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Souza BRA, Nóbrega KCC, Silva BEDAD, Gonçalves RA, Martins TS, Santos GF, Frazão AH, Roque AC, Nascimento IAPDS, Piemonte MEP. The Impact of Motor, Non-Motor, and Social Aspects on the Sexual Health of Men Living with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:565-574. [PMID: 38427499 DOI: 10.3233/jpd-230212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Sexual health (SH) is influenced by several biological, mental, and social factors that may be negatively impacted by Parkinson's disease (PD). Despite its prevalence and relevance for quality of life, the factors that affect SH in men with PD (MwPD) are still poorly understood. Objectives To investigate the impact of motor, non-motor, and social aspects on the SH in MwPD. Methods We conducted a cross-sectional study of 80 men (mean-age 53.55±10.8) in stages 1-3 of Hoehn and Yahr classification (H&Y), who reported having an active sex life in the last six months. The following data were collected for each person: 1) Demographic and clinical features; 2) global cognitive capacity (T-MoCA); 3) Non-Motor Aspects of Experiences of Daily Living (MDS-UPDRS, part I); 4) Motor Aspects of Experiences of Daily Living (MDS-UPDRS, part II); 5) Fatigue (FSS); 6) Self-esteem (RSES); 7) Sleep disorder (PDSS); 8) Couple relationship quality (DAS); 9) Depressive signals (BDI); 10) Short-term sexual health by International Index of Erectile Function (IIFE); and 11) Long-term sexual health by Sexual Quotient-Male (SQ-M). Results Our results showed that although several motor, non-motor, and social factors were correlated with SH, only motor disability levels in daily living predicted short-term SH and erectile dysfunction, while only depression predicted long-term SH in MwPD. Age, disease onset, and medication daily dosage were not correlated with SH. Conclusions Our findings confirm that multidimensional factors can affect the SH of MwPD and emphasize that only a multi-professional team can offer proper care to improve SH in MwPD.
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Affiliation(s)
| | - Kátia Cirilo Costa Nóbrega
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Thalyta Silva Martins
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | - Geovanna Ferreira Santos
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | - André Helene Frazão
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Roque
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Elisa Pimentel Piemonte
- Department of Neuroscience and Behavior, Institute of Psychology, University of São Paulo, Brazil
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, University of São Paulo, São Paulo, Brazil
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2
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Souza RJD, Shigaki IADA, Terra MB, Barboza NM, Bueno MEB, Mesas AE, Smaili SM. Effectiveness of Neurofunctional Physical Therapy on the Quality of Sleep of Individuals with Parkinson's Disease: Case Series. Sleep Sci 2023; 16:206-215. [PMID: 37425968 PMCID: PMC10325842 DOI: 10.1055/s-0043-1770801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Objective Sleep disorders are disabling and highly prevalent comorbidities in Parkinson's disease (PD). This study's objective was to verify the effectiveness of neurofunctional physiotherapy in sleep quality, objectively and subjectively assessing it among individuals with PD. Methods A sample of individuals with PD was assessed before and after 32 physiotherapy sessions and three months later (follow-up). The following instruments were used: Pittsburgh Sleep Quality Index (PSQI); Epworth Sleepiness Scale (ESS); Parkinson's Disease Sleep Scale (PDSS), and actigraphy. Results Nineteen individuals aged 67.37 years old ( ± 8.03) on average were included. No differences were found in any of the variables measured by the actigraphy or the ESS. Improvement was found from pre- to post-intervention in terms of nocturnal movements (p = 0.04; d = 0.46) and total score (p = 0.03; d = 0.53) obtained on the PDSS. Improvement was also found in the PDSS sleep onset/maintenance domain (p = 0.001; d = 0.75) between pre-intervention and follow-up. The participants' total score obtained in the PSQI improved from pre- to post-intervention (p = 0.03; d = 0.44). Significant differences were found in nighttime sleep (p = 0.02; d = 0.51) and nocturnal movements (p = 0.02; d = 0.55), and in the PDSS total score (p = 0.04; d = 0.63) between pre- and post-intervention when only the poor sleepers subgroup (n = 13) was considered, while improvements were found in sleep onset/maintenance (p = 0.003; d = 0.91) between pre-intervention and follow-up. Discussion Neurofunctional physiotherapy was ineffective in improving objective parameters of sleep but was effective in improving the perception of sleep quality subjectively assessed among individuals with PD, especially those who perceived themselves to be poor sleepers.
