1
|
van der Gaag BL, Hepp DH, Hoff JI, van Hilten JJB, Darweesh SKL, Bloem BR, van de Berg WDJ. [Risk factors for Parkinson's disease: possibilities for prevention and intervention]. Ned Tijdschr Geneeskd 2023; 167:D6655. [PMID: 37688454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Considering age to be the primary risk factor for developing Parkinson's disease and the observation that the Dutch population is rapidly aging, the parkinson prevalence is expected to increase over the coming years, as there is still no cure available for the disease. This has been confirmed by epidemiological data, which show a steady increase of the disease prevalence in the Netherlands for the period 2010-2021. Genetic risk factors only partially explain the disease pathogenesis. Environmental factors, such as exposure to pesticides and trichloroethylene are associated with a higher risk for developing Parkinson's disease. Lifestyle factors such as exercise, caffeine intake and the Mediterranean diet are associated with a lower risk for developing the disease and possibly delay the disease progression. Policy makers and healthcare providers should employ stricter regulations for pesticide use and should stimulate a healthy lifestyle to slow down the increasing prevalence.
Collapse
Affiliation(s)
- Bram L van der Gaag
- Amsterdam UMC, afd. Anatomie en Neurowetenschappen, Amsterdam
- Contact: Bram L. van der Gaag
| | - Dagmar H Hepp
- Amsterdam UMC, afd. Anatomie en Neurowetenschappen, Amsterdam
| | - Jorrit I Hoff
- St. Antonius Ziekenhuis, afd. Neurologie, Nieuwegein
| | | | - Sirwan K L Darweesh
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, afd. Neurologie, Nijmegen
| | - Bas R Bloem
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, afd. Neurologie, Nijmegen
| | | |
Collapse
|
2
|
Schootemeijer S, Coker D, Shelton JF, Chanoff E, Rowbotham HM, Darweesh SKL, Bloem BR, Cannon P, de Vries NM. Exercise knowledge, barriers and motivators among LRRK2 G2019S mutation carriers. Parkinsonism Relat Disord 2023; 113:105497. [PMID: 37441884 DOI: 10.1016/j.parkreldis.2023.105497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION People with a Gly2019Ser mutation in the leucine-rich repeat kinase 2 (LRRK2 G2019S) are at increased risk of developing Parkinson's disease (PD). Recent evidence suggests that exercise may delay or prevent the development of clinically overt symptoms of PD in people at risk of PD. We determined whether LRRK2 G2019S mutation carriers with and without manifest PD are aware of the relationship between exercise and PD and how they differ in awareness, barriers and motivators to exercise. METHODS We deployed a survey among 4422 LRRK2 G2019S mutation carriers. In total, 505 (11.4%) of them completed the survey, of whom 105 had self-reported manifest PD. RESULTS Ninety-two percent of the LRRK2 G2019S mutation carriers with manifest PD and 63% of those with non-manifest PD were aware of the relationship between exercise and PD. Lack of motivation was the top barrier for those without manifest PD, while having an injury/disability was the most common barrier for those with manifest PD. Improvement of body functioning was the top motivator for both. CONCLUSION The fact that many at-risk individuals are not aware of the importance of exercise and would exercise more with fewer barriers creates opportunities for trials using exercise as a possible prevention strategy for PD.
Collapse
Affiliation(s)
- S Schootemeijer
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Center of Expertise for Parkinson & Movement Disorders; Nijmegen, the Netherlands
| | - D Coker
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | - J F Shelton
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | - E Chanoff
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | - H M Rowbotham
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | - S K L Darweesh
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Center of Expertise for Parkinson & Movement Disorders; Nijmegen, the Netherlands
| | - B R Bloem
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Center of Expertise for Parkinson & Movement Disorders; Nijmegen, the Netherlands.
| | - P Cannon
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | - N M de Vries
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Center of Expertise for Parkinson & Movement Disorders; Nijmegen, the Netherlands
| |
Collapse
|
3
|
Klaver EC, van Vugt JPP, Bloem BR, van Wezel RJA, Nonnekes J, Tjepkema-Cloostermans MC. Good vibrations: tactile cueing for freezing of gait in Parkinson's disease. J Neurol 2023:10.1007/s00415-023-11663-9. [PMID: 36944760 DOI: 10.1007/s00415-023-11663-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cueing strategies can alleviate freezing of gait (FOG) in people with Parkinson's disease (PD). We evaluated tactile cueing delivered via vibrating socks, which has the benefit of not being noticeable to bystanders. OBJECTIVE To evaluate the effect of tactile cueing compared to auditory cueing on FOG. METHODS Thirty-one persons with PD with FOG performed gait tasks during both ON and OFF state. The effect of open loop and closed loop tactile cueing, as delivered by vibrating socks, was compared to an active control group (auditory cueing) and to a baseline condition (uncued gait). These four conditions were balanced between subjects. Gait tasks were videotaped and annotated for FOG by two experienced raters. Motion data were collected to analyze spatiotemporal gait parameters. Responders were defined as manifesting a relative reduction of > 10% in the percent time frozen compared to uncued gait. RESULTS The average percent time frozen during uncued gait was 11.2% in ON and 21.5% in OFF state. None of the three tested cueing modalities affected the percentage of time frozen in either the ON (p = 0.20) or OFF state (p = 0.12). The number of FOG episodes and spatiotemporal gait parameters were also not affected. We found that 22 out of 31 subjects responded to cueing, the response to the three types of cueing was highly individual. CONCLUSIONS Cueing did not improve FOG at the group level; however, tactile as well as auditory cueing improved FOG in many individuals. This highlights the need for a personalized approach when using cueing to treat FOG.
Collapse
Affiliation(s)
- E C Klaver
- Department of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, The Netherlands.
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525 AJ, Nijmegen, The Netherlands.
| | - J P P van Vugt
- Department of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, The Netherlands
| | - B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525 AJ, Nijmegen, The Netherlands
- Department of Biomedical Signals and Systems, MedTech Centre, University of Twente, Enschede, The Netherlands
| | - J Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - M C Tjepkema-Cloostermans
- Department of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, The Netherlands
- MedTech Centre, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| |
Collapse
|
4
|
Talebi AH, Ypinga JHL, De Vries NM, Nonnekes J, Munneke M, Bloem BR, Heskes T, Ben-Shlomo Y, Darweesh SKL. Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications. Mov Disord 2023; 38:223-231. [PMID: 36424819 DOI: 10.1002/mds.29274] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Specialized versus generic physiotherapy (PT) reduces Parkinson's disease (PD)-related complications. It is unclear (1) whether other specialized allied heath disciplines, including occupational therapy (OT) and speech and language therapy (S<), also reduce complications; (2) whether there is a synergistic effect among multiple specialized disciplines; and (3) whether each allied health discipline prevents specific complications. OBJECTIVES To longitudinally assessed whether the level of expertise (specialized vs. generic training) of PT, OT, and S< was associated with the incidence rate of PD-related complications. METHODS We used claims data of all insured persons with PD in the Netherlands between January 1, 2010, and December 31, 2018. ParkinsonNet-trained therapists were classified as specialized, and other therapists as generic. We used mixed-effects Poisson regression models to estimate rate ratios adjusting for sociodemographic and clinical characteristics. RESULTS The population of 51,464 persons with PD (mean age, 72.4 years; standard deviation 9.8) sustained 10,525 PD-related complications during follow-up (median 3.3 years). Specialized PT was associated with fewer complications (incidence rate ratio [IRR] of specialized versus generic = 0.79; 95% confidence interval, [0.74-0.83]; P < 0.0001), as was specialized OT (IRR = 0.88 [0.77-0.99]; P = 0.03). We found a trend of an association between specialized S< and a lower rate of PD-related complications (IRR = 0.88 [0.74-1.04]; P = 0.18). The inverse association of specialized OT persisted in the stratum, which also received specialized PT (IRR = 0.62 [0.42-0.90]; P = 0.001). The strongest inverse association of PT was seen with orthopedic injuries (IRR = 0.78 [0.73-0.82]; P < 0.0001) and of S< with pneumonia (IRR = 0.70 [0.53-0.93]; P = 0.03). CONCLUSIONS These findings support a wider introduction of specialized allied health therapy expertise in PD care and conceivably for other medical conditions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Amir H Talebi
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jan H L Ypinga
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sirwan K L Darweesh
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| |
Collapse
|
5
|
Feenstra W, Nonnekes J, Rahimi T, Reinders-Messelink HA, Dijkstra PU, Bloem BR. Dance classes improve self-esteem and quality of life in persons with Parkinson's disease. J Neurol 2022; 269:5843-5847. [PMID: 35763112 DOI: 10.1007/s00415-022-11206-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/29/2022] [Accepted: 05/29/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Dance can reduce motor symptoms in persons with Parkinson's disease (PD). However, the effect on psychosocial wellbeing, including self-esteem and quality of life is less clear. METHODS Forty-nine persons with PD (Hoehn and Yahr stage 1-4) participated in weekly dance classes for a consecutive period of 22 weeks, 36 participants completed the classes. Two baseline measurements (T1a and T1b) were performed during a 2-week control period prior to the dance classes. Post-measurements (T2) were performed immediately after 22 weeks of dance classes. Primary outcome was self-esteem as measured with the Rosenberg Self-Esteem Score. RESULTS Self-esteem scores were stable across the two baseline measurements and improved significantly after the dance classes (1.5 points improvement between T1b and T2, 95% CI 0.3, 2.7; p = 0.012). Additionally, quality of life as measured with the Parkinson's Disease Questionnaire 39 improved significantly (3.4 points reduction between T1b and T2, 95%CI - 5.7, - 1.2; p = 0.003) as did motor symptoms as measured with the Movement Disorders Society-Unified Parkinson's Disease Rating Scale-part III (6.2 points reduction between T1b and T2, 95%CI - 10.1, - 2.4; p = 0.002). Balance confidence as measured with the Activities-Specific Balance Confidence Scale did not change. DISCUSSION AND CONCLUSIONS Dance classes seem to improve self-esteem, quality of life and motor symptoms in persons with PD. These effects should be investigated further in a randomized clinical trial. CLINICAL MESSAGE Dance classes may be a valuable complementary treatment option in people with PD to improve not only motor symptoms, but also self-esteem and quality of life.
