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Sadek AT, Djerdjour L, Reyes RA, Adams GP, Logan CH, Smith MA, Biddle SG, Wiles TS, Urrea-Mendoza E, McConnell TM, Revilla FJ, Trilk JL. The Feasibility and Efficacy of a Virtual Reality Tandem Cycling Program for Persons with Parkinson's Disease and Their Care Partners. Neurol Ther 2024; 13:1237-1257. [PMID: 38878129 PMCID: PMC11263444 DOI: 10.1007/s40120-024-00636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/30/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Persons with Parkinson's disease (PwPD) suffer from motor and non-motor symptoms which significantly affect their quality of life (QoL), and the QoL of their care partners (CP). Tandem cycling reduces PwPD motor symptoms; however, no studies have examined other benefits or included PwPD CP. We conducted an 8-week community virtual reality (VR) tandem cycling intervention to assess the feasibility and efficacy for PwPD and their CP (i.e., PD dyads). We hypothesized that dyadic tandem cycling would improve (1) PwPD motor and non-motor symptoms and (2) dimensions of PD dyads' QoL and physiologic health. METHODS Ten PD dyads were recruited to complete 8 weeks of progressive intensity, bi-weekly tandem cycling. At pre- and post-testing, PwPD were assessed using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III), functional gait assessment (FGA), and 10-m gait speed test. PD dyads also completed emotional and cognitive status questionnaires [e.g., Geriatric Depression Scale-Short Form (GDS-SF)], and wore BodyGuard 2 heart rate (HR) monitors for 48 h to assess surrogate measures of heart rate variability. Statistical analyses were conducted using Student's t tests with significance set at p ≤ 0.05. RESULTS Eight PD dyads and one PwPD completed the intervention. Retention of PwPD (90%) and CP (80%) was adequate, and PD dyad adherence ranged from 91.67 to 97.91%. PwPD demonstrated significant clinical improvements in MDS-UPDRS-III scores (- 7.38, p < 0.01), FGA scores (+ 3.50, p < 0.01), and 10-m gait speed times (+ 0.27 m/s, p < 0.01), in addition to significant self-reported improvements in mobility (- 13.61, p = 0.02), fatigue (- 5.99, p = 0.02), and social participation (+ 4.69, p < 0.01). CP depressive symptoms significantly decreased (- 0.88, p = 0.02), and PD dyads shared a significant increase in root mean square of the successive differences (RMSSD; p = 0.04). CONCLUSION Our pilot study demonstrated feasibility and multiple areas of efficacy supporting further investigation of community VR tandem cycling as a therapeutic intervention for PD dyads.
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Affiliation(s)
- Alia T Sadek
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Leila Djerdjour
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Ryan A Reyes
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Greggory P Adams
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Cara H Logan
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Margaret A Smith
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Sara G Biddle
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | | | - Enrique Urrea-Mendoza
- Department of Clinical Science/TMH Physicians Partners, Medical School, Florida State University, Tallahassee, FL, USA
| | - Tracie M McConnell
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
- Neuroscience Associates, Prisma Health-Upstate, Greenville, SC, USA
| | - Fredy J Revilla
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
- Neuroscience Associates, Prisma Health-Upstate, Greenville, SC, USA
| | - Jennifer L Trilk
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
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Subbarao B, Hayani Z, Clemmens Z. Complementary and Integrative Medicine in Treating Headaches, Cognitive Dysfunction, Mental Fatigue, Insomnia, and Mood Disorders Following Traumatic Brain Injury: A Comprehensive Review. Phys Med Rehabil Clin N Am 2024; 35:651-664. [PMID: 38945657 DOI: 10.1016/j.pmr.2024.02.013] [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] [Indexed: 07/02/2024]
Abstract
Traumatic brain injury (TBI) is a complex condition associated with a range of persistent symptoms including headaches, cognitive dysfunction, mental fatigue, insomnia, and mood disorders. Conventional treatments for TBI-related symptoms can be insufficient, leading to interest in complementary and integrative medicine (CIM) approaches. This comprehensive article examines the existing literature on CIM modalities, including mind-body interventions, acupuncture/acupressure, herbal remedies, nutritional supplements, biofeedback, yoga, and tai chi in the context of managing secondary complications following TBI. The article highlights potential benefits and limitations of CIM modalities, while acknowledging the need for further research to better establish efficacy and safety in this specific population.
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Affiliation(s)
- Bruno Subbarao
- Wellness and Administrative Medicine, Phoenix Veterans Healthcare System, 650 East Indian School Road, Phoenix, AZ 85012, USA.
| | - Zayd Hayani
- HonorHealth, 8850 East Pima Center Parkway, Scottsdale, AZ 85258, USA
| | - Zeke Clemmens
- HonorHealth, 8850 East Pima Center Parkway, Scottsdale, AZ 85258, USA
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3
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Chen J, Zhou Y, Rao H, Liu J. Mental Fatigue in Parkinson's Disease: Systematic Review and Evaluation of Self-Reported Fatigue Scales. PARKINSON'S DISEASE 2024; 2024:9614163. [PMID: 38939533 PMCID: PMC11208863 DOI: 10.1155/2024/9614163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/15/2024] [Accepted: 05/04/2024] [Indexed: 06/29/2024]
Abstract
Fatigue is a common and debilitating symptom affecting a significant proportion of individuals with Parkinson's disease (PD), often overshadowing even motor symptoms in its impact on quality of life. The accurate definition and assessment of mental fatigue in PD is crucial for both clinical management and research, yet it remains a challenge due to the subjective nature of the symptom and the heterogeneity of assessment scales. This systematic review examined the existing measures of self-reported mental fatigue in PD by searching through PubMed, Embase, and Scopus databases using specific keywords from 2001 to 2024. Out of the 4182 articles found, 40 met the inclusion criteria, and 14 different scales were identified to measure self-reported fatigue in PD patients. However, most of these scales lack a consistent definition of fatigue, indicating a need for validated combinations of unidimensional and multidimensional scales to accurately assess mental fatigue in PD. The review found that it is best to use Fatigue Severity Inventory (FSI) and Multidimensional Fatigue Inventory (MdFI) to screen for severity of PD mental fatigue and Neuro-QoL Item Bank v1.0 (Neuro-QoL) to evaluate its impact on patients' lives. Furthermore, multidimensional scales Parkinson's Disease Questionnaire (PDQ) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) are frequently coupled with Fatigue Severity Scale (FSS), Parkinson's Fatigue Scale (PFS), and/or Modified Fatigue Impact Scale (MFIS) due to their short length and holistic coverage of variables in patients' quality of life. Combining fatigue scales can be used for screening and scoring methods. The review also recommends validating fatigue scales translation and combining them with biomarkers to improve the accuracy and effectiveness of fatigue assessment in clinical practice. Future research should analyze correlations between fatigue scales, expand language types, and explore the link between fatigue scales and the pathophysiological basis of PD. Our findings underscore the need for a standardized approach to the measurement of fatigue in PD and set the stage for future research to consolidate assessment tools that can reliably guide treatment strategies and improve patient outcomes.
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Affiliation(s)
- Junle Chen
- Department of Neuroscience, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yanjun Zhou
- Department of Neuroscience, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hengyi Rao
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jianghong Liu
- Department of Neuroscience, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
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Pauletti C, Locuratolo N, Mannarelli D, Maffucci A, Petritis A, Menini E, Fattapposta F. Fatigue in fluctuating Parkinson's disease patients: possible impact of safinamide. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02654-1. [PMID: 37210459 DOI: 10.1007/s00702-023-02654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Fatigue is a common non-motor symptom in Parkinson's disease (PD). Among other pathophysiological mechanisms, neuroinflammation, a pathological PD hallmark associated with changes in glutamatergic transmission in basal ganglia, has been proposed as a crucial factor closely related to fatigue. To test the hypothesis that safinamide could represent an effective treatment of fatigue in PD patients, given its dual mechanism of action (it selectively and reversibly inhibits MAOB and modulates glutamate release), we administered the validated versions of fatigue severity scale (FSS) and Parkinson fatigue scale-16 (PFS-16) to 39 fluctuating PD patients with fatigue before and after a 24-week treatment period with safinamide as add-on therapy. An assessment of secondary variables such as depression, quality of life (QoL), and motor and non-motor symptoms (NMS) was conducted. After 24 weeks of treatment with safinamide, both FSS (p < 0.001) and PF-S16 (p = 0.02) scores were significantly lower than at baseline. Moreover, 46.2% and 41% of patients scored below the cut-off for the presence of fatigue according to FSS and PFS-16, respectively (responders). At follow-up, a significant difference emerged between responders and non-responders in mood, QoL, and NMS. Fatigue improved in fluctuating PD, and more than 40% of patients were "fatigue-free" after a 6 month treatment with safinamide. Patients without fatigue at follow-up displayed significantly better scores in QoL domains, such as mobility or activities of daily living, although disease severity remained stable, supporting the hypothesis that fatigue could considerably affect QoL. Drugs that interact with multiple neurotransmission systems, such as safinamide, could be useful in reducing this symptom.
