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Bower AE, Crisomia SJ, Chung JW, Martello JP, Burciu RG. Free water imaging unravels unique patterns of longitudinal structural brain changes in Parkinson's disease subtypes. Front Neurol 2023; 14:1278065. [PMID: 37965163 PMCID: PMC10642764 DOI: 10.3389/fneur.2023.1278065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Research shows that individuals with Parkinson's disease (PD) who have a postural instability and gait difficulties (PIGD) subtype have a faster disease progression compared to those with a tremor dominant (TD) subtype. Nevertheless, our understanding of the structural brain changes contributing to these clinical differences remains limited, primarily because many brain imaging techniques are only capable of detecting changes in the later stages of the disease. Objective Free water (FW) has emerged as a robust progression marker in several studies, showing increased values in the posterior substantia nigra that predict symptom worsening. Here, we examined longitudinal FW changes in TD and PIGD across multiple brain regions. Methods Participants were TD and PIGD enrolled in the Parkinson's Progression Marker Initiative (PPMI) study who underwent diffusion MRI at baseline and 2 years later. FW changes were quantified for regions of interest (ROI) within the basal ganglia, thalamus, brainstem, and cerebellum. Results Baseline FW in all ROIs did not differ between groups. Over 2 years, PIGD had a greater percentage increase in FW in the putamen, globus pallidus, and cerebellar lobule V. A logistic regression model incorporating percent change in motor scores and FW in these brain regions achieved 91.4% accuracy in discriminating TD and PIGD, surpassing models based solely on clinical measures (74.3%) or imaging (76.1%). Conclusion The results further suggest the use of FW to study disease progression in PD and provide insight into the differential course of brain changes in early-stage PD subtypes.
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Affiliation(s)
- Abigail E. Bower
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Sophia J. Crisomia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Jae Woo Chung
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Justin P. Martello
- Department of Neurosciences, Christiana Care Health System, Newark, DE, United States
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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Chen Y, Guo Z, Wang Y, Yin H, Zhang S, Liu W. Structural and functional differences of the thalamus between drug-naïve Parkinson's disease motor subtypes. Front Neurol 2023; 14:1102927. [PMID: 37265464 PMCID: PMC10229767 DOI: 10.3389/fneur.2023.1102927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
Objective The thalamus is an integrative hub of motor circuits in Parkinson's disease (PD). This study aimed to investigate the alterations of structure and functional connectivity (FC) of the thalamic subregions in the tremor-dominant (TD) subtype and the postural instability and gait difficulty (PIGD) subtype in PD. Methods A total of 59 drug-naïve patients (24 TD and 35 PIGD) and 37 healthy controls were recruited. The volumes of the thalamus and the thalamic subregions were calculated using FreeSurfer. Functional connectivity (FC) analysis of the resting-state functional MRI (rsfMRI) was conducted on the thalamic subregions. Finally, the altered structure and FC were used for correlation analysis with clinical motor scores and for further motor subtypes differentiation. Results The volumes of the left posterior parietal thalamus (PPtha) in TD patients were significantly lower than those of PIGD patients. Compared with PIGD patients, TD patients exhibited higher FC between the thalamic subregions, the left middle temporal gyrus (MTG), the right dorsolateral superior frontal gyrus (SFGdl), the left middle occipital gyrus (MOG), and the right superior temporal gyrus (STG). Compared with HCs, TD patients showed higher FC between the thalamic subregions and the right SFGdl, as well as the left MOG. Compared with HCs, PIGD patients showed lower FC between the thalamic subregions and the left MTG. In addition, the altered FC was closely related to clinical symptoms and performed high-discriminative power in differentiating the motor subtypes. Conclusion Increased FC between the thalamic subregions and the sensory cortices in TD patients may indicate a better compensatory capacity for impairment of sensory information integration than that in PIGD patients. The altered FC between the thalamus and the MTG was a potential biomarker for the distinction of the PD motor subtypes.