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Affiliation(s)
- Rogério José de Souza
- Department of Physiotherapy, Londrina State University (UEL), Londrina, Paraná, Brazil
| | | | | | | | | | - Arthur Eumann Mesas
- Centro de Estudios Sociosanitario, Universidad de Castilla-La Mancha, Cuenca, Cuenca, Spain
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3
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de Almeida CMO, Brito MMC, Bosaipo NB, Pimentel AV, Sobreira-Neto MA, Tumas V, Zuardi AW, Crippa JADS, Hallak JEC, Eckeli AL. The Effect of Cannabidiol for Restless Legs Syndrome/Willis-Ekbom Disease in Parkinson's Disease Patients with REM Sleep Behavior Disorder: A Post Hoc Exploratory Analysis of Phase 2/3 Clinical Trial. Cannabis Cannabinoid Res 2022; 8:374-378. [PMID: 35749710 DOI: 10.1089/can.2021.0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cannabidiol (CBD) is one of the main nonpsychoactive components of Cannabis sativa and may represent an alternative treatment for Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) in patients with Parkinson's disease (PD) and REM (Rapid Eye Movement) sleep behavior disorder (RBD). Objective: Our purpose was a post hoc exploratory analysis to evaluate the CBD's efficacy to improve the severity of RLS/WED symptoms in patients with PD and RBD. Methods: A post hoc exploratory analysis of a phase II/III, a parallel, double-blind, placebo-controlled clinical trial was conducted in 18 patients with RLS/WED and PD plus RBD associated. Six patients were randomized to the CBD group in doses of 75-300 mg, and twelve received placebo capsules. They were followed up for 14 weeks. The primary outcome was the severity of RLS/WED by Restless Legs Syndrome Rating Scale of the International Restless Legs Syndrome Study Group (IRLSSG). Results: CBD showed no difference in relationship to placebo for primary and secondary outcomes. Conclusion: CBD showed no reduction in the severity of RLS/WED manifestation in patients with PD and RBD.
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Affiliation(s)
| | - Manuelina Mariana Capellari Brito
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Nayanne Beckmann Bosaipo
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Angela Vieira Pimentel
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Vitor Tumas
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Waldo Zuardi
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil.,National Institute of Science and Technology in Translational Medicine, CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
| | - Jose Alexandre de Souza Crippa
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil.,National Institute of Science and Technology in Translational Medicine, CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
| | - Jaime Eduardo Cecílio Hallak
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil.,National Institute of Science and Technology in Translational Medicine, CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
| | - Alan Luiz Eckeli
- Division of Neurology, Department of Neuroscience and Sciences of Behavior, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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4
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Personalized Assessment of Insomnia and Sleep Quality in Patients with Parkinson's Disease. J Pers Med 2022; 12:jpm12020322. [PMID: 35207811 PMCID: PMC8875986 DOI: 10.3390/jpm12020322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023] Open
Abstract
Sleep disturbances are more common in patients with Parkinson’s disease (PD) than in the general population and are considered one of the most troublesome symptoms by these patients. Insomnia represents one of the most common sleep disturbances in PD, and it correlates significantly with poor quality of life. There are several known causes of insomnia in the general population, but the complex manifestations that might be associated with PD may also induce insomnia and impact the quality of sleep. The treatment of insomnia and the strategies needed to improve sleep quality may therefore represent a challenge for the neurologist. A personalized approach to the PD patient with insomnia may help the clinician to identify the factors and comorbidities that should also be considered in order to establish a better individualized therapeutic plan. This review will focus on the main characteristics and correlations of insomnia, the most common risk factors, and the main subjective and objective methods indicated for the assessment of insomnia and sleep quality in order to offer a concise guide containing the main steps needed to approach the PD patient with chronic insomnia in a personalized manner.
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5
