Who Can Diagnose Parkinson's Disease First? Role of Pre-motor Symptoms

Revolutionizing our understanding of Parkinson's disease: Dr. Heinz Reichmann's pioneering research and future research direction

Millions of individuals around the world are afflicted with Parkinson's disease (PD), a prevalent and incapacitating neurodegenerative disorder. Dr. Reichmann, a distinguished professor and neurologist, has made substantial advancements in the domain of PD research, encompassing both fundamental scientific investigations and practical applications. His research has illuminated the etiology and treatment of PD, as well as the function of energy metabolism and premotor symptoms. As a precursor to a number of neurotransmitters and neuromodulators that are implicated in the pathophysiology of PD, he has also investigated the application of tryptophan (Trp) derivatives in the disease. His principal findings and insights are summarized and synthesized in this narrative review article, which also emphasizes the challenges and implications for future PD research. This narrative review aims to identify and analyze the key contributions of Reichmann to the field of PD research, with the ultimate goal of informing future research directions in the domain. By examining Reichmann's work, the study seeks to provide a comprehensive understanding of his major contributions and how they can be applied to advance the diagnosis and treatment of PD. This paper also explores the potential intersection of Reichmann's findings with emerging avenues, such as the investigation of Trp and its metabolites, particularly kynurenines, which could lead to new insights and potential therapeutic strategies for managing neurodegenerative disorders like PD.

Importance of health history analysis in Parkinson's disease

The objective of this research article is to investigate the impact of various health history factors on the risk of developing Parkinson's disease (PD). From the medical history we can identify PD Symptoms and this also help to detect the progression of PD symptoms. By conducting statistical analyses, the study seeks to identify independent risk and protective factors for Parkinson's disease (PD), considering variations in impact across genders and BMI categories.

Introduction

In the diagnosis of PD the analysis of previous health history is very rare in practice while the main diagnosis have been done through the different motor and non-motor symptoms taking in consideration besides the cardinal symptoms of PD for identification and determination the stages of PD. Here we have analyzed the impact of 56 different diseases, symptoms, and surgeries which a subject may have experienced in their life before PD, considered as a health history.

Methods

The behavioral impact for each types of health history have been analyzed statistically with 31,265 subjects including PD, and Control. In this analysis we have calculated the variation of impact for both the Male, and Female, as well as subjects BMI.

Results

98.12 % PD patients, where 97.63 % Male PD, and 98.71 % Female PD were found with at least one health history record. Coronary heart disease odds ratio (OR) 2.15 (1.85-2.51), Colon Cancer OR 2.11 (1.45-3.05), Cranial brain surgery OR 6.21 (5.11-7.56) have the higher risks to PD. Having the history of Asthma OR 0.66 (0.6-0.72), Anemia OR 0.56 (0.51-0.63), Cirrhosis in Liver OR 0.7 (0.57-0.86), Cosmetic surgery OR 0.7 (0.64-0.77), and Gastritis OR 0.78 (0.71-0.87) have been found to be protective to PD. The risk of developing PD varies between male, and female including subjects BMI for each individual health history types. The diseases which reduce the oxygen saturation in blood like, anemia, asthma, and thalassemia act as protective to PD.

Conclusions

In this study we have analyzed fifty six diseases which include surgeries as a health history of PD patients. Study suggests that a thorough health history could greatly aid in understanding the onset and progression of Parkinson's disease (PD).

Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects

PURPOSE

to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population.

METHODS

40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry.

RESULTS

geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values ​​were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume.