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Kurihara K, Fujioka S, Mishima T, Tsuboi Y. Evaluation of perception threshold and pain in patients with Parkinson's disease using PainVision ®. Front Neurol 2023; 14:1130986. [PMID: 37213902 PMCID: PMC10196013 DOI: 10.3389/fneur.2023.1130986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Pain is one of the most frequent non-motor symptoms occurring in patients with Parkinson's disease (PD). Traditionally, the Visual Analog Pain Scale (VAS), Numerical Rating Scale (NRS), and Wong-Baker Faces Pain Rating Scale (FRS) have been used for clinical pain assessment, but these assessments are subjective at best. In contrast, PainVision® is a perceptual/pain analyzer that can quantitatively evaluate pain as "pain intensity" based on "current perception threshold" and "pain equivalent current." We evaluated the current perception threshold in all PD patients and pain intensity in PD patients with pain using PainVision®. Methods We recruited 48 patients with PD (PwPD) with pain and 52 PwPD without pain. For patients with pain, we measured current perception threshold, pain equivalent current, and pain intensity using PainVision®, in addition to evaluation by VAS, NRS, and FRS. For patients without pain, only current perception threshold was measured. Results There was no correlation with either VAS or FRS, whereas only weak correlation was identified for NRS (γ = -0.376) with pain intensity. Current perception threshold was positively correlated with duration of the disease (γ = 0.347) and the Hoehn and Yahr stage (γ = 0.259). As a quantitative evaluation of pain, pain intensity by PainVision® does not correlate with conventional subjective pain assessments. Discussion This new quantitative evaluation method of pain may be suitable as an evaluation tool for future intervention research. Current perception threshold in PwPD was related to the duration and severity of the disease and may be involved in peripheral neuropathy associated with PD.
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Affiliation(s)
| | | | | | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
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Jost ST, Konitsioti A, Loehrer PA, Ashkan K, Rizos A, Sauerbier A, Dos Santos Ghilardi MG, Rosenkranz F, Strobel L, Gronostay A, Barbe MT, Evans J, Visser-Vandewalle V, Nimsky C, Fink GR, Silverdale M, Cury RG, Fonoff ET, Antonini A, Chaudhuri KR, Timmermann L, Martinez-Martin P, Dafsari HS. Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes. Parkinsonism Relat Disord 2023; 109:105318. [PMID: 36842866 DOI: 10.1016/j.parkreldis.2023.105318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with 'postural instability and gait difficulty' (PIGD) experience more beneficial non-motor effects than 'tremor-dominant' patients undergoing DBS for PD. METHODS In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and -motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests. RESULTS In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores. CONCLUSIONS This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.
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Affiliation(s)
- Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
| | - Agni Konitsioti
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- University Hospital Giessen and Marburg, Campus Marburg, Department of Neurology, Marburg, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Maria Gabriela Dos Santos Ghilardi
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Franz Rosenkranz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Lena Strobel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | | | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Rubens G Cury
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom
| | - Lars Timmermann
- University Hospital Giessen and Marburg, Campus Marburg, Department of Neurology, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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Zhang M, Gan Y, Wang X, Wang Z, Feng T, Zhang Y. Gait performance and non-motor symptoms burden during dual-task condition in Parkinson's disease. Neurol Sci 2023; 44:181-190. [PMID: 36125574 DOI: 10.1007/s10072-022-06411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Impaired gait is observed in patients with Parkinson's disease (PD) in both single-task (ST) and dual-task (DT) conditions. Non-motor symptoms (NMSs), another vital symptom future experienced along the PD disease trajectory, contribute to gait performance in PD. However, whether DT gait performance is indicative of NMS burden (NMSB) remains unknown. This study investigated correlation between NMS and DT gait performance and whether NMSB is reflected in the DT effects (DTEs) of gait parameters in PD. METHODS Thirty-three idiopathic PD participants were enrolled in this study; the median H-Y staging was 2.5. NMSB was assessed by Non-motor Symptoms Scale (NMSS). Spatiotemporal gait parameters under ST and DT conditions were evaluated by wearable sensors. Gait parameters under ST and DT conditions and DTEs of gait parameters were compared across NMSB groups. The associations between NMS and DTEs of gait parameters were analyzed by correlation analysis and linear regression models. RESULTS Compared to PD patients with mild-moderate NMSB, the severe-very severe NMSB group showed slower gait speed and shorter stride length under both ST and DT conditions (p < 0.05). DT had significantly negative effect on gait parameters in PD patients, including gait speed, stride length, and gait cycle duration (p < 0.05). PD patients with mild-moderate NMSB showed larger DTEs of cadence and bilateral gait cycle duration (p < 0.05). DTEs of bilateral gait cycle duration and swing phase on the more affected (MA) side were significantly correlated with NMSS scores (∣rSp∣ ≥ 0.3, p < 0.05). Gait cycle duration on the less affected (LA) side explained 43% of the variance in NMSS scores, when accounting for demographic and clinical confounders (β = - 1.095 95% CI - 4.061 ~ - 0.058, p = 0.044; adjusted R2 = 0.434). CONCLUSION DT gait performance could reflect NMSB in PD patients at early stage, and gait cycle duration is a valuable gait parameter to further investigate and to provide more evidence for PD management.
