1
|
YAZICI S, ÖNCÜ ÇETİNKAYA B. Sleep Disorders during Adolescence. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1105463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Sleep disorders during adolescence period increase each year and adversely affect the physical and mental health of adolescents. After-school social activities and various work outside the school may cause delays in bedtime. In addition, there can be shifts in the circadian rhythm due to a number of biological changes seen in the transition to adolescence, which can result in a wide range of sleep problems, such as not being able to fall asleep at night, difficulty waking up in the morning, daytime sleepiness, sleep deprivation and deterioration in sleep quality. It is important to know the causes of sleep disorders, possible effects on physical health and mental health, and protective and risk-forming factors seen in adolescent period; to intervene in these disorders and to develop preventive measures. Preventive measures, such as increasing awareness about sleep disorders in adolescents, informing families and adolescents about the issue, and organizing school start-up times for this age group, may contribute significantly to solving this important issue, which has increased year-to-year.
Collapse
|
2
|
Su W, Huang P, Ma X, Shang H, Ye Q, Cheng O, Chan P, Liu C, Liu W, Tang B, Wang L, Zhang B, Wang T, Shao M, Xie A, Chen X, Zhu X, Wang J, Tao E, Chen S, Chen H. Evaluation of Nocturnal Symptoms in Chinese Parkinson's Disease Patients Based on the PDSS-2 Scale: A Multicenter Cross-Sectional Study. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1061-1071. [PMID: 37522220 PMCID: PMC10578254 DOI: 10.3233/jpd-230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Nocturnal symptoms have a significant effect on the quality of life in Parkinson's disease (PD) patients. OBJECTIVE This study aimed to investigate the prevalence and associated factors of nocturnal symptoms in Chinese PD patients. METHODS This multicenter cross-sectional study included 1,500 patients with primary PD from 18 centers in China was carried out between February 2019 and February 2020. Questionnaires including Parkinson's disease sleep scale 2 (PDSS-2), Parkinson's disease questionnaire 8 (PDQ-8), Beck depression inventory (BDI), and generalized anxiety disorder scale 7 (GAD-7) were used to assess nocturnal symptoms, quality of life, depression, and anxiety. RESULTS Among 1,500 Chinese PD patients, 576 (38.4%) reported nocturnal symptoms. Of them, 59.2% were older than 65 years. The PDQ-8 total score was higher in patients with nocturnal symptoms (p < 0.01). Moderate and severe depression was reported more often in patients with nocturnal symptoms (p < 0.01), and the occurrence and severity of anxiety were higher as well (p < 0.01). Longer disease duration and higher Hoehn-Yahr (HY) stage were independently associated with nocturnal symptoms (p < 0.01). Education level, depression, disease course, HY stage, and nocturnal symptoms were related to the quality of life in Chinese PD patients (p < 0.01). CONCLUSION Our study found that 38.4% of Chinese PD patients have nocturnal symptoms, even in early and mid-stage PD. Nocturnal symptoms were associated with worse quality of life and higher incidences of depression and anxiety. Nocturnal symptoms should be included in the assessment and care plan, especially in patients with longer disease courses and higher HY stages.
Collapse
Affiliation(s)
- Wen Su
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Huang
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinxin Ma
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huifang Shang
- Department of Neurology, West China Hospital of Sichuan University, Sichuan, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Oumei Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Piu Chan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chunfeng Liu
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weiguo Liu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Jiangsu, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital Central South University, Changsha, China
| | - Lijuan Wang
- Department of Neurology, Guangdong Provincial People’s Hospital, Guangzhou, Guangdong, China
| | - Baorong Zhang
- Internal Medicine-Neurology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Tao Wang
- Department of Neurology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ming Shao
- Department of Neurology, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Anmu Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated hospital of Anhui Medical University, Anhui, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Wang
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Enxiang Tao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shengdi Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
3
|
Santos García D, Yáñez Baña R, Labandeira Guerra C, Cimas Hernando MI, Cabo López I, Paz González JM, Alonso Losada MG, Gonzalez Palmás MJ, Cores Bartolomé C, Martínez Miró C. Pain Improvement in Parkinson's Disease Patients Treated with Safinamide: Results from the SAFINONMOTOR Study. J Pers Med 2021; 11:jpm11080798. [PMID: 34442442 PMCID: PMC8402181 DOI: 10.3390/jpm11080798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/30/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background and objective: Pain is a frequent and disabling symptom in Parkinson’s disease (PD) patients. Our aim was to analyze the effectiveness of safinamide on pain in PD patients from the SAFINONMOTOR (an open-label study of the effectiveness of SAFInamide on NON-MOTOR symptoms in Parkinson´s disease patients) study. Material and Methods: SAFINONMOTOR is a prospective open-label single-arm study conducted in five centers from Spain. In this analysis, a secondary objective of the study, the score in the KPPS (King´s Parkinson´s Disease Pain Scale) at V1 (baseline) and V4 (6 months ± 1 month) were compared. Wilcoxon´s rank sum test was performed to test the changes from V1 to V4. Results: Forty-four (88%) out of 50 PD patients (age 68.5 ± 9.12 years; 58% women; 6.4 ± 5.1 years from diagnosis) completed the study. The KPPS total score was reduced by 43.6% (from 40.04 ± 36.18 in V1 to 22.60 ± 21.42 in V4; p < 0.0001). By domains, improvement was observed in musculoskeletal (−35.9%; p = 0.009), fluctuation-related (−51.7%; p = 0.020), nocturnal (−46.1%; p = 0.001), discoloration and/or edema/swelling (−50.4%; p = 0.009) and radicular pain (−40.1%; p = 0.048). A total of 21 adverse events in 11 patients (22%) were reported, five being severe, but not related to safinamide. Conclusion: Safinamide is well tolerated and improves pain in PD patients at 6 months. Future studies are necessary to analyze the possible beneficial effect of safinamide on pain in PD patients.
