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Qin Y, Meng DT, Jin ZH, Du WJ, Fang BY. Association between autonomic dysfunction with motor and non-motor symptoms in patients with Parkinson's disease. J Neural Transm (Vienna) 2024; 131:323-334. [PMID: 38253927 DOI: 10.1007/s00702-024-02745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
To investigate the association between autonomic dysfunction (AutD) and motor as well as non-motor symptoms (NMS) in patients with Parkinson's disease (PD). Fifty-three PD patients were divided into two groups based on the number of domains affected by AutD: a multi-domain AutD group (AutD-M) and a single-domain AutD group (AutD-S), as evaluated using the Scale for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT), which assesses autonomic symptoms, one of the NMS. A comprehensive comparison was conducted between the two groups, including clinical measures such as clinical scales, quantitative evaluations of motor function and exercise capacity. Spearman correlation analysis was employed to investigate the relationship between AutD severity and PD symptoms. Additionally, we performed multiple linear regression model analysis to determine whether associations between SCOPA-AUT scores and clinical assessments remained significant after adjusting for Hoehn and Yahr stage, sex, and age. PD patients in the AutD-M group exhibited significantly more severe NMS and motor symptoms compared to those in the AutD-S group. In correlation analysis, SCOPA-AUT scores showed significant correlations with multiple clinical symptoms, such as most of the NMS, 10-MWT and CPET parameters. Furthermore, regression analysis also revealed that more pronounced fatigue, anxiety, depressive symptoms, worse walking speed and impaired exercise capacity were associated with higher SCOPA-AUT scores. The presence of AutD is correlated with emotional disturbances, decreased exercise endurance, and impaired gait function in patients with PD. Early management of AutD may prove beneficial in alleviating some NMS and motor symptoms in PD.
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Affiliation(s)
- Yi Qin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Beijing, 100144, China
- Beijing Rehabilitation Medical College, Capital Medical University, Beijing, China
| | - De-Tao Meng
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Beijing, 100144, China
| | - Zhao-Hui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Beijing, 100144, China
| | - Wen-Jun Du
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Beijing, 100144, China
| | - Bo-Yan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Beijing, 100144, China.
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2
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Sanchez-Luengos I, Lucas-Jiménez O, Ojeda N, Peña J, Gómez-Esteban JC, Gómez-Beldarrain MÁ, Vázquez-Picón R, Foncea-Beti N, Ibarretxe-Bilbao N. Predictors of health-related quality of life in Parkinson's disease: the impact of overlap between health-related quality of life and clinical measures. Qual Life Res 2022; 31:3241-3252. [PMID: 35842497 PMCID: PMC9546987 DOI: 10.1007/s11136-022-03187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine predictors of health-related quality of life (HRQoL) in Parkinson's disease (PD) and to explore their predictive value before and after controlling overlapping items between HRQoL and clinical variables. METHODS One hundred and eight PD patients underwent motor, anxiety, depression, apathy, fatigue, and neurocognition assessment. HRQoL was assessed by the Parkinson's Disease Questionnaire-39 (PDQ-39). In order to determine predictors of HRQoL in PD, stepwise multiple regression analyses were performed in two ways: before and after removing the emotional well-being dimension from PDQ-39 to control the overlap between depression and anxiety, and HRQoL. RESULTS HRQoL total index was predicted by anxiety, fatigue, motor symptoms, and depression, explaining 26.9%, 7.2%, 2.8%, and 1.9% of the variance. However, after removing overlapping items, HRQoL total index was predicted by fatigue (16.5%), anxiety (6.1%), motor symptoms (3.9%), and neurocognition (2.5%), but not depression. Regarding HRQoL dimensions, mobility and activities of daily living were predicted by fatigue (19.7% and 5%) and UPDRS-III (4% and 10.2%); emotional well-being by fatigue (7.9%); social support by anxiety (12.2%) and UPDRS-III (8.6%); communication by neurocognition (5.3%) and UPDRS-III (3.4%); cognition by anxiety (10.6%) and bodily discomfort by anxiety (23%) and fatigue (4.1%). CONCLUSION These findings showed the importance of identifying and controlling overlapping items of HRQoL and clinical measures to perform an accurate interpretation. HRQoL dimensions showed different predictors before and after controlling the overlap. Based on these results fatigue, anxiety, motor symptoms, and neurocognition, but not depression are the main predictors of HRQoL in PD patients.