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de Almeida CMO, Brito MMC, Bosaipo NB, Pimentel AV, Tumas V, Zuardi AW, Crippa JAS, Hallak JEC, Eckeli AL. Cannabidiol for Rapid Eye Movement Sleep Behavior Disorder. Mov Disord 2021; 36:1711-1715. [PMID: 33754375 DOI: 10.1002/mds.28577] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/01/2021] [Accepted: 02/26/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND REM sleep behaviour disorder (RBD) is a common non-motor feature of Parkinson's disease (PD). Cannabidiol (CBD) is one of the main non-psychoactive components of Cannabis sativa and may represent an alternative route for treating RBD. OBJECTIVE This study assessed the efficacy and safety of CBD for RBD in PD. METHODS We conducted a phase II/III, double-blind, placebo-controlled clinical trial in 33 patients with RBD and PD. Patients were randomized 1:1 to CBD in doses of 75 to 300mg or matched capsules placebo and were followed up for 14 weeks. The primary outcomes were the frequency of nights with RBD, CGI-I, and CGI-S. RESULTS CBD showed no difference to placebo for primary outcomes. Regarding secondary outcomes, we observed a significant improvement in average sleep satisfaction from the 4th to 8th week in the CBD versus placebo group with P = 0.049 and P = 0.038, respectively. CONCLUSION CBD, as an adjunct therapy, showed no reduction in RBD manifestations in PD patients. A transient improvement in sleep satisfaction with a dose of 300mg has been noted. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Manuelina M C Brito
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Nayanne B Bosaipo
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Angela V Pimentel
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Vitor Tumas
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio W Zuardi
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,National Institute of Science and Technology in Translational Medicine, CNPq /FAPESP/CAPES, São Paulo, Brazil
| | - Jose A S Crippa
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,National Institute of Science and Technology in Translational Medicine, CNPq /FAPESP/CAPES, São Paulo, Brazil
| | - Jaime E C Hallak
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,National Institute of Science and Technology in Translational Medicine, CNPq /FAPESP/CAPES, São Paulo, Brazil
| | - Alan L Eckeli
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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6
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Chan LG, Siang KSS, Yong TT, Chander R, Tan L, Kandiah N. The Longitudinal Impact of Excessive Daytime Somnolence on Motor and Nonmotor Symptoms of Parkinson's Disease in a Southeast Asian Cohort. J Geriatr Psychiatry Neurol 2020; 33:363-369. [PMID: 31830849 DOI: 10.1177/0891988719892326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Sleep-wake disturbances, such as excessive daytime somnolence (EDS), are nonmotor symptoms of Parkinson's disease (PD) and significantly affect the quality of life. This study aimed to examine the relationship between EDS and motor and nonmotor symptoms of PD. METHODS Eighty-two patients with idiopathic mild PD were followed up twice a year for 2 years and assessed on sleep, mood, anxiety, cognition, function, and disease severity. Data were analyzed retrospectively, comparing motor and nonmotor outcomes between those with EDS and those without. RESULTS At baseline, 27.9% had EDS and were similar in demographic and clinical characteristics to those without; 10% had persistent EDS during the first year of follow-up. Excessive daytime somnolence had a significant main effect on mood and anxiety as shown by consistently higher scores on the Geriatric Depression Scale (P = .022) and Hospital Anxiety and Depression Scale-Anxiety subscale scores (P = .011) throughout duration of follow-up. The group with persistent EDS showed greater rate of worsening Frontal Assessment Battery scores by the end of first-year follow-up (P = .025) and greater rate of worsening Apathy Scale scores by the end of 2-year follow-up (P = .002). No significant effects of EDS on motor symptoms and disease severity were found. CONCLUSIONS In a Southeast Asian cohort of patients with PD, EDS had a negative longitudinal impact on mood, anxiety, apathy, and cognitive function but no impact on motor symptoms and disease severity. Excessive daytime somnolence is thus a potential therapeutic target to improve nonmotor outcomes.
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Affiliation(s)
- Lai Gwen Chan
- Department of Psychological Medicine, 63703Tan Tock Seng Hospital, Singapore
| | | | - Ting Ting Yong
- Department of Neurology, 54738National Neuroscience Institute, Singapore
| | - Russell Chander
- Department of Neurology, 54738National Neuroscience Institute, Singapore
| | - Louis Tan
- Department of Neurology, 54738National Neuroscience Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, 54738National Neuroscience Institute, Singapore.,Duke-NUS Medical School, Singapore
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7
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Lima DP, de Almeida SB, Bonfadini JDC, Sobreira EST, Damasceno PG, Viana Júnior AB, de Alencar MS, de Luna JRG, Rodrigues PGB, Pereira IDS, Gadelha ALDC, de Oliveira LM, Chaves ÉCB, Carneiro VG, Monteiro RR, Costa TADM, Helal L, Signorile J, Lima LAO, Sobreira-Neto MA, Braga-Neto P. Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study). BMJ Open 2020; 10:e039941. [PMID: 33046475 PMCID: PMC7552828 DOI: 10.1136/bmjopen-2020-039941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands. METHODS AND ANALYSIS This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group. ETHICS AND DISSEMINATION The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants. TRIAL REGISTRATION NUMBER Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.
