Epidemiology of Parkinson's disease. J Neural Transm (Vienna). 2017;124:901-905. [PMID: 28150045 DOI: 10.1007/s00702-017-1686-y]

Role of iron in brain development, aging, and neurodegenerative diseases

It is now understood that iron crosses the blood-brain barrier via a complex metabolic regulatory network and participates in diverse critical biological processes within the central nervous system, including oxygen transport, energy metabolism, and the synthesis and catabolism of myelin and neurotransmitters. During brain development, iron is distributed throughout the brain, playing a pivotal role in key processes such as neuronal development, myelination, and neurotransmitter synthesis. In physiological aging, iron can selectively accumulate in specific brain regions, impacting cognitive function and leading to intracellular redox imbalance, mitochondrial dysfunction, and lipid peroxidation, thereby accelerating aging and associated pathologies. Furthermore, brain iron accumulation may be a primary contributor to neurodegenerative diseases such as Alzheimer's and Parkinson's diseases. Comprehending the role of iron in brain development, aging, and neurodegenerative diseases, utilizing iron-sensitive Magnetic Resonance Imaging (MRI) technology for timely detection or prediction of abnormal neurological states, and implementing appropriate interventions may be instrumental in preserving normal central nervous system function.

Small extracellular vesicles from adipose derived stem cells alleviate microglia activation and improve motor deficit of Parkinson's disease via miR-100-5p/DTX3L/STAT1 signaling axis

Dopaminergic neuron loss caused by microglia activation is an important pathological factor of Parkinson's disease (PD). Previously, we reported that small extracellular vesicle from adipose derived stem cells (ADSC-sEVs) could inhibit the activation of microglia and protect neuron apoptosis from microglia activation. However, whether ADSC-sEVs have protective effect on the motor deficit of PD mouse and the exact mechanism remains unknown. In this study, ADSC-sEVs were delivered to experimental model of Parkinson's disease by tail vein injection to explore the in vivo effect of ADSC-sEVs on PD. Next, the potential key microRNA in ADSC-sEVs was screened by RNA sequencing (RNA-seq), and the exact mechanism was further explored. We found that ADSC-sEVs greatly alleviated the activation of microglia and reduced the loss of dopaminergic neurons in the substantia nigra of PD mice, the motor deficit was also significantly improved. By RNA-seq analysis, miR-100-5p was verified as a potential microRNA in this process, because knockdown of miR-100-5p in ADSC-sEVs weakened the protective effect of ADSC-sEVs on PD mouse as well as the anti-inflammatory effect on microglia activation. Finally, we found that miR-100-5p could target Deltex E3 ubiquitin ligase 3 L (DTX3L) and suppress its expression, which then decreased the expression and phosphorylation of Signal Transducers and Activators of Transcription 1 (STAT1), as well as alleviating the activation of microglia. Our findings illustrate that ADSC-sEVs are an effective therapy for PD, and it could be a promising therapy for the treatment of PD.

Improving mitochondria-associated endoplasmic reticulum membranes integrity as converging therapeutic strategy for rare neurodegenerative diseases and cancer

Membrane contact sites harbor a distinct set of proteins with varying biological functions, thereby emerging as hubs for localized signaling nanodomains underlying adequate cell function. Here, we will focus on mitochondria-associated endoplasmic reticulum membranes (MAMs), which serve as hotspots for Ca2+ signaling, redox regulation, lipid exchange, mitochondrial quality and unfolded protein response pathway. A network of MAM-resident proteins contributes to the structural integrity and adequate function of MAMs. Beyond endoplasmic reticulum (ER)-mitochondrial tethering proteins, MAMs contain several multi-protein complexes that mediate the transfer of or are influenced by Ca2+, reactive oxygen species and lipids. Particularly, IP3 receptors, intracellular Ca2+-release channels, and Sigma-1 receptors (S1Rs), ligand-operated chaperones, serve as important platforms that recruit different accessory proteins and intersect with these local signaling processes. Furthermore, many of these proteins are directly implicated in pathophysiological conditions, where their dysregulation or mutation is not only causing diseases such as cancer and neurodegeneration, but also rare genetic diseases, for example familial Parkinson's disease (PINK1, Parkin, DJ-1), familial Amyotrophic lateral sclerosis (TDP43), Wolfram syndrome1/2 (WFS1 and CISD2), Harel-Yoon syndrome (ATAD3A). In this review, we will discuss the current state-of-the-art regarding the molecular components, protein platforms and signaling networks underlying MAM integrity and function in cell function and how their dysregulation impacts MAMs, thereby driving pathogenesis and/or impacting disease burden. We will highlight how these insights can generate novel, potentially therapeutically relevant, strategies to tackle disease outcomes by improving the integrity of MAMs and the signaling processes occurring at these membrane contact sites.

Effects of multicomponent combinations training on respiratory function in individuals with Parkinson's disease: A randomized clinical trial

INTRODUCTION

Individuals with mild to moderate Parkinson's disease may experience respiratory impairments. Exercise interventions can be prophylactic, reduce progression, and/or mitigate these problems, improving the patient's quality of life. This study aimed to analyze and compare the effect of two different combinations of multicomponent training on lung function, respiratory muscle strength, and aerobic capacity in individuals with Parkinson's disease.

METHODS

A randomized clinical trial was conducted. 13 people with a mild to moderate Parkinson's disease diagnosis were randomly assigned to two groups - group 1 (G1) undertook stretching, stationary bicycle, and strength exercises; and G2 undertook stretching, stationary bicycle exercises, inspiratory muscle training, and abdominal exercises. Both groups undertook two 60-min sessions of multicomponent training per week for 12 weeks. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced vital capacity, forced expiratory volume in 1 s, thoracoabdominal expansion, the 6-min walk test, and the five times sit-to-stand test were measured. The study was approved by the Human Research Ethics Committee, with the consent of all participants.

RESULTS

We observed effects on MIP and MEP over this time in both groups. Other variables did not present effects for time, group, or interaction.

CONCLUSION

12 weeks of training with both combinations of multicomponent training increased respiratory muscle strength in individuals with mild to moderate Parkinson's disease.

Effects of immersive and non- immersive virtual reality on anxiety and cognition in Parkinson's disease: A comparative study

INTRODUCTION

Parkinson's disease (PD) is chronic and progressive, manifested by both motor and non-motor symptoms, such as anxiety. Anxiety occurs in more than 50% of patients. Rehabilitation in PD is more focused on controlling motor symptoms. However, non-motor symptoms affect independence, functionality, and motivation.

PURPOSE

The present study aimed to compare the effects of immersive virtual reality (IVR) and non-immersive virtual reality (NIVR) training on anxiety and cognition in PD patients.

METHODS

Two VR devices were used: Nintendo Wii (NIVR) and Samsung Gear VR (IVR). A convenience sample of 60 participants was distributed into 3 groups: a no intervention control group (CG) and two training groups (IVR and NIVR). All were evaluated at the baseline (T1), 7 days after (T7), and 30 days after training (T30). The Beck Anxiety Inventory (BAI), Semantic Verbal Fluency test (VF), and Digits subtest in reverse order (DR) were evaluated. The intervention protocol consisted of 10 sessions, each lasting 1 h, twice a week, for 5 weeks. According to the motor and cognitive requirements of games, 4 games were selected for each VR system. The Friedman test was used for comparing groups at different times (P ≤ 0.05).

RESULTS

The findings revealed a significant decrease in the BAI score in the IVR group (F = 15 217; p < 0.001) between T1 and T7 (and between T1 and T30. No significant differences were found between T7 and T30. No significant differences were found for the cognition variables.

CONCLUSION

IVR is a useful and feasible tool for managing anxiety symptoms in patients with PD.

Assessing Laryngeal Neuromotor Activity from Phonation

Neurodegenerative motor disorders affect the neuromuscular system challenging daily life and normal activity. Parkinson's Disease (PD) is among the most prevalent ones, with a large impact and rising prevalence rates. Speech is most affected by PD as far as phonatory and articulatory performance is concerned. Neuromotor activity (NMA) alterations have an impact on larynx muscles responsible for vocal fold adduction and abduction, hampering phonation stability and regularity. The main muscular articulators involved in phonation control are the cricothyroid (tensor) and thyroarytenoid (relaxer) systems, regulated by two distinct direct neuromotor pathways, activated by the precentral gyrus laryngeal control areas. These articulations control the musculus vocalis, directly responsible for regular vocal fold vibration. An indirect estimation of the muscular tension produced by inverse filtering may split into two independent channels, assumed to be the tensor and relaxer neuromotor pathways such as the differential neuromotor activity (DNMA). The amplitude distributions of both DNMA channels allow comparing phonations from PD-affected persons (PDPs) and age-matched healthy control participants (HCPs) with respect to a set of reference mid-age normative participants (RSPs). The comparisons are carried out by Jensen-Shannon distributions of PDP and HCP phonations with respect to those of RSPs. A dataset of 96 phonation samples from participants balanced by gender is used to train a set of decision tree classifiers (DTCs) to distinguish PDP from HCP phonation. The best results from 10-fold cross-validation offered accumulated mismatches of 0.09 and 0.1292 for male and female subsets. The sensitivity, specificity, and accuracy of the classification results when separating PDP from HCP phonatios were 93.33%, 88.23%, and 90.63% (male PDP versus HCP) and 92.86%, 83.33%, and 87.50% (female PDP versus HCP), providing a stratification of PDPs and HCPs by objective disease grading from explainable AI (XAI) methods.

