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Child B, Saywell I, da Silva R, Collins‐Praino L, Baetu I. Cognitive function in different motor subtypes of Parkinson's disease: A systematic review protocol. Health Sci Rep 2024; 7:e2092. [PMID: 38706802 PMCID: PMC11066185 DOI: 10.1002/hsr2.2092] [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: 09/21/2023] [Revised: 01/12/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Background and Aims As the fastest-growing neurological disorder globally, a better understanding of Parkinson's disease (PD) is needed to improve patient outcomes and reduce the increasing economic and healthcare burden associated with the disease. Whilst classified as a movement disorder, this disease is highly heterogeneous, encompassing a broad range of both motor and non-motor symptoms (NMS). Cognitive impairment, presenting as either mild cognitive impairment or PD-dementia, is one of the most prevalent and disabling NMS. To better understand heterogeneity in PD, researchers have sought to identify subtypes of individuals who share similar symptom profiles. To date, this research has predominantly focused on motor subtyping, with many studies comparing these motor subtypes on non-motor outcomes, such as cognitive impairment. However, despite evidence of a motor-cognitive relationship in healthy aging, findings regarding the presence of a motor-cognitive relationship in PD are inconsistent. In our proposed systematic review, we will investigate motor subtyping studies that have evaluated the relationship between motor and cognitive function in PD. We aim to examine what is currently known about the relationship between motor and cognitive impairment in PD and evaluate the state of the field with respect to the subtyping methods and quality of cognitive assessment tools used. Methods Systematic literature searches will be conducted in PubMed, PsycINFO, CINAHL, Scopus, and Web of Science. Results Results will be synthesized using meta-analysis and, where meta-analysis is not feasible, narrative synthesis. Conclusion Despite the preponderance of motor subtyping research in PD, our study will be the first to systematically review evidence regarding the association between motor subtypes and cognitive impairment. Understanding the nature of the motor-cognitive relationship in PD may lead to important insights regarding shared underlying disease pathology, which would have significant implications for early diagnosis, prognosis, and treatment of cognitive impairment in PD.
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Affiliation(s)
- Brittany Child
- School of PsychologyUniversity of AdelaideAdelaideAustralia
| | - Isaac Saywell
- School of PsychologyUniversity of AdelaideAdelaideAustralia
| | - Robyn da Silva
- College of Education, Psychology, and Social WorkFlinders UniversityAdelaideAustralia
| | | | - Irina Baetu
- School of PsychologyUniversity of AdelaideAdelaideAustralia
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Doskas T, Vadikolias K, Ntoskas K, Vavougios GD, Tsiptsios D, Stamati P, Liampas I, Siokas V, Messinis L, Nasios G, Dardiotis E. Neurocognitive Impairment and Social Cognition in Parkinson's Disease Patients. Neurol Int 2024; 16:432-449. [PMID: 38668129 PMCID: PMC11054167 DOI: 10.3390/neurolint16020032] [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: 01/03/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
In addition to motor symptoms, neurocognitive impairment (NCI) affects patients with prodromal Parkinson's disease (PD). NCI in PD ranges from subjective cognitive complaints to dementia. The purpose of this review is to present the available evidence of NCI in PD and highlight the heterogeneity of NCI phenotypes as well as the range of factors that contribute to NCI onset and progression. A review of publications related to NCI in PD up to March 2023 was performed using PubMed/Medline. There is an interconnection between the neurocognitive and motor symptoms of the disease, suggesting a common underlying pathophysiology as well as an interconnection between NCI and non-motor symptoms, such as mood disorders, which may contribute to confounding NCI. Motor and non-motor symptom evaluation could be used prognostically for NCI onset and progression in combination with imaging, laboratory, and genetic data. Additionally, the implications of NCI on the social cognition of afflicted patients warrant its prompt management. The etiology of NCI onset and its progression in PD is multifactorial and its effects are equally grave as the motor effects. This review highlights the importance of the prompt identification of subjective cognitive complaints in PD patients and NCI management.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Konstantinos Vadikolias
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | | | - George D. Vavougios
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, Faculty of Medicine, University of Cyprus, 1678 Lefkosia, Cyprus
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece
| | - Dimitrios Tsiptsios
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Polyxeni Stamati
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Vasileios Siokas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Lambros Messinis
- School of Psychology, Laboratory of Neuropsychology and Behavioural Neuroscience, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
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Xiromerisiou G, Marogianni C, Lampropoulos IC, Dardiotis E, Speletas M, Ntavaroukas P, Androutsopoulou A, Kalala F, Grigoriadis N, Papoutsopoulou S. Peripheral Inflammatory Markers TNF-α and CCL2 Revisited: Association with Parkinson's Disease Severity. Int J Mol Sci 2022; 24:ijms24010264. [PMID: 36613708 PMCID: PMC9820450 DOI: 10.3390/ijms24010264] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
One of the major mediators of neuroinflammation in PD is tumour necrosis factor alpha (TNF-α), which, similar to other cytokines, is produced by activated microglia and astrocytes. Although TNF-α can be neuroprotective in the brain, long-term neuroinflammation and TNF release can be harmful, having a neurotoxic role that leads to death of oligodendrocytes, astrocytes, and neurons and, therefore, is associated with neurodegeneration. Apart from cytokines, a wide family of molecules with homologous structures, namely chemokines, play a key role in neuro-inflammation by drawing cytotoxic T-lymphocytes and activating microglia. The objective of the current study was to examine the levels of the serum TNF-α and CCL2 (Chemokine (C-C motif) ligand 2), also known as MCP-1 (Monocyte Chemoattractant Protein-1), in PD patients compared with healthy controls. We also investigated the associations between the serum levels of these two inflammatory mediators and a number of clinical symptoms, in particular, disease severity and cognition. Such an assessment may point to their prognostic value and provide some treatment hints. PD patients with advanced stage on the Hoehn-Yahr scale showed an increase in TNF-α levels compared with PD patients with stages 1 and 2 (p = 0.01). Additionally, the UPDRS score was significantly associated with TNF-α levels. CCL2 levels, however, showed no significant associations.
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Affiliation(s)
- Georgia Xiromerisiou
- Department of Medicine, Faculty of Life Sciences, University of Thessaly, 41500 Larisa, Greece
- Correspondence:
| | - Chrysoula Marogianni
- Department of Medicine, Faculty of Life Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Ioannis C. Lampropoulos
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Efthimios Dardiotis
- Department of Medicine, Faculty of Life Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Matthaios Speletas
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Panagiotis Ntavaroukas
- Department of Biochemistry and Biotechnology, Faculty of Life Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Anastasia Androutsopoulou
- Department of Biochemistry and Biotechnology, Faculty of Life Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Fani Kalala
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Nikolaos Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology, Second Department of Neurology, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatia Papoutsopoulou
- Department of Biochemistry and Biotechnology, Faculty of Life Sciences, University of Thessaly, 41500 Larisa, Greece
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Höllerhage M, Klietz M, Höglinger GU. Disease modification in Parkinsonism: obstacles and ways forward. J Neural Transm (Vienna) 2022; 129:1133-1153. [PMID: 35695938 PMCID: PMC9463344 DOI: 10.1007/s00702-022-02520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 12/19/2022]
Abstract
To date, the diagnoses of Parkinson syndromes are based on clinical examination. Therefore, these specific diagnoses are made, when the neuropathological process is already advanced. However, disease modification or neuroprotection, is considered to be most effective before marked neurodegeneration has occurred. In recent years, early clinical or prodromal stages of Parkinson syndromes came into focus. Moreover, subtypes of distinct diseases will allow predictions of the individual course of the diseases more precisely. Thereby, patients will be enrolled into clinical trials with more specific disease entities and endpoints. Furthermore, novel fluid and imaging biomarkers that allow biochemical diagnoses are under development. These will lead to earlier diagnoses and earlier therapy in the future as consequence. Furthermore, therapeutic approaches will take the underlying neuropathological process of neurodegenerative Parkinson syndromes more specific into account. Specifically, future therapies will target the aggregation of aggregation-prone proteins such as alpha-synuclein and tau, the degradation of pathological aggregates, and the spreading of pathological protein aggregates throughout the brain. Many of these approaches are already in (pre)clinical development. In addition, anti-inflammatory approaches are in development. Furthermore, drug-repurposing is a feasible approach to shorten the developmental process of new drugs.
