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Cantuaria ML, Pedersen ER, Waldorff FB, Wermuth L, Pedersen KM, Poulsen AH, Raaschou-Nielsen O, Sørensen M, Schmidt JH. Hearing Loss, Hearing Aid Use, and Risk of Dementia in Older Adults. JAMA Otolaryngol Head Neck Surg 2024; 150:157-164. [PMID: 38175662 PMCID: PMC10767640 DOI: 10.1001/jamaoto.2023.3509] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024]
Abstract
Importance Hearing loss has been suggested as a risk factor for dementia, but there is still a need for high-quality research to better understand the association between these 2 conditions and the underlying causal mechanisms and treatment benefits using larger cohorts and detailed data. Objective To investigate the association between hearing loss and incident dementia, as well as how hearing aid use contributes to this association. Design, Setting, and Participants This population-based cohort study was conducted in Southern Denmark between January 2003 and December 2017 and included all residents 50 years and older. We excluded all persons with dementia before baseline as well as those who did not live in the region 5 years before baseline, with incomplete address history, or who had missing covariate information. Exposures Individual hearing status based on the Hearing Examinations in Southern Denmark database, which contains data on all pure-tone audiometry examinations performed at public hearing rehabilitation clinics in Southern Denmark. Main Outcomes and Measures Incident cases of dementia and Alzheimer disease as identified from national registries. Results The study population comprised 573 088 persons (298 006 women [52%]; mean [SD] age, 60.8 [11.3] years) with 23 023 cases of dementia and mean (SD) follow-up of 8.6 (4.3) years. Having a hearing loss was associated with an increased risk of dementia, with an adjusted hazard ratio (HR) of 1.07 (95% CI, 1.04-1.11) compared with having no hearing loss. Severe hearing loss in the better and worse ear was associated with a higher dementia risk, with an HR of 1.20 (95% CI, 1.09-1.32) and 1.13 (95% CI, 1.06-1.20), respectively, compared with having no hearing loss in the corresponding ear. Compared with people without hearing loss, the risk of dementia was higher among people with hearing loss who were not using hearing aids than those who had hearing loss and were using hearing aids, with HRs of 1.20 (95% CI, 1.13-1.27) and 1.06 (95% CI, 1.01-1.10), respectively. Conclusions and Relevance The results of this cohort study suggest that hearing loss was associated with increased dementia risk, especially among people not using hearing aids, suggesting that hearing aids might prevent or delay the onset and progression of dementia. The risk estimates were lower than in previous studies, highlighting the need for more high-quality longitudinal studies.
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Affiliation(s)
- Manuella Lech Cantuaria
- Research Unit for ORL–Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
- Work, Environment and Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Ellen Raben Pedersen
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Department of Public Health, Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Ole Raaschou-Nielsen
- Work, Environment and Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Mette Sørensen
- Work, Environment and Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Jesper Hvass Schmidt
- Research Unit for ORL–Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
- Brain Research–Inter-Disciplinary Guided Excellence, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Frederiksen KS, Jensen CS, Høgh P, Gergelyffy R, Waldemar G, Andersen BB, Gottrup H, Vestergaard K, Wermuth L, Søndergaard HB, Sellebjerg F, Hasselbalch SG, Simonsen AH. Aerobic exercise does not affect serum neurofilament light in patients with mild Alzheimer's disease. Front Neurosci 2023; 17:1108191. [PMID: 36761410 PMCID: PMC9902368 DOI: 10.3389/fnins.2023.1108191] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Aerobic exercise has been shown to modify Alzheimer pathology in animal models, and in patients with multiple sclerosis to reduce neurofilament light (NfL), a biomarker of neurodegeneration. Objective To investigate whether a 16-week aerobic exercise program was able to reduce serum NfL in patients with mild Alzheimer's disease (AD). Methods This is a secondary analysis of data from the multi-center Preserving Cognition, Quality of Life, Physical Health, and Functional Ability in Alzheimer's disease: The Effect of Physical Exercise (ADEX) study. Participants were randomized to 16 weeks of moderate intensity aerobic exercise or usual care. Clinical assessment and measurement of serum NfL was done at baseline and after the intervention. Results A total of 136 participants were included in the analysis. Groups were comparable at baseline except for APOEε4 carriership which was higher in the usual care group (75.3 versus 60.2%; p = 0.04). There was no effect of the intervention on serum NfL [intervention: baseline NfL (pg/mL) 25.76, change from baseline 0.87; usual care: baseline 27.09, change from baseline -1.16, p = 0.09]. Conclusion The findings do not support an effect of the exercise intervention on a single measure of neurodegeneration in AD. Further studies are needed using other types and durations of exercise and other measures of neurodegeneration. Clinical trial registration clinicaltrials.gov, identifier NCT01681602.