Collapse
Affiliation(s)
- Wya Feenstra
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.
| | - Jorik Nonnekes
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Tahmina Rahimi
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.,Utrecht University, Utrecht, The Netherlands
| | - Heleen A Reinders-Messelink
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bas R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Maas JJL, De Vries NM, Bloem BR, Kalf JG. Design of the PERSPECTIVE study: PERsonalized SPEeCh Therapy for actIVE conversation in Parkinson's disease (randomized controlled trial). Trials 2022; 23:274. [PMID: 35395953 PMCID: PMC8990485 DOI: 10.1186/s13063-022-06160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of personalized and home-based speech therapy on quality of life, intelligibility, and social participation for people with Parkinson’s disease (PD) who have a reduced intelligibility of speech. Background Speech problems in PD have a profound negative impact on social interaction and quality of life. Evidence for speech therapy in PD is growing, but more work remains needed to explore its full potential. Efficacy exists for highly intensive standardized speech treatment programs, but not all patients can comply with this rather intense intervention, especially the more severely affected ones. Here, we aim to study the effectiveness of personalized and home-based (remote) speech therapy in PD on quality of life and speech. The intervention will be supported by a dedicated speech training app. We expect that this approach will improve speech intelligibility and quality of life in patients irrespective of disease stage. Methods We will perform a single blind, randomized controlled trial, comparing 8 weeks of speech therapy to no intervention using a waiting list design. A total of 215 PD patients with problems in intelligibility will be recruited by 12 highly experienced speech therapists. All patients will be measured at baseline and after 8 weeks (primary endpoint). Additionally, the experimental group will be re-assessed one more time, after a wash-out period of 24 weeks. The control group will receive deferred treatment after 8 weeks, but without additional follow-up assessments. Our primary outcome is quality of life (as measured with PDQ-39). Secondary outcomes include speech and voice quality, intelligibility, severity of voice and speech complaints, and caregiver burden. Results The inclusion of participants has started on March 1, 2019, and is expected to be finalized on April 1, 2021. We expect to have the first results in January 2022. Conclusions We will investigate the effectiveness of speech therapy in PD. Particular strengths of our study include a randomized and single-blinded design, the personalized treatment approach, the inclusion of PD patients irrespective of disease stage or severity of the speech complaint, the long-term follow-up, the adequate power, and the use of a patient-relevant primary endpoint. This will allow us to draw firm conclusions about the effectiveness of personalized and remote speech therapy for PD patients in all disease stages. Trial registration ClinicalTrials.govNCT03963388. Registered on May 24, 2019
Collapse
Affiliation(s)
- J J L Maas
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - N M De Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J G Kalf
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Verschuur CV, Suwijn SR, de Haan RJ, Boel JA, Post B, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Munts A, Dijkgraaf MG, de Bie RM. Cost-Effectiveness and Cost-Utility of Early Levodopa in Parkinson's Disease. J Parkinsons Dis 2022; 12:2171-2178. [PMID: 35938258 PMCID: PMC9661337 DOI: 10.3233/jpd-223247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the Levodopa in EArly Parkinson's disease (LEAP) study, 445 patients were randomized to levodopa/carbidopa 100/25 mg three times per day for 80 weeks (early-start) or placebo for 40 weeks followed by levodopa/carbidopa 100/25 mg three times per day for 40 weeks (delayed-start). OBJECTIVE This paper reports the results of the economic evaluation performed alongside the LEAP-study. METHODS Early-start treatment was evaluated versus delayed-start treatment, in which the cost-effectiveness analysis (CEA) and the cost-utility analysis (CUA) were performed from the societal perspective, including health care costs among providers, non-reimbursable out-of-pocket expenses of patients, employer costs of sick leave, and lowered productivity while at work. The outcome measure for the CEA was the extra cost per unit decrease on the Unified Parkinson's Disease Rating Scale 80 weeks after baseline. The outcome measure for the CUA was the extra costs per additional quality adjusted life year (QALY) during follow-up. RESULTS 212 patients in the early-start and 219 patients in the delayed-start group reported use of health care resources. With savings of € 59 per patient (BCa 95% CI: -829, 788) in the early-start compared to the delayed-start group, societal costs were balanced. The early-start group showed a mean of 1.30 QALYs (BCa 95% CI: 1.26, 1.33) versus 1.30 QALYs (BCa 95% CI: 1.27, 1.33) for the delayed-start group. Because of this negligible difference, incremental cost-effectiveness and cost-utility ratios were not calculated. CONCLUSION From an economic point of view, this study suggests that early treatment with levodopa is not more expensive than delayed treatment with levodopa.
Collapse
Affiliation(s)
- Constant V.M. Verschuur
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sven R. Suwijn
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob J. de Haan
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith A. Boel
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit Tissingh
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Alexander Munts
- Department of Neurology, Excellent Klinieken, Dordrecht, The Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M.A. de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Johansson ME, Cameron IGM, van der Kolk NM, De Vries NM, Klimars E, Toni I, Bloem BR, Helmich RC. Aerobic exercise alters brain function and structure in Parkinson's disease a randomized controlled trial. Ann Neurol 2021; 91:203-216. [PMID: 34951063 PMCID: PMC9306840 DOI: 10.1002/ana.26291] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022]
Abstract
Objective Randomized clinical trials have shown that aerobic exercise attenuates motor symptom progression in Parkinson's disease, but the underlying neural mechanisms are unclear. Here, we investigated how aerobic exercise influences disease‐related functional and structural changes in the corticostriatal sensorimotor network, which is involved in the emergence of motor deficits in Parkinson's disease. Additionally, we explored effects of aerobic exercise on tissue integrity of the substantia nigra, and on behavioral and cerebral indices of cognitive control. Methods The Park‐in‐Shape trial is a single‐center, double‐blind randomized controlled trial in 130 Parkinson's disease patients who were randomly assigned (1:1 ratio) to aerobic exercise (stationary home trainer) or stretching (active control) interventions (duration = 6 months). An unselected subset from this trial (exercise, n = 25; stretching, n = 31) underwent resting‐state functional and structural magnetic resonance imaging (MRI), and an oculomotor cognitive control task (pro‐ and antisaccades), at baseline and at 6‐month follow‐up. Results Aerobic exercise, but not stretching, led to increased functional connectivity of the anterior putamen with the sensorimotor cortex relative to the posterior putamen. Behaviorally, aerobic exercise also improved cognitive control. Furthermore, aerobic exercise increased functional connectivity in the right frontoparietal network, proportionally to fitness improvements, and it reduced global brain atrophy. Interpretation MRI, clinical, and behavioral results converge toward the conclusion that aerobic exercise stabilizes disease progression in the corticostriatal sensorimotor network and enhances cognitive performance. ANN NEUROL 2022;91:203–216
Collapse
Affiliation(s)
- M E Johansson
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - I G M Cameron
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Enschede, The Netherlands.,OnePlanet Research Center, Nijmegen, The Netherlands
| | - N M van der Kolk
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - N M De Vries
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - E Klimars
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - I Toni
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - B R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - R C Helmich
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| |
Collapse
|
9
|
Dommershuijsen LJ, Van der Heide A, Van den Berg EM, Labrecque JA, Ikram MK, Ikram MA, Bloem BR, Helmich RC, Darweesh SKL. Mental health in people with Parkinson's disease during the COVID-19 pandemic: potential for targeted interventions? NPJ Parkinsons Dis 2021; 7:95. [PMID: 34711842 PMCID: PMC8553848 DOI: 10.1038/s41531-021-00238-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has introduced a myriad of challenges to the social life and care of people with Parkinson’s disease (PD), which could potentially worsen mental health problems. We used baseline data of the PRIME-NL study (N = 844) to examine whether the association between COVID-19 stressors and mental health is disproportionately large in specific subgroups of people with PD and to explore effects of hypothetical reductions in COVID-19 stressors on mental health and quality of life. The mean (SD) age of the study population was 70.3 (7.8) years and 321 (38.0%) were women. The linear regression effect estimate of the association of COVID-19 stressors with mental health was most pronounced in women, highly educated people, people with advanced PD and people prone to distancing or seeking social support. Smaller effect estimates were found in people scoring high on confrontive coping or planful problem solving. The parametric G-formula method was used to calculate the effects of hypothetical interventions on COVID-19 stressors. An intervention reducing stressors with 50% in people with above median MDS-UPDRS-II decreased the Beck Depression Inventory in this group from 14.7 to 10.6, the State-Trait Anxiety Inventory from 81.6 to 73.1 and the Parkinson’s Disease Quality of Life Questionnaire from 35.0 to 24.3. Insights from this cross-sectional study help to inform tailored care interventions to subgroups of people with PD most vulnerable to the impact of COVID-19 on mental health and quality of life.
Collapse
Affiliation(s)
- L J Dommershuijsen
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Centre of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Van der Heide
- Centre of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M Van den Berg
- Centre of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J A Labrecque
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M K Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - B R Bloem
- Centre of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R C Helmich
- Centre of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S K L Darweesh
- Centre of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| |
Collapse
|
10
|
Janssen S, Heijs J, Bittner M, Droog E, Bloem BR, Van Wezel R, Heida T. Visual cues added to a virtual environment paradigm do not improve motor arrests in Parkinson's disease. J Neural Eng 2021; 18. [PMID: 33540389 DOI: 10.1088/1741-2552/abe356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/12/2022]
Abstract
Objective. Elucidating how cueing alleviates freezing of gait (FOG) in Parkinson's disease (PD) would enable the development of more effective, personalized cueing strategies. Here, we aimed to validate a visual cueing virtual environment (VE) paradigm for future use in e.g. neuroimaging studies and behavioral studies on motor timing and scaling in PD patients with FOG.Approach. We included 20 PD patients with FOG and 16 age-matched healthy control subjects. Supine participants were confronted with a VE displaying either no cues, bars or staircases. They navigated forward using alternate suppression of foot pedals. Motor arrests (as proxy for FOG), and measures of motor timing and scaling were compared across the three VE conditions for both groups.Main results. VE cues (bars and staircases) did not reduce motor arrests in PD patients and healthy control subjects. The VE cues did reduce pedal amplitude in healthy control subjects, without effects on other motor parameters.Conclusion. We could not validate a visual cueing VE paradigm to study FOG. The VE cues possibly failed to convey the necessary spatial and temporal information to support motor timing and scaling. We discuss avenues for future research.
Collapse
Affiliation(s)
- S Janssen
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Jja Heijs
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| | - M Bittner
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Current Address: VicarVision, Amsterdam, The Netherlands
| | - E Droog
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Rja Van Wezel
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Department of Biophysics, Donders Institute of Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - T Heida
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| |
Collapse
|
11
|
Venhovens J, Meulstee J, Bloem BR, Verhagen WIM. Neurovestibular Dysfunction and Falls in Parkinson's Disease and Atypical Parkinsonism: A Prospective 1 Year Follow-Up Study. Front Neurol 2020; 11:580285. [PMID: 33193032 PMCID: PMC7658339 DOI: 10.3389/fneur.2020.580285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
Our primary aim was to determine whether neurovestibular laboratory tests can predict future falls in patients with either Parkinson's disease (PD) or atypical parkinsonism (AP). We included 25 healthy subjects, 30 PD patients (median Hoehn and Yahr stage 2.5, range 1–4), and 14 AP patients (6 multiple system atrophy, 3 progressive supranuclear palsy, and 5 vascular parkinsonism) in a case-control study design (all matched for age and gender). At baseline, all subjects underwent clinical neurological and neurotological assessments, cervical and ocular vestibular evoked myogenic potentials (VEMP), brainstem auditory evoked potentials (BAEP), subjective visual vertical measurements (SVV), and video nystagmography with caloric and rotary test stimulation. After 1 year follow-up, all subjects were contacted by telephone for an interview about their fall frequency (based upon fall diaries) and about their balance confidence (according to the ABC-16 questionnaire); only one participant was lost to follow-up (attrition bias of 1.4%). Cervical and ocular VEMPs combined with clinical tests for postural imbalance predicted future fall incidents in both PD and AP groups with a sensitivity of 100%. A positive predictive value of 68% was achieved, if only one VEMP test was abnormal, and of 83% when both VEMP tests were abnormal. The fall frequency at baseline and after 1 year was significantly higher and the balance confidence scale (ABC-16) was significantly lower in both the PD and AP groups compared to healthy controls. Therefore, VEMP testing can predict the risk of future fall incidents in PD and AP patients with postural imbalance.