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Affiliation(s)
- Danielle Pessoa Lima
- Geriatric Division, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
- Medical School, Universidade de Fortaleza, Fortaleza, Brazil
| | - Samuel Brito de Almeida
- Clinical Research Unit, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Janine de Carvalho Bonfadini
- Clinical Research Unit, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | | | - Patrícia Gomes Damasceno
- Division of Neurology, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Antonio Brazil Viana Júnior
- Clinical Research Unit, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Madeleine Sales de Alencar
- Geriatric Division, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - João Rafael Gomes de Luna
- Geriatric Division, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | | | - Isabelle de Sousa Pereira
- Medical School, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | | | - Liliane Maria de Oliveira
- School of Kinesiology, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | - Érica Carneiro Barbosa Chaves
- School of Kinesiology, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | | | - Rayane Rodrigues Monteiro
- School of Kinesiology, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | - Thatyara Almeida de Macedo Costa
- School of Nutrition, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | - Lucas Helal
- School of Kinesiology, Universidade do Extremo Sul Catarinense, Criciuma, Brazil
| | - Joseph Signorile
- Kinesiology and Sport Sciences, University of Miami, Coral Gables, Florida, USA
| | | | - Manoel Alves Sobreira-Neto
- Division of Neurology, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
- Medical School, Universidade Estadual do Ceará, Curso de Medicina, Fortaleza, Brazil
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8
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Sobreira EST, Sobreira-Neto MA, Pena-Pereira MA, Chagas MHN, Fernandes RMF, Eckeli AL, Tumas V. Global cognitive performance is associated with sleep efficiency measured by polysomnography in patients with Parkinson's disease. Psychiatry Clin Neurosci 2019; 73:248-253. [PMID: 30636105 DOI: 10.1111/pcn.12819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/16/2018] [Accepted: 01/08/2019] [Indexed: 01/26/2023]
Abstract
AIM Sleep disorders can be associated with an increased risk for cognitive decline in patients with Parkinson's disease (PD). The aim of this study was to examine the association between cognitive status and presence of sleep symptoms and sleep disorders in PD patients. METHODS We evaluated excessive sleepiness, other sleep symptoms, and performed polysomnography and neuropsychological evaluation in 79 patients. They were classified as having normal cognition (PDNC), mild cognitive impairment (PDMCI), or dementia (PDD). RESULTS There were 29 PDNC, 39 PDMCI, and 11 PDD patients. PDD patients were older, had higher scores on the Unified Parkinson's Disease Rating Scale, and lower Schwab and England Activities of Daily Living scores than PDNC patients. After analysis of the polysomnographic variables, it was also found that PDD patients had a lower sleep efficiency, lower total sleep time, and lower number of sleep state changes than PDNC patients. In a stepwise analysis, defining Mattis Dementia Rating Scale scores as the dependent variable, the results were a model that selected three variables that accounted for 59% of the variation in the Mattis Dementia Rating Scale score: wake time after sleep onset, number of state changes, and schooling. CONCLUSION We found a significant association between global cognitive performance and wake time after sleep onset and the number of state changes during sleep measured in the polysomnography of PD patients. However, we did not find any other association between sleep disorders or symptoms and cognitive status or cognitive performance of PD patients.
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Affiliation(s)
- Emmanuelle S T Sobreira
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Manoel A Sobreira-Neto
- Unichristus University, Fortaleza, Brazil.,Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Márcio A Pena-Pereira
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcos H N Chagas
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Regina M F Fernandes
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Alan L Eckeli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Vitor Tumas
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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9
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Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev 2017; 35:33-50. [PMID: 27863901 PMCID: PMC5332351 DOI: 10.1016/j.smrv.2016.08.001] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023]
Abstract
Sleep disorders are among the most common non-motor manifestations in Parkinson's disease (PD) and have a significant negative impact on quality of life. While sleep disorders in PD share most characteristics with those that occur in the general population, there are several considerations specific to this patient population regarding diagnosis, management, and implications. The available research on these disorders is expanding rapidly, but many questions remain unanswered. We thus conducted a systematic review of the literature published from 2005 to 2015 on the following disorders of sleep and wakefulness in PD: REM sleep behavior disorder, insomnia, nocturia, restless legs syndrome and periodic limb movements, sleep disordered breathing, excessive daytime sleepiness, and circadian rhythm disorders. We discuss the epidemiology, etiology, clinical implications, associated features, evaluation measures, and management of these disorders. The influence on sleep of medications used in the treatment of motor and non-motor symptoms of PD is detailed. Additionally, we suggest areas in need of further research.
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Affiliation(s)
- Lama M Chahine
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 330 S. 9th st, Philadelphia, PA 19107, USA.
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aleksandar Videnovic
- Neurobiological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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10
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Carvalho DZ, Schönwald SV, Schumacher-Schuh AF, Braga CW, Souza DO, Oses JP, Donis KC, Rieder CR. Overnight S100B in Parkinson's Disease: A glimpse into sleep-related neuroinflammation. Neurosci Lett 2015; 608:57-63. [PMID: 26453767 DOI: 10.1016/j.neulet.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/15/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
Calcium-binding protein B (S100B), a primary product of astrocytes, is a proposed marker of Parkinson's Disease (PD) pathophysiology, diagnosis and progression. However, it has also been implicated in sleep disruption, which is very common in PD. To explore the relationship between S100B, disease severity, sleep symptoms and polysomnography (PSG) findings, overnight changes in serum S100B levels were investigated for the first time in PD. 17 fully treated, non-demented, moderately advanced PD patients underwent PSG and clinical assessment of sleep symptoms. Serum S100B samples were collected immediately before and after the PSG. Results are shown as median [interquartile range]. Night and morning S100B levels were similar, but uncorrelated (rs=-0.277, p=0.28). Morning S100B levels, as opposed to night levels, positively correlated with the Unified Parkinson's Disease rating scale (UPDRS) subsections I and II (rs=0.547, p=0.023; rs=0.542, p=0.025). Compared to those with overnight S100B reduction, patients with overnight S100B elevation had higher H&Y scores (2.5 [0.87] vs. 2 [0.25], p=0.035) and worse total Pittsburgh Sleep Quality Index (PSQI) and Parkinson's Disease Sleep Scores (10 [3.2] vs. 8 [4.5], p=0.037; 92.9 [39] vs. 131.4 [28], p=0.034). Correlation between morning S100B levels and total UPDRS score was strengthened after controlling for total PSQI score (rs=0.531, p=0.034; partial rs=0.699, p=0.004, respectively). Overnight S100B variation and morning S100B were associated with PD severity and perceived sleep disruption. S100B is proposed as a putative biomarker for sleep-related neuroinflammation in PD. Noradrenergic-astrocytic dysfunction is hypothesized as a possible mechanism underlying these findings.