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Affiliation(s)
- Caterina Pauletti
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy.
| | - Nicoletta Locuratolo
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Daniela Mannarelli
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Andrea Maffucci
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Alessia Petritis
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Elisa Menini
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Fattapposta
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
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Folkerts AK, Nielsen J, Gollan R, Lansu A, Solfronk D, Monsef I, Ernst M, Skoetz N, Zeuner KE, Kalbe E. Physical Exercise as a Potential Treatment for Fatigue in Parkinson's Disease? A Systematic Review and Meta-Analysis of Pharmacological and Non-Pharmacological Interventions. JOURNAL OF PARKINSON'S DISEASE 2023; 13:659-679. [PMID: 37334618 PMCID: PMC10473113 DOI: 10.3233/jpd-225116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Fatigue is one of the most common and debilitating non-motor symptoms among patients with Parkinson's disease (PD) and significantly impacts quality of life. Therefore, effective treatment options are needed. OBJECTIVE To provide an update on randomized controlled trials (RCTs) including pharmacological and non-pharmacological (but non-surgical) treatments that examine the effects of fatigue on PD patients. METHODS We searched the MEDLINE, EMBASE, PsycINFO, CENTRAL, and CINAHL databases for (cross-over) RCTs on pharmacological and non-pharmacological interventions for treating fatigue in PD patients until May 2021. Meta-analyses for random-effects models were calculated when two or more studies on the same treatment option were available using standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Fourteen pharmacological and 16 non-pharmacological intervention RCTs were identified. For pharmacological approaches, a meta-analysis could only be performed for modafinil compared to placebo (n = 2) revealing a non-significant effect on fatigue (SMD = - 0.21, 95% CI - 0.74-0.31, p = 0.43). Regarding non-pharmacological approaches, physical exercise (n = 8) following different training approaches versus passive or placebo control groups showed a small significant effect (SMD = - 0.37, 95% CI - 0.69- - 0.05, p = 0.02) which could not be demonstrated for acupuncture vs. sham-acupuncture (SMD = 0.16, 95% CI - 0.19-0.50, p = 0.37). CONCLUSION Physical exercise may be a promising strategy to treat fatigue in PD patients. Further research is required to examine the efficacy of this treatment strategy and further interventions. Future studies should differentiate treatment effects on physical and mental fatigue as the different underlying mechanisms of these symptoms may lead to different treatment responses. More effort is required to develop, evaluate, and implement holistic fatigue management strategies for PD patients.
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Affiliation(s)
- Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jörn Nielsen
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Annika Lansu
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dominik Solfronk
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Ernst
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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6
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Liu W, Liu J, Bhavsar R, Mao T, Mamikonyan E, Raizen D, Detre JA, Weintraub D, Rao H. Perfusion Imaging of Fatigue and Time-on-Task Effects in Patients With Parkinson's Disease. Front Aging Neurosci 2022; 14:901203. [PMID: 35754969 PMCID: PMC9226473 DOI: 10.3389/fnagi.2022.901203] [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: 03/21/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Fatigue is a highly prevalent and debilitating non-motor symptom in Parkinson's disease (PD), yet its' neural mechanisms remain poorly understood. Here we combined arterial spin labeling (ASL) perfusion functional magnetic resonance imaging (fMRI) with a sustained mental workload paradigm to examine the neural correlates of fatigue and time-on-task effects in PD patients. Twenty-one PD patients were scanned at rest and during continuous performance of a 20-min psychomotor vigilance test (PVT). Time-on-task effects were measured by the reaction time changes during the PVT and by self-reported fatigue ratings before and after the PVT. PD subjects demonstrated significant time-on-task effects, including progressively slower reaction time on the PVT and increased post-PVT fatigue ratings compared to pre-PVT. Higher levels of general fatigue were associated with larger increases in mental fatigue ratings after the PVT. ASL imaging data showed increased CBF in the right middle frontal gyrus (MFG), bilateral occipital cortex, and right cerebellum during the PVT compared to rest, and decreased CBF in the right MFG at post-task rest compared to pre-task rest. The magnitude of regional CBF changes in the right MFG and right inferior parietal lobe correlated with subjective fatigue rating increases after the PVT task. These results demonstrate the utility of continuous PVT paradigm for future studies of fatigue and cognitive fatigability in patients, and support the key role of the fronto-parietal attention network in mediating fatigue in PD.
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Affiliation(s)
- Wanting Liu
- School of Psychology, South China Normal University, Guangzhou, China,Center for Magnetic Resonance Imaging Research and Key Laboratory of Applied Brain and Cognitive Sciences, School of Business and Management, Shanghai International Studies University, Shanghai, China,Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jianghong Liu
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Rupal Bhavsar
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Tianxin Mao
- Center for Magnetic Resonance Imaging Research and Key Laboratory of Applied Brain and Cognitive Sciences, School of Business and Management, Shanghai International Studies University, Shanghai, China,Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Eugenia Mamikonyan
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - David Raizen
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - John A. Detre
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Hengyi Rao
- Center for Magnetic Resonance Imaging Research and Key Laboratory of Applied Brain and Cognitive Sciences, School of Business and Management, Shanghai International Studies University, Shanghai, China,Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States,*Correspondence: Hengyi Rao,
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Adibi I, Sanayei M, Tabibian F, Ramezani N, Pourmohammadi A, Azimzadeh K. Multiple sclerosis-related fatigue lacks a unified definition: A narrative review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:24. [PMID: 35419061 PMCID: PMC8995308 DOI: 10.4103/jrms.jrms_1401_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/19/2021] [Accepted: 11/01/2021] [Indexed: 11/05/2022]
Abstract
Fatigue is the most common symptom in multiple sclerosis (MS). Although MS-related fatigue (MS-F) strongly affects quality of life and social performance of patients, there is currently a lack of knowledge about its pathophysiology, which in turns leads to poor objective diagnosis and management. Recent studies have attempted to explain potential etiologies as well as treatments for MS-F. However, it seems that without a consensus on its nature, these data could not provide a route to a successful approach. In this Article, we review definitions, epidemiology, risk factors and correlated comorbidities, pathophysiology, assessment methods, neuroimaging findings, and pharmacological and nonpharmacological treatments of MS-F. Further studies are warranted to define fatigue in MS patients more accurately, which could result in precise diagnosis and management.
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Affiliation(s)
- Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Sanayei
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Farinaz Tabibian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Pourmohammadi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kiarash Azimzadeh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Scheffer DDL, Freitas FC, Aguiar AS, Ward C, Guglielmo LGA, Prediger RD, Cronin SJF, Walz R, Andrews NA, Latini A. Impaired dopamine metabolism is linked to fatigability in mice and fatigue in Parkinson's disease patients. Brain Commun 2021; 3:fcab116. [PMID: 34423297 PMCID: PMC8374980 DOI: 10.1093/braincomms/fcab116] [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: 11/30/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Fatigue is a common symptom of Parkinson’s disease that compromises significantly the patients’ quality of life. Despite that, fatigue has been under-recognized as symptom, its pathophysiology remains poorly understood, and there is no adequate treatment so far. Parkinson’s disease is characterized by the progressive loss of midbrain dopaminergic neurons, eliciting the classical motor symptoms including slowing of movements, muscular rigidity and resting tremor. The dopamine synthesis is mediated by the rate-limiting enzyme tyrosine hydroxylase, which requires tetrahydrobiopterin as a mandatory cofactor. Here, we showed that reserpine administration (1 mg/kg, two intraperitoneal injections with an interval of 48 h) in adult Swiss male mice (8–10 weeks; 35–45 g) provoked striatal depletion of dopamine and tetrahydrobiopterin, and intolerance to exercise. The poor exercise performance of reserpinized mice was not influenced by emotional or anhedonic factors, mechanical nociceptive thresholds, electrocardiogram pattern alterations or muscle-impaired bioenergetics. The administration of levodopa (100 mg/kg; i.p.) plus benserazide (50 mg/kg; i.p.) rescued reserpine-induced fatigability-like symptoms and restored striatal dopamine and tetrahydrobiopterin levels. Remarkably, it was observed, for the first time, that impaired blood dopamine metabolism inversely and idependently correlated with fatigue scores in eighteen idiopathic Parkinson’s disease patients (male n = 13; female n = 5; age 61.3 ± 9.59 years). Altogether, this study provides new experimental and clinical evidence that fatigue symptoms might be caused by the impaired striatal dopaminergic neurotransmission, pointing to a central origin of fatigue in Parkinson’s disease.