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Affiliation(s)
- Kristian Steen Frederiksen
- Department of Neurology, Danish Dementia Research Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark,*Correspondence: Kristian Steen Frederiksen,
| | - Camilla Steen Jensen
- Department of Neurology, Danish Dementia Research Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - Peter Høgh
- Department of Neurology, Regional Dementia Research Centre, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Regional Dementia Research Centre, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Bo Andersen
- Department of Neurology, Danish Dementia Research Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - Hanne Gottrup
- Dementia Clinic, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Wermuth
- Department of Neurology, Dementia Clinic, Slagelse Hospital, Slagelse, Denmark,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helle Bach Søndergaard
- Danish Multiple Sclerosis Center, Copenhagen University Hospital–Rigshospitalet, Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital–Rigshospitalet, Glostrup, Denmark
| | - Steen Gregers Hasselbalch
- Department of Neurology, Danish Dementia Research Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Hviid Simonsen
- Department of Neurology, Danish Dementia Research Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
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Cantuaria ML, Waldorff FB, Wermuth L, Pedersen ER, Poulsen AH, Thacher JD, Raaschou-Nielsen O, Ketzel M, Khan J, Valencia VH, Schmidt JH, Sørensen M. Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study. BMJ 2021; 374:n1954. [PMID: 34497091 PMCID: PMC8424489 DOI: 10.1136/bmj.n1954] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association between long term residential exposure to road traffic and railway noise and risk of incident dementia. DESIGN Nationwide prospective register based cohort study. SETTING Denmark. PARTICIPANTS 1 938 994 adults aged ≥60 years living in Denmark between 1 January 2004 and 31 December 2017. MAIN OUTCOME MEASURES Incident cases of all cause dementia and dementia subtypes (Alzheimer's disease, vascular dementia, and Parkinson's disease related dementia), identified from national hospital and prescription registries. RESULTS The study population included 103 500 participants with incident dementia, and of those, 31 219 received a diagnosis of Alzheimer's disease, 8664 of vascular dementia, and 2192 of Parkinson's disease related dementia. Using Cox regression models, 10 year mean exposure to road traffic and railway noise at the most (Ldenmax) and least (Ldenmin) exposed façades of buildings were associated with a higher risk of all cause dementia. These associations showed a general pattern of higher hazard ratios with higher noise exposure, but with a levelling off or even small declines in risk at higher noise levels. In subtype analyses, both road traffic noise and railway noise were associated with a higher risk of Alzheimer's disease, with hazard ratios of 1.16 (95% confidence interval 1.11 to 1.22) for road Ldenmax ≥65 dB compared with <45 dB, 1.27 (1.22 to 1.34) for road Ldenmin ≥55 dB compared with <40 dB, 1.16 (1.10 to 1.23) for railway Ldenmax ≥60 dB compared with <40 dB, and 1.24 (1.17 to 1.30) for railway Ldenmin ≥50 dB compared with <40 dB. Road traffic, but not railway, noise was associated with an increased risk of vascular dementia. Results indicated associations between road traffic Ldenmin and Parkinson's disease related dementia. CONCLUSIONS This nationwide cohort study found transportation noise to be associated with a higher risk of all cause dementia and dementia subtypes, especially Alzheimer's disease.
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Affiliation(s)
- Manuella Lech Cantuaria
- The Mærsk McKinney Møller Institute, University of Southern Denmark, Odense, Denmark
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ellen Raben Pedersen
- The Mærsk McKinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Aslak Harbo Poulsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jesse Daniel Thacher
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Victor H Valencia
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jesper Hvass Schmidt
- Research Unit for ORL - Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
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Elkjaer ML, Nawrocki A, Kacprowski T, Lassen P, Simonsen AH, Marignier R, Sejbaek T, Nielsen HH, Wermuth L, Rashid AY, Høgh P, Sellebjerg F, Reynolds R, Baumbach J, Larsen MR, Illes Z. CSF proteome in multiple sclerosis subtypes related to brain lesion transcriptomes. Sci Rep 2021; 11:4132. [PMID: 33603109 PMCID: PMC7892884 DOI: 10.1038/s41598-021-83591-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/13/2020] [Accepted: 02/02/2021] [Indexed: 02/08/2023] Open
Abstract
To identify markers in the CSF of multiple sclerosis (MS) subtypes, we used a two-step proteomic approach: (i) Discovery proteomics compared 169 pooled CSF from MS subtypes and inflammatory/degenerative CNS diseases (NMO spectrum and Alzheimer disease) and healthy controls. (ii) Next, 299 proteins selected by comprehensive statistics were quantified in 170 individual CSF samples. (iii) Genes of the identified proteins were also screened among transcripts in 73 MS brain lesions compared to 25 control brains. F-test based feature selection resulted in 8 proteins differentiating the MS subtypes, and secondary progressive (SP)MS was the most different also from controls. Genes of 7 out these 8 proteins were present in MS brain lesions: GOLM was significantly differentially expressed in active, chronic active, inactive and remyelinating lesions, FRZB in active and chronic active lesions, and SELENBP1 in inactive lesions. Volcano maps of normalized proteins in the different disease groups also indicated the highest amount of altered proteins in SPMS. Apolipoprotein C-I, apolipoprotein A-II, augurin, receptor-type tyrosine-protein phosphatase gamma, and trypsin-1 were upregulated in the CSF of MS subtypes compared to controls. This CSF profile and associated brain lesion spectrum highlight non-inflammatory mechanisms in differentiating CNS diseases and MS subtypes and the uniqueness of SPMS.