CONCLUSION

individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

Combining the Katritzky Reaction and Paper Spray Ionization Mass Spectrometry for Enhanced Detection of Amino Acid Neurotransmitters in Mouse Brain Sections

This work describes the development of a system that combines a derivatization protocol based on the Katritzky reaction with paper spray ionization mass spectrometry (PSI-MS) for the analysis of amino acid neurotransmitters in mouse brain tissues. The system is relatively simple, consisting of spraying the derivatization solution onto a mouse brain section mounted on a glass slide, applying a small volume of solvent to moisten the sample, pressing a triangular paper onto the sample surface to transfer the sample constituents to the paper surface, and using the paper as a substrate for PSI-MS analysis. The Katritzky reaction facilitated the ionization of the amino acids by reacting a pyrylium salt with the amino group of the analytes, forming very stable pyridinium cations, which greatly increased the sensitivity of the PSI-MS analysis. Most of the intensities of the amino acids modified by the Katritzky reaction were more than 10 times greater than the nonderivatized ones. The system was applied for the analysis of brain sections obtained from mice with Parkinson's disease, and the amino acids gamma-aminobutyric acid (GABA) and glycine (Gly), two compounds very well-known in studies of Parkinson's disease, were readily detected. The results suggest that the Katritzky reaction combined with PSI-MS might offer a significant advance in the knowledge on protocols that improve the sensitivity of detection of crucial biological compounds.

Progressive parkinsonism due to mitochondrial impairment: Lessons from the MitoPark mouse model

The cardinal pathophysiological finding of Parkinson's disease (PD) is a chronic, progressive degeneration of dopamine (DA) neurons in the substantia nigra, which is responsible for the motor and some of the non-motor symptomatology. While the primary causes of nigrostriatal degeneration are hotly debated, considerable evidence supports a central role for impaired mitochondrial function. Postmortem analysis of PD patients reveals impaired respiratory chains and increased mutations of mitochondrial DNA (mtDNA), in addition to increased markers of oxidative stress indicative of mitochondrial impairment. Most animal models of PD, both genetic and toxin-based, target some component of mitochondrial function to reproduce aspects of the human disease. One model that continues to gain attention is the MitoPark mouse, created through a cell type-specific knockout of mitochondrial transcription factor A specifically in midbrain DA neurons. This model effectively recapitulates the slowly developing, adult onset motor decline seen in PD due to mass loss of DA neurons. MitoPark mice therefore represent an effective tool for studying the sequence of events that occurs in the early stages of DA neuron degeneration following mitochondrial impairment, as well as for testing the efficacy of potential disease-modifying therapies in a progressive model of neurodegeneration. A targeted review of key findings from MitoPark mice has not been published since the early years following the initial report of the model in 2007. The current review synthesizes findings from several groups that are exploring MitoPark mice and discusses implications for the future identification of disease-modifying treatments for PD.

Validation of Cognitive Rehabilitation as a Balance Rehabilitation Strategy in Patients with Parkinson's Disease: Study Protocol for a Randomized Controlled Trial

Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder. This disease is characterized by motor symptoms, such as bradykinesia, tremor, and rigidity. Although balance impairment is characteristic of advanced stages, it can be present with less intensity since the beginning of the disease. Approximately 60% of PD patients fall once a year and 40% recurrently. On the other hand, cognitive symptoms affect up to 20% of patients with PD in early stages and can even precede the onset of motor symptoms. There are cognitive requirements for balance and can be challenged when attention is diverted or reduced, linking a worse balance and a higher probability of falls with a slower cognitive processing speed and attentional problems. Cognitive rehabilitation of attention and processing speed can lead to an improvement in postural stability in patients with Parkinson's. Methods: We present a parallel and controlled randomized clinical trial (RCT) to assess the impact on balance of a protocol based on cognitive rehabilitation focused on sustained attention through the NeuronUP platform (Neuronup SI, La Rioja, Spain) in patients with PD. For 4 weeks, patients in the experimental group will receive cognitive therapy three days a week while the control group will not receive any therapy. The protocol has been registered at trials.gov NCT04730466. Conclusions: Cognitive therapy efficacy on balance improvement may open the possibility of new rehabilitation strategies for prevention of falls in PD, reducing morbidity, and saving costs to the health care system.