Predictors of Informal Caregiver Burden in Parkinson's Disease: A Systematic Review

BACKGROUND

Caregivers of people with Parkinson's disease are at risk of experiencing caregiver burden. Understanding contributing factors is required to develop appropriate targeted interventions and support for this group. This systematic review provides an updated appraisal and synthesis of quantitative studies assessing predictors of burden among informal caregivers of people with Parkinson's.

METHOD

Five electronic databases (APA PsycINFO, CINAHL, MEDLINE, Web of Science, and Cochrane Library) were systematically searched (from inception until July 2024), supplemented by hand-searches. Study quality was assessed using the cross-sectional JBI Critical Appraisal Checklist. Results were synthesized narratively.

RESULTS

Forty-one studies were included. Predictors of increased burden included greater impact of motor symptoms on activities of daily living, greater severity of neuropsychiatric symptoms, poorer quality of life of the person with Parkinson's, and poorer caregiver mental health. Demographics, presence of motor symptoms, motor complications, and general cognitive function did not predict burden. Evidence was inconclusive for several variables including disease stage and duration, motor symptom severity, functional ability, overall non-motor symptoms, mental health of the person with Parkinson's, and caregivers' involvement and protective factors.

CONCLUSION

Several areas for potential future intervention are indicated, although methodological weaknesses within the literature constrain the robustness of conclusions. Key areas for future research include exploring understudied variables (caregiver personality and coping style, relationship quality, and positive aspects of caregiving) that may be important predictors of burden, specifying and utilizing a more consistent definition of "informal caregiver," and recruiting younger and non-spousal caregivers and more diverse samples regarding disease severity.

Effectiveness of electrical stimulation with conservative treatment for lower urinary tract symptoms in Parkinson's disease: A three-armed randomized controlled trial protocol

Background

Despite the high prevalence of lower urinary tract symptoms (LUTS) in patients with Parkinson's disease (PD)-ranging from 27 % to 85 % including symptoms such as urinary urgency,- incontinence, frequency, and nocturia-evidence-based treatment options remain limited. Conservative treatments, such as bladder training, pelvic floor muscle exercises (PFME) with biofeedback and electrical stimulation, have been shown safe and effective in the general population, with minimal side effects. However, their efficacy specifically in PD patients remains unclear. Therefore this study aims to evaluate the effect of electrical stimulation with conservative treatment for LUTS in PD patients.

Methods and analysis

This randomized controlled trial includes three study arms. All three groups will receive conservative treatment in combination with different electrical stimulation parameters, small- and broad pulse duration and sham electrical stimulation. In total 150 PD patients with self-reported LUTS who are able to attend a pelvic physical therapy practice independently and complete online questionnaires will be enrolled. The primary outcome is the difference in international prostate symptom score (IPSS), with a range of 0-35.A minimal important difference of 4.2 between baseline and 12 weeks of treatment will be statistical significant (p˂0.05). Secondary outcome include questionnaires evaluating bladder dysfunction, burden, and quality of life and will be collected at baseline, 12 weeks and 24 weeks and at one year. Additionally pelvic floor muscle function will be assed at baseline and after 12 weeks.All participants receive eight sessions along with their assigned electrical stimulation treatment and conservative treatment.

Parkinson's disease and brain insulin signaling: Mechanisms and potential role of GLP-1 mimetics

Parkinson's disease (PD) is a common neurodegenerative disorder characterized primarily by the degeneration of dopaminergic neurons in the substantia nigra pars compacta. The pathophysiology of PD is complex and multifactorial involving genetic factors, oxidative stress, mitochondrial dysfunction, impaired protein clearance, and neuroinflammation but recent evidence emphasizes the role of impaired brain insulin signaling. Insulin is a metabolic hormone with extensive effects on metabolic substrates but recent studies have demonstrated that it is also involved in central signaling pathways and induces different brain areas related to food craving, motor activities, cognitive abilities, and emotional feelings. Hence it has been suggested that induction of brain insulin sensitivity may be a promising treatment for PD. Glucagon-like peptide-1 (GLP-1) mimetics are a new-generation class of antidiabetics that normalize glucose homeostasis via several pathways. Recent studies suggest extra-glycemic benefits for GLP-1 mimetics against PD. GLP-1 mimetics can prevent or slow PD progression. Additionally, these agents can improve cognitive functions by improving brain insulin signaling pathways. In this review, we aim to highlight the role of brain insulin signaling in PD pathophysiology and discuss the possible benefits of GLP-1 mimetics in PD management.

PINK1 deficiency rewires early immune responses in a mouse model of Parkinson's disease triggered by intestinal infection

Parkinson's disease is characterized by a period of non-motor symptoms, including gastrointestinal dysfunction, preceding motor deficits by several years to decades. This long prodrome is suggestive of peripheral immunity involvement in the initiation of disease. We previously developed a model system in PINK1 KO mice displaying PD-like motor symptoms at late stages following intestinal infections. Herein, we map the initiating immune events at the site of infection in this model. Using single-cell RNAseq, we demonstrate that peripheral myeloid cells are the earliest highly dysregulated immune cell type followed by an aberrant T cell response shortly after. We also demonstrate an increased propensity for antigen presentation and that activated myeloid cells acquire a proinflammatory profile capable of inducing cytotoxic T cell responses. Together, our study provides the first evidence that PINK1 is a key regulator of immune functions in the gut underlying early PD-related disease mechanisms.

Multiple system biology approaches reveals the role of the hsa-miR-21 in increasing risk of neurological disorders in patients suffering from hypertension

Hypertension is a prevalent disease that substantially elevates the risk of neurological disorders such as dementia, stroke and Parkinson's disease. MicroRNAs (miRNAs) play a critical role in the regulation of gene expression related to brain function and disorders. Understanding the involvement of miRNAs in these conditions could provide new insights into potential therapeutic targets. The main objective of this study is to target and investigate microRNAs (miRNAs) associated with neurological disorders in patients suffering from hypertension. The genes involved in hypertension were identified from various databases including GeneCard, MalaCard, DisGeNet, OMIM & GEO2R. The key gene for hypertension was identified using a systems biology approach. Also, potent phytochemical for hypertension was determined by computer-aided drug-designing approach. Functional miRNAs were determined for the key target gene using miRNet analytics platform by hypergeometric tests. Further, the gene-miRNA interaction was determined and enrichment analysis was done. RPS27A was identified as a key target gene for hypertension. Naringenin showed effective molecular interaction with RPS27A with a binding energy score (-6.28). Further, a list of miRNAs which were targeting brain disorders was determined from miRNet. A gene-miRNA network was constructed using the PSRR tool for Parkinson's Disease, Autism Spectrum Disorder, Acute Cerebral Infarction, ACTH-Secreting Pituitary Adenoma, & Ependymoma. Further, miRNA 21 & miRNA 16 were found to be associated with four of the neurological disorders. The study identifies specific miRNAs that may serve as potential biomarkers for brain disorders in hypertensive patients. Targeting these miRNAs could open new avenues for therapeutic strategies aimed at mitigating neurological damage in this patient population.

Nose-to-brain drug delivery: from bench to bedside

There is increasing interest in nose-to-brain delivery as an innovative drug delivery strategy for neurodegenerative disorders such as Parkinson's or Alzheimer's disease. The unique anatomy of the nose-brain interface facilitates direct drug transport via the olfactory and trigeminal pathways to the brain, bypassing the blood-brain barrier. Different administration techniques as well as advanced drug formulations like targeted nanoparticles and thermoresponsive systems have been explored to improve the delivery efficiency and the therapeutic efficacy. This review provides an up-to-date perspective on this fast-developing field, and discusses different studies on safety and pharmacokinetic properties. A thorough evaluation of preclinical and clinical studies reveals both promises and challenges of this delivery method, highlighting approved drugs for the treatment of epilepsy and migraine that successfully utilize intranasal routes. The current landscape of research on nose-to-brain delivery is critically discussed, and a rationale is provided for ongoing research to optimize therapeutic strategies.

Individualising Galvanic Vestibular Stimulation Further Improves Visuomotor Performance in Parkinson's Disease

Impaired motor function is a defining characteristic of Parkinson's disease (PD). Galvanic vestibular stimulation (GVS) has been proposed as a potential non-invasive intervention to enhance motor performance; however, its efficacy depends on both stimulation parameters and electrode configuration. In this study, we examined the effects of two-pole and three-pole GVS configurations, utilising different stimulation parameters, on motor performance in individuals with PD. Twelve participants with PD were administered eight distinct subthreshold amplitude-modulated GVS stimuli, along with sham stimulation, while performing a visuomotor target tracking task. Analysis of tracking error demonstrated substantial inter-individual variability in response to different stimuli and electrode configurations. While the three-pole configuration yielded superior motor performance in some cases, the two-pole configuration was more effective in others. The most effective overall stimulus across all subjects, characterised by an envelope frequency of 30 Hz and a carrier frequency of 110 Hz, improved motor performance by 25% relative to the sham stimulus. Moreover, tailoring the stimulation parameters to the individual further enhanced performance by an additional 24%. These findings suggest that GVS can yield significant motor improvements in individuals with PD. Furthermore, individualised optimisation of stimulation parameters, including the selection of the appropriate electrode configuration, may further enhance therapeutic efficacy.