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Affiliation(s)
- Débora da Luz Scheffer
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Fernando Cini Freitas
- Graduate Program in Medical Sciences, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Neurology Division, Hospital Governador Celso Ramos, Florianópolis, SC 88015-270, Brazil
| | - Aderbal Silva Aguiar
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Catherine Ward
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | | | - Rui Daniel Prediger
- Departamento de Farmacologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Shane J F Cronin
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, A-1090 Vienna, Austria
| | - Roger Walz
- Graduate Program in Medical Sciences, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Center for Applied Neuroscience, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Neurology Division, Departament of Internal Medicine, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Nick A Andrews
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.,The Salk in Institute for Biological Studies, La Jolla, CA 92037, USA
| | - Alexandra Latini
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
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9
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Senthinathan A, Adams S, Page AD, Jog M. Speech Intensity Response to Altered Intensity Feedback in Individuals With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2261-2275. [PMID: 33830820 DOI: 10.1044/2021_jslhr-20-00278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Hypophonia (low speech intensity) is the most common speech symptom experienced by individuals with Parkinson's disease (IWPD). Previous research suggests that, in IWPD, there may be abnormal integration of sensory information for motor production of speech intensity. In the current study, intensity of auditory feedback was systematically manipulated (altered in both positive and negative directions) during sensorimotor conditions that are known to modulate speech intensity in everyday contexts in order to better understand the role of auditory feedback for speech intensity regulation. Method Twenty-six IWPD and 24 neurologically healthy controls were asked to complete the following tasks: converse with the experimenter, start vowel production, and read sentences at a comfortable loudness, while hearing their own speech intensity randomly altered. Altered intensity feedback conditions included 5-, 10-, and 15-dB reductions and increases in the feedback intensity. Speech tasks were completed in no noise and in background noise. Results IWPD displayed a reduced response to the altered intensity feedback compared to control participants. This reduced response was most apparent when participants were speaking in background noise. Specific task-based differences in responses were observed such that the reduced response by IWPD was most pronounced during the conversation task. Conclusions The current study suggests that IWPD have abnormal processing of auditory information for speech intensity regulation, and this disruption particularly impacts their ability to regulate speech intensity in the context of speech tasks with clear communicative goals (i.e., conversational speech) and speaking in background noise.
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Affiliation(s)
| | - Scott Adams
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Allyson D Page
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
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10
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Yang JS, Xu HL, Chen PP, Sikandar A, Qian MZ, Lin HX, Lin MT, Chen WJ, Wang N, Wu H, Gan SR. Ataxic Severity Is Positively Correlated With Fatigue in Spinocerebellar Ataxia Type 3 Patients. Front Neurol 2020; 11:266. [PMID: 32390927 PMCID: PMC7188758 DOI: 10.3389/fneur.2020.00266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Spinocerebellar ataxia type 3 (SCA3) is an inherited form of ataxia that leads to progressive neurodegeneration. Fatigue is a common non-motor symptom in SCA3 and other neurodegenerative diseases, such as Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Although risk factors to fatigue in these diseases have been thoroughly studied, whether or not fatigue can affect clinical phenotypes has yet to be investigated. Methods: Ninety-one molecularly confirmed SCA3 patients and 85 age- and sex-matched controls were recruited for this study. The level of fatigue was measured using the 14-item Fatigue Scale (FS-14), and the risk factors to fatigue and how fatigue correlates with clinical phenotypes were studied using multivariable linear regression models. Results: We found that the severity was significantly higher in the SCA3 group than in the control group (9.30 ± 3.04% vs. 3.94 ± 2.66, P = 0.000). Daytime somnolence (β = 0.209, P = 0.002), severity of ataxia (β = 0.081, P = 0.006), and poor sleep quality (β = 0.187, P = 0.037) were found to have a positive relationship with fatigue. Although fatigue had no relationship with age at onset or ataxic progression, we found that it did have a positive relationship with the severity of ataxia (β = 7.009, P = 0.014). Conclusions: The high level of fatigue and the impact of fatigue on the clinical manifestation of SCA3 patients suggest that fatigue plays a large role in the pathogenesis of SCA3, thus demonstrating the need for intervention and treatment options in this patient cohort.
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Affiliation(s)
- Jin-Shan Yang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hao-Ling Xu
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ping-Ping Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Arif Sikandar
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Mei-Zhen Qian
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hui-Xia Lin
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Min-Ting Lin
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Wu
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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11
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Reward presentation reduces on-task fatigue in traumatic brain injury. Cortex 2020; 126:16-25. [PMID: 32062140 DOI: 10.1016/j.cortex.2020.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/10/2019] [Accepted: 01/07/2020] [Indexed: 11/22/2022]
Abstract
While cognitive fatigue is experienced by up to 80% of individuals with traumatic brain injury (TBI), little is known about its neural underpinnings. We previously hypothesized that presentation of rewarding outcomes leads to cognitive fatigue reduction and activation of the striatum, a brain region shown to be associated with cognitive fatigue in clinical populations and processing of rewarding outcomes. We have demonstrated this in individuals with multiple sclerosis. Here, we tested this hypothesis in individuals with TBI. Twenty-one individuals with TBI and 24 healthy participants underwent functional magnetic resonance imaging. Participants performed a task during which they were presented with 1) the Outcome condition where they were exposed to monetary rewards, and 2) the No Outcome condition that served as the control condition and was not associated with monetary rewards. In accordance with our hypothesis, results showed that attainment of rewarding outcomes leads to cognitive fatigue reduction in individuals with TBI, as well as activation of the striatum. Specifically, we observed a significant group by condition interaction on fatigue scores driven by the TBI group reporting lower levels of fatigue after the Outcome condition. fMRI data revealed a significant main-effect of condition in regions previously implicated in outcome processing, while a significant group by condition interaction was observed in the left ventral striatum as revealed by a priori region of interest analysis. Results suggest that a salient motivator can significantly reduce fatigue and that outcome presentation leads to increased activation of the ventral striatum in TBI. These findings can inform the development of future non-pharmacological cognitive fatigue treatment methods and contribute to the growing body of evidence showing the association between cognitive fatigue and the striatum.
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Alves ACDB, Bristot VJDO, Limana MD, Speck AE, Barros LSD, Solano AF, Aguiar AS. Role of Adenosine A 2A Receptors in the Central Fatigue of Neurodegenerative Diseases. J Caffeine Adenosine Res 2019. [DOI: 10.1089/caff.2019.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ana Cristina de Bem Alves
- Exercise Biology Lab, Department of Health Sciences, UFSC—Universidade Federal de Santa Catarina, Araranguá, Brazil
| | | | - Mirieli Denardi Limana
- Exercise Biology Lab, Department of Health Sciences, UFSC—Universidade Federal de Santa Catarina, Araranguá, Brazil
| | - Ana Elisa Speck
- Exercise Biology Lab, Department of Health Sciences, UFSC—Universidade Federal de Santa Catarina, Araranguá, Brazil
| | - Leonardo Soares de Barros
- LABOX—Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, UFSC—Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Alexandre Francisco Solano
- LABOX—Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, UFSC—Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Aderbal S. Aguiar
- Exercise Biology Lab, Department of Health Sciences, UFSC—Universidade Federal de Santa Catarina, Araranguá, Brazil
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Ghani HA, Justine M, Manaf H. Effects of lower limb muscle fatigue on gait performance and postural control among individuals with Parkinson’s disease: a review of literature. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1648716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Halimatul Abd Ghani
- Center of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi Mara, Puncak Alam, Selangor, Malaysia
| | - Maria Justine
- Center of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi Mara, Puncak Alam, Selangor, Malaysia
- Clinical and Rehabilitation Exercise Research Group, Faculty of Health Sciences, Universiti Teknologi Mara, Puncak Alam, Selangor, Malaysia
| | - Haidzir Manaf
- Center of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi Mara, Puncak Alam, Selangor, Malaysia
- Clinical and Rehabilitation Exercise Research Group, Faculty of Health Sciences, Universiti Teknologi Mara, Puncak Alam, Selangor, Malaysia
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14
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Filippi M, Preziosa P, Rocca MA. Brain mapping in multiple sclerosis: Lessons learned about the human brain. Neuroimage 2019; 190:32-45. [DOI: 10.1016/j.neuroimage.2017.09.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 02/07/2023] Open
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15
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The Parkinson fatigue scale: an evaluation of its validity and reliability in Greek Parkinson’s disease patients. Neurol Sci 2019; 40:683-690. [DOI: 10.1007/s10072-018-3695-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/31/2018] [Indexed: 01/25/2023]
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Herlofson K, Heijnen CJ, Lange J, Alves G, Tysnes OB, Friedman JH, Fagundes CP. Inflammation and fatigue in early, untreated Parkinson's Disease. Acta Neurol Scand 2018; 138:394-399. [PMID: 29947088 DOI: 10.1111/ane.12977] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Parkinson's disease (PD)-related fatigue is a significant clinical problem, and the pathological processes that cause fatigue remain unknown. The aim of the present study was to explore the possible association of peripheral inflammation markers and fatigue in PD. MATERIALS & METHODS We included 47 drug naïve, newly diagnosed PD patients with low (≤3.0) or high (>5.5) fatigue levels as evaluated by the Fatigue Severity Scale (FSS). Strict diagnostic criteria were applied for inclusion. Patients with possible confounding causes for fatigue were excluded. Serum concentrations of a panel of inflammatory markers (IL-8, TNF-α, MCP1, MIP-1β, IL-6, IL-6R, p-selectin, E-selectin-1, ICAM, VCAM-1, CCL5, IL1-Ra, and TNFR1) were measured using ELISA technology in PD patients with and without fatigue to assess the potential relationships of fatigue in newly diagnosed, treatment-naïve patients. RESULTS Fatigued PD patients had significantly higher levels of the IL-1 receptor antagonist (IL1-Ra) (1790 pg/mL (SD1007) vs 1262 pg/mL (SD379)) and of the adhesion molecule VCAM 1 (1071 ng/mL (SD276) vs 895 ng/mL (SD229)) than non-fatigued patients. A binary logistic regression model, including high or low FSS score as the dependent variable and UPDRS motor score, MADRS, MMSE, ESS, and IL1-Ra/VCAM-1 as independent variables, showed a significant effect both for IL1-Ra and VCAM-1. CONCLUSIONS Higher serum levels of the inflammatory molecules IL1-Ra and VCAM-1 were associated with higher fatigue levels in patients with newly diagnosed, drug-naïve PD. These findings highlight an altered immune response as a potential contributor to PD-related fatigue, from the earliest clinical stages of the disease.