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Affiliation(s)
- Maria L Elkjaer
- Department of Neurology, Odense University Hospital, J.B. Winslowsvej 4, 5000, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Arkadiusz Nawrocki
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Tim Kacprowski
- Research Group Computational Systems Medicine, Chair of Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany.,Division Data Science in Biomedicine, Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Medical School Hannover, Brunswick, Germany
| | - Pernille Lassen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Anja Hviid Simonsen
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Lyon Neuroscience Research Center, Lyon, France
| | - Tobias Sejbaek
- Department of Neurology, Odense University Hospital, J.B. Winslowsvej 4, 5000, Odense C, Denmark.,Department of Neurology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Helle H Nielsen
- Department of Neurology, Odense University Hospital, J.B. Winslowsvej 4, 5000, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, J.B. Winslowsvej 4, 5000, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alyaa Yakut Rashid
- Department of Neurology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Peter Høgh
- Regional Dementia Research Centre, Department of Neurology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark., Copenhagen, Denmark
| | | | - Jan Baumbach
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark.,Chair of Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | - Martin R Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, J.B. Winslowsvej 4, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
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5
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Jensen CS, Musaeus CS, Frikke-Schmidt R, Andersen BB, Beyer N, Gottrup H, Høgh P, Vestergaard K, Wermuth L, Frederiksen KS, Waldemar G, Hasselbalch S, Simonsen AH. Physical Exercise May Increase Plasma Concentration of High-Density Lipoprotein-Cholesterol in Patients With Alzheimer's Disease. Front Neurosci 2020; 14:532. [PMID: 32536853 PMCID: PMC7269030 DOI: 10.3389/fnins.2020.00532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/06/2020] [Accepted: 04/29/2020] [Indexed: 12/27/2022] Open
Abstract
Lifestyle factors have been shown to increase the risk of developing Alzheimer’s disease (AD) later in life. Specifically, an unfavorable cholesterol profile, and insulin resistance are associated with increased risk of developing AD. One way to non-pharmacologically affect the levels of plasma lipids is by exercise, which has been shown to be beneficial in cognitively healthy individuals. In this randomized controlled trial y, we therefore aimed to clarify the effect of physical exercise on the lipid profile, insulin and glucose in patients with AD. In addition, we investigated the effect of apolipoproteinE genotype on total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein–cholesterol (LDL-C), and triglycerides (TG) in plasma from patients with AD. Plasma samples from 172 patients who underwent 16 weeks of moderate-to-high intensity exercise (n = 90) or treatment as usual (n = 82) were analyzed change from baseline for the levels of total cholesterol, LDL-C, HDL-C, TG, glucose, and insulin. In addition, we analyzed those from the exercise group who adhered to the protocol with an attendance of 2/3 or more of the exercise session and who followed the protocol of an intensity of 70% of the maximum heart rate. We found a significant increase in plasma HDL-C levels between the “high exercise sub-group” compared to control group. After intervention HDL-C was increased by 4.3% in the high-exercise group, and decreased by 0.7% in the control group, after adjustment for statin use. In conclusion, short term physical activity may be beneficial on the cholesterol profile in patients with AD.
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Affiliation(s)
- Camilla Steen Jensen
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Sandøe Musaeus
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Bo Andersen
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Gottrup
- Dementia Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Høgh
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Regional Dementia Research Centre, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | | | - Lene Wermuth
- Dementia Clinic, Department of Neurology, Odense University Hospital, Odense, Denmark
| | | | - Gunhild Waldemar
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Hasselbalch
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anja Hviid Simonsen
- Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Malling ASB, Morberg BM, Wermuth L, Gredal O, Bech P, Jensen BR. Associations of Motor Symptom Severity and Quality of Life to Motor Task Performance in Upper and Lower Extremities Across Task Complexity in Parkinson's Disease. Motor Control 2019; 23:445-460. [PMID: 30827179 DOI: 10.1123/mc.2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/09/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2023]
Abstract
The authors examined the associations between the performance of upper- and lower-extremity motor tasks across task complexity and motor symptom severity, overall disease severity, and the physical aspects of quality of life in persons with Parkinson's disease. The performance was assessed for three lower-extremity tasks and two upper-extremity tasks of different levels of complexity. The motor symptoms and overall disease severity correlated significantly with all motor tasks with higher correlation coefficients in the complex tasks. Thus, the strength of the association between disease severity or severity of motor symptoms and motor performance is task-specific, with higher values in complex motor tasks than in simpler motor tasks. Mobility-related and activity-of-daily-living-related quality of life correlated with lower-extremity tasks of low and medium complexity and with the complex upper-extremity task, respectively; this suggests that Parkinson's Disease Questionnaire-39 is capable of differentiating between the impact of gross and fine motor function on quality of life.
