, and CINAHL databases from 1946 to November 2020. Studies that assessed the application of telemedicine for delivering care to patients with a movement disorder were included. We reported the aims and employed methodologies and categorized the outcomes from each study. Results: The search retrieved 228 articles, and 41 studies met the criteria for inclusion in the review. The majority of telemedicine studies were case series or randomized controlled pilot trials, investigating feasibility and acceptability in Parkinson's disease. Even with heterogeneity among outcome measures, they can be categorized into themes, such as feasibility, satisfaction, and efficacy. Conclusions: Telemedicine use has grown rapidly, due to the demands of providing care during a global pandemic. This application of telemedicine has been considered a promising way to expand care in Neurology, although research evaluating the dissemination of its use is dilatory. This review highlights the number of studies that have found telemedicine to be an acceptable and feasible way to deliver care for movement disorders. Further research is needed to expand on harmonization of outcomes, reach, adoption, and long-term use of telemedicine.
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Affiliation(s)
- Emily Houston
- Department of Neurology, University of Vermont Medical Center, Burlington, Vermont, USA.,Clinical Translational Science Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Amanda G Kennedy
- Clinical Translational Science Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Quality Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Donna O'Malley
- Dana Medical Library, University of Vermont Libraries, Burlington, Vermont, USA
| | - Terry Rabinowitz
- Department of Psychiatry and The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Psychiatry Consultation at the University of Vermont Medical Center, Burlington, Vermont, USA
| | - Gail L Rose
- Clinical Translational Science Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Department of Psychiatry and The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - James Boyd
- Department of Neurology, University of Vermont Medical Center, Burlington, Vermont, USA.,Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
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38
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Watts J, Khojandi A, Vasudevan R, Nahab FB, Ramdhani RA. Improving Medication Regimen Recommendation for Parkinson's Disease Using Sensor Technology. SENSORS 2021; 21:s21103553. [PMID: 34065245 PMCID: PMC8160757 DOI: 10.3390/s21103553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Parkinson's disease medication treatment planning is generally based on subjective data obtained through clinical, physician-patient interactions. The Personal KinetiGraph™ (PKG) and similar wearable sensors have shown promise in enabling objective, continuous remote health monitoring for Parkinson's patients. In this proof-of-concept study, we propose to use objective sensor data from the PKG and apply machine learning to cluster patients based on levodopa regimens and response. The resulting clusters are then used to enhance treatment planning by providing improved initial treatment estimates to supplement a physician's initial assessment. We apply k-means clustering to a dataset of within-subject Parkinson's medication changes-clinically assessed by the MDS-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III) and the PKG sensor for movement staging. A random forest classification model was then used to predict patients' cluster allocation based on their respective demographic information, MDS-UPDRS-III scores, and PKG time-series data. Clinically relevant clusters were partitioned by levodopa dose, medication administration frequency, and total levodopa equivalent daily dose-with the PKG providing similar symptomatic assessments to physician MDS-UPDRS-III scores. A random forest classifier trained on demographic information, MDS-UPDRS-III scores, and PKG time-series data was able to accurately classify subjects of the two most demographically similar clusters with an accuracy of 86.9%, an F1 score of 90.7%, and an AUC of 0.871. A model that relied solely on demographic information and PKG time-series data provided the next best performance with an accuracy of 83.8%, an F1 score of 88.5%, and an AUC of 0.831, hence further enabling fully remote assessments. These computational methods demonstrate the feasibility of using sensor-based data to cluster patients based on their medication responses with further potential to assist with medication recommendations.
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Affiliation(s)
- Jeremy Watts
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN 37996, USA; (J.W.); (A.K.)
| | - Anahita Khojandi
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN 37996, USA; (J.W.); (A.K.)