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Affiliation(s)
- M Höllerhage
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - G U Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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5
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Chen J, Jiang X, Wu J, Wu H, Zhou C, Guo T, Bai X, Liu X, Wen J, Cao Z, Gu L, Yang W, Pu J, Guan X, Xu X, Zhang B, Zhang M. Gray and white matter alterations in different predominant side and type of motor symptom in Parkinson's disease. CNS Neurosci Ther 2022; 28:1372-1379. [PMID: 35673762 PMCID: PMC9344082 DOI: 10.1111/cns.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Parkinson's disease (PD) is highly heterogeneous reflected by different affected side of body and type of motor symptom. We aim to explore clinical characteristics and underlying brain structure alterations in PD with different predominant sides and motor types. Methods We recruited 161 PD patients and 50 healthy controls (HC). Patients were classified into four subtypes according to their predominant side and motor type: left akinetic/rigid‐dominant (LAR), left tremor‐dominant (LTD), right akinetic/rigid‐dominant (RAR), and right tremor‐dominant (RTD). All participants assessed motor and cognitive performances, then underwent T1‐weighted and diffusion tensor imaging scanning. A general linear model was used to compare neuroimaging parameters among five groups. Results Among four PD subtypes, patients of LAR subtype experienced the worst motor impairment, and only this subtype showed worse cognitive performance compared with HC. Compared with HC and other subtypes, LAR subtype showed a significant reduction in cortical thickness of the right caudal‐anterior‐cingulate gyrus and fractional anisotropy of the right cingulum bundle. Conclusions We demonstrated that LAR subtype had the worst clinical performance, which the severer damage in the right cingulate region might be the underlying mechanism. This study underscores the importance of classifying PD subtypes based on both the side and type of motor symptom for clinical intervention and research to optimize behavioral outcomes in the future.
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Affiliation(s)
- Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xianchen Jiang
- Quzhou Center for Disease Control and Prevention, Quzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Wenyi Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
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Shin HW, Hong SW, Youn YC. Clinical Aspects of the Differential Diagnosis of Parkinson's Disease and Parkinsonism. J Clin Neurol 2022; 18:259-270. [PMID: 35589315 PMCID: PMC9163948 DOI: 10.3988/jcn.2022.18.3.259] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
Parkinsonism is a clinical syndrome presenting with bradykinesia, tremor, rigidity, and postural instability. Nonmotor symptoms have recently been included in the parkinsonian syndrome, which was traditionally associated with motor symptoms only. Various pathologically distinct and unrelated diseases have the same clinical manifestations as parkinsonism or parkinsonian syndrome. The etiologies of parkinsonism are classified as neurodegenerative diseases related to the accumulation of toxic protein molecules or diseases that are not neurodegenerative. The former class includes Parkinson's disease (PD), multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. Over the past decade, clinical diagnostic criteria have been validated and updated to improve the accuracy of diagnosing these diseases. The latter class of disorders unrelated to neurodegenerative diseases are classified as secondary parkinsonism, and include drug-induced parkinsonism (DIP), vascular parkinsonism, and idiopathic normal-pressure hydrocephalus (iNPH). DIP and iNPH are regarded as reversible and treatable forms of parkinsonism. However, studies have suggested that the absence of protein accumulation in the nervous system as well as managing the underlying causes do not guarantee recovery. Here we review the differential diagnosis of PD and parkinsonism, mainly focusing on the clinical aspects. In addition, we describe recent updates to the clinical criteria of various disorders sharing clinical symptoms with parkinsonism.
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Affiliation(s)
- Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Wook Hong
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea.
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Fabiani G, Camargo CHF, Filho RM, Froehner GS, Teive HAG. Evaluation of Brain SPECT with 99mTc-TRODAT-1 in the Differential Diagnosis of Parkinsonism. PARKINSON'S DISEASE 2022; 2022:1746540. [PMID: 35300121 PMCID: PMC8923776 DOI: 10.1155/2022/1746540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Brain SPECT with 99mTc-TRODAT-1 (SPECT-TRODAT) may be a useful tool in the differential diagnosis of Parkinsonism. OBJECTIVE To compare results of SPECT-TRODAT with clinical findings in patients with Parkinsonism. METHODS We evaluated 153 outpatients. SPECT-TRODAT results were visually analyzed into normal, abnormal, symmetric, and asymmetric, and according to the degree of impairment into mild, moderate, marked, and severe (1-4). RESULTS A direct relationship was found between motor scores severity (MDS-UPDRS-III) and SPECT-TRODAT-reduced binding in general, in the group of patients with synucleinopathies (rho = 0.258, p=0.005), especially in patients with Parkinson's disease (rho = 0.204, p=0.049). Changes in SPECT-TRODAT had high correspondence with symmetry in all Parkinsonism. When comparing groups to the correspondence predominantly bilateral or unilateral impairment in SPECT, there was a difference between patients with SNP (p=0.041) and between this group and patients with secondary Parkinsonism (SP) (p < 0.0001). It was handy in differentiating drug-induced Parkinsonism from synucleinopathies. In the group of drug-induced Parkinsonism, younger people were the ones who showed the most significant reductions in radiotracer uptake. In this group, nonmotor signs resulted in examinations with more significant reductions in radiotracer uptake. When the scans without alterations and those that did not correspond to the symmetry were considered negative, SPECT-TRODAT's accuracy and specificity to differentiate PD from other forms of Parkinsonism were low. There was an inverse correlation between the severity of the SPECT-TRODAT result and the absence of nonmotor signs in patients with drug-induced Parkinsonism. CONCLUSION The authors concluded that the SPECT with 99mTc-TRODAT-1 was mainly useful in differentiating between synucleinopathies and secondary Parkinsonism.
