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Scott BM, Eisinger RS, Mara R, Rana AN, Thompson S, Okun MS, Gunduz A, Bowers D. Co-Occurrence of Apathy and Impulse Control Disorders in Parkinson Disease: Variation across Multiple Measures. Arch Clin Neuropsychol 2024:acae036. [PMID: 38704737 DOI: 10.1093/arclin/acae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To determine if the co-occurrence of apathy and impulse control disorders (ICDs) in Parkinson disease is dependent on instrument selection and assess the concurrent validity of three motivation measures by examining interrelationships between them. METHOD Ninety-seven cognitively normal individuals with idiopathic Parkinson disease (PD) completed the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease-Rating Scale (QUIP-RS) and three apathy measures: the Apathy Scale, Lille Apathy Rating Scale, and Item 4 of the Movement Disorder Society-Unified Parkinson Disease Rating Scale. RESULTS Fifty (51.5%) participants were classified as apathetic on at least one measure, and only four individuals (4.3%) obtained clinically elevated scores on all three measures. The co-occurrence of apathy and ICD varied across measures. CONCLUSIONS We observed a co-occurrence of apathy and ICDs in PD patients with each apathy instrument; however, limited concurrent validity exists across measures. This is important for future investigations into shared pathophysiology and the design of future clinical trials aimed at improving the early detection and treatment of these debilitating syndromes.
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Affiliation(s)
- Bonnie M Scott
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Roshan Mara
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amtul-Noor Rana
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Mayeli M, Shafie M, Shiravi M, Adl Parvar T, Mirsepassi Z, Rahiminejad F, Sattarpour R, Aghamollaii V. Depression is associated with the nonmotor symptoms of Parkinson's disease: A comparative analysis. Health Sci Rep 2024; 7:e2106. [PMID: 38803654 PMCID: PMC11128496 DOI: 10.1002/hsr2.2106] [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] [Received: 07/29/2023] [Revised: 11/01/2023] [Accepted: 04/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background and aims The nonmotor symptoms (NMS) of Parkinson's disease (PD) and their potential role in early diagnosis are recent debates. Herein, we aimed to investigate the association between depression and NMS of PD including sleep disorders, hyposexuality, hyposmia, constipation, and orthostatic hypotension. Methods A total of 93 PD patients with depression and 67 PD patients without depression were included in the study, and NMS were compared between the two groups. Furthermore, the possible associations between depression severity measured by Beck Depression Inventory (BDI) and NMS were investigated using linear regression or binary logistic regression models controlled for possible confounders. Eventually, we performed a subgroup analysis in each mild, moderate, and severe depression group. Results Orthostatic hypotension, constipation, and hyposexuality showed a significant difference between PD patients with and without depression (p < 0.001, p = 0.029, and p < 0.001, respectively). The BDI score was significantly associated with hyposexuality, Montreal cognitive assessment (MoCA), and Pittsburgh Sleep Quality (p = 0.016, p = 0.010, and p = 0.011, respectively); however, after adjustments for possible confounders, the associations of the BDI score with the MoCA score and hyposexuality remained significant (p = 0.015 and p = 0.019, respectively). Considering subgroup analysis, a similar pattern of significant results was observed particularly in the severe group. Conclusions This study suggests a possible association between depression in PD patients and some NMS observed in the course of PD. These findings could be beneficial for early diagnosis of the disease, which eventually could make a considerable difference in the management of PD patients. Additional interventional longitudinal studies are warranted to explore how controlling depression could impact the NMS of patients with PD.
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Affiliation(s)
- Mahsa Mayeli
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Mahan Shafie
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Maryam Shiravi
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Tanin Adl Parvar
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Zahra Mirsepassi
- Department of Psychiatry, School of Medicine, Roozbeh HospitalTehran University of Medical SciencesTehranIran
| | - Fatemeh Rahiminejad
- Psychiatry Department, Cognitive Neurology and Neuropsychiatry DivisionTehran University of Medical SciencesTehranIran
| | - Reza Sattarpour
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Vajiheh Aghamollaii
- Psychiatry Department, Cognitive Neurology and Neuropsychiatry DivisionTehran University of Medical SciencesTehranIran
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Bowling DL. Biological principles for music and mental health. Transl Psychiatry 2023; 13:374. [PMID: 38049408 PMCID: PMC10695969 DOI: 10.1038/s41398-023-02671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 12/06/2023] Open
Abstract
Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music's specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music's impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality-describing each element's functional origins, development, phylogeny, and neural bases-is critical to advancing rational applications of music in mental health and wellness.
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Affiliation(s)
- Daniel L Bowling
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.
- Center for Computer Research in Music and Acoustics (CCRMA), Stanford University, School of Humanities and Sciences, Stanford, CA, USA.
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Huether AX, Pottinger T, Lou JS. Screening cut-off scores for clinically significant fatigue in early Parkinson's disease. Clin Park Relat Disord 2023; 9:100228. [PMID: 38021342 PMCID: PMC10656208 DOI: 10.1016/j.prdoa.2023.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Fatigue is one of the most disabling non-motor symptoms in PD. Researchers have previously used cut-offs validated in non-PD conditions when using the Fatigue Severity Scale (FSS) or the Multidimensional Fatigue Inventory (MFI) scores to evaluate fatigue in PD. Objective We used a set of criteria for diagnosing clinically significant fatigue in PD to identify the proper cut-offs of the FSS and MFI. Methods One hundred thirty-one PD patients (59F; age 67.3 ± 7.6 y; H&Y 1.6 ± 0.7) were assessed for clinically significant fatigue, followed by the FSS, MFI, Center for Epidemiologic Studies Depression Scale (CES-D), and Montreal Cognitive Assessment (MOCA). Mean scores were compared between 17 patients who met diagnostic criteria (significant fatigue group, SFG) and 114 who did not (non-significant fatigue group, NSFG). Results The SFG had significantly higher scores in the 9-item FSS (p <.0001), total MFI score (p <.0001), and every MFI dimension except reduced motivation (p =.1) than the NSFG. Using area under the curve (AUC) of receiver operating characteristic (ROC) analyses, we recommend the following cut-offs: 9-item FSS 37; total MFI 60; general fatigue 11; reduced activity 10; physical fatigue 9; mental fatigue 9; and reduced motivation 9. Conclusions The recommended cut-offs for clinically significant fatigue in the FSS, MFI, and MFI dimensions will be valuable for diagnosing clinically significant fatigue and for future studies in investigating pathophysiology and potential treatments of fatigue in PD.
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Affiliation(s)
| | - Todd Pottinger
- Department of Neurology, Sanford Health, 2301 25th St S, Fargo, ND 58103, USA
| | - Jau-Shin Lou
- Department of Neurology, Sanford Health, 2301 25th St S, Fargo, ND 58103, USA
- Department of Neurology, University of North Dakota School of Medicine and Health Science, 1301 N Columbia Rd, Grand Forks, ND 58203, USA
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Corveleyn X, Corbel C, Fabre R, Zeghari R, Dujardin K, Robert P, Manera V. Validation study of the apathy motivation index in French adults. Front Psychol 2023; 14:1252965. [PMID: 37928593 PMCID: PMC10624122 DOI: 10.3389/fpsyg.2023.1252965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Apathy is present in many brain disorders, but it is also prevalent to varying degrees in healthy people. While many tools have been developed to assess levels of apathy in pathology, no standardized measure of apathy in healthy people exists. Method Therefore, this study aimed to validate the French version of the Apathy Motivation Index (f-AMI). The results of 729 participants were analyzed using an exploratory factorial analysis. Results Preliminary analyses suggested that the three domains of apathy extracted in the original AMI scale-behavioral activation (BA), social motivation (SM), and emotional sensitivity (ES)-could be found also in the f-AMI. A further exploratory analysis showed that a higher number of factors could be extracted, particularly for women. Specifically, both social and emotional factors could be divided into two sub-factors: (1) social motivation toward strangers or toward an acquaintance and (2) self-directed emotional sensitivity directed toward others. Regarding construct validity, the scores of f-AMI were correlated with the French Dimensional Apathy Scale results. Concerning the divergent validity, emotional sensitivity in apathy is different from depression, anhedonia, and fatigue levels. Conclusion These results suggest that the f-AMI can be used to assess levels of apathy in healthy adults.
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Affiliation(s)
- Xavier Corveleyn
- LAPCOS, Université Côte d'Azur, Nice, France
- MSHS Sud-Est, Maison des Sciences de l'Homme et de la Société Sud-Est, Nice, France
| | - Camille Corbel
- LAPCOS, Université Côte d'Azur, Nice, France
- MSHS Sud-Est, Maison des Sciences de l'Homme et de la Société Sud-Est, Nice, France
| | - Roxane Fabre
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France
| | | | - Kathy Dujardin
- CHU Lille, Lille Neurosciences and Cognition, INSERM, Université Lille, Lille, France
| | - Philippe Robert
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Centre mémoire CMRR, Nice, France
- Association Innovation Alzheimer, Nice, France
| | - Valeria Manera
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Centre mémoire CMRR, Nice, France
- Association Innovation Alzheimer, Nice, France
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Trojsi F, Di Nardo F, D'Alvano G, Passaniti C, Sharbafshaaer M, Canale F, Russo A, Silvestro M, Lavorgna L, Cirillo M, Esposito F, Tedeschi G, Siciliano M. Cognitive, behavioral, and brain functional connectivity correlates of fatigue in amyotrophic lateral sclerosis. Brain Behav 2023; 13:e2931. [PMID: 37349911 PMCID: PMC10338806 DOI: 10.1002/brb3.2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Fatigue is defined as a symptom of exhaustion unexplained by drug effects or psychiatric disorders and comprises two main components (i.e., central or "mental" and peripheral or "physical" components), both influencing global disability in amyotrophic lateral sclerosis (ALS). We aim at investigating the clinical correlations between "physical" and "mental" components of fatigue, measured by the Multidimensional Fatigue Inventory scale, and motor and cognitive/behavioral disability in a large sample of patients with ALS. We also investigated the correlations between these measures of fatigue and resting-state functional connectivity of brain functional magnetic resonance imaging (RS-fMRI) large-scale networks in a subset of patients. METHODS One hundred and thirty ALS patients were assessed for motor disability, cognitive and behavioral dysfunctions, fatigue, anxiety, apathy, and daytime sleepiness. Moreover, the collected clinical parameters were correlated with RS-fMRI functional connectivity changes in the large-scale brain networks of 30 ALS patients who underwent MRI. RESULTS Multivariate correlation analysis revealed that "physical" fatigue was related to anxiety and respiratory dysfunction, while "mental" fatigue was related to memory impairment and apathy. Moreover, the mental fatigue score was directly related to functional connectivity in the right and left insula (within the salience network), and inversely related to functional connectivity in the left middle temporal gyrus (within the default mode network). CONCLUSIONS Although the "physical" component of fatigue may be influenced by the disease itself, in ALS the "mental" component of fatigue correlates with cognitive and behavioral impairment, as well as with alterations of functional connectivity in extra-motor networks.