Development of 18F-Labeled Deuterated Tropane Derivatives with High Metabolic Stability for PET Imaging of the Dopamine Transporter

PURPOSE

Dopamine transporter (DAT) in the central nervous system is an attractive biomarker for the diagnosis and study of various neurodegenerative diseases. To develop in vivo metabolically stable positron emission tomography (PET) probes for DAT imaging with a high target/background ratio, two 18F-labeled tropane derivatives with deuteration on both the N-fluoropropyl and 2β-carbomethoxy groups of the tropane scaffold were synthesized and evaluated.

METHODS

Radioligands [18F]6 and [18F]10 were synthesized from anhydroecgonine and radiolabeled with 18F through a "two-step one-pot" method. Lipophilicity, in vitro binding assay and microPET imaging in rats were performed. [18F]10 showed a higher standardized uptake value ratio (SUVr) and was selected for further evaluations by in vivo metabolism and biodistribution.

RESULTS

The radioligands [18F]6 and [18F]10 were obtained in radiochemical purities > 98% and molar activity of about 30 GBq/μmol. [18F]6 or [18F]10 demonstrated high specificity and binding affinity to DAT in vitro, with IC50 values between 2 ~ 3 nM. MicroPET imaging in wild type Sprague-Dawley rats revealed that [18F]10 has a higher SUVr than [18F]6. Blocking experiments demonstrated the selectivity and reversibility of [18F]10 for DAT binding in microPET imaging. The diagnostic efficacy of [18F]10 for DAT-related disorders was verified in semi-PD model rats with microPET. In vivo metabolic studies in rats indicated that [18F]10 exhibited enhanced stability. Biodistribution experiments further confirmed that [18F]10 accumulated in the DAT-rich region of the striatum.

CONCLUSION

[18F]10 is a highly promising metabolically stable 18F-labeled PET probe for DAT imaging, with potential clinical applications in detecting and monitoring DAT-related neurological disorders.

Koopman-based linearization of preparatory EEG dynamics in Parkinson's disease during galvanic vestibular stimulation

Introduction

Parkinson's disease (PD) impairs motor preparation due to basal ganglia dysfunction, contributing to motor deficits. Galvanic Vestibular Stimulation (GVS), a non-invasive neuromodulation technique, shows promise in enhancing motor function in PD, but its underlying neural mechanisms are poorly understood. This study employs a Deep Koopman model to linearize and analyze preparatory EEG dynamics in PD, hypothesizing that GVS restores cortical activity patterns critical for motor planning.

Methods

EEG data from 18 PD participants (on/off medication) and 18 healthy controls were collected during a preparatory phase of a motor task under three conditions: sham, GVS1 (50-100 Hz multi-sine), and GVS2 (100-150 Hz multi-sine). A Deep Koopman framework mapped EEG signals into a three-dimensional latent space for linear dynamical analysis. Temporal dynamics were assessed via eigenvalue analysis, spatial contributions via regression-based scalp mapping, and motor performance correlations via Pearson's coefficients. A Linear Quadratic Regulator (LQR) simulated control of PD dynamics toward healthy patterns.

Results

The Deep Koopman model accurately captured EEG dynamics, with eigenvalue analysis showing no significant temporal dynamic differences across groups. Spatial contribution analysis revealed that PD-Off sham conditions deviated most from healthy control EEG patterns, while GVS and medication significantly reduced these deviations, aligning PD patterns closer to controls. Closer alignment correlated with improved motor performance metrics, including reduced reaction and squeeze times. LQR control effectively guided PD neural dynamics toward healthy trajectories in the latent space.

Discussion

GVS enhances motor preparation in PD by restoring healthy cortical EEG patterns, with additive benefits from dopaminergic medication. The Deep Koopman framework offers a powerful approach for dissecting complex EEG dynamics and designing targeted neuromodulation strategies. These findings elucidate GVS's therapeutic mechanisms and highlight its potential for personalized PD interventions, warranting further exploration in larger cohorts and varied stimulation protocols.

Effects and mechanisms of acupuncture for PIGD-subtype Parkinson's disease via integration of fMRI and gut microbiota-metabolomics analysis: protocol for a prospective randomized controlled trial

Introduction

Parkinson's disease (PD) can be categorized into various subtypes based on the primary symptoms associated with motor dysfunction. One subtype, known as postural instability and gait difficulty (PIGD), is characterized by severe clinical symptoms, an increased risk of walking difficulties and falls, and a poorer prognosis compared to other subtypes. This condition imposes a significant burden on patients, their families, and the healthcare system. Recently, acupuncture, a practice rooted in traditional Chinese medicine, has gained attention for its potential to influence neurophysiological pathways and enhance the overall brain function in individuals with PD. This randomized controlled study aimed to evaluate the clinical effectiveness of acupuncture in patients with the PIGD subtype of PD and to investigate the preliminary exploration of mechanisms of acupuncture by analyzing intestinal microbiota and metabolomics, thereby providing deeper insights into its impact on patients.

Methods

This randomized controlled trial will involve 64 patients diagnosed with the PIGD subtype of PD. Participants in both groups will undergo three acupuncture sessions weekly for a duration of 4 weeks, followed by an 8-week follow-up period. The primary outcome measure will be the Unified Parkinson's Disease Rating Scale III. Secondary outcomes will include the Berg Balance Scale (BBS), wearable gait analysis, and functional magnetic resonance imaging (fMRI). Additionally, serum and stool samples will be collected for 16S ribosomal RNA sequencing, and liquid chromatography coupled with tandem mass spectrometry analysis (LC-MS/MS) will be employed to elucidate theunderlying mechanisms. This trial has been reviewed and approved by the Medical Ethics Committee of Zhejiang Hospital (Approval no. 2023-15 K). Participation in this study will require written informed consent from all patients. The findings of this study will be published in a peer-reviewed journal, and there will be no restrictions on publication.

Discussion

In this study, we integrate traditional assessment scales with fMRI to demonstrate the therapeutic effects of acupuncture. We will also analyze the modulation of gut microbiota and serum metabolome to explore the underlying neural mechanisms. Our results will provide a foundation for future studies in this area.

Clinical trial registration

https://www.chictr.org.cn, identifier ChiCTR2300071703.

Research hotspots and future trends of insomnia in Parkinson's disease: a bibliometric and visualization analysis from 1973 to 2024

Background and objectives: Despite the growing body of research on Parkinson's disease (PD) and insomnia, comprehensive analysis of overall research trends remains limited. This study aims to evaluate these trends and identify research hot spots using bibliometric analysis.

Methods

Publications on PD and insomnia from 1973 to 2024 were extracted from the Web of Science Core Collection. Analytical tools such as VOSviewer, CiteSpace, and R 4.3.3 were employed for evaluation.

Results

A total of 610 publications are analyzed, demonstrating a consistent upward trend. The United States leads the field with 150 articles, representing 24.59% of total output, followed by China with 79 publications. Harvard University is the top contributing institution with 44 articles. Movement Disorders ranks as the leading journal, publishing 28 papers (4.59% of the total) and also securing the top spot in total citations. The most prolific author is Lima Marcelo M. S., with 15 publications and 50 recorded collaborations. Burst keyword analysis revealed increasing interest in terms such as "validation," "index," and "scale" since 2019.

Conclusion

Research on PD and insomnia exhibits a clear upward trend, reflecting increasing academic interest. Future studies are expected to focus on the validation of diagnostic tools, the development of scales, and the integration of artificial intelligence and personalized medicine for improved treatment precision.

The ocular surface tear film as a biomarker for systemic health

The tear film is a complex structure with rich interactions with the human body. A growing body of evidence suggests that measuring changes in protein, lipid, or other metabolite concentration in the tear film can be used to help detect disease. Particularly in the era of precision medicine, the tear film serves as a promising source of non-invasive insights into systemic health for early diagnosis and treatment. This paper analyzes the latest research in tear film biomarkers for systemic diseases. The review was conducted through PubMed and Embase databases using the PRISMA protocol and includes 54 articles. This paper first reviews the anatomy and physiology of tear film, as well as the latest proteomic analysis techniques on the tear film. We then provide a disease-by-disease review on the tear film as a biomarker including 5 articles related to Alzheimer's Disease, 10 articles related to Cancers, 1 article related to Cystic Fibrosis, 1 article related to Migraines, 4 articles related to Multiple Sclerosis, 15 articles related to Parkinson's Disease, 7 articles related to Rheumatoid Arthritis, and 11 articles related to Thyroid Disease. This paper highlights the promising results of these studies yet also reviews the challenges with limited sample sizes, reproducibility, and biological understanding of biomarkers. We conclude this paper with insights for future work to ensure clinical validity and generalizability. Ultimately, the tear film is a clinically accessible, complex structure that provides a wealth of information that may contribute to a more comprehensive understanding of systemic health.