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Affiliation(s)
- K. Herlofson
- Department of Neurology; Sorlandet Hospital; Arendal Norway
| | - C. J. Heijnen
- Department of Symptom Research; M. D. Anderson Cancer Center; Houston TX USA
| | - J. Lange
- The Norwegian Centre for Movement Disorders; Stavanger University Hospital; Stavanger Norway
| | - G. Alves
- The Norwegian Centre for Movement Disorders; Stavanger University Hospital; Stavanger Norway
- Department of Mathematics and Natural Sciences; University of Stavanger; Stavanger Norway
| | - O.-B. Tysnes
- Department of Neurology; Haukeland University Hospital; Department of Clinical Medicine; Bergen Norway
- Department of Clinical Medicine; Haukeland University Hospital; Bergen Norway
| | - J. H. Friedman
- Butler Hospital; Warren Alpert Medical School of Brown University; Providence RI USA
| | - C. P. Fagundes
- Department of Psychology; Rice University and MD Anderson Cancer Center; Houston TX USA
- Department of Behavioral Science; Rice University and MD Anderson Cancer Center; Houston TX USA
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Ibrahimagic OC, Jakubovic AC, Smajlovic D, Dostovic Z, Kunic S, Iljazovic A. Psychological Stress and Changes of Hypothalamic-Pituitary-Adrenal Axis in Patients with "De Novo" Parkinson's Disease. Med Arch 2018; 70:445-448. [PMID: 28210018 PMCID: PMC5292222 DOI: 10.5455/medarh.2016.70.445-448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Psychological stress and changes in hypothalamic-pituitary-adrenal (HPA) axis in period after diagnosis of “de novo” Parkinson disease (PD) could be a big problem for patients. Materials and Methods: We measured psychological stress and changes in hypothalamic-pituitary-adrenal axis (HPA) in thirty patients (15:15) with “de novo” Parkinson’s disease, average age 64.17 ± 13.19 (28-82) years (Department of Neurology, University Clinical Center Tuzla). We used Impact of events scale (with 15 questions) to evaluate psychological stress. Normal level of morning cortisol was 201-681 nmol/l, and morning adrenocorticotropic hormone (ACTH) up to 50 pg/ml. Results: Almost 55% patients suffered from mild or serious psychological stress according to IES testing (Horowitz et al.). Non-iatrogenic changes in HPA axis were noticed at 30% patients. The differences between female and male patients regarding to the age (p=0.561), value of cortisol (p=0.745), value of ACTH (p=0.886) and IES testing (p=0.318) were not noticed. The value of cortisol was the predictor of value of ACTH (r=0.427). Conclusion: Psychological stress and changes in hypothalamic-pituitary-adrenal axis are present in patients with “de novo” PD. There is significant relation between values of cortisol and ACTH. Psychological stress is frequent problem for “de novo” PD patients.
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Affiliation(s)
- Omer C Ibrahimagic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amra Cickusic Jakubovic
- Department of Radiology and Nuclear Medicine, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dzevdet Smajlovic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zikrija Dostovic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Suljo Kunic
- Primary Health Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amra Iljazovic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Nassif DV, Pereira JS. Fatigue in Parkinson's disease: concepts and clinical approach. Psychogeriatrics 2018; 18:143-150. [PMID: 29409156 DOI: 10.1111/psyg.12302] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/25/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022]
Abstract
Parkinson's disease (PD) is a progressive neurological disorder characterized by a large number of motor and non-motor features. Fatigue is one of the most common and most disabling symptoms among patients with PD, and it has a significant impact on their quality of life. Although fatigue has been recognized for a long time, its pathophysiology remains poorly understood, and there is no evidence to support any therapeutic approach in PD patients. Expert consensus on case definition and diagnostic criteria for PD-related fatigue have been recently published, and although they still need to be adequately validated, they provide a great step forward in the study of fatigue. The goal of this article is to provide relevant information for the identification and management of patients with fatigue.
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Affiliation(s)
- Daniel V Nassif
- Department of Neurology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João S Pereira
- Department of Neurology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
PURPOSE OF REVIEW Review of recent literature pertaining to frequency, associations, mechanisms, and overall significance of sleep--wake disturbances (SWD) in the premotor and early phase of Parkinson's disease. RECENT FINDINGS SWD are frequent in Parkinson's disease and their prevalence increases with disease progression. Recent studies confirm previous findings that SWD can appear as initial manifestation of Parkinson's disease even decades before motor signs appear and highlight their clinical associations in these early stages. More intriguingly, new evidence underpins their role as risk factors, predictors, or even as driving force for the neurodegenerative process. As our understanding of sleep--wake neurobiology increases, new hypotheses emerge concerning the pathophysiology of SWD in early Parkinson's disease stages involving dopaminergic and nondopaminergic mechanisms. SUMMARY SWD are predictors for the development of parkinsonian syndromes including Parkinson's disease. This may offer the opportunity of developing new preventive strategies and interventions at an early stage of this neurodegenerative disease.
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20
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Kong KH, Ng HL, Li W, Ng DW, Tan SI, Tay KY, Au WL, Tan LCS. Acupuncture in the treatment of fatigue in Parkinson's disease: A pilot, randomized, controlled, study. Brain Behav 2018; 8:e00897. [PMID: 29568693 PMCID: PMC5853635 DOI: 10.1002/brb3.897] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/11/2017] [Accepted: 11/19/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Fatigue is a common and disabling problem in patients with Parkinson's disease (PD), and there is currently no satisfactory treatment. As acupuncture has been reported to be effective in fatigue related to other conditions, we sought to evaluate its efficacy in PD. METHODS This was a single center, randomized, sham-controlled study. Forty PD patients with moderately severe fatigue were randomized to receive 5 weeks of biweekly real or sham acupuncture. The primary outcome was change on the General Fatigue score of the Multidimensional Fatigue Inventory (MFI-GF) at 5 weeks. Secondary outcomes included MFI-Total score, Unified Parkinson's Disease Rating Scale Motor score (UPDRS Motor), Parkinson's Disease Questionnaire-39 (PDQ 39), Geriatrics Depression Scale (GDS), and Epworth Sleepiness Scale ESS). All outcome measures were evaluated at baseline, 5 and 9 weeks. RESULTS Both groups showed significant improvements in MFI-GF and MFI-Total scores at 5 and 9 weeks, but there were no significant between-group differences. There were no improvements from baseline for PDQ 39, GDS, and ESS. Although improvements were noted for the UPDRS Motor score in the real acupuncture group, no between-group difference could be demonstrated. CONCLUSIONS Both real and sham acupuncture are equally effective in improving PD-related fatigue, and it is likely that this is due to nonspecific or placebo effects.
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Affiliation(s)
- Keng H Kong
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Hwee L Ng
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Wei Li
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Dora W Ng
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Siang I Tan
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Kay Y Tay
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Wing L Au
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Louis C S Tan
- Neurology, National Neuroscience Institute Singapore City Singapore
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Fu R, Cui SS, Du JJ, He YC, Gao C, Huang P, Qian YW, Luo XG, Chen SD. Fatigue correlates with LRRK2 G2385R variant in Chinese Parkinson's disease patients. Parkinsonism Relat Disord 2017; 44:101-105. [PMID: 28941828 DOI: 10.1016/j.parkreldis.2017.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Fatigue is common in patients with Parkinson's disease (PD). The leucine-rich repeat kinase 2 (LRRK2) G2385R variant predisposes individuals to develop PD in China. The aim of this study was to evaluate whether the LRRK2 G2385R variant is associated with fatigue in patients with PD. METHODS Fatigue was evaluated by the Parkinson Fatigue Scale (PFS) in 329 PD patients and 180 controls, a cut-off score of ≥3.3 was used to define the presence of fatigue. All the enrolled PD patients were assessed by a comprehensive battery of motor and non-motor questionnaires. PD patients were genotyped for the G2385R variant. Associations of fatigue with the clinical assessments and with the G2385R variant in PD patients were analyzed by logistic regression. RESULTS Fatigue frequency was 55.62%. A logistic regression model found that the female sex (OR = 10.477; 95%CI: 2.806-39.120; p < 0.001), motor function (OR = 1.060; 95%CI: 1.012-1.110; p = 0.013), sleep disturbance (OR = 0.943; 95%CI: 0.910-0.976; p = 0.001) and depression severity (OR = 0.843; 95%CI: 0.736-0.965; p = 0.013) collectively predict the presence of fatigue in PD patients. After adjustment for demographics and associated clinical factors, the G2385R variant was associated with an increased risk for the presence of fatigue (OR = 10.699; 95% CI = 2.387-47.958; p = 0.002) in the PD population in this study. CONCLUSION We confirm that fatigue in PD patients is common, and we have strengthened the associations between fatigue and female sex, motor severity and non-motor symptoms, particularly depression and sleep disturbances. Overall, we found that carriers of the G2385R variant were more prone to fatigue than non-carriers in PD patients.