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Affiliation(s)
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | | | | | | | - Nerea Foncea-Beti
- Department of Neurology, Hospital of Galdakao, Galdakao-Usansolo, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
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3
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Jørgensen LM, Henriksen T, Mardosiene S, Wyon O, Keller SH, Jespersen B, Knudsen GM, Stenbæk DS. Hot and Cold Cognitive Disturbances in Parkinson Patients Treated with DBS-STN: A Combined PET and Neuropsychological Study. Brain Sci 2022; 12:brainsci12050654. [PMID: 35625040 PMCID: PMC9139237 DOI: 10.3390/brainsci12050654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with Parkinson’s disease (PD) often suffer from non-motor symptoms, which may be caused by serotonergic dysfunction. Deep Brain Stimulation (DBS) in the subthalamic nucleus (STN) may also influence non-motor symptoms. The aim of this study is to investigate how the cerebral 5-HT system associates to disturbances in cognition and mood in PD patients with DBS-STN turned on and off. We used psychological tests and questionnaires to evaluate cognitive function and the effects on mood from turning DBS-STN off. We applied a novel PET neuroimaging methodology to evaluate the integrity of the cerebral serotonin system. We measured 5-HT1BR binding in 13 DBS-STN-treated PD patients, at baseline and after turning DBS off. Thirteen age-matched volunteers served as controls. The measures for cognition and mood were correlated to the 5-HT1BR availability in temporal limbic cortex. 5-HT1BR binding was proportional to working memory performance and inverse proportional to affective bias for face recognition. When DBS is turned off, patients feel less vigorous; the higher the limbic and temporal 5-HT1BR binding, the more they are affected by DBS being turned off. Our study suggests that cerebral 5-HTR binding is associated with non-motor symptoms, and that preservation of serotonergic functions may be predictive of DBS-STN effects.
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Affiliation(s)
- Louise M. Jørgensen
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Copenhagen Spine Research Unit, Center for Rheumatology and Spine Disease, Copenhagen University Hospital-Rigshospitalet, 2600 Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Tove Henriksen
- Department of Neurology, Copenhagen University Hospital-Bispebjerg, 2400 Copenhagen, Denmark; (T.H.); (S.M.)
| | - Skirmante Mardosiene
- Department of Neurology, Copenhagen University Hospital-Bispebjerg, 2400 Copenhagen, Denmark; (T.H.); (S.M.)
| | - Ottilia Wyon
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Copenhagen Spine Research Unit, Center for Rheumatology and Spine Disease, Copenhagen University Hospital-Rigshospitalet, 2600 Glostrup, Denmark
| | - Sune H. Keller
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Bo Jespersen
- Department of Neurosurgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Gitte M. Knudsen
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Dea S. Stenbæk
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Department of Psychology, University of Copenhagen, 1353 Copenhagen, Denmark
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4
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Scheffer DDL, Freitas FC, Aguiar AS, Ward C, Guglielmo LGA, Prediger RD, Cronin SJF, Walz R, Andrews NA, Latini A. Impaired dopamine metabolism is linked to fatigability in mice and fatigue in Parkinson's disease patients. Brain Commun 2021; 3:fcab116. [PMID: 34423297 PMCID: PMC8374980 DOI: 10.1093/braincomms/fcab116] [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: 11/30/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Fatigue is a common symptom of Parkinson’s disease that compromises significantly the patients’ quality of life. Despite that, fatigue has been under-recognized as symptom, its pathophysiology remains poorly understood, and there is no adequate treatment so far. Parkinson’s disease is characterized by the progressive loss of midbrain dopaminergic neurons, eliciting the classical motor symptoms including slowing of movements, muscular rigidity and resting tremor. The dopamine synthesis is mediated by the rate-limiting enzyme tyrosine hydroxylase, which requires tetrahydrobiopterin as a mandatory cofactor. Here, we showed that reserpine administration (1 mg/kg, two intraperitoneal injections with an interval of 48 h) in adult Swiss male mice (8–10 weeks; 35–45 g) provoked striatal depletion of dopamine and tetrahydrobiopterin, and intolerance to exercise. The poor exercise performance of reserpinized mice was not influenced by emotional or anhedonic factors, mechanical nociceptive thresholds, electrocardiogram pattern alterations or muscle-impaired bioenergetics. The administration of levodopa (100 mg/kg; i.p.) plus benserazide (50 mg/kg; i.p.) rescued reserpine-induced fatigability-like symptoms and restored striatal dopamine and tetrahydrobiopterin levels. Remarkably, it was observed, for the first time, that impaired blood dopamine metabolism inversely and idependently correlated with fatigue scores in eighteen idiopathic Parkinson’s disease patients (male n = 13; female n = 5; age 61.3 ± 9.59 years). Altogether, this study provides new experimental and clinical evidence that fatigue symptoms might be caused by the impaired striatal dopaminergic neurotransmission, pointing to a central origin of fatigue in Parkinson’s disease.