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Affiliation(s)
- D Z Carvalho
- Clinical Neurophysiology Laboratory, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - S V Schönwald
- Clinical Neurophysiology Laboratory, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Sleep and Movement Disorders Clinics, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - A F Schumacher-Schuh
- Sleep and Movement Disorders Clinics, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - C W Braga
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - D O Souza
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - J P Oses
- Laboratory of Clinical Neurosciences, Postgraduate Program in Health and Behavior, Center for Life and Health Sciences, Universidade Católica de Pelotas (UCPel), Porto Alegre, RS, Brazil
| | - K C Donis
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - C R Rieder
- Sleep and Movement Disorders Clinics, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Department of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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11
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Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, Tumas V, Fernandes RMF, Eckeli AL. Excessive fragmentary myoclonus in patients with Parkinson’s disease: prevalence and clinico-polysomnographic profile. Sleep Breath 2015; 19:997-1002. [DOI: 10.1007/s11325-014-1098-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/04/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Távora DGF, de Bruin VMS, Lopes Gama R, Lopes EMS, Jorge IF, de Bruin PFC. The nature of excessive sleepiness and sudden sleep onset in Parkinson׳s disease. ACTA ACUST UNITED AC 2014; 7:13-8. [PMID: 26483896 PMCID: PMC4521648 DOI: 10.1016/j.slsci.2014.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/20/2014] [Indexed: 11/17/2022]
Abstract
Objectives Excessive daytime sleepiness (EDS) and sudden sleep onset (SOS) episodes are frequent in Parkinson׳s disease (PD). The objectives are to identify clinical characteristics and factors associated with EDS and SOS episodes. Methods Clinical demographic data were recorded (N=100, mean age=65.0±10.4). EDS was identified by the Epworth Sleepiness Scale (ESS>10) and SOS episodes were registered. Disease severity was evaluated by the Unified Parkinson׳s Disease Rating Scale (UPDRS, I, II, and III), sleep disturbances by the Parkinson׳s Disease Sleep Scale (PDSS<100), depressive symptoms by the Beck Depression Inventory (BDI>10) and rapid eye movement (REM) sleep behavior disorder (RBD) by the REM sleep behavior scale. Levodopa equivalent dose was measured. Results: PD patients with EDS (67%) were predominately male (73.1%) and had worse disease severity (UPDRS II and III p= 0.005); SOS episodes (39%) were associated with disease duration, diabetes, sleep disturbances (PDSS Scale), disease severity (UPDRS I, II, III) and RBD symptoms (p<0.05). Stepwise regression analysis showed that EDS was independently associated with motor-symptoms severity (UPDRS III scale, p=0.003). SOS episodes were independently associated with disease duration (p=0.006) and sleep disturbances (PDSS scale, p=0.03): patients had more uncomfortable immobility at night, tremor on waking and snoring or difficult breathing. Discussion EDS and or SOS episodes are frequent and manifest a differential pattern in PD. SOS episodes are associated with longer disease duration, diabetes, sleep disturbances and RBD symptoms indicating that these “sleep attacks” are of multifactorial origin and probably influenced by brain structural abnormalities.
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Affiliation(s)
| | | | - Romulo Lopes Gama
- Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil
| | | | - Iago Farias Jorge
- Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil
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13
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Gama RL, Bruin VMSD, Bruin PFCD, Távora DGF, Lopes EMS, Jorge IF, Bittencourt LRA, Tufik S. Risk factors for visual hallucinations in patients with Parkinson’s disease. Neurol Res 2014; 37:112-6. [DOI: 10.1179/1743132814y.0000000418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Zea-Sevilla MA, Martínez-Martín P. Rating scales and questionnaires for assessment of sleep disorders in Parkinson's disease: what they inform about? J Neural Transm (Vienna) 2014; 121 Suppl 1:S33-40. [PMID: 24756217 DOI: 10.1007/s00702-014-1217-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
Sleep disorders are very prevalent in Parkinson's disease (PD) and include a diversity of disturbances. Rating scales and questionnaires are widely used to assess the presence and severity of the sleep disorders. The objective is to review rating scales and questionnaires used for assessment of sleep disorders in PD. To this purpose, a description and update of the sleep scales reviewed by the ad hoc Movement Disorder Society task force (MDS-TF) and other sleep disorder assessments was performed. Two specific (Parkinson's Disease Sleep Scale and Scales for Outcomes in PD Sleep) and two generic scales (Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) were "Recommended" by the MDS-TF as they were used in PD patients, by researchers others than their developers and properly validated. Two other generic scales (Inappropriate Sleep Composite Score and Stanford Sleepiness Scale), "Suggested" due to incomplete validation, are also reviewed. Other instruments included in this review are three comprehensive PD-specific instruments for assessing multiple domains in addition to sleep problems (e.g., Non-Motor Symptoms Questionnaire, Non-Motor Symptoms Scale, MDS-UPDRS), and three generic instruments focused on particular disturbances (e.g., International Restless Legs Syndrome Study Group Rating Scale, REM behavioral disorders questionnaires), although these latter lack formal validation in PD populations. The "Recommended" instruments cover satisfactorily the needs for screening and evaluation of the nocturnal sleep disorders and daytime sleepiness in PD patients. It would be convenient to validate or complete the validation in PD populations of those instruments that cannot be recommended due to the lack of information on their clinimetric attributes.