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Affiliation(s)
- Rao Fu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Shi-Shuang Cui
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Juan-Juan Du
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ya-Chao He
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chao Gao
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Pei Huang
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi-Wei Qian
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiao-Guang Luo
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
| | - Sheng-Di Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Benzing C, Krenzien F, Krezdorn N, Wiltberger G, Hinz A, Förster J, Atanasov G, Schmelzle M, Glaesmer H, Hau HM, Bartels M. Fatigue After Liver Transplant and Combined Liver and Kidney Transplant. EXP CLIN TRANSPLANT 2017. [PMID: 28621633 DOI: 10.6002/ect.2016.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To date, fatigue is still poorly understood in recipients of orthotopic liver transplant and simultaneous/sequential liver and kidney transplant procedures. The present study examined the appearance of fatigue in patients who received orthotopic liver and sequential liver and kidney transplant procedures compared with the general population and the influence of various clinical and socioeconomic factors on fatigue levels. MATERIALS AND METHODS The Multidimensional Fatigue Inventory survey was sent to all patients with a history of orthotopic liver and simultaneous/sequential liver and kidney transplant. The results were compared to data from a reference population. RESULTS Our survey included 276 eligible patients: 256 recipients (92.7%) of orthotopic liver transplant and 20 recipients (7.3%) of simultaneous/sequential liver and kidney transplant. Significantly lower fatigue scores were found in the general population compared with both transplant groups (P < .001). There were also no significant differences between the transplant groups. Among the clinical and socioeconomic factors, history of hepatocellular carcinoma, chronic kidney disease, age, family status, and education had a significant impact on fatigue levels. CONCLUSIONS This is the first study to compare fatigue in recipients of orthotopic liver and simultaneous/sequential liver and kidney transplant. We found that fatigue is an important but still poorly understood outcome after transplant.
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Affiliation(s)
- Christian Benzing
- From the Department of Surgery, Campus Charité-Mitte
- Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
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Fu R, Cui SS, Du JJ, Huang P, He YC, Gao C, Luo XG, Chen SD. Validation of the Parkinson Fatigue Scale in Chinese Parkinson's disease patients. Brain Behav 2017; 7:e00712. [PMID: 28638717 PMCID: PMC5474715 DOI: 10.1002/brb3.712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Fatigue is a common nonmotor symptom in Parkinson's disease (PD); however, the Parkinson's disease fatigue scale (PFS), which is designed to measure fatigue in PD, has not been validated in China. The aim of this study was to determine the validity and reliability of the Chinese version of the PFS in PD patients. METHODS A total of 115 PD patients were evaluated at baseline and after 7 days. Assessments included the PFS, the Fatigue Severity Scale (FSS), and scales assessing motor, cognition, depression, and anxiety. Acceptability was assessed in terms of the rate of missing data and floor and ceiling effects. Cronbach's alpha was calculated to determine internal consistency. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Spearman's rank correlation coefficients were used to calculate convergent and divergent validity between PFS scores and scales assessing clinical characteristics. RESULTS No data were missing for the PFS. Compared with the original scoring method, the binary scoring method had relatively large floor effects (5.21% vs. 17.39%) and ceiling effects (0.90% vs. 4.31%). The internal consistency and test-retest reliability of the PFS were satisfactory (original scoring method: Cronbach's alpha = 0.97, ICC = 0.94; binary scoring method: Cronbach's alpha = 0.94, ICC = 0.94). The PFS score exhibited strong convergent validity with FSS score (correlation coefficient = 0.87). PFS score was weakly to moderately correlated with disease duration and with measures of disease stage, motor function, depression, and anxiety (range of correlation coefficients: 0.25-0.48). There was no significant correlation between PFS score and either onset age or MoCA score (range of correlation coefficients: -0.05 to 0.12). CONCLUSION The Chinese version of the PFS is a valid measure for assessing fatigue in PD.
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Affiliation(s)
- Rao Fu
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Shi-Shuang Cui
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Juan-Juan Du
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Pei Huang
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ya-Chao He
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chao Gao
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiao-Guang Luo
- Department of Neurology First Affiliated Hospital of China Medical University Shenyang China
| | - Sheng-Di Chen
- Department of Neurology & Institute of Neurology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
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Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, Kurtis MM, Skorvanek M. Measurement of Nonmotor Symptoms in Clinical Practice. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:291-345. [PMID: 28802923 DOI: 10.1016/bs.irn.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonmotor symptoms constitute a prominent part of Parkinson's disease manifestations. They are present since the first phases of the disease, increase their number and severity with disease progression, and importantly impact on patients' health and quality of life, caregivers' burden, and social resources. Research on Parkinson's disease has traditionally focused on the motor aspects of the disease, but an increasing interest in the nonmotor manifestations has risen in the past decade. The availability of assessment instruments for detecting and measuring these symptoms has allowed understanding of their importance and course over time, as well as estimation of therapeutic effects on them. In this chapter, a review of the basic characteristics of nonmotor symptom assessments used in clinical practice and research are presented.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain.
| | | | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M Kurtis
- Movement Disorders Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Matej Skorvanek
- P.J. Safarik University, Kosice, Slovakia; University Hospital of L. Pasteur, Kosice, Slovakia
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Zhang JJ, Ding J, Li JY, Wang M, Yuan YS, Zhang L, Jiang SM, Wang XX, Zhu L, Zhang KZ. Abnormal Resting-State Neural Activity and Connectivity of Fatigue in Parkinson's Disease. CNS Neurosci Ther 2017; 23:241-247. [PMID: 28044431 DOI: 10.1111/cns.12666] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 12/29/2022] Open
Abstract
AIMS Fatigue is a common burdensome problem in patients with Parkinson's disease (PD), but its pathophysiological mechanisms are poorly understood. This study aimed at investigating the neural substrates of fatigue in patients with PD. METHODS A total of 17 PD patients with fatigue, 32 PD patients without fatigue, and 25 matched healthy controls were recruited. The 9-item fatigue severity scale (FSS) was used for fatigue screening and severity rating. Resting-state functional magnetic resonance imaging (RS-fMRI) data were obtained from all subjects. Amplitude of low-frequency fluctuations (ALFF) was used to measure regional brain activity, and functional connectivity (FC) was applied to investigate functional connectivity at a network level. RESULTS PD-related fatigue was associated with ALFF changes in right middle frontal gyrus within the attention network and in left insula as well as right midcingulate cortex within the salience network. FC analysis revealed that above three regions showing ALFF differences had altered functional connectivity mainly in the temporal, parietal, and motor cortices. CONCLUSION Our findings do reveal that abnormal regional brain activity within attention and salience network and altered FC of above abnormal regions are involved in neural mechanism of fatigue in patients with PD.
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Affiliation(s)
- Jie-Jin Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Ding
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun-Yi Li
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yong-Sheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Si-Ming Jiang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi-Xi Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Zhu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke-Zhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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26
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Bryant MS, Jackson GR, Hou JG, Protas EJ. Treadmill exercise tests in persons with Parkinson's disease: responses and disease severity. Aging Clin Exp Res 2016; 28:1009-14. [PMID: 26590841 DOI: 10.1007/s40520-015-0498-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/03/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS There is a paucity of information on cardiovascular responses with regard to the disease stage of Parkinson's disease (PD) when using an exercise test. Our purpose was to examine whether cardiovascular responses to the treadmill exercise test differed among persons with PD who have different disease severity. METHODS Forty-five subjects with PD were studied (34 men and 11 women). The subjects underwent a treadmill exercise test using a modified Bruce protocol. Resting heart rate (HR), resting blood pressure (BP), maximal HR, maximal BP, exercise duration, maximum percentage HR and METs achieved after the treadmill exercise test were studied. RESULTS Seventeen subjects were in Hoehn and Yahr Staging Scale (HY) 2, 16 were in HY 2.5, and 12 were in HY 3. HR increased significantly in all three stages. Systolic BP increased significantly in the HY 2 and 2.5, but not the HY 3. Diastolic BP did not change in any stage. Resting HR was lower in the HY 2 compared to the HY 3 and resting systolic BP was higher in HY 2 compared to the HY 2.5. The three HY stages were not different in exercise duration, HR and BP responses, maximum percentage HR achieved, and METs achieved. Fatigue was a primary reason to discontinue the test. There were no fall incidents in any of the tests. CONCLUSIONS Cardiovascular responses to the treadmill exercise test did not vary with disease severity. Treadmill exercise tests were safe to perform in persons with PD.
