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Varshney A, Kumar P, Ram VS. Nonmotor Symptoms and Impulse Control Disorders in Parkinson's Disease Patients in India: A Cross-sectional Study. Ann Afr Med 2024; 23:400-405. [PMID: 39034565 PMCID: PMC11364333 DOI: 10.4103/aam.aam_198_23] [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: 11/27/2023] [Revised: 12/15/2023] [Accepted: 03/25/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a prevalent neurodegenerative disorder with significant nonmotor symptom (NMS) burden, including impulse control disorders. This study aimed to comprehensively evaluate NMS and impulse control disorders in PD patients under primary care. MATERIALS AND METHODS A descriptive cross-sectional study was conducted on 32 PD patients and evaluated using standardized assessment tools. Demographics, comorbidities, and symptom burdens were recorded. Evaluation tools included the Hoehn and Yahr Scale, REM Sleep Behavior Disorder assessment, Geriatric Depression Scale, Montreal Cognitive Assessment scale for cognitive impairment, NMS scale, and identification of impulse control disorders. RESULTS In PD, comorbidities were prevalent (84%), and most were at Hoehn and Yahr Stages 2 and 3. REM Sleep Behavior Disorder was present in 28.12%, with 5 receiving clonazepam treatment. Depression affected 28.12%, with 5 receiving pharmacological treatment. Cognitive impairment was notable in 9 patients. NMS burden was high, with varying severity. Impulse control disorders were limited, whereas one case of dopamine dysregulation syndrome was identified. DISCUSSION This primary care-based study in India assessed NMS and impulse control disorders in PD patients, highlighting comorbidities and management opportunities. The study's strength lies in evaluating an unselected primary care population, whereas limitations include small sample size. CONCLUSION This study emphasizes the importance of primary care physicians in monitoring and managing NMS in PD patients. Impulse control disorders and cognitive impairment are critical aspects that need attention. The findings support an integrated approach involving health-care professionals across various disciplines to provide holistic care for PD patients.
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Affiliation(s)
- Amit Varshney
- Department of General Medicine, Noida International Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Pankaj Kumar
- Department of Medicine, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Vidya Sagar Ram
- Department of Medicine, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
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Ray Chaudhuri K, Antonini A, Robieson WZ, Sanchez-Soliño O, Bergmann L, Poewe W. Burden of non-motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa-carbidopa intestinal gel. Eur J Neurol 2018; 26:581-e43. [PMID: 30353942 PMCID: PMC6590168 DOI: 10.1111/ene.13847] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/12/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE GLORIA, a registry conducted with 375 advanced Parkinson's disease patients treated with levodopa-carbidopa intestinal gel (LCIG) for 24 months in routine clinical care, demonstrated significant reductions from baseline in 'off' time and 'on' time with dyskinesia and improvements in the Non-Motor Symptom Scale (NMSS) total and individual domain scores, and in Parkinson's Disease Questionnaire 8 item (PDQ-8) total score. METHODS Associations between baseline NMSS burden (NMSB), the multi-domain NMSS total score and the PDQ-8 total score were investigated for 233 patients. Baseline NMSB was assigned to five numerical categories defined by the NMSS total cutoff scores (0-20, 21-40, 41-60, 61-80 and >80). Pearson and Spearman correlations were calculated at month 24. RESULTS The response of LCIG was assessed using validated criteria after 24 months. The proportion of patients decreasing ≥ 30 NMSS score points was 47% in the most affected NMSB category (NMSS total score > 80). A positive association was noted between baseline NMSB and NMSS total score (0.57, P < 0.0001), as well as between NMSS total score and PDQ-8 total score (0.46, P < 0.0001). Associations between improvements of the NMSS domain sleep/fatigue and PDQ-8 total score (0.32, P = 0.0001) as well as between the NMSS domain mood/cognition and PDQ-8 total score (0.37, P < 0.0001) were also shown. CONCLUSIONS This analysis demonstrated positive associations between NMSS baseline burden and improvements of non-motor symptoms. Improvements of non-motor symptoms were associated with improved quality of life in advanced parkinsonian patients during a 2-year treatment with LCIG and reflect the long-term non-motor efficacy of this treatment.