| | - Rama Vasudevan
- Center for Nanophase Materials Science, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA;
| | - Fatta B. Nahab
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA;
| | - Ritesh A. Ramdhani
- Department of Neurology, Donald and Barbara School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Correspondence:
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Man's best friend in life and death: scientific perspectives and challenges of dog brain banking. GeroScience 2021; 43:1653-1668. [PMID: 33970413 PMCID: PMC8492856 DOI: 10.1007/s11357-021-00373-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Biobanking refers to the systematic collection, storage, and distribution of pre- or post-mortem biological samples derived from volunteer donors. The demand for high-quality human specimens is clearly demonstrated by the number of newly emerging biobanking facilities and large international collaborative networks. Several animal species are relevant today in medical research; therefore, similar initiatives in comparative physiology could be fruitful. Dogs, in particular, are gaining increasing attention in translational research on complex phenomena, like aging, cancer, and neurodegenerative diseases. Therefore, biobanks gathering and storing dog biological materials together with related data could play a vital role in translational and veterinary research projects. To achieve these aims, a canine biobank should meet the same standards in sample quality and data management as human biobanks and should rely on well-designed collaborative networks between different professionals and dog owners. While efforts to create dog biobanks could face similar financial and technical challenges as their human counterparts, they can widen the spectrum of successful collaborative initiatives towards a better picture of dogs’ physiology, disease, evolution, and translational potential. In this review, we provide an overview about the current state of dog biobanking and introduce the “Canine Brain and Tissue Bank” (CBTB)—a new, large-scale collaborative endeavor in the field.
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40
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Mahajan A, El-Nazer R, Chitnis S. An Online Education Method for Movement Disorders During COVID-19: Opportunity and Experience. Mov Disord 2021; 36:1475-1480. [PMID: 33938588 PMCID: PMC8242782 DOI: 10.1002/mds.28648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/04/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Abhimanyu Mahajan
- Department of Neurology, Rush Parkinson's Disease and Movement Disorders Program, Chicago, Illinois, USA
| | - Rasheda El-Nazer
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shilpa Chitnis
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
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41
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Mahajan A, London Z, Southerland AM, Khan J, Schuyler EA. Immigrant Neurologists in the United States: The Path of Most Resistance. Neurology 2021; 96:378-385. [PMID: 33199436 DOI: 10.1212/wnl.0000000000011196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
International medical graduates (IMGs), individuals who graduated from medical school outside of the United States or Canada, constitute 31.3% of active neurologists and one-third of current neurology trainees. Although three-fourths of IMG neurology trainees are not US citizens, they are an integral part of our trainee and practice workforce. IMGs play a vital role in providing greater access to health care for millions of patients, particularly in traditionally underserved regions and in the face of a current global health care crisis. With this article, we outline some of the unique challenges faced by immigrant, US-trained neurologists as they seek to provide neurologic care across the country, including preparing and applying for residency, securing authorization to remain in the United States to practice, and positioning themselves for successful careers in academic and private practice. We also call for advocacy and legislation to help reduce these barriers as a means to address the increasing physician workforce gap.
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Affiliation(s)
- Abhimanyu Mahajan
- From the University of Cincinnati Gardner Neuroscience Institute (A.M.), OH; Department of Neurology (Z.L.), University of Michigan, Ann Arbor, MI; Departments of Neurology and Public Health Sciences (A.M.S.), University of Virginia, Charlottesville, VA; Department of Neurology (J.K.), Emory University, Atlanta, GA; and Department of Neurology (E.A.S.), Hartford HealthCare Ayer Neuroscience Institute, CT
| | - Zachary London
- From the University of Cincinnati Gardner Neuroscience Institute (A.M.), OH; Department of Neurology (Z.L.), University of Michigan, Ann Arbor, MI; Departments of Neurology and Public Health Sciences (A.M.S.), University of Virginia, Charlottesville, VA; Department of Neurology (J.K.), Emory University, Atlanta, GA; and Department of Neurology (E.A.S.), Hartford HealthCare Ayer Neuroscience Institute, CT
| | - Andrew M Southerland
- From the University of Cincinnati Gardner Neuroscience Institute (A.M.), OH; Department of Neurology (Z.L.), University of Michigan, Ann Arbor, MI; Departments of Neurology and Public Health Sciences (A.M.S.), University of Virginia, Charlottesville, VA; Department of Neurology (J.K.), Emory University, Atlanta, GA; and Department of Neurology (E.A.S.), Hartford HealthCare Ayer Neuroscience Institute, CT
| | - Jaffar Khan
- From the University of Cincinnati Gardner Neuroscience Institute (A.M.), OH; Department of Neurology (Z.L.), University of Michigan, Ann Arbor, MI; Departments of Neurology and Public Health Sciences (A.M.S.), University of Virginia, Charlottesville, VA; Department of Neurology (J.K.), Emory University, Atlanta, GA; and Department of Neurology (E.A.S.), Hartford HealthCare Ayer Neuroscience Institute, CT
| | - Erica A Schuyler
- From the University of Cincinnati Gardner Neuroscience Institute (A.M.), OH; Department of Neurology (Z.L.), University of Michigan, Ann Arbor, MI; Departments of Neurology and Public Health Sciences (A.M.S.), University of Virginia, Charlottesville, VA; Department of Neurology (J.K.), Emory University, Atlanta, GA; and Department of Neurology (E.A.S.), Hartford HealthCare Ayer Neuroscience Institute, CT.