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Affiliation(s)
- Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
- First Division of NeurologyUniversity Hospital Università degli studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Federica Di Nardo
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Giulia D'Alvano
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Carla Passaniti
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Minoo Sharbafshaaer
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Fabrizio Canale
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
- First Division of NeurologyUniversity Hospital Università degli studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Luigi Lavorgna
- First Division of NeurologyUniversity Hospital Università degli studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
- First Division of NeurologyUniversity Hospital Università degli studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research CenterUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
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Béreau M, Van Waes V, Servant M, Magnin E, Tatu L, Anheim M. Apathy in Parkinson's Disease: Clinical Patterns and Neurobiological Basis. Cells 2023; 12:1599. [PMID: 37371068 DOI: 10.3390/cells12121599] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Apathy is commonly defined as a loss of motivation leading to a reduction in goal-directed behaviors. This multidimensional syndrome, which includes cognitive, emotional and behavioral components, is one of the most prevalent neuropsychiatric features of Parkinson's disease (PD). It has been established that the prevalence of apathy increases as PD progresses. However, the pathophysiology and anatomic substrate of this syndrome remain unclear. Apathy seems to be underpinned by impaired anatomical structures that link the prefrontal cortex with the limbic system. It can be encountered in the prodromal stage of the disease and in fluctuating PD patients receiving bilateral chronic subthalamic nucleus stimulation. In these stages, apathy may be considered as a disorder of motivation that embodies amotivational behavioral syndrome, is underpinned by combined dopaminergic and serotonergic denervation and is dopa-responsive. In contrast, in advanced PD patients, apathy may be considered as cognitive apathy that announces cognitive decline and PD dementia, is underpinned by diffuse neurotransmitter system dysfunction and Lewy pathology spreading and is no longer dopa-responsive. In this review, we discuss the clinical patterns of apathy and their treatment, the neurobiological basis of apathy, the potential role of the anatomical structures involved and the pathways in motivational and cognitive apathy.
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Affiliation(s)
- Matthieu Béreau
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Vincent Van Waes
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Mathieu Servant
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Eloi Magnin
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Laurent Tatu
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
- Laboratoire d'Anatomie, Université de Franche-Comté, 25000 Besançon, France
| | - Mathieu Anheim
- Département de Neurologie, CHU de Strasbourg, 67200 Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
- Institut de génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), INSERM-U964, CNRS-UMR7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
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Lambregts BIHM, Vassena E, Jansen A, Stremmelaar DE, Pickkers P, Kox M, Aarts E, van der Schaaf ME. Fatigue during acute systemic inflammation is associated with reduced mental effort expenditure while task accuracy is preserved. Brain Behav Immun 2023:S0889-1591(23)00131-9. [PMID: 37257522 DOI: 10.1016/j.bbi.2023.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Earlier work within the physical domain showed that acute inflammation changes motivational prioritization and effort allocation rather than physical abilities. It is currently unclear whether a similar motivational framework accounts for the mental fatigue and cognitive symptoms of acute sickness. Accordingly, this study aimed to assess the relationship between fatigue, cytokines and mental effort-based decision making during acute systemic inflammation. METHODS Eighty-five participants (41 males; 18-30 years (M=23.0, SD=2.4)) performed a mental effort-based decision-making task before, 2 hours after, and 5 hours after intravenous administration of 1 ng/kg bacterial lipopolysaccharide (LPS) to induce systemic inflammation. Plasma concentrations of cytokines (interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)) and fatigue levels were assessed at similar timepoints. In the task, participants decided whether they wanted to perform (i.e., 'accepted') arithmetic calculations of varying difficulty (3 levels: easy, medium, hard) in order to obtain rewards (3 levels: 5, 6 or 7 points). Acceptance rates were analyzed using a binomial generalized estimated equation (GEE) approach with effort, reward and time as independent variables. Arithmetic performance was measured per effort level prior to the decisions and included as a covariate. Associations between acceptance rates, fatigue (self-reported) and cytokine concentrations levels were analyzed using partial correlation analyses. RESULTS Plasma cytokine concentrations and fatigue were increased at 2 hours post-LPS compared to baseline and 5 hours post-LPS administration. Acceptance rates decreased for medium, but not for easy or hard effort levels at 2 hours post-LPS versus baseline and 5 hours post-LPS administration, irrespective of reward level. This reduction in acceptance rates occurred despite improved accuracy on the arithmetic calculations itself. Reduced acceptance rates for medium effort were associated with increased fatigue, but not with increased cytokines. CONCLUSION Fatigue during acute systemic inflammation is associated with alterations in mental effort allocation, similarly as observed previously for physical effort-based choice. Specifically, willingness to exert mental effort depended on effort and not reward information, while task accuracy was preserved. These results extend the motivational account of inflammation to the mental domain and suggest that inflammation may not necessarily affect domain-specific mental abilities, but rather affects domain-general effort-allocation processes.
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Affiliation(s)
- B I H M Lambregts
- Department of Psychiatry, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Postbus 9104, HE Nijmegen, The Netherlands.
| | - E Vassena
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Postbus 9104, HE Nijmegen, The Netherlands; Experimental Psychopathology and Treatment, Behavioural Science Institute Radboud University Nijmegen Postbus 9104, 6500 HE Nijmegen, The Netherlands.
| | - A Jansen
- Department of Intensive Care Medicine, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands; Radboud Center for Infectious Diseases, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - D E Stremmelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Postbus 9104, HE Nijmegen, The Netherlands.
| | - P Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands; Radboud Center for Infectious Diseases, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - M Kox
- Department of Intensive Care Medicine, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands; Radboud Center for Infectious Diseases, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - E Aarts
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Postbus 9104, HE Nijmegen, The Netherlands.
| | - M E van der Schaaf
- Department of Psychiatry, Radboud University Medical Center Postbus 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Postbus 9104, HE Nijmegen, The Netherlands; Department of Cognitive Neuropsychology, Tilburg University Postbus 90153, 5000 LE Tilburg, The Netherlands.
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Vortioxetine Improves Depressive Symptoms and Cognition in Parkinson's Disease Patients with Major Depression: An Open-Label Prospective Study. Brain Sci 2022; 12:brainsci12111466. [PMID: 36358393 PMCID: PMC9688230 DOI: 10.3390/brainsci12111466] [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] [Received: 09/15/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Depression is frequent in Parkinson’s disease (PD) patients, but the evidence for many antidepressant agents to treat it in PD is insufficient. The aim of the present prospective open-label single-arm study (VOPARK, an open-label study of the effectiveness and safety of VOrtioxetine in PARKinson’s disease patients with depression) was to analyze the effectiveness of vortioxetine on depressive symptoms in PD patients with major depression. The primary efficacy outcome was the change from baseline (VB) at the end of the observational period (12 weeks ± 14 days; V12w) in the 17-item Hamilton Depression Rating Scale (HAM-D17) total score. At VB, all patients had a HAM-D17 total score ≥16. A total of 30 patients (age 66.23 ± 10.27; 73.3% males) were included between February 2021 (first patient, 12/FEB/21) and March 2022 (last patient, 14/MAR/22). At 12 weeks, 27 patients completed the follow-up (90%). The total HAM-D17 total score was reduced by 52.7% (from 21.5 ± 4.75 at VB to 10.44 ± 7.54 at V12w; Cohen’s effect size = −2.5; p < 0.0001) and the response and remission rates were 50% and 43.3%, respectively. Apathy (Apathy Scale; p < 0.0001), cognition (PD-Cognitive Rating Scale; p = 0.007), fatigue (Fatigue Severity Scale; p = 0.014), and quality of life (PDQ-39 (p = 0.001) and EUROHIS-QOL8 (p < 0.0001)) improved at 3 weeks as well. A total of 11 adverse events in 10 patients (33.3%) were reported, one of which was severe (vomiting related to vortioxetine with full recovery after drug withdrawal). Vortioxetine was safe and well tolerated and improved depressive symptoms and other non-motor symptoms in PD patients.
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Beserra-Filho JIA, Maria-Macêdo A, Silva-Martins S, Custódio-Silva AC, Soares-Silva B, Silva SP, Lambertucci RH, de Souza Araújo AA, Lucchese AM, Quintans-Júnior LJ, Santos JR, Silva RH, Ribeiro AM. Lippia grata essential oil complexed with β-cyclodextrin ameliorates biochemical and behavioral deficits in an animal model of progressive parkinsonism. Metab Brain Dis 2022; 37:2331-2347. [PMID: 35779151 DOI: 10.1007/s11011-022-01032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Parkinson's disease (PD) is identified by the loss of dopaminergic neurons in the Substantia Nigra pars compacta (SNpc), and is correlated to aggregates of proteins such as α-synuclein, Lewy's bodies. Although the PD etiology remains poorly understood, evidence suggests a main role of oxidative stress on this process. Lippia grata Schauer, known as "alecrim-do-mato", "alecrim-de-vaqueiro", "alecrim-da-chapada", is a native bush from tropical areas mainly distributed throughout the Central and South America. This plant species is commonly used in traditional medicine for relief of pain and inflammation conditions, and that has proven antioxidant effects. We evaluated the effects of essential oil of the L. grata after its complexed with β-cyclodextrin (LIP) on PD animal model induced by reserpine (RES). Behavioral assessments were performed across the treatment. Upon completion the treatment, the animals were euthanized, afterwards their brains were isolated and processed for immunohistochemical and oxidative stress analysis. The LIP treatment delayed the onset of the behavior of catalepsy, decreased the number of oral movements and prevented the memory impairment on the novel object recognition task. In addition, the treatment with LIP protected against dopaminergic depletion in the SNpc and dorsal striatum (STRd), and decreased the α-syn immunoreactivity in the SNpc and hippocampus (HIP). Moreover, there was reduction of the oxidative stability index. These findings demonstrated that the LIP treatment has neuroprotective effect in a progressive parkinsonism model, suggesting that LIP could be an important source for novel treatment approaches in PD.
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Affiliation(s)
- Jose Ivo A Beserra-Filho
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Amanda Maria-Macêdo
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | - Suellen Silva-Martins
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | | | - Beatriz Soares-Silva
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | - Sara Pereira Silva
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | | | | | - Angélica Maria Lucchese
- Graduate Programm in Biotechnology, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brazil
| | | | - José Ronaldo Santos
- Department of Biosciences, Universidade Federal de Sergipe, Itabaiana, Sergipe, Brazil
| | - Regina H Silva
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alessandra M Ribeiro
- Departament of Biosciences, Universidade Federal de São Paulo, Santos, São Paulo, Brazil.
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11
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Lee Y, Chang YY, Chen YF, Lin TK, Hung CF, Chiou YJ, Wang LJ. Prevalence and Risk Factors of Depression between Patients with Parkinson’s Disease and Their Caregivers: A One-Year Prospective Study. Healthcare (Basel) 2022; 10:healthcare10071305. [PMID: 35885832 PMCID: PMC9318994 DOI: 10.3390/healthcare10071305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Depression is a common comorbidity in patients with Parkinson’s disease (PD) and in their caregivers. This study aimed to compare the prevalence and risk factors of depression between patients with PD and their caregivers. In total, 113 patients with PD and 101 caregivers were enrolled. Patients with PD were assessed using the Mini International Neuropsychiatric Interview, Unified Parkinson’s Disease Rating Scale (UPDRS), Activities of Daily Living (ADL), Hospital Anxiety and Depression Scale, Beck Hopelessness Scale, Brief Fatigue Inventory, Connor–Davidson Resilience Scale, and Big Five Inventory-10. Caregivers of patients with PD were also assessed using the above-mentioned instruments, with the exception of the UPDRS and ADL. During a 12-month follow-up period, depressive disorders were the most common psychiatric diagnosis of PD patients (27.4%) and their caregivers (17.8%). Depressive disorders were more prevalent in PD patients than in caregivers of PD patients throughout the entire follow-up phase. The severity of fatigue and severity of suicide risk were significantly associated with depression among patients with PD. The severity of pain and severity of anxiety were predictors of depression in caregivers of PD patients. The findings in this study provide references for early detection and treatment of depressive disorders in PD patients and their caregivers.
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Affiliation(s)
- Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.L.); (C.-F.H.); (Y.-J.C.)
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Ying-Fa Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Tsu-Kung Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.L.); (C.-F.H.); (Y.-J.C.)
| | - Yu-Jie Chiou
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.L.); (C.-F.H.); (Y.-J.C.)