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Affiliation(s)
- Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yawen Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Yumei Zhang
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Wang Y, Li D, Chen Y, Zhu S, Jiang X, Jiang Y, Gu R, Shen B, Zhu J, Pan Y, Yan J, Zhang L. Clinical features of minor hallucinations in different phenotypes of Parkinson's disease: A cross-sectional study. Front Neurol 2023; 14:1158188. [PMID: 37034082 PMCID: PMC10079986 DOI: 10.3389/fneur.2023.1158188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Background Minor hallucinations (MHs) are the most common psychiatric symptom associated with Parkinson's disease (PDPsy), but little is known about their characteristics in different motor phenotypes, especially postural instability gait difficulty (PIGD). The aim of this study was to explore the clinical features of MHs in different subtypes of PD. Methods In this cross-sectional study, 213 patients with Parkinson's disease (PD) were recruited, and the data obtained included comprehensive demographics, motor subtypes, clinical scale scores, and MH contents. Motor subtypes were classified as tremor-dominant (TD), PIGD or indeterminate according to Stebbins' method. Results A total of 213 PD patients were included: 90 (42.3%) TD patients, 98 (46.0%) PIGD patients and 25 (11.7%) indeterminate. In total, 70 (32.9%) patients experienced MHs. Compared to patients with the TD phenotype, we found that patients with the PIGD phenotype had more severe motor and nonmotor symptoms. They also had a higher incidence of visual illusions (VIs) and a shorter MH latency. Conclusion Our study demonstrated that compared to patients with the TD phenotype, patients with the PIGD phenotype had a higher incidence of MHs, especially VIs, which may lead to a higher incidence of visual hallucinations (VHs). They also had a shorter latency of MHs than patients with the TD phenotype, suggesting an earlier onset of MHs and a worse prognosis.
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Profiles of Motor-Cognitive Interference in Parkinson's Disease-The Trail-Walking-Test to Discriminate between Motor Phenotypes. Brain Sci 2022; 12:brainsci12091217. [PMID: 36138953 PMCID: PMC9497145 DOI: 10.3390/brainsci12091217] [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: 07/20/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims. Most research on Parkinson’s disease (PD) focuses on describing symptoms and movement characteristics. Studies rarely focus on the early detection of PD and the search for suitable markers of a prodromal stage. Early detection is important, so treatments that may potentially change the course of the disease can be attempted early on. While gait disturbances are less pronounced in the early stages of the disease, the prevalence, and severity increase with disease progression. Therefore, postural instability and gait difficulties could be identified as sensitive biomarkers. The aim was to evaluate the discriminatory power of the Trail-Walking Test (TWT; Schott, 2015) as a potential diagnostic instrument to improve the predictive power of the clinical evaluation concerning the severity of the disease and record the different aspects of walking. Methods. A total of 20 older healthy (M = 72.4 years, SD = 5.53) adults and 43 older adults with PD and the motor phenotypes postural instability/gait difficulty (PIGD; M = 69.7 years, SD = 8.68) and tremor dominant (TD; M = 68.2 years, SD = 8.94) participated in the study. The participants performed a motor-cognitive dual task (DT) of increasing cognitive difficulty in which they had to walk a given path (condition 1), walk to numbers in ascending order (condition 2), and walk to numbers and letters alternately and in ascending order (condition 3). Results. With an increase in the cognitive load, the time to complete the tasks (seconds) became longer in all groups, F(1.23, 73.5) = 121, p < 0.001, ɳ2p = 0.670. PIGD showed the longest times in all conditions of the TWT, F(2, 60) = 8.15, p < 0.001, ɳ2p = 0.214. Mutual interferences in the cognitive and motor domain can be observed. However, clear group-specific patterns cannot be identified. A differentiation between the motor phenotypes of PD is especially feasible with the purely motor condition (TWT-M; AUC = 0.685, p = 0.44). Conclusions. PD patients with PIGD must be identified by valid, well-evaluated clinical tests that allow for a precise assessment of the disease’s individual fall risk, the severity of the disease, and the prognosis of progression. The TWT covers various aspects of mobility, examines the relationship between cognitive functions and walking, and enables differentiation of the motor phenotypes of PD.