Transforming neurodegenerative disorder care with machine learning: Strategies and applications

Neurodegenerative diseases (NDs), characterized by progressive neuronal degeneration and manifesting in diverse forms such as memory loss and movement disorders, pose significant challenges due to their complex molecular mechanisms and heterogeneous patient presentations. Diagnosis often relies heavily on clinical assessments and neuroimaging, with definitive confirmation frequently requiring post-mortem autopsy. However, the emergence of Artificial Intelligence (AI) and Machine Learning (ML) offers a transformative potential. These technologies can enable the development of non-invasive tools for early diagnosis, biomarker identification, personalized treatment strategies, patient subtyping and stratification, and disease risk prediction. This review aims to provide a starting point for researchers, both with and without clinical backgrounds, who are interested in applying ML to NDs. We will discuss available data resources for key diseases like Alzheimer's and Parkinson's, explore how ML can revolutionize neurodegenerative care, and emphasize the importance of integrating multiple high-dimensional data sources to gain deeper insights and inform effective therapeutic strategies.

Dopamine D2 receptor upregulation in dorsal striatum in the LRRK2-R1441C rat model of early Parkinson's disease revealed by in vivo PET imaging

We conducted PET imaging with [18F]FDOPA and dopamine D2/3 receptor ligand [18F]fallypride in aged transgenic rats carrying human pathogenic LRRK2 R1441C or G2019S mutations. These rats have mild age-dependent deficits in dopamine release restricted to dorsal striatum despite no overt loss of dopamine neurons or dopamine content and demonstrate L-DOPA-responsive movement deficits.LRRK2 mutant rats displayed no deficit in [18F]FDOPA uptake, consistent with intact dopamine synthesis in striatal axons. However, LRRK2-R1441C rats demonstrated greater binding of [18F]fallypride than LRRK2-G2019S or non-transgenic controls, from a regionally selective increase in dorsal striatum. Immunocytochemical labelling post-mortem confirmed a greater density of D2 receptors in LRRK2-R1441C than other genotypes restricted to dorsal striatum, consistent with upregulation of D2-receptors as a compensatory response to the greater dopamine release deficit previously demonstrated in this genotype.These results show that [18F]fallypride PET imaging is sensitive to dysregulation of dopamine signalling in the LRRK2-R1441C rat, revealing upregulation of D2 receptors that parallels observations in human putamen in early sporadic PD. Future studies of candidate therapies could exploit this non-invasive approach to assess treatment efficacy.

Mobile phone use characteristics, genetic predisposition and the risk of Parkinson's disease: a prospective cohort study

We investigated the association between mobile phone use characteristics and Parkinson's disease (PD) risk and whether genetic predisposition modified these associations, utilising data from the UK Biobank. Participants using mobile phones for at least one hour weekly had a lower risk of PD compared to those using less than five minutes weekly (HR: 0.75, 95% CI: 0.65-0.87). Long-term users of mobile phones over eight years had an 18% reduced risk compared to participants with a length of mobile phone use ≤1 year (HR: 0.82, 95% CI: 0.68-1.00), and increased frequency of mobile phone use over two years was associated with a 12% lower risk than those who did not change (HR: 0.88, 95% CI: 0.79-0.98). No interaction between mobile phone use characteristics and PD-PRS was detected. Total brain volume, grey matter and white matter were positively associated with mobile phone use, while white matter hyperintensity was negatively associated.

Neuro_DeFused-Net: A novel multi-scale 2DCNN architecture assisted diagnostic model for Parkinson's disease diagnosis using deep feature-level fusion of multi-site multi-modality neuroimaging data

BACKGROUND

Neurological disorders, particularly Parkinson's Disease (PD), are serious and progressive conditions that significantly impact patients' motor functions and overall quality of life. Accurate and timely diagnosis is still crucial, but it is quite challenging. Understanding the changes in the brain linked to PD requires using neuroimaging modalities like magnetic resonance imaging (MRI). Artificial intelligence (AI), particularly deep learning (DL) methods, can potentially improve the precision of diagnosis.

METHOD

In the current study, we present a novel approach that integrates T1-weighted structural MRI and rest-state functional MRI using multi-site-cum-multi-modality neuroimaging data. To maximize the richness of the data, our approach integrates deep feature-level fusion across these modalities. We proposed a custom multi-scale 2D Convolutional Neural Network (CNN) architecture that captures features at different spatial scales, enhancing the model's capacity to learn PD-related complex patterns.

RESULTS

With an accuracy of 97.12 %, sensitivity of 97.26 %, F1-Score of 97.63 %, Area Under the Curve (AUC) of 0.99, mean average precision (mAP) of 99.53 %, and Dice Coefficient of 0.97, the proposed Neuro_DeFused-Net diagnostic model performs exceptionally well. These results highlight the model's robust ability to distinguish PD patients from Controls (Normal), even across a variety of datasets and neuroimaging modalities.

CONCLUSIONS

Our findings demonstrate the transformational ability of AI-driven models to facilitate the early diagnosis of PD. The proposed Neuro_DeFused-Net model enables the rapid detection of health markers through fast analysis of complicated neuroimaging data. Thus, timely intervention and individualized treatment strategies lead to improved patient outcomes and quality of life.

Neuroprotective effect of Thymus vulgaris on paraquat induced Parkinson's disease

The dramatic surge of neurodegenerative disorders among elderly population underscore the pressing demand for development of optimal and evidence based noninvasive natural treatment strategies. Paraquat exposure in animal models used in scientific studies can cause a variety of clinical signs of Parkinson disease (PD). The health benefits of thyme include antioxidant, anti-inflammatory, pulmonary, and neurological benefits. Thyme and other herbal treatments are frequently used to treat a variety of conditions, including neurological issues. The primary factor in the etiology of neurodegeneration is oxidative stress. Conventional treatments are indicated to potentially have negative side effects. The primary phytochemicals of Thymus vulgaris (TV), which are responsible for its unique therapeutic property of neuro-protection, include hydrocarbon and phenolic compounds like thymol and carvacrol. The goal of the current investigation was to examine T. vulgaris' potential for neuroprotection while also ensuring its safety. Analyses of the plant's physicochemical and phytochemical composition were performed by liquid chromatographic analysis. Neuro-behavioral and biochemical parameters were evaluated to determine the impact of T. vulgaris in paraquat induced parkinsonian rodents model. The neurobehavioral tests include open field tests for movement and exploration, Y maze test and elevated plus maze test for natural behavior, memory, and anxiety, hole board tests for exploratory behavior, ladder climbing, foot printing, and wire hanging tests for estimating neuromuscular coordination. T. vulgaris treatment significantly improved neurobehavioral parameters dose-dependently, Biochemical analysis revealed that extract treatment mitigated the declined level of antioxidant enzymes. RT-PCR analysis showed that in paraquat treated group mRNA expression of IL-1α, IL-1β, Alpha-Synuclein, TNF-α, and IL-6 was upregulated markedly. However, T. vulgaris treatment dose dependently down-regulated the mRNA expression of these genes. The groundbreaking results of current study revealed that T. vulgaris restored the degenerative alterations, neuro-inflammation, and nerve loss in the brain structure, as evident by histopathological investigation. Particularly remarkable restoration in neuropsychological and biochemical markers emphasize the medicinal potential of T. vulgaris as a revolutionary treatment for neurodegenerative disorders, offering new hope for millions worldwide afflicted by these devastating conditions.

Microcystin-LR Exposure Damages Neurons by Inducing α-Syn Aggregation via MAPK4/GATA2/SNCA and PP2A/GRKs Pathways

Microcystin-LR (MC-LR) is a natural neurotoxin with strong toxicity, and studies have demonstrated that chronic MC-LR exposure generated Parkinson-like dyskinesia in mice. Parkinson's disease (PD) is a neurologic degenerative disease mostly occurring in elderly people, and the progressive loss of dopaminergic neurons and the formation of Lewy bodies are the hallmark pathological features. The main component of Lewy bodies is α-synuclein (α-syn) encoded by the SNCA gene, and the copy number mutation of SNCA gene can promote the overexpression of α-syn. A mouse model of MC-LR exposure for 15 months was established to confirm the deposition of Lewy bodies. SH-SY5Y cells exposed to MC-LR were constructed as an in vitro model of PD, and the transcription factor that regulated the SNCA gene (the encoding gene of α-syn) was identified through the database. MC-LR enhanced the transcription level of SNCA gene and upregulated α-syn protein expression by promoting MAPK4 into the nucleus and binding to GATA2 295-480 fragment. In addition, MC-LR inhibited PP2A activity and activated GRKs kinase to promote α-syn phosphorylation at Ser129. These results suggest that MC-LR is involved in α-syn aggregate formation and PD pathogenesis by enhancing SNCA transcriptional activity to promote α-syn elevation via the MAPK4/GATA2 pathway and inducing α-syn phosphorylation via the PP2A/GRKs pathway.

An Open-Label, Non-randomized, Drug-Repurposing Study to Explore the Clinical Effects of Angiotensin II Type 1 (AT1) Receptor Antagonists on Anxiety and Depression in Parkinson's Disease

BACKGROUND

The cerebral Renin-Angiotensin System might have a role in anxiety and depression development.

OBJECTIVE

We explored the effects of Angiotensin II Type 1 receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) on anxiety and depression in Parkinson's Disease (PD).