Collapse
Affiliation(s)
- Diego Santos García
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
- Correspondence: ; Tel.: +34-646173341
| | - Rosa Yáñez Baña
- Department of Neurology, CHUO, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Carmen Labandeira Guerra
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | | | - Iria Cabo López
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Jose Manuel Paz González
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| | - Maria Gema Alonso Losada
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - Maria José Gonzalez Palmás
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Carlos Cores Bartolomé
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| | - Cristina Martínez Miró
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| |
Collapse
|
4
|
He G, Liu CF, Ye Q, Liu Z, Jin M, Shang H, Chen L, Tuo H, Jiang H, Cai J, Joshi K, Cooper J, Zi L, Chen S. Prevalence and profile of nocturnal disturbances in Chinese patients with advanced-stage Parkinson's disease: a cross-sectional epidemiology study. BMC Neurol 2021; 21:194. [PMID: 33980158 PMCID: PMC8114718 DOI: 10.1186/s12883-021-02217-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/22/2021] [Indexed: 02/08/2023] Open
Abstract
Background The impact of nocturnal disturbance (ND) in Parkinson’s disease on quality of life of patients in Western Countries is increasingly understood. Our study aimed to investigate ND prevalence and its quality of life impact in patients with advanced Parkinson’s disease in China. Methods In a multicenter, tertiary-care hospital, outpatient-based, cross-sectional study, patients with advanced Parkinson’s disease (Modified Hoehn & Yahr [H&Y] Stage II–IV with ≥3 h awake “off” time/day) from 10 tertiary hospitals throughout China completed the Parkinson’s Disease Sleep Scale-2 (PDSS-2) and Parkinson’s Disease Questionnaire-39 (PDQ-39). The primary endpoint was the percentage of patients with significant ND (PDSS-2 total score ≥ 15). Additional endpoints were demographic and clinical characteristics, PDSS-2 and PDQ-39 total and subscale scores, correlation between PDSS-2 and PDQ-39, and risk factors for ND and higher PDSS-2 or PDQ-39 scores. Results Of 448 patients analyzed (mean age 63.5 years, 47.3% female), 70.92% (95% confidence interval: 66.71, 75.13) had significant ND. Presence of ND and higher PDSS-2 scores were associated with longer disease duration and higher H&Y stage. Presence of ND was also associated with more awake “off” time/day and female sex. PDQ-39 scores were significantly worse for patients with ND versus those without ND; worse scores were associated with more awake “off” time/day, female sex, and higher H&Y stage. PDSS-2 and PDQ-39 total scores were associated: Pearson correlation coefficient 0.62 (p < 0.001). Conclusions In China, ND was highly prevalent in patients with advanced Parkinson’s disease and adversely impacted quality of life. This study highlights the importance of early diagnosis and optimized management of ND in patients with Parkinson’s disease in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02217-5.
Collapse
Affiliation(s)
- Guiying He
- Department of Neurology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Feng Liu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qinyong Ye
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhenguo Liu
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Miao Jin
- China-Japan Friendship Hospital, Beijing, China
| | - Huifang Shang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Chen
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Houzhen Tuo
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong Jiang
- Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jifu Cai
- The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | | | | | | | - Shengdi Chen
- Department of Neurology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
5
|
Park KW, Jo S, Lee SH, Hwang YS, Lee D, Ryu HS, Chung SJ. Therapeutic Effect of Levodopa/Carbidopa/Entacapone on Sleep Disturbance in Patients with Parkinson's Disease. J Mov Disord 2020; 13:205-212. [PMID: 32894900 PMCID: PMC7502296 DOI: 10.14802/jmd.20055] [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: 04/28/2020] [Accepted: 06/15/2020] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the efficacy of levodopa/carbidopa/entacapone (LCE) at bedtime for treating sleep disturbance in patients with Parkinson’s disease (PD) with motor fluctuations. Methods Participants included 128 PD patients with motor fluctuations. All patients were assessed for motor, nonmotor, and sleep-specific symptoms using the United Parkinson’s Disease Rating Scale (UPDRS), the Korean version of the Nonmotor Symptom Scale, the Parkinson’s Disease Sleep Scale (PDSS), the Epworth Sleepiness Scale, and the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ). We compared the baseline characteristics of patients with sleep disturbance (PDSS score < 120) and those without sleep disturbance (PDSS score ≥ 120). Thirty-nine patients with sleep disturbance who agreed to take LCE at bedtime completed 3-month follow-ups. We analyzed changes in the scores of motor, nonmotor, and sleep symptom scales over the 3 months. Results PD patients with sleep disturbance were at more advanced disease stages and had more severe motor, nonmotor, and sleep symptoms than those without sleep disturbance. Patients who took LCE at night showed improvements in motor (UPDRS part III, p = 0.007) and sleep symptoms (total PDSS, p < 0.001). Sleep features that benefitted from LCE included not only nocturnal motor components but also insomnia (PDSS items 2 and 3, p = 0.005 and p < 0.001) and rapid eye movement behavior disorder (PDSS item 6, p = 0.002; and RBDSQ, p < 0.001). Conclusion The use of LCE at bedtime may be a useful treatment for sleep disturbance in advanced PD patients with motor fluctuations.
Collapse
Affiliation(s)
- Kye Won Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Su Hwang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dagyo Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Hwang SR, Hwang SW, Chen JC, Hwang JH. Association of periodic limb movements during sleep and Parkinson disease: A retrospective clinical study. Medicine (Baltimore) 2019; 98:e18444. [PMID: 31861016 PMCID: PMC6940135 DOI: 10.1097/md.0000000000018444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Both of periodic limb movements during sleep (PLMS) and Parkinson disease (PD) were related with dopaminergic system dysfunction. We aimed to investigate the detailed association of PLMS severity and PD.Clinical and overnight polysomnographic data of 2230 adults older than 40 from a community hospital between November 2011 and June 2017 in Taiwan were collected retrospectively. The association of PLMS severity and PD was analyzed by Fisher exact test, univariate, and multivariate logistic regression.The mean age was 55.6 years old (standard deviation = 9.8, range = 40-91) for all subjects. There were 2205 subjects without PD and 25 subjects with PD in this study. The distribution of PLMS severity was not significantly different between subjects without PD and with PD (Fischer exact test, P = .215). Also, PLMS was not significantly associated with PD using univariate and multivariate logistic regression.The PLMS severity was not associated with PD.
Collapse
Affiliation(s)
| | | | - Jin-Cherng Chen
- Departments of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
| | - Juen-Haur Hwang
- School of Medicine, Tzu Chi University, Hualien
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| |
Collapse
|
7
|
Bhidayasiri R, Sringean J, Taechalertpaisarn P, Thanawattano C. Capturing nighttime symptoms in Parkinson disease: Technical development and experimental verification of inertial sensors for nocturnal hypokinesia. ACTA ACUST UNITED AC 2018; 53:487-98. [PMID: 27533042 DOI: 10.1682/jrrd.2015.04.0062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/17/2015] [Indexed: 11/05/2022]
Abstract
Although nocturnal hypokinesia represents one of the most common nocturnal disabilities in Parkinson disease (PD), it is often a neglected problem in daily clinical practice. We have developed a portable ambulatory motion recorder (the NIGHT-Recorder), which consists of 16-bit triaxial integrated microelectromechanical system inertial sensors that are specifically designed to measure movements, register the position of the body with respect to gravity, and provide information on rotations on the longitudinal axis while lying in bed. The signal processing uses the forward derivative method to identify rolling over and getting out of bed as primary indicators. The prototype was tested on six PD pairs to measure their movements for one night. Using predetermined definitions, 134 movements were captured consisting of rolling over 115 times and getting out of bed 19 times. Patients with PD rolled over significantly fewer times than their spouses (p = 0.03), and the position change was significantly smaller in patients with PD (p = 0.03). Patients with PD rolled over at a significantly slower speed (p = 0.03) and acceleration (p = 0.03) than their spouses. In contrast, patients with PD got out of bed significantly more often than their spouses (p = 0.02). It is technically feasible to develop an easy-to-use, portable, and accurate device that can assist physicians in the assessment of nocturnal movements of patients with PD.