Factors associated with bite force in people with Parkinson's disease

ABSTRACT Purpose: to assess the bite force in people with Parkinson’s disease and correlate it with age, sex, stage and time of the disease, dentures use, presence of temporomandibular disorder, side of symptom onset, and masticatory preference. Methods: the Research Diagnostic Criteria for Temporomandibular Disorders and the Hoehn & Yahr Parkinson’s disease scale were used, and the participants’ oral cavity was clinically examined. Then, the bite force was measured with an analog dynamometer, whose bar was adapted for mouth grip. The bite force results and their correlation with the variables were analyzed with the independent t-test (p<0.05). Results: the sample comprised 42 parkinsonians at a mean age of 64 years, 67% of whom were males. No difference was observed in the correlation with age, temporomandibular disorder, stage and time of Parkinson's disease; or between the sides, symptom onset and masticatory preference. However, there was a significant association between the sexes (males and females) for both sides (right - p=0.002; left - p=0.04) and denture use for bite force on the right side (p=0.03). Conclusion: being a female and using dentures are factors associated with decreased bite force in people with Parkinson’s disease.

Association of Multiple Dopamine D3 Receptor Gene 3'UTR Polymorphisms with Susceptibility to Parkinson's Disease and Clinical Efficacy of Piribedil Therapy

Objective: To investigate the correlation between the Dopamine D3 receptor (DRD3) 3'untranslated region (3'UTR) gene polymorphism and susceptibility to Parkinson's disease (PD) and the clinical effect of the DRD2 and DRD3 agonist piribedil treatment. Methods: Sanger sequencing was used to analyze the single nucleotide polymorphisms (SNPs) within the 3'UTR rs76126170, rs9868039, rs9817063, and rs3732790 loci of the DRD3 gene in 284 PD patients and 284 controls. PD patients were treated with piribedil sustained-release tablets (50 mg) combined with levodopa and benserazide hydrochloride tablets, three times daily (patients with first-diagnosed PD were only administrated with piribedil sustained-release tablets) for 3 months. The Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr disease stage were evaluated at baseline and after 3 months of treatment. Results: The T allele carriers of the DRD3 gene rs76126170 locus were more susceptible to PD than the C allele carriers (odds ratio [OR] = 3.44, 95% confidence interval [CI]: 2.46-4.80, p < 0.01). Carriers of the rs9868039 A allele had a decreased risk of PD compared to those with G allele (OR = 0.67, 95% CI: 0.53-0.86, p < 0.01). C allele carriers at rs9817063 were less likely to develop PD than those with T allele (OR = 0.74, 95% CI: 0.58-0.94, p = 0.02). No significant correlation was observed between the alleles or genotypes of the rs3732790 locus and PD susceptibility (p > 0.05). The various genotypes of the DRD3 gene loci rs76126170, rs9868039, and rs9817063 in PD patients were associated with significant differences with regard to reduction of UPDRS scores and Hoehn and Yahr stage after 3 months of treatment (p < 0.05). Conclusion: The alleles and genotypes of the DRD3 gene 3' UTR SNP loci rs76126170, rs9868039, and rs9817063 are associated with PD susceptibility and the clinical efficacy of piribedil treatment.

Parkinson's disease and the non-motor symptoms: hyposmia, weight loss, osteosarcopenia

Non-motor symptoms (NMSs) are common in Parkinson's disease (PD) and can precede, sometimes for several years. NMSs include, other than gastrointestinal symptoms like constipation and dysphagia, also hyposmia, weight loss and osteosarcopenia. These three NMSs seem to be inter-related and affect patients' health and quality of life. Unfortunately, patients with these symptoms usually are not initially seen by a neurologist, and by the time they are consulted, nearly ~ 80% of the dopaminergic neurons in the substantia nigra have died. To date, no guidelines exist for screening, assessment and management of NMSs in general. A better understanding of these specific NMSs, likely in the context of others, will make it possible to approach and optimise the treatment of the motor symptoms thereby enhancing the welfare of PD patients. Identifying the NMSs could be very helpful, and among them, hyposmia, weight loss and osteosarcopenia may play an important role in solving the limitations in the diagnosis of PD. A strict collaboration between general practitioners, clinicians, geriatricians and neurologists can be one approach towards the diagnosis of pre-PD. Waiting until the motor symptoms develop and the patient is finally visited by the neurologist could be too late, considering the catastrophic prognosis of the disease.