METHODS

Four hundred and twenty-three newly diagnosed drug-naïve PD patients were evaluated using the State-Trait Anxiety Inventory (STAI) and Geriatric Depression Scale (GDS-15) tests and were monitored at baseline and for up to 3 years.

RESULTS

Twelve patients were treated with ARBs and 42 with ACE-Is. ARB-treated patients had lower anxiety STAI scores than those on ACE-Is or drug-free at baseline (17.2 ± 1.3 vs. 21.3 ± 1.3, or 23.8 ± 0.5, respectively, P = 0.021) and during the follow-up (P < 0.01). Depression scores were unaffected by any of the drugs throughout the study.

CONCLUSION

This small sample of ARB-treated PD patients displayed lower levels of anxiety. Randomized clinical trials are warranted.

Calcium modulating ligand confers risk for Parkinson's disease and impacts lysosomes

OBJECTIVE

Several genetic loci known to confer risk for Parkinson's disease (PD) function in lysosomal pathways. We systematically screened common variants linked to PD risk by genome-wide association studies (GWAS) for impact on cerebrospinal fluid (CSF) proteins reflecting lysosomal function.

METHODS

Starting with 525 candidate gene-single nucleotide polymorphism (SNPs) pairs nominated by Mendelian randomization from published PD GWAS, we filtered SNPs for downstream evaluation, based on strength of association with PD and impact on brain gene expression. We genotyped top SNPs in 173 PD participants, adding three SNPs capturing variation at the TMEM106B, CTSB, and RAB29 loci, encoding genes with known lysosomal function. In the same 173 individuals, we measured 15 CSF proteins (nine lysosomal proteins and six other proteins implicated in neurodegeneration) by parallel reaction monitoring mass spectrometry. We tested SNPs for association with lysosomal proteins. For our top SNP associating with multiple lysosomal proteins, we characterized expression of its target gene CAMLG in human brain tissue.

RESULTS

Sixteen SNPs emerged from our analysis of GWAS-nominated loci. Genotypes at rs12657663 (CAMLG) associated with CSF levels of multiple lysosomal markers (cathepsin F, cathepsin L, hexosaminidase B, and tripeptidyl peptidase I) and genotypes at rs7910668 (ITGA8) with CSF levels of cathepsin B. The protein encoded by CAMLG, calcium modulating ligand (CAML), is highly expressed in neurons of multiple human brain regions, with higher expression in Lewy body disease cases.

INTERPRETATION

Systematic analysis of PD risk loci nominates CAMLG as a neuronally expressed risk gene with effects on lysosomes.

In vitro electrophysiological characterization of Parkinson's disease: challenges, advances, and future directions

Parkinson's disease is the second most common neurodegenerative disorder, characterized by the progressive loss of dopaminergic neurons in the substantia nigra and the accumulation of α-synuclein aggregates. While significant progress has been made in understanding the genetic and biological aspects of Parkinson's disease, its complex pathophysiology remains poorly understood, and current therapeutic approaches are largely symptomatic. Advanced in vitro models have emerged as essential tools for studying Parkinson's disease related mechanisms and developing new therapeutic strategies. However, the electrophysiological characterization of neurons in these models remains underexplored. This review highlights the importance of employing electrophysiological techniques, such as patch-clamp recordings and microelectrode arrays, in providing critical insights into neuronal dysfunction, synaptic impairments, and network disruptions in Parkinson's disease. The aim is to summarize the key discoveries in the electrophysiological characterization of the pathology and the related progress made in recent years, underlying the main challenges, including the lack of standardized protocols, and the heterogeneity of cellular sources and culture systems. Addressing these limitations is crucial for improving reproducibility and facilitating cross-study comparisons, allowing for a deeper understanding of Parkinson's disease pathophysiology. By refining and standardizing electrophysiological approaches, these efforts will enhance our understanding of Parkinson's disease's underlying mechanisms, ultimately accelerating the discovery of robust biomarkers and the development of more effective therapeutic strategies.

Assessment of causality association between serum adiponectin levels and the risk of Alzheimer's disease and Parkinson's disease: a Mendelian randomization study

Background

Until recently, the association between circulating adiponectin (ADPN) levels and the risk of Alzheimer's disease (AD) and Parkinson's disease (PD) remained unclear.

Methods

We utilized public data from the IEU GWAS database to conduct a two-sample bidirectional Mendelian randomization (MR) analysis and multiple sensitivity analyses. The MR analysis was performed using the aggregated data, with the genetic risk score (GRS) serving as an instrumental variable.

Results

The MR analyses revealed no significant causal association between genetically determined ADPN levels and the risk of AD (ORIVW = 0.852, 95% confidence interval [CI]: 0.586-1.117, p = 0.235) or PD (ORIVW = 0.830, 95% CI: 0.780-1.156, p = 0.606). Conversely, neither AD nor PD demonstrated any causal association with ADPN levels. The GRS approach yielded similar results (p > 0.05). However, it exhibited a negative correlation with interleukin 1β (IL1β, βIVW = -0.31; 95% CI: -0.55 to -0.07, p = 0.011). The Cochrane's Q test and MR-PRESSO analysis revealed no evidence of pleiotropy.

Conclusion

Our findings provide no evidence to substantiate a causal relationship between ADPN levels and the risk of AD and PD or vice versa. However, elevated levels of ADPN may correlate with lower levels of IL1β.

Status and influencing factors of balance in middle-aged and older adults with Parkinson's disease: a national longitudinal study

Background

To examine the current status and influencing factors of balance in middle-aged and older adults with Parkinson's disease (PD) and explore the correlations of these factors with balance.

Methods

The China Health and Retirement Longitudinal Study (CHARLS) Database in 2015, 2018 and 2020 were utilized as the data source, from which the missing value samples were excluded and 1,390 participants aged ≥45 years were recruited. Using the chi-square test, balance comparisons were made among middle-aged and older adults PD patients under different indicators. The influences of different factors on the patient balance were investigated through regression analysis.

Results

Regression analysis revealed the correlations of age, gender, smoking, falls, hypertension, diabetes and physical activity with balance in PD patients. A significant association between aging and declined balance was found, with middle-aged and older adults PD patients aged > 65 years showing a higher probability of declined balance (OR = 0.716, p = 0.016). Male middle-aged and older adults PD patients exhibited better balance than female counterparts (OR = 1.829, p = 0.001). Previous smoking (OR = 0.580, p = 0.004), falls (OR = 0.769, p = 0.035), hypertension (OR = 0.738, p = 0.019) and diabetes (OR = 0.734, p = 0.027) were positively correlated with the declined balance in PD patients. Light physical activity could significantly improve balance in middle-aged and older adults PD patients (OR = 1.672, p < 0.001).

Conclusion

Balance impairment is a major concern for middle-aged and older adults with PD. Our findings highlight that age, gender, smoking, history of falls, hypertension, diabetes, and physical activity significantly influence balance. Specifically, old age, male gender, light physical activity (such as walking), and lower risks of hypertension and diabetes are linked to better balance. Clinicians should focus on managing these risk factors and promoting light physical activity to improve balance and reduce fall risks.

Clinical Spectrum of Non-motor Symptoms in Correlation with Quality of Life in Parkinson's Disease and Atypical Parkinsonism: Evidence in Reaching Consensus

Background

Non-motor symptoms (NMS) are frequently overlooked, yet they significantly contribute to the progression of Parkinson's disease (PD) or atypical parkinsonism (AP), which include multiple system atrophy (MSA), progressive supranuclear palsy (PSP). Moreover, discrepancies exist in non-motor symptom scale (NMSS) scores for AP and PD, and no consensus has yet been reached.

Purpose

We evaluated and compared the NMS and their association with life quality in patients with AP and PD.

Methods

This cross-sectional observational report at a single-centre enrolling 204 patients (155 PD, 49 AP (27 MSA), and 22 PSP) from a tertiary care hospital's movement disorder clinic. We used Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS UPDRS)-III and modified Hoehn and Yahr (H&Y) to compute a motor score and disease severity, respectively. We assessed patients' mental capabilities, such as cognitive impairment, through a Mini-Mental State Examination (MMSE). Meanwhile, the NMSS determined the NMSs. Quality of life (QoL) was estimated by PD Questionnaire-39 (PDQ-39).

Results

We observed insignificant differences between the PD and atypical parkinsonian syndrome (APS) groups based on disease duration and gender. Worsened motor disability and disease severity were observed in AP (PSP>MSA) (P < .001). The mean NMSS scores for PD, PSP and MSA were 23.7 ± 27.9, 47.6 ± 41.3 and 65.6 ± 35.5, respectively (P < .05). MSA had a comparatively high score for sexual, cardiovascular and urinary domains, while PSP scored higher for memory/attention domains. In contrast, PD group revealed significantly lower scores for perceptual and sexual domains.

Conclusion

Compared to PD, NMS was severe and highly prevalent among AP (MSA > PSP), which could be confirmed through the prevalence of sexual cardiovascular and urinary domains in MSA, while attention and mood/cognition, and sleep in PSP.

Parkinson´s day-clinic: which patients should be selected and what services should be offered for successful therapy?