Collapse
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | | | | |
Collapse
|
8
|
Catalan MJ, Molina-Arjona JA, Mir P, Cubo E, Arbelo JM, Martinez-Martin P. Improvement of impulse control disorders associated with levodopa-carbidopa intestinal gel treatment in advanced Parkinson's disease. J Neurol 2018; 265:1279-1287. [PMID: 29557989 DOI: 10.1007/s00415-018-8803-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 12/01/2022]
Abstract
Impulse control behaviors are a frequent comorbidity for patients with Parkinson's disease (PD). The objective of the present study was to evaluate the effectiveness levodopa-carbidopa intestinal gel (LCIG) therapy on impulse control disorders (ICDs) in patients with advanced PD. We conducted a multicenter, observational, and prospective (6 months follow-up) study that included consecutive PD patients assigned to LCIG through routine medical practice. Patients completed visits at baseline, 1, 3, and 6 months after percutaneous endoscopic gastrostomy procedure. The following outcomes were evaluated: presence and severity of ICDs and other neuropsychiatric disorders, sleep disturbances, patients' quality of life, and caregivers' burden. Sixty-two patients were included at baseline: mean age 72.2 years (SD ± 7.0), 42% women. Median duration of PD symptoms was 13.5 years (IQR 5.5-21.5) and median time with motor fluctuations was 5.0 years (IQR 1.0-9.0). Treatment with LCIG infusion was associated with progressive and significant improvements in ICDs symptoms over the study period (64.4% reduction in the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease-Rating Scale score). Psychotic and other neuropsychiatric symptoms were also significantly reduced, and patients' sleep quality and psychosocial function improved. Caregivers' burden remained unchanged. There was a significant improvement in the daily "Off" time [7.4 h (SD ± 4.0) vs 1.5 h (SD ± 1.8); p < 0.0001] at the end of follow-up, whereas duration of dyskinesias was not affected. ICDs significantly improved after 6-month LCIG treatment in a group of PD patients with mild-to-moderate neuropsychiatric disturbances.
Collapse
Affiliation(s)
- Maria Jose Catalan
- Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain.
| | | | - Pablo Mir
- Movement Disorders Unit, Neurology and Clinical Neurophysiology Service, Seville Biomedicine Institute (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Esther Cubo
- Department of Neurology, Hospital General Yagüe, Burgos, Spain
| | - Jose Matias Arbelo
- Department of Neurology, University Hospital Insular de Gran Canaria, Las Palmas, Gran Canaria, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | | |
Collapse
|
9
|
Bhidayasiri R, Sringean J, Chaiwong S, Anan C, Penkeaw N, Leaknok A, Boonpang K, Saksornchai K, Rattanachaisit W, Thanawattano C, Jagota P. Rotigotine for nocturnal hypokinesia in Parkinson's disease: Quantitative analysis of efficacy from a randomized, placebo-controlled trial using an axial inertial sensor. Parkinsonism Relat Disord 2017; 44:124-128. [PMID: 28818560 DOI: 10.1016/j.parkreldis.2017.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/12/2017] [Accepted: 08/08/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nocturnal hypokinesia is a common symptom in Parkinson's disease (PD), negatively affecting quality of life of both patients and caregivers. However, evidence-based treatment strategies are limited. OBJECTIVE To evaluate the efficacy of rotigotine transdermal patch, using a wearable sensor, in the management of nocturnal immobility. METHODS 34 PD subjects with nocturnal immobility were randomized to receive rotigotine transdermal patch (mean ± SD of 10.46 ± 4.63 mg/24 h, n = 17) or placebo patch (n = 17). Treatment was titrated to an optimal dose over 1-8 weeks, then maintained for 4 weeks. Primary endpoints were objective parameters assessing axial rotation measured using an axial inertial sensor (the NIGHT-Recorder) over two nights at the patients' home. Scale-based assessments were also performed. RESULTS There was a significant difference, in favor of rotigotine, in change from baseline score in the number of turns in bed (ANCOVA, p = 0.001), and degree of axial turn (p = 0.042). These objective improvements were mirrored by significantly greater improvements in clinical scale-based assessments, including the Unified Parkinson's Disease Rating Scale (UPDRS) total scores (p = 0.009), UPDRS-motor scores (p < 0.001), UPDRS-axial scores (p = 0.01), the Modified Parkinson's Disease Sleep Scale (p < 0.001), the Nocturnal Akinesia Dystonia and Cramp Scale (p = 0.003) and the eight-item PD Questionnaire (PDQ-8) scores (p = 0.01) from baseline to end of treatment in patients given rotigotine compared to placebo. CONCLUSION We show that the rotigotine patch provides a significant improvement in nocturnal symptoms as assessed using both objective measures and clinical rating scales. The study demonstrates the feasibility of using wearable sensors to record objective outcomes in PD-related clinical trials.
Collapse
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Suchapit Chaiwong
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Nuntiwat Penkeaw
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Amarinee Leaknok
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Karn Saksornchai
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Watchara Rattanachaisit
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chusak Thanawattano
- Biomedical Signal Processing Laboratory, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
| | - Priya Jagota
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| |
Collapse
|
10
|
Wang L, Xiong N, Huang J, Guo S, Liu L, Han C, Zhang G, Jiang H, Ma K, Xia Y, Xu X, Li J, Liu JY, Wang T. Protein-Restricted Diets for Ameliorating Motor Fluctuations in Parkinson's Disease. Front Aging Neurosci 2017; 9:206. [PMID: 28701947 PMCID: PMC5487390 DOI: 10.3389/fnagi.2017.00206] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/08/2017] [Indexed: 11/13/2022] Open
Abstract
Levodopa is considered to be the most effective symptomatic drug for Parkinson's disease (PD). As the disease progresses, however, the patients are likely to experience a reduced response to levodopa and develop motor fluctuations (i.e., end-of-dose wearing off and unpredictable "on-off"). Protein-rich diets and elevated plasma concentrations of large neutral amino acids have been proved to impair the therapeutic effect of levodopa by reducing its absorption and influx into the brain. On the other hand, the protein-restricted diets including low-protein diet (LPD), protein-redistribution diet (PRD) and PRD with use of low-protein products can all improve the efficacy of levodopa in patients with motor fluctuations. However, it should be noted that protein-restricted diets may also contribute to several side effects, including dyskinesia, weight loss, and malnutrition (e.g., protein and calcium insufficiency). Together, protein-restricted diets are an effective approach to improve motor fluctuations in PD patients, while long-term adherence to these diets requires monitoring for side effects.