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Affiliation(s)
- María Ascensión Zea-Sevilla
- Alzheimer Disease Research Unit, CIEN Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain
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15
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Gama RL, Bruin VMS, Távora DGF, Duran FLS, Bittencourt L, Tufik S. Structural brain abnormalities in patients with Parkinson's disease with visual hallucinations: a comparative voxel-based analysis. Brain Cogn 2014; 87:97-103. [PMID: 24732953 DOI: 10.1016/j.bandc.2014.03.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 03/15/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
The objective is to evaluate clinical characteristics and cerebral alterations in Parkinson's disease (PD) patients with diurnal visual hallucinations (VHs). Assessment was performed using magnetic resonance image (MRI) and voxel-based morphometry (VBM). Thirty-nine patients with PD (53.8%) and ten controls were studied. Voxel based morphology analysis was performed. Eleven patients presented diurnal VHs and among these, six had cognitive dysfunction. Patients with VHs performed worse in the mentation-related UPDRS I (p=0.005) and motor-related UPDRS III (p=0.02). Patients with VHs showed significant clusters of reduced grey matter volume compared to controls in the left opercula frontal gyrus and left superior frontal gyrus. PD without hallucinations demonstrated reduced grey matter volume in the left superior frontal gyrus compared to controls. Comparisons between patients with VHs regarding the presence of cognitive dysfunction showed that cases with cognitive dysfunction as compared to those without cognitive dysfunction showed significant clusters of reduced grey matter volume in the left opercular frontal gyrus. Cases without cognitive dysfunction had reduced grey matter substance in the left insula and left trigonal frontal gyrus. Judging from our findings, an abnormal frontal cortex, particularly left sided insula, frontal opercular, trigonal frontal gyrus and orbital frontal would make PD patients vulnerable to hallucinations. Compromise of the left operculum distinguished cases with VHs and cognitive dysfunction. Our findings reinforce the theoretical concept of a top-down visual processing in the genesis of VHs in PD.
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Affiliation(s)
- Romulo Lopes Gama
- Pós Graduação Ciências Médicas, Universidade Federal do Ceara, Fortaleza, Brazil
| | | | | | - Fábio L S Duran
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
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Daytime sleepiness in Parkinson's disease: perception, influence of drugs, and mood disorder. SLEEP DISORDERS 2014; 2014:939713. [PMID: 24587912 PMCID: PMC3920819 DOI: 10.1155/2014/939713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 10/31/2013] [Indexed: 12/02/2022]
Abstract
Parkinson's disease (PD) is associated with sleep complaints as excessive daytime sleepiness (EDS) and several factors have been implicated in the genesis of these complaints. Objective. To correlate the subjective perception of EDS with variables as the severity of the motor symptoms, medications, and the presence of depressive symptoms. Materials and Methods. A cross-sectional study, using specific scales as Epworth sleepiness scale (ESS), Beck depression inventory (iBeck) and Hoehn and Yahr (HY), in 42 patients with PD. Results. The patients had a mean age of 61.2 ± 11.3 years and mean disease duration of 4.96 ± 3.3 years. The mean ESS was 7.5 ± 4.7 and 28.6% of patients reached a score of abnormally high value (>10). There was no association with gender, disease duration, and dopamine agonists. Patients with EDS used larger amounts of levodopa (366.7 ± 228.0 versus 460.4 ± 332.25 mg, P = 0.038), but those who had an iBeck >20 reached lower values of ESS than the others (5.9 ± 4.1 versus 9.3 ± 4.8, P = 0.03). Conclusions. EDS was common in PD patients, being related to levodopa intake. Presence of depressed mood may influence the final results of self-assessment scales for sleep disorders.