Wearable Sensors for Prodromal Motor Assessment of Parkinson's Disease using Supervised Learning

Parkinson's disease (PD) is a common neurodegenerative disorder characterized by disabling motor and non-motor symptoms. Idiopathic hyposmia (IH), a reduced olfactory sensitivity, is a preclinical marker for the pathology and affects >95% of PD patients. In this paper, SensHand V1 and SensFoot V2, two inertial wearable sensors for upper and lower limbs, were developed to acquire motion data in ten tasks of the MDS-UPDRS III. Fifteen healthy subjects of control, 15 IH people, and 15 PD patients were enrolled. Seventy-one parameters per side were computed by spatiotemporal and frequency data analysis, and the most significant were selected to distinguish among the different classes. Performances of supervised learning algorithms (i.e., Support Vector Machine (SVM), and Random Forest (RF)) were compared on two-group and three-group classification and considering upper and lower limbs separately or together as a full system. Excellent results were obtained for healthy vs. patients classification (accuracy 1.00 for RF, and 0.97 for SVM), and good results were achieved by including IH subjects (0.92 F-measure with RF) within a three-group classification. Overall, the best performances were obtained using the full system with an RF classifier. The system is, thus, suitable to support an objective PD diagnosis. Furthermore, combining motion analysis with a validated olfactory screening test, people at risk for PD can be appropriately analyzed, and subtle changes in motor performance that characterize the prodromal phase and the early PD onset can be identified.

The Challenge and Opportunity to Diagnose Parkinson's Disease in Midlife

Parkinson's disease (PD) is the most common neurodegenerative movement disorder that affects extensive regions of the nervous system. Its current clinical diagnosis is based on motor symptoms that appear late during disease progression when substantial proportions of the nigrostriatal dopaminergic neuron population are lost already. Although disturbances in sleep and other biofunctions often surface years prior to motor impairments and point to a long prodromal phase, these phenotypic signs in a person's midlife lack predictive power. They do, however, signal the unfolding of the disease and suggest molecular correlates that begin deviating early on. Revealing such trajectories, hence, promises not only a better understanding of prodromal PD but may also enable a much-needed earlier diagnosis. A nexus that may harbor such molecular trajectories is the epigenome as key etiological factors of PD-genetics, age, and environment-influence this substrate. An earlier diagnosis would also allow earlier interventions and lifestyle adjustments to improve brain function and reduce symptoms. In this review, we describe the challenges of diagnosing PD early on and highlight the opportunities that may arise from steering research efforts towards comprehensive interrogations of molecular layers during the long-time neglected midlife phase. In particular, we emphasize how existing cohorts of at-risk individuals, available animal models, and suitable markers may come together and aid in revealing molecular trajectories that offer diagnostic utility for PD in its prodromal stage.

Forestalling the Epidemics of Parkinson's Disease Through Plant-Based Remedies

Parkinson's disease (PD) as the second leading neurodegenerative disease, imposes a heavy burden among individuals as well as economies worldwide. The main characteristics of PD is a progressive loss of dopaminergic neurons resulting in the loss of motor function, the occurrence of non-motor symptoms, and cognitive decline. Similar to many other chronic diseases, complementary and alternative therapies (CAT) are very popular for the treatment of this disease. This review evaluates six plants, three each from European and Asian traditional medicinal systems: (1) Atropa belladonna, (2) Hyoscyamus niger, (3) Lepidium meyenii, (4) Aspargus racemosus, (5) Mucuna pruriens L., and (6) Gingko biloba. Atropa belladonna, and Hyoscyamus niger in particular, are better known for their poisonous and narcotic effects than as potentially effective plants for the treatment of neurodegenerative diseases. Ginkgo biloba is one of the most widely cultured plants in Traditional Chinese Medicine with high antioxidant potential which contributes to its neuroprotective/ anti-apoptotic activity. The bioactive compounds, anti-neurodegenerative effects and other neuroprotective effects of all six plants are discussed herein.