Collapse
Affiliation(s)
- Luxi Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Shiyi Guo
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Ling Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Chao Han
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Guoxin Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Haiyang Jiang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Kai Ma
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Yun Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Xiaoyun Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Jie Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Jing Y Liu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and TechnologyWuhan, China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| |
Collapse
|
11
|
Bhidayasiri R, Martinez-Martin P. Clinical Assessments in Parkinson's Disease: Scales and Monitoring. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:129-182. [PMID: 28554406 DOI: 10.1016/bs.irn.2017.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement of disease state is essential in both clinical practice and research in order to assess the severity and progression of a patient's disease status, effect of treatment, and alterations in other relevant factors. Parkinson's disease (PD) is a complex disorder expressed through many motor and nonmotor manifestations, which cause disabilities that can vary both gradually over time or come on suddenly. In addition, there is a wide interpatient variability making the appraisal of the many facets of this disease difficult. Two kinds of measure are used for the evaluation of PD. The first is subjective, inferential, based on rater-based interview and examination or patient self-assessment, and consist of rating scales and questionnaires. These evaluations provide estimations of conceptual, nonobservable factors (e.g., symptoms), usually scored on an ordinal scale. The second type of measure is objective, factual, based on technology-based devices capturing physical characteristics of the pathological phenomena (e.g., sensors to measure the frequency and amplitude of tremor). These instrumental evaluations furnish appraisals with real numbers on an interval scale for which a unit exists. In both categories of measures, a broad variety of tools exist. This chapter aims to present an up-to-date summary of the most relevant characteristics of the most widely used scales, questionnaires, and technological resources currently applied to the assessment of PD. The review concludes that, in our opinion: (1) no assessment methods can substitute the clinical judgment and (2) subjective and objective measures in PD complement each other, each method having strengths and weaknesses.
Collapse
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Juntendo University, Tokyo, Japan.
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| |
Collapse
|
12
|
Zhu K, van Hilten JJ, Marinus J. The course of insomnia in Parkinson's disease. Parkinsonism Relat Disord 2016; 33:51-57. [PMID: 27639814 DOI: 10.1016/j.parkreldis.2016.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/01/2016] [Accepted: 09/07/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Insomnia is a debilitating symptom in Parkinson's disease (PD) that has been scarcely investigated in a longitudinal design. Knowledge of factors associated with occurrence of insomnia may provide clues for an increased understanding of underlying pathophysiology and facilitate early detection. The objective of this study is to examine the course and factors associated with longitudinal changes in insomnia severity in patients with PD. METHODS Analyses were performed in data of the SCOPA-PROPARK cohort, a 5-year longitudinal cohort study (2003-2011) of 421 PD patients who have been examined annually. Linear mixed models were used to identify factors associated with longitudinal changes in scores of the SCOPA-SLEEP-Nighttime sleep (NS) problems section. A generalized estimating equations (GEE) analysis was performed to determine which baseline variables were associated with the different aspects of insomnia (sleep initiation or maintenance difficulty). RESULTS Baseline SCOPA-SLEEP-NS scores were available for 412 patients, of whom 110 (27%) had insomnia (i.e. score ≥ 7). Of the remaining 302 patients, 99 (33%) developed insomnia at some point during follow-up. More severe depressive symptoms, motor fluctuations, higher dopamine agonist doses and sleep medication use were independently associated with higher SCOPA-SLEEP-NS scores over time. GEE analysis did not identify an unique set of determinants that affected specific aspects of insomnia. CONCLUSION The presence of depressive symptoms, motor fluctuations and the use of higher doses of dopamine agonists are associated with more severe insomnia. Attention to these aspects could potentially contribute to a better management of insomnia symptoms in PD.
Collapse
Affiliation(s)
- Kangdi Zhu
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
13
|
Batla A, Phé V, De Min L, Panicker JN. Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage? Mov Disord Clin Pract 2016; 3:443-451. [PMID: 30363512 PMCID: PMC6178648 DOI: 10.1002/mdc3.12374] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/18/2016] [Accepted: 03/11/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Nocturia is one of the commonest nonmotor symptoms in Parkinson's disease (PD) and has a significant impact on quality of life both for patients and their carers. There exists a relation between nocturia and poor sleep quality, falls, and institutionalization. Nocturia may manifest as a result of reduced functional bladder capacity or nocturnal polyuria; however, most often the cause is multifactorial. Disorders of circadian rhythm regulation are known to occur with sleep disturbances in PD may also contribute to nocturia. METHODS AND RESULTS In this review, an overview of the assessment and management of nocturia in patients with PD is presented. History taking, medication review, and a bladder diary form the cornerstone of the evaluation. Urinalysis, ultrasonography, and urodynamic studies help to assess the cause for lower urinary tract symptoms and exclude concomitant pathologies, such as bladder outlet obstruction. Antimuscarinic medications are the first-line treatment for the overactive bladder; however, caution is needed when using these medications in individuals predisposed to cognitive impairment. Desmopressin is effective for managing nocturnal polyuria. CONCLUSIONS An individualized approach is recommended to optimize the management of nocturia in PD.