Collapse
Affiliation(s)
- Jeroen Venhovens
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.,Department of Neurology and Clinical Neurophysiology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Jan Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Behaviour and Cognition, Nijmegen, Netherlands
| | - Wim I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| |
Collapse
|
12
|
Cubo E, Hassan A, Bloem BR, Mari Z. Implementation of Telemedicine for Urgent and Ongoing Healthcare for Patients with Parkinson's Disease During the COVID-19 Pandemic: New Expectations for the Future. J Parkinsons Dis 2020; 10:911-913. [PMID: 32417800 DOI: 10.3233/jpd-202108] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Esther Cubo
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain.,Department of Health Science, University of Burgos, Burgos, Spain
| | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health Department, Las Vegas, NV, USA
| | | |
Collapse
|
13
|
Hommel ALAJ, Meinders MJ, Weerkamp NJ, Richinger C, Schmotz C, Lorenzl S, Dodel R, Coelho M, Ferreira JJ, Tison F, Boraud T, Meissner WG, Rosqvist K, Timpka J, Odin P, Wittenberg M, Bloem BR, Koopmans RT, Schragand A. Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial. J Parkinsons Dis 2020; 10:1171-1184. [PMID: 32568111 DOI: 10.3233/jpd-202033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment of patients with late-stage parkinsonism is often sub-optimal. OBJECTIVE To test the effectiveness of recommendations by a movement disorder specialist with expertise in late-stage parkinsonism. METHODS Ninety-one patients with late-stage parkinsonism considered undertreated were included in apragmatic a pragmatic multi-center randomized-controlled trial with six-month follow-up. The intervention group received a letter with treatment recommendations to their primary clinician based on an extensive clinical assessment. Controls received care as usual. The primary outcome was the Unified Parkinson Disease Rating Scale (UPDRS)part-II (Activities of Daily Living). Other outcomes included quality-of-life (PDQ-8), mental health (UPDRS-I), motor function (UPDRS-III), treatment complications (UPDRS-IV), cognition (Mini-mental-state-examination), non-motor symptoms (Non-Motor-Symptoms-scale), health status (EQ-5D-5L) and levodopa-equivalent-daily-dose (LEDD). We also assessed adherence to recommendations. In addition to intention-to-treat analyses, a per-protocol analysis was conducted. RESULTS Sample size calculation required 288 patients, but only 91 patients could be included. Treating physicians followed recommendations fully in 16 (28%) and partially in 21 (36%) patients. The intention-to-treat analysis showed no difference in primary outcome (between-group difference = -1.2, p = 0.45), but there was greater improvement for PDQ-8 in the intervention group (between-group difference = -3.7, p = 0.02). The per-protocol analysis confirmed these findings, and showed less deterioration in UPDRS-part I, greater improvement on UPDRS-total score and greater increase in LEDD in the intervention group. CONCLUSIONS The findings suggest that therapeutic gains may be reached even in this vulnerable group of patients with late-stage parkinsonism, but also emphasize that specialist recommendations need to be accompanied by better strategies to implement these to further improve outcomes.
Collapse
Affiliation(s)
- Adrianus L A J Hommel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; Groenhuysen Organisation, Roosendaal, the Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientici Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Nico J Weerkamp
- Department of Neurology, Bronovo Medical Center, The Hague, The Netherlands
| | - Carmen Richinger
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany. Institute of Nursing Science and -Practice, Paracelsus Medical University Salzburg, Austria
| | - Christian Schmotz
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany. Institute of Nursing Science and -Practice, Paracelsus Medical University Salzburg, Austria
| | - Stefan Lorenzl
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany. Institute of Nursing Science and -Practice, Paracelsus Medical University Salzburg, Austria
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Miguel Coelho
- Instituto de Medicina Molecular Universidad di Lisboa, Lisbon, Portugal
| | | | - Francois Tison
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France and Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux, France
| | - Thomas Boraud
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France and Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux, France
| | - Wassilios G Meissner
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France and Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux, France.,Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Kristina Rosqvist
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonathan Timpka
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Per Odin
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Michael Wittenberg
- Coordinating Centre for Clinical Trials (KKS), Philipps-University Marburg, Marburg, Germany
| | - Bas R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands
| | - Raymond T Koopmans
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands; Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Anette Schragand
- UCL Queen Square Institute of Neurology, University College London, Royal Free Campus, Rowland Hill Street, London, UK
| | | |
Collapse
|
14
|
Hosking A, Hommel AALJ, Lorenzl S, Coelho M, Ferreira JJ, Meissner WG, Odin P, Bloem BR, Dodel R, Schrag A. Characteristics of Patients with Late-Stage Parkinsonism Who are Nursing Home Residents Compared with those Living at Home. J Am Med Dir Assoc 2020; 22:440-445.e2. [PMID: 32723531 DOI: 10.1016/j.jamda.2020.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home. DESIGN Cross-sectional analysis. SETTING AND PARTICIPANTS This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP). MEASURES Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis. RESULTS Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement. CONCLUSIONS AND IMPLICATIONS These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder.
Collapse
Affiliation(s)
- Alice Hosking
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Adrianus A L J Hommel
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands; Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany; Department of Neurology, Agatharied Hospital, Hausham, Germany
| | - Miguel Coelho
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Wassilios G Meissner
- Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand; Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Per Odin
- Department of Neurology, Lund University Hospital, Lund, Sweden
| | - Bas R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands; Groenhuysen Organisation, Roosendaal, the Netherlands
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Anette Schrag
- UCL Queen Square Institute of Neurology, University College London, London, UK.
| | | |
Collapse
|
15
|
van Wamelen DJ, Podlewska AM, Leta V, Śmiłowska K, Rizos A, Martinez-Martin P, Bloem BR, Chaudhuri K. Slave to the rhythm: Seasonal differences in non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2019; 63:73-76. [DOI: 10.1016/j.parkreldis.2019.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
|
16
|
de Vries NM, Smilowska K, Hummelink J, Abramiuc B, van Gilst MM, Bloem BR, de With PHN, Overeem S. Exploring the Parkinson patients' perspective on home-based video recording for movement analysis: a qualitative study. BMC Neurol 2019; 19:71. [PMID: 31029123 PMCID: PMC6486968 DOI: 10.1186/s12883-019-1301-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background Parkinson’s disease is a complex neurological disorder characterized by a variety of motor- as well as non-motor symptoms. Video-based technology (using continuous home monitoring) may bridge the gap between the fragmented in-clinic observations and the need for a comprehensive understanding of the progression and fluctuation of disease symptoms. However, continuous monitoring can be intrusive, raising questions about feasibility as well as potential privacy violation. Methods We used a grounded theory approach in which we performed semi-structured interviews to explore the opinion of Parkinson’s patients on home-based video recording used for vision-based movement analysis. Results Saturation was reached after sixteen interviews. Three first–level themes were identified that specify the conditions required to perform continuous video monitoring: Camera recording (e.g. being able to turn off the camera), privacy protection (e.g. patient’s behaviour, patient’s consent, camera location) and perceived motivation (e.g. contributing to science or clinical practice). Conclusion Our findings show that Parkinson patients’ perception of continuous, home-based video recording is positive, when a number of requirements are taken into account. This knowledge will enable us to start using this technology in future research and clinical practice in order to better understand the disease and to objectify outcomes in the patients’ own homes.
Collapse
Affiliation(s)
- N M de Vries
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - K Smilowska
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - J Hummelink
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - B Abramiuc
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands
| | - M M van Gilst
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands.,Eindhoven University of Technology, Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands
| | - B R Bloem
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - P H N de With
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands
| | - S Overeem
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands.,Eindhoven University of Technology, Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands
| |
Collapse
|
17
|
Vlaanderen FP, Tanke MA, Bloem BR, Faber MJ, Eijkenaar F, Schut FT, Jeurissen PPT. Design and effects of outcome-based payment models in healthcare: a systematic review. Eur J Health Econ 2019; 20:217-232. [PMID: 29974285 PMCID: PMC6438941 DOI: 10.1007/s10198-018-0989-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 06/22/2018] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. METHODS We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. RESULTS We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. DISCUSSION Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.
Collapse
Affiliation(s)
- F P Vlaanderen
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands.
| | - M A Tanke
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - B R Bloem
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - M J Faber
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands
| | - F Eijkenaar
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - F T Schut
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - P P T Jeurissen
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
18
|
Verschuur CVM, Suwijn SR, Boel JA, Post B, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Munts AG, Deuschl G, Lang AE, Dijkgraaf MGW, de Haan RJ, de Bie RMA. Randomized Delayed-Start Trial of Levodopa in Parkinson's Disease. N Engl J Med 2019; 380:315-324. [PMID: 30673543 DOI: 10.1056/nejmoa1809983] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Levodopa is the main treatment for symptoms of Parkinson's disease. Determining whether levodopa also has a disease-modifying effect could provide guidance as to when in the course of the disease the treatment with this drug should be initiated. METHODS In a multicenter, double-blind, placebo-controlled, delayed-start trial, we randomly assigned patients with early Parkinson's disease to receive levodopa (100 mg three times per day) in combination with carbidopa (25 mg three times per day) for 80 weeks (early-start group) or placebo for 40 weeks followed by levodopa in combination with carbidopa for 40 weeks (delayed-start group). The primary outcome was the between-group difference in the mean change from baseline to week 80 in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS; scores range from 0 to 176, with higher scores signifying more severe disease). Secondary analyses included the progression of symptoms, as measured by the UPDRS score, between weeks 4 and 40 and the noninferiority of early initiation of treatment to delayed initiation between weeks 44 and 80, with a noninferiority margin of 0.055 points per week. RESULTS A total of 445 patients were randomly assigned: 222 to the early-start group and 223 to the delayed-start group. The mean (±SD) UPDRS score at baseline was 28.1±11.4 points in the early-start group and 29.3±12.1 points in the delayed-start group. The change in UPDRS score from baseline to week 80 was -1.0±13.1 points and -2.0±13.0 points, respectively (difference, 1.0 point; 95% confidence interval [CI], -1.5 to 3.5; P=0.44); this finding of no significant between-group difference at week 80 implies that levodopa had no disease-modifying effect. Between weeks 4 and 40, the rate of progression of symptoms, as measured in UPDRS points per week, was 0.04±0.23 in the early-start group and 0.06±0.34 in the delayed-start group (difference, -0.02; 95% CI, -0.07 to 0.03). The corresponding rates between weeks 44 and 80 were 0.10±0.25 and 0.03±0.28 (difference, 0.07; two-sided 90% CI, 0.03 to 0.10); the difference in the rate of progression between weeks 44 and 80 did not meet the criterion for noninferiority of early receipt of levodopa to delayed receipt. The rates of dyskinesia and levodopa-related fluctuations in motor response did not differ significantly between the two groups. CONCLUSIONS Among patients with early Parkinson's disease who were evaluated over the course of 80 weeks, treatment with levodopa in combination with carbidopa had no disease-modifying effect. (Funded by the Netherlands Organization for Health Research and Development and others; LEAP Current Controlled Trials number, ISRCTN30518857 .).