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Zheng JH, Sun WH, Ma JJ, Wang ZD, Chang QQ, Dong LR, Shi XX, Li MJ, Gu Q, Chen SY, Li DS. Differences in neuroanatomy and functional connectivity between motor subtypes of Parkinson’s disease. Front Neurosci 2022; 16:905709. [PMID: 35937868 PMCID: PMC9354573 DOI: 10.3389/fnins.2022.905709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe “postural instability/gait difficulty” (PIGD) and “tremor-dominant” (TD) motor subtypes of Parkinson’s disease (PD) differ in their clinical manifestations. The neurological basis of these differences is unclear.MethodsWe performed voxel-based morphometric analysis and measured amplitudes of low-frequency fluctuation (ALFF) on 87 PIGD patients and 51 TD patients. We complemented this neuroanatomical comparison with seed-to-voxel analysis to explore differences in functional connectivity.ResultsThe PIGD group showed significantly smaller gray matter volume in the medial frontal gyrus (mainly on the right side) than the TD group. Across all patients, gray matter volume in the medial frontal gyrus correlated negatively with severity of PIGD symptoms after controlling for age (r = −0.250, p = 0.003), but this correlation was not observed in separate analyses of only PIGD or TD patients. The PIGD group showed greater functional connectivity of the right superior frontal gyrus with the left lingual gyrus, right lateral occipital cortex, and right lingual gyrus. ALFF did not differ significantly between the two groups.ConclusionPostural instability/gait difficulty may be associated with smaller gray matter volume in medial frontal gyrus than TD, as well as with greater functional connectivity between the right superior frontal gyrus and occipital cortex. These results may help explain the clinical differences between the two motor subtypes of PD.
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Affiliation(s)
- Jin Hua Zheng
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, China
| | - Wen Hua Sun
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Jun Ma
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, China
- *Correspondence: Jian Jun Ma,
| | - Zhi Dong Wang
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Qing Chang
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Rui Dong
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Xue Shi
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Jian Li
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, China
| | - Qi Gu
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, China
| | - Si Yuan Chen
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, China
| | - Dong Sheng Li
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, China
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Morel T, Cleanthous S, Andrejack J, Barker RA, Blavat G, Brooks W, Burns P, Cano S, Gallagher C, Gosden L, Siu C, Slagle AF, Trenam K, Boroojerdi B, Ratcliffe N, Schroeder K. Patient Experience in Early-Stage Parkinson's Disease: Using a Mixed Methods Analysis to Identify Which Concepts Are Cardinal for Clinical Trial Outcome Assessment. Neurol Ther 2022; 11:1319-1340. [PMID: 35778541 PMCID: PMC9338202 DOI: 10.1007/s40120-022-00375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/01/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Qualitative research on patient experiences in early-stage Parkinson's disease (PD) is limited. It is increasingly acknowledged that clinical outcome assessments used in trials do not fully capture the range of symptoms/impacts that are meaningful to people with early-stage PD. We aimed to conceptualize the patient experience in early-stage PD and identify, from the patient perspective, those cardinal symptoms/impacts which might be more useful to measure in clinical trials. METHODS In a mixed-methods analysis, 50 people with early-stage PD and nine relatives were interviewed. Study design and results interpretation