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42
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Kluger BM, Miyasaki J, Katz M, Galifianakis N, Hall K, Pantilat S, Khan R, Friedman C, Cernik W, Goto Y, Long J, Fairclough D, Sillau S, Kutner JS. Comparison of Integrated Outpatient Palliative Care With Standard Care in Patients With Parkinson Disease and Related Disorders: A Randomized Clinical Trial. JAMA Neurol 2021; 77:551-560. [PMID: 32040141 PMCID: PMC7042842 DOI: 10.1001/jamaneurol.2019.4992] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Parkinson disease and related disorders (PDRD) have consequences for quality of life (QoL) and are the 14th leading cause of death in the United States. Despite growing interest in palliative care (PC) for persons with PDRD, few studies are available supporting its effectiveness. Objective To determine if outpatient PC is associated with improvements in patient-centered outcomes compared with standard care among patients with PDRD and their caregivers. Design, Setting, and Participants This randomized clinical trial enrolled participants at 3 academic tertiary care centers between November 1, 2015, and September 30, 2017, and followed them up for 1 year. A total of 584 persons with PDRD were referred to the study. Of those, 351 persons were excluded by phone and 23 were excluded during in-person screenings. Patients were eligible to participate if they had PDRD and moderate to high PC needs. Patients were excluded if they had urgent PC needs, another diagnosis meriting PC, were already receiving PC, or were unable or unwilling to follow the study protocol. Enrolled participants were assigned to receive standard care plus outpatient integrated PC or standard care alone. Data were analyzed between November 1, 2018, and December 9, 2019. Interventions Outpatient integrated PC administered by a neurologist, social worker, chaplain, and nurse using PC checklists, with guidance and selective involvement from a palliative medicine specialist. Standard care was provided by a neurologist and a primary care practitioner. Main Outcomes and Measures The primary outcomes were the differences in patient quality of life (QoL; measured by the Quality of Life in Alzheimer Disease scale) and caregiver burden (measured by the Zarit Burden Interview) between the PC intervention and standard care groups at 6 months. Results A total of 210 patients with PDRD (135 men [64.3%]; mean [SD] age, 70.1 [8.2] years) and 175 caregivers (128 women [73.1%]; mean [SD] age, 66.1 [11.1] years) were enrolled in the study; 193 participants (91.9%) were white and non-Hispanic. Compared with participants receiving standard care alone at 6 months, participants receiving the PC intervention had better QoL (mean [SD], 0.66 [5.5] improvement vs 0.84 [4.2] worsening; treatment effect estimate, 1.87; 95% CI, 0.47-3.27; P = .009). No significant difference was observed in caregiver burden (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, -1.62; 95% CI, -3.32 to 0.09; P = .06). Other significant differences favoring the PC intervention included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months. No outcomes favored standard care alone. Secondary analyses suggested that benefits were greater for persons with higher PC needs. Conclusions and Relevance Outpatient PC is associated with benefits among patients with PDRD compared with standard care alone. This study supports efforts to integrate PC into PDRD care. The lack of diversity and implementation of PC at experienced centers suggests a need for implementation research in other populations and care settings. Trial Registration ClinicalTrials.gov Identifier: NCT02533921.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora.,Now with Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Janis Miyasaki
- Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Maya Katz
- Department of Neurology, University of California, San Francisco, San Francisco
| | | | - Kirk Hall
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Steven Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Ryan Khan
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Cari Friedman
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Wendy Cernik
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Yuika Goto
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Judith Long
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Diane Fairclough
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora
| | - Stefan Sillau
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora
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Zenuni H, Grillo P, Sancesario GM, Bernardini S, Mercuri NB, Schirinzi T. How Comorbidity Reflects on Cerebrospinal Fluid Biomarkers of Neurodegeneration in Aging. J Alzheimers Dis Rep 2021; 5:87-92. [PMID: 33681720 PMCID: PMC7902985 DOI: 10.3233/adr-200280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/23/2022] Open
Abstract
Systemic comorbidity precipitates the risk for dementia. To comprehend the underlying mechanisms into a therapeutic perspective, we analyzed how comorbidity affects neurodegeneration-related cerebrospinal fluid (CSF) biomarkers of 55 cognitively intact subjects. The Charson Comorbidity Index (CCI) was correlated with CSF amyloid-β42 (Aβ42), amyloid-β40, total-tau, 181-phosphorylated-tau (p-tau), the Aβ42/p-tau ratio, neurogranin, and lactate. The age-related brain lesions at imaging were also considered. CCI had a raw association with Aβ42/p-tau and p-tau, and a stronger, age-independent correlation with lactate. These preliminary findings suggested that, in normal subjects, systemic comorbidity might increase CNS oxidative stress and, together with aging, contribute to develop an Alzheimer's disease-like biochemical profile.