Collapse
Affiliation(s)
- Constant V M Verschuur
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Sven R Suwijn
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Judith A Boel
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Bart Post
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Bas R Bloem
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Johannes J van Hilten
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Teus van Laar
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Gerrit Tissingh
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Alexander G Munts
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Guenther Deuschl
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Anthony E Lang
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Marcel G W Dijkgraaf
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Rob J de Haan
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| | - Rob M A de Bie
- From the Department of Neurology, Amsterdam Neuroscience (C.V.M.V., S.R.S., J.A.B., R.M.A.B.), Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), and the Clinical Research Unit (R.J.H.), Amsterdam UMC, University of Amsterdam, AMC, Amsterdam, the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen (B.P., B.R.B.), the Department of Neurology, Leiden University Medical Center, Leiden (J.J.H.), the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (T.L.), the Department of Neurology, Zuyderland Medical Center, Heerlen (G.T.), and the Department of Neurology, Spaarne Gasthuis, Haarlem (A.G.M.) - all in the Netherlands; the Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany (G.D.); and the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto (A.E.L.)
| |
Collapse
|
19
|
Affiliation(s)
- B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - I M F van Balken
- Department of Neurology, Rivierenland Hospital, Tiel, The Netherlands
| | - J Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
20
|
Bekkers EMJ, Dijkstra BW, Heremans E, Verschueren SMP, Bloem BR, Nieuwboer A. Balancing between the two: Are freezing of gait and postural instability in Parkinson's disease connected? Neurosci Biobehav Rev 2018; 94:113-125. [PMID: 30125601 DOI: 10.1016/j.neubiorev.2018.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 01/11/2023]
Abstract
Postural instability and freezing of gait (FoG) are key features of Parkinson's disease (PD) closely related to falls. Growing evidence suggests that co-existing postural deficits could influence the occurrence and severity of FoG. To date, the exact nature of this interrelationship remains largely unknown. We analyzed the complex interaction between postural instability and gait disturbance by comparing the findings available in the posturographic literature between patients with and without FoG. Results showed that FoG and postural instability are intertwined, can influence each other behaviorally and may coincide neurologically. The most common FoG-related postural deficits included weight-shifting impairments, and inadequate scaling and timing of postural responses most apparent at forthcoming postural changes under time constraints. Most likely, a negative cycle of combined and more severe postural deficits in people with FoG will enhance postural stability breakdown. As such, the wide brain network deficiencies involved in FoG may also concurrently influence postural stability. Future work needs to examine whether training interventions targeting both symptoms will have extra clinical benefits on fall frequency.
Collapse
Affiliation(s)
- E M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium; Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Center Nijmegen (ParC), Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands.
| | - B W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - E Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - S M P Verschueren
- Research Group for Musculoskeletal Research, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Center Nijmegen (ParC), Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands.
| | - A Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| |
Collapse
|
21
|
Darweesh SKL, Ikram MK, Faber MJ, de Vries NM, Haaxma CA, Hofman A, Koudstaal PJ, Bloem BR, Ikram MA. Professional occupation and the risk of Parkinson's disease. Eur J Neurol 2018; 25:1470-1476. [PMID: 30007105 PMCID: PMC6282552 DOI: 10.1111/ene.13752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Creativity in Parkinson's disease (PD) is strongly related to dopaminergic activity and medication. We hypothesized that patients with PD, including those who are in the pre-diagnostic phase of PD, are prone to choose highly structured 'conventional' professional occupations and avoid highly creative 'artistic' occupations. METHODS At baseline of the population-based Rotterdam Study, we asked 12 147 individuals aged ≥45 years about their latest occupation and categorized occupations according to the RIASEC model. Participants underwent baseline and follow-up (median 11 years) examinations for PD. We determined associations of artistic (versus any other occupation) and conventional (versus any other occupation) occupations with PD. Additionally, we pooled our results with a recently published case-control study (Radboud Study). RESULTS At baseline, conventional occupations were common [n = 4356 (36%)], whereas artistic occupations were rare [n = 137 (1%)]. There were 217 patients with PD, including 91 with prevalent PD and 126 with incident PD. The risk of PD varied substantially across occupational categories (chi-square, 14.61; P = 0.01). The penalized odds ratio (OR) of artistic occupations for PD was 0.19 [95% confidence interval (CI), 0.00-1.31; P = 0.11], whereas the OR of conventional occupations for PD was 1.23 (95% CI, 0.95-1.66; P = 0.10). The direction and magnitude of ORs were similar in cross-sectional and longitudinal subsamples. Pooled ORs across the Rotterdam and Radboud Studies were 0.20 (95% CI, 0.08-0.52; P < 0.001) for artistic and 1.23 (95% CI, 0.92-1.67; P = 0.08) for conventional occupations. CONCLUSIONS The risk of PD varies substantially by choice of professional occupation. Our findings suggest that dopaminergic degeneration affects choice of occupation, which may start in the pre-diagnostic phase of PD.
Collapse
Affiliation(s)
- S K L Darweesh
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M K Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M J Faber
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C A Haaxma
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - P J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
22
|
Bloem BR, Rompen L, Vries NMD, Klink A, Munneke M, Jeurissen P. ParkinsonNet: A Low-Cost Health Care Innovation With A Systems Approach From The Netherlands. Health Aff (Millwood) 2018; 36:1987-1996. [PMID: 29137501 DOI: 10.1377/hlthaff.2017.0832] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ParkinsonNet, a low-cost innovation to optimize care for patients with Parkinson disease, was developed in 2004 as a network of physical therapists in several regions in the Netherlands. Since that time, the network has achieved full national reach, with 70 regional networks and around 3,000 specifically trained professionals from 12 disciplines. Key elements include the empowerment of professionals who are highly trained and specialized in Parkinson disease, the empowerment of patients by education and consultation, and the empowerment of integrated multidisciplinary teams to better address and manage the disease. Studies have found that the ParkinsonNet approach leads to outcomes that are at least as good as, if not better than, outcomes from usual care. One study found a 50 percent reduction in hip fractures and fewer inpatient admissions. Other studies suggest that ParkinsonNet leads to modest but important cost savings (at least US$439 per patient annually). These cost savings outweigh the costs of building and maintaining the network. Because of ParkinsonNet's success, the program has now spread to several other countries and serves as a model of a successful and scalable frugal innovation.
Collapse
Affiliation(s)
- Bas R Bloem
- Bas R. Bloem is a professor in the Department of Neurology, Radboud University Medical Centre, in Nijmegen, and medical director of ParkinsonNet, in the Netherlands
| | - Lonneke Rompen
- Lonneke Rompen is a policy adviser at the Department of Neurology, Radboud University Medical Centre
| | - Nienke M de Vries
- Nienke M. de Vries is a researcher in the Department of Neurology, Radboud University Medical Centre
| | - Ab Klink
- Ab Klink is on the Faculty of Social Sciences, Political Science, and Public Administration at Vrije Universiteit Amsterdam, in the Netherlands
| | - Marten Munneke
- Marten Munneke is an associate professor in the Department of Neurology and the Department of Rehabilitation and Allied Health, Radboud University Medical Centre
| | - Patrick Jeurissen
- Patrick Jeurissen ( ) is a professor in fiscal sustainable health care systems, Radboud University Medical School, and holds an affiliation with the Ministry of Health in the Netherlands
| |
Collapse
|
23
|
Klemann CJHM, Xicoy H, Poelmans G, Bloem BR, Martens GJM, Visser JE. Physical Exercise Modulates L-DOPA-Regulated Molecular Pathways in the MPTP Mouse Model of Parkinson's Disease. Mol Neurobiol 2018; 55:5639-5657. [PMID: 29019056 PMCID: PMC5994219 DOI: 10.1007/s12035-017-0775-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022]
Abstract
Parkinson's disease (PD) is characterized by the degeneration of dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc), resulting in motor and non-motor dysfunction. Physical exercise improves these symptoms in PD patients. To explore the molecular mechanisms underlying the beneficial effects of physical exercise, we exposed 1-methyl-4-phenyl-1,2,3,6-tetrahydropyrimidine (MPTP)-treated mice to a four-week physical exercise regimen, and subsequently explored their motor performance and the transcriptome of multiple PD-linked brain areas. MPTP reduced the number of DA neurons in the SNpc, whereas physical exercise improved beam walking, rotarod performance, and motor behavior in the open field. Further, enrichment analyses of the RNA-sequencing data revealed that in the MPTP-treated mice physical exercise predominantly modulated signaling cascades that are regulated by the top upstream regulators L-DOPA, RICTOR, CREB1, or bicuculline/dalfampridine, associated with movement disorders, mitochondrial dysfunction, and epilepsy-related processes. To elucidate the molecular pathways underlying these cascades, we integrated the proteins encoded by the exercise-induced differentially expressed mRNAs for each of the upstream regulators into a molecular landscape, for multiple key brain areas. Most notable was the opposite effect of physical exercise compared to previously reported effects of L-DOPA on the expression of mRNAs in the SN and the ventromedial striatum that are involved in-among other processes-circadian rhythm and signaling involving DA, neuropeptides, and endocannabinoids. Altogether, our findings suggest that physical exercise can improve motor function in PD and may, at the same time, counteract L-DOPA-mediated molecular mechanisms. Further, we hypothesize that physical exercise has the potential to improve non-motor symptoms of PD, some of which may be the result of (chronic) L-DOPA use.
Collapse
Affiliation(s)
- Cornelius J H M Klemann
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Helena Xicoy
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Cell Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Poelmans
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gerard J M Martens
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jasper E Visser
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Neurology, Amphia Hospital, Breda, The Netherlands.
| |
Collapse
|
24
|
Abstract
Depression is a frequent non-motor symptom of Parkinson's disease. Its prevalence varies widely across studies (between 2.7% and 90%); around 35% have clinically significant depressive symptoms. Although depression can have an immense impact on the quality of life of affected patients and their caregivers, depressive symptoms in Parkinson's disease frequently remain unrecognised and, as a result, remain untreated. Here we overview the diagnostic challenges and pitfalls, including the factors contributing to the underdiagnosis of depression. We also discuss current ideas on the underlying pathophysiology. Finally, we offer a treatment approach based on currently available evidence.