The demographic development and the advance of intensified yet time and personnel-intensive therapeutic options constitute increasing challenges for the care of people with advanced Parkinson's disease (PD). Often, the multitude of motor and non-motor symptoms cannot be adequately addressed in an ambulatory setting The concept of a Parkinson's day clinic has been put forward to meet the requirements for these patients who not necessarily require the full medical support of an inpatient treatment and was included into the Parkinson's guidelines of the German Neurological Society as a novel and promising medical care model. While the guidelines put forward some recommendations as to which patients are most likely to benefit from treatment in a Parkinson's day clinic, it has not yet been decided which infrastructural, operational, personnel and qualitative requirements such a setting should provide. Here we provide recommendations on the basis of an expert consensus as to which patients will particularly benefit from treatment in a Parkinson´s day clinic and which services such a day clinic should address in order to provide successful therapy. Furthermore we suggest a standard operating procedure (SOP) and we give examples of patients who are suitable for treatment in a Parkinson´s day clinic.

Dual stream transformer for medication state classification in Parkinson's disease patients using facial videos

Hypomimia is a prominent, levodopa-responsive symptom in Parkinson's disease (PD). In our study, we aimed to distinguish ON and OFF dopaminergic medication state in a cohort of PD patients, analyzing their facial videos with a unique, interpretable Dual Stream Transformer model. Our approach integrated two streams of data: facial frame features and optical flow, processed through a transformer-based architecture. Various configurations of embedding dimensions, dense layer sizes, and attention heads were examined to enhance model performance. The final model, trained on 183 PD patients, attained an accuracy of 86% in differentiating between ON- and OFF-medication state. Moreover, uniform classification performance (up to 88%) was obtained across various stages of PD severity, as expressed by the Hoehn and Yahr (H&Y) scale. These values highlight the potential of our model as a non-invasive, cost-effective instrument for clinicians to remotely and accurately detect patients' response to treatment from early to more advanced PD stages.

Implementing potential biomarkers for early detection of retinal changes in Parkinson's disease: Preliminary study on BDNF role

BackgroundVisual dysfunctions in Parkinson's disease (PD) patients suggest a possible degeneration of dopaminergic retinal layers, This study aimed to investigate macular retinal thickness in PD patients versus healthy controls using Optical Coherence Tomography (OCT), a non-invasive technique for in vivo retinal imaging. The role of the Val66Met polymorphism in the BDNF gene in relation to retinal degeneration and clinical features of PD was also explored.MethodsThis case-control study included 26 patients with idiopathic PD and 78 age- and sex-matched healthy controls, for a total of 208 eyes. All subjects underwent a 512 × 496-line OCT volumetric scan centred on the macular region.ResultsMacular thickness was measured in each sector and as an average across 360°. Significant differences were found in the superior sector of the left eye (OS2) (increase of 3 units in PD), the inferior sector of the left eye (OS2) (decrease of 3 units in PD), and the total volume of both eyes (decrease of 0.13 units in PD). An inverse correlation between retinal thickness and age at onset was observed in the temporal and inferior sectors of both eyes. The Val/Met heterozygous polymorphism was identified in 30.7% of PD patients.ConclusionsThe study confirms that thinning of the inner retinal layers is associated with PD. OCT provides a rapid, non-invasive, repeatable, and cost-effective method for in vivo assessment of retinal layers, supporting its potential as an early biomarker for PD. Further longitudinal studies with larger samples are needed to clarify the role of the BDNF polymorphism in retinal degeneration in PD.

Walking reduces the risk of dementia in patients with Parkinson's disease: a longitudinal follow-up study

Background

Physical activity, particularly regular aerobic exercise, is effective in preventing dementia. However, such activities are less feasible for patients with Parkinson's disease (PD) or other motor dysfunctions.

Objectives

In this study, we investigated whether the minimal amount of exercise (MAE) through walking, which is practical for individuals with motor dysfunction, can reduce the risk of dementia in patients with PD.

Design

For this retrospective longitudinal study, we enrolled 470 patients with PD without dementia from 3 centers in Taiwan.

Methods

In total, 187 (39.8%) subsequently developed dementia, whereas 283 (60.2%) did not; the mean follow-up periods for these cohorts were 3.1 (range 0.3-6.1) and 2.4 (range 0.3-6.0) years, respectively. MAE was defined as walking approximately 1500-3000 steps or for 15-30 min. The patients were further stratified by the weekly frequency of MAE into MAE-no (frequency: 0), MAE-weekly (frequency: 1 or 2), and MAE-daily (frequency: ⩾3) groups, respectively. The incidence rates of dementia were compared among the three groups. Cox proportional-hazards analyses were performed to measure the effect of MAE on the incidence of dementia. The statistical model was adjusted for age, sex, education level, cognition level, activities of daily living, neuropsychiatric symptoms, vascular risk factors, and relevant medications.

Results

The MAE-weekly and MAE-daily groups were 0.69 (95% confidence interval (CI): 0.41-1.17) and 0.59 (95% CI: 0.41-0.84) times, respectively, less likely to develop dementia than the MAE-no group. When the MAE-weekly and MAE-daily groups were combined, the hazard ratio for dementia was 0.62 (95% CI: 0.45-0.85). Cox regression revealed that older age, female sex, atrial fibrillation, antidiabetic drug use, and poor daily function were associated with an increased incidence of dementia.

Conclusion

MAE may help prevent dementia in patients with PD. This finding highlights the benefits of walking for patients with PD and, potentially, older adults with motor dysfunction due to various disorders.

Efficacy of Repetitive Transcranial Magnetic Stimulation Over the Supplementary Motor Area on Motor Function in Parkinson's Disease: A Meta-analysis

OBJECTIVE

The objective of this study was to assess the effect of repetitive transcranial magnetic stimulation on the supplementary motor area in motor function in Parkinson's disease patients.

METHOD

Databases searched included five databases from October 7, 2022, to January 4, 2023. The Cochrane Bias Risk Assessment Tool was used for quality assessment. Standardized mean differences were calculated using a random-effects model. Outcome measure is the motor function examination of the motor part of Unified Parkinson's Disease Rating Scale.

RESULTS

Seven studies totaling 374 patients were included. Meta-analysis showed that stimulation of supplementary motor area significantly improved motor function in Parkinson's disease patients compared with sham stimulation (standardized mean differences = -1.24; 95% CI, -2.24 to -0.24; P = 0.02; I2 = 93%). Stimulation of the same target (supplementary motor area) subgroup analysis showed that high-frequency repetitive transcranial magnetic stimulation is more effective than low-frequency repetitive transcranial magnetic stimulation in improving motor function in Parkinson's disease (standardized mean differences = -1.39; 95% CI, -2.21 to -0.57; P = 0.04; I2 = 77.2%).

CONCLUSIONS

Overall, repetitive transcranial magnetic stimulation over supplementary motor area had a statistically significant improvement in motor function in Parkinson's disease patients, and high-frequency repetitive transcranial magnetic stimulation is statistically significantly more effective than low-frequency repetitive transcranial magnetic stimulation.

Pushing the limit to reach meaningful change: the impact of intensity-driven exercise on clinical outcomes for individuals with Parkinson's disease. A single-subject design

PURPOSE

Parkinson's disease creates an inability to perform previous learned autonomic tasks, such as walking, which worsens with disease progression. Recommendations to incorporate exercise at moderate to high intensities for this population has been established but there is limited knowledge about its impact on clinical based outcomes. The purpose of this research is to investigate the effectiveness of a 6-week intensity-driven walking program on clinical-based outcomes in individuals with PD.

MATERIALS/METHODS

Five individuals with PD were recruited for this single-subject withdrawal design (A-B-A-B) study. 6-minute walk performance and other core neurological measures of gait were collected. Intervention phases incorporated a 30-minute individualized intensity-driven treadmill walking program practiced at 65% or more of ones maximum heart rate. Increased treadmill speed, incline, and resistance were manipulated to reach the target heart rate zone.

RESULTS

6-minute walk test within condition visual analysis demonstrated a therapeutic change during intervention phases and a countertherapeutic change during withdraw periods for all 5 individuals. An abrupt therapeutic effect was demonstrated for all individuals between conditions with the percent of nonoverlapping data ranging from 70-90%. Band method analysis revealed a range of 9-19 sessions two standard deviations above baseline mean performances for all individuals.

CONCLUSION

To achieve sufficient walking performance, gait practiced at higher intensity levels may provide the optimal solution as an adjunct to standard care for individuals with PD who want to improve their walking.

Parkinson's Disease and the Microbiota-Gut-Brain Axis: Metabolites, Mechanisms, and Innovative Therapeutic Strategies Targeting the Gut Microbiota

The human gut microbiota is diverse and abundant and plays important roles in regulating health by participating in metabolism and controlling physiological activities. The gut microbiota and its metabolites have been shown to affect the functioning of the gut and central nervous system through the microbiota-gut-brain axis. It is well established that microbiota play significant roles in the pathogenesis and progression of Parkinson's disease (PD). Disorders of the intestinal microbiota and altered metabolite levels are closely associated with PD. Here, the changes in intestinal microbiota and effects of metabolites in patients with PD are reviewed. Potential mechanisms underlying intestinal microbiota disorders in the pathogenesis of PD are briefly discussed. Additionally, we outline the current strategies for the treatment of PD that target the gut microbiota, emphasizing the development of promising novel strategies.