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8753); Fax: +886-7-7326817
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12
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Apathy in Parkinson’s Disease: Defining the Park Apathy Subtype. Brain Sci 2022; 12:brainsci12070923. [PMID: 35884730 PMCID: PMC9313138 DOI: 10.3390/brainsci12070923] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023] Open
Abstract
Apathy is a neurobehavioural symptom affecting Parkinson’s disease patients of all disease stages. Apathy seems to be associated with a specific underlying non-motor disease subtype and reflects dysfunction of separate neural networks with distinct neurotransmitter systems. Due to the complicated neuropsychiatric aetiology of apathy, clinical assessment of this invalidating non-motor symptom remains challenging. We aim to summarize the current findings on apathy in Parkinson’s disease and highlight knowledge gaps. We will discuss the prevalence rates across the different disease stages and suggest screening tools for clinically relevant apathetic symptoms. We will approach the fundamental knowledge on the neural networks implicated in apathy in a practical manner and formulate recommendations on patient-tailored treatment. We will discuss the Park apathy phenotype in detail, shedding light on different clinical manifestations and implications for prognosis. With this review, we strive to distil the vast available theoretical knowledge into a clinical and patient-oriented perspective.
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13
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Daumas L, Zory R, Robert P, Manera V. Apathetic patients with neurocognitive disorders are more fatigued and fatigable. Aging Clin Exp Res 2022; 34:2237-2241. [PMID: 35608793 DOI: 10.1007/s40520-022-02146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Apathy is common in neurocognitive disorders (NCD) and manifests as reduced goal-directed behaviors and activities. A decrease in everyday activities can also be due to fatigue, another common symptom in NCD. The aim of this study was to investigate if apathetic patients with NCD are more fatigued and more fatigable. METHOD A self-report questionnaire and clinical functional tests assessed fatigue and fatigability in 30 apathetic vs 26 non-apathetic NCD participants. The Fatigue Severity Scale (FSS) was administered and a 15-s sustained maximal handgrip contraction and a 6-min walk test (6MWT) were performed. RESULTS Apathetic subjects had higher FSS scores. A decrease in performance was observed in apathetic participants during the sustained maximal handgrip contraction but not the 6MWT. CONCLUSION Higher self-reported fatigue and greater fatigability during the sustained maximal handgrip contraction test in apathetic subjects suggest the importance of assessing these symptoms in apathetic subjects to properly guide treatment. CLINICAL TRIAL REGISTRATION NCT04573712.
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Affiliation(s)
- Lyne Daumas
- Université Côte d'Azur, CoBTeK lab, Nice, France.
- Université Côte d'Azur, LAMHESS Lab, Nice, France.
| | - Raphaël Zory
- Université Côte d'Azur, LAMHESS Lab, Nice, France
- Institut Universitaire de France, Paris, France
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14
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Siciliano M, Kluger B, De Micco R, Chiorri C, Sant'Elia V, Silvestro M, Giordano A, Tedeschi G, Passamonti L, Trojano L, Tessitore A. Validation of new diagnostic criteria for fatigue in patients with Parkinson's disease. Eur J Neurol 2022; 29:2631-2638. [PMID: 35587108 PMCID: PMC9544823 DOI: 10.1111/ene.15411] [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] [Received: 03/21/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Although disabling fatigue is common in Parkinson disease (PD), available consensus‐based diagnostic criteria have not yet been empirically validated. The aim of this study was to evaluate the clinimetric properties of the criteria. Methods A sample of outpatients with PD was evaluated for demographic, clinical, behavioral, and cognitive features. Fatigue was diagnosed according to the new diagnostic criteria and was rated by means of the Parkinson Fatigue Scale (PFS) and Fatigue Severity Scale (FSS). Acceptability, concurrent and discriminant validity, and interrater reliability were evaluated with binary logistic regression analyses and Cohen kappa (κ). Results Of 241 included patients, 17 (7.1%) met the diagnostic criteria for PD‐related fatigue. Eight of nine symptoms described in Section A of the diagnostic criteria occurred in >50% of patients with fatigue. Acceptability (missing data = 0.8%) of the criteria was good, as was their concurrent validity with the PFS (odds ratio = 3.65) and FSS (odds ratio = 3.63). The discriminant validity of fatigue criteria with other PD‐related behavioral and cognitive features was good (odds ratio < 1.68). The interrater reliability was excellent (κ = 0.92). Conclusions This is the first study to test the clinimetric properties of case definition diagnostic criteria for PD‐related fatigue. Our results suggest that current diagnostic criteria may be useful in both clinical practice and research. Future longitudinal studies should examine their long‐term stability.
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Affiliation(s)
- Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Benzi Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genova, Genova, Italy
| | - Valeria Sant'Elia
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Giordano
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Institute of Molecular Bioimaging and Physiology, CNR, Milan, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
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15
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Daumas L, Corbel C, Zory R, Corveleyn X, Fabre R, Robert P, Manera V. Associations, overlaps and dissociations between apathy and fatigue. Sci Rep 2022; 12:7387. [PMID: 35513461 PMCID: PMC9072543 DOI: 10.1038/s41598-022-11071-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022] Open
Abstract
Apathy and fatigue have a high prevalence in many pathological populations, but they are also present in healthy adults. The relationship between apathy and fatigue, which are both multidimensional, is still poorly understood. This study aims to describe the associations between the subdimensions of both apathy and fatigue and to investigate their overlaps and dissociations in healthy people. 729 participants (mean age = 30.8 ± 10.7 years) completed online self-assessment questionnaires. The Apathy Motivation Index and Dimensional Apathy Scale were used to assess apathy. The Multidimensional Fatigue Inventory was used to assess fatigue. The executive dimension of apathy showed the strongest correlations with mental fatigue and the two appeared to be underpinned by the same latent factor, according to exploratory factor analysis (EFA). The factor structure of EFA showed overlaps between behavioral apathy and both reduced motivation and activity in fatigue. Emotional and social dimensions of apathy were separately underpinned by a latent factor that comprised no items of fatigue. Apathy and fatigue have reduced activity and mental difficulties in common, whereas emotional and social disorders distinguish apathy from fatigue. This has important implications for assessing apathy and fatigue in the general population, and may be relevant for clinical practice.
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Affiliation(s)
- Lyne Daumas
- Université Côte d'Azur, CoBTeK Lab, Nice, France. .,Université Côte d'Azur, LAMHESS Lab, Nice, France.
| | - Camille Corbel
- Université Côte d'Azur, CoBTeK Lab, Nice, France.,Université Côte d'Azur, LAPCOS Lab, Nice, France
| | - Raphaël Zory
- Université Côte d'Azur, LAMHESS Lab, Nice, France.,Institut Universitaire de France, Paris, France
| | | | - Roxane Fabre
- Université Côte d'Azur, CoBTeK Lab, Nice, France.,Public Health Department, Université Côte d'Azur, Nice University Hospital, Nice, France
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16
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Laux G. Parkinson and depression: review and outlook. J Neural Transm (Vienna) 2022; 129:601-608. [PMID: 34982207 DOI: 10.1007/s00702-021-02456-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/19/2021] [Indexed: 01/06/2023]
Abstract
Depression in Parkinson's Disorder (DPD) has been estimated to appear in up to 40% of people with PD and negatively impacts quality of life, motor and cognitive deficits and functional disability. Knowledge of the pathophysiology of DPD is unclear, DPD may be related to dysfunction in subcortical nuclei and the prefrontal cortex, striatal-thalamic-prefrontal and basotemporal limbic circuits, brainstem monoamine, and indolamine (i.e. dopamine, serotonin, and norepinephrine) systems. DPD is characterized by sadness, loss of interest, increased exhaustibility, feelings of helplessness, reduced drive, dysphoria, irritability, and pessimism about future. The diagnosis is complicated by overlap with PD symptoms, Detection of depression in PD should be made by psychometric depression scales. DPD is underrecognized and undertreated in clinical practice. Treatment mainly includes antidepressive medications and behavioral interventions as psychotherapy. Dopamine agonists showed some antidepressant effects, there are no sufficient numbers of RCTs. Important randomized clinical trials (RCTs) are summarized. SSRIs and SNRIs have a satisfying efficacy in DPD. TCAs are also good for improving depression. Side effects of different antidepressants (e.g. TCAs, SSRIs, SNRIs, bupropion, MAOIs) and potential interactions should be considered. In existing guidelines so far no statements, algorithms and recommendations are given for diagnosis and treatment of DPD. Methodologically adequate designed RCTs and comparative studies (NIS) which offer evidence-based results are urgently needed having the impact of DPD in mind.
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Affiliation(s)
- Gerd Laux
- Institute of Psychological Medicine (IPM), Soyen, Germany. .,MVZ Waldkraiburg of Muehldorf Clinics/Hospital, Center of Neuropsychiatry, Waldkraiburg, Germany. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Munich, Germany.
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17
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Shi Y, Hu X, Cui J, Li J, Bi Z, Li J, Fu H, Wang Y, Cui L, Xu J. Correlation Analysis of Data of Tongue and Pulse in Patients With Disease Fatigue and Sub-health Fatigue. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211060781. [PMID: 35112891 PMCID: PMC8819780 DOI: 10.1177/00469580211060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Fatigue is one of the most common subjective symptoms of abnormal health state,
there is still no reliable and stable evaluation method to distinguish disease
fatigue and non-disease fatigue. Studies have shown that tongue diagnosis and
pulse diagnosis are the reflection of overall state of the body. This study aims
to explore the distribution rules and correlation of data of tongue and pulse in
population with disease fatigue and sub-health fatigue and provide a new method
of clinical diagnosis of fatigue from the perspective of tongue diagnosis and
pulse diagnosis. In this study, a total of 736 people were selected and divided
into healthy controls (n = 250), sub-health fatigue group (n = 242), and disease
fatigue group (n = 244). TFDA-1 tongue diagnosis instrument and PDA-1 pulse
diagnosis instrument were used to collect tongue image and sphygmogram, simple
correlation analysis and canonical correlation analysis were used to analyze the
correlation of tongue and pulse data about the two groups of fatigue people. The
study had shown that tongue and pulse data could provide a certain reference for
the diagnosis of different types of fatigue, tongue and pulse data in disease
fatigue and sub-health fatigue population had different distribution rules, and
there was a simple correlation and canonical correlation in the disease fatigue
population, the coefficient of canonical correlation was .649 (P <.05).
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Affiliation(s)
- Yulin Shi
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojuan Hu
- Shanghai Collaborative Innovation Center of Health Service in Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji Cui
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Li
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zijuan Bi
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiacai Li
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyuan Fu
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Wang
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Longtao Cui
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiatuo Xu
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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18
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Röttgering JG, Belgers V, De Witt Hamer PC, Knoop H, Douw L, Klein M. Toward unraveling the correlates of fatigue in glioma. Neurooncol Adv 2022; 4:vdac169. [PMID: 36425844 PMCID: PMC9680534 DOI: 10.1093/noajnl/vdac169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Even though fatigue is one of the most prevalent and burdensome symptoms in patients with glioma, its etiology and determinants are still poorly understood. We aimed to identify which demographic, tumor- and treatment-related characteristics and patient-reported outcome measures (PROMs) are associated with or are predictors of fatigue in glioma. METHODS In this retrospective observational study, we included glioma patients with preoperative and postoperative assessments including PROMs on fatigue, depression, cognitive functioning, and health-related quality of life (HRQoL). Linear mixed models were used to identify which clinical factors and PROMs were associated with fatigue and linear multiple regression was used to detect predictors of postoperative fatigue. RESULTS In this study, 222 patients were included (78% grade II-III glioma, 22% grade IV). These patients had performed 333 assessments (193 preoperative and 116 one year postoperatively). Of all assessments, 39% was indicative of severe fatigue. Several HRQoL domains, depression, and right-sided tumors were significantly associated with fatigue (marginal R 2 = 0.63). Contrary to common expectations, tumor type, treatment-related factors, and timing of the assessment, were not associated with fatigue. In a subgroup of 70 patients with follow-up assessments, preoperative fatigue, and physical functioning were predictors of postoperative fatigue (adjusted R 2 = 0.31). CONCLUSION Fatigue is a complex symptom, which should not solely be attributed to the tumor or its treatment, but is instead related to different aspects of mood and HRQoL. These insights are important in understanding fatigue and could guide symptom management, especially in patients with lower-grade tumors.