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27
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Ongre SO, Larsen JP, Tysnes OB, Herlofson K. Fatigue in early Parkinson's disease: the Norwegian ParkWest study. Eur J Neurol 2016; 24:105-111. [DOI: 10.1111/ene.13161] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S. O. Ongre
- Department of Neurology; Sorlandet Hospital; Arendal Norway
| | - J. P. Larsen
- Network for Medical Sciences; University of Stavanger; Stavanger Norway
| | - O. B. Tysnes
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - K. Herlofson
- Department of Neurology; Sorlandet Hospital; Arendal Norway
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Cho SS, Aminian K, Li C, Lang AE, Houle S, Strafella AP. Fatigue in Parkinson's disease: The contribution of cerebral metabolic changes. Hum Brain Mapp 2016; 38:283-292. [PMID: 27571419 DOI: 10.1002/hbm.23360] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 01/18/2023] Open
Abstract
Fatigue is a common and disabling non-motor symptom in Parkinson's disease associated with a feeling of overwhelming lack of energy. The aim of this study was to identify the neural substrates that may contribute to the development of fatigue in Parkinson's disease. Twenty-three Parkinson's disease patients meeting UK Brain Bank criteria for the diagnosis of idiopathic Parkinson's disease were recruited and completed the 2-[18 F]fluoro-2-deoxy-D-glucose (FDG)-PET scan. The metabolic activities of Parkinson's disease patients with fatigue were compared to those without fatigue using statistical parametric mapping analysis. The Parkinson's disease group exhibiting higher level of fatigue showed anti-correlated metabolic changes in cortical regions associated with the salience (i.e., right insular region) and default (i.e., bilateral posterior cingulate cortex) networks. The metabolic abnormalities detected in these brain regions displayed a significant correlation with level of fatigue and were associated with a disruption of the functional correlations with different cortical areas. These observations suggest that fatigue in Parkinson's disease may be the expression of metabolic abnormalities and impaired functional interactions between brain regions linked to the salience network and other neural networks. Hum Brain Mapp 38:283-292, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sang Soo Cho
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, University of Toronto, Ontario, Canada.,Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Kelly Aminian
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, University of Toronto, Ontario, Canada.,Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Crystal Li
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Anthony E Lang
- Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Toronto Western Hospital, Neurology Div., University Health Network, University of Toronto, Ontario, Canada
| | - Sylvain Houle
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Antonio P Strafella
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, University of Toronto, Ontario, Canada.,Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada.,Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Toronto Western Hospital, Neurology Div., University Health Network, University of Toronto, Ontario, Canada
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29
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Ulrichsen KM, Kaufmann T, Dørum ES, Kolskår KK, Richard G, Alnæs D, Arneberg TJ, Westlye LT, Nordvik JE. Clinical Utility of Mindfulness Training in the Treatment of Fatigue After Stroke, Traumatic Brain Injury and Multiple Sclerosis: A Systematic Literature Review and Meta-analysis. Front Psychol 2016; 7:912. [PMID: 27445888 PMCID: PMC4917545 DOI: 10.3389/fpsyg.2016.00912] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom following neurological illnesses and injuries, and is rated as one of the most debilitating sequela in conditions such as stroke, traumatic brain injury (TBI), and multiple sclerosis (MS). Yet effective treatments are lacking, suggesting a pressing need for a better understanding of its etiology and mechanisms that may alleviate the symptoms. Recently mindfulness-based interventions have demonstrated promising results for fatigue symptom relief. OBJECTIVE Investigate the efficacy of mindfulness-based interventions for fatigue across neurological conditions and acquired brain injuries. MATERIALS AND METHODS Systematic literature searches were conducted in PubMed, Medline, Web of Science, and PsycINFO. We included randomized controlled trials applying mindfulness-based interventions in patients with neurological conditions or acquired brain injuries. Four studies (N = 257) were retained for meta-analysis. The studies included patients diagnosed with MS, TBI, and stroke. RESULTS The estimated effect size for the total sample was -0.37 (95% CI: -0.58, -0.17). CONCLUSION The results indicate that mindfulness-based interventions may relieve fatigue in neurological conditions such as stroke, TBI, and MS. However, the effect size is moderate, and further research is needed in order to determine the effect and improve our understanding of how mindfulness-based interventions affect fatigue symptom perception in patients with neurological conditions.
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Affiliation(s)
| | - Tobias Kaufmann
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
| | - Erlend S. Dørum
- Sunnaas Rehabilitation Hospital HT, NesoddenNorway
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
| | - Knut K. Kolskår
- Sunnaas Rehabilitation Hospital HT, NesoddenNorway
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
| | - Geneviève Richard
- Sunnaas Rehabilitation Hospital HT, NesoddenNorway
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
| | - Dag Alnæs
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
| | - Tone J. Arneberg
- Department of Behavioural Sciences, Oslo and Akershus University College of Applied Sciences, OsloNorway
| | - Lars T. Westlye
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
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Fatigue and Its Associated Factors in Spinocerebellar Ataxia Type 3/Machado-Joseph Disease. THE CEREBELLUM 2016; 16:118-121. [DOI: 10.1007/s12311-016-0775-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zuo LJ, Yu SY, Wang F, Hu Y, Piao YS, Du Y, Lian TH, Wang RD, Yu QJ, Wang YJ, Wang XM, Chan P, Chen SD, Wang Y, Zhang W. Parkinson's Disease with Fatigue: Clinical Characteristics and Potential Mechanisms Relevant to α-Synuclein Oligomer. J Clin Neurol 2016; 12:172-80. [PMID: 26869370 PMCID: PMC4828563 DOI: 10.3988/jcn.2016.12.2.172] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 12/31/2022] Open
Abstract
Background and Purpose The aim of this study was to identify the clinical characteristics and potential mechanisms relevant to pathological proteins in Parkinson's disease (PD) patients who experience fatigue. Methods PD patients (n=102) were evaluated using a fatigue severity scale and scales for motor and nonmotor symptoms. The levels of three pathological proteins—α-synuclein oligomer, β-amyloid (Aβ)1-42, and tau—were measured in 102 cerebrospinal fluid (CSF) samples from these PD patients. Linear regression analyses were performed between fatigue score and the CSF levels of the above-listed pathological proteins in PD patients. Results The frequency of fatigue in the PD patients was 62.75%. The fatigue group had worse motor symptoms and anxiety, depression, and autonomic dysfunction. The CSF level of α-synuclein oligomer was higher and that of Aβ1-42 was lower in the fatigue group than in the non-fatigue group. In multiple linear regression analyses, fatigue severity was significantly and positively correlated with the α-synuclein oligomer level in the CSF of PD patients, after adjusting for confounders. Conclusions PD patients experience a high frequency of fatigue. PD patients with fatigue have worse motor and part nonmotor symptoms. Fatigue in PD patients is associated with an increased α-synuclein oligomer level in the CSF.
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Affiliation(s)
- Li Jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Yang Yu
- Department of Geriatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Hu
- Department of Geriatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shan Piao
- Department of Geriatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Teng Hong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Dan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiu Jin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ya Jie Wang
- Core Laboratory for Clinical Medical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao Min Wang
- Department of Physiology, Capital Medical University, Beijing, China
| | - Piu Chan
- Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurobiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sheng Di Chen
- Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei Zhang
- Department of Geriatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Key Laboratory on Parkinson's Disease, Beijing, China.
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Friedman JH, Beck JC, Chou KL, Clark G, Fagundes CP, Goetz CG, Herlofson K, Kluger B, Krupp LB, Lang AE, Lou JS, Marsh L, Newbould A, Weintraub D. Fatigue in Parkinson's disease: report from a mutidisciplinary symposium. NPJ Parkinsons Dis 2016; 2:15025. [PMID: 27239558 PMCID: PMC4883681 DOI: 10.1038/npjparkd.2015.25] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/28/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a severe problem for many people living with Parkinson's disease (PD). Best estimates suggest that more than 50% of patients experience this debilitating symptom. Little is known about its etiology or treatment, making the understanding of fatigue a true unmet need. As part of the Parkinson's Disease Foundation Community Choice Research Program, patients, caregivers, and scientists attended a symposium on fatigue on 16 and 17 October 2014. We present a summary of that meeting, reviewing what is known about the diagnosis and treatment of fatigue, its physiology, and what we might learn from multiple sclerosis (MS), depression, and cancer-disorders in which fatigue figures prominently too. We conclude with focused recommendations to enhance our understanding and treatment of this prominent problem in PD.