Urological dysfunctions in patients with Parkinson's disease: clues from clinical and non-invasive urological assessment

Background

Autonomic nervous system dysfunction, common in patients with Parkinson’s disease (PD), causes significant morbidity and it is correlated with poor quality of life. To assess frequency of urinary symptoms in patients with PD, without conditions known to interfere with urinary function.

Methods

Non-demented PD patients were consecutively enrolled from the outpatients clinic of our department. Scales investigating motor and non-motor symptoms were carried out. Evaluation of urinary dysfunctions was carried out using the AUTonomic Scale for Outcomes in Parkinson’s disease (SCOPA-AUT) questionnaire. Patients underwent noninvasive urological studies (nUS), including uroflowmetry and ultrasound of the urinary tract.

Results

Forty-eight (20 women, 42%) out of 187 PD patients met the inclusion criteria and were enrolled in the study. Mean SCOPA-AUT score was 14.1 ± 6.9 (urinary symptoms subscore 5.2 ± 3.8). Among those evaluated by the SCOPA-AUT scale, the urinary symptoms were among the most common complaints (93.8%). At nUS mean maximum flow rate (Qmax) was 17.9 ± 9.1 ml/s, and mean postvoid residual (PVR) urine volume was 24.4 ± 44.1 ml. Ultrasound investigation documented prostate hypertrophy in 12 male patients (42.8%). Urinary items of the SCOPA-AUT (SCOPA-U subscore) correlated with measures of disease severity only in female patients.

Conclusion

Urinary symptoms and abnormal findings in nUS are common in PD. Though nigrostriatal degeneration might be responsible for urinary symptoms also in the early-intermediate stage of the disease, when urinary dysfunction occurs other medical conditions need to be excluded.

Anatomical Templates of the Midbrain Ventral Tegmental Area and Substantia Nigra for Asian Populations

Increasing evidence shows that the midbrain dopaminergic system is involved in various functions. However, details of the role of the midbrain dopaminergic system in these functions are still to be determined in humans. Considering that the ventral tegmental area (VTA) and substantia nigra (SN) in the midbrain are the primary dopamine producers, creating reliable anatomical templates of the VTA and SN through neuroimaging studies would be useful for achieving a detailed understanding of this dopaminergic system. Although VTA and SN anatomical templates have been created, no specific templates exist for the Asian population. Thus, we conducted anatomical and resting-state functional magnetic resonance imaging (rs-fMRI) studies to create VTA and SN templates for the Asian population. First, a neuromelanin-sensitive MRI technique was used to visualize the VTA and SN, and then individual hand-drawn VTA and SN regions of interests (ROIs) were traced on a small sample of neuromelanin-sensitive MRIs (dataset 1). Second, individual hand-drawn VTA and SN ROIs were normalized to create normalized VTA and SN templates for the Asian population. Third, a seed-based functional connectivity analysis was performed on rs-fMRI data using hand-drawn ROIs to calculate neural networks of VTA and SN in dataset 1. Fourth, a seed-based functional connectivity analysis was performed using VTA and SN seeds that were created based on normalized templates from dataset 1. Subsequently, a seed-based functional connectivity analysis was performed using VTA and SN seeds in another, larger sample (dataset 2) to assess whether neural networks of VTA or SN seeds from dataset 1 would be replicated in dataset 2. The Asian VTA template was smaller and located in a more posterior and inferior part of the midbrain compared to the published VTA template, while the Asian SN template, relative to the published SN template, did not differ in size but was located in the more inferior part of the midbrain. The neural networks of the VTA and SN seeds in dataset 1 were replicated in dataset 2. Altogether, our normalized template of the VTA and SN could be used for measuring fMRI activities related to the VTA and SN in the Asian population.