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Affiliation(s)
- Giorgio Fabiani
- Neurological Diseases Group, Post-Graduate Program of Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
- Movement Disorders Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
- Neurology Service, Hospital Angelina Caron, Campina Grande do Sul, Curitiba, Paraná, Brazil
| | - Carlos Henrique Ferreira Camargo
- Neurological Diseases Group, Post-Graduate Program of Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Raul Martins Filho
- Centro de Medicina Nuclear do Paraná, CETAC—Center for Imaging Diagnosis, Curitiba, Paraná, Brazil
| | - Gabriel Sampaio Froehner
- Neurological Diseases Group, Post-Graduate Program of Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Hélio Afonso Ghizoni Teive
- Neurological Diseases Group, Post-Graduate Program of Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
- Movement Disorders Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
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Examination of pituitary adenylate cyclase-activating polypeptide in Parkinson’s disease focusing on correlations with motor symptoms. GeroScience 2022; 44:785-803. [PMID: 35220508 PMCID: PMC9135934 DOI: 10.1007/s11357-022-00530-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/15/2022] [Indexed: 12/16/2022] Open
Abstract
The neuroprotective effects of pituitary adenylate cyclase-activating polypeptide (PACAP) have been shown in numerous in vitro and in vivo models of Parkinson’s disease (PD) supporting the theory that PACAP could have an important role in the pathomechanism of the disorder affecting mostly older patients. Earlier studies found changes in PACAP levels in neurological disorders; therefore, the aim of our study was to examine PACAP in plasma samples of PD patients. Peptide levels were measured with ELISA and correlated with clinical parameters, age, stage of the disorder based on the Hoehn and Yahr (HY) scale, subtype of the disease, treatment, and specific scores measuring motor and non-motor symptoms, such as movement disorder society-unified Parkinson’s disease rating scale (MDS-UPDRS), Epworth sleepiness scale (ESS), Parkinson’s disease sleep scale (PDSS-2), and Beck depression inventory (BDI). Our results showed significantly decreased PACAP levels in PD patients without deep brain stimulation (DBS) therapy and in akinetic-rigid subtype; additionally we also observed a further decrease in the HY stage 3 and 4. Elevated PACAP levels were found in patients with DBS. There were no significant correlations between PACAP level with MDS-UPDRS, type of pharmacological treatment, PDSS-2 sleepiness, or depression (BDI) scales, but we found increased PACAP level in patients with more severe sleepiness problems based on the ESS scale. Based on these results, we suggest that following the alterations of PACAP with other frequently used clinical biomarkers in PD patients might improve strategic planning of further therapeutic interventions and help to provide a clearer prognosis regarding the future perspective of the disease.
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Li XN, Hao DP, Qu MJ, Zhang M, Ma AB, Pan XD, Ma AJ. Development and Validation of a Plasma FAM19A5 and MRI-Based Radiomics Model for Prediction of Parkinson's Disease and Parkinson's Disease With Depression. Front Neurosci 2022; 15:795539. [PMID: 34975391 PMCID: PMC8718551 DOI: 10.3389/fnins.2021.795539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Prediction and early diagnosis of Parkinson’s disease (PD) and Parkinson’s disease with depression (PDD) are essential for the clinical management of PD. Objectives: The present study aimed to develop a plasma Family with sequence similarity 19, member A5 (FAM19A5) and MRI-based radiomics nomogram to predict PD and PDD. Methods: The study involved 176 PD patients and 181 healthy controls (HC). Sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure FAM19A5 concentration in the plasma samples collected from all participants. For enrolled subjects, MRI data were collected from 164 individuals (82 in the PD group and 82 in the HC group). The bilateral amygdala, head of the caudate nucleus, putamen, and substantia nigra, and red nucleus were manually labeled on the MR images. Radiomics features of the labeled regions were extracted. Further, machine learning methods were applied to shrink the feature size and build a predictive radiomics signature. The resulting radiomics signature was combined with plasma FAM19A5 concentration and other risk factors to establish logistic regression models for the prediction of PD and PDD. Results: The plasma FAM19A5 levels (2.456 ± 0.517) were recorded to be significantly higher in the PD group as compared to the HC group (2.23 ± 0.457) (P < 0.001). Importantly, the plasma FAM19A5 levels were also significantly higher in the PDD subgroup (2.577 ± 0.408) as compared to the non-depressive subgroup (2.406 ± 0.549) (P = 0.045 < 0.05). The model based on the combination of plasma FAM19A5 and radiomics signature showed excellent predictive validity for PD and PDD, with AUCs of 0.913 (95% CI: 0.861–0.955) and 0.937 (95% CI: 0.845–0.970), respectively. Conclusion: Altogether, the present study reported the development of nomograms incorporating radiomics signature, plasma FAM19A5, and clinical risk factors, which might serve as potential tools for early prediction of PD and PDD in clinical settings.
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Affiliation(s)
- Xue-Ning Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mei-Jie Qu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - An-Bang Ma
- Shanghai Xunshi Technology Co., Ltd., Shanghai, China
| | - Xu-Dong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Cerebrovascular, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ai-Jun Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Cerebrovascular, The Affiliated Hospital of Qingdao University, Qingdao, China
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10
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Jang W, Lee JY, Kim JY, Lee SJ, Kim TY, Choi YY, Kim HT, Kim CK. Intrasubject relationship between striatal 18F-FP-CIT uptake and cardiac 123I-MIBG uptake differs by motor subtype in early Parkinson disease. Medicine (Baltimore) 2021; 100:e26995. [PMID: 34414983 PMCID: PMC8376390 DOI: 10.1097/md.0000000000026995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 08/01/2021] [Indexed: 01/04/2023] Open
Abstract
Parkinson disease (PD) is a heterogeneous neurodegenerative disorder. Dopamine transporter imaging using 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (FP-CIT) and noradrenergic cardiac imaging using 123I-meta-iodobenzylguanidine (MIBG) have been used in combination or separately to study PD patients. Published results regarding uptake of the 2 tracers in each motor subtype are fairly abundant and mostly in agreement. However, data on the intrasubject association between dopaminergic and noradrenergic systems in PD patients are relatively scant and vary. We aimed to assess the intrasubject relationship between striatal dopamine transporter density using a PET tracer and cardiac sympathetic innervation in tremor-dominant subtype (TD) and akinetic-rigid subtype (AR) of PD.This study has a cross-sectional design. Thirty-one patients with early PD (17 TD/14 AR) who underwent both 123I-MIBG cardiac scintigraphy and 18F-FP-CIT PET/CT were retrospectively selected. We assessed the relationship between heart-to-mediastinum ratio (H/M) of 123I-MIBG and specific (striatal)-to-nonspecific (cerebellar) dopamine transporter binding ratio (S/N) measured from 4 separate regions-of-interest (bilateral caudate nuclei and lentiform nuclei) of 18F-FP-CIT in each motor subtype.S/N of all 4 striatal regions were significantly lower in the AR subgroup than in the TD subgroup. H/M was not significantly different. There was a significant intrasubject correlation between H/M and S/N of the lentiform nucleus in AR-PD but no correlation between H/M and any of 4 S/N in TD-PD.Our data suggest a coupled degeneration of nigrostriatal dopaminergic and myocardial sympathetic denervation in AR subtype, but not in TD subtype, of early PD patients. These different results between the 2 motor subtypes likely reflects the heterogeneous pathophysiology of PD.
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Affiliation(s)
- Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Republic of Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Soo Jin Lee
- Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Yoon Kim
- Department of Radiology, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hee-Tae Kim
- Department of Neurology, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chun K. Kim
- Department of Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
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11
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Shirahige L, Berenguer-Rocha M, Mendonça S, Rocha S, Rodrigues MC, Monte-Silva K. Quantitative Electroencephalography Characteristics for Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSONS DISEASE 2021; 10:455-470. [PMID: 32065804 PMCID: PMC7242841 DOI: 10.3233/jpd-191840] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individualized treatment guided by biomarkers certainly will play a crucial role in the more effective treatment of various neurological diseases in the near future. Identifying the electroencephalographic biomarkers in the brain of patients with Parkinson's disease (PD) may help in the decision-making process of health professionals regarding the non-invasive brain stimulation (NIBS) protocols. OBJECTIVE To summarize quantitative electroencephalographic (qEEG) characteristics of patients with PD with motor symptoms at rest or during movement to identify potential biomarker associated with motor impairment in PD. METHODS A systematic search was conducted in the databases MEDLINE/PubMed, LILACS/BIREME, CINAHL/EBSCO, Web of Science, and CENTRAL, performed according to PRISMA-statement guidelines. Two independent authors searched for studies that reported qEEG data related to motor outcomes at rest or during movements in patients with PD and compared the data with control healthy group. The studies' methodological quality was examined using the Cochrane Handbook. Studies/sample characteristics, qEEG parameters/analyses, and the studies' results were summarized. Prospero-register: CRD42018085660. RESULTS Nineteen studies (18 cross-sectional/one cross-over) with 312 PD patients and 277 controls, published between 1994-2018, were included for the qualitative analysis. In comparison to healthy controls, our findings suggest a slowing down of the cortical activity in patients with PD due to an increase of slower band waves activity and a decrease of fast band waves at resting and during complex movement execution mainly in the central and frontal cortex. CONCLUSION Slowing down of cortical waves suggest excitatory NIBS for motor impairment in PD. However, qEEG biomarker for motor symptoms of PD cannot be established yet because the studies that related qEEG with motor outcomes presented methodological poor quality.