Hallmarks of aging in age-related macular degeneration and age-related neurological disorders: novel insights into common mechanisms and clinical relevance

Age-related macular degeneration (AMD) and age-related neurological diseases (ANDs), such as Alzheimer's and Parkinson's Diseases, are increasingly prevalent conditions that significantly contribute to global morbidity, disability, and mortality. The retina, as an accessible part of the central nervous system (CNS), provides a unique window to study brain aging and neurodegeneration. By examining the associations between AMD and ANDs, this review aims to highlight novel insights into fundamental mechanisms of aging and their role in neurodegenerative disease progression. This review integrates knowledge from the emerging field of aging research, which identifies common denominators of biological aging, specifically loss of proteostasis, impaired macroautophagy, mitochondrial dysfunction, and inflammation. Finally, we emphasize the clinical relevance of these pathways and the potential for cross-disease therapies that target common aging hallmarks. Identifying these shared pathways could open avenues to develop therapeutic strategies targeting mechanisms common to multiple degenerative diseases, potentially attenuating disease progression and promoting the healthspan.

Shaping Outcomes: Levodopa-Carbidopa Intestinal Gel Treatment and Nutrition in Parkinson's Disease-A Prospective Observational Cohort Study

Background/Objectives: Parkinson's Disease (PD) is a neurodegenerative disorder resulting in bradykinesia, rigidity and tremor, as well as numerous non-motor symptoms. Malnutrition in PD is correlated with levodopa-induced dyskinesia, decreased food intake, gastrointestinal symptoms and neurodegenerative processes. With disease progression, oral levodopa treatment becomes insufficient. One of the therapies used in advanced PD is levodopa-carbidopa intestinal gel. Its effect on the weight and nutrition of PD patients is poorly understood. The aim of this prospective single-center observational cohort study was to assess the effect of this treatment on weight, body composition and biochemical parameter changes over a two-year-long observation. The mood, cognition and motor status of the patients were also assessed. Methods: This study included 15 patients with advanced PD treated with levodopa-carbidopa intestinal gel. Body composition analysis, anthropometric measurements, blood tests, psychological assessments and disease control measurements were carried out over a span of two years after the initiation of therapy. Results: Significant improvement in disease management was observed. Anthropometric measurements, biochemical parameters and psychological assessments did not show significant differences. Among the body composition parameters, only resting metabolic rate and extracellular and intracellular water percentages were significantly affected. Conclusions: Our findings indicate a lack of negative effects of levodopa-carbidopa intestinal gel treatment on weight loss in patients with Parkinson's Disease in a 2-year long observation period. Furthermore, better disease management may result in a lower energy expenditure due to less time with dyskinesia. The limitations of our study include a small study group and limited follow-up.

Low-Frequency Dual Target Deep Brain Stimulation May Relieve Parkinsonian Symptoms

Background

Deep brain stimulation (DBS) reduces the motor symptoms of Parkinson's disease. The two most common targets are the subthalamic nucleus and the globus pallidus. Dual target deep brain stimulation may better reduce symptoms and minimize side effects, but the optimal parameters of dual target deep brain stimulation and their potential interactions are unknown.

Objective

Our purpose was to quantify the frequency response of dual target DBS on bradykinesia and beta oscillations in participants with Parkinson's disease, and to explore intrahemispheric pulse delays as a means to reduce total energy delivered.

Methods

We applied dual target DBS using the Summit RC+S in six participants, varying deep brain stimulation frequency.

Results

Dual target DBS at 50 Hz was effective at reducing bradykinesia, whereas increasing deep brain stimulation frequency up to 125 Hz also significantly reduced beta power. This frequency effect on beta power was replicated in a biophysical model. The model suggested that 22 Hz dual target deep brain stimulation, with an intrahemispheric delay of 40 ms, can reduce beta power by 87%.

Conclusion

We conclude that dual target DBS at 125 Hz best reduced bradykinesia. However, low frequency DBS with an appropriate intrahemispheric delay could improve symptom relief.

Early Alterations in De Novo Parkinson's Disease Revealed by Diffusion Tensor Imaging: Preliminary Study

Background/Objectives: Parkinson's disease (PD) is characterized by progressive neurodegeneration affecting both motor and non-motor functions. Identifying early alterations in PD patients before the onset of dopaminergic therapy is crucial for understanding disease progression and developing targeted interventions. This study aimed to investigate early changes in the putamen and thalamus in de novo PD patients using diffusion tensor imaging (DTI) compared to healthy controls. Methods: Thirty-one de novo PD patients and thirty-three healthy controls underwent DTI scanning. Tract-based spatial statistics were used to compare fractional anisotropy (FA) values between groups. Results: De novo PD patients exhibited significantly lower FA values in the right thalamus compared to controls, suggesting alterations in neuronal integrity or fiber degeneration in the early stages of the disease. However, no significant differences were demonstrated for FA values in the putamen between groups. Conclusions: We demonstrated that the FA value in the right thalamus was lower in PD compared with healthy controls. These findings highlight the potential of DTI as a non-invasive tool for detecting early neural changes in PD patients. Further studies would be helpful to assess the clinical utility of serial FA measurements of the subcortical gray matter in objective quantification of disease progression and monitoring of the therapeutic response.

Metallic nanomaterials in Parkinson's disease: a transformative approach for early detection and targeted therapy

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by substantial loss of dopaminergic neurons in the substantia nigra, leading to both motor and non-motor symptoms that significantly impact quality of life. The prevalence of PD is expected to increase with the aging population, affecting millions globally. Current detection techniques, including clinical assays and neuroimaging, lack the sensitivity and specificity to sense PD in its earliest stages. Despite extensive research, there is no cure for PD, and available treatments primarily focus on symptomatic relief rather than halting disease progression. Conventional treatments, such as levodopa and dopamine agonists, provide limited and often temporary relief, with long-term use associated with significant side effects and diminished efficacy. Nanotechnology, particularly the use of metallic-based nanomaterials (MNMs), offers a promising approach to overcome these limitations. MNMs, due to their unique physicochemical properties, can be engineered to target specific cellular and molecular mechanisms involved in PD. These MNMs can improve drug delivery, enhance imaging and biosensing techniques, and provide neuroprotective effects. For example, gold and silver nanoparticles have shown potential in crossing the blood-brain barrier, providing real-time imaging for early diagnosis and delivering therapeutic agents directly to the affected neurons. This review aims to reveal the current advancements in the use of MNMs for the detection and treatment of PD. It will provide a comprehensive overview of the limitations of conventional detection techniques and therapies, followed by a detailed discussion on how nanotechnology can address these challenges. The review will also highlight recent preclinical research and examine the potential toxicity of MNMs. By emphasizing the potential of MNMs, this review article aims to underscore the transformative impact of nanotechnology in revolutionizing the detection and treatment of PD.

Identification of Key Active Constituents in Eucommia ulmoides Oliv. Leaves Against Parkinson's Disease and the Alleviative Effects via 4E-BP1 Up-Regulation

Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder, affecting an increasing number of older adults. Despite extensive research, a definitive cure remains elusive. Eucommia ulmoides Oliv. leaves (EUOL) have been reported to exhibit protective effects on neurodegenerative diseases, however, their efficacy, key active constituents, and pharmacological mechanisms are not yet understood. This study aims to explore the optimal constituents of EUOL regarding anti-PD activity and its underlying mechanisms. Using a zebrafish PD model, we found that the 30% ethanol fraction extract (EF) of EUOL significantly relieved MPTP-induced locomotor impairments, increased the length of dopaminergic neurons, inhibited the loss of neuronal vasculature, and regulated the misexpression of autophagy-related genes (α-syn, lc3b, p62, and atg7). Assays of key regulators involved in PD further verified the potential of the 30% EF against PD in the cellular PD model. Reverse phase protein array (RPPA) analysis revealed that 30% EF exerted anti-PD activity by activating 4E-BP1, which was confirmed by Western blotting. Phytochemical analysis indicated that cryptochlorogenic acid, chlorogenic acid, asperuloside, caffeic acid, and asperulosidic acid are the main components of the 30% EF. Molecular docking and surface plasmon resonance (SPR) indicated that the main components of the 30% EF exhibited favorable binding interactions with 4E-BP1, further highlighting the roles of 4E-BP1 in this process. Accordingly, these components were observed to ameliorate PD-like behaviors in the zebrafish model. Overall, this study revealed that the 30% EF is the key active constituent of EUOL, which had considerable ameliorative effects on PD by up-regulating 4E-BP1. This suggests that EUOL could serve as a promising candidate for the development of novel functional foods aimed at supporting PD treatment.

Sleep and Prodromal Synucleinopathies

α-synucleinopathies are a complex group of progressive neurodegenerative disorders with an increasingly recognized long prodromal period, during which sleep dysfunction is a hallmark. Sleep disorders during the prodromal synucleinopathy period, primarily isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and daytime hypersomnolence correlate best with the recently proposed "body-first" Lewy body disease progression. iRBD is the most widely recognized form of prodromal α-synucleinopathy, and patients with iRBD show abnormal α-synuclein in tissues and biofluids even in the absence of cognitive or motor symptoms. More importantly, individuals with iRBD have an elevated risk for near-term development of a clinically diagnosable symptomatic synucleinopathy. Other sleep disorders such as hypersomnia and circadian rhythm dysfunction also occur across the synucleinopathy spectrum, although their prognostic significance is less well understood than iRBD. Finally, isolated REM sleep without atonia may represent an even earlier stage of prodromal synucleinopathy, but further studies are needed.