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Nocturnal disturbances and restlessness in Parkinson's disease: using the Japanese version of the Parkinson's disease sleep scale-2. J Neurol Sci 2012; 318:76-81. [PMID: 22534309 DOI: 10.1016/j.jns.2012.03.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/08/2012] [Accepted: 03/28/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the validity and the reliability of the Japanese version of the Parkinson's disease sleep scale (PDSS)-2 and to use this scale to identify nocturnal symptoms and their impact on patient's quality of life. METHODS A cross-sectional, case-controlled study was conducted consisting of 93 patients with Parkinson's disease (PD) and 93 age- and gender-matched control subjects. The Japanese version of the PDSS-2 was used for the evaluation of nocturnal disturbances. The patient's quality of life was evaluated with the Parkinson's Disease Quality of Life questionnaire (PDQ-39) and their depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II), respectively. In addition, the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Parkinson Fatigue Scale (PFS) were administered. RESULTS As assessed using the PDSS-2, PD patients had significantly impaired scores compared with control subjects (15.0±9.7 vs. 9.1±6.6, p<0.001). The ESS, BDI-II and PFS scores were significantly impaired in PD patients compared with controls. A satisfactory internal consistency and test-retest reliability score were obtained for the PDSS-2 total score (Cronbach's alpha=0.86). The PDSS-2 was correlated with the PSQI, ESS, BDI-II, PFS, PDQ-39 summary index, all of the PDQ-39 domains and Unified Parkinson's Disease Rating Scale part III. The frequency of restless legs syndrome (RLS) was not significantly different between PD patients and controls (5.5% vs. 2.2%), but nocturnal restlessness was significantly more frequent in PD patients than controls. Stepwise linear regression analyses revealed the PDQ-39 summary index and the PSQI global score as significant predictors for the PDSS-2 total score. CONCLUSIONS Our study confirmed the usefulness of the Japanese version of the PDSS-2 that enables the comprehensive assessment of nocturnal disturbances in PD. The association between RLS and nocturnal restlessness in PD requires further study.
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Suzuki K, Miyamoto M, Miyamoto T, Iwanami M, Hirata K. Sleep disturbances associated with Parkinson's disease. PARKINSONS DISEASE 2011; 2011:219056. [PMID: 21876839 PMCID: PMC3159123 DOI: 10.4061/2011/219056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 04/23/2011] [Accepted: 06/22/2011] [Indexed: 02/01/2023]
Abstract
Sleep disturbances are common problems affecting the quality life of Parkinson's disease (PD) patients and are often underestimated. The causes of sleep disturbances are multifactorial and include nocturnal motor disturbances, nocturia, depressive symptoms, and medication use. Comorbidity of PD with sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, or circadian cycle disruption also results in impaired sleep. In addition, the involvement of serotoninergic, noradrenergic, and cholinergic neurons in the brainstem as a disease-related change contributes to impaired sleep structures. Excessive daytime sleepiness is not only secondary to nocturnal disturbances or dopaminergic medication but may also be due to independent mechanisms related to impairments in ascending arousal system and the orexin system. Notably, several recent lines of evidence suggest a strong link between rapid eye movement sleep behavior disorder and the risk of neurodegenerative diseases such as PD. In the present paper, we review the current literature concerning sleep disorders in PD.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Center of Sleep Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
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Ray Chaudhuri K, Martinez-Martin P, Rolfe KA, Cooper J, Rockett CB, Giorgi L, Ondo WG. Improvements in nocturnal symptoms with ropinirole prolonged release in patients with advanced Parkinson's disease. Eur J Neurol 2011; 19:105-13. [PMID: 21699627 DOI: 10.1111/j.1468-1331.2011.03442.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 24-week, double-blind Efficacy and Safety Evaluation in PD-Adjunct (EASE-PD Adjunct) study randomized patients with advanced Parkinson's disease (PD) suboptimally controlled with levodopa to once-daily placebo or adjunctive ropinirole prolonged release (2-24 mg/day). We investigated the effect of ropinirole prolonged release on nocturnal symptoms in these patients. METHODS Total and grouped item PD Sleep Scale (PDSS) scores were analyzed post hoc in patients with baseline PDSS total scores ≤ 100 (troublesome nocturnal symptoms) and >100. RESULTS Baseline PDSS total score was ≤ 100 in 93 of 198 (47%) and 89 of 189 (47%) patients receiving ropinirole prolonged release and placebo, respectively; this subgroup displayed evidence at baseline of greater daily awake 'off' time, reduced night-time sleep and worse quality of life, than the PDSS >100 subgroup. Significant improvements with ropinirole prolonged release versus placebo in PDSS score from baseline to Week 24 last observation carried forward were observed for those with baseline PDSS ≤ 100 [adjusted mean treatment difference 9.0 (95% CI: 2.76, 15.33; P = 0.0051)], but not >100. The PDSS ≤ 100 subgroup demonstrated treatment benefits for PDSS groupings of motor symptoms on waking and global quality of sleep. Changes in daytime sleepiness were similar between treatment groups. The PDSS >100 subgroup demonstrated significant treatment benefit for global quality of sleep. The unadjusted odds ratio for a positive response with ropinirole prolonged release relative to placebo, for the PDSS ≤ 100 subgroup, was 2.90 (95% CI: 1.42, 5.95, P = 0.004). CONCLUSIONS Once-daily ropinirole prolonged release improves nocturnal symptoms in patients with advanced PD not optimally controlled with levodopa who suffer troublesome nocturnal disturbance.