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Affiliation(s)
- Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marina Berenguer-Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Sarah Mendonça
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Sérgio Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marcelo Cairrão Rodrigues
- Neurodinamics Laboratory, Department of Physiology, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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12
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Ben-Joseph A, Marshall CR, Lees AJ, Noyce AJ. Ethnic Variation in the Manifestation of Parkinson's Disease: A Narrative Review. JOURNAL OF PARKINSONS DISEASE 2021; 10:31-45. [PMID: 31868680 PMCID: PMC7029316 DOI: 10.3233/jpd-191763] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The global prevalence of Parkinson's disease is increasing, yet the characteristics, risk factors and genetics of PD in Black, Asian and Hispanic populations is little understood. In this paper we review the published literature on clinical variation in the symptoms and signs of Parkinson's disease in different ethnic groups and responses to treatment. We included any study that sampled patients with Parkinson's disease from distinct ethnic backgrounds. We conclude that whilst there is little published evidence for ethnic variation in the clinical features of Parkinson's disease, there are substantial limitations and gaps in the current literature, which mean that the evidence does necessarily not fit with clinical observation. Possible explanations for expected differences in manifestation include genetic determinants, the co-existence of cerebrovascular disease and/or Alzheimer's disease pathology, healthcare inequalities and socio-cultural factors.
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Affiliation(s)
- Aaron Ben-Joseph
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies and Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Reta Lila Weston Institute of Neurological Studies and Department of Clinical and Movement Neurosciences, University College London, London, UK
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13
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Tang X, Zhang Y, Liu D, Hu Y, Jiang L, Zhang J. Association of Gyrification Pattern, White Matter Changes, and Phenotypic Profile in Patients With Parkinson Disease. Neurology 2021; 96:e2387-e2394. [PMID: 33766988 DOI: 10.1212/wnl.0000000000011894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the cortical gyrification changes as well as their relationships with white matter (WM) microstructural abnormalities in the akinetic-rigid (AR) and tremor-dominant (TD) subtypes of Parkinson disease (PD). METHODS Sixty-four patients with the AR subtype, 26 patients with the TD subtype, and 56 healthy controls (HCs) were included in this study. High-resolution T1-weighted and diffusion-weighted images were acquired for each participant. We computed local gyrification index (LGI) and fractional anisotropy (FA) to identify the cortical gyrification and WM microstructural changes in the AR and TD subtypes. RESULTS Compared with HCs, patients with the AR subtype showed decreased LGI in the precentral, postcentral, inferior and superior parietal, middle and superior frontal/temporal, anterior and posterior cingulate, orbitofrontal, supramarginal, precuneus, and some visual cortices, and decreased FA in the corticospinal tract, inferior and superior longitudinal fasciculus, inferior fronto-occipital fasciculus, forceps minor/major, and anterior thalamic radiation. Decreases in LGI and FA of the AR subtype were found to be tightly coupled. LGIs of the left inferior and middle frontal gyrus correlated with Mini-Mental State Examination and Hoehn & Yahr scores of patients with the AR subtype. Patients with the TD subtype showed no significant change in the LGI and FA compared with patients with the AR subtype and HCs. CONCLUSIONS Our results suggest that cortical gyrification changes in PD are motor phenotype-specific and are possibly mediated by the microstructural abnormalities of the underlying WM tracts.
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Affiliation(s)
- Xie Tang
- From the Key Laboratory for NeuroInformation of Ministry of Education (X.T., Y.Z.), School of Life Science and Technology, University of Electronic Science and Technology of China; and Department of Radiology (D.L., Y.H., L.J., J.Z.), Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, China
| | - Yuanchao Zhang
- From the Key Laboratory for NeuroInformation of Ministry of Education (X.T., Y.Z.), School of Life Science and Technology, University of Electronic Science and Technology of China; and Department of Radiology (D.L., Y.H., L.J., J.Z.), Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, China.
| | - Daihong Liu
- From the Key Laboratory for NeuroInformation of Ministry of Education (X.T., Y.Z.), School of Life Science and Technology, University of Electronic Science and Technology of China; and Department of Radiology (D.L., Y.H., L.J., J.Z.), Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, China
| | - Yixin Hu
- From the Key Laboratory for NeuroInformation of Ministry of Education (X.T., Y.Z.), School of Life Science and Technology, University of Electronic Science and Technology of China; and Department of Radiology (D.L., Y.H., L.J., J.Z.), Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, China
| | - Liling Jiang
- From the Key Laboratory for NeuroInformation of Ministry of Education (X.T., Y.Z.), School of Life Science and Technology, University of Electronic Science and Technology of China; and Department of Radiology (D.L., Y.H., L.J., J.Z.), Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, China
| | - Jiuquan Zhang
- From the Key Laboratory for NeuroInformation of Ministry of Education (X.T., Y.Z.), School of Life Science and Technology, University of Electronic Science and Technology of China; and Department of Radiology (D.L., Y.H., L.J., J.Z.), Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, China.
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Horisawa S, Fukui A, Yamahata H, Tanaka Y, Kuwano A, Momosaki O, Iijima M, Nanke M, Kawamata T, Taira T. Unilateral pallidothalamic tractotomy for akinetic-rigid Parkinson's disease: a prospective open-label study. J Neurosurg 2021; 135:799-805. [PMID: 33450738 DOI: 10.3171/2020.7.jns201547] [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: 04/29/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgical ablation is an effective treatment for medically refractory motor symptoms of Parkinson's disease (PD). A limited number of studies have reported the effect of ablation of the pallidothalamic tract for PD. In this study, the authors evaluated the safety and efficacy of unilateral pallidothalamic tractotomy for akinetic-rigid (AR)-PD. METHODS Fourteen AR-PD patients, who were enrolled in this prospective open-label study, underwent unilateral pallidothalamic tractotomy. The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and Part IV (dyskinesia and dystonia) scores and levodopa equivalent daily dose (LEDD) were evaluated at baseline and at 3 and 12 months postoperatively. RESULTS Of the 14 patients enrolled in the study, 4 were lost to follow-up and 10 were analyzed. The total MDS-UPDRS Part III score significantly improved from 45 ± 4.6 at baseline to 32.9 ± 4.8 at 12 months postoperatively (p = 0.005). Contralateral side rigidity and bradykinesia significantly improved from 4.4 ± 0.5 and 10.4 ± 1.5 at baseline to 1.7 ± 0.4 (p = 0.005) and 5.2 ± 1.4 (p = 0.011) at 12 months, respectively. While posture significantly improved with a 20% reduction in scores (p = 0.038), no significant improvement was found in gait (p = 0.066). Dyskinesia and dystonia were improved with a 79.2% (p = 0.0012) and 91.7% (p = 0.041) reduction in scores, respectively. No significant change was found in the LEDD. Hypophonia was noted in 2 patients, eyelid apraxia was noted in 1 patient, and a reduced response to levodopa, which resulted in an increase in the daily dose of levodopa, was noted in 3 patients. No serious permanent neurological deficits were observed. CONCLUSIONS Unilateral pallidothalamic tractotomy improved contralateral side rigidity and bradykinesia, dyskinesia, and dystonia in patients with AR-PD. Clinical trial registration no.: UMIN000031138 (umin.ac.jp).