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Affiliation(s)
- Débora da Luz Scheffer
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Fernando Cini Freitas
- Graduate Program in Medical Sciences, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Neurology Division, Hospital Governador Celso Ramos, Florianópolis, SC 88015-270, Brazil
| | - Aderbal Silva Aguiar
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Catherine Ward
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | | | - Rui Daniel Prediger
- Departamento de Farmacologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Shane J F Cronin
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, A-1090 Vienna, Austria
| | - Roger Walz
- Graduate Program in Medical Sciences, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Center for Applied Neuroscience, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Neurology Division, Departament of Internal Medicine, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Nick A Andrews
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.,The Salk in Institute for Biological Studies, La Jolla, CA 92037, USA
| | - Alexandra Latini
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
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5
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Fernandes M, Pierantozzi M, Stefani A, Cattaneo C, Bonizzoni EA, Cerroni R, Mercuri NB, Liguori C. Frequency of Non-motor Symptoms in Parkinson's Patients With Motor Fluctuations. Front Neurol 2021; 12:678373. [PMID: 34267721 PMCID: PMC8276257 DOI: 10.3389/fneur.2021.678373] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Non-motor symptoms (NMS), including neuropsychiatric, sleep, autonomic, and sensory domains, are an integral aspect of the clinical presentation of Parkinson disease (PD) and affect neurocognitive functioning as well as patients' and caregivers' well-being. Objective: To describe the occurrence of NMS in PD patients with motor fluctuations in real-life condition. Methods: The present study is a secondary analysis of a previous multinational, multicenter, retrospective-prospective cohort observational study (SYNAPSES). Patients with PD diagnosis and motor fluctuations aged ≥18 years were included. Data collected at the baseline visit were used for this study, and descriptive analyzes were conducted to describe the distribution of NMS in motor-fluctuating PD patients distributed according to different clinical characteristics. Results: Of the 1,610 patients enrolled, 1,589 were included for the analysis (978 males and 611 females), with a mean age of 68.4 (SD = 9.6). Most patients had at least one NMS (88.5%). Sleep problems and psychiatric symptoms were the most prevalent NMS in motor fluctuating PD patients in all H and Y stages. Psychiatric disorders were more frequent in older patients and in patients with a larger number of years of PD diagnosis, while sleep problems were more preeminent in younger patients and with inferior disease duration. Conclusions: The present findings further support the high prevalence of NMS in PD patients with motor fluctuations, thus reinforcing the need for assessing them for diagnostic accuracy and for delivering holistic care.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, Sleep Medicine Center, University of Rome "Tor Vergata," Rome, Italy
| | - Mariangela Pierantozzi
- Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.,Parkinson's Disease Center, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Alessandro Stefani
- Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.,Parkinson's Disease Center, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Erminio A Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics and Biometry "GA Maccacaro," University of Milan, Milan, Italy
| | - Rocco Cerroni
- Parkinson's Disease Center, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Parkinson's Disease Center, University Hospital of Rome Tor Vergata, Rome, Italy.,Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, Sleep Medicine Center, University of Rome "Tor Vergata," Rome, Italy.,Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.,Parkinson's Disease Center, University Hospital of Rome Tor Vergata, Rome, Italy
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6
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Müller T. Experimental Dopamine Reuptake Inhibitors in Parkinson's Disease: A Review of the Evidence. J Exp Pharmacol 2021; 13:397-408. [PMID: 33824605 PMCID: PMC8018398 DOI: 10.2147/jep.s267032] [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: 01/08/2021] [Accepted: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