Collapse
Affiliation(s)
- Monique H M Timmer
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria H C T van Beek
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas R Bloem
- Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rianne A J Esselink
- Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
25
|
Bouça-Machado R, Titova N, Chaudhuri KR, Bloem BR, Ferreira JJ. Palliative Care for Patients and Families With Parkinson's Disease. Int Rev Neurobiol 2017; 132:475-509. [PMID: 28554419 DOI: 10.1016/bs.irn.2017.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is the second most common neurodegenerative disease worldwide. There is widespread consensus that Parkinson patients, their carers, and clinicians involved in their care would benefit from a fully integrated, need-based provision of palliative care. However, the concept of palliative care in Parkinson's disease is still poorly defined and, consequently, poorly implemented into daily clinical practice. A particular challenge is the gradually progressive nature of Parkinson's disease-with insidiously increasing disability-making it challenging to clearly define the onset of palliative care needs for Parkinson patients. As people with Parkinson's disease are now living longer than in the past, future research needs to develop a more robust evidence-based approach to clarify the disease events associated with increased palliative care needs, and to examine these, prospectively, in an integrated palliative care service. The modern palliative care outlook, termed "simultaneous care,",is no longer restricted to the final stage of disease. It involves incorporating a continuity of care, effective management of the chronic-palliative interface, and a multidisciplinary network of professionals working both in the community and in specialized clinics, with active involvement of caregivers. Although promising, there is still a need to demonstrate the effectiveness of palliative care for patients with Parkinson's disease.
Collapse
Affiliation(s)
- Raquel Bouça-Machado
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Bas R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
| |
Collapse
|
26
|
Nijhuis FAP, Faber MJ, Post B, Bloem BR. [Shared decision-making: dilemmas in daily practice]. Ned Tijdschr Geneeskd 2017; 161:D1227. [PMID: 28443811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Shared decision-making is an essential - but often neglected - component of evidence-based medicine. In practice, doctors, nurses and patients encounter dilemmas which are understandable, but not insurmountable. We illustrate this by means of a complex decision concerning therapy in the advanced stage of Parkinson's disease. Evidence of effectiveness differs with each individual therapy, and, in practice, the experiences of neurologists also vary widely. In addition, the various treatment strategies all require a different sort of daily care, and have differing impacts on people's lives. It is time that we worked towards a realistic view of shared decision-making. Shared decision-making cannot be generalised to a 'one size fits all' strategy that we can choose to apply or not to apply at will. It should be a flexible instrument which, depending on the individual and the specific situation, can be put to use to deliver the best tailored care.
Collapse
Affiliation(s)
- F A P Nijhuis
- Canisius-Wilhelmina Ziekenhuis, afd. Neurologie, Nijmegen
| | | | | | | |
Collapse
|
27
|
Marques TM, Kuiperij HB, Bruinsma IB, van Rumund A, Aerts MB, Esselink RAJ, Bloem BR, Verbeek MM. MicroRNAs in Cerebrospinal Fluid as Potential Biomarkers for Parkinson's Disease and Multiple System Atrophy. Mol Neurobiol 2016; 54:7736-7745. [PMID: 27844283 PMCID: PMC5684261 DOI: 10.1007/s12035-016-0253-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/24/2016] [Indexed: 12/24/2022]
Abstract
Parkinson’s disease (PD) and multiple system atrophy (MSA) are both part of the spectrum of neurodegenerative movement disorders and α-synucleinopathies with overlap of symptoms especially at early stages of the disease but with distinct disease progression and responses to dopaminergic treatment. Therefore, having biomarkers that specifically classify patients, which could discriminate PD from MSA, would be very useful. MicroRNAs (miRNAs) regulate protein translation and are observed in biological fluids, including cerebrospinal fluid (CSF), and may therefore have potential as biomarkers of disease. The aim of our study was to determine if miRNAs in CSF could be used as biomarkers for either PD or MSA. Using quantitative PCR (qPCR), we evaluated expression levels of 10 miRNAs in CSF patient samples from PD (n = 28), MSA (n = 17), and non-neurological controls (n = 28). We identified two miRNAs (miR-24 and miR-205) that distinguished PD from controls and four miRNAs that differentiated MSA from controls (miR-19a, miR-19b, miR-24, and miR-34c). Combinations of miRNAs accurately discriminated either PD (area under the curve (AUC) = 0.96) or MSA (AUC = 0.86) from controls. In MSA, we also observed that miR-24 and miR-148b correlated with cerebellar ataxia symptoms, suggesting that these miRNAs are involved in cerebellar degeneration in MSA. Our findings support the potential of miRNA panels as biomarkers for movement disorders and may provide more insights into the pathological mechanisms related to these disorders.
Collapse
Affiliation(s)
- Tainá M Marques
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.,Parkinson Center Nijmegen, Nijmegen, The Netherlands
| | - H Bea Kuiperij
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Ilona B Bruinsma
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Anouke van Rumund
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Nijmegen, The Netherlands
| | - Marjolein B Aerts
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Nijmegen, The Netherlands
| | - Rianne A J Esselink
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Nijmegen, The Netherlands
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Parkinson Center Nijmegen, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. .,Department of Laboratory Medicine, Radboud University Medical Center, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands. .,Parkinson Center Nijmegen, Nijmegen, The Netherlands.
| |
Collapse
|
28
|
Hommel ALAJ, Faber MJ, Weerkamp NJ, van Dijk JG, Bloem BR, Koopmans RT. Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson’s Disease. JPD 2016; 6:805-810. [DOI: 10.3233/jpd-160853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- ALAJ Hommel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands, Groenhuysen Organisation, Roosendaal, The Netherlands
| | - MJ Faber
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - NJ Weerkamp
- Department of Neurology, Bronovo Medical Center, The Hague, The Netherlands
| | - JG van Dijk
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - BR Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - RT Koopmans
- Radboud University Medical Center, Department of Primary and Community care, Centre for Family Medicine, Geriatric Care and Public health, Nijmegen, The Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen
| |
Collapse
|
29
|
Koppen H, Boele HJ, Palm-Meinders IH, Koutstaal BJ, Horlings CG, Koekkoek BK, van der Geest J, Smit AE, van Buchem MA, Launer LJ, Terwindt GM, Bloem BR, Kruit MC, Ferrari MD, De Zeeuw CI. Cerebellar function and ischemic brain lesions in migraine patients from the general population. Cephalalgia 2016; 37:177-190. [PMID: 27059879 DOI: 10.1177/0333102416643527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective The objective of this article is to obtain detailed quantitative assessment of cerebellar function and structure in unselected migraine patients and controls from the general population. Methods A total of 282 clinically well-defined participants (migraine with aura n = 111; migraine without aura n = 89; non-migraine controls n = 82; age range 43-72; 72% female) from a population-based study were subjected to a range of sensitive and validated cerebellar tests that cover functions of all main parts of the cerebellar cortex, including cerebrocerebellum, spinocerebellum, and vestibulocerebellum. In addition, all participants underwent magnetic resonance imaging (MRI) of the brain to screen for cerebellar lesions. As a positive control, the same cerebellar tests were conducted in 13 patients with familial hemiplegic migraine type 1 (FHM1; age range 19-64; 69% female) all carrying a CACNA1A mutation known to affect cerebellar function. Results MRI revealed cerebellar ischemic lesions in 17/196 (8.5%) migraine patients and 3/79 (4%) controls, which were always located in the posterior lobe except for one control. With regard to the cerebellar tests, there were no differences between migraine patients with aura, migraine patients without aura, and controls for the: (i) Purdue-pegboard test for fine motor skills (assembly scores p = 0.1); (ii) block-design test for visuospatial ability (mean scaled scores p = 0.2); (iii) prism-adaptation task for limb learning (shift scores p = 0.8); (iv) eyeblink-conditioning task for learning-dependent timing (peak-time p = 0.1); and (v) body-sway test for balance capabilities (pitch velocity score under two-legs stance condition p = 0.5). Among migraine patients, those with cerebellar ischaemic lesions performed worse than those without lesions on the assembly scores of the pegboard task ( p < 0.005), but not on the primary outcome measures of the other tasks. Compared with controls and non-hemiplegic migraine patients, FHM1 patients showed substantially more deficits on all primary outcomes, including Purdue-peg assembly ( p < 0.05), block-design scaled score ( p < 0.001), shift in prism-adaptation ( p < 0.001), peak-time of conditioned eyeblink responses ( p < 0.05) and pitch-velocity score during stance-sway test ( p < 0.001). Conclusions Unselected migraine patients from the general population show normal cerebellar functions despite having increased prevalence of ischaemic lesions in the cerebellar posterior lobe. Except for an impaired pegboard test revealing deficits in fine motor skills, these lesions appear to have little functional impact. In contrast, all cerebellar functions were significantly impaired in participants with FHM1.
Collapse
Affiliation(s)
- Hille Koppen
- 1 Department of Neurology, Haga Hospital, The Netherlands.,2 Department of Neurology, Leiden University Medical Center, The Netherlands
| | - Henk-Jan Boele
- 3 Department of Neuroscience, Erasmus Medical Center, The Netherlands
| | | | | | - Corinne Gc Horlings
- 5 Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, The Netherlands
| | - Bas K Koekkoek
- 3 Department of Neuroscience, Erasmus Medical Center, The Netherlands
| | - Jos van der Geest
- 3 Department of Neuroscience, Erasmus Medical Center, The Netherlands
| | - Albertine E Smit
- 3 Department of Neuroscience, Erasmus Medical Center, The Netherlands
| | - Mark A van Buchem
- 4 Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Lenore J Launer
- 6 Laboratory of Epidemiology, Demography and Biometry, National Institutes of Health, USA
| | - Gisela M Terwindt
- 2 Department of Neurology, Leiden University Medical Center, The Netherlands
| | - Bas R Bloem
- 5 Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, The Netherlands
| | - Mark C Kruit
- 4 Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Michel D Ferrari
- 2 Department of Neurology, Leiden University Medical Center, The Netherlands
| | - Chris I De Zeeuw
- 3 Department of Neuroscience, Erasmus Medical Center, The Netherlands.,7 Netherlands Institute for Neuroscience, Royal Academy of Arts & Sciences (KNAW), The Netherlands
| |
Collapse
|
30
|
|
31
|
Maidan I, Nieuwhof F, Bernad-Elazari H, Reelick MF, Bloem BR, Giladi N, Deutsch JE, Hausdorff JM, Claassen JAH, Mirelman A. The Role of the Frontal Lobe in Complex Walking Among Patients With Parkinson's Disease and Healthy Older Adults: An fNIRS Study. Neurorehabil Neural Repair 2016; 30:963-971. [PMID: 27221042 DOI: 10.1177/1545968316650426] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gait is influenced by higher order cognitive and cortical control mechanisms. Functional near infrared spectroscopy (fNIRS) has been used to examine frontal activation during walking in healthy older adults, reporting increased oxygenated hemoglobin (HbO2) levels during dual task walking (DT), compared with usual walking. OBJECTIVE To investigate the role of the frontal lobe during DT and obstacle negotiation, in healthy older adults and patients with Parkinson's disease (PD). METHODS Thirty-eight healthy older adults (mean age 70.4 ± 0.9 years) and 68 patients with PD (mean age 71.7 ± 1.1 years,) performed 3 walking tasks: (a) usual walking, (b) DT walking, and (c) obstacles negotiation, with fNIRS and accelerometers. Linear-mix models were used to detect changes between groups and within tasks. RESULTS Patients with PD had higher activation during usual walking (P < .030). During DT, HbO2 increased only in healthy older adults (P < .001). During obstacle negotiation, HbO2 increased in patients with PD (P = .001) and tended to increase in healthy older adults (P = .053). Higher DT and obstacle cost (P < .003) and worse cognitive performance were observed in patients with PD (P = .001). CONCLUSIONS A different pattern of frontal activation during walking was observed between groups. The higher activation during usual walking in patients with PD suggests that the prefrontal cortex plays an important role already during simple walking. However, higher activation relative to baseline during obstacle negotiation and not during DT in the patients with PD demonstrates that prefrontal activation depends on the nature of the task. These findings may have important implications for rehabilitation of gait in patients with PD.