A review of machine learning and deep learning for Parkinson's disease detection

Millions of people worldwide suffer from Parkinson's disease (PD), a neurodegenerative disorder marked by motor symptoms such as tremors, bradykinesia, and stiffness. Accurate early diagnosis is crucial for effective management and treatment. This article presents a novel review of Machine Learning (ML) and Deep Learning (DL) techniques for PD detection and progression monitoring, offering new perspectives by integrating diverse data sources. We examine the public datasets recently used in studies, including audio recordings, gait analysis, and medical imaging. We discuss the preprocessing methods applied, the state-of-the-art models utilized, and their performance. Our evaluation included different algorithms such as support vector machines (SVM), random forests (RF), convolutional neural networks (CNN). These algorithms have shown promising results in PD diagnosis with accuracy rates exceeding 99% in some studies combining data sources. Our analysis particularly showcases the effectiveness of audio analysis in early symptom detection and gait analysis, including the Unified Parkinson's Disease Rating Scale (UPDRS), in monitoring disease progression. Medical imaging, enhanced by DL techniques, has improved the identification of PD. The application of ML and DL in PD research offers significant potential for improving diagnostic accuracy. However, challenges like the need for large and diverse datasets, data privacy concerns, and data quality in healthcare remain. Additionally, developing explainable AI is crucial to ensure that clinicians can trust and understand ML and DL models. Our review highlights these key challenges that must be addressed to enhance the robustness and applicability of AI models in PD diagnosis, setting the groundwork for future research to overcome these obstacles.

6-Shogaol, a neuro-nutraceutical derived from ginger, alleviates motor symptoms and depression-like behaviors and modulates the release of monoamine neurotransmitters in Parkinson's disease mice

PURPOSE

Parkinson's disease (PD) disrupts the regulation of neurotransmitters in the brain, causing patients to experience not only motor symptoms but also non-motor symptoms such as depression. 6-shogaol (6S) is a potential neuro-nutraceutical derived from ginger, and is known to ameliorate motor symptoms by suppressing inflammation in PD mice. In this study, we investigated whether 6S can attenuate motor symptoms and depression-like behaviors through neurotransmitter regulation and to elucidate which neurotransmitters are intimately correlated with these effects.

METHODS

C57BL/6 J mice were injected with 30 mg/kg of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) for 5 d to induce PD. 6S was administered via oral gavage for 11 d, including the MPTP injection period.

RESULTS

6S alleviated MPTP-induced motor symptoms and depression-like behaviors. MPTP injection decreased the levels of seven neurotransmitters in the striatum and four neurotransmitters in the hippocampus. Administration of 6S increased striatal dopamine, serotonin, and norepinephrine levels and hippocampal dopamine, norepinephrine, serotonin, and γ-aminobutyric acid levels. Moreover, correlation analysis shown that the motor symptom improvement effect of 6S was associated with striatal dopamine, norepinephrine, serotonin, and 5-hydroxyindoleacetic acid levels. The effect of 6S on depressive-like behavior was significantly correlated with striatal dopamine metabolites and serotonin and hippocampal dopamine, norepinephrine, and serotonin. Immunohistochemistry showed that 6S upregulated the expression of the vesicular monoamine transporter 2, which was reduced by MPTP in the striatum and hippocampus.

CONCLUSION

This study demonstrated that 6S improved motor symptoms and depression-like behaviors by regulating the release of monoamine neurotransmitters.

PTEN: a new dawn in Parkinson's disease treatment

In recent years, the study of phosphatase and tension homolog (PTEN) has gradually become a research hotspot. As an important oncogene, the role of PTEN in cancer has long been widely recognized and intensively studied, but it has been relatively less studied in other diseases. Parkinson's disease (PD) is a neurodegenerative refractory disease commonly observed in middle-aged and elderly individuals. The etiology and pathogenesis of PD are numerous, complex, and incompletely understood. With the continuous deepening of research, numerous studies have proven that PTEN is related to the occurrence of PD. In this review, we discuss the relationship between PTEN and PD through the phosphorylation and ubiquitination of PTEN and other possible regulatory mechanisms, including the role of RNA molecules, exosomes, transcriptional regulation, chemical modification, and subtype variation, with the aim of clarifying the regulatory role of PTEN in PD and better elucidating its pathogenesis. Finally, we summarize the shortcomings of PTEN in PD research and highlight the great potential of its future application in PD clinical treatment. These findings provide research ideas and new perspectives for the possible use of PTEN as a PD therapeutic target for targeted drug development and clinical application in the future.

Neuroprotective effect of Cistanche deserticola glycosides in MPTP-Induced Parkinson's disease mouse model involves Nrf2 activation

Parkinson's Disease (PD) a progressive neurodegenerative disorder is attributed to dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta. A major risk factors associated with PD development is presence of excess oxidative stress. Previously, glycosides derived from Cistanche deserticola were reported to play a key role in counteracting PD; however, the underlying mechanisms remain to be determined. This study aimed to examine the neuroprotective effect attributed to glycosides derived from C. deserticola in PD model in mice. The model of PD was established by injecting intraperitoneally 1-methyl-4-penyl-1,2,3,6-tetrahydropyridine (MPTP). Rotarod and pole tests determined neurological behavior. The following immunohistochemistry, and metabolic biomarkers were measured mid-brain substantia nigra: (1) number of dopaminergic neuronal cell using immunohistochemistry (2) oxidative stress as evidenced by activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as well levels of malondialdehyde (MDA), (3) inflammatory infiltration as measured by levels of IL-1β and TNF-α (4) by Western blot involvement of protein expression levels of Nrf2 signaling pathway. Data demonstrated that C. deserticola glycosides treatment improved behavioral performance, increased number of dopaminergic neurons, reduced cytokine levels of IL-1β and TNF-α accompanied by enhanced antioxidant activity in PD mice. These observations were associated with activation of Nrf2 signaling pathway. Data suggest that C. deserticola glycosides may thus be considered as an alternative compound for PD treatment.

Next Generation Sequencing Analysis in Patients Affected by Parkinson's Disease and Correlation Between Genotype and Phenotype in Selected Clinical Cases

Parkinson's Disease (PD) is the most frequent movement disorder and is second only to Alzheimer's Disease as the most frequent neurodegenerative pathology. Early onset Parkinson's disease (EOPD) is less common and may be characterized by genetic predisposition. NGS testing might be useful in the diagnostic assessment of these patients. A panel of eight genes (SNCA, PRKN, PINK1, DJ1, LRRK2, FBXO7, GBA1 and HFE) was validated and used as a diagnostic tool. A total of 38 in sequence EOPD patients of the Parkinson's Disease Unit of our Hospital Institution were tested. In addition, the number of the hexanucleotide repeats of the C9ORF72 gene and the frequency of main HFE mutations were evaluated. Six patients were carriers of likely pathogenic mutations in heterozygosity in the analyzed genes, one of them presented mutations in association and another had a complex genetic background. Their clinical symptoms were correlated with their genotypes. In the cohort of patients, only the p.Cys282Tyr of HFE was significantly decreased in the dominant model and allele contrast comparison. Only one patient with one allele of C9ORF72 containing 10 repeats was identified and clinically described. The clinical signs of sporadic and monogenic PD are often very similar; for this reason, it is fundamental to correlate genotypes and phenotypes, as we tried to describe here, to better classify PD patients with the aim to deepen our knowledge in the molecular mechanisms involved and collaborate in reaching a personalized management and treatment.

Mesenchymal stromal/stem cells from perinatal sources: biological facts, molecular biomarkers, and therapeutic promises

The use of mesenchymal stem cells (MSCs) from perinatal tissue sources has gained attention due to their availability and lack of significant ethical or moral concerns. These cells have a higher proliferative capability than adult MSCs and less immunogenic or tumorigenesis risk than fetal and embryonic stem cells. Additionally, they do not require invasive isolation methods like fetal and adult MSCs. We reviewed the main biological and therapeutic aspects of perinatal MSCs in a three-part article. In the first part, we revised the main biological features and characteristics of MSCs and the advantages of perinatal MSCs over other types of SCs. In the second part, we provided a detailed molecular background for the main biomarkers that can be used to identify MSCs. In the final part, we appraised the therapeutic application of perinatal MSCs in four major degenerative disorders: degenerative disc disease, retinal degenerative diseases, ischemic heart disease, and neurodegenerative diseases. In conclusion, there is no single specific molecular marker to identify MSCs. We recommend using at least two positive markers of stemness (CD29, CD73, CD90, or CD105) and two negative markers (CD34, CD45, or CD14) to exclude the hematopoietic origin. Moreover, utilizing perinatal MSCs for managing degenerative diseases presents a promising therapeutic approach. This review emphasizes the significance of employing more specialized progenitor cells that originated from the perinatal MSCs. The review provides scientific evidence from the literature that applying these progenitor cells in therapeutic procedures provides a greater regenerative capacity than the original primitive MSCs. Finally, this review provides a valuable reference for researchers exploring perinatal MSCs and their therapeutic applications.