Collapse
Affiliation(s)
- Amit Batla
- Department of Motor neuroscience and Movement DisordersUCL Institute of NeurologyLondonUnited Kingdom
| | - Véronique Phé
- Department of Uro‐NeurologyThe National Hospital for Neurology and Neurosurgery and UCL Institute of NeurologyLondonUnited Kingdom
- Pitié‐Salpêtrière Academic HospitalDepartment of UrologyAssistance Publique‐Hôpitaux de ParisPierre and Marie Curie Medical School, Paris 6 UniversityParisFrance
| | - Lorenzo De Min
- Department of Uro‐NeurologyThe National Hospital for Neurology and Neurosurgery and UCL Institute of NeurologyLondonUnited Kingdom
| | - Jalesh N. Panicker
- Department of Uro‐NeurologyThe National Hospital for Neurology and Neurosurgery and UCL Institute of NeurologyLondonUnited Kingdom
| |
Collapse
|
14
|
Effects of Night-Time Use of Rotigotine on Nocturnal Symptoms in Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:475630. [PMID: 26576319 PMCID: PMC4632005 DOI: 10.1155/2015/475630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/30/2015] [Indexed: 11/18/2022]
Abstract
Objectives. This open-label study assessed the efficacy and safety of exclusive night-time administration of transdermal rotigotine in patients with nocturnal and early morning PD symptoms. Methods. Patients with PD and nocturnal and early morning symptoms received transdermal rotigotine patches (2–16 mg/24 h) applied in the evening and removed in the morning for 3 months. Sleep disturbance was assessed with modified Parkinson's Disease Sleep Scale (PDSS-2). Other outcomes included a pain visual analogue scale (VAS) and short-form Parkinson's Disease Questionnaire (PDQ-8) for quality of life. Results. 74 patients completed treatment in this study. At the end of treatment, PDSS-2 total score had improved by mean 10.9 points from baseline (p < 0.001). All three PDSS-2 domain scores (sleep disturbances, nocturnal motor symptoms, and nocturnal symptoms) were also significantly improved by 41%, 56%, and 48%, respectively (p < 0.001). VAS-pain score decreased from 3.2 to 2.3 (p < 0.001). PDQ-8 score decreased from 23.8 to 18.1 (p < 0.001). The most frequently reported adverse events included nausea (9%), anxiety (4%), and dizziness (4%). Conclusions. Night-time administration of transdermal rotigotine is an effective and well tolerated treatment for nocturnal symptoms in patients with PD.
Collapse
|
15
|
|
16
|
Stocchi F, Stirpe P. The relevance of dopaminergic level in nocturnal disability in Parkinson's disease: implications of continuous dopaminergic stimulation at night to treat the symptoms. J Neural Transm (Vienna) 2014; 121 Suppl 1:S79-83. [PMID: 24990308 DOI: 10.1007/s00702-014-1259-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/08/2014] [Indexed: 11/30/2022]
Abstract
Sleep problems are an under-emphasized cause of disability in Parkinson's disease (PD). Difficult sleep maintenance (light and fragmented sleep) and difficulties in initiating sleep are often the earliest and the most frequent symptoms observed in PD patients. In fluctuating patients, nocturnal akinesia, dystonia, painful cramps, and parasomnias may aggravate nocturnal problems. Treatment of sleep problems can be complex and challenging for the physicians. Dopaminergic treatment may improve some of the nocturnal symptoms in PD. In this paper, the effect of drugs and technique that ensure a more continuous delivery of dopaminergic drugs on sleep problems in PD is reviewed.
Collapse
Affiliation(s)
- Fabrizio Stocchi
- Institute for Research and Medical Care IRCCS San Raffaele, Via della Pisana 235, 00163, Rome, Italy,
| | | |
Collapse
|
17
|
Nocturnal journey of body and mind in Parkinson's disease: the manifestations, risk factors and their relationship to daytime symptoms. Evidence from the NIGHT-PD study. J Neural Transm (Vienna) 2014; 121 Suppl 1:S59-68. [PMID: 24682359 DOI: 10.1007/s00702-014-1199-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
Abstract
Nocturnal manifestations of Parkinson's disease (PD) are myriad, have diverse etiologies and include motor, sleep, urinary, and neuropsychiatric symptoms which are often associated with daytime somnolence. While most patients perceive these symptoms as troublesome, the recognition of nocturnal problems related to PD is still low in clinical practice. We conducted a survey using semi-structured interviews and self-rated questionnaires of 215 consecutive patients with PD enrolled in three centers in Thailand to determine the prevalence and risk factors of nocturnal disabilities and their relationship to daytime symptoms. We found that 96.6% of patients reported the presence of nocturnal symptoms as determined by the modified version of Parkinson's Disease Sleep Scale (MPDSS). Our survey indicated that the most frequent and distressing symptom was the interruption of sleep to pass urine (56.7%, 4.4 ± 3.9). The severity of symptoms revealed in the MPDSS increased along with the disease duration (p < 0.05) and Hoehn and Yahr stages (p = 0.01). There were similar to findings of the Nocturnal Akinesia Dystonia and Cramp Score (NADCS) where patients with advanced disease had significantly higher NADCS scores than early/moderate disease (p < 0.001). There was a significant correlation of total MPDSS scores with the total scores of the 9-item Wearing-Off Questionnaire (WOQ-9); (r = -0.43, p < 0.05) [motor (r = -0.35, p < 0.05) and nonmotor subscores (r = -0.43, p < 0.05)]; total nonmotor symptoms (NMS) scores (r = -0.55, p < 0.05); Parkinson's Disease Questionnaire-8 Summary Index (PDQ-8 SI) (r = -0.52, p < 0.05); and the total NADCS (r = -0.35, p < 0.05). Multiple regression analysis identified PDQ-8 SI (β = -0.27, p = 0.005) as the most significant predictor of nocturnal manifestations of PD, followed by the nonmotor subscore of WOQ (β = -0.24, p = 0.006), and the NMS item 20 (feeling light-headed, dizzy, or weak when standing from sitting or lying) (β = -0.22, p = 0.003). Our study found that nocturnal symptoms of PD are very common and we suggest that good clinical practice should include a comprehensive review of nighttime manifestations, particularly for those patients who already experience "wearing-off" symptoms.
