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Lyu S, Zhang CS, Mao Z, Guo X, Li Z, Luo X, Sun J, Su Q. Real-world Chinese herbal medicine for Parkinson's disease: a hospital-based retrospective analysis of electronic medical records. Front Aging Neurosci 2024; 16:1362948. [PMID: 38756536 PMCID: PMC11096516 DOI: 10.3389/fnagi.2024.1362948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Parkinson's disease (PD) is a progressive neurodegenerative condition. Chinese medicine therapies have demonstrated effectiveness for PD in controlled settings. However, the utilization of Chinese medicine therapies for PD in real-world clinical practice and the characteristics of patients seeking these therapies have not been thoroughly summarized. Method The study retrospectively analyzed initial patient encounters (PEs) with a first-listed diagnosis of PD, based on electronic medical records from Guangdong Provincial Hospital of Chinese Medicine between July 2018 and July 2023. Results A total of 3,206 PEs, each corresponding to an individual patient, were eligible for analyses. Approximately 60% of patients made initial visits to the Chinese medicine hospital after receiving a PD diagnosis, around 4.59 years after the onset of motor symptoms. Over 75% of the patients visited the Internal Medicine Outpatient Clinic at their initial visits, while a mere 13.85% visited PD Chronic Care Clinic. Rest tremor (61.98%) and bradykinesia (52.34%) are the most commonly reported motor symptoms, followed by rigidity (40.70%). The most commonly recorded non-motor symptoms included constipation (31.88%) and sleep disturbance (25.27%). Integration of Chinese medicine and conventional medicine therapies was the most common treatment method (39.15%), followed by single use of Chinese herbal medicine (27.14%). The most frequently prescribed herbs for PD included Glycyrrhiza uralensis Fisch. (gan cao), Astragalus mongholicus Bunge (huang qi), Atractylodes macrocephala Koidz. (bai zhu), Angelica sinensis (Oliv.) Diels (dang gui), Rehmannia glutinosa (Gaertn.) DC. (di huang), Paeonia lactiflora Pall. (bai shao), Bupleurum chinense DC. (chai hu), Citrus aurantium L. (zhi qiao/zhi shi/chen pi), Panax ginseng C. A. Mey. (ren shen), and Poria cocos (Schw.) Wolf (fu ling). These herbs contribute to formulation of Bu zhong yi qi tang (BZYQT). Conclusion Patients typically initiated Chinese medical care after the establishment of PD diagnosis, ~4.59 years post-onset of motor symptoms. The prevalent utilization of CHM decoctions and patented Chinese herbal medicine products, underscores its potential in addressing both motor and non-motor symptoms. Despite available evidence, rigorous clinical trials are needed to validate and optimize the integration of CHM, particularly BZYQT, into therapeutic strategies for PD.
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Affiliation(s)
- Shaohua Lyu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Claire Shuiqing Zhang
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Zhenhui Mao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Zhe Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xiaodong Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jingbo Sun
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Qiaozhen Su
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
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Swallow DMA, Counsell CE. The evolution of diagnosis from symptom onset to death in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) compared to Parkinson’s disease (PD). J Neurol 2023:10.1007/s00415-023-11629-x. [DOI: 10.1007/s00415-023-11629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
Misdiagnosis and delayed diagnosis in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are common. Few studies have systematically evaluated the diagnostic process from symptom onset to death in representative cohorts.
Methods
All PSP/CBD cases (n = 28/2) and age-sex matched Parkinson’s disease (PD) cases (n = 30) were identified from a UK prospective incident Parkinsonism cohort. Medical and research records were reviewed to compare median times from first index symptom to key diagnostic milestones and the nature/timing of secondary care referral and review.
Results
Index symptoms were similar apart from more tremor in PD (p < 0.001) and more impaired balance (p = 0.008) and falls (p = 0.004) in PSP/CBD. PD was diagnosed a median 0.96 years after index symptom. In PSP/CBD the median times from index symptom to identifying parkinsonism and then including PSP/CBD in the differential diagnosis and the final diagnosis were 1.88, 3.41 and 4.03 years, respectively (all p < 0.001). Survival from symptom onset in PSP/CBD and PD was not significantly different (5.98 vs 6.85 years, p = 0.72). More diagnoses (p < 0.001) were considered in PSP/CBD. Prior to diagnosis, PSP/CBD patients had more recurrent emergency attendances (33.3% vs 10.0%, p = 0.01) and were referred to more specialities than PD (median 5 vs 2). Time to any outpatient referral (0.70 vs 0.03 years, p = 0.025) and to specialist movement disorder review (1.96 vs 0.57 years, p = 0.002) was longer in PSP/CBD.
Conclusions
The duration and complexity of the diagnostic journey were greater in PSP/CBD than age-sex matched PD but can be improved. In this older cohort, there was little difference in survival from symptom onset in PSP/CBD and age-sex matched PD.