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Affiliation(s)
- Jantine G Röttgering
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
| | - Vera Belgers
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Neurology, Boelelaan 1117, Amsterdam, The Netherlands
| | - Philip C De Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Neurosurgery, Boelelaan 1117, Amsterdam, The Netherlands
| | - Hans Knoop
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Linda Douw
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, The Netherlands
| | - Martin Klein
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
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19
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Béreau M, Castrioto A, Lhommée E, Maillet A, Gérazime A, Bichon A, Pélissier P, Schmitt E, Klinger H, Longato N, Fraix V, Benatru I, Durif F, Azulay JP, Moro E, Broussolle E, Tranchant C, Anheim M, Thobois S, Krack P. Fatigue in de novo Parkinson's Disease: Expanding the Neuropsychiatric Triad? JOURNAL OF PARKINSON'S DISEASE 2022; 12:1329-1337. [PMID: 35253781 DOI: 10.3233/jpd-213116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Fatigue is a frequent and troublesome symptom present from the early stages of Parkinson's disease (PD). OBJECTIVE To examine the relationship between fatigue and the neuropsychiatric triad, which includes apathy, depression, and anxiety, in de novo PD. METHODS We performed a cross-sectional study including 197 patients with de novo PD and assessed fatigue using the Parkinson's Disease Fatigue Scale (PDFS-16). We evaluated motor status using the Unified Parkinson's Disease Rating Scale (UPDRS) part III score and evaluated neuropsychiatric status using the Ardouin Scale of Behavior in Parkinson's Disease (ASBPD). We carried out univariate and multivariate analyses to model association between motor signs, non-motor signs, and fatigue risk. RESULTS Frequency of fatigue (28.9%) was of the same order of magnitude as that of apathy. PD patients with fatigue reported a lower quality of life than patients without fatigue (p < 0.0001). The ASBPD showed that patients with fatigue had higher scores for depressed mood (p < 0.0001), anxiety (p < 0.0001), and apathy (p < 0.0001). In the univariate analysis, fatigue score was positively correlated with apathy, depression, anxiety, and the neuropsychiatric triad as a whole, and to a lesser extent with female sex, hyperemotivity, and the UPDRS part III score. In the multivariate analysis, after adjusting for sex and motor status, the fatigue score remained significantly correlated with apathy (OR = 11.17 [4.33-28.78], p < 0.0001) and depression (OR = 4.28 [1.39-13.12], p = 0.01), but not with anxiety (OR = 0.94 [0.34-2.58], p = 0.9). CONCLUSION We propose that the neuropsychiatric triad could be expanded to include fatigue.
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Affiliation(s)
- Matthieu Béreau
- Department of Neurology, University Hospital of Besançon, Besançon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR LINC, Université Bourgogne Franche-Comté, Besançon, France
- NS-PARK/FCRIN Network, France
| | - Anna Castrioto
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Eugénie Lhommée
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Audrey Maillet
- Movement Disorders Unit, Neurology Department, Hospices Civils de Lyon, University Lyon, Lyon, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Bron, France
| | - Aurélie Gérazime
- Unité de Méthodologie, CIC INSERM 1431, CHRU de Besançon, Besançon, France
| | - Amélie Bichon
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Pierre Pélissier
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Emmanuelle Schmitt
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Hélène Klinger
- Movement Disorders Unit, Neurology Department, Hospices Civils de Lyon, University Lyon, Lyon, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Bron, France
| | - Nadine Longato
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Valérie Fraix
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Isabelle Benatru
- Department of Neurology, University Hospital of Poitiers, Poitiers, France
- INSERM, CHU de Poitiers, University of Poitiers, Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Franck Durif
- Neurology Department, Université Clermont Auvergne, EA7280 NPsy-Sydo, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-Philippe Azulay
- Movement Disorders Unit, Neurology Department, University Hospital of Marseille, Marseille, France
| | - Elena Moro
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France
| | - Emmanuel Broussolle
- Movement Disorders Unit, Neurology Department, Hospices Civils de Lyon, University Lyon, Lyon, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Stéphane Thobois
- NS-PARK/FCRIN Network, France
- Movement Disorders Unit, Neurology Department, Hospices Civils de Lyon, University Lyon, Lyon, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Bron, France
| | - Paul Krack
- Movement Disorders Center, Department of Neurology, University Hospital of Bern, Bern, Switzerland
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20
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Bossola M, Di Stasio E, Monteburini T, Santarelli S, Cenerelli S, Manes M, Parodi EL, Angioletti L, Balconi M. Fatigue and apathy in patients on chronic hemodialysis. Ther Apher Dial 2021; 26:932-940. [PMID: 34953022 DOI: 10.1111/1744-9987.13784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/12/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study explores the link between fatigue and apathy in patients on chronic hemodialysis (HD). METHODS One hundred thirty-nine chronic HD patients underwent the assessment of fatigue, apathy, depression, and their functional status, with the fatigue severity scale (FSS), the Apathy Evaluation Scale (AES), the beck depression inventory (BDI), the activity of daily living (ADL), and instrumental activity of daily living (IADL). RESULTS Patients with high FSS had a significantly lower ADL and IADL score, higher BDI, Charlson Comorbidity Index, and AES score, and lower serum levels of creatinine, compared to low FSS patients. FSS was highly correlated with the AES, as well as with the BDI and the AES correlates with the BDI. At multiple regression analyses, only apathy and IADL were independent predictor variables of fatigue in HD population. CONCLUSION Future longitudinal studies could determine if apathy is a causative factor for fatigue manifestation and development in HD patients.
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi, Università Cattolica del Sacro Cuore, Roma, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Enrico Di Stasio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | | | - Massimo Manes
- Dipartimento di Nefrologia, Ospedale "Umberto Parini", Aosta, Italy
| | | | - Laura Angioletti
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Università Cattolica del Sacro Cuore, Milano, Italy.,Research Unit in Affective and Social Neuroscience, Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - Michela Balconi
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Università Cattolica del Sacro Cuore, Milano, Italy.,Research Unit in Affective and Social Neuroscience, Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milano, Italy
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21
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Heightened effort discounting is a common feature of both apathy and fatigue. Sci Rep 2021; 11:22283. [PMID: 34782630 PMCID: PMC8593117 DOI: 10.1038/s41598-021-01287-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022] Open
Abstract
Apathy and fatigue have distinct aetiologies, yet can manifest in phenotypically similar ways. In particular, each can give rise to diminished goal-directed behaviour, which is often cited as a key characteristic of both traits. An important issue therefore is whether currently available approaches are capable of distinguishing between them. Here, we examined the relationship between commonly administered inventories of apathy and fatigue, and a measure of goal-directed activity that assesses the motivation to engage in effortful behaviour. 103 healthy adults completed self-report inventories on apathy (the Dimensional Apathy Scale), and fatigue (the Multidimensional Fatigue Inventory, and/or Modified Fatigue Impact Scale). In addition, all participants performed an effort discounting task, in which they made choices about their willingness to engage in physically effortful activity. Importantly, self-report ratings of apathy and fatigue were strongly correlated, suggesting that these inventories were insensitive to the fundamental differences between the two traits. Furthermore, greater effort discounting was strongly associated with higher ratings across all inventories, suggesting that a common feature of both traits is a lower motivation to engage in effortful behaviour. These results have significant implications for the assessment of both apathy and fatigue, particularly in clinical groups in which they commonly co-exist.
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22
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Ou R, Hou Y, Liu K, Lin J, Jiang Z, Wei Q, Zhang L, Cao B, Zhao B, Song W, Shang H. Progression of Fatigue in Early Parkinson's Disease: A 3-Year Prospective Cohort Study. Front Aging Neurosci 2021; 13:701906. [PMID: 34744684 PMCID: PMC8568310 DOI: 10.3389/fnagi.2021.701906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/28/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: To explore the frequency, evolution, associated factors, and risk factors of fatigue over 3-year of prospective follow-up in a cohort of patients with early Parkinson’s disease (PD). Methods: A total of 174 PD patients in the early stage were enrolled and quantitively assessed motor and non-motor symptoms using comprehensive scales including the Fatigue Severity Scale (FSS) annually. Each subject was categorized as PD with and without fatigue based on a cut-off mean value of 4 using FSS. The generalized estimating equation (GEE) was utilized to investigate the associated factors, and the stepwise binary logistic regression model was performed to explore the predictors. Results: The frequency of fatigue was slightly changed (ranging from 35.1 to 40.4%) during the 3-year follow-up. The changed pattern of the frequency of fatigue was similar to that of anxiety. Fatigue was significantly associated with nocturnal sleep disorders (B 2.446, P < 0.001), high Hamilton Anxiety Rating Scale (HAMA) score (B 1.072, P = 0.011), and high Unified PD Rating Scale (UPDRS) III score (B 1.029, P = 0.003) over time. High UPDRS III score [odds ratio (OR) 1.051, P = 0.015] at baseline increased the risk of developing fatigue after 1-year; high LEDD (OR 1.002, P = 0.037) increased the risk of developing fatigue after 2-year; and high LEDD (OR 1.003, P = 0.049) and high HAMA score (OR 1.077, P = 0.042) increased the risk of developing fatigue after 3-year. Conclusion: Our present study provided evidence of the longitudinal evolution of fatigue in patients with early PD and help clinical management of fatigue.
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Affiliation(s)
- Ruwei Ou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Kuncheng Liu
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Junyu Lin
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Jiang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyu Zhang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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23
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Diaz-Arias LA, Yeshokumar AK, Glassberg B, Sumowski JF, Easton A, Probasco JC, Venkatesan A. Fatigue in Survivors of Autoimmune Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e1064. [PMID: 34389660 PMCID: PMC8369511 DOI: 10.1212/nxi.0000000000001064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the impact of fatigue after autoimmune encephalitis, determine associations with patients' characteristics, and identify factors that contribute to its development. METHODS In a first cohort recruited via several encephalitis support organizations, self-reported questionnaires were used to evaluate fatigue, depression, and sleep quality in adults after autoimmune encephalitis. In a second cohort where more in-depth clinical characterization could be performed, adults with encephalitis from 2 tertiary hospitals were evaluated using the same questionnaires. Patients' characteristics were retrospectively captured. RESULTS In the first cohort (mean [SD] age; 43 [16] years, 220 [65%] female), 220 of 338 participants (65%) reported fatigue, 175 of 307 (57%) depression, and 211 of 285 (74%) poor sleep quality. In the second cohort (48 [19] years; 43 [50%] women), 42 of 69 participants (61%) reported fatigue, whereas 23 of 68 (34%) reported depression and 44 of 66 (67%) poor sleep quality, despite more than 80% having "good" modified Rankin scale (mRS) scores (0-2). Individuals with anti-NMDA receptor encephalitis reported lower fatigue scores than those with other autoimmune encephalitis types. In a multivariate analysis examining factors at discharge that might predict fatigue scores, only anti-NMDA receptor encephalitis was a (negative) predictor of fatigue and remained so when potential confounders were included. DISCUSSION The impact of fatigue after autoimmune encephalitis is prominent and not fully accounted for by depression or sleep quality, nor adequately captured by mRS scores for disability. Fatigue is pervasive across autoimmune encephalitis, although lower scores are reported in anti-NMDA receptor encephalitis. Fatigue should be screened routinely, considered as an outcome measure in clinical trials, and further studied from a mechanistic standpoint.
