Sleep disorders in Parkinson's disease: facts and new perspectives

Translation of Parkinson's Disease Sleep Scale-2 (PDSS-2) in Hindi (H-PDSS-2) and its Validation for Assessment of Sleep Disturbances among Indian Parkinson's Disease Patients

Background and Objective

Parkinson's disease sleep scale-2 (PDSS-2) is a reliable sleep assessment tool which has been validated in several languages. As sleep problems have a great impact on the quality of life of Parkinson's disease patients, we aimed to translate and validate PDSS-2 in Hindi for its wider use among Hindi-speaking Indian patients. Our study objective was to translate PDSS-2 in Hindi (H-PDSS-2) and to assess the psychometric properties of H-PDSS-2 questionnaire for its use in Hindi-speaking Indian PD patients. Secondly, we aimed to compare the results with those of the other language PDSS-2 validation studies.

Material and Methods

This study was done in two phases, enrolling 16 patients and 16 controls in the first/translation phase for assessment of internal consistency and discriminative power of PDSS-2. The test-retest reliability was determined in the second phase on 35 Parkinson's disease patients who were followed-up at an interval of 7-10 days.

Results

No difficulties were faced by the patients and controls in the first phase, and internal consistency of the scale was good (Cronbach's alpha = 0.804). There was no significant difference in total H-PDSS-2 score at baseline 16.86 ± 10.59 and on retest 16.40 ± 9.54, suggesting good reliability. Intraclass correlation coefficients ranged from 0.710 to 0.901, and precision was 2.82 over the period of 7-10 days. Subdomains of H-PDSS-2 had moderate/high internal validity, and they showed significant correlation with Unified PD Rating Scale (UPDRS) and HY disease scale.

Conclusion

H-PDSS-2 is equivalent to the original PDSS-2 for tested psychometric attributes. Its use among Indian Parkinson's disease patients will help in the comprehensive assessment of sleep problems among PD patients.

WATSU therapy for individuals with Parkinson's disease to improve quality of sleep and quality of life: A randomized controlled study

BACKGROUND

and Purpose: Sleep disorders are one of the most frequent non-motor symptoms of Parkinson's disease (PD). This study aimed to verify whether adding WATSU to land-based therapy leads to additional beneficial therapeutic effects regarding quality of sleep and quality of life (QOL) in individuals with PD.

MATERIALS & METHODS

A randomized control trial design was used. Participants completed nine-week interventions. The control group (CG) received land-based therapy, while the intervention group (IG) received the same land-based therapy and additionally WATSU. Sleep quality and QOL were measured at baseline and post-interventions by Pittsburgh Sleep Quality Index and Nottingham Health Profile, respectively.

RESULTS

Twenty-eight participants completed the study. In contrast to CG, the IG presented with significant improvements in both, quality of sleep and QOL (p < 0.001).

CONCLUSION

WATSU has the potential to be an attractive adjunct therapy for producing positive health impacts regarding sleep quality, which may translate to an overall improvement in QOL of individuals with PD.

[Circadian changes in the structure of cardiac rhythm during pre-symptomatic and symptomatic stages of Parkinson's disease]

AIM

To study circadian regulation of heart rhythm during the pre-symptomatic (PS) and early symptomatic (ESS) stages of Parkinson's disease (PD) and determine the functionally most unfavorable periods during which there is a risk of life-threatening arrhythmias.

MATERIAL AND METHODS

The studies were performed on C57BL/6 mice. ECG monitoring was performed in online mode using a wireless telemetry system (ADInstruments Australia).

RESULTS

Characteristics of circadian changes heart rate during PS and ESS of PD were detected. During PS changes in the autonomic regulation of the heart occur at night. The increase at this time of the parasympathetic tone indicates compensatory mechanisms that prevent changes in the total power spectrum. However, they can't prevent the high risk of life-threatening arrhythmias. The early symptomatic stage leads to the changes in mechanisms of not only sympathetic, but also parasympathetic regulation of the heart, increase in sympathetic tone and disturbed structure of the heart rhythm over most of the day. The decrease in the total power of the spectrum indicates a decrease in the adaptive capacity of the cardiovascular system. The increase in the intervals of QT, QTc and Tpeak Tend, indicates a risk of life-threatening arrhythmias.

CONCLUSION

PD predetermines complications of circadian autonomic regulation of the heart during PS and ESS, which can become the pathogenetic basis for severe cerebrocardial disorders.

The Relationships Between Poor Sleep Efficiency and Mild Cognitive Impairment in Parkinson Disease

BACKGROUND

Mild cognitive impairment (MCI) and sleep disturbances are common features in Parkinson disease (PD). This study sought to investigate whether patients with MCI in PD (PD-MCI) have more pronounced sleep disturbance compared to those without PD-MCI and whether phenotypic presentations differ according to the PD-MCI subtypes.

METHODS

A total of 95 patients with idiopathic PD (53 meeting criteria for PD-MCI and 42 who were not cognitively impaired) and 22 controls underwent neurological and neuropsychological examination. They wore actigraphy watches for 2 weeks, from which measures of nocturnal sleep efficiency were calculated.

RESULTS

Patients with PD-MCI has significantly poorer sleep efficiency compared to those without PD-MCI. This effect was particularly apparent in those with multiple-domain PD-MCI, compared to those with single-domain PD-MCI. Furthermore, patients in the PD-MCI group had significantly more nontremor features.