Collapse
|
18
|
Kalaitzakis ME, Gentleman SM, Pearce RKB. Disturbed sleep in Parkinson's disease: anatomical and pathological correlates. Neuropathol Appl Neurobiol 2013; 39:644-53. [DOI: 10.1111/nan.12024] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 01/23/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. E. Kalaitzakis
- Neuropathology Unit; Division of Brain Sciences; Department of Medicine; Imperial College London; London; UK
| | - S. M. Gentleman
- Neuropathology Unit; Division of Brain Sciences; Department of Medicine; Imperial College London; London; UK
| | - R. K. B. Pearce
- Neuropathology Unit; Division of Brain Sciences; Department of Medicine; Imperial College London; London; UK
| |
Collapse
|
19
|
Willison LD, Kudo T, Loh DH, Kuljis D, Colwell CS. Circadian dysfunction may be a key component of the non-motor symptoms of Parkinson's disease: insights from a transgenic mouse model. Exp Neurol 2013; 243:57-66. [PMID: 23353924 PMCID: PMC3994881 DOI: 10.1016/j.expneurol.2013.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/20/2012] [Accepted: 01/15/2013] [Indexed: 01/09/2023]
Abstract
Sleep disorders are nearly ubiquitous among patients with Parkinson's disease (PD), and they manifest early in the disease process. While there are a number of possible mechanisms underlying these sleep disturbances, a primary dysfunction of the circadian system should be considered as a contributing factor. Our laboratory's behavioral phenotyping of a well-validated transgenic mouse model of PD reveals that the electrical activity of neurons within the master pacemaker of the circadian system, the suprachiasmatic nuclei (SCN), is already disrupted at the onset of motor symptoms, although the core features of the intrinsic molecular oscillations in the SCN remain functional. Our observations suggest that the fundamental circadian deficit in these mice lies in the signaling output from the SCN, which may be caused by known mechanisms in PD etiology: oxidative stress and mitochondrial disruption. Disruption of the circadian system is expected to have pervasive effects throughout the body and may itself lead to neurological and cardiovascular disorders. In fact, there is much overlap in the non-motor symptoms experienced by PD patients and in the consequences of circadian disruption. This raises the possibility that the sleep and circadian dysfunction experienced by PD patients may not merely be a subsidiary of the motor symptoms, but an integral part of the disease. Furthermore, we speculate that circadian dysfunction can even accelerate the pathology underlying PD. If these hypotheses are correct, more aggressive treatment of the circadian misalignment and sleep disruptions in PD patients early in the pathogenesis of the disease may be powerful positive modulators of disease progression and patient quality of life.
Collapse
Affiliation(s)
- L David Willison
- Division of Child and Adolescent Psychiatry, Laboratory of Circadian and Sleep Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | | |
Collapse
|
20
|
|
21
|
Nonmotor symptoms in Parkinson's disease in 2012: relevant clinical aspects. PARKINSONS DISEASE 2012; 2012:198316. [PMID: 22888466 PMCID: PMC3410355 DOI: 10.1155/2012/198316] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/18/2012] [Indexed: 01/19/2023]
Abstract
Nonmotor symptoms (NMSs) of Parkinson's disease (PD) are common, but they are often underrecognized in clinical practice, because of the lack of spontaneous complaints by the patients, and partly because of the absence of systematic questioning by the consulting physician. However, valid specific instruments for identification and assessment of these symptoms are available in 2012. The administration of the self-completed screening tool, NMSQuest, associated with questioning during the consultation, improves the diagnosis of NMSs. NMSs play a large role in degradation of quality of life. More relevant NMSs are described in this review, mood disorders, impulse control disorders, cognitive deficits, hallucinations, pain, sleep disorders, and dysautonomia.
Collapse
|
22
|
Recognition and diagnosis of sleep disorders in Parkinson's disease. J Neurol 2012; 259:2031-40. [PMID: 22535255 PMCID: PMC3464375 DOI: 10.1007/s00415-012-6505-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
Sleep disturbances are among the most frequent and incapacitating non-motor symptoms of Parkinson’s disease (PD), and are increasingly recognized as an important determinant of impaired quality of life. Here we review several recent developments regarding the recognition and diagnosis of sleep disorders in PD. In addition, we provide a practical and easily applicable approach to the diagnostic process as a basis for tailored therapeutic interventions. This includes a stepwise scheme that guides the clinical interview and subsequent ancillary investigations. In this scheme, the various possible sleep disorders are arranged not in order of prevalence, but in a ‘differential diagnostic’ order. We also provide recommendations for the use of sleep registrations such as polysomnography. Furthermore, we point out when a sleep specialist could be consulted to provide additional diagnostic and therapeutic input. This structured approach facilitates early detection of sleep disturbances in PD, so treatment can be initiated promptly.
Collapse
|
23
|
Chen W, Xu ZM, Wang G, Chen SD. Non-motor symptoms of Parkinson's disease in China: a review of the literature. Parkinsonism Relat Disord 2012; 18:446-52. [PMID: 22425544 DOI: 10.1016/j.parkreldis.2012.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 02/10/2012] [Accepted: 02/12/2012] [Indexed: 01/18/2023]
Abstract
Parkinson's disease (PD) is generally considered as a neurodegenerative disorder commonly characterized by bradykinesia, resting tremor, rigidity and postural instability. However, increasing evidence demonstrates that serial non-motor symptoms (NMSs), including sensory symptoms, dysautonomia, neurobehavioral disorders and sleep disturbances frequently occur prior to motor signs and invariably emerge with the disease progression. Compared with motor symptoms, the NMSs are frequently under-recognized and poorly managed in clinical practice. A growing number of clinical studies on NMSs of PD have been carried out in China over the past decade. They revealed that there were not only common features, but also some differences on NMSs between Chinese patients and those in the West. Meanwhile, pharmacological and non-pharmacological strategies are available for the treatment of some NMSs associated with PD in China contained in Chinese guidelines for the treatment of PD. Large cohort studies across the country are warranted in the future to explore the epidemiological and biological features of specific NMSs in Chinese PD patients.
Collapse
Affiliation(s)
- Wei Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | | | | | | |
Collapse
|
24
|
Tef polymorphism is associated with sleep disturbances in patients with Parkinson's disease. Sleep Med 2012; 13:297-300. [PMID: 22257907 DOI: 10.1016/j.sleep.2011.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/12/2011] [Accepted: 06/17/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Circadian mechanisms play an important role in the regulation of sleep. A circadian clock-controlled gene, Tef, has been suggested to be associated with depressive symptoms, restless legs syndrome, and slow wave sleep in patients with sleep disorders. The present study sought to explore the association between Tef and sleep disturbances in patients with Parkinson's disease (PD). METHODS Three hundred and ninety-two unrelated patients with PD were recruited for this study. All of them completed the PD Sleep Scale (PDSS) and other clinical and demographic assessments. rs738499, a single nucleotide polymorphism of the Tef gene, was genotyped by polymerase chain reaction-restriction fragment length polymorphism. RESULTS Mean total PDSS scores were 111.5 (standard deviation [SD] 23.0) in the TT genotype and 122.2 (SD 18.2) in the TG+GG genotypes (P<0.01). Significant differences were found between genotypes (TT vs TG+GG) for 14 item scores (all P<0.05). Total and item scores displayed negative associations with the TT genotype (all P<0.05) except Item 2 (P=0.178). Linear regression adjusted for gender, duration, depression and disease severity showed that the polymorphism could explain 0.9% of the variance in PDSS scores. CONCLUSIONS These preliminary results suggest that the TT genotype in Tef rs738499 is associated with sleep disturbances in PD. Depression and disease severity are the main contributors to these findings, but rs738499 itself is an independent risk factor.