Collapse
Affiliation(s)
- Inbal Maidan
- Neurological Institute, Tel Aviv Medical Center, Israel Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Freek Nieuwhof
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Miriam F Reelick
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Nir Giladi
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| | | | - Jeffery M Hausdorff
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| | - Jurgen A H Claassen
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Anat Mirelman
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
32
|
Bloem BR, Voermans NC, Aerts MB, Bhatia KP, van Engelen BGM, van de Warrenburg BP. The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa). Pract Neurol 2016; 16:264-9. [PMID: 26965497 DOI: 10.1136/practneurol-2015-001311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/04/2022]
Abstract
The rapid advances in modern neurology have led to increased specialisation in clinical practice. Being an expert in a neurology subspecialty offers advantages for diagnosing and managing specific disorders. However, specialisation also risks tunnel vision: interpreting symptoms and signs within one's own framework of reference, while ignoring differential diagnostic options from other subspecialties. This is particularly relevant when the patient's presentation potentially belongs to different neurological subspecialties. We illustrate this challenge by highlighting a series of clinical features that partially overlap between two common subspecialties: movement disorders and neuromuscular disorders. An overlap in clinical presentation is not rare, and includes, for example, involuntary eyelid closure (which could be active eye closure due to blepharospasm, or ptosis due to weakness). Other overlapping features include abnormal postures, involuntary movements and gait changes. We describe two of these overlapping features in more detail and emphasise the possible consequences of 'looking through the wrong end of the telescope' in such patients, as this may lead to a wrong differential diagnosis, unnecessary investigations and a delayed treatment start.
Collapse
Affiliation(s)
- B R Bloem
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M B Aerts
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, UK
| | - B G M van Engelen
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B P van de Warrenburg
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
33
|
Bengevoord A, Vervoort G, Spildooren J, Heremans E, Vandenberghe W, Bloem BR, Nieuwboer A. Center of mass trajectories during turning in patients with Parkinson's disease with and without freezing of gait. Gait Posture 2016; 43:54-9. [PMID: 26669952 DOI: 10.1016/j.gaitpost.2015.10.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/16/2015] [Accepted: 10/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the strong relationship between freezing of gait (FOG) and turning in Parkinson's disease (PD), few studies have addressed specific postural characteristics during turning that might contribute to freezing. METHODS Thirty participants with PD (16 freezers, 14 non-freezers) (all tested OFF medication) and 14 healthy controls walked 5 meters and turned 180° in a 3D gait laboratory. COM behavior was analyzed during four turning quadrants of 40° between 10° and 170° pelvic rotation and during 40° before actual FOG episodes. These pre-FOG segments were compared with similar turning sections in turns of freezers without FOG. Outcome parameters were turn time, COM distance, COM velocity, step width and the medial- and anterior COM position. RESULTS Turn time was increased in freezers compared to non-freezers (p=.000). No differences were found regarding COM distance and velocity during turning quadrants between groups and between freezers' pre-FOG segments and similar turning segments without FOG. Medial COM deviation was reduced in PD patients compared to controls (p=.004), but no differences were found between freezers and non-freezers. In turns with freezing, turn time increased (p=.005) and step width decreased (p=.025) pre-FOG. Freezers also showed a less medial (p=.020) and more anterior (p=.016) COM position pre-FOG compared to turning sections without FOG. CONCLUSIONS Our results revealed no subgroup differences in COM behavior during uninterrupted turning. However, we found a reduced medial deviation, a forward COM shift and a decreased step width in freezers just before FOG episodes. These abnormalities may play a causal role, as they could hamper stability and fluent weight shifting necessary for continued stepping during turning.
Collapse
Affiliation(s)
- A Bengevoord
- KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
| | - G Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium.
| | - J Spildooren
- KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium; Hasselt University, Rehabilitation Sciences and Physiotherapy, Hasselt, Belgium
| | - E Heremans
- KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium
| | | | - B R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - A Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium
| |
Collapse
|
34
|
Verschuur CVM, Suwijn SR, Post B, Dijkgraaf M, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Deuschl G, Lang AE, de Haan RJ, de Bie RMA. Protocol of a randomised delayed-start double-blind placebo-controlled multi-centre trial for Levodopa in EArly Parkinson's disease: the LEAP-study. BMC Neurol 2015; 15:236. [PMID: 26584951 PMCID: PMC4653886 DOI: 10.1186/s12883-015-0491-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/07/2015] [Indexed: 02/02/2023] Open
Abstract
Background The aim of this study is to investigate if early treatment with levodopa has a beneficial disease modifying effect on Parkinson’s disease (PD) symptoms and functional health, improves the ability to (maintain) work, and reduces the use of (informal) care, caregiver burden, and costs. Additionally, cost-effectiveness and cost-utility of early levodopa treatment will be assessed. Methods To differentiate between the direct symptomatic effects and possible disease modifying effects of levodopa, we use a randomised delayed-start double-blind placebo-controlled multi-centre trial design. Patients with early stage PD whose functional health does not yet necessitate initiation of PD-medication will be randomised to either 40 weeks of treatment with levodopa/carbidopa 100/25 mg TID including 2 weeks of dose escalation or to 40 weeks placebo TID. Subsequently, all patients receive levodopa/carbidopa 100/25 mg TID for 40 weeks. There are 8 assessments: at baseline and at 4, 22, 40, 44, 56, 68, and 80 weeks. The primary outcome measure is the difference in the mean total Unified Parkinson’s Disease Rating Scale scores between the early- and delayed-start groups at 80 weeks. Secondary outcome measures are rate of progression, the AMC Linear Disability Score, side effects, perceived quality of life with the Parkinson’s Disease Questionnaire-39, the European Quality of Life-5 Dimensions (EQ-5D), ability to (maintain) work, the use of (informal) care, caregiver burden, and costs. 446 newly diagnosed PD patients without impaired functional health need to be recruited in order to detect a minimal clinical relevant difference of 4 points on the total UPDRS at 80 weeks. Discussion The LEAP-study will provide insights into the possible disease modifying effects of early levodopa. Trial registration ISRCTN30518857, EudraCT number 2011-000678-72
Collapse
Affiliation(s)
- Constant V M Verschuur
- Department of Neurology, Academic Medical Center, University of Amsterdam, PO BOX 22600, 1100 DD, Amsterdam, The Netherlands.
| | - S R Suwijn
- Department of Neurology, Academic Medical Center, University of Amsterdam, PO BOX 22600, 1100 DD, Amsterdam, The Netherlands.
| | - B Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M Dijkgraaf
- Academic Medical Center, Clinical Research Unit, Amsterdam, The Netherlands.
| | - B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - J J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - T van Laar
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
| | - G Tissingh
- Department of Neurology, Atrium-Orbis Medical Center Heerlen/Sittard, Heerlen, The Netherlands.
| | - G Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany.
| | - A E Lang
- The Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - R J de Haan
- Academic Medical Center, Clinical Research Unit, Amsterdam, The Netherlands.
| | - R M A de Bie
- Department of Neurology, Academic Medical Center, University of Amsterdam, PO BOX 22600, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
35
|
van der Kolk NM, Overeem S, de Vries NM, Kessels RPC, Donders R, Brouwer M, Berg D, Post B, Bloem BR. Design of the Park-in-Shape study: a phase II double blind randomized controlled trial evaluating the effects of exercise on motor and non-motor symptoms in Parkinson's disease. BMC Neurol 2015; 15:56. [PMID: 25880966 PMCID: PMC4418070 DOI: 10.1186/s12883-015-0312-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disorder with a wide range of motor and non-motor symptoms. Despite optimal medical management, PD still results in a high disability rate and secondary complications and many patients lead a sedentary lifestyle, which in turn is also associated with a higher co-morbidity and mortality. Exercise has been explored as a strategy to reduce secondary complications and results suggests that it not only provides general health benefits, but may also provide symptomatic relief. If this holds true exercise would be a very attractive addition to the therapeutic arsenal in PD. The supportive evidence remains incomplete. Here, we describe the design of the Park-in-Shape study, which primarily aims to evaluate whether aerobic exercise affords clinically relevant improvements in motor symptoms in sedentary PD patients. A specific new element is the introduction of gaming to optimize compliance to the exercise intervention. Methods/Design The Park-in-Shape study is a randomized controlled, assessor- and patient-blinded single center study. Two parallel groups will include a total of 130 patients, receiving either aerobic exercise on a home trainer equipped with gaming elements (“exergaming”), or a non-aerobic intervention (stretching, flexibility and relaxation exercises). Both groups are supported by a specifically designed motivational app that uses gaming elements to stimulate patients to exercise and rewards them after having completed the exercise. Both interventions are delivered at home at least 3 times a week for 30–45 minutes during 6 months. Eligible patients are community-dwelling, sedentary patients diagnosed with mild-moderate PD. The primary outcome is the MDS-UPDRS motor score (tested in the off state) after 6 months. Secondary outcomes include various motor and non-motor symptoms, quality of life, physical fitness, and adherence. Discussion This Park-in-Shape study is anticipated to answer the question whether high intensity aerobic exercise combined with gaming elements (“exergaming”) provides symptomatic relief in PD. Strong elements include the double-blinded randomized controlled trial design, the MDS-UPDRS as valid primary outcome, the large sample size and unique combination of home-based pure aerobic exercise combined with gaming elements and motivational aspects. Trial registration Dutch trial register NTR4743
Collapse
Affiliation(s)
- Nicolien M van der Kolk
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Sebastiaan Overeem
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Nienke M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Roy P C Kessels
- Department of Medical Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Rogier Donders
- Department of Health Evidence, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Marc Brouwer
- Department of Cardiology, Radboudumc, Nijmegen, the Netherlands.
| | - Daniela Berg
- Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, Tübingen, Germany.