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Affiliation(s)
| | | | - Brittany Glassberg
- From the Johns Hopkins Encephalitis Center (L.A.D.-A., J.C.P., A.V.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.K.Y., B.G., J.F.S.), Icahn School of Medicine at Mount Sinai, New York; Encephalitis Society (A.E.), Malton; and Institute of Infection and Global Health (A.E.), University of Liverpool, United Kingdom
| | - James F. Sumowski
- From the Johns Hopkins Encephalitis Center (L.A.D.-A., J.C.P., A.V.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.K.Y., B.G., J.F.S.), Icahn School of Medicine at Mount Sinai, New York; Encephalitis Society (A.E.), Malton; and Institute of Infection and Global Health (A.E.), University of Liverpool, United Kingdom
| | - Ava Easton
- From the Johns Hopkins Encephalitis Center (L.A.D.-A., J.C.P., A.V.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.K.Y., B.G., J.F.S.), Icahn School of Medicine at Mount Sinai, New York; Encephalitis Society (A.E.), Malton; and Institute of Infection and Global Health (A.E.), University of Liverpool, United Kingdom
| | - John C. Probasco
- From the Johns Hopkins Encephalitis Center (L.A.D.-A., J.C.P., A.V.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.K.Y., B.G., J.F.S.), Icahn School of Medicine at Mount Sinai, New York; Encephalitis Society (A.E.), Malton; and Institute of Infection and Global Health (A.E.), University of Liverpool, United Kingdom
| | - Arun Venkatesan
- From the Johns Hopkins Encephalitis Center (L.A.D.-A., J.C.P., A.V.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.K.Y., B.G., J.F.S.), Icahn School of Medicine at Mount Sinai, New York; Encephalitis Society (A.E.), Malton; and Institute of Infection and Global Health (A.E.), University of Liverpool, United Kingdom
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24
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Ineichen C, Baumann-Vogel H. Deconstructing Apathy in Parkinson's Disease: Challenges in Isolating Core Components of Apathy From Depression, Anxiety, and Fatigue. Front Neurol 2021; 12:720921. [PMID: 34512530 PMCID: PMC8427284 DOI: 10.3389/fneur.2021.720921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
Apathy, fatigue and depression are amongst the most debilitating non-motor syndromes of Parkinson's disease (PD). The aim of this study was to examine the prevalence of apathy, depression, anxiety and fatigue and whether these syndromes are separable in PD. A total of 337 patients were examined using the Unified Parkinson's Disease Rating Scale (UPDRS part III), the Apathy Evaluation Scale, the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. Using standard cutoff criteria, the prevalence rates of significant apathy, mild-to-severe depression, mild-to-severe anxiety and severe fatigue were 23.7, 13.4, 15.4, and 17.8%, respectively. Next, confirmatory factor analysis was employed of items from these three clinical scales. A priori hypothesis testing including four different factors (reduced motivation/interest, physical fatigue, reduced pleasure, anxiety) was performed. The factor analysis revealed strong fit statistics for the model with χ2 (57, N = 377) = 58.9, p = 0.41, CMIN/DF = 1,034, NFI = 0.977, CFI = 0.999, IFI = 0.999, RFI = 0.968, and TLI = 0.999. The RMSEA was 0.01, and the standardized RMR was 0.027. These results support the hypothesis that apathy, fatigue, depression and anxiety represent prevalent syndromes that can be separated in Parkinson's disease and that apathy is not just a subcomponent of depression or fatigue. The results of this study may contribute to a clearer diagnostic process for apathy, fatigue and depression and may aid in patient care.
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Affiliation(s)
- Christian Ineichen
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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25
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George DD, Baer NK, Berliner JM, Jones J, Kluger BM. What Fatigue Means to Persons Living with Parkinson's Disease? A Qualitative Study. Mov Disord Clin Pract 2021; 8:919-924. [PMID: 34405099 PMCID: PMC8354068 DOI: 10.1002/mdc3.13270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Fatigue is one of the most prevalent non-motor symptoms of Parkinson's disease (PD). Research is hampered by imprecise terminology and the lack of case definition criteria. OBJECTIVES To elicit the experiences of persons living with PD-related fatigue and provide ecological validation for case definition criteria. METHODS Qualitative interviews were conducted with 22 individuals and 4 focus groups, and analyzed using an inductive qualitative method. RESULTS Six core themes emerged: (i) difficulty initiating and completing important tasks; (ii) desire for others to understand their fatigue experience; (iii) heterogeneity of experiences and descriptions of fatigue; (iv) complex relationships with other non-motor symptoms; (v) variable self-management strategies; and (vi) general alignment with proposed case definition criteria. CONCLUSIONS PD-related fatigue impacts function, is subjectively distinguishable from other non-motor symptoms, has heterogeneous descriptions, and may be mitigated by various self-management strategies. Proposed case definition criteria appear ecologically valid and warrant further optimization and testing.
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Affiliation(s)
- Derek D. George
- Department of Neurology, School of MedicineUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Nicholas K. Baer
- Department of Neurology, School of MedicineUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Jean M. Berliner
- Rehabilitation Sciences ProgramSchool of Medicine, University of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Jacqueline Jones
- College of NursingUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Benzi M. Kluger
- Departments of Neurology and MedicineSchool of Medicine, University of Rochester Medical CenterRochesterNew YorkUSA
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26
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Shaw SR, El-Omar H, Roquet D, Hodges JR, Piguet O, Ahmed RM, Whitton AE, Irish M. Uncovering the prevalence and neural substrates of anhedonia in frontotemporal dementia. Brain 2021; 144:1551-1564. [PMID: 33843983 DOI: 10.1093/brain/awab032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/21/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Much of human behaviour is motivated by the drive to experience pleasure. The capacity to envisage pleasurable outcomes and to engage in goal-directed behaviour to secure these outcomes depends upon the integrity of frontostriatal circuits in the brain. Anhedonia refers to the diminished ability to experience, and to pursue, pleasurable outcomes, and represents a prominent motivational disturbance in neuropsychiatric disorders. Despite increasing evidence of motivational disturbances in frontotemporal dementia (FTD), no study to date has explored the hedonic experience in these syndromes. Here, we present the first study to document the prevalence and neural correlates of anhedonia in FTD in comparison with Alzheimer's disease, and its potential overlap with related motivational symptoms including apathy and depression. A total of 172 participants were recruited, including 87 FTD, 34 Alzheimer's disease, and 51 healthy older control participants. Within the FTD group, 55 cases were diagnosed with clinically probable behavioural variant FTD, 24 presented with semantic dementia, and eight cases had progressive non-fluent aphasia (PNFA). Premorbid and current anhedonia was measured using the Snaith-Hamilton Pleasure Scale, while apathy was assessed using the Dimensional Apathy Scale, and depression was indexed via the Depression, Anxiety and Stress Scale. Whole-brain voxel-based morphometry analysis was used to examine associations between grey matter atrophy and levels of anhedonia, apathy, and depression in patients. Relative to controls, behavioural variant FTD and semantic dementia, but not PNFA or Alzheimer's disease, patients showed clinically significant anhedonia, representing a clear departure from pre-morbid levels. Voxel-based morphometry analyses revealed that anhedonia was associated with atrophy in an extended frontostriatal network including orbitofrontal and medial prefrontal, paracingulate and insular cortices, as well as the putamen. Although correlated on the behavioural level, the neural correlates of anhedonia were largely dissociable from that of apathy, with only a small region of overlap detected in the right orbitofrontal cortices whilst no overlapping regions were found between anhedonia and depression. This is the first study, to our knowledge, to demonstrate profound anhedonia in FTD syndromes, reflecting atrophy of predominantly frontostriatal brain regions specialized for hedonic tone. Our findings point to the importance of considering anhedonia as a primary presenting feature of behavioural variant FTD and semantic dementia, with distinct neural drivers to that of apathy or depression. Future studies will be essential to address the impact of anhedonia on everyday activities, and to inform the development of targeted interventions to improve quality of life in patients and their families.
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Affiliation(s)
- Siobhán R Shaw
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Hashim El-Omar
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Daniel Roquet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia.,The University of Sydney, School of Medical Sciences, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Medical Sciences, Sydney, New South Wales, Australia.,Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexis E Whitton
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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27
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Zeghari R, König A, Guerchouche R, Sharma G, Joshi J, Fabre R, Robert P, Manera V. Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study. JMIR Form Res 2021; 5:e24727. [PMID: 33787499 PMCID: PMC8047819 DOI: 10.2196/24727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 01/20/2023] Open
Abstract
Background Neurocognitive disorders are often accompanied by behavioral symptoms such as anxiety, depression, and/or apathy. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. Objective We focus in this study on apathy, one of the most common and debilitating neuropsychiatric symptoms in neurocognitive disorders. Specifically, we investigated whether facial expressivity extracted through computer vision software correlates with the severity of apathy symptoms in elderly subjects with neurocognitive disorders. Methods A total of 63 subjects (38 females and 25 males) with neurocognitive disorder participated in the study. Apathy was assessed using the Apathy Inventory (AI), a scale comprising 3 domains of apathy: loss of interest, loss of initiation, and emotional blunting. The higher the scale score, the more severe the apathy symptoms. Participants were asked to recall a positive and a negative event of their life, while their voice and face were recorded using a tablet device. Action units (AUs), which are basic facial movements, were extracted using OpenFace 2.0. A total of 17 AUs (intensity and presence) for each frame of the video were extracted in both positive and negative storytelling. Average intensity and frequency of AU activation were calculated for each participant in each video. Partial correlations (controlling for the level of depression and cognitive impairment) were performed between these indexes and AI subscales. Results Results showed that AU intensity and frequency were negatively correlated with apathy scale scores, in particular with the emotional blunting component. The more severe the apathy symptoms, the less expressivity in specific emotional and nonemotional AUs was displayed from participants while recalling an emotional event. Different AUs showed significant correlations depending on the sex of the participant and the task’s valence (positive vs negative story), suggesting the importance of assessing male and female participants independently. Conclusions Our study suggests the interest of employing computer vision-based facial analysis to quantify facial expressivity and assess the severity of apathy symptoms in subjects with neurocognitive disorders. This may represent a useful tool for a preliminary apathy assessment in nonspecialized settings and could be used to complement classical clinical scales. Future studies including larger samples should confirm the clinical relevance of this kind of instrument.
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Affiliation(s)
- Radia Zeghari
- Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France
| | - Alexandra König
- Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d'Azur, Nice, France.,French Institute for Research in Computer Science and Automation, Valbonne, France
| | - Rachid Guerchouche
- French Institute for Research in Computer Science and Automation, Valbonne, France
| | | | | | - Roxane Fabre
- Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d'Azur, Nice, France.,Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Nice, France
| | - Philippe Robert
- Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France
| | - Valeria Manera
- Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France
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28
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Sadeghniiat-Haghighi K, Mehrabinejad MM, Hajighaderi A, Najafi A, Rahimi-Golkhandan A, Zahabi A. Shift Work Disorder, Insomnia, and Depression among Offshore Oil Rig Workers. IRANIAN JOURNAL OF PSYCHIATRY 2021; 16:162-167. [PMID: 34221042 PMCID: PMC8233558 DOI: 10.18502/ijps.v16i2.5817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Numerous offshore jobs require 24-hour tasks, such as in industrial workplaces (eg, oil rigs). The purpose of this study was to assess shift work disorder (SWD), insomnia, daytime sleepiness, and depression among Iranian offshore oil rig workers in different shift schedules. Method : This cross-sectional study was conducted on Iranian offshore oil workers at the Persian Gulf. A questionnaire package consisted of Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI- II), and SWD filled. The scores were calculated among different groups of shift schedules (fixed-day, fixed-night, swing and standby shift workers). ISI, BDI-II, and ESS scores were also compared between individuals with or without SWD. Results: A total of 188 participants were recruited in the study, and all were male. The mean age was 37.06 ± 9.2 years. Among different shift schedules, the highest and lowest ISI and ESS scores were related to fixed-night shifts workers and fixed-day shift workers, respectively. ISI, ESS, and BDI mean scores in different shift schedules were not significantly different (p values = 0.14, 0.57, and 0.93, respectively). SWD was diagnosed in 57 (30.3%) of studied shift workers. The difference between SWD prevalence was not significant between different shift schedules (P value =0.13). Workers with SWD had higher ISI, ESS, and BDI-II score (P values <0.0001, <0.0001, and <0.0001, respectively) and workers without SWD had higher job satisfaction (p value = 0.04). Conclusion: SWD is considered as a serious health-related issue in Persian Gulf oil rig shift workers. Insomnia, daytime sleepiness, and depression are associated with SWD.