Parkinson’s disease (PD) is the second most chronic neurodegenerative disorder worldwide. Deficit of monoamines, particularly dopamine, causes an individually varying compilation of motor and non-motor features. Constraint of presynaptic uptake extends monoamine stay in the synaptic cleft. This review discusses possible benefits of dopamine reuptake inhibition for the treatment of PD. Translation of this pharmacologic principle into positive clinical study results failed to date. Past clinical trial designs did not consider a mandatory, concomitant stable inhibition of glial monoamine turnover, i.e. with monoamine oxidase B inhibitors. These studies focused on improvement of motor behavior and levodopa associated motor complications, which are fluctuations of motor and non-motor behavior. Future clinical investigations in early, levodopa- and dopamine agonist naïve patients shall also aim on alleviation of non-motor symptoms, like fatigue, apathy or cognitive slowing. Oral levodopa/dopa decarboxylase inhibitor application is inevitably necessary with advance of PD. Monoamine reuptake (MRT) inhibition improves the efficacy of levodopa, the blood brain barrier crossing metabolic precursor of dopamine. The pulsatile brain delivery pattern of orally administered levodopa containing formulations results in synaptic dopamine variability. Ups and downs of dopamine counteract the physiologic principle of continuous neurotransmission, particularly in nigrostriatal, respectively mesocorticolimbic pathways, both of which regulate motor respectively non-motor behavior. Thus synaptic dopamine pulsatility overwhelms the existing buffering capacity. Onset of motor and non-motor complications occurs. Future MRT inhibitor studies shall focus on a stabilizing and preventive effect on levodopa related fluctuations of motor and non-motor behavior. Their long-term study designs in advanced levodopa treated patients shall allow a cautious adaptation of oral l-dopa therapy combined with a mandatory inhibition of glial monoamine turnover. Then the evidence for a preventive and beneficial, symptomatic effect of MRT inhibition on motor and non-motor complications will become more likely.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Berlin, 13088, Germany
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7
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Sabino-Carvalho JL, Vianna LC. Altered cardiorespiratory regulation during exercise in patients with Parkinson's disease: A challenging non-motor feature. SAGE Open Med 2020; 8:2050312120921603. [PMID: 32435491 PMCID: PMC7222646 DOI: 10.1177/2050312120921603] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/03/2020] [Indexed: 01/27/2023] Open
Abstract
The incidence of Parkinson’s disease is increasing worldwide. The motor dysfunctions are the hallmark of the disease, but patients also experience non-motor impairments, and over 40% of the patients experience coexistent abnormalities, such as orthostatic hypotension. Exercise training has been suggested as a coping resource to alleviate Parkinson’s disease symptoms and delay disease progression. However, the body of knowledge is showing that the cardiovascular response to exercise in patients with Parkinson’s disease is altered. Adequate cardiovascular and hemodynamic adjustments to exercise are necessary to meet the metabolic demands of working skeletal muscle properly. Therefore, since Parkinson’s disease affects parasympathetic and sympathetic branches of the autonomic nervous system and the latter are crucial in ensuring these adjustments are adequately made, the understanding of these responses during exercise in this population is necessary. Several neural control mechanisms are responsible for the autonomic changes in the cardiovascular and hemodynamic systems seen during exercise. In this sense, the purpose of the present work is to review the current knowledge regarding the cardiovascular responses to dynamic and isometric/resistance exercise as well as the mechanisms by which the body maintains appropriate perfusion pressure to all organs during exercise in patients with Parkinson’s disease. Results from patients with Parkinson’s disease and animal models of Parkinson’s disease provide the reader with a well-rounded knowledge base. Through this, we will highlight what is known and not known about how the neural control of circulation is responding during exercise and the adaptations that occur when individuals exercise regularly.