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Affiliation(s)
| | | | | | | | | | | | | | - Magi Nanke
- 3School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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15
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Balestrassi LS, Silva SMCA. Descriptive epidemiological study on patients with movement disorders, with emphasis on Parkinson's disease. SAO PAULO MED J 2021; 139:30-37. [PMID: 33656125 PMCID: PMC9632504 DOI: 10.1590/1516-3180.2020.0119.r1.30102020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Knowing the epidemiological profile is relevant for improving healthcare practices. Movement disorders are neurological disorders characterized by the presence of involuntary movements. They have a negative impact on patients' quality of life. OBJECTIVES To outline the frequencies of the different diagnoses seen among patients, along with their demographic characteristics, at a hospital in São Paulo (SP), Brazil, and to highlight the clinical aspects of those with Parkinson's disease. DESIGN AND SETTING Retrospective descriptive epidemiological analysis at a specialized outpatient clinic in a state public hospital in São Paulo. METHODS Patients treated at this clinic over a four-year period were analyzed. Diagnoses, demographic variables and associations with clinical aspects of Parkinson's disease were evaluated. RESULTS Out of the 680 medical records analyzed, 58.4% related to females. Most patients were over 60 years of age, white, married and teachers. The most frequent diagnosis was Parkinson's disease, followed by essential tremor and dystonia. Parkinson's disease presented in the mixed clinical form; the most common initial symptom was tremor. The akinetic-rigid clinical form occurred in younger individuals and mostly presented with postural instability and freezing of gait in the early years of disease. CONCLUSIONS Parkinson's disease, essential tremor and dystonia were the most frequent diagnoses. Characteristics like sex, frequency of other pathological conditions and the clinical and demographic aspects of Parkinson's disease were consistent with the data in the relevant literature.
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Affiliation(s)
- Luiza Serafini Balestrassi
- MD, MSc. Neurologist, Department of Neurology, Hospital do Servidor Público Estadual (IAMSPE), São Paulo (SP), Brazil.
| | - Sonia Maria Cesar Azevedo Silva
- MD, PhD. Neurologist, Movement Disorders Unit, Department of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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16
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Csoti I, Koleva-Alazeh N. Benserazide-induced diarrhea - A retrospective clinical study. Clin Park Relat Disord 2020; 4:100087. [PMID: 34316665 PMCID: PMC8299959 DOI: 10.1016/j.prdoa.2020.100087] [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: 07/22/2020] [Revised: 11/08/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
A largely unknown and unrecognized side effect of L-DOPA/benserazide is severe diarrhea in rare cases, which can lead to physicians initiating misguided and drug treatments or patients discontinuing their L-DOPA medication altogether. A simple change to L-DOPA/carbidopa has proven to be an effective solution in virtually all cases of benserazide-induced diarrhea, usually leading to full remission within days. A cohort of 50 patients is examined in search for a possible biochemical basis for benserazide intolerance.
Background Although diarrhea has been reported as a side effect of L-3,4- dihydroxyphenylalanine (L-DOPA)/benserazide, it is largely unknown and unrecognized, presumably because it is very rare. There is almost no literature on benserazide-induced diarrhea (BID), no pharmacological explanation and, crucially, no treatment recommendation. This can lead to physicians misdiagnosing BID, for example as colitis, and initiating misguided and ultimately ineffective drug treatments. Or it can lead to erroneous assumptions about a general intolerance and subsequent discontinuation of L-DOPA medication – for lack of a better solution – at the high price of living with the recurring symptoms of Parkinson’s disease. Thus, our study aims to fill these gaps, beginning with a treatment recommendation: A simple switch to LDOPA/ carbidopa has proven to be an effective solution in virtually all cases of BID, usually leading to full remission within days. Finding a possible pharmacological explanation was the next objective of this study. Methods We retrospectively analyzed 50 case files of patients with BID, searching for patterns that could potentially explain this intolerance. Results The most frequent concomitant disease was hypertension, likely due to high average age. Beta-blockers and acetylsalicylic acid were the most frequent concomitant medications. Otherwise, no conspicuous pattern emerged in this seemingly rather heterogeneous sample. Conclusions Plasma protein binding (PPB) was suspected as a key difference between benserazide and carbidopa that might potentially explain why some patients can tolerate carbidopa but not benserazide. However, reports on PPB of carbidopa and benserazide vary wildly from one source to another, making definitive conclusions impossible.
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Affiliation(s)
- Ilona Csoti
- Gertrudisklinik, Parkinson-Zentrum, Leun-Biskirchen, Germany
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17
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Rozhdestvensky AS, Delov RA, Marks EA, Gaponenko IA, Khanokh EV. Clinical and Epidemiological Aspects of Parkinson's Disease in the South of Western Siberia. Front Neurol 2020; 11:538782. [PMID: 33224082 PMCID: PMC7671006 DOI: 10.3389/fneur.2020.538782] [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: 03/12/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The article is devoted to one of the most common neurodegenerative diseases in the world—Parkinson's disease (PD), the prevalence of which in Russia reaches 140–150 people per 100,000 people. The clinical and anamnestic profile of a patient with PD is presented, the prevalence of motor and non-motor symptoms is reflected, and a comparative characteristic of the neurological deficit in the Siberian population of patients with other cohorts of patients with Parkinson's disease in different countries and ethnic groups is presented. Methods: We studied 140 patients with Parkinson's disease. A comprehensive assessment of neurological status was performed using the “Unified Parkinson's Disease Rating Scale (UPDRS).” In addition, we used the Beck Depression and MoCA scale test. Assessment of the presence and severity of olfactory dysfunction was performed using the Sniffin Stick odor identification test. The stage of PD was evaluated according to the classification of M. M. Hoehn and M. D. Yahr. Results: The cohort of the study was dominated by overweight patients with a higher level of education, with concomitant arterial hypertension, coronary heart disease, and dyslipidemia. The severity of motor and most non-motor symptoms directly correlates with the duration of PD and the stage of the disease. The predominant form of the disease was a mixed form, which was also noted in research cohorts in Canada and the UK. The Siberian cohort tends to be more prevalent in hyposmia, daytime sleepiness, orthostatic hypotension, and depressive and REM disorders. Conclusion: Our data show the importance of a comprehensive assessment of both motor and non-motor neurological deficits as well as the analysis of comorbid disorders and risk factors for the occurrence and progression of Parkinson's disease. They also show the prevalence of certain motor and non-motor symptoms in the Siberian cohort of patients with Parkinson's disease.
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Affiliation(s)
| | - Roman Andreevich Delov
- Department of Neurology Continuing Professional Education, Omsk State Medical University, Omsk, Russia
| | - Elena Andreevna Marks
- Department of Neurology Continuing Professional Education, Omsk State Medical University, Omsk, Russia
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18
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Brown KA, Spencer KA. The Relationship Between Speech Characteristics and Motor Subtypes of Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2145-2154. [PMID: 32997516 DOI: 10.1044/2020_ajslp-20-00058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this study was to examine whether acoustic dysarthria characteristics align with overall motor profile in individuals with Parkinson's disease (PD). Potential speech differences between tremor-dominant and non-tremor-dominant subtypes are theoretically motivated but empirically inconclusive. Method Twenty-seven individuals with dysarthria from PD provided a contextual speech sample. Participants were grouped into non-tremor-dominant (n = 12) and tremor-dominant (n = 15) motor subtypes according to the Unified Parkinson Disease Rating Scale. Dependent speech variables included fundamental frequency range, average pause duration, cepstral peak prominence, stuttering dysfluencies, and maze dysfluencies. Results There were no significant differences between the speech of the tremor-dominant and non-tremor-dominant groups. High within-group variability existed across parameters and motor subtypes. Conclusion Speech characteristics across the areas of phonation, prosody, and fluency did not differ appreciably between PD motor subtypes.