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Affiliation(s)
- K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, Denmark Hill, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | | | - W Poewe
- Medical University of Innsbruck, Innsbruck, Austria
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Makkos A, Kovács M, Aschermann Z, Harmat M, Janszky J, Karádi K, Kovács N. Are the MDS-UPDRS-Based Composite Scores Clinically Applicable? Mov Disord 2018; 33:835-839. [DOI: 10.1002/mds.27303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Attila Makkos
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | | | - Márk Harmat
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - Kázmér Karádi
- Institute of Behavioural Sciences; University of Pécs; Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
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Horváth K, Aschermann Z, Kovács M, Makkos A, Harmat M, Janszky J, Komoly S, Karádi K, Kovács N. Minimal clinically important differences for the experiences of daily living parts of movement disorder society-sponsored unified Parkinson's disease rating scale. Mov Disord 2017; 32:789-793. [DOI: 10.1002/mds.26960] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Krisztina Horváth
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
| | - Zsuzsanna Aschermann
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Attila Makkos
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márk Harmat
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - Sámuel Komoly
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Kázmér Karádi
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Behavioral Sciences, Universiyt of Pecs, Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
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Telarovic S, Mijatovic D, Telarovic I. Effects of various factors on sleep disorders and quality of life in Parkinson's disease. Acta Neurol Belg 2015; 115:615-21. [PMID: 25944510 DOI: 10.1007/s13760-015-0478-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/17/2015] [Indexed: 11/29/2022]
Abstract
In Parkinson's disease (PD), sleep disorders (SD) occur as a result of the neurochemical changes in sleep centres, neurodegenerative changes in dopaminergic neurons, and other factors. The most common SD include excessive daytime sleepiness, insomnia, restless legs syndrome and nocturia. The aim of the study was to compare quality of sleep, as a factor that greatly impacts quality of life (QoL), between PD patients and a control group and to further examine SD in the PD group with focus on incidence and SD types as well as on effects various factors (age, sex, PD characteristics, medication usage) have on these disorders. The study included 110 patients who met the criteria for the diagnosis of PD and 110 age-matched healthy controls. We used the Pittsburgh Sleep Quality Index, PD Sleep Scale, Epworth Sleepiness Scale, PD QoL Questionnaire-8 and PD Questionnaire-39 (items 30 and 33). In the group with PD, we considered the duration of the disease, the stage of disease according to the Hoehn and Yahr scale, medications and their impact on the SD. The average duration of the disease was 6 years and the mean stage was 2.44. The result showed significant differences in the sleep quality between groups. In the PD group, SD differences were also found according to gender, duration of the disease and medication usage. The most common SD were fragmented sleep, insomnia and nocturia. To improve the QoL of PD patients, it is necessary to pay more attention to detecting and solving SD.
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Affiliation(s)
- Srdjana Telarovic
- University of Zagreb, School of Medicine, Salata 3, 10000, Zagreb, Croatia.
- Department of Neurology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Dragana Mijatovic
- Unit for Neurology, Community Health Centre Umag, Edoardo Pascali 3A, 52470, Umag, Croatia
| | - Irma Telarovic
- University of Zagreb, School of Medicine, Salata 3, 10000, Zagreb, Croatia
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Horváth K, Aschermann Z, Ács P, Deli G, Janszky J, Komoly S, Balázs É, Takács K, Karádi K, Kovács N. Minimal clinically important difference on the Motor Examination part of MDS-UPDRS. Parkinsonism Relat Disord 2015; 21:1421-6. [DOI: 10.1016/j.parkreldis.2015.10.006] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/24/2015] [Accepted: 10/05/2015] [Indexed: 01/31/2023]
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Advanced Parkinson's disease: Clinical characteristics and treatment (part 1). NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kulisevsky J, Luquin MR, Arbelo JM, Burguera JA, Carrillo F, Castro A, Chacón J, García-Ruiz PJ, Lezcano E, Mir P, Martinez-Castrillo JC, Martínez-Torres I, Puente V, Sesar A, Valldeoriola-Serra F, Yañez R. [Advanced Parkinson's disease: clinical characteristics and treatment (part 1)]. Neurologia 2013; 28:503-21. [PMID: 23856182 DOI: 10.1016/j.nrl.2013.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/16/2013] [Accepted: 05/02/2013] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinson's disease. OBJECTIVE To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease. DEVELOPMENT This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL). CONCLUSIONS Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.