CONCLUSIONS

These data suggest that PD-MCI is associated with greater sleep disturbance and nontremor features of PD. This is further evidence for the potential role that sleep disturbance plays in the heterogeneity of PD.

Need for neurology specialists to be dedicated to hospital care in Italy

Any patients admitted to healthcare facilities with a neurological diseases deserves to be managed by a neurologist. This is particularly important for acute onset neurological disorders, because of their severity and the requirement of early and appropriate diagnostic-therapeutic approach. In addition, this may reduce both unnecessary admissions and length of stay, with a significant saving of resources for the National Health System (NHS). To ensure this, it is important to evaluate predictable needs for hospital neurologists in Italy. The hospital discharges for neurological medical diseases of the Major Disease Category (MDC) 1 were 455,132 in 2009 and 491,836 in 2008, more than 50 % of which were acute neurological disorders. Stroke and transient ischemic attacks (TIA) accounted for about 170,000 per year. Currently available neurologists in Italian healthcare facilities are largely insufficient to assist such a large number of patients. The 270 Neurological Care Units in Italy (of which 243 open to the emergency care) are equipped with an average number of 7.7 neurologists per unit, inadequate to ensure on duty care 24 h a day, 7 days a week. In addition, the mean age of hospital neurologists is quite high, with provision for large retirement. It is therefore required to increase in the next few years the number of neurologists by at least 30 %, with an increase of 562 units. To meet the need for neurology specialists committed to hospital care in Italy is also necessary to increase the number of scholarships for residents in post-graduate schools.

Is migraine a risk factor for the occurrence of eating disorders? Prevalence and biochemical evidences

The eating disorders (ED), anorexia nervosa (AN) and bulimia nervosa (BN), are severe psychiatric and somatic conditions occurring mainly in young woman. Although the aetiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. To understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected by ED is very high (<75 %). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients in respect to the control subjects. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that of ED patients shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

Sleep disorders in Parkinson's disease

Sleep disorders in Parkinson's disease (PD) are frequent and have numerous etiologies. Both nighttime sleep disturbances and daytime sleepiness can occur. The key to effective treatment is appropriate diagnosis. A careful interview of the patient and his or her bed partner provides direction for additional evaluations. Referral to a sleep specialist for quantitative studies is necessary to evaluate for rapid eye movement (REM) sleep behavior disorder, sleep apnea, periodic limb movements, and other sleep disorders. Excessive daytime sleepiness may be attributed to interrupted nighttime sleep or daytime medications (particularly the dopamine agonists) or it may be intrinsic to PD. When the diagnosis is established, treatment is directed toward the primary sleep disturbance. Fragmented sleep due to recurrence of PD symptoms may improve with the use of long-acting preparations of carbidopa/levodopa. Sleep apnea is treated using continuous positive airway pressure, and REM sleep behavior disorder may improve using pharmacologic interventions, although controlled trials are lacking. Restless legs syndrome and periodic limb movements during sleep are treated with direct dopaminergic agonists at bedtime. Excessive daytime sleepiness related to the use of direct dopaminergic agonists may improve with dosage reduction or discontinuation. Stimulants such as modafinil may provide modest benefit.

Sleep disturbances in Parkinson disease and their potential role in heterogeneity

Parkinson disease (PD) is commonly conceptualized as a movement disorder. Most previous attempts to define the heterogeneity of the condition have used prospective methods based on arbitrary features such as motor symptoms or age of disease onset. However, nonmotor symptoms including neuropsychological, neuropsychiatric, and behavioral impairments have received less attention. Sleep disturbances are extremely common in PD and appear to be associated with cognitive and psychiatric problems. Recent research has begun to elucidate the links between these variables, but the origin and extent of these relationships are not clearly understood. This review outlines the importance of sleep for healthy cognition and mood, highlighting the possible implications that disturbed sleep may have with regard to patients with PD. It also emphasizes the need for further studies that explore the heterogeneity of all disease features in PD.

Migraine prevalence in eating disorders and pathophysiological correlations

The eating disorders (ED): anorexia nervosa (AN) and Bulimia nervosa (BN) are severe psychiatric and somatic conditions occurring mainly in young woman. Although the etiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. In order to understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected be EA is very high (>75%). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients with respect to the control subject. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that ED patients have shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in the young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

Study of tyrosine metabolism in eating disorders. Possible correlation with migraine

In order to understand the possible role of tyrosine metabolism and in particular that of elusive amines in the pathogenesis of eating disorders (ED), we measured the plasma levels of dopamine, noradrenaline, tyramine (Tyr) and octopamine (Oct) in a large group of anorexic and bulimic patients. In comparison to the control group, the levels of nordrenaline were significantly lower and those of dopamine and Tyr higher in the ED patients. The plasma levels of Oct were in the same range in both subject groups. However when comparing the bulimic vs. the anorexic group, the Oct levels were significantly lower in the anorexic group, whereas those of Tyr were significantly higher in the bulimic patients, suggesting that different activation in the metabolism of elusive amines may underlie the shift from the anorexic into the bulimic state. These biochemical findings raise the possibility that abnormalities of the limbic and hypothalamic circuitries play a role in the pathogenesis of ED. In addition, the very high prevalence of migraine (>75%) in our group of ED sufferers, and the biochemical profile(s) reported in migraine, which appear similar to that found in ED patients, suggest that migraine constitutes a risk factor for the occurrence of ED in young females.