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Affiliation(s)
- Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
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8
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Walker LAS, Lindsay-Brown AP, Berard JA. Cognitive Fatigability Interventions in Neurological Conditions: A Systematic Review. Neurol Ther 2019; 8:251-271. [PMID: 31586303 PMCID: PMC6858900 DOI: 10.1007/s40120-019-00158-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Although fatigue is a well-studied concept in neurological disease, cognitive fatigability (CF) is less understood. While most studies measure fatigue using subjective self-report, fewer have measured CF objectively. Given the negative impact of CF on quality-of-life, there is a need for targeted interventions. The objective of this review was to determine which procedural, behavioural and pharmacological treatments for objectively measured CF are available to people living with neurological conditions. METHODS In accordance with the PRISMA guidelines, systematic searches for randomized control trials (RCTs), case-controlled studies and case reports/series were conducted across the Ovid Medline, PsycInfo, EMBASE and Cochrane Library databases. English-language articles published between 1980 and February 2019 were considered for eligibility. Included were those that objectively measured CF in individuals with neurological disease/disorder/dysfunction between the ages of 18 and 65 years. Studies were reviewed using a modified Cochrane Data Extraction Template. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review process was facilitated using Covidence software (www.covidence.org). Two authors reviewed articles independently, with a third resolving conflicts regarding article inclusion. RESULTS The search identified 450 records. After duplicates were removed and remaining titles/abstracts were screened for eligibility, 28 full-text articles were assessed, and two studies were included in the qualitative synthesis. Studies were a priori divided into those with pharmacological, procedural or behavioural interventions. Two studies met eligibility criteria; both of these included participants with multiple sclerosis. One study utilized a procedural intervention (i.e. transcranial direct current stimulation), while the other utilized a pharmacological intervention (i.e. fampridine-SR). Studies were evaluated for risk of bias, and evidence from both eligible studies was discussed. CONCLUSION Despite the positive results of the procedural intervention, the paucity of eligible studies and the nascent nature of the field suggests that more studies are required before firm conclusions can be drawn regarding the amenability of CF to treatment. TRIAL REGISTRATION The review was registered with PROSPERO (CRD42019118706).
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Affiliation(s)
- Lisa A S Walker
- Ottawa Hospital Research Institute, Ottawa, Canada.
- University of Ottawa Brain and Mind Research Institute, Ottawa, Canada.
- Carleton University, Ottawa, Canada.
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9
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Yang F, Zhou L, Song J, WangJinMei A, Yang Y, Tang ZW, Huang QY. Liver CEBPβ Modulates the Kynurenine Metabolism and Mediates the Motility for Hypoxia-Induced Central Fatigue in Mice. Front Physiol 2019; 10:243. [PMID: 30930794 PMCID: PMC6428026 DOI: 10.3389/fphys.2019.00243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Central fatigue is defined as a failure of the central nervous system to adequately drive the muscle, manifesting limited development, and maintenance of locomotor activity. A plateau in hypoxia leads to central fatigue and followed by maximal motility recession. However, the underlying mechanism is still unclear. The present study describes a mechanism by which liver CEBPβ (CCAAT/enhancer-binding protein beta) induced by hypoxic environment alters the kynurenine (KYN) metabolism and causes the suppression of motility function recession. The activation of CEBPβ under hypoxia increases the liver expression of tryptophan dioxygenase, thereby enhancing the conversion of tryptophan into KYN; the KYN metabolite can traverse the blood-brain barrier and result in the suppression of motility function. However, the knockdown of CEBPβ by injecting pAAV-shRNA-CEBPβ via the hepatic portal vein reduces the KYN production and improves the motility function. KYN is a neurochemical that which restricts the exercise capacity after injection in the basal ganglia in mice. Reducing the plasma KYN protects the brain from hypoxia-induced changes associated with fatigue, and the knockdown liver of CEBPβ in mice renders resistance to fatigue post-acute hypoxia or tryptophan treatment. This study reveals resistance to central fatigue as a strategy for acclimatization to hypoxia mediated by transcription factor CEBPβ in the liver.