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Affiliation(s)
- K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital, Kings College and Institute of Psychiatry, London, UK.
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Trenkwalder C, Kies B, Rudzinska M, Fine J, Nikl J, Honczarenko K, Dioszeghy P, Hill D, Anderson T, Myllyla V, Kassubek J, Steiger M, Zucconi M, Tolosa E, Poewe W, Surmann E, Whitesides J, Boroojerdi B, Chaudhuri KR. Rotigotine effects on early morning motor function and sleep in Parkinson's disease: a double-blind, randomized, placebo-controlled study (RECOVER). Mov Disord 2010; 26:90-9. [PMID: 21322021 PMCID: PMC3072524 DOI: 10.1002/mds.23441] [Citation(s) in RCA: 303] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/06/2010] [Accepted: 08/27/2010] [Indexed: 11/24/2022] Open
Abstract
In a multinational, double-blind, placebo-controlled trial (NCT00474058), 287 subjects with Parkinson's disease (PD) and unsatisfactory early-morning motor symptom control were randomized 2:1 to receive rotigotine (2–16 mg/24 hr [n = 190]) or placebo (n = 97). Treatment was titrated to optimal dose over 1–8 weeks with subsequent dose maintenance for 4 weeks. Early-morning motor function and nocturnal sleep disturbance were assessed as coprimary efficacy endpoints using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III (Motor Examination) measured in the early morning prior to any medication intake and the modified Parkinson's Disease Sleep Scale (PDSS-2) (mean change from baseline to end of maintenance [EOM], last observation carried forward). At EOM, mean UPDRS Part III score had decreased by −7.0 points with rotigotine (from a baseline of 29.6 [standard deviation (SD) 12.3] and by −3.9 points with placebo (baseline 32.0 [13.3]). Mean PDSS-2 total score had decreased by −5.9 points with rotigotine (from a baseline of 19.3 [SD 9.3]) and by −1.9 points with placebo (baseline 20.5 [10.4]). This represented a significantly greater improvement with rotigotine compared with placebo on both the UPDRS Part III (treatment difference: −3.55 [95% confidence interval (CI) −5.37, −1.73]; P = 0.0002) and PDSS-2 (treatment difference: −4.26 [95% CI −6.08, −2.45]; P < 0.0001). The most frequently reported adverse events were nausea (placebo, 9%; rotigotine, 21%), application site reactions (placebo, 4%; rotigotine, 15%), and dizziness (placebo, 6%; rotigotine 10%). Twenty-four-hour transdermal delivery of rotigotine to PD patients with early-morning motor dysfunction resulted in significant benefits in control of both motor function and nocturnal sleep disturbances. © 2010 Movement Disorder Society
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Affiliation(s)
- Claudia Trenkwalder
- Department of Clinical Neurophysiology, University of Goettingen and Paracelsus-Elena Klinik, Kassel, Germany.
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Margis R, Donis KC, Schönwald SV, Rieder CRM. WHOQOL-OLD assessment of quality of life in elderly patients with Parkinson's disease: influence of sleep and depressive symptoms. ACTA ACUST UNITED AC 2010; 32:125-31. [PMID: 20428729 DOI: 10.1590/s1516-44462010005000008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 11/14/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Parkinson's disease is a neurodegenerative disease with a number of motor and non-motor features that can affect quality of life. In this study, we aimed to assess quality of life, as well as to evaluate the potential determinants of quality of life, such as sleep quality, motor and depressive symptoms, in elderly patients with Parkinson's disease. METHOD This was a cross-sectional study in which we applied the World Health Organization Quality of Life Assessment for Older Adults in 57 Parkinson's disease patients over 60 years of age. RESULTS Total World Health Organization Quality of Life Assessment for Older Adults score was found to be associated with Parkinson's disease severity (rs = -0.43; p < 0.001). World Health Organization Quality of Life Assessment for Older Adults scores for sensory abilities (facet 1) and social participation (facet 4) were higher among the patients with mild Parkinson's disease than among those in the more advanced stages (rs = -0.43; p < 0.001). Facet 1 scores were found to be associated with Pittsburgh Sleep Quality Index and Parkinson's Disease Sleep Scale score (rp = -0.46 and rp = 0.41; p < 0.001, respectively). The Geriatric Depression Scale score showed an association with the total score on the World Health Organization Quality of Life Assessment for Older Adults (rp = -0.70; p < 0.001) CONCLUSION Quality of life in Parkinson's disease patients can be assessed by the World Health Organization Quality of Life Assessment for Older Adults. Greater Parkinson's disease severity can worsen patient quality of life, as can the presence of depressive symptoms.
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Affiliation(s)
- Regina Margis
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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