were led by a multidisciplinary group of patient, clinical, regulatory, and outcome measurements experts, and patient organization representatives. Identification of the cardinal concepts was informed by the relative frequency of reported concepts combined with insights from patient experts and movement disorder specialists. RESULTS A conceptual model of the patient experience of early-stage PD was developed. Concept elicitation generated 145 unique concepts mapped across motor and non-motor symptoms, function, and impacts. Bradykinesia/slowness (notably in the form of "functional slowness"), tremor, rigidity/stiffness, mobility (particularly fine motor dexterity and subtle gait abnormalities), fatigue, depression, sleep/dreams, and pain were identified as cardinal in early-stage PD. "Functional slowness" (related to discrete tasks involving the upper limbs, complex mobility tasks, and general activities) was deemed to be more relevant than "difficulty" to patients with early-stage PD, who report being slower at completing tasks rather than encountering significant impairment with task completion. CONCLUSION Patient experiences in early-stage PD are complex and wide-ranging, and the currently available patient-reported outcome (PRO) instruments do not evaluate many early-stage PD concepts such as functional slowness, fine motor skills, and subtle gait abnormalities. The development of a new PRO instrument, created in conjunction with people with PD, that fully assesses symptoms and the experience of living with early-stage PD, is required.
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Affiliation(s)
| | | | - John Andrejack
- Patient Author, Parkinson's Foundation, New York, NY, USA
| | | | | | - William Brooks
- Patient Author, Parkinson's Foundation, New York, NY, USA
| | - Paul Burns
- Patient Author, Parkinson's UK, London, UK
| | - Stefan Cano
- Modus Outcomes, a Division of Thread, London, UK
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Iwarsson S, Andersson N, Slaug B, Nilsson MH. People with Parkinson's disease and housing issues: A scoping review. Health Sci Rep 2022; 5:e511. [PMID: 35155833 PMCID: PMC8827270 DOI: 10.1002/hsr2.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIMS There is evidence that housing issues are associated with health outcomes as people age, but little is known in this respect regarding the specific population of people with Parkinson's disease (PD). The objective of this literature review was to identify and analyze the knowledge gap concerning people with PD and housing issues. METHODS Applying established guidelines for scoping reviews, a systematic literature search was done in relevant databases applying the following inclusion criteria: empirical studies including human participants with PD, addressing housing in the objective, hypothesis or research questions, and published in English in peer-reviewed journals. Data were analyzed using a framework of domains, factors, and variables influencing housing decisions among older people. RESULTS Twelve publications were identified, originating from a few researchers and with very different scopes. While the social dimension was scarcely attended to, the publications addressed all six domains of the analytical framework and 30% of the variables specified therein, but many were only used for descriptive purposes. CONCLUSION This scoping review reveals that there is a substantial knowledge gap regarding people with PD and housing issues. The knowledge gap is most evident in the social dimension, while the studies identified provide more information relating to the health dimension than what is the case in research on housing targeting the general aging population. Because society urgently needs evidence to support the development of housing policies and provide suitable housing for this vulnerable population, more research targeting people with PD and housing issues is warranted.