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Affiliation(s)
- Fan Yang
- Joint Surgery, General Hospital of Tibetan Military Command Lhasa, Lhasa, China.,Department of Cold Environment Medicine, College of High Altitude Military Medicine, Third Military Medical University and Key Laboratory of High Altitude Medicine, Ministry of Education, Key Laboratory of High Altitude Medicine, PLA, Chongqing, China
| | - Li Zhou
- Department of Pharmacy, General Hospital of Tibetan Military Command Lhasa, Lhasa, China
| | - Jun Song
- Joint Surgery, General Hospital of Tibetan Military Command Lhasa, Lhasa, China
| | - A WangJinMei
- Joint Surgery, General Hospital of Tibetan Military Command Lhasa, Lhasa, China
| | - Yuan Yang
- Joint Surgery, General Hospital of Tibetan Military Command Lhasa, Lhasa, China
| | - Zhong-Wei Tang
- Department of Cold Environment Medicine, College of High Altitude Military Medicine, Third Military Medical University and Key Laboratory of High Altitude Medicine, Ministry of Education, Key Laboratory of High Altitude Medicine, PLA, Chongqing, China
| | - Qing-Yuan Huang
- Department of Cold Environment Medicine, College of High Altitude Military Medicine, Third Military Medical University and Key Laboratory of High Altitude Medicine, Ministry of Education, Key Laboratory of High Altitude Medicine, PLA, Chongqing, China
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10
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Han JW, Ahn YD, Kim WS, Shin CM, Jeong SJ, Song YS, Bae YJ, Kim JM. Psychiatric Manifestation in Patients with Parkinson's Disease. J Korean Med Sci 2018; 33:e300. [PMID: 30450025 PMCID: PMC6236081 DOI: 10.3346/jkms.2018.33.e300] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/11/2018] [Indexed: 01/18/2023] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder. Although its major manifestation is motor symptoms, resulting from the loss of dopaminergic neurons in the substantia nigra, psychiatric symptoms, such as depression, anxiety, hallucination, delusion, apathy and anhedonia, impulsive and compulsive behaviors, and cognitive dysfunction, may also manifest in most patients with PD. Given that the quality of life - and the need for institutionalization - is so highly dependent on the psychiatric well-being of patients with PD, psychiatric symptoms are of high clinical significance. We reviewed the prevalence, risk factors, pathophysiology, and treatment of psychiatric symptoms to get a better understanding of PD for improved management.
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Affiliation(s)
- Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yebin D. Ahn
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Serrano JI, del Castillo MD, Cortés V, Mendes N, Arroyo A, Andreo J, Rocon E, del Valle M, Herreros J, Romero JP. EEG Microstates Change in Response to Increase in Dopaminergic Stimulation in Typical Parkinson's Disease Patients. Front Neurosci 2018; 12:714. [PMID: 30374285 PMCID: PMC6196245 DOI: 10.3389/fnins.2018.00714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives: Characterizing pharmacological response in Parkinson's Disease (PD) patients may be a challenge in early stages but gives valuable clues for diagnosis. Neurotropic drugs may modulate Electroencephalography (EEG) microstates (MS). We investigated EEG-MS default-mode network changes in response to dopaminergic stimulation in PD. Methods: Fourteen PD subjects in HY stage III or less were included, and twenty-one healthy controls. All patients were receiving dopaminergic stimulation with levodopa or dopaminergic agonists. Resting EEG activity was recorded before the first daily PD medication dose and 1 h after drug intake resting EEG activity was again recorded. Time and frequency variables for each MS were calculated. Results: Parkinson's disease subjects MS A duration decreases after levodopa intake, MS B appears more often than before levodopa intake. MS E was not present, but MS G was. There were no significant differences between control subjects and patients after medication intake. Conclusion: Clinical response to dopaminergic drugs in PD is characterized by clear changes in MS profile. Significance: This work demonstrates that there are clear EEG MS markers of PD dopaminergic stimulation state. The characterization of the disease and its response to dopaminergic medication may be of help for early therapeutic diagnosis.
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Affiliation(s)
- J. Ignacio Serrano
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
| | - María Dolores del Castillo
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
| | - Verónica Cortés
- Faculty of Experimental Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Nuno Mendes
- Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Aida Arroyo
- Faculty of Experimental Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Jorge Andreo
- Faculty of Experimental Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
| | - María del Valle
- Department of Neurology, Fuenlabrada University Hospital, Madrid, Spain
| | - Jaime Herreros
- Department of Neurology, Infanta Leonor University Hospital, Madrid, Spain
| | - Juan Pablo Romero
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
- Brain Damage Unit, Hospital Beata Maria Ana, Madrid, Spain
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Rönnefarth M, Bathe-Peters R, Jooss A, Haberbosch L, Scholz M, Schmidt S, Brandt SA. Force Increase in a Repetitive Motor Task Inducing Motor Fatigue. J Mot Behav 2018; 51:406-415. [PMID: 30199347 DOI: 10.1080/00222895.2018.1495172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To evaluate task induced motor fatigue in a well-established finger tapping task, we analyzed tapping parameters and included the time course of measures of force. We hypothesized that a decline in tapping force would reflect task induced motor fatigue, defined by a lengthening of inter-tap intervals (ITI). A secondary aim was to investigate the reliability of tapping data acquisition with the force sensor. Results show that, as expected, tapping speed decreased linearly over time, due to both an increase of ITI and tap duration. In contrast, tapping force increased non-linearly over time and was uncorrelated to changes in tapping speed. Force data could serve as a measure to characterize task induced motor fatigue. Force sensors can assess a decline in tapping speed as well as an independent increase of tapping force. We argue that the increase of force reflects central compensation, i.e. perception of fatigue, due to an increase in task effort and difficulty.