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Affiliation(s)
- Henri Zenuni
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Piergiorgio Grillo
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | | | - Sergio Bernardini
- Department of Experimental Medicine, University of Roma Tor Vergata, Rome, Italy
- Department of Clinical Biochemistry, Tor Vergata University Hospital, Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
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Abstract
PURPOSE OF REVIEW This review summarizes the current state of evidence for palliative care (PC) in movement disorders, describes the application of PC to clinical practice, and suggests future research directions. RECENT FINDINGS PC needs are common in persons living with movement disorders and their families from the time of diagnosis through end-of-life and contribute to quality of life. Early advance care planning is preferred by patients, impacts outcomes and is promoted by PC frameworks. Systematic assessment of non-motor symptoms, psychosocial needs and spiritual/existential distress may address gaps in current models of care. Several complementary and emerging models of PC may be utilized to meet the needs of this population. A PC approach may identify and improve important patient and caregiver-centered outcomes. As a relatively new application of PC, there is a need for research to adapt, develop and implement approaches to meet the unique needs of this population.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado, Aurora, CO Building 400, Mail Stop F429, 12469 E 17th Place, Aurora, CO, 80045, USA.
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Medicine, Palliative Care Division, University of Rochester, Rochester, NY, USA
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45
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Finley JM, Gotsis M, Lympouridis V, Jain S, Kim A, Fisher BE. Design and Development of a Virtual Reality-Based Mobility Training Game for People With Parkinson's Disease. Front Neurol 2021; 11:577713. [PMID: 33519665 PMCID: PMC7843522 DOI: 10.3389/fneur.2020.577713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022] Open
Abstract
People with Parkinson's disease (PD) commonly have gait impairments that reduce their ability to walk safely in the community. These impairments are characterized, in part, by a compromised ability to turn and negotiate both predictable and unpredictable environments. Here, we describe the development and usability assessment of a virtual reality training application, Wordplay VR, that allows people with PD to practice skills such as turning, obstacle avoidance, and problem-solving during over-ground walking in a game-based setting. Nine people with PD completed three sessions with Wordplay VR, and each session was directed by their personal physical therapist. Our outcome measures included perceived sense of presence measured using the International Test Commission–Sense of Presence Inventory (ITC-SOPI), levels of motivation using the Intrinsic Motivation Inventory (IMI), overall system usability using the System Usability Scale (SUS), and setup time by the physical therapists. Both the people with PD and the physical therapists rated their sense of presence in the training system positively. The system received high ratings on the interest and value subscales of the IMI, and the system was also rated highly on usability, from the perspective of both the patient during gameplay and the therapist while controlling the experience. These preliminary results suggest that the application and task design yielded an experience that was motivating and user-friendly for both groups. Lastly, with repeated practice over multiple sessions, therapists were able to reduce the time required to help their patients don the headset and sensors and begin the training experience.
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Affiliation(s)
- James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
| | - Marientina Gotsis
- School of Cinematic Arts, University of Southern California, Los Angeles, CA, United States
| | - Vangelis Lympouridis
- Department of Computer Science, University of Southern California, Los Angeles, CA, United States
| | - Shreya Jain
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Aram Kim
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Ou GY, Lin WW, Zhao WJ. Neuregulins in Neurodegenerative Diseases. Front Aging Neurosci 2021; 13:662474. [PMID: 33897409 PMCID: PMC8064692 DOI: 10.3389/fnagi.2021.662474] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS), are typically characterized by progressive neuronal loss and neurological dysfunctions in the nervous system, affecting both memory and motor functions. Neuregulins (NRGs) belong to the epidermal growth factor (EGF)-like family of extracellular ligands and they play an important role in the development, maintenance, and repair of both the central nervous system (CNS) and peripheral nervous system (PNS) through the ErbB signaling pathway. They also regulate multiple intercellular signal transduction and participate in a wide range of biological processes, such as differentiation, migration, and myelination. In this review article, we summarized research on the changes and roles of NRGs in neurodegenerative diseases, especially in AD. We elaborated on the structural features of each NRG subtype and roles of NRG/ErbB signaling networks in neurodegenerative diseases. We also discussed the therapeutic potential of NRGs in the symptom remission of neurodegenerative diseases, which may offer hope for advancing related treatment.