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Nomoto M, Tsuda H, Yamato K, Arai M. The Assessment of the Diagnostic Delay in Japanese People with Parkinson's Disease Using a Web-based Survey of Patients and Physicians. Intern Med 2023; 62:839-847. [PMID: 36928276 PMCID: PMC10076140 DOI: 10.2169/internalmedicine.8527-21] [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] [Indexed: 03/15/2023] Open
Abstract
Objective Although diagnostic criteria of Parkinson's disease (PD) have been established, the details of the process by which patients notice symptoms, visit a physician, and receive a diagnosis of PD is unclear. We therefore explored factors influencing latency in diagnosing PD. Methods We performed an internet-based survey of patients with PD and their families as well as physicians treating patients with PD to identify any diagnostic latency and its determinants. Evaluated factors included motor and non-motor symptoms, the diagnosis history and symptoms, patients' feelings toward PD prior to the diagnosis, and physician-determined reasons for the diagnostic delay. Results Among the 186 eligible patient respondents (including 87 responses from family members of patients), 24% received a PD diagnosis >1 year after the onset of PD-related symptoms, 58.6% had mid- or late-stage PD at the diagnosis, and 29% of patients had initially thought their symptoms were common age-related phenomena. Tremor (42%) was the most frequent symptom that led patients to visit a medical institution, whereas gait disturbance (14%) was the least frequent. More patients diagnosed with early-stage PD than those diagnosed with mid- or late-stage PD consulted a neurologist at their first visit. Among the 331 eligible physicians, patients' misinterpretation of their symptoms as being age-related was deemed one of or the most common cause (s) of a diagnostic delay by 67% and 36%, respectively. Conclusion Patients' insufficient or misinterpreted information about PD may cause delays in accessing healthcare services, leading to diagnostic delay.
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Affiliation(s)
- Masahiro Nomoto
- Saiseikai Imabari Center for Health and Welfare, Japan
- Neurology, Clinical Trial Research Center, Imabari Hospital, Japan
- Department of Neurology and Clinical Pharmacology, School of Medicine, Ehime University, Japan
| | - Hiroshi Tsuda
- Department of Neurology, Faculty of Medicine, Toho University, Japan
- Department of Neurology, Juntendo University School of Medicine, Japan
- Japan Medical Office, Takeda Pharmaceutical, Company Limited, Japan
| | - Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical, Company Limited, Japan
| | - Masaki Arai
- Japan Medical Office, Takeda Pharmaceutical, Company Limited, Japan
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Early diagnosis of Parkinson's disease using Continuous Convolution Network: Handwriting recognition based on off-line hand drawing without template. J Biomed Inform 2022; 130:104085. [DOI: 10.1016/j.jbi.2022.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/18/2022] [Accepted: 04/25/2022] [Indexed: 11/21/2022]
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Kuusimäki T, Sainio J, Kurki S, Vahlberg T, Kaasinen V. Prediagnostic expressions in health records predict mortality in Parkinson's disease: A proof-of-concept study. Parkinsonism Relat Disord 2022; 95:35-39. [PMID: 34998147 DOI: 10.1016/j.parkreldis.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The relationship of prodromal markers of PD with PD mortality is unclear. Electronic health records (EHRs) provide a large source of raw data that could be useful in the identification of novel relevant prognostic factors in PD. We aimed to provide a proof of concept for automated data mining and pattern recognition of EHRs of PD patients and to study associations between prodromal markers and PD mortality. METHODS Data from EHRs of PD patients (n = 2522) were collected from the Turku University Hospital database between 2006 and 2016. The data contained >27 million words/numbers and >750000 unique expressions. The 5000 most common words were identified in three-year time period before PD diagnosis. Cox regression was used to investigate the association of expressions with the 5-year survival of PD patients. RESULTS During the five-year period after PD diagnosis, 839 patients died (33.3%). If expressions associated with psychosis/hallucinations were identified within 3 years before the diagnosis, worse survival was observed (hazard ratio = 1.71, 95%CI = 1.46-1.99, p < 0.001). Similar effects were observed for words associated with cognition (1.23, 1.05-1.43, p = 0.009), constipation (1.34, 1.15-1.56, p = 0.0002) and pain (1.34, 1.12-1.60, p = 0.001). CONCLUSIONS Automated mining of EHRs can predict relevant clinical outcomes in PD. The approach can identify factors that have previously been associated with survival and detect novel associations, as observed in the link between poor survival and prediagnostic pain. The significance of early pain in PD prognosis should be the focus of future studies with alternate methods.