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Affiliation(s)
| | - Nilla Andersson
- Department of Health SciencesLund UniversityLundSweden
- Memory ClinicSkåne University HospitalMalmöSweden
| | - Björn Slaug
- Department of Health SciencesLund UniversityLundSweden
| | - Maria H. Nilsson
- Department of Health SciencesLund UniversityLundSweden
- Memory ClinicSkåne University HospitalMalmöSweden
- Clinical Memory Research Unit, Department of Clinical Sciences MalmöLund UniversityLundSweden
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11
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Serum neurofilament light chain and postural instability/gait difficulty (PIGD) subtypes of Parkinson’s disease in the MARK-PD study. J Neural Transm (Vienna) 2022; 129:295-300. [PMID: 35072765 PMCID: PMC8930951 DOI: 10.1007/s00702-022-02464-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
Abstract
The PIGD (postural instability / gait difficulty) subtype of Parkinson´s disease (PD) is associated with faster cognitive and motor decline. So far, there are no quantifiable biomarkers to aid clinical subtyping. Neurofilament light chain (NfL) is a highly specific marker of neuro-axonal damage and can be assessed in blood. Here, we investigated if serum NfL concentrations are associated with PIGD subtype and PIGD scores in PD patients at advanced disease stages. Furthermore, we evaluated if serum NfL is associated with motor and cognitive function assessed with MDS-UPDRS part III and Montreal cognitive assessment (MoCA). Serum NfL levels were analyzed with Single Molecule Assays (Simoa) in blood of 223 PD patients from the bioMARKers in Parkinson’s Disease (MARK-PD) study. Serum NfL concentrations were higher in PIGD patients independent of age, sex and disease duration. In linear regression analysis, serum NfL levels were associated with MoCA, MDS-UPDRS III and PIGD scores in unadjusted models, but remained significant after adjustment only with PIGD scores. In conclusion, increased serum NfL levels were associated with PIGD subtype and PIGD scores in patients with advanced PD.
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12
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van der Lijn I, de Haan GA, Huizinga F, van der Feen FE, Rutgers AWF, Stellingwerf C, van Laar T, Heutink J. Self-Reported Visual Complaints in People with Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSON'S DISEASE 2022; 12:785-806. [PMID: 35001897 PMCID: PMC9108577 DOI: 10.3233/jpd-202324] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Scientific research increasingly focuses on visual symptoms of people with Parkinson's disease (PD). However, this mostly involves functional measures, whereas self-reported data are equally important for guiding clinical care. OBJECTIVE This review provides an overview of the nature and prevalence of self-reported visual complaints by people with PD, compared to healthy controls. METHODS A systematic literature search was performed. Studies from three databases (PubMed, PsycInfo, and Web of Science) were screened for eligibility. Only studies that reported results of visual self-reports in people with idiopathic PD were included. RESULTS One hundred and thirty-nine eligible articles were analyzed. Visual complaints ranged from function-related complaints (e.g., blurred vision, double vision, increased sensitivity to light or changes in contrast sensitivity) to activity-related complaints (e.g., difficulty reading, reaching, or driving). Visual complaints were more prevalent in people with PD compared to healthy controls. The presence of visual complaints leads to a reduced quality of life (QoL). Increased prevalence and severity of visual complaints in people with PD are related to longer disease duration, higher disease severity, and off-state. CONCLUSION A large proportion of people with PD have visual complaints, which negatively affect QoL. Complaints are diverse in nature, and specific and active questioning by clinicians is advised to foster timely recognition, acknowledgement, and management of these complaints.
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Affiliation(s)
- Iris van der Lijn
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Gera A. de Haan
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Famke Huizinga
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Fleur E. van der Feen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | | | - Catherina Stellingwerf
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
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13
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Santos García D, Canfield H, de Deus Fonticoba T, Cores Bartolomé C, Naya Ríos L, García Roca L, Martínez Miró C, Jesús S, Aguilar M, Pastor P, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Parkinson's Disease Motor Subtypes Change with the Progression of the Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up. JOURNAL OF PARKINSON'S DISEASE 2022; 12:935-955. [PMID: 34957949 DOI: 10.3233/jpd-213004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Motor phenotype (MP) can be associated with a different prognosis in Parkinson's disease (PD), but it is not fixed and can change over time. OBJECTIVE Our aim was to analyze how the MP changed over time and to identify factors associated with the changes in PD patients from a multicenter Spanish PD cohort. METHODS PD patients who were recruited from January-2016 to November-2017 (baseline visit; V0) and evaluated again at a 2-year±30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort, were included in this study.MP was calculated at both visits based on Jankovic classification in TD (tremor dominant), IND (indeterminate), or PIGD (postural instability and gait difficulty). Sociodemographic and clinical data were collected, including serum biomarkers. RESULTS Five hundred eleven patients (62.57±8.59 years old; 59.2%males) were included in the study. At V0, MP was: 47.4%(242/511) TD; 36.6%(187/511) PIGD; 16%(82/511) IND. Up to 38%(194/511) of the patients changed their phenotype from V0 to V2, being the most frequent from TD to IND (8.4%) and from TD to PIGD (6.7%). A worse cognitive status (OR = 0.966) and less autonomy for activities of daily living (OR = 0.937) at V0 and a greater increase in the globalNMS burden (OR = 1.011) from V0 to V2 were associated with changing from TD to another phenotype after 2-year follow-up. CONCLUSION The MP in PD can change over time. With disease progression, the percentage of cases with non-tremoric MP increases. PD patients who changed from TD to postural instability and gait difficulty increased NMS burden significantly.