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Affiliation(s)
- Guan-yong Ou
- Center for Neuroscience, Shantou University Medical College, Shantou, China
| | - Wen-wen Lin
- Center for Neuroscience, Shantou University Medical College, Shantou, China
| | - Wei-jiang Zhao
- Center for Neuroscience, Shantou University Medical College, Shantou, China
- Cell Biology Department, Wuxi School of Medicine, Jiangnan University, Wuxi, China
- *Correspondence: Wei-jiang Zhao
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Rps27a might act as a controller of microglia activation in triggering neurodegenerative diseases. PLoS One 2020; 15:e0239219. [PMID: 32941527 PMCID: PMC7498011 DOI: 10.1371/journal.pone.0239219] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/01/2020] [Indexed: 01/10/2023] Open
Abstract
Neurodegenerative diseases (NDDs) are increasing serious menaces to human health in the recent years. Despite exhibiting different clinical phenotypes and selective neuronal loss, there are certain common features in these disorders, suggesting the presence of commonly dysregulated pathways. Identifying causal genes and dysregulated pathways can be helpful in providing effective treatment in these diseases. Interestingly, in spite of the considerable researches on NDDs, to the best of our knowledge, no dysregulated genes and/or pathways were reported in common across all the major NDDs so far. In this study, for the first time, we have applied the three-way interaction model, as an approach to unravel sophisticated gene interactions, to trace switch genes and significant pathways that are involved in six major NDDs. Subsequently, a gene regulatory network was constructed to investigate the regulatory communication of statistically significant triplets. Finally, KEGG pathway enrichment analysis was applied to find possible common pathways. Because of the central role of neuroinflammation and immune system responses in both pathogenic and protective mechanisms in the NDDs, we focused on immune genes in this study. Our results suggest that "cytokine-cytokine receptor interaction" pathway is enriched in all of the studied NDDs, while "osteoclast differentiation" and "natural killer cell mediated cytotoxicity" pathways are enriched in five of the NDDs each. The results of this study indicate that three pathways that include "osteoclast differentiation", "natural killer cell mediated cytotoxicity" and "cytokine-cytokine receptor interaction" are common in five, five and six NDDs, respectively. Additionally, our analysis showed that Rps27a as a switch gene, together with the gene pair {Il-18, Cx3cl1} form a statistically significant and biologically relevant triplet in the major NDDs. More specifically, we suggested that Cx3cl1 might act as a potential upstream regulator of Il-18 in microglia activation, and in turn, might be controlled with Rps27a in triggering NDDs.
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Loewenbrück KF, Stein DB, Amelung VE, Bitterlich R, Brumme M, Falkenburger B, Fehre A, Feige T, Frank A, Gißke C, Helmert C, Kerkemeyer L, Knapp A, Lang C, Leuner A, Lummer C, Minkman MMN, Müller G, van Munster M, Schlieter H, Themann P, Zonneveld N, Wolz M. Parkinson Network Eastern Saxony (PANOS): Reaching Consensus for a Regional Intersectoral Integrated Care Concept for Patients with Parkinson's Disease in the Region of Eastern Saxony, Germany. J Clin Med 2020; 9:E2906. [PMID: 32911841 PMCID: PMC7563971 DOI: 10.3390/jcm9092906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
As integrated care is recognized as crucial to meet the challenges of chronic conditions such as Parkinson's disease (PD), integrated care networks have emerged internationally and throughout Germany. One of these networks is the Parkinson Network Eastern Saxony (PANOS). PANOS aims to deliver timely and equal care to PD patients with a collaborative intersectoral structured care pathway. Additional components encompass personalized case management, an electronic health record, and communicative and educative measures. To reach an intersectoral consensus of the future collaboration in PANOS, a structured consensus process was conducted in three sequential workshops. Community-based physicians, PD specialists, therapists, scientists and representatives of regulatory authorities and statutory health insurances were asked to rate core pathway-elements and supporting technological, personal and communicative measures. For the majority of core elements/planned measures, a consensus was reached, defined as an agreement by >75% of participants. Additionally, six representatives from all partners involved in the network-design independently assessed PANOS based on the Development Model for Integrated Care (DMIC), a validated model addressing the comprehensiveness and maturity of integrated care concepts. The results show that PANOS is currently in an early maturation state but has the potential to comprehensively represent the DMIC if all planned activities are implemented successfully. Despite the favorable high level of consensus regarding the PANOS concept and despite its potential to become a balanced integrated care concept according to the DMIC, its full implementation remains a considerable challenge.