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Affiliation(s)
- Tomi Kuusimäki
- Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter, Turku University Hospital, Turku, Finland.
| | - Jani Sainio
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Valtteri Kaasinen
- Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter, Turku University Hospital, Turku, Finland
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Poortvliet PC, Gluch A, Silburn PA, Mellick GD. The Queensland Parkinson's Project: An Overview of 20 Years of Mortality from Parkinson's Disease. J Mov Disord 2021; 14:34-41. [PMID: 33278869 PMCID: PMC7840238 DOI: 10.14802/jmd.20034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The consensus is that life expectancy for individuals with Parkinson's disease (PD) is reduced, but estimations vary. We aimed to provide an overview of 20 years of mortality and risk factor data from the Queensland Parkinson's Project. METHODS The analysis included 1,334 PD and 1,127 control participants. Preliminary analysis of baseline characteristics (sex, age at onset, family history, smoking status, pesticide exposure, depression and neurosurgery) was conducted, and Kaplan-Meier curves were generated for each potential risk factor. Standardized mortality ratios (SMRs) were calculated comparing this cohort to the general Australian population. Cox proportional hazards regression modeling was used to analyze potential predictors of mortality. RESULTS In total, 625 (46.8%) PD and 237 (21.0%) control participants were deceased. Mean disease duration until death was 15.3 ± 7.84 years. Average ages at death were 78.0 ± 7.4 years and 80.4 ± 8.4 years for the deceased PD and control participants, respectively. Mortality was significantly increased for PD in general {SMR = 2.75 [95% confidence interval (CI): 2.53-2.96]; p = 0.001}. SMRs were slightly higher for women and those with an age of onset before 60 years. Multivariate analysis showed that deep brain stimulation (DBS) treatment was associated with lower mortality [hazard ratio (HR) = 0.76; 95% CI: 0.59-0.98], while occasional pesticide exposure increased mortality risk (HR = 1.48; 95% CI: 1.17-1.88). Family history of PD, smoking and depression were not independent predictors of mortality. CONCLUSION Mortality in PD is increased. Sex, age at onset and occasional pesticide exposure were independent determinants of increased mortality, while DBS treatment was associated with reduced mortality.
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Affiliation(s)
- Peter Cornelis Poortvliet
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Brisbane, Australia
| | - Alexander Gluch
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Brisbane, Australia
| | - Peter A. Silburn
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - George D. Mellick
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Brisbane, Australia
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Wan Y, Yuan C, Hou X, Chen W, Wang C, Gao S, Wang Y, Jin L, Liu Z. Wearing-off Identification in Parkinson's Disease: The shapd-woq Study. Front Neurol 2020; 11:116. [PMID: 32231634 PMCID: PMC7083219 DOI: 10.3389/fneur.2020.00116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To clarify the frequency of wearing-off phenomenon (WO) and the validity of the Chinese version of the 9-item wearing-off questionnaire (CWOQ-9) in WO identification in this large population. Methods: Parkinson's patients treated with antiparkinsonian medications were consecutively recruited into this observational, cross-sectional investigation. Patients completed the CWOQ-9 prior to the independent clinician assessment. Results: A total of 1,385 patients were included in the analysis. The mean age was 69.7 ± 9.5 years and the mean disease duration was 5.8 ± 4.7 years. Clinicians identified WO in 763 patients, with an overall prevalence of 55.1%. In patients within 1 year of disease duration, clinicians diagnosed WO in eight patients, with a percentage of 12.9%. With the disease progression, the WO frequency gradually increased to 76.2% in patients with 10-15 years of disease duration. Then, it slowly decreased at a longer disease duration. The occurrence of WO was closely associated with the disease duration, H&Y staging, and levodopa daily dose. CWOQ-9 identified 1,071 patients (1071/1398, 77.33%) that had WO-related symptoms. The mean CWOQ-9 score was 3.4 ± 1.6. CWOQ-9 corresponded with clinician assessments of WO in 734 of 763 cases; clinicians disagreed with the CWOQ-9 considering the presence of WO in 337 of 1,071 cases. The sensitivity and specificity of CWOQ-9 were 96.2 and 45.8%, respectively. Conclusions: WO occurred frequently at the early and middle stage of PD. CWOQ-9 was qualified as a pre-visiting screening tool for clinicians to better identify WO.
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Affiliation(s)
- Ying Wan
- Department of Neurology, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China
| | - Canxing Yuan
- Department of Neurology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojun Hou
- Department of Neurology, The Second Military Medical University Affiliated Changhai Hospital, Shanghai, China
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ChunYan Wang
- Department of Neurology, Shanghai Yangpu Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Shan Gao
- Department of Neurology, Shanghai JiaoTong University Affiliated the Sixth People Hospital, Shanghai, China
| | - Yuhui Wang
- Department of Neurology, Shanghai Punan Hospital, Shanghai, China
| | - Lingjing Jin
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China
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