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Bas R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
36
|
Meijer FJA, van Rumund A, Fasen BACM, Titulaer I, Aerts M, Esselink R, Bloem BR, Verbeek MM, Goraj B. Susceptibility-weighted imaging improves the diagnostic accuracy of 3T brain MRI in the work-up of parkinsonism. AJNR Am J Neuroradiol 2014; 36:454-60. [PMID: 25339647 DOI: 10.3174/ajnr.a4140] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE The differentiation between Parkinson disease and atypical parkinsonian syndromes can be challenging in clinical practice, especially in early disease stages. Brain MR imaging can help to increase certainty about the diagnosis. Our goal was to evaluate the added value of SWI in relation to conventional 3T brain MR imaging for the diagnostic work-up of early-stage parkinsonism. MATERIALS AND METHODS This was a prospective observational cohort study of 65 patients presenting with parkinsonism but with an uncertain initial clinical diagnosis. At baseline, 3T brain MR imaging with conventional and SWI sequences was performed. After clinical follow-up, probable diagnoses could be made in 56 patients, 38 patients diagnosed with Parkinson disease and 18 patients diagnosed with atypical parkinsonian syndromes, including 12 patients diagnosed with multiple system atrophy-parkinsonian form. In addition, 13 healthy controls were evaluated with SWI. Abnormal findings on conventional brain MR imaging were grouped into disease-specific scores. SWI was analyzed by a region-of-interest method of different brain structures. One-way ANOVA was performed to analyze group differences. Receiver operating characteristic analyses were performed to evaluate the diagnostic accuracy of conventional brain MR imaging separately and combined with SWI. RESULTS Disease-specific scores of conventional brain MR imaging had a high specificity for atypical parkinsonian syndromes (80%-90%), but sensitivity was limited (50%-80%). The mean SWI signal intensity of the putamen was significantly lower for multiple system atrophy-parkinsonian form than for Parkinson disease and controls (P < .001). The presence of severe dorsal putaminal hypointensity improved the accuracy of brain MR imaging: The area under the curve was increased from 0.75 to 0.83 for identifying multiple system atrophy-parkinsonian form, and it was increased from 0.76 to 0.82 for identifying atypical parkinsonian syndromes as a group. CONCLUSIONS SWI improves the diagnostic accuracy of 3T brain MR imaging in the work-up of parkinsonism by identifying severe putaminal hypointensity as a sign indicative of multiple system atrophy-parkinsonian form.
Collapse
Affiliation(s)
- F J A Meijer
- From the Departments of Radiology and Nuclear Medicine (F.J.A.M., B.A.C.M.F., B.G.)
| | - A van Rumund
- Department of Neurology (A.v.R., I.T., M.A., R.E., B.R.B., M.M.V.), Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - B A C M Fasen
- From the Departments of Radiology and Nuclear Medicine (F.J.A.M., B.A.C.M.F., B.G.)
| | - I Titulaer
- Department of Neurology (A.v.R., I.T., M.A., R.E., B.R.B., M.M.V.), Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M Aerts
- Department of Neurology (A.v.R., I.T., M.A., R.E., B.R.B., M.M.V.), Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - R Esselink
- Department of Neurology (A.v.R., I.T., M.A., R.E., B.R.B., M.M.V.), Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - B R Bloem
- Department of Neurology (A.v.R., I.T., M.A., R.E., B.R.B., M.M.V.), Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M M Verbeek
- Laboratory Medicine (M.M.V.) Department of Neurology (A.v.R., I.T., M.A., R.E., B.R.B., M.M.V.), Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - B Goraj
- From the Departments of Radiology and Nuclear Medicine (F.J.A.M., B.A.C.M.F., B.G.) Department of Diagnostic Imaging (B.G.), Medical Center of Postgraduate Education, Warsaw, Poland
| |
Collapse
|
37
|
Bloem BR, Stocchi F. Move for Change Part III: a European survey evaluating the impact of the EPDA Charter for People with Parkinson's Disease. Eur J Neurol 2014; 22:133-41, e8-9. [PMID: 25196038 DOI: 10.1111/ene.12544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Move for Change is an online pan-European patient survey based on the European Parkinson's Disease Association (EPDA) Charter for People with Parkinson's Disease (PD), which states that all PD patients have the right to: be referred to a doctor with a specialist interest in PD; receive an accurate diagnosis; have access to support services; receive continuous care; and take part in managing their illness. METHODS This part of the survey focuses on the final two elements of the Charter. It was administered online through the EPDA website and through affiliated patient associations' websites. A total of 1591 questionnaires were received and 1546 were analysed (97.2%). RESULTS Approximately half of the patients (53.0%) consulted a neurologist regularly (every 4-6 months). Consultations were usually arranged as part of a follow-up process (65.5%) and lasted for 15-30 min (63.2%), with 16.1% lasting <10 min and 17.9% lasting >30 min. Patients were largely satisfied with the attention they received (63.2%) but just 11.6% of patients were involved in treatment decisions, and 39.1% prepared a list of symptom changes for discussion. Two hundred caregivers also took part in the survey, and 71.4% felt included in the treatment plan by the doctor. CONCLUSIONS These results highlight that PD disease-management is driven by the clinician; he/she arranges consultations and makes the majority of management decisions, rather than patients being included in the process. This survey can be used to raise awareness for PD patients, encouraging greater involvement in the management of PD.
Collapse
Affiliation(s)
- B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
38
|
Weerkamp NJ, Tissingh G, Poels PJE, Zuidema SU, Munneke M, Koopmans RTCM, Bloem BR. Diagnostic accuracy of Parkinson's disease and atypical parkinsonism in nursing homes. Parkinsonism Relat Disord 2014; 20:1157-60. [PMID: 25258327 DOI: 10.1016/j.parkreldis.2014.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/21/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Management of Parkinson's disease (PD) and atypical parkinsonism in nursing homes depends on a timely and accurate diagnosis. However, little is known about the diagnostic accuracy of these parkinsonian syndromes in nursing homes. We examined this issue in a large group of Dutch nursing home residents. METHODS Twelve large nursing home organizations in the Netherlands accounting for 100 nursing homes with a total population of 5480 residents participated. Residents with PD or atypical parkinsonism were identified according to their nursing home medical chart diagnosis. Additionally, local pharmacists provided a list of all residents using antiparkinson medication. We compared the admission diagnosis to a clinical diagnosis made in the study, based upon interview and detailed neurological examination by movement disorders experts. Diagnoses were based on accepted clinical criteria for PD and atypical parkinsonism. RESULTS In the total population of 5480 residents, 258 had previously been diagnosed with a form of parkinsonism according to their medical record. In 53 of these residents (20.5%) we changed or rejected the diagnosis. Specifically, we found no parkinsonism in 22 of these 53 residents (8.5% of all patients with suspected parkinsonism). In the remaining 31 residents (12%), we established a new diagnosis within the parkinsonian spectrum. CONCLUSIONS In a large population of Dutch nursing home residents, 20% of diagnoses within the parkinsonian spectrum were inaccurate. Almost 9% of residents had inadvertently received a diagnosis of parkinsonism. Better recognition of parkinsonism in nursing homes is important, because of the consequences for management and prognosis.
Collapse
Affiliation(s)
- N J Weerkamp
- Bronovo Hospital, Department of Neurology, The Hague, The Netherlands; Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands
| | - G Tissingh
- Bronovo Hospital, Department of Neurology, The Hague, The Netherlands
| | - P J E Poels
- Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands
| | - S U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, The Netherlands
| | - M Munneke
- Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands
| | - R T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, The Netherlands
| | - B R Bloem
- Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, The Netherlands.
| |
Collapse
|
39
|
Balint B, van Winsen LML, Bhatia KP, Bloem BR. Psychogenic Movement Disorders: Gait Is a Give-Away! Mov Disord Clin Pract 2014; 1:110-111. [PMID: 30363891 DOI: 10.1002/mdc3.12031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/27/2014] [Accepted: 03/30/2014] [Indexed: 11/10/2022] Open
Abstract
The aim of this article is to point out that an incongruity of gait disorder (either in relation to the presenting movement disorder or incongruity with any type of organic gait disorder) is a useful clue in diagnosing psychogenic movement disorders. To illustrate this, we present a case series of patients with various types of psychogenic movement disorders (rest tremor, myoclonus, dystonia, and chorea). Incongruity of the walking pattern with the presenting movement disorder was a revealing diagnostic clue in all cases. "Incongruity" is currently a main plank in the diagnosis of psychogenic conditions. Our series emphasizes that incongruity of the gait pattern may be the most important sign in a patient where it is otherwise difficult to establish whether the movement disorder is congruous or incongruous with an organic disorder.
Collapse
Affiliation(s)
- Bettina Balint
- Department of Neurology Medical University Heidelberg Heidelberg Germany.,Institute of Neurology University College London London United Kingdom
| | - Lisa M L van Winsen
- Department of Neurology Radboud University Nijmegen Medical Center Donders Institute for Brain, Cognition and Behavior Nijmegen The Netherlands
| | - Kailash P Bhatia
- Institute of Neurology University College London London United Kingdom
| | - Bas R Bloem
- Department of Neurology Radboud University Nijmegen Medical Center Donders Institute for Brain, Cognition and Behavior Nijmegen The Netherlands
| |
Collapse
|
40
|
van Wensen E, van Leeuwen RB, van der Zaag-Loonen HJ, Masius-Olthof S, Bloem BR. Benign paroxysmal positional vertigo in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:1110-2. [PMID: 23948517 DOI: 10.1016/j.parkreldis.2013.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dizziness is a frequent complaint of patients with Parkinson's disease (PD), and orthostatic hypotension (OH) is often thought to be the cause. We studied whether benign paroxysmal positional vertigo (BPPV) could also be an explanation. AIM To assess the prevalence of benign paroxysmal positional vertigo in patients with Parkinson's disease, with and without dizziness. METHODS 305 consecutive outpatients with PD completed the Movement Disorders Society-sponsored revision of the Unified Parkinsons' Disease Rating Scale-motor score, the Dizziness Handicap Inventory, the Dix-Hallpike maneuver and a test for orthostatic hypotension. When positive for benign paroxysmal positional vertigo, a repositioning maneuver was performed. Patients were followed for three months to determine the clinical response. RESULTS 305 patients responded (186 men (61%), mean age 70.5 years (Standard Deviation 9.5 years)), of whom 151 (49%) complained of dizziness. 57 (38%) of the dizzy patients appeared to have orthostatic hypotension; 12 patients (8%) had a classical but previously unrecognized benign paroxysmal positional vertigo. A further four patients (3%) had a more atypical presentation of benign paroxysmal positional vertigo. Three months after treatment, 11 (92%) of patients with classical benign paroxysmal positional vertigo were almost or completely without complaints. We found no 'hidden' benign paroxysmal positional vertigo among patients without dizziness. The prevalence of benign paroxysmal positional vertigo among all patients with PD was 5.3%. CONCLUSION Among Parkinson patients with symptoms of dizziness, up to 11% may have benign paroxysmal positional vertigo, which can be treated easily and successfully.
Collapse
Affiliation(s)
- E van Wensen
- Gelre Hospitals, Apeldoorn, A. Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.
| | | | | | | | | |
Collapse
|
41
|
Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. Eur J Neurol 2013; 20:5-15. [PMID: 23279439 DOI: 10.1111/j.1468-1331.2012.03866.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. METHODS For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. RESULTS AND CONCLUSIONS For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.