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Affiliation(s)
- Joseph H Friedman
- Movement Disorders Program, Butler Hospital, Province, RI, USA
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - James C Beck
- Parkinson’s Disease Foundation, New York, NY, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan Health System, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gracia Clark
- Parkinson’s Disease Foundation, New York, NY, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, M.D. Anderson Cancer Center, Houston, TX, USA
- Department of Health Disparities, Houston, TX, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Karen Herlofson
- Department of Neurology, Sorlandet Hospital, Arendal, Norway
| | - Benzi Kluger
- Department of Neurology, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Lauren B Krupp
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Anthony E Lang
- Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Clinic and Edmond J Safra Program in Parkinson’s Disease, Toronto, ON, Canada
| | - Jao-Shin Lou
- University of North Dakota School of Medicine and Health Services, Sanford Health, Grand Forks, ND, USA
| | - Laura Marsh
- Department of Psychiatry, Baylor College of Medicine, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Elbers RG, Verhoef J, van Wegen EEH, Berendse HW, Kwakkel G. Interventions for fatigue in Parkinson's disease. Cochrane Database Syst Rev 2015; 2015:CD010925. [PMID: 26447539 PMCID: PMC9240814 DOI: 10.1002/14651858.cd010925.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Factors contributing to subjective fatigue in people with idiopathic Parkinson's disease (PD) are not well known. This makes it difficult to manage fatigue effectively in PD. OBJECTIVES To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE (via PubMed); Ovid EMBASE; EBSCO CINAHL; Ovid PsycINFO; PEDro; and the WHO International Clinical Trials Registry Platform Search Portal up to April 2015. References of included studies and identified review articles were screened for additional studies. There were no restrictions based on language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) that report on subjective fatigue in people with PD. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data collection and risk of bias assessments. MAIN RESULTS Eleven studies were eligible for this systematic review, with a total of 1817 people. Three studies included only people who experienced clinically relevant fatigue (Fatigue Severity Scale score ≥ 4 out of 7 or Multidimensional Fatigue Inventory total score > 48 out of 100), whereas all other studies did not select participants on the basis of experienced fatigue. Nine studies investigated the effects of medication (i.e. levodopa-carbidopa, memantine, rasagiline, caffeine, methylphenidate, modafinil or doxepin) on subjective fatigue. All studies were placebo controlled. There was insufficient evidence to determine the effect of doxepin on the impact of fatigue on activities in daily life (ADL) or fatigue severity (one study, N = 12, standardised mean difference (SMD) = -1.50, 95% confidence interval (CI) -2.84 to -0.15; low quality evidence). We found high quality evidence that rasagiline reduced or slowed down the progression of physical aspects of fatigue (one study, N = 1176, SMD = -0.27, 95% CI -0.39 to -0.16, I(2) = 0%). None of the other pharmacological interventions affected subjective fatigue in PD. With regard to adverse effects, only levodopa-carbidopa showed an increase for the risk of nausea (one study, N = 361, risk ratio (RR) = 1.85, 95% CI 1.05 to 3.27; high quality evidence). Two studies investigated the effect of exercise on fatigue compared with usual care. We found low quality evidence for the effect of exercise on reducing the impact of fatigue on ADL or fatigue severity (two studies, N = 57, SMD = -0.45, 95% CI -1.21 to 0.32, I(2) = 44%). AUTHORS' CONCLUSIONS Based on the current evidence, no clear recommendations for the treatment of subjective fatigue in PD can be provided. Doxepin may reduce the impact of fatigue on ADL and fatigue severity; however, this finding has to be confirmed in high quality studies. Rasagiline may be effective in reducing levels of physical fatigue in PD. No evidence was found for the effectiveness of levodopa-carbidopa, memantine, caffeine, methylphenidate, modafinil or exercise. Studies are needed to investigate the effect of exercise intensity on exercise capacity and subjective fatigue. Future studies should focus on interventions that address the maladaptive behavioural or cognitive aspects of fatigue in people with PD. Characteristics, such as severity and nature of perceived fatigue and underlying mood disorders should be considered to identify responders and non-responders when studying interventions for fatigue. The development of a core-set of self-report fatigue questionnaires with established responsiveness and known minimal important difference values will facilitate the interpretation of change in fatigue scores.
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Affiliation(s)
- Roy G Elbers
- University of Applied Sciences LeidenDepartment of PhysiotherapyZernikedreef 11PO Box 382LeidenNetherlands2300 AJ
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - John Verhoef
- Faculty of Health, University of Applied Sciences LeidenP.O.Box 382LeidenNetherlands2300 AJ
| | - Erwin EH van Wegen
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Henk W Berendse
- Neuroscience Campus Amsterdam, VU University Medical CenterDepartment of NeurologyAmsterdamNetherlands
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
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Herrera AJ, Espinosa-Oliva AM, Carrillo-Jiménez A, Oliva-Martín MJ, García-Revilla J, García-Quintanilla A, de Pablos RM, Venero JL. Relevance of chronic stress and the two faces of microglia in Parkinson's disease. Front Cell Neurosci 2015; 9:312. [PMID: 26321913 PMCID: PMC4536370 DOI: 10.3389/fncel.2015.00312] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/28/2015] [Indexed: 12/26/2022] Open
Abstract
This review is aimed to highlight the importance of stress and glucocorticoids (GCs) in modulating the inflammatory response of brain microglia and hence its potential involvement in Parkinson’s disease (PD). The role of inflammation in PD has been reviewed extensively in the literature and it is supposed to play a key role in the course of the disease. Historically, GCs have been strongly associated as anti-inflammatory hormones. However, accumulating evidence from the peripheral and central nervous system have clearly revealed that, under specific conditions, GCs may promote brain inflammation including pro-inflammatory activation of microglia. We have summarized relevant data linking PD, neuroinflamamation and chronic stress. The timing and duration of stress response may be critical for delineating an immune response in the brain thus probably explain the dual role of GCs and/or chronic stress in different animal models of PD.
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Affiliation(s)
- Antonio J Herrera
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - Ana M Espinosa-Oliva
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - Alejandro Carrillo-Jiménez
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - María J Oliva-Martín
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - Juan García-Revilla
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - Alberto García-Quintanilla
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - Rocío M de Pablos
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
| | - José L Venero
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia and Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Sevilla, Spain
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Kim J, Sidransky E, Lopez G. Understanding and managing parkinsonism in patients with glucocerebrosidase mutations. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1034271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dobryakova E, Genova HM, DeLuca J, Wylie GR. The dopamine imbalance hypothesis of fatigue in multiple sclerosis and other neurological disorders. Front Neurol 2015; 6:52. [PMID: 25814977 PMCID: PMC4357260 DOI: 10.3389/fneur.2015.00052] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/25/2015] [Indexed: 11/13/2022] Open
Abstract
Fatigue is one of the most pervasive symptoms of multiple sclerosis (MS), and has engendered hundreds of investigations on the topic. While there is a growing literature using various methods to study fatigue, a unified theory of fatigue in MS is yet to emerge. In the current review, we synthesize findings from neuroimaging, pharmacological, neuropsychological, and immunological studies of fatigue in MS, which point to a specific hypothesis of fatigue in MS: the dopamine imbalance hypothesis. The communication between the striatum and prefrontal cortex is reliant on dopamine, a modulatory neurotransmitter. Neuroimaging findings suggest that fatigue results from the disruption of communication between these regions. Supporting the dopamine imbalance hypothesis, structural and functional neuroimaging studies show abnormalities in the frontal and striatal regions that are heavily innervated by dopamine neurons. Further, dopaminergic psychostimulant medication has been shown to alleviate fatigue in individuals with traumatic brain injury, chronic fatigue syndrome, and in cancer patients, also indicating that dopamine might play an important role in fatigue perception. This paper reviews the structural and functional neuroimaging evidence as well as pharmacological studies that suggest that dopamine plays a critical role in the phenomenon of fatigue. We conclude with how specific aspects of the dopamine imbalance hypothesis can be tested in future research.
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Affiliation(s)
- Ekaterina Dobryakova
- Traumatic Brain Injury Laboratory, Kessler Foundation , West Orange, NJ , USA ; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ , USA
| | - Helen M Genova
- Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ , USA ; Neuropsychology and Neuroscience Laboratory, Kessler Foundation , West Orange, NJ , USA
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ , USA ; Neuropsychology and Neuroscience Laboratory, Kessler Foundation , West Orange, NJ , USA ; Department of Neurology and Neurosciences, Rutgers - New Jersey Medical School , Newark, NJ , USA
| | - Glenn R Wylie
- Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ , USA ; Neuropsychology and Neuroscience Laboratory, Kessler Foundation , West Orange, NJ , USA ; War Related Illness and Injury Study Center, Department of Veterans Affairs , East Orange, NJ , USA
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Skorvanek M, Gdovinova Z, Rosenberger J, Ghorbani Saeedian R, Nagyova I, Groothoff JW, van Dijk JP. The associations between fatigue, apathy, and depression in Parkinson's disease. Acta Neurol Scand 2015; 131:80-7. [PMID: 25288130 DOI: 10.1111/ane.12282] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Fatigue and apathy are two of the most common and most disabling non-motor symptoms of Parkinson's disease (PD). They have a high coincidence and can often be confused; moreover, their relationship is not fully understood. The aim of our study was to describe the coincidence of apathy with different fatigue domains in the presence/absence of depression and to separately describe the associations of different aspects of primary and secondary fatigue with apathy and other clinical and disease-related factors. MATERIALS AND METHODS A total of 151 non-demented patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II, and Epworth Sleepiness Scale. RESULTS The prevalence and severity of fatigue and apathy were significantly higher in depressed PD patients. However, our results show that depression, fatigue, and apathy can be clearly distinguished in PD. Apathy was associated with the MFI's-reduced motivation domain in both depressed and non-depressed patients. However, apathy was associated with mental fatigue aspects only in non-depressed patients, and it was not related to the physical aspects of fatigue in any of the studied groups. CONCLUSIONS Although the pathophysiology of fatigue and apathy in PD is clearly multifactorial, in a proportion of PD patients, these symptoms are associated with depression, dopaminergic depletion in the mesocorticolimbic structures, and disruption of the prefrontal cortex-basal ganglia axis. Therefore, in some PD patients, adequate management of depression and optimal dopaminergic medication may improve both fatigue and apathy.