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Affiliation(s)
| | - Mohammad-Mehdi Mehrabinejad
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolkarim Hajighaderi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ania Rahimi-Golkhandan
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Zahabi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Research and Technology Department, National Iranian Drilling Company (NIDC), Ahvaz, Iran
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Feng F, Cai Y, Hou Y, Ou R, Jiang Z, Shang H. Excessive daytime sleepiness in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2021; 85:133-140. [PMID: 33637423 DOI: 10.1016/j.parkreldis.2021.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To provide a robust estimate of the prevalence of excessive daytime sleepiness (EDS) and its clinical correlates in patients with Parkinson's disease (PD). METHOD We searched the PubMed and Embase databases for studies investigating the prevalence and clinical correlates of EDS from inception to March 01, 2020. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale. Random-effects models were set to pool the risk estimates. Sensitivity analyses were performed to evaluate the stability of the outcomes. RESULTS After screening 1367 titles and abstracts, 59 studies involving 12,439 participants were included in the systematic review and meta-analysis. The pooled prevalence of EDS in PD was 35.1%, which was higher in South America, North America, Europe, and Australia than that in Asia. Compared to patients without EDS, patients with EDS had higher effect size on disease duration (0.76 years; 95% CI: 0.16-1.37, I2 = 68.8%), Hoehn and Yahr (HY) stage (0.23 grade; 95% CI: 0.11-0.34, I2 = 69.1%), Unified PD Rating Scale (UPDRS)-III (3.02 points; 95% CI: 1.53-4.51, I2: 61.2%), levodopa equivalent daily dose (LEDD) (141.46 mg; 95% CI: 64.17-218.77, I2 = 86.1%), depression symptoms (Hedges' g = 0.35; 95% CI: 0.15-0.55, I2 = 72.0%) and male sex (OR = 1.50; 95% CI: 1.30-1.72, I2 = 0). CONCLUSION Our results showed that approximately one-third of patients with PD had EDS, which may be associated with the severity of the disease, depression, and male sex, or a combination of neurodegeneration and medication.
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Affiliation(s)
- Fei Feng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - YingYing Cai
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - YanBing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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30
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Shi Y, Hu X, Cui J, Cui L, Huang J, Ma X, Jiang T, Yao X, Lan F, Li J, Bi Z, Li J, Wang Y, Fu H, Wang J, Lin Y, Bai J, Guo X, Tu L, Xu J. Clinical data mining on network of symptom and index and correlation of tongue-pulse data in fatigue population. BMC Med Inform Decis Mak 2021; 21:72. [PMID: 33627103 PMCID: PMC7905588 DOI: 10.1186/s12911-021-01410-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background Fatigue is a kind of non-specific symptom, which occurs widely in sub-health and various diseases. It is closely related to people's physical and mental health. Due to the lack of objective diagnostic criteria, it is often neglected in clinical diagnosis, especially in the early stage of disease. Many clinical practices and researches have shown that tongue and pulse conditions reflect the body's overall state. Establishing an objective evaluation method for diagnosing disease fatigue and non-disease fatigue by combining clinical symptom, index, and tongue and pulse data is of great significance for clinical treatment timely and effectively. Methods In this study, 2632 physical examination population were divided into healthy controls, sub-health fatigue group, and disease fatigue group. Complex network technology was used to screen out core symptoms and Western medicine indexes of sub-health fatigue and disease fatigue population. Pajek software was used to construct core symptom/index network and core symptom-index combined network. Simultaneously, canonical correlation analysis was used to analyze the objective tongue and pulse data between the two groups of fatigue population and analyze the distribution of tongue and pulse data. Results Some similarities were found in the core symptoms of sub-health fatigue and disease fatigue population, but with different node importance. The node-importance difference indicated that the diagnostic contribution rate of the same symptom to the two groups was different. The canonical correlation coefficient of tongue and pulse data in the disease fatigue group was 0.42 (P < 0.05), on the contrast, correlation analysis of tongue and pulse in the sub-health fatigue group showed no statistical significance. Conclusions The complex network technology was suitable for correlation analysis of symptoms and indexes in fatigue population, and tongue and pulse data had a certain diagnostic contribution to the classification of fatigue population.
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Affiliation(s)
- Yulin Shi
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Xiaojuan Hu
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Ji Cui
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Longtao Cui
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Jingbin Huang
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Xuxiang Ma
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Tao Jiang
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Xinghua Yao
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Fang Lan
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Jun Li
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Zijuan Bi
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Jiacai Li
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Yu Wang
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Hongyuan Fu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Jue Wang
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Yanting Lin
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Jingxuan Bai
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Xiaojing Guo
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China
| | - Liping Tu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China.
| | - Jiatuo Xu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai, China.
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Tinaz S, Kamel S, Aravala SS, Sezgin M, Elfil M, Sinha R. Distinct neural circuits are associated with subclinical neuropsychiatric symptoms in Parkinson's disease. J Neurol Sci 2021; 423:117365. [PMID: 33636663 DOI: 10.1016/j.jns.2021.117365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/24/2021] [Accepted: 02/18/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Parkinson's disease (PD) can present with neuropsychiatric symptoms (here, anxiety, depression, and apathy) at any stage of the disease. We investigated the neural correlates of subclinical neuropsychiatric symptoms in relation to motor and cognitive symptoms in a high-functioning PD cohort. METHODS Brain morphometry of the cognitively intact, early-stage (Hoehn & Yahr 2) PD group (n = 48) was compared to matched controls (n = 37). Whole-brain, pairwise, resting-state functional connectivity measures were correlated with neuropsychiatric symptom, motor exam, and global cognitive scores of the PD group. RESULTS Factor analysis of highly collinear anxiety, depression, and apathy scores revealed a single principal component (i.e., composite neuropsychiatric symptom score) explaining 71.6% of variance. There was no collinearity between the neuropsychiatric, motor, and cognitive scores. Compared to controls, PD group showed only subcortical changes including amygdala and nucleus accumbens atrophy, and greater pallidal volume. Reduced functional connectivity in the limbic cortical-striatal circuits and increased functional connectivity between the cerebellum and occipito-temporal regions were associated with a more impaired neuropsychiatric profile. This functional connectivity pattern was distinct from those associated with motor deficits and global cognitive functioning. The individual components of the neuropsychiatric symptoms also exhibited unique connectivity patterns. LIMITATIONS Patients were scanned in "on-medication" state only and a control group with similar neuropsychiatric symptoms was not included. CONCLUSION Abnormal functional connectivity of distinct neural circuits is present even at the subclinical stage of neuropsychiatric symptoms in PD. Neuropsychiatric phenotyping is important and may facilitate early interventions to "reorganize" these circuits and delay/prevent clinical symptom onset.
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Affiliation(s)
- Sule Tinaz
- Yale University School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA; Yale University School of Medicine, Clinical Neurosciences Imaging Center, 789 Howard Ave, New Haven, CT 06519, USA.
| | - Serageldin Kamel
- Yale University School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA
| | - Sai S Aravala
- Yale University School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA
| | - Mine Sezgin
- Yale University School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA; Istanbul University Faculty of Medicine, Department of Neurology, Millet Street, Fatih, Istanbul 34093, Turkey
| | - Mohamed Elfil
- Yale University School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA
| | - Rajita Sinha
- Yale School of Medicine, Yale Stress Center, 2 Church St South, Suite 209, New Haven, CT 06519, USA; Yale School of Medicine, Department of Psychiatry, 300 George St, New Haven, CT 06511, USA; Yale School of Medicine, Department of Neuroscience, 333 Cedar St, SHM-L-200, New Haven, CT 06510, USA
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Eglit GM, Lopez F, Schiehser DM, Pirogovsky‐Turk E, Litvan I, Lessig S, Filoteo JV. Delineation of Apathy Subgroups in Parkinson's Disease: Differences in Clinical Presentation, Functional Ability, Health-related Quality of Life, and Caregiver Burden. Mov Disord Clin Pract 2021; 8:92-99. [PMID: 33426163 PMCID: PMC7780962 DOI: 10.1002/mdc3.13127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Apathy is a prevalent, multidimensional neuropsychiatric condition in Parkinson's disease (PD). Several authors have proposed apathy subtypes in PD, but no study has examined the classification of PD patients into distinct apathy subtypes, nor has any study examined the clinical utility of doing so. OBJECTIVES The current study used a data-driven approach to explore the existence and associated clinical characteristics of apathy subtypes in PD. METHOD The Apathy Scale (AS) was administered to 157 non-demented individuals with PD. Participants were classified into apathy subgroups through cluster analysis. Differences among apathy subtypes on external clinical indicators were explored across apathy subgroups. RESULTS Individuals with PD were classified into three subgroups: a Non-Apathetic group with low levels of apathy symptoms, a Low Interest/Energy group, characterized by elevated symptoms of low interest/energy and minimal low initiation/emotional indifference symptoms, and a Low Initiation group, characterized by an absence of low interest/energy symptoms and elevated levels of low initiation/emotional indifference symptoms. Both Low Interest/Energy and Low Initiation groups exhibited worse depression, fatigue, anxiety, health-related quality of life, and caregiver burden than the Non-Apathetic subgroup. The Low Initiation group exhibited worse overall cognition, emotional well-being, state anxiety, communicative ability, and functional ability than the Low Interest/Energy group. Importantly, disease-related characteristics did not differ across apathy symptom subgroups. CONCLUSIONS Non-demented PD patients can be separated into distinct apathy symptom subgroups, which are differentially associated with important clinical variables. Apathy subgroup membership may reflect disruption to different neural systems independent of disease progression.
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Affiliation(s)
- Graham M.L. Eglit
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Sam and Rose Stein Institute for Research on AgingUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Francesca Lopez
- Psychology and Research ServicesVeterans Administration San Diego Health Care SystemSan DiegoCaliforniaUSA
| | - Dawn M. Schiehser
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Psychology and Research ServicesVeterans Administration San Diego Health Care SystemSan DiegoCaliforniaUSA
| | - Eva Pirogovsky‐Turk
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Irene Litvan
- Department of Neurosciences, Movement Disorder CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Stephanie Lessig
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Neurosciences, Movement Disorder CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - J. Vincent Filoteo
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Psychology and Research ServicesVeterans Administration San Diego Health Care SystemSan DiegoCaliforniaUSA
- Department of Neurosciences, Movement Disorder CenterUniversity of California San DiegoLa JollaCaliforniaUSA
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Saksvik SB, Karaliute M, Kallestad H, Follestad T, Asarnow R, Vik A, Håberg AK, Skandsen T, Olsen A. The Prevalence and Stability of Sleep-Wake Disturbance and Fatigue throughout the First Year after Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:2528-2541. [PMID: 32460623 PMCID: PMC7698981 DOI: 10.1089/neu.2019.6898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In this prospective, longitudinal study, we aimed to determine the prevalence and stability of sleep-wake disturbance (SWD) and fatigue in a large representative sample of patients (Trondheim mild traumatic brain injury [mTBI] follow-up study). We included 378 patients with mTBI (age 16-60), 82 matched trauma controls with orthopedic injuries, and 83 matched community controls. Increased sleep need, poor sleep quality, excessive daytime sleepiness, and fatigue were assessed at 2 weeks, 3 months, and 12 months after injury. Mixed logistic regression models were used to evaluate clinically relevant group differences longitudinally. Prevalence of increased sleep need, poor sleep quality, and fatigue was significantly higher in patients with mTBI than in both trauma controls and community controls at all time points. More patients with mTBI reported problems with excessive daytime sleepiness compared to trauma controls, but not community controls, at all time points. Patients with complicated mTBI (intracranial findings on computed tomography or magnetic resonance imaging) had more fatigue problems compared to those with uncomplicated mTBI, at all three time points. In patients with mTBI who experienced SWDs and fatigue 2 weeks after injury, around half still had problems at 3 months and approximately one third at 12 months. Interestingly, we observed limited overlap between the different symptom measures; a large number of patients reported one specific problem with SWD or fatigue rather than several problems. In conclusion, our results provide strong evidence that mTBI contributes significantly to the development and maintenance of SWDs and fatigue.