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Affiliation(s)
- Katherine A Brown
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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19
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Krishnagopal S. Multi-layer Trajectory Clustering: a Network Algorithm for Disease Subtyping. Biomed Phys Eng Express 2020; 6. [PMID: 35046146 DOI: 10.1088/2057-1976/abad8f] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/06/2020] [Indexed: 01/16/2023]
Abstract
Many diseases display heterogeneity in clinical features and their progression, indicative of the existence of disease subtypes. Extracting patterns of disease variable progression for subtypes has tremendous application in medicine, for example, in early prognosis and personalized medical therapy. This work presents a novel, data-driven, network-based Trajectory Clustering (TC) algorithm for identifying Parkinson's subtypes based on disease trajectory. Modeling patient-variable interactions as a bipartite network, TC first extracts communities of co-expressing disease variables at different stages of progression. Then, it identifies Parkinson's subtypes by clustering similar patient trajectories that are characterized by severity of disease variables through a multi-layer network. Determination of trajectory similarity accounts for direct overlaps between trajectories as well as second-order similarities, i.e., common overlap with a third set of trajectories. This work clusters trajectories across two types of layers: (a) temporal, and (b) ranges of independent outcome variable (representative of disease severity), both of which yield four distinct subtypes. The former subtypes exhibit differences in progression of disease domains (Cognitive, Mental Health etc.), whereas the latter subtypes exhibit different degrees of progression, i.e., some remain mild, whereas others show significant deterioration after 5 years. The TC approach is validated through statistical analyses and consistency of the identified subtypes with medical literature. This generalizable and robust method can easily be extended to other progressive multi-variate disease datasets, and can effectively assist in targeted subtype-specific treatment in the field of personalized medicine.
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Affiliation(s)
- Sanjukta Krishnagopal
- Department of Physics, University of Maryland, College Park, Maryland, 20742, United States of America.,Gatsby Computational Neuroscience Unit, University College London, London, W1T4JG, United Kingdom
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20
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Meng Y, Pople CB, Kalia SK, Kalia LV, Davidson B, Bigioni L, Li DZ, Suppiah S, Mithani K, Scantlebury N, Schwartz ML, Hamani C, Lipsman N. Cost-effectiveness analysis of MR-guided focused ultrasound thalamotomy for tremor-dominant Parkinson's disease. J Neurosurg 2020; 135:273-278. [PMID: 32764177 DOI: 10.3171/2020.5.jns20692] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The development of transcranial MR-guided focused ultrasound (MRgFUS) has revitalized the practice of lesioning procedures in functional neurosurgery. Previous health economic analysis found MRgFUS thalamotomy to be a cost-effective treatment for patients with essential tremor, supporting its reimbursement. With the publication of level I evidence in support of MRgFUS thalamotomy for patients with tremor-dominant Parkinson's disease (TDPD), the authors performed a health economic comparison between MRgFUS, deep brain stimulation (DBS), and medical therapy. METHODS The authors used a decision tree model with rollback analysis and one-factor sensitivity analysis. Literature searches of MRgFUS thalamotomy and unilateral DBS of the ventrointermediate nucleus of the thalamus for TDPD were performed to determine the utility and probabilities for the model. Costs in Canadian dollars (CAD) were derived from the Schedule of Benefits and Fees in Ontario, Canada, and expert opinion on usage. RESULTS MRgFUS was associated with an expected cost of $14,831 CAD. Adding MRgFUS to continued medical therapy resulted in an incremental cost-effectiveness ratio of $30,078 per quality-adjusted life year (QALY), which remained cost-effective under various scenarios in the sensitivity analysis. Comparing DBS to MRgFUS, while DBS did not achieve the willingness-to-pay threshold ($56,503 per QALY) in the base case scenario, it did so under several scenarios in the sensitivity analysis. CONCLUSIONS MRgFUS thalamotomy is a cost-effective treatment for patients with TDPD, particularly over continued medical therapy. While MRgFUS remains competitive with DBS, the cost-effectiveness advantage is less substantial. These results will help inform the integration of this technology in the healthcare system.
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Affiliation(s)
- Ying Meng
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | - Christopher B Pople
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | - Suneil K Kalia
- 3Division of Neurosurgery, Toronto Western Hospital, University Health Network
- 4Krembil Research Institute, Toronto Western Hospital, University Health Network
| | - Lorraine V Kalia
- 4Krembil Research Institute, Toronto Western Hospital, University Health Network
- 5Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network; and
- 6Tanz Centre for Research in Neurodegenerative Diseases, and
- 7Department of Medicine, Division of Neurology, University of Toronto, Ontario, Canada
| | - Benjamin Davidson
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | - Luca Bigioni
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | - Daniel Zhengze Li
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | - Suganth Suppiah
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
| | - Karim Mithani
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | | | | | - Clement Hamani
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
| | - Nir Lipsman
- 1Division of Neurosurgery, Sunnybrook Health Sciences Centre
- 2Harquail Centre for Neuromodulation, Sunnybrook Research Institute
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Identifying and predicting Parkinson's disease subtypes through trajectory clustering via bipartite networks. PLoS One 2020; 15:e0233296. [PMID: 32555729 PMCID: PMC7299311 DOI: 10.1371/journal.pone.0233296] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/02/2020] [Indexed: 11/29/2022] Open
Abstract
Chronic medical conditions show substantial heterogeneity in their clinical features and progression. We develop the novel data-driven, network-based Trajectory Profile Clustering (TPC) algorithm for 1) identification of disease subtypes and 2) early prediction of subtype/disease progression patterns. TPC is an easily generalizable method that identifies subtypes by clustering patients with similar disease trajectory profiles, based not only on Parkinson’s Disease (PD) variable severity, but also on their complex patterns of evolution. TPC is derived from bipartite networks that connect patients to disease variables. Applying our TPC algorithm to a PD clinical dataset, we identify 3 distinct subtypes/patient clusters, each with a characteristic progression profile. We show that TPC predicts the patient’s disease subtype 4 years in advance with 72% accuracy for a longitudinal test cohort. Furthermore, we demonstrate that other types of data such as genetic data can be integrated seamlessly in the TPC algorithm. In summary, using PD as an example, we present an effective method for subtype identification in multidimensional longitudinal datasets, and early prediction of subtypes in individual patients.