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Affiliation(s)
| | - Hector Canfield
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | | | - Lucía Naya Ríos
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Lucía García Roca
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Inés Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Julio Dotor
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Berta Solano Vila
- Institut d'Assistència Sanitària (IAS) - Institut Català de la Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | | | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
- Hospital de Sant Pau, Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | - Carlos Ordás
- Hospital Rey Juan Carlos, Madrid, Spain, Madrid, Spain
| | | | - Darrian McAfee
- Univeristy of Maryland School of Medicine, Baltimore, MD, USA
| | - Pablo Martinez-Martin
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
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14
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Kohat AK, Ng SYE, Wong ASY, Chia NSY, Choi X, Heng DL, Li W, Ng HL, Chua ST, Neo SXM, Xu Z, Tay KY, Au WL, Tan EK, Tan LCS. Stability of MDS-UPDRS Motor Subtypes Over Three Years in Early Parkinson's Disease. Front Neurol 2021; 12:704906. [PMID: 34630281 PMCID: PMC8498197 DOI: 10.3389/fneur.2021.704906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Various classifications have been proposed to subtype Parkinson's disease (PD) based on their motor phenotypes. However, the stability of these subtypes has not been properly evaluated. Objective: The goal of this study was to understand the distribution of PD motor subtypes, their stability over time, and baseline factors that predicted subtype stability. Methods: Participants (n = 170) from two prospective cohorts were included: the Early PD Longitudinal Singapore (PALS) study and the National Neuroscience Institute Movement Disorders Database. Early PD patients were classified into tremor-dominant (TD), postural instability and gait difficulty (PIGD), and indeterminate subtypes according to the Movement Disorder Society's Unified PD Rating Scale (MDS-UPDRS) criteria and clinically evaluated for three consecutive years. Results: At baseline, 60.6% patients were TD, 12.4% patients were indeterminate, and 27.1% patients were PIGD subtypes (p < 0.05). After 3 years, only 62% of patients in TD and 50% of patients in PIGD subtypes remained stable. The mean levodopa equivalent daily dose (LEDD) was higher in the PIGD subtype (276.92 ± 232.91 mg; p = 0.01). Lower LEDD [p < 0.05, odds ratio (OR) 0.99, 95% confidence interval (CI): 0.98–0.99] and higher TD/PIGD ratios (p < 0.05, OR 1.77, 95% CI: 1.29–2.43) were independent predictors of stability of TD subtype with an area under the curve (AUC) of 0.787 (95%CI: 0.669–0.876), sensitivity = 57.8%, and specificity = 89.7%. Conclusion: Only 50–62% of PD motor subtypes as defined by MDS-UPDRS remained stable over 3 years. TD/PIGD ratio and baseline LEDD were independent predictors for TD subtype stability over 3 years.