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Affiliation(s)
- J Kulisevsky
- Servicio de Neurología, Hospital Sant Pau, IIB Sant Pau, CIBERNED, Universitat Autònoma de Barcelona, Barcelona, España.
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Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review. Aging Clin Exp Res 2013; 25:265-74. [PMID: 23784725 DOI: 10.1007/s40520-013-0039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.
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Shirota Y, Ohtsu H, Hamada M, Enomoto H, Ugawa Y. Supplementary motor area stimulation for Parkinson disease. Neurology 2013; 80:1400-5. [DOI: 10.1212/wnl.0b013e31828c2f66] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective:To explore the efficacy and stimulation frequency dependence of repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) in Parkinson disease (PD).Methods:In this randomized, double-blind, sham-controlled, multicenter study with a parallel design, a weekly intervention was performed 8 times. The effects were monitored up to 20 weeks. By central registration, participants were assigned to 1 of 3 arms of the study: low-frequency (1-Hz) rTMS, high-frequency (10-Hz) rTMS, and realistic sham stimulation. The primary end point was the score change of the Unified Parkinson's Disease Rating Scale (UPDRS) part III from the baseline. Several nonmotor symptom scales such as the Hamilton Rating Scale for Depression, apathy score, and nonmotor symptoms questionnaire were defined as secondary end points.Results:Of the 106 patients enrolled, 36 were allocated to 1-Hz rTMS, 34 to 10-Hz rTMS, and 36 to realistic sham stimulation. Results show 6.84-point improvement of the UPDRS part III in the 1-Hz group at the last visit of the 20th week. Sham stimulation and 10-Hz rTMS improved motor symptoms transiently, but their effects disappeared in the observation period. Changes in nonmotor symptoms were not clear in any group. No severe adverse event was reported.Conclusions:The 1-Hz rTMS over the SMA was effective for motor, but not nonmotor, symptoms in PD.Level of evidence:This study provides Class I evidence that 1-Hz rTMS over the SMA is effective for motor symptoms in PD.
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Rendas-Baum R, Buck PO, White MK, Castelli-Haley J. Psychometric validation of the revised SCOPA-Diary Card: expanding the measurement of non-motor symptoms in Parkinson's disease. Health Qual Life Outcomes 2011; 9:69. [PMID: 21851616 PMCID: PMC3173285 DOI: 10.1186/1477-7525-9-69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/18/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To identify key non-motor symptoms of Parkinson's disease (PD) to include in a daily diary assessment for off-time, revise the Scales for Outcomes of Parkinson's disease Diary Card (SCOPA-DC) to include these non-motor symptoms, and investigate the validity, reliability and predictive utility of the Revised SCOPA-DC in a U.S. population. METHODS A convenience sample was used to recruit four focus groups of PD patients. Based on findings from focus groups, the SCOPA-DC was revised and administered to a sample of 101 PD patients. Confirmatory factor analysis was conducted to test the domain structure of the Revised SCOPA-DC. The reliability, convergent and discriminant validity, and ability to predict off-time of the Revised SCOPA-DC were then assessed. RESULTS Based on input from PD patients, the Revised SCOPA-DC included several format changes and the addition of non-motor symptoms. The Revised SCOPA-DC was best represented by a three-factor structure: Mobility, Physical Functioning and Psychological Functioning. Correlations between the Revised SCOPA-DC and other Health-Related Quality of Life scores were supportive of convergent validity. Known-groups validity analyses indicated that scores on the Revised SCOPA-DC were lower among patients who reported experiencing off-time when compared to those without off-time. The three subscales had satisfactory predictive utility, correctly predicting off-time slightly over two-thirds of the time. CONCLUSIONS These findings provide evidence of content validity of the Revised SCOPA-DC and suggest that a three-factor structure is an appropriate model that provides reliable and valid scores to assess symptom severity among PD patients with symptom fluctuations in the U.S.
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