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Affiliation(s)
- Kai F. Loewenbrück
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Doron B. Stein
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Volker E. Amelung
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Robert Bitterlich
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
| | - Martin Brumme
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Björn Falkenburger
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Annekathrin Fehre
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
| | - Tim Feige
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
| | - Anika Frank
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Carola Gißke
- Chair of Business Informatics, esp. Systems Development, Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (C.G.); (H.S.)
| | - Claudia Helmert
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Andreas Knapp
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Caroline Lang
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Annegret Leuner
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
| | - Carina Lummer
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Mirella M. N. Minkman
- Vilans, National Centre of Expertise in Long Term Care, 3527 GV Utrecht, The Netherlands; (M.M.N.M.); (N.Z.)
- Tilburg University/TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Marlena van Munster
- Department of Neurology, University Hospital Marburg, 35043 Marburg, Germany;
| | - Hannes Schlieter
- Chair of Business Informatics, esp. Systems Development, Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (C.G.); (H.S.)
| | - Peter Themann
- Department of Neurology, Klinik am Tharandter Wald Hetzdorf, Herzogswalder Straße 1, 09633 Halsbrücke, Germany;
| | - Nick Zonneveld
- Vilans, National Centre of Expertise in Long Term Care, 3527 GV Utrecht, The Netherlands; (M.M.N.M.); (N.Z.)
- Tilburg University/TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
| | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
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Fullard M, Thibault D, Zisling H, Crispo JA, Willis A. Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis. JOURNAL OF PARKINSONS DISEASE 2020; 10:1577-1586. [PMID: 32597816 PMCID: PMC7683077 DOI: 10.3233/jpd-201992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.
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Affiliation(s)
- Michelle Fullard
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Dylan Thibault
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - James A Crispo
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,University of Delaware, Newark, DE, USA
| | - Allison Willis
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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Validation of Parkinson's Disease-Related Questionnaires in South Africa. PARKINSONS DISEASE 2020; 2020:7542138. [PMID: 32617145 PMCID: PMC7306845 DOI: 10.1155/2020/7542138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022]
Abstract
Background There are very few epidemiological studies investigating Parkinson's disease (PD) in Africa. The hundreds of local languages and dialects make traditional screening and clinical evaluation tools difficult to use. Objective The objective of the study was to validate two commonly used PD questionnaires in an African population. Methods The PD Screening Questionnaire (PDSQ) and Parkinson's Disease Questionnaire (PDQ-39) were modified and translated into Afrikaans, Setswana, and isiZulu and administered to a sample of healthy local residents. We assessed the internal consistencies and cluster characteristics of the questionnaires, using a Cronbach's alpha test and exploratory factor analysis. The questionnaires were then administered to a population-based sample of 416 research participants. We evaluated the correlations between the questionnaires and both a timed motor task and the Unified Parkinson's Disease Rating Scale motor subsection 3 (UPDRS3), using locally weighted scatterplot smoothing (LOWESS) regression analysis and Spearman's rank correlation. Results Both questionnaires had high overall internal consistency (Cronbach's alpha = 0.86 and 0.95, respectively). The modified PDQ-39 had evidence of five subscales, with Factor 1 explaining 57% and Factor 2 explaining 14%, of the variance in responses. The PDSQ and PDQ-39 scores were correlated with the UPDRS3 score (ρ = 0.35, P < 0.001; and ρ = 0.28, P < 0.001, respectively). Conclusion The translated PDSQ and PDQ-39 questionnaires demonstrated high internal consistency and correlations with clinical severity of parkinsonism and a timed motor task, suggesting that they are valid tools for field-based epidemiological studies.
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