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Affiliation(s)
- Abhijeet K Kohat
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Samuel Y E Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Aidan S Y Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Nicole S Y Chia
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Xinyi Choi
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Dede L Heng
- Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wei Li
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Hwee-Lan Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Shu-Ting Chua
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Shermyn X M Neo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Kay-Yaw Tay
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
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15
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Ren J, Pan C, Li Y, Li L, Hua P, Xu L, Zhang L, Zhang W, Xu P, Liu W. Consistency and Stability of Motor Subtype Classifications in Patients With de novo Parkinson's Disease. Front Neurosci 2021; 15:637896. [PMID: 33732106 PMCID: PMC7957002 DOI: 10.3389/fnins.2021.637896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/02/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Patients with Parkinson’s disease (PD) are commonly classified into subtypes based on motor symptoms. The aims of the present study were to determine the consistency between PD motor subtypes, to assess the stability of PD motor subtypes over time, and to explore the variables influencing PD motor subtype stability. Methods This study was part of a longitudinal study of de novo PD patients at a single center. Based on three different motor subtype classification systems proposed by Jankovic, Schiess, and Kang, patients were respectively categorized as tremor-dominant/indeterminate/postural instability and gait difficulty (TD/indeterminate/PIGD), TDS/mixedS/akinetic-rigidS (ARS), or TDK/mixedK/ARK at baseline evaluation and then re-assessed 1 month later. Demographic and clinical characteristics were recorded at each evaluation. The consistency between subtypes at baseline evaluation was assessed using Cohen’s kappa coefficient (κ). Additional variables were compared between PD subtype groups using the two-sample t-test, Mann–Whitney U-test or Chi-squared test. Results Of 283 newly diagnosed, untreated PD patients, 79 were followed up at 1 month. There was fair agreement between the Jankovic, Schiess, and Kang classification systems (κS = 0.383 ± 0.044, κK = 0.360 ± 0.042, κSK = 0.368 ± 0.038). Among the three classification systems, the Schiess classification was the most stable and the Jankovic classification was the most unstable. The non-motor symptoms questionnaire (NMSQuest) scores differed significantly between PD patients with stable and unstable subtypes based on the Jankovic classification (p = 0.008), and patients with a consistent subtype had more severe NMSQuest scores than patients with an inconsistent subtype. Conclusion Fair consistency was observed between the Jankovic, Schiess, and Kang classification systems. For the first time, non-motor symptoms (NMSs) scores were found to influence the stability of the TD/indeterminate/PIGD classification. Our findings support combining NMSs with motor symptoms to increase the effectiveness of PD subtypes.
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Affiliation(s)
- Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenxi Pan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqian Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lanting Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Hua
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ligang Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pingyi Xu
- Department of Neurology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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16
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Ren J, Hua P, Li Y, Pan C, Yan L, Yu C, Zhang L, Xu P, Zhang M, Liu W. Comparison of Three Motor Subtype Classifications in de novo Parkinson's Disease Patients. Front Neurol 2020; 11:601225. [PMID: 33424750 PMCID: PMC7785849 DOI: 10.3389/fneur.2020.601225] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/04/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: The aims of this study were to compare the characteristics of three motor subtype classifications in patients with de novo Parkinson's disease (PD) and to find the most suitable motor subtype classification for identifying non-motor symptoms (NMSs). Methods: According to previous studies, a total of 256 patients with de novo PD were classified using the tremor-dominant/mixed/akinetic-rigid (TD/mixed/AR), TD/indeterminate/postural instability and gait disturbance (PIGD), and predominantly TD/predominantly PIGD (p-TD/p-PIGD) classification systems. Results: Among the TD/mixed/AR subgroups, the patients with the AR subtype obtained more severe motor scores than the patients with the TD subtype. Among the TD/indeterminate/PIGD subgroups and between the p-TD and p-PIGD subgroups, the patients with the PIGD/p-PIGD subtype obtained more severe scores related to activities of daily living (ADL), motor and non-motor symptoms, including depression, anxiety, and sleep impairment, than the patients with the TD/p-TD subtype. Furthermore, symptoms in the cardiovascular, gastrointestinal, and miscellaneous domains of the Non-motor Questionnaire (NMSQuest) were more prevalent in the patients with the PIGD/p-PIGD subtypes than the patients with the TD/p-TD subtypes. Conclusions: The PIGD/p-PIGD subtypes had more severe ADL, motor and non-motor symptoms than the TD/p-TD subtypes. We disclosed for the first time that the TD/indeterminate/PIGD classification seems to be the most suitable classification among the three motor subtype classifications for identifying NMSs in PD.
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Affiliation(s)
- Jingru Ren
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Hua
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqian Li
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenxi Pan
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Yan
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Cuiyu Yu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatrics, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pingyi Xu
- Department of Neurology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Weiguo Liu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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