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Affiliation(s)
- Simen Berg Saksvik
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Migle Karaliute
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Robert Asarnow
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Han V, Skorvanek M, Smit M, Turcanova Koprusakova M, Hoekstra T, Dijk JP, Tijssen MA, Gdovinova Z, Reijneveld SA. Prevalence of non-motor symptoms and their association with quality of life in cervical dystonia. Acta Neurol Scand 2020; 142:613-622. [PMID: 32579704 DOI: 10.1111/ane.13304] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Non-motor symptoms (NMS) are commonly present along with motor impairment in patients with cervical dystonia (CD) and have a significant impact on health-related quality of life (HRQoL). However, the prevalence of NMS and their association with dystonia are still unclear. The aim of our study was to assess the prevalence of depression, anxiety, fatigue, apathy, pain, sleep problems, and excessive daytime sleepiness (EDS) in CD using different evaluation approaches and to explore their association with HRQoL relative to that of motor symptoms. MATERIALS AND METHODS We enrolled 102 Slovak patients with CD. The severity of both motor and non-motor symptoms was assessed using validated scales. HRQoL was determined by the 36-item Short Form Health Survey (SF-36). Association of NMS with poor HRQoL was assessed using multiple regressions. RESULTS The most frequent NMS in our sample were sleep impairment (67.3%), anxiety (65.5%), general and physical fatigue (57.5% and 52.9%, respectively), depression (47.1%), mental fatigue (31.4%), apathy (30.4%), reduced activity (29.4%), EDS (20.2%), and reduced motivation (18.6%). Univariate analysis showed that NMS, but not motor symptoms, were significantly linked to poor HRQoL, with EDS being most commonly associated with poor HRQoL, followed by disrupted sleep, depression, and fatigue. CONCLUSIONS The prevalence of NMS among patients with CD is high, and some NMS are strongly associated with poor HRQoL, while motor impairment was not associated with the severity of NMS or poor HRQoL. Actively diagnosing and treating NMS should therefore be a routine part of the clinical management of patients with CD.
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Affiliation(s)
- Vladimir Han
- Department of Neurology Faculty of Medicine Safarik University Kosice Slovakia
- Department of Neurology University Hospital L. Pasteur Kosice Slovakia
- Graduate School Kosice Institute for Society and Health Faculty of Medicine Safarik University Kosice Slovakia
| | - Matej Skorvanek
- Department of Neurology Faculty of Medicine Safarik University Kosice Slovakia
- Department of Neurology University Hospital L. Pasteur Kosice Slovakia
| | - Marenka Smit
- Department of Neurology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Monika Turcanova Koprusakova
- Department of Neurology University Hospital in Martin Martin Slovakia
- Department of Neurology Jessenius Faculty of Medicine Comenius University in Bratislava Martin Slovakia
| | - Tialda Hoekstra
- Department of Community and Occupational Medicine University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
| | - Jitse P. Dijk
- Graduate School Kosice Institute for Society and Health Faculty of Medicine Safarik University Kosice Slovakia
- Department of Community and Occupational Medicine University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
| | - Marina A.J. Tijssen
- Department of Neurology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Zuzana Gdovinova
- Department of Neurology Faculty of Medicine Safarik University Kosice Slovakia
- Department of Neurology University Hospital L. Pasteur Kosice Slovakia
| | - Sijmen A. Reijneveld
- Department of Community and Occupational Medicine University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
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Parrotta I, Maltais M, Rolland Y, Spampinato DA, Robert P, de Souto Barreto P, Vellas B. The association between apathy and frailty in older adults: a new investigation using data from the Mapt study. Aging Ment Health 2020; 24:1985-1989. [PMID: 31411039 DOI: 10.1080/13607863.2019.1650890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Apathy is a behavioral syndrome that has been suggested to share similar neuro-physiological pathways with frailty. OBJECTIVE To investigate the cross-sectional association between apathy and frailty using original data from dementia-free, community-dwelling older adults. METHOD A cross-sectional analysis was performed to test the association between frailty (according to Fried's frailty phenotype) and apathy (defined by three items from Geriatric Depression Scale) using data from MAPT, a 3-year, randomized, multicenter, placebo-controlled trial among community-dwelling, dementia-free participants (1.679 individuals with mean age of 75 years). RESULTS The ordinal logistic regression showed that apathetic individuals had a two-fold more probability to be rated as frail (OR 2.20, 95% CI 1.7-2.9), when adjusting for confounders. Apathetic individuals display a two-fold more likelihood to be rated as pre-frail (RRR 2.1; 95% CI 1.5-2.8) and a three-fold higher probability to be rated as frail (RRR 3.5, 95% CI 1.8-6.9) compared to robust participants. CONCLUSION Although data on the associations between apathy and frailty are scarce, these conditions potentially shares physiological mechanisms and were found to be closely associated. Temporal association between frailty and apathy deserve to be further investigated.
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Affiliation(s)
- Ilaria Parrotta
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,Faculty of Medicine and Dentistry, La Sapienza Università di Roma, Roma, Italy
| | - Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Danny A Spampinato
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London
| | | | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
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Cohen ET, Karpatkin HI, DiCarrado S, Zervas M. A clinical reasoning framework for fatigue for neurologic physical therapy. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1834329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Evan T. Cohen
- Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Blackwood, NJ, USA
| | - Herb I. Karpatkin
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | | | - Michael Zervas
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
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Wuqinxi Exercise Improves Hand Dexterity in Patients with Parkinson's Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8352176. [PMID: 33178323 PMCID: PMC7644302 DOI: 10.1155/2020/8352176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/19/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022]
Abstract
Objective This study was designed to evaluate the effect of Wuqinxi after one session and 12-week intervention on hand dexterity in patients with Parkinson's disease (PD). Methods Forty-six elderly participants with mild-to-moderate PD were randomly assigned to the groups trained with Wuqinxi (n = 23) or stretching (n = 23). All participants practiced 60 min session of either of these exercises, 2 sessions a week for 12 weeks in standing position. The score of Purdue Pegboard Test (PPT) and time for Soda Pop Test (SPT) were performed to assess hand dexterity and motor function along assessing the 39 items of Parkinson's Disease Questionnaire before and after 12-week interventions. In addition, the PPT scores were compared before vs. after one session of either of these two exercise modes. Results Single session with either Wuqinxi or stretching exercise tended to improve PPT scores in PD patients. Furthermore, the improved SPT time was significant (P < 0.01) following 12-week training interventions with Wuqinxi (−1.32 ± 0.38 sec) or stretching (−0.89 ± 0.16 sec), which showed no group difference (P=0.734). However, only the participants in Wuqinxi group significantly improved the PPT scores of the dominant hand (+0.61 ± 1.34), both hand (+1.83 ± 3.13) and assemble (+2.04 ± 3.44) performance after 12-week training intervention. In parallel with improved hand dexterity and motor function, 12-week Wuqinxi training also significantly improved the patient's emotional wellbeing. Conclusion The Wuqinxi intervention could be safely and effectively applied to improve hand dexterity following single-session exercise or 12-week training, which were accompanied by improved quality of life in patients with mild-to-moderate PD.
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Hezemans FH, Wolpe N, Rowe JB. Apathy is associated with reduced precision of prior beliefs about action outcomes. J Exp Psychol Gen 2020; 149:1767-1777. [PMID: 32039624 PMCID: PMC7397861 DOI: 10.1037/xge0000739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023]
Abstract
Apathy is a debilitating syndrome that is associated with reduced goal-directed behavior. Although apathy is common and detrimental to prognosis in many neuropsychiatric diseases, its underlying mechanisms remain controversial. We propose a new model of apathy, in the context of Bayesian theories of brain function, whereby actions require predictions of their outcomes to be held with sufficient precision for "explaining away" differences in sensory inputs. In the active inference model, apathy results from reduced precision of prior beliefs about action outcomes. We tested this hypothesis using a visuomotor task in healthy adults (N = 47), with experimental manipulation of physical effort and financial reward. Bayesian modeling of performance and participants' perception of their performance was used to infer the precision of their priors. We confirmed that the perception of performance was biased toward the target, which was accounted for by relatively precise prior beliefs about action outcomes. These priors were consistently more precise than the corresponding performance distribution, and were scaled to effort and reward. Crucially, prior precision was negatively associated with trait apathy, suggesting that apathetic individuals had less precise prior beliefs about action outcomes. The results support a Bayesian account of apathy that could inform future studies of clinical populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Frank H Hezemans
- Medical Research Council (MRC) Cognition, University of Cambridge
| | - Noham Wolpe
- Medical Research Council (MRC) Cognition, University of Cambridge
| | - James B Rowe
- Medical Research Council (MRC) Cognition, University of Cambridge
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Lu ZH, Chen YK, Fu XL, Liu YL, Qu JF, Xiao WM. Global cortical atrophy may be associated with fatigue in patients with parkinson's disease. J Clin Neurosci 2020; 79:172-177. [PMID: 33070891 DOI: 10.1016/j.jocn.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Fatigue has been recognized as a common non-motor problem in patients with Parkinson's disease (PD). The determination of the clinical correlates of fatigue in PD patients is necessary. The purpose of this study was to explore the risk factors related to the severity of fatigue in PD. PATIENTS AND METHODS In this study, 141 patients with PD were recruited. All patients were evaluated comprehensively, including motor function, fatigue severity scale (FSS), cognition and psychiatric status. Brain magnetic resonance imaging (MRI) examinations were performed to assess the severity of white matter hyperintensities, and the presence of silent lacunes, medial temporal lobe atrophy (MTLA), and global cortical atrophy (GCA). The crude associations of variables with FSS were examined using Pearson (nor-mally distributed) or Spearman correlation (categorical or non-normal distributed) analyses. Multiple linear regression analysis was performed to find the correlates of fatigue severity in PD patients. RESULTS In the whole sample, with FSS as the dependent variable in a linear regression model, Hamilton Depression Rating Scale (HAM-D), GCA, female sex were significant correlates of FSS, accounting for 24% of the variance of it. When subjects with depression (HAM-D ≥ 35) were excluded, HAM-D, GCA, female sex remained significant correlates of FSS, accounting for 22% of the variance of FSS. There is no correlation between white matter hyperintensities and FSS. CONCLUSION GCA may be an important correlate of the fatigue severity commonly observed in PD patients.
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Affiliation(s)
- Zhi-Hao Lu
- Department of Neurology, the Affiliated Dongguan Hospital, South Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, China; Graduate School, Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Yang-Kun Chen
- Department of Neurology, the Affiliated Dongguan Hospital, South Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, China.
| | - Xiao-Li Fu
- Department of Neurology, the Affiliated Dongguan Hospital, South Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, the Affiliated Dongguan Hospital, South Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, the Affiliated Dongguan Hospital, South Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, China
| | - Wei-Min Xiao
- Department of Neurology, the Affiliated Dongguan Hospital, South Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, China
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40
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Lacourt TE, Heijnen CJ, Manzullo EF, Escalante C. A central role for apathy in the effectiveness of interventions for cancer-related fatigue. Psychooncology 2020; 29:1613-1619. [PMID: 32658377 PMCID: PMC10406137 DOI: 10.1002/pon.5476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) affects a substantial number of cancer patients and survivors. Recommendations for CRF treatments are largely based on results of randomized controlled trials. The interpretability of such results is limited to patients eligible and willing to participate in these trials. We aimed to address this limitation in a retrospective study of patients seen at a CRF clinic in a comprehensive cancer center. The objectives were to (a) determine the effectiveness of clinician-initiated interventions for CRF and identify their mediators and (b) describe the frequency and effectiveness of patient-initiated physical activity (PA) behavior for alleviating CRF and identify determinants of this PA. METHODS Data (patient-reported somatic and mood symptoms; clinical data; clinician-documented changes in medication and behavior) from n = 213 patients collected as part of the clinic's standard of care at initial clinical consult and follow-up 4 to 11 weeks later were included. Effects of clinician-initiated interventions and patient-initiated PA on change in fatigue were analyzed using linear models. RESULTS Of all clinician-initiated interventions, only psychostimulant start was recorded frequent enough for further investigation and was associated with reduced fatigue; this association was mediated by a reduction in apathy. PA was also associated with reduced fatigue severity. PA initiation/increase after consult was associated with lower apathy at consult. CONCLUSIONS These results demonstrate a major role for patient apathy in the effectiveness and initiation of CRF-targeting interventions. Behavioral therapies focusing on reduction in apathy should be considered as initial treatment of CRF in those with substantial apathy.