Collapse
|
25
|
Abstract
SUMMARY Parkinson’s disease (PD) patients demonstrate a variety of sleep/wake complaints. Some of these are associated with dopaminergic dysfunction, some presumed to arise from nondopaminergic PD pathology, some from PD treatments and, in some, the etiologies are multifactorial or unknown. Optimal management of sleep/wake problems requires a good understanding of sleep/wake principals in the PD population, as there are few controlled trials to dictate therapy. In this article, we review the main causes of sleep/wake disorders in PD patients, namely sleep fragmentation, excessive daytime sleepiness, restless legs syndrome, periodic limb movement of sleep, rapid eye movement sleep behavioral disorder and sleep apnea. Available therapies and management recommendations for each disorder are given particular emphasis.
Collapse
Affiliation(s)
- Raja Mehanna
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
26
|
Yong MH, Fook-Chong S, Pavanni R, Lim LL, Tan EK. Case control polysomnographic studies of sleep disorders in Parkinson's disease. PLoS One 2011; 6:e22511. [PMID: 21799880 PMCID: PMC3142152 DOI: 10.1371/journal.pone.0022511] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 06/23/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The relationship between a number of primary sleep disorders and Parkinson's disease (PD) is still debated. There are limited case control polysomnographic studies in PD and most of these study sample sizes are small. METHODOLOGY/FINDINGS We conducted one of the largest case-control studies involving overnight polysomnographic evaluation, with prospective recruitment of unselected Parkinson's disease patients and healthy controls from an Asian population. The cases were recruited from the specialized movement disorder outpatient clinics in a tertiary referral center, and controls from the same geographical locations. All subjects underwent an overnight polysomnographic study and a multiple sleep latency test. A total of 124 subjects including 56 patients and 68 controls frequency-matched for age and sex were included. Multivariate analysis revealed that patients had significantly shorter total sleep time than controls (p = 0.01), lower sleep efficiency (p = 0.001) and increased REM latency (p = 0.007). In patients, multivariate analysis showed that reduced total sleep time was significantly associated with increased age (p = 0.001) and increased levodopa dose (p = 0.032). The mean Insomnia Severity Index was higher in PD patients (9.0±7.1) compared to controls (3.3±3.9, p<0.001). The mean Epworth Sleepiness Scale score was higher in PD patients (9.3±5.9 vs. 5.7±4.8, p<0.001). Nocturnal arousals, obstructive sleep apnea, periodic leg movements and objective abnormal sleepiness were not increased in our patients. CONCLUSIONS/SIGNIFICANCE Our case-control polysomnographic study, the first-ever performed in an Asian population, revealed altered sleep architecture and reduced sleep in PD patients compared to controls. Reduced total sleep time was associated with increased age and levodopa dose. However, nocturnal arousals, primary sleep disorders and abnormal sleepiness were not increased in our PD patients suggesting that ethnic/genetic differences may be a factor in the pathophysiology of these conditions.
Collapse
Affiliation(s)
- Ming-Hui Yong
- Department of Neurology, National Neuroscience Institute, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | | | - Ratnagopal Pavanni
- Department of Neurology, National Neuroscience Institute, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Li-Ling Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore
- Duke-NUS Graduate Medical School, Singapore
| |
Collapse
|
27
|
Perez Lloret S, Rossi M, Merello M, Rascol O, Cardinali DP. Nonmotor symptoms groups in Parkinson's disease patients: results of a pilot, exploratory study. PARKINSONS DISEASE 2011; 2011:473579. [PMID: 21687754 PMCID: PMC3109353 DOI: 10.4061/2011/473579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 02/24/2011] [Accepted: 03/23/2011] [Indexed: 11/20/2022]
Abstract
Nonmotor symptoms (NMS) like neuropsychiatric symptoms, sleep disturbances or autonomic symptoms are a common feature of Parkinson's disease (PD). To explore the existence of groups of NMS and to relate them to PD characteristics, 71 idiopathic non-demented PD out-patients were recruited. Sleep was evaluated by the PD Sleep Scale (PDSS). Several neuropsychiatric, gastrointestinal and urogenital symptoms were obtained from the NMSQuest. Sialorrhea or dysphagia severity was obtained from the Unified PD Rating Scale activities of daily living section. MADRS depression scale was also administered. Exploratory factor analysis revealed the presence of 5 factors, explaining 70% of variance. The first factor included PDSS measurement of sleep quality, nocturnal restlessness, off-related problems and daytime somnolence; the second factor included nocturia (PDSS) and nocturnal activity; the third one included gastrointestinal and genitourinary symptoms; the forth one included nocturnal psychosis (PDSS), sialorrhea and dysphagia (UPDRS); and the last one included the MADRS score as well as neuropsychiatric symptoms. Sleep disorders correlated with presence of wearing-off, nocturia with age >69 years, and nocturnal psychosis with levodopa equivalent dose or UPDRS II score. Neuropsychiatric symptoms correlated with UPDRS II+III score and non-tricyclic antidepressants. These results support the occurrence of significant NMS grouping in PD patients.
Collapse
Affiliation(s)
- Santiago Perez Lloret
- Department of Clinical Pharmacology and Neurosciences, Faculty of Medicine, Paul Sabatier University, and NSERM CIC9023 and UMR 825 Allées Jules Guesde, 31000 Toulouse, France
| | | | | | | | | |
Collapse
|
28
|
Weinstock LB, Bosworth BP, Scherl EJ, Li E, Iroku U, Munsell MA, Mullen GE, Walters AS, Walters AS. Crohn's disease is associated with restless legs syndrome. Inflamm Bowel Dis 2010; 16:275-9. [PMID: 19575360 PMCID: PMC3864021 DOI: 10.1002/ibd.20992] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Extraintestinal manifestations of Crohn's disease (CD) have not previously included the central nervous system (CNS). Restless legs syndrome (RLS) is a CNS disorder that is either idiopathic or secondary to a number of diseases. The aim of this study was to determine if RLS was associated with CD because both are associated with iron deficiency, inflammation, and bacterial overgrowth. METHODS Consecutive CD outpatients (N = 272) were prospectively surveyed at 4 centers for criteria for RLS. Incidence (having RLS at any point in time), prevalence (having RLS at time of survey), clinical characteristics, risk factors, and potential qualitative relationship between RLS and gastrointestinal symptoms were queried. RESULTS The incidence of RLS in patients with CD was 42.7%. Prevalence was 30.2% compared with 9% of spouses. CD patients with and without RLS had a mean age of 46.8 versus 42.6 years, small intestine involvement in 77.9% versus 66.7%, colon involvement in 39.7% versus 63.2%, and prior iron deficiency anemia in 49.3% versus 33.1%. There was no difference between the CD groups with respect to current iron deficiency, RLS family history, or rare prevalence of concomitant RLS disorders. In 91.8% of patients with RLS and CD, RLS started during or after the onset of CD diagnosis. Among 73 patients with RLS, 67 (44.5%) stated there was a relationship between qualitative RLS symptom improvement with overall CD symptom improvement. CONCLUSIONS These results demonstrate that RLS occurs frequently in CD and appears to be a possible extraintestinal manifestation. The potential relationship of RLS with CD activity warrants further investigation.