Collapse
Affiliation(s)
- J J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M. EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013; 20:16-34. [PMID: 23279440 DOI: 10.1111/ene.12022] [Citation(s) in RCA: 323] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
Collapse
Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Dontje ML, de Greef MHG, Speelman AD, van Nimwegen M, Krijnen WP, Stolk RP, Kamsma YPT, Bloem BR, Munneke M, van der Schans CP. Quantifying daily physical activity and determinants in sedentary patients with Parkinson's disease. Parkinsonism Relat Disord 2013; 19:878-82. [PMID: 23769178 DOI: 10.1016/j.parkreldis.2013.05.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/11/2013] [Accepted: 05/20/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although physical activity is beneficial for Parkinson's disease (PD) patients, many do not meet the recommended levels. The range of physical activity among sedentary PD patients is unknown, as are factors that determine this variability. Hence, we aimed to (1) assess daily physical activity in self-identified sedentary PD patients; (2) compare this with criteria of a daily physical activity guideline; and (3) identify determinants of daily physical activity. METHODS Daily physical activity of 586 self-identified sedentary PD patients was measured with a tri-axial accelerometer for seven consecutive days. Physical fitness and demographic, disease-specific, and psychological characteristics were assessed. Daily physical activity was compared with the 30-min activity guideline. A linear mixed-effects model was estimated to identify determinants of daily physical activity. RESULTS Accelerometer data of 467 patients who fulfilled all criteria revealed that >98% of their day was spent on sedentary to light-intensity activities. Eighty-two percent of the participants were 'physically inactive' (0 days/week of 30-min activity); 17% were 'semi-active' (1-4 days/week of 30-min activity). Age, gender, physical fitness, and scores on the Unified Parkinson's Disease Rating Scale explained 69% of the variability in daily physical activity. CONCLUSIONS Performance-based measurements confirmed that most self-identified sedentary PD patients are 'physically inactive'. However, the variance in daily physical activity across subjects was considerable. Higher age, being female, and lower physical capacity were the most important determinants of reduced daily physical activity. Future therapeutic interventions should aim to improve daily physical activity in these high-risk patients, focusing specifically on modifiable risk factors.
Collapse
Affiliation(s)
- M L Dontje
- Hanze University of Applied Sciences, Professorship in Health Care and Nursing, Groningen, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Nonnekes J, Scotti A, Oude Nijhuis LB, Smulders K, Queralt A, Geurts ACH, Bloem BR, Weerdesteyn V. Are postural responses to backward and forward perturbations processed by different neural circuits? Neuroscience 2013; 245:109-20. [PMID: 23624061 DOI: 10.1016/j.neuroscience.2013.04.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 11/17/2022]
Abstract
Startle pathways may contribute to rapid accomplishment of postural stability. Here we investigate the possible influence of a startling auditory stimulus (SAS) on postural responses. We formulated four specific questions: (1) can a concurrent SAS shorten the onset of automatic postural responses?; and if so (2) is this effect different for forward versus backward perturbations?; (3) does this effect depend on prior knowledge of the perturbation direction?; and (4) is this effect different for low- and high-magnitude perturbations? Balance was perturbed in 11 healthy participants by a movable platform that suddenly translated forward or backward. Each participant received 160 perturbations, 25% of which were combined with a SAS. We varied the direction and magnitude of the perturbations, as well as the prior knowledge of perturbation direction. Perturbation trials were interspersed with SAS-only trials. The SAS accelerated and strengthened postural responses with clear functional benefits (better balance control), but this was only true for responses that protected against falling backwards (i.e. in tibialis anterior and rectus femoris). These muscles also demonstrated the most common SAS-triggered responses without perturbation. Increasing the perturbation magnitude accelerated postural responses, but again with a larger acceleration for backward perturbations. We conclude that postural responses to backward and forward perturbations may be processed by different neural circuits, with influence of startle pathways on postural responses to backward perturbations. These findings give directions for future studies investigating whether deficits in startle pathways may explain the prominent backward instability seen in patients with Parkinson's disease and progressive supranuclear palsy.
Collapse
Affiliation(s)
- J Nonnekes
- Radboud University Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Evers AWM, Rovers MM, Kremer JAM, Veltman JA, Schalken JA, Bloem BR, van Gool AJ. An integrated framework of personalized medicine: from individual genomes to participatory health care. Croat Med J 2013; 53:301-3. [PMID: 22911520 PMCID: PMC3428816 DOI: 10.3325/cmj.2012.53.301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Promising research developments in both basic and applied sciences, such as genomics and participatory health care approaches, have generated widespread interest in personalized medicine among almost all scientific areas and clinicians. The term personalized medicine is, however, frequently used without defining a clear theoretical and methodological background. In addition, to date most personalized medicine approaches still lack convincing empirical evidence regarding their contribution and advantages in comparison to traditional models. Here, we propose that personalized medicine can only fulfill the promise of optimizing our health care system by an interdisciplinary and translational view that extends beyond traditional diagnostic and classification systems.
Collapse
Affiliation(s)
- Andrea W M Evers
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
| | | | | | | | | | | | | |
Collapse
|
46
|
Smittenaar P, Chase HW, Aarts E, Nusselein B, Bloem BR, Cools R. Decomposing effects of dopaminergic medication in Parkinson's disease on probabilistic action selection--learning or performance? Eur J Neurosci 2013; 35:1144-51. [PMID: 22487043 DOI: 10.1111/j.1460-9568.2012.08043.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dopamine has long been implicated in reward-based learning and the expression of such learned associations on performance. Robust evidence supports its effects on learning and performance, but teasing these apart has proved challenging. Here we have adapted a classic test of value-based learning, the probabilistic selection task, to disentangle effects of dopamine on value-based performance from effects on value-based learning. Valence-specific effects of dopamine on this specific task cannot be accounted for by modulation of learning, and therefore must reflect modulation of performance. We found that dopaminergic medication, consisting of levodopa and/or dopamine agonists taken at own dose, in 18 patients with mild Parkinson's disease (Hoehn and Yahr < 2.5) potentiated reward-based approach in terms of both accuracy and reaction times, while leaving punishment-based avoidance unaffected. These data demonstrate that the effects of dopamine on probabilistic action selection are at least partly mediated by effects on the expression of learned associations rather than on learning itself, and help refine current models of dopamine's role in reward.
Collapse
Affiliation(s)
- P Smittenaar
- The Wellcome Trust Centre for Neuroimaging, University College London, London, UK.
| | | | | | | | | | | |
Collapse
|
47
|
Fonteyn EMR, Schmitz-Hübsch T, Verstappen CCP, Baliko L, Bloem BR, Boesch S, Bunn L, Giunti P, Globas C, Klockgether T, Melegh B, Pandolfo M, Schöls L, Timmann D, van de Warrenburg BPC. Prospective analysis of falls in dominant ataxias. Eur Neurol 2012; 69:53-7. [PMID: 23146840 DOI: 10.1159/000342907] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/20/2012] [Indexed: 11/19/2022]
Abstract
In a previous retrospective study, we demonstrated that falls are common and often injurious in dominant spinocerebellar ataxias (SCAs) and that nonataxia features play an important role in these falls. Retrospective surveys are plagued by recall bias for the presence and details of prior falls. We therefore sought to corroborate and extend these retrospective findings by means of a prospective extension of this fall study. 113 patients with SCA1, SCA2, SCA3 or SCA6, recruited from the EuroSCA natural history study, were asked to keep a fall diary in between their annual visits to the participating centres. Additionally, patients completed a detailed questionnaire about the first three falls, to identify specific fall circumstances. Relevant disease characteristics were retrieved from the EuroSCA registry. 84.1% of patients reported at least one fall during a time period of 12 months. Fall-related injuries were common and their frequency increased with that of falls. The presence of nonataxia symptoms was associated with a higher fall frequency. This study confirms that falls are a frequent and serious complication of SCA, and that the presence of nonataxia symptoms is an important etiological factor in its occurrence.
Collapse
Affiliation(s)
- E M R Fonteyn
- Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Stocchi F, Bloem BR. Move for Change Part II: a European survey evaluating the impact of the EPDA Charter for people with Parkinson's disease. Eur J Neurol 2012; 20:461-472. [PMID: 23034057 PMCID: PMC3593160 DOI: 10.1111/j.1468-1331.2012.03876.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The Move for Change campaign is a three-part series of pan-European surveys designed by the European Parkinson's Disease Association (EPDA) to assess the impact that the EPDA Charter for People with Parkinson's disease (PD) has had since its launch in 1997. Here, we report results from the second survey, focusing on the third right of the Charter; that is, 'all patients have the right to have access to support services'. Although the level of evidence for different support services varies, it is important to ensure that patients can access services with clinically proven benefits. METHODS This survey comprised nine questions administered online via the EPDA and PD organization Web sites. Accessibility of support services was defined as 'services/medication/multidisciplinary healthcare professionals, etc. being available and on hand to patients when required'. RESULTS Neurologists and general practitioners (GPs) received highest accessibility results (90.0 and 87.0% of respondents, respectively), with moderate results for physiotherapists (68.0%) and PD organizations (72.0%) and lower results for PD specialist nurses (26.0%), occupational therapists (23.0%), and counselors (27.0%). Support provided by neurologists and PD specialists was considered to be 'very helpful' by 59.0 and 55.7%, respectively, whilst only 31.8% of respondents gave such favorable ratings to GPs. Funding of services was variable across Europe. CONCLUSIONS These data demonstrate the challenges faced by PD patients in accessing the adequate care and support required throughout the course of their disease. These findings can assist healthcare professionals and policymakers in improving access to support services for patients and their families across Europe.
Collapse
Affiliation(s)
- F Stocchi
- Department of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy
| | - B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
49
|
Louter M, van der Marck MA, Pevernagie DAA, Munneke M, Bloem BR, Overeem S. Sleep matters in Parkinson's disease: use of a priority list to assess the presence of sleep disturbances. Eur J Neurol 2012; 20:259-65. [PMID: 22900781 DOI: 10.1111/j.1468-1331.2012.03836.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/04/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Despite their high prevalence and clinical impact, sleep disorders in Parkinson's disease appear to receive insufficient attention in clinical practice. We compared the importance of sleep disorders relative to other symptoms and daily issues. Furthermore, we determined whether relevance as perceived by patients correlated with the subjective presence of sleep disruption scored with a rating scale. METHODS We studied a cohort of 153 consecutive patients (95 men) who were referred for problems other than sleep to our referral center. Prior to their visit, patients ranked their individual top five clinical priorities (of 23 items), indicating the most problematic domains for which they requested medical attention. Additionally, nocturnal sleep quality and excessive daytime sleepiness (EDS) were assessed with validated questionnaires. RESULTS The top three important domains according to the patient were movement (79.9%), medication (73.2%), and physical condition (63.4%). Sleep was the sixth most frequently reported item, marked by 37.9% of the patients. Amongst the patients who scored sleep as a priority, 47 (81%) had a poor sleep quality (Pittsburgh Sleep Quality Index > 5). Although EDS was present in almost 30% of patients, a minority of them put it on their priority list. CONCLUSION A priority list can be used to prioritize patient-centered quality of life issues. Our results show that sleep is a clinical priority for about one-third of patients. Surprisingly, EDS was usually not prioritized by patients during the consultation, underscoring the need to use ratings scales alongside subjective priorities.
Collapse
Affiliation(s)
- M Louter
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | |
Collapse
|
50
|
Kalf JG, de Swart BJM, Munneke M, Bloem BR. Author reply to "Oropharyngeal dysphagia in Parkinson's disease: comments on paper by Kalf et al." by Boot & Chaudhuri. Parkinsonism Relat Disord 2012; 19:276. [PMID: 22902809 DOI: 10.1016/j.parkreldis.2012.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 11/17/2022]
|