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Affiliation(s)
- M. Skorvanek
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - Z. Gdovinova
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
| | - J. Rosenberger
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - R. Ghorbani Saeedian
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - I. Nagyova
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - J. W. Groothoff
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
| | - J. P. van Dijk
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
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Frayne E, Coulson S, Adams R, Croxson GR. Self-regulatory fatigue after neurological and musculoskeletal injury: implications for physiotherapy management. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x14y.0000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The dopamine reuptake inhibitor MRZ-9547 increases progressive ratio responding in rats. Int J Neuropsychopharmacol 2014; 17:2045-56. [PMID: 24964269 DOI: 10.1017/s1461145714000996] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Drugs that are able to shift effort-related decision making in intact rats towards high-effort response options are largely unknown. Here, we examined the effects of two candidate drugs, MRZ-9547 and its l-enantiomer MRZ-9546 on progressive ratio (PR) responding using two different tasks, a standard PR task that involves increasing ratio requirements and a PR/chow feeding choice task in which animals can lever press for preferred food pellets under a PR schedule or approach freely available less preferred lab chow. Furthermore, we assessed the mechanisms of action of both drugs using in vitro-assay methods and in vivo-microdialysis. Results reveal that MRZ-9547 is a selective dopamine transporter (DAT) inhibitor that moderately stimulated striatal dopamine release. MRZ-9546 was a much less potent DAT inhibitor. Furthermore, MRZ-9547 dose dependently increased the tendency to work for food reinforcement both in the standard PR task and the PR/chow feeding choice task, MRZ-9546 was considerably less active. Relative to MRZ-9547, other DAT-interfering drugs had only moderate (methylphenidate) or marginal (modafinil, d-amphetamine) stimulant effects on PR responding in either task. Collectively, our data demonstrate that the DAT inhibitor MRZ-9547 can markedly stimulate PR responding and shift effort-related decision making in intact rats towards high-effort response options. An analysis of effort-related decision making in rodents could provide an animal model for motivational dysfunctions related to effort expenditure such as fatigue, e.g. in Parkinson's disease or major depression. Our findings suggest that DAT inhibitors such as MRZ-9547 could be potentially useful for treating energy-related symptoms in neurological or neuropsychiatric disorders.
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Effects of dopamine uptake inhibitor MRZ-9547 in animal models of Parkinson’s disease. J Neural Transm (Vienna) 2014; 122:809-18. [DOI: 10.1007/s00702-014-1326-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/08/2014] [Indexed: 01/31/2023]
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Abstract
In this manuscript we summarize the role of chronic stress as a potential trigger factor for Parkinson's disease. Underlying mechanisms and stress-induced changes to the neuronal networks have been highlighted. Examples of stress induced reversible symptoms that resemble parkinsonism in humans and in animal models raise the question whether emotional stress can cause striatal degeneration in susceptible patients. A Pubmed literature review searching for the terms 'Stress', 'Distress and Parkinson's disease', 'Emotional Distress and Parkinson's disease', 'Stress and Parkinson's disease', 'Prodromal Parkinson's disease', 'Non motor symptoms and Parkinson's disease', 'Paradoxical kinesia', 'Psychogenic parkinsonism', 'Functional somatic syndromes', 'Chronic fatigue syndrome', 'Irritable bowel syndrome', 'Fibromyalgia', 'Dopamine and fibromyalgia', 'Dopamine and chronic fatigue syndrome' and 'Dopamine and irritable bowel syndrome' was carried out until April 2013. Articles were also identified through searches of the authors' own files. Only papers published in English were reviewed. The final reference list was generated on the basis of originality and relevance to the broad scope of this viewpoint.
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Affiliation(s)
- Atbin Djamshidian
- The National Hospital for Neurology and Neurosurgery, Queen Square and the Reta Lila Weston Institute of Neurological Studies, UCL, London, UK
| | - Andrew J Lees
- The National Hospital for Neurology and Neurosurgery, Queen Square and the Reta Lila Weston Institute of Neurological Studies, UCL, London, UK
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Uc EY, Doerschug KC, Magnotta V, Dawson JD, Thomsen TR, Kline JN, Rizzo M, Newman SR, Mehta S, Grabowski TJ, Bruss J, Blanchette DR, Anderson SW, Voss MW, Kramer AF, Darling WG. Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting. Neurology 2014; 83:413-25. [PMID: 24991037 DOI: 10.1212/wnl.0000000000000644] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To (1) investigate effects of aerobic walking on motor function, cognition, and quality of life in Parkinson disease (PD), and (2) compare safety, tolerability, and fitness benefits of different forms of exercise intervention: continuous/moderate intensity vs interval/alternating between low and vigorous intensity, and individual/neighborhood vs group/facility setting. METHODS Initial design was a 6-month, 2 × 2 randomized trial of different exercise regimens in independently ambulatory patients with PD. All arms were required to exercise 3 times per week, 45 minutes per session. RESULTS Randomization to group/facility setting was not feasible because of logistical factors. Over the first 2 years, we randomized 43 participants to continuous or interval training. Because preliminary analyses suggested higher musculoskeletal adverse events in the interval group and lack of difference between training methods in improving fitness, the next 17 participants were allocated only to continuous training. Eighty-one percent of 60 participants completed the study with a mean attendance of 83.3% (95% confidence interval: 77.5%-89.0%), exercising at 46.8% (44.0%-49.7%) of their heart rate reserve. There were no serious adverse events. Across all completers, we observed improvements in maximum oxygen consumption, gait speed, Unified Parkinson's Disease Rating Scale sections I and III scores (particularly axial functions and rigidity), fatigue, depression, quality of life (e.g., psychological outlook), and flanker task scores (p < 0.05 to p < 0.001). Increase in maximum oxygen consumption correlated with improvements on the flanker task and quality of life (p < 0.05). CONCLUSIONS Our preliminary study suggests that aerobic walking in a community setting is safe, well tolerated, and improves aerobic fitness, motor function, fatigue, mood, executive control, and quality of life in mild to moderate PD. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in patients with PD, an aerobic exercise program improves aerobic fitness, motor function, fatigue, mood, and cognition.
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Affiliation(s)
- Ergun Y Uc
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
| | - Kevin C Doerschug
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Vincent Magnotta
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Jeffrey D Dawson
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Teri R Thomsen
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Joel N Kline
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Matthew Rizzo
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Sara R Newman
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Sonya Mehta
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Thomas J Grabowski
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Joel Bruss
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Derek R Blanchette
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Steven W Anderson
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Michelle W Voss
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Arthur F Kramer
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
| | - Warren G Darling
- From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign
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Elbers RG, Verhoef J, van Wegen EEH, Berendse HW, Kwakkel G. Interventions for fatigue in Parkinson's disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Skogar Ö, Borg A, Larsson B, Robertsson L, Andersson L, Andersson L, Backstrom P, Fall PA, Hallgren G, Bringer B, Carlsson M, Lennartsson U, Sandbjork H, Lökk J, Törnhage CJ. “Effects of Tactile Touch on pain, sleep and health related quality of life in Parkinson's disease with chronic pain”: A randomized, controlled and prospective study. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2012.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sallam K, Amr M. The use of the mini-mental state examination and the clock-drawing test for dementia in a tertiary hospital. J Clin Diagn Res 2013; 7:484-8. [PMID: 23634401 DOI: 10.7860/jcdr/2013/4203.2803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 01/17/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION An early and a quick identification of dementia is desirable to improve the overall care to the affected persons in the developing countries. The aim of this study was to evaluate the discriminative abilities of the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) in differentiating the demented patients from the controls and also the differentiation between the different types of dementia. PATIENTS AND METHODS This study was designed to evaluate the patients with varied types and severities of dementia, who were diagnosed by using the Clinical Dementia Rating (CDR) scale. All the patients completed the MMSE and the simplified CDT. RESULTS This study included 197 patients with an age range of 43-79 years. Fifty-one patients (25.9%) were diagnosed with Alzheimer Dementia (AD), 37 patients (18.8%) with Vascular Dementia (VD), 23 patients (11.7%) with Parkinson's Disease Dementia (PDD) and 86 patients (43.6%) with other variants of dementia. The total MMSE score of the enrolled patients was significantly lower as compared to that of the control subjects, with a non-significant difference between the varied diagnoses. The total CDT scores were significantly lower in the patients as compared to those in the controls, with significantly lower scores in the PDD group as compared to those in the AD group. The patients who had AD showed non-significantly higher CDT scores as compared to the patients who had vascular and other types of dementia. CONCLUSION A combined application of both MMSE and CDT can identify the persons with a cognitive affection and this may be a useful tool for the diagnosis of the non Alzheimer's type of dementia.
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Affiliation(s)
- Khaled Sallam
- Assistant Professor, Department of Neurology, Faculty of Medicine, Benha University , Egypt
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46
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Validation of the Modified Fatigue Impact Scale in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:335-8. [DOI: 10.1016/j.parkreldis.2012.11.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 10/31/2012] [Accepted: 11/12/2012] [Indexed: 01/19/2023]
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47
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Skorvanek M, Nagyova I, Rosenberger J, Krokavcova M, Ghorbani Saeedian R, Groothoff JW, Gdovinova Z, van Dijk JP. Clinical determinants of primary and secondary fatigue in patients with Parkinson’s disease. J Neurol 2013; 260:1554-61. [DOI: 10.1007/s00415-012-6828-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 12/20/2012] [Accepted: 12/27/2012] [Indexed: 01/18/2023]
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Jenkinson C, Dummett S, Kelly L, Peters M, Dawson J, Morley D, Fitzpatrick R. The development and validation of a quality of life measure for the carers of people with Parkinson’s disease (the PDQ-Carer). Parkinsonism Relat Disord 2012; 18:483-7. [DOI: 10.1016/j.parkreldis.2012.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
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