Collapse
Affiliation(s)
- Leonard B. Weinstock
- Washington University School of Medicine, MO,Specialists in Gastroenterology, LLC, St Louis, MO
| | | | | | - Ellen Li
- Washington University School of Medicine, MO
| | | | | | | | | | | |
Collapse
|
29
|
Uemura Y, Nomura T, Inoue Y, Yamawaki M, Yasui K, Nakashima K. Validation of the Parkinson's disease sleep scale in Japanese patients: a comparison study using the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and Polysomnography. J Neurol Sci 2009; 287:36-40. [PMID: 19804890 DOI: 10.1016/j.jns.2009.09.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 08/22/2009] [Accepted: 09/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Characteristic sleep disturbance in patients with Parkinson's disease (PD) was evaluated using a subjective questionnaire called the PD sleep scale (PDSS). In this study we sought to examine the relationship between the results from the PDSS with those from the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and polysomnography (PSG) in Japanese PD patients. SUBJECTS AND METHODS Subjects were 79 PD patients and 79 age and gender matched controls. The length of morbidity in patients with PD was 8.4+/-8.0 years, and their Hoehn and Yahr grade was 2.9+/-1.0. All subjects completed the PDSS, PSQI, and ESS questionnaires, and we compared the results from patients with PD to controls. We also evaluated the correlation among the PDSS, PSQI, and ESS in patients with PD. Moreover, we performed PSG on 33 of 79 PD patients, and examined the correlation between the PDSS and PSG. RESULTS PDSS total scores and subscales from patients with PD were significantly lower than those in controls, except for items 3, 8, and 14. PDSS scores had significant internal consistency and significant correlation with PSQI and ESS scores. The total PDSS score also correlated with sleep efficiency as measured by PSG. In subscales of the PDSS, night psychosis was negatively correlated with percentage of REM sleep without atonia on PSG. DISCUSSION Based on our comparisons with PSQI, ESS, and PSG, the PDSS appears to be a reliable tool to evaluate the characteristics of sleep disturbances in PD patients.
Collapse
Affiliation(s)
- Yusuke Uemura
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan.
| | | | | | | | | | | |
Collapse
|
30
|
Silkis IG. Search for approaches to correction of daytime sleepiness induced by dopaminergic drugs during treatment of Parkinson’s disease: Neurochemical aspects. NEUROCHEM J+ 2009. [DOI: 10.1134/s1819712409030118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
31
|
Steiger M. Constant dopaminergic stimulation by transdermal delivery of dopaminergic drugs: a new treatment paradigm in Parkinson's disease. Eur J Neurol 2007; 15:6-15. [PMID: 18042245 DOI: 10.1111/j.1468-1331.2007.01674.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current dopaminergic therapies for the treatment of Parkinson's disease are associated with the development of long-term motor complications. Abnormal pulsatile stimulation of dopamine receptors is thought to underlie the development of motor complications. There is thus a need for therapies that mimic the normal physiological state more closely by resulting in constant dopaminergic stimulation (CDS). Several studies support the hypothesis that CDS can reverse levodopa-induced motor complications. Other potential benefits of CDS include alleviating nocturnal disturbances, minimizing daytime sleepiness, avoiding priming for motor fluctuations and dyskinesia, preventing the development of gastrointestinal dysfunction and reducing the risk of developing psychosis or behavioural disturbances. Continuous infusion of dopaminergic therapies is impractical for the routine treatment of large numbers of patients. Although catechol-O-methyltransferase inhibitors or sustained-release preparations of levodopa may be beneficial, they do not entirely eliminate pulsatile stimulation of dopamine receptors. A new dopamine agonist (rotigotine), delivered over 24 h by a once-daily transdermal patch, has been investigated in several clinical trials. Continuous delivery of rotigotine has been shown to provide 'true' CDS in animal models. The potential of true CDS therapy to prevent or reduce long-term motor and non-motor complications requires investigation in appropriately designed clinical trials.
Collapse
Affiliation(s)
- M Steiger
- Walton Centre for Neurology and Neurosurgery, NHS Trust, Liverpool, UK.
| |
Collapse
|
32
|
Poston KL, Waters C. Zydis selegiline in the management of Parkinson's disease. Expert Opin Pharmacother 2007; 8:2615-24. [DOI: 10.1517/14656566.8.15.2615] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
|
34
|
Suzuki K, Okuma Y, Hattori N, Kamei S, Yoshii F, Utsumi H, Iwasaki Y, Iijima M, Miyamoto T, Miyamoto M, Hirata K. Characteristics of sleep disturbances in Japanese patients with Parkinson's disease. A study using Parkinson's disease sleep scale. Mov Disord 2007; 22:1245-51. [PMID: 17557325 DOI: 10.1002/mds.21257] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The present multicenter cross-sectional study was performed using semistructured questionnaires to determine the contributing factors of sleep disturbances in Japanese patients with Parkinson's disease (PD). We used the Parkinson's disease sleep scale (PDSS, Japanese version). All data were obtained by means of interviewed questionnaire and physical examination by neurologists. The study was carried out between April 2005 and December 2005 at eight university hospitals and affiliated facilities in the Kanto area of Japan. A total of 188 (85 men and 103 women) PD patients and 144 controls (64 men and 80 women) were included. Stepwise regression analysis identified complications of treatment, depression, age, and disease duration as significant risk factors of sleep disturbances in PD. Significant differences in total PDSS score were observed between Hoehn & Yahr (H&Y) Stages 1 and 4, between H&Y Stages 2 and 4, and between H&Y stages 3 and 4 (Bonferroni test). The results of this survey suggested that complications due to treatment (dyskinesia, wearing off, on-off), depressive state, and disease stage are significant determinants of sleep disorders in Japanese patients with PD. We speculate that the reduction of neurotransmitters involved in the sleep-wakefulness mechanism and degeneration of neurons progress together in parallel with deterioration of motor function.
Collapse
Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
|
36
|
|