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22
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Tsiouris KM, Konitsiotis S, Koutsouris DD, Fotiadis DI. Prognostic factors of Rapid symptoms progression in patients with newly diagnosed parkinson's disease. Artif Intell Med 2020; 103:101807. [PMID: 32143804 DOI: 10.1016/j.artmed.2020.101807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Tracking symptoms progression in the early stages of Parkinson's disease (PD) is a laborious endeavor as the disease can be expressed with vastly different phenotypes, forcing clinicians to follow a multi-parametric approach in patient evaluation, looking for not only motor symptomatology but also non-motor complications, including cognitive decline, sleep problems and mood disturbances. Being neurodegenerative in nature, PD is expected to inflict a continuous degradation in patients' condition over time. The rate of symptoms progression, however, is found to be even more chaotic than the vastly different phenotypes that can be expressed in the initial stages of PD. In this work, an analysis of baseline PD characteristics is performed using machine learning techniques, to identify prognostic factors for early rapid progression of PD symptoms. Using open data from the Parkinson's Progression Markers Initiative (PPMI) study, an extensive set of baseline patient evaluation outcomes is examined to isolate determinants of rapid progression within the first two and four years of PD. The rate of symptoms progression is estimated by tracking the change of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score over the corresponding follow-up period. Patients are ranked according to their progression rates and those who expressed the highest rates of MDS-UPDRS total score increase per year of follow-up period are assigned into the rapid progression class, using 5- and 10-quantiles partition. Classification performance against the rapid progression class was evaluated in a per quantile partition analysis scheme and in quantile-independent approach, respectively. The results shown a more accurate patient discrimination with quantile partitioning, however, a much more compact subset of baseline factors is extracted in the latter, making a more suitable for actual interventions in practice. Classification accuracy improved in all cases when using the longer 4-year follow-up period to estimate PD progression, suggesting that a prolonged patient evaluation can provide better outcomes in identifying rapid progression phenotype. Non-motor symptoms are found to be the main determinants of rapid symptoms progression in both follow-up periods, with autonomic dysfunction, mood impairment, anxiety, REM sleep behavior disorders, cognitive decline and memory impairment being alarming signs at baseline evaluation, along with rigidity symptoms, certain laboratory blood test results and genetic mutations.
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Affiliation(s)
- Kostas M Tsiouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, GR15773, Athens, Greece; Unit of Medical Technology and Intelligent Information Systems, Dept. of Material Science and Engineering, University of Ioannina, GR45110, Ioannina, Greece
| | - Spiros Konitsiotis
- Dept. of Neurology, Medical School, University of Ioannina, GR45110, Ioannina, Greece
| | - Dimitrios D Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, GR15773, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Material Science and Engineering, University of Ioannina, GR45110, Ioannina, Greece; Dept. of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR45110, Ioannina, Greece.
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23
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Rajput AH, Rajput EF, Bocking SM, Auer RN, Rajput A. Parkinsonism in essential tremor cases: A clinicopathological study. Mov Disord 2019; 34:1031-1040. [PMID: 31180613 PMCID: PMC6771898 DOI: 10.1002/mds.27729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Essential tremor and Parkinson's syndrome are two common movement disorders that may co-occur in some individuals. There is no diagnostic neuropathology for essential tremor, but in PD and other Parkinson's syndrome variants, the neuropathology is well known. The spectrum of Parkinson's syndrome variants associated with essential tremor, their clinical features, and course have not been determined in autopsy-confirmed cases. OBJECTIVES To identify: diagnostic features of essential tremor/Parkinson's syndrome, different Parkinson's syndrome variants, and long-term clinical profile in such cases. METHODS Patients that had an essential tremor diagnosis and a subsequent clinical or pathological diagnosis of Parkinson's syndrome seen in our clinic during 50 years were included. The diagnosis of parkinsonism was made when bradykinesia, rigidity, and resting tremor were all clinically evident. RESULTS Twenty-one cases were included. All the common variants of parkinsonism co-occurred with essential tremor. The most common was PD (67%) followed by PSP. The pathological findings were not predicted clinically in 2 cases that had essential tremor/PD and in all 5 essential tremor/PSP cases. CONCLUSION In most essential tremor/Parkinson's syndrome patients, the main motor features of parkinsonism-bradykinesia, rigidity, and resting tremor-were identifiable. All known degenerative Parkinson's syndrome variants co-occurred in essential tremor patients. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ali H. Rajput
- Saskatchewan Movement Disorders ProgramUniversity of Saskatchewan/ Saskatchewan Health AuthoritySaskatoonSaskatchewanCanada
| | - Emma F. Rajput
- Saskatchewan Movement Disorders ProgramUniversity of Saskatchewan/ Saskatchewan Health AuthoritySaskatoonSaskatchewanCanada
| | - Sarah M. Bocking
- Saskatchewan Movement Disorders ProgramUniversity of Saskatchewan/ Saskatchewan Health AuthoritySaskatoonSaskatchewanCanada
| | - Roland N. Auer
- Department of PathologySaskatchewan Health AuthoritySaskatoonSaskatchewanCanada
| | - Alex Rajput
- Saskatchewan Movement Disorders ProgramUniversity of Saskatchewan/ Saskatchewan Health AuthoritySaskatoonSaskatchewanCanada
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24
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The Dual-Tasking Overload on Functional Mobility Is Related to Specific Cognitive Domains in Different Subtypes of Parkinson's Disease. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Lian TH, Guo P, Zuo LJ, Hu Y, Yu SY, Yu QJ, Jin Z, Wang RD, Li LX, Zhang W. Tremor-Dominant in Parkinson Disease: The Relevance to Iron Metabolism and Inflammation. Front Neurosci 2019; 13:255. [PMID: 30971879 PMCID: PMC6445850 DOI: 10.3389/fnins.2019.00255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Tremor is one of the most predominant symptoms of patients with Parkinson disease (PD), but the underlying mechanisms for tremor relating to iron and its metabolism-related proteins and the inflammatory factors in cerebrospinal fluid (CSF) and serum have not been fully elucidated. Methods: A total of 135 PD patients were divided into a tremor-dominant (PD-TD) group (N = 74) and a postural instability and gait difficulty-dominant (PD-PIGD) group (N = 39) based on the ratio of mean tremor score to the mean bradykinesia/rigid score of the Unified Parkinson’s Disease Rating Scale (UPDRS) III. Age and sex-matched healthy controls were recruited (N = 35). Demographic variables were evaluated; iron and its metabolism-related proteins and the inflammatory mediators in both CSF and serum were measured in these groups. The relevance of iron metabolism, inflammation and PD-TD were analyzed. Results: (1) The PD-TD group had significantly decreased L-ferritin, increased iron levels in CSF and increased ferritin levels in the serum compared with the PD-PIGD and control groups (P < 0.05). (2) The PD-TD group had significantly enhanced IL-6 levels in both CSF and serum compared with the PD-PIGD and control groups (P < 0.05). (3) In CSF, the IL-6 level was increased as the iron level was elevated in the PD-TD group (r = 0.308, P = 0.022). In serum, the IL-6 level was increased as the ferritin level was elevated in the PD-TD group (r = 0.410, P = 0.004). Conclusion: The interplay between disturbed iron metabolism and relevant inflammation might modulate clinical phenotypes of PD.
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Affiliation(s)
- Teng-Hong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu-Yang Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiu-Jin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhao Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui-Dan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Xia Li
- Department of Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory on Parkinson's Disease, Beijing, China
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26
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Hu Z, Hao M, Xu S, Xiao Q, Lan N. Evaluation of tremor interference with control of voluntary reaching movements in patients with Parkinson's disease. J Neuroeng Rehabil 2019; 16:38. [PMID: 30866977 PMCID: PMC6417201 DOI: 10.1186/s12984-019-0505-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/24/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A large population of patients with Parkinson's disease (PD) displays the symptom of resting tremor. However, the extent that resting tremor may affect the performance of movement control has not been evaluated specifically. This study aims at establishing methods to quantitatively evaluate motor performance in PD patients with tremor, and at analyzing the interfering effects of tremor on control of reaching movements. METHODS Ten PD patients with tremor and Ten healthy control subjects were recruited to participate in this study. All patients and healthy control subjects performed point-to-point reaching movements with their tremor affected arm or preferred arm. We verified that a smoothing model of minimum-jerk trajectory (MJT) can be used to extract voluntary movement trajectory from tremor-corrupted movement trajectory in the reaching tasks by the patients. Performance indices of reaction time (RT) and movement time (MT) of reaching movements by the PD subjects with tremor were evaluated using MJT trajectories. Differences of RT and MT between the recorded trajectories and MJT in PD and control subjects were calculated to investigate the extent that tremor may affect their motor performance. Linear mixed-effects model was used to identify the contributions of tremor, bradykinesia and rigidity to the performance indices of RT and MT based on UPDRS scores. The power spectrum densities (PSD) of tremor were also evaluated using hand velocities to represent tremor intensity and to analyze their correlations with RT and MT. RESULTS The MJT model demonstrated good fit to recorded trajectory with a more consistent estimation of motor performance for both PD and control subjects. The RT and MT of patients were found to be 43.4 and 79.5% longer respectively than those of healthy control subjects. Analysis of the linear mixed-effects model was not able to reveal that tremor, bradykinesia and rigidity each had a significant contribution to RT or MT in PD patients with tremor. However, the PSD of tremor was found to correlate significantly to RT, but not to MT, in both linear regression and linear mixed-effects model. CONCLUSIONS The minimum-jerk trajectory and power spectrum densities are effective quantitative tools for evaluating motor performance for PD patients with tremor. Resting tremor is one of the factors prolonging the initiation of voluntary reaching movement in these patients.