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Affiliation(s)
- Maria Rönnefarth
- a Department of Neurology , Charité-Universitaetsmedizin Berlin , Berlin , Germany
| | - Rouven Bathe-Peters
- a Department of Neurology , Charité-Universitaetsmedizin Berlin , Berlin , Germany
| | - Andreas Jooss
- a Department of Neurology , Charité-Universitaetsmedizin Berlin , Berlin , Germany
| | - Linus Haberbosch
- a Department of Neurology , Charité-Universitaetsmedizin Berlin , Berlin , Germany
| | - Michael Scholz
- b Department of Neural Information Processing, Fak IV , Technische Universitaet Berlin , Berlin , Germany
| | - Sein Schmidt
- a Department of Neurology , Charité-Universitaetsmedizin Berlin , Berlin , Germany
| | - Stephan A Brandt
- a Department of Neurology , Charité-Universitaetsmedizin Berlin , Berlin , Germany
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13
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Ginis P, Heremans E, Ferrari A, Dockx K, Canning CG, Nieuwboer A. Prolonged Walking with a Wearable System Providing Intelligent Auditory Input in People with Parkinson's Disease. Front Neurol 2017; 8:128. [PMID: 28428770 PMCID: PMC5382170 DOI: 10.3389/fneur.2017.00128] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Rhythmic auditory cueing is a well-accepted tool for gait rehabilitation in Parkinson's disease (PD), which can now be applied in a performance-adapted fashion due to technological advance. This study investigated the immediate differences on gait during a prolonged, 30 min, walk with performance-adapted (intelligent) auditory cueing and verbal feedback provided by a wearable sensor-based system as alternatives for traditional cueing. Additionally, potential effects on self-perceived fatigue were assessed. Twenty-eight people with PD and 13 age-matched healthy elderly (HE) performed four 30 min walks with a wearable cue and feedback system. In randomized order, participants received: (1) continuous auditory cueing; (2) intelligent cueing (10 metronome beats triggered by a deviating walking rhythm); (3) intelligent feedback (verbal instructions triggered by a deviating walking rhythm); and (4) no external input. Fatigue was self-scored at rest and after walking during each session. The results showed that while HE were able to maintain cadence for 30 min during all conditions, cadence in PD significantly declined without input. With continuous cueing and intelligent feedback people with PD were able to maintain cadence (p = 0.04), although they were more physically fatigued than HE. Furthermore, cadence deviated significantly more in people with PD than in HE without input and particularly with intelligent feedback (both: p = 0.04). In PD, continuous and intelligent cueing induced significantly less deviations of cadence (p = 0.006). Altogether, this suggests that intelligent cueing is a suitable alternative for the continuous mode during prolonged walking in PD, as it induced similar effects on gait without generating levels of fatigue beyond that of HE.
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Affiliation(s)
- Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alberto Ferrari
- Department of Electrical, Electronic and Information Engineering - Guglielmo Marconi, University of Bologna, Bologna, Italy
| | - Kim Dockx
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Colleen G Canning
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Shin JY, Pohlig RT, Habermann B. Self-Reported Symptoms of Parkinson's Disease by Sex and Disease Duration. West J Nurs Res 2016; 39:1412-1428. [PMID: 27664144 DOI: 10.1177/0193945916670904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease with a wide range of symptom presentations. The purpose of this research was to compare self-reported motor and non-motor symptoms of PD by sex and disease duration. This study was a cross-sectional descriptive survey in community-dwelling people with PD. A total of 141 participants (64.6% response rate; 59.6% men; Mage = 69.7 years) were included. Males reported more rigidity, speech problems, sexual dysfunction, memory problems, and socializing problems than females. The number of motor symptoms in three groups divided by increments of 5 years was significantly increased. Postural instability, freezing, off periods, dyskinesia, speech problems, and hallucinations/psychosis were significantly increased as the disease duration increased. Thorough assessment of motor and non-motor symptoms could decrease the risk of inadequate symptom management. Provision of information regarding PD symptoms at each stage may help people with PD and their caregivers in planning their future care and life.
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