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Affiliation(s)
- Tamara E Lacourt
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cobi J Heijnen
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ellen F Manzullo
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carmen Escalante
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Vachez Y, Carcenac C, Magnard R, Kerkerian‐Le Goff L, Salin P, Savasta M, Carnicella S, Boulet S. Subthalamic Nucleus Stimulation Impairs Motivation: Implication for Apathy in Parkinson's Disease. Mov Disord 2020; 35:616-628. [DOI: 10.1002/mds.27953] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yvan Vachez
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Carole Carcenac
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Robin Magnard
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | | | | | - Marc Savasta
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Sebastien Carnicella
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Sabrina Boulet
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
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Parikh S, Galioto R, Lapin B, Haas R, Hirano M, Koenig MK, Saneto RP, Zolkipli-Cunningham Z, Goldstein A, Karaa A. Fatigue in primary genetic mitochondrial disease: No rest for the weary. Neuromuscul Disord 2019; 29:895-902. [DOI: 10.1016/j.nmd.2019.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 01/05/2023]
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Association between fatigue and motor progression in Parkinson's disease in southern Chinese. Neurol Sci 2019; 41:161-164. [PMID: 31485861 PMCID: PMC6940320 DOI: 10.1007/s10072-019-04059-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/28/2019] [Indexed: 01/06/2023]
Abstract
Study objectives The aim was to investigate whether fatigue could predict the development of motor symptoms of Parkinson’s disease (PD) in a southern Chinese population. Methods In total, 246 PD patients were recruited. All patients were evaluated by Fatigue Severity Scale (FSS), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Unified PD Rating Scale provided by Movement Disorders Society (MDS-UPDRS). MDS-UPDRS was re-evaluated after 2 years. Results FSS scores were associated with total score and subparts of MDS-UPDRS (total: p 0.039, p 0.030, adjusted; part III: p 0.022, p 0.016, adjusted). Conclusions The symptom of subjective fatigue could predict the progression of PD.
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Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
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Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
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45
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Fatigue in Parkinson's disease: Italian validation of the Parkinson Fatigue Scale and the Fatigue Severity Scale using a Rasch analysis approach. Parkinsonism Relat Disord 2019; 65:105-110. [DOI: 10.1016/j.parkreldis.2019.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/17/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022]
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Straka I, Minár M, Škorvánek M, Grofik M, Danterová K, Benetin J, Kurča E, Gažová A, Boleková V, Wyman-Chick KA, Kyselovič J, Valkovič P. Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication. Front Neurol 2019; 10:799. [PMID: 31417484 PMCID: PMC6684743 DOI: 10.3389/fneur.2019.00799] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/11/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Once-daily treatment formulation is associated with better adherence in comparison to more complex medication regimens. The study aimed to detect the extent of adherence to pharmacotherapy in Parkinson disease (PD) patients who take a minimum of three daily doses of drugs, and to identify factors associated with lower levels of adherence. Methods: The cohort was selected from non-demented PD patients. The 8-Item Morisky Medication Adherence Scale (MMAS-8), 8-Item Parkinson's Disease Questionnaire (PDQ-8), Geriatric Depression Scale (GDS), Non-Motor Symptom Assessment Scale (NMSS), 9-Item Wearing-off Questionnaire (WOQ-9), MDS-UPDRS III (motor examination), and IV (motor complications) scales were used in this study. Results: From a total of 124 subjects, 33.9% reported a high level of adherence, 29.8% reported a medium level of adherence, and 36.3% reported a low level of adherence to their pharmacotherapy. The level of non-adherence correlated with gender, longer disease duration, higher scores of PDQ-8, NMSS, WOQ-9, and MDS-UPDRS IV. Detailed analysis of NMSS demonstrated a correlation between the level of adherence and domains sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, and urinary symptoms. Independent risk factors for non-adherence were excessive daytime sleepiness, anhedonia, and forgetfulness. Conclusion: Non-adherence to more complicated medication regimens is frequent in PD patients and is associated with gender, longer PD duration, poorer quality of life, frequency and severity of non-motor symptoms, and more severe motor and non-motor fluctuations. Non-adherence was predicted by non-motor symptoms including fatigue, mood disturbances, and subjective cognitive complaints.
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Affiliation(s)
- Igor Straka
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Michal Minár
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Matej Škorvánek
- Department of Neurology, Pavol Jozef Safarik University in Kosice Faculty of Medicine, University Hospital of Louis Pasteur, Košice, Slovakia
| | - Milan Grofik
- Department of Neurology, Comenius University in Bratislava Jessenius Faculty of Medicine in Martin, University Hospital Martin, Martin, Slovakia
| | - Katarína Danterová
- Department of Neurology, University Hospital Bratislava, Slovak Medical University, Bratislava, Slovakia
| | - Ján Benetin
- Department of Neurology, University Hospital Bratislava, Slovak Medical University, Bratislava, Slovakia
| | - Egon Kurča
- Department of Neurology, Comenius University in Bratislava Jessenius Faculty of Medicine in Martin, University Hospital Martin, Martin, Slovakia
| | - Andrea Gažová
- Comenius University in Bratislava Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Bratislava, Slovakia
| | - Veronika Boleková
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.,Pan-European University Faculty of Psychology, Institute of Clinical Psychology, Bratislava, Slovakia
| | | | - Ján Kyselovič
- Fifth Department of Internal Medicine, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Valkovič
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.,Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
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Park HY, Lee JH, Lee SY, Yu DS, Han KD, Park YG, Lee YB. Risk for Parkinson's Disease in Patients with Behçet's Disease: A Nationwide Population-Based Dynamic Cohort Study in Korea. JOURNAL OF PARKINSONS DISEASE 2019; 9:583-589. [PMID: 31227655 DOI: 10.3233/jpd-191622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although several studies have reported a correlation between Behçet's disease (BD) and Parkinson's disease, this association has not yet been clarified. OBJECTIVE To determine the risk of Parkinson's disease in patients with BD. METHODS BD patients (n = 17,179; mean age, 51.12±8.09 years; male, 34.95%) without known previous diagnosis of Parkinson's disease were selected from the Korean National Health Insurance Database between 2010 and 2013. An age- and gender-matched control population of individuals without BD was randomly sampled at a ratio of 3:1 (n = 34,575). Both cohorts were followed for development of Parkinson's disease until 2015. RESULTS Among a total of 11,525 BD patients, 50 (0.43%) developed Parkinson's disease, whereas only 51 among the 34,575 individuals in the non-BD group developed Parkinson's (0.15%, P < 0.0001). The incidence of Parkinson's disease was significantly higher in BD patients than in controls. In addition, during the follow-up period, patients with BD were more likely to be diagnosed with Parkinson's disease than those in the non-BD group. CONCLUSIONS BD patients had a higher risk of Parkinson's disease compared to non-BD controls. Physicians should carefully monitor patients with BD for potential development of Parkinson's disease.
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Affiliation(s)
- Ho Youn Park
- Department of Orthopedics, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Hee Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Young Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Soo Yu
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Psychometric Properties of the Apathy Scale in Advanced Parkinson's Disease. PARKINSONS DISEASE 2019; 2019:1965394. [PMID: 31031906 PMCID: PMC6458845 DOI: 10.1155/2019/1965394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 11/18/2022]
Abstract
Objectives To assess the psychometric attributes of the Apathy Scale- (AS-) Spanish version in patients with advanced Parkinson's disease (APD). Materials and Methods Over 6 months, 61 patients participated in a clinical study of levodopa-carbidopa intestinal gel (LCIG) and were evaluated using the AS and other clinical tools. Various psychometric attributes of the AS were assessed. Results Patients (60.7% men) were aged 68.02 ± 7.43 years, with 12.57 ± 5.97 years from PD diagnosis. Median HY of patients in “on state” was 2 (range, 1–4), and mean levodopa equivalent daily dose was 1455.98 ± 456.00 mg. Overall, the parameters of feasibility/acceptability were satisfactory, except for a moderate-to-high floor effect in AS items but not in its total score (both 3.3%). Cronbach's alpha was 0.78, while item homogeneity coefficient was 0.21. Almost all items (11/14) reached acceptable item-total corrected correlations (rS = 0.16–0.50). AS total score was moderately correlated with Beck Depression Inventory (0.34) and with Non-Motor Symptoms Scale domains 2 (sleep/fatigue, 0.35), 3 (mood/apathy, 0.56), and 5 (attention/memory, 0.41). There were no significant differences between AS total scores by established groups of sex, time from diagnosis, HY, and Clinical Global Impression-Severity Scale. Following LCIG treatment, there was no significant change in the AS total score. The relative change was 5.56%, the standard error of the difference was 4.17, and Cohen's d effect was 0.10. Conclusions The AS showed satisfactory feasibility, acceptability, scaling assumptions, internal consistency, and convergent validity. Responsiveness parameters were poor, probably due to the characteristics of the clinical study from which these data came. This trial is registered with NCT02289729.
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Connor KI, Cheng EM, Barry F, Siebens HC, Lee ML, Ganz DA, Mittman BS, Connor MK, Edwards LK, McGowan MG, Vickrey BG. Randomized trial of care management to improve Parkinson disease care quality. Neurology 2019; 92:e1831-e1842. [PMID: 30902908 PMCID: PMC6550506 DOI: 10.1212/wnl.0000000000007324] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/26/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test effects on care quality of Chronic Care Model-based Parkinson disease (PD) management. METHODS This 2-group stratified randomized trial involved 328 veterans with PD in southwestern United States. Guided care management, led by PD nurses, was compared to usual care. Primary outcomes were adherence to 18 PD care quality indicators. Secondary outcomes were patient-centered outcome measures. Data sources were telephone survey and electronic medical record (EMR). Outcomes were analyzed as intent-to-treat comparing initial and final survey and repeated-measures mixed-effects models. RESULTS Average age was 71 years; 97% of participants were male. Mean proportion of participants receiving recommended PD care indicators was significantly higher for the intervention than for usual care (0.77 vs 0.58) (mean difference 0.19, 95% confidence interval [CI] 0.16, 0.22). Of 8 secondary outcomes, the only significant difference of the changes over time was in the positive Patient Health Questionnaire-2 depression screen for intervention minus usual care (-11.52 [95% CI -20.42, -2.62]). CONCLUSION A nurse-led chronic care management intervention, Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS), substantially increased adherence to PD quality of care indicators among veterans with PD, as documented in the EMR. Of 8 secondary outcomes assessed, a screening measure for depressive symptomatology was the only measure that was better in the intervention compared to usual care. More telephone calls in CHAPS were the only utilization difference over usual care. While CHAPS appears promising for improving PD care, additional iterative research is needed to refine the CHAPS model in routine clinical care so that it measurably improves patient-centered outcomes (NCT01532986). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with PD, CHAPS increased adherence to PD quality of care indicators.
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Affiliation(s)
- Karen I Connor
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY.
| | - Eric M Cheng
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Frances Barry
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Hilary C Siebens
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Martin L Lee
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - David A Ganz
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Brian S Mittman
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Megan K Connor
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Lisa K Edwards
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Michael G McGowan
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
| | - Barbara G Vickrey
- From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY
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Pharmacological treatment of apathy in Lewy body disorders: A systematic review. Parkinsonism Relat Disord 2019; 60:14-24. [DOI: 10.1016/j.parkreldis.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 11/03/2018] [Indexed: 12/27/2022]
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