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Affiliation(s)
- Zixiang Hu
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China
| | - Manzhao Hao
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China
| | - Shaoqing Xu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Xiao
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ning Lan
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China.
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27
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Prange S, Danaila T, Laurencin C, Caire C, Metereau E, Merle H, Broussolle E, Maucort-Boulch D, Thobois S. Age and time course of long-term motor and nonmotor complications in Parkinson disease. Neurology 2018; 92:e148-e160. [DOI: 10.1212/wnl.0000000000006737] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/11/2018] [Indexed: 01/12/2023] Open
Abstract
ObjectiveTo determine the time course of hazard for motor and nonmotor milestones of Parkinson disease (PD) in the long term and to investigate whether risk scales nonlinearly with time is instrumental in identifying changes in pathological processes and evaluating disease-modifying therapies in PD.MethodsOutpatients with PD at the Lyon University Movement Disorders Center were evaluated for 7 clinical milestones in this retrospective cohort study, encompassing 4 domains of PD progression: (1) motor (motor fluctuations, dyskinesias); (2) axial (postural instability and falls, freezing of gait); (3) neuropsychiatric (impulse control disorders, hallucinations); and (4) cognitive (dementia) complications. For each complication, we estimated the outcome-specific hazard using parsimonious smooth parametric Poisson regression models allowing for nonlinear scaling over disease duration, age at diagnosis, current age, and their interaction.ResultsA total of 1,232 patients with PD experienced 1,527 disease-related complications in up to 12 years of follow-up. Specific to each complication, hazard rates increased dramatically starting from diagnosis and were highest for motor fluctuations and lowest for dementia up to 6 years after diagnosis in patients aged 65 years at diagnosis. Nonlinear patterns indicated dramatic changes in the course of PD after 5 years and predicted more severe axial prognosis after 70 years and for motor fluctuations, dyskinesias, and impulse control disorders before 60 years at diagnosis.ConclusionTime course of motor and nonmotor milestones in PD is determined by disease duration and age at diagnosis in nonlinear patterns and their interaction. This indicates disease- and age-specific thresholds across the multiple neurodegenerative processes accumulating in PD at different paces.
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Paolucci T, Iosa M, Morone G, Fratte MD, Paolucci S, Saraceni VM, Villani C. Romberg ratio coefficient in quiet stance and postural control in Parkinson's disease. Neurol Sci 2018; 39:1355-1360. [PMID: 29737443 DOI: 10.1007/s10072-018-3423-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine the function of visual afference in postural control in Parkinson patients. We enrolled 29 patients and 30 healthy controls. The stabilometry test was performed for posture and balance and Romberg ratio coefficients were calculated. In addition, the Berg Balance Scale and the 6-Minute Walking Test were administered to assess balance and functional exercise capacity; the Unified Parkinson's Disease Rating Scale was used to determine the stage of the disease; and the Short Form (SF)-36 Health Survey was given to collect information on quality of life. RESULTS significantly longer Center of Pressure (CoP) sway lengths were observed in the parkinson group. The Romberg index for CoP length of sway in parkinson patients was 94.3 ± 19.3%, versus 147.4 ± 120.6% for the control group. (p = 0.025). CONCLUSION Parkinson patients use the increase in CoP sway length and ellipse area to stabilize their balance and sight does not facilitate static postural control as in healthy subjects.
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Affiliation(s)
- Teresa Paolucci
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Delle Fratte
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Vincenzo M Saraceni
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Ciro Villani
- Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences - Section of Locomotor Apparatus Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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29
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The genetics of Parkinson disease. Ageing Res Rev 2018; 42:72-85. [PMID: 29288112 DOI: 10.1016/j.arr.2017.12.007] [Citation(s) in RCA: 321] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
About 15% of patients with Parkinson disease (PD) have family history and 5-10% have a monogenic form of the disease with Mendelian inheritance. To date, at least 23 loci and 19 disease-causing genes for parkinsonism have been found, but many more genetic risk loci and variants for sporadic PD phenotype have been identified in various association studies. Investigating the mutated protein products has uncovered potential pathogenic pathways that provide insights into mechanisms of neurodegeneration in familial and sporadic PD. To commemorate the 200th anniversary of Parkinson's publication of An Essay on the Shaking Palsy, we provide a comprehensive and critical overview of the current clinical, neuropathological, and genetic understanding of genetic forms of PD. We also discuss advances in screening for genetic PD-related risk factors and how they impact genetic counseling and contribute to the development of potential disease-modifying therapies.
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30
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Jin R, Ge J, Wu P, Lu J, Zhang H, Wang J, Wu J, Han X, Zhang W, Zuo C. Validation of abnormal glucose metabolism associated with Parkinson's disease in Chinese participants based on 18F-fluorodeoxyglucose positron emission tomography imaging. Neuropsychiatr Dis Treat 2018; 14:1981-1989. [PMID: 30122931 PMCID: PMC6086566 DOI: 10.2147/ndt.s167548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We previously identified disease-related cerebral metabolic characteristics associated with Parkinson's disease (PD) in the Chinese population using 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging. The present study aims to assess data reproducibility and robustness of the metabolic activity characteristics across independent cohorts. PATIENTS AND METHODS Forty-eight patients with PD and 48 healthy controls from Chongqing district, in addition to 33 patients with PD and 33 healthy controls from Shanghai district were recruited. Each subject underwent brain 18F-FDG PET/CT imaging in a resting state. Based on the brain images, differences between the groups and PD-related cerebral metabolic activities were graphically and quantitatively evaluated. RESULTS Both PD patient cohorts exhibited analogous cerebral patterns characterized by metabolic increase in the putamen, globus pallidus, thalamus, pons, sensorimotor cortex and cerebellum, along with metabolic decrease in parieto-occipital areas. Additionally, the metabolic pattern was highly indicative of the disease, with a significant elevation in PD patients compared with healthy controls (p<0.001) in both the derivation (Shanghai) and validation (Chongqing) cohorts. CONCLUSION This dual-center study demonstrated the high comparability and reproducibility of PD-related cerebral metabolic activity patterns across independent Chinese cohorts and may serve as an objective diagnostic marker for the disease.
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Affiliation(s)
- Rongbing Jin
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Jingjie Ge
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China,
| | - Ping Wu
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China,
| | - Jiaying Lu
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China,
| | - Huiwei Zhang
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China,
| | - Jian Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jianjun Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xianhua Han
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China,
| | - Weishan Zhang
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China,
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China, .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai 200433, China,
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