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Affiliation(s)
| | - Bo M Morberg
- University of Southern Denmark
- Odense University Hospital
| | - Lene Wermuth
- University of Southern Denmark
- Odense University Hospital
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases
| | - Per Bech
- University Hospital of Copenhagen
| | - Bente R Jensen
- University of Southern Denmark
- Odense University Hospital
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7
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Malling ASB, Morberg BM, Wermuth L, Gredal O, Bech P, Jensen BR. The influence of posture duration on hand tremor during tasks with attention-distraction in persons with Parkinson's disease. J Neuroeng Rehabil 2019; 16:61. [PMID: 31138267 PMCID: PMC6537174 DOI: 10.1186/s12984-019-0534-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/12/2018] [Accepted: 05/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tremor is one of the hallmarks and most bothersome symptoms in Parkinson's disease (PD). The classical PD tremor is present at rest, but postural tremor also occurs. PD tremor can be continuous or intermittently present and can have a re-emergent nature. The tremor intensity is affected by attention and stress level. Observations of PD tremor have indicated increased tremor intensity with time during 30-s tremor assessments. This phenomenon has not previously been studied systematically. Thus, in order to contribute to our understanding of the mechanisms associated with PD tremor, our aim was to investigate the influence of time during a posture holding and a resting task on hand tremor characteristics in persons with PD compared to healthy peers. METHOD Fifty persons with PD and at least one tremoring hand (tremor intensity exceeding mean + 2SD of a healthy reference group (REF), N = 40) were included from a clinical trial population. Hand accelerations in a rest and postural condition were measured in 30-s assessments while the participants performed a self-paced simple subtraction task with eyes closed to standardize attention without inducing stress. Tremor intensity, maximal power, frequency of maximal power and tremor onset time was calculated for three consecutive 10-s time intervals. RESULTS Tremor intensity and maximal power increased significantly during the 30-s recording in the PD-group in both conditions (1st-3rd time-interval, tremor intensity: rest + 65% p < 0.0001, postural + 55% p < 0.0001; maximal power: rest + 93% p < 0.0001, postural + 82% p < 0.001). No effect of time was found on frequency of maximal power in the PD-group or on any effect measure in the REF-group. CONCLUSION Tremor intensity and maximal power increased with time in the PD-group during 30-s tasks, while no change with time was found in the REF-group. In contrast, frequency of maximal power remained unchanged, which may suggest that the same neural circuits were responsible for the tremor generation throughout the tasks. The increase in tremor intensity and maximal power could not solely be explained by re-emergence of tremor. This suggests an increasing or gradually more synchronized cortico-spinal drive throughout the tasks. However, this requires further studies to determine.
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Affiliation(s)
- Anne Sofie Bøgh Malling
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Bo Mohr Morberg
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases, Taastrup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Bente Rona Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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8
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Jensen CS, Bahl JM, Østergaard LB, Høgh P, Wermuth L, Heslegrave A, Zetterberg H, Heegaard NHH, Hasselbalch SG, Simonsen AH. Exercise as a potential modulator of inflammation in patients with Alzheimer's disease measured in cerebrospinal fluid and plasma. Exp Gerontol 2019; 121:91-98. [PMID: 30980923 DOI: 10.1016/j.exger.2019.04.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 11/07/2018] [Revised: 02/04/2019] [Accepted: 04/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuroinflammation is recognized as part of the pathological progression of Alzheimer's disease (AD), but the molecular mechanisms are still not entirely clear. Systemically, physical exercise has shown to have a positive modulating effect on markers of inflammation. It is not known if this general effect also takes place in the central nervous system in AD. The aim of this study was to investigate the effect of 16 weeks of moderate to high-intensity physical exercise on selected biomarkers of inflammation both systemically and in the CNS, in patients with AD. METHODS Plasma and cerebrospinal fluid (CSF) from 198 patients with Alzheimer's disease participating in the Preserving Cognition, Quality of Life, Physical Health and Functional Ability in Alzheimer's Disease: The Effect of Physical Exercise (ADEX) study were analyzed for concentrations of 8‑isoprostane, soluble trigger receptor expressed on myeloid cells 2 (sTREM2), and the MSD v-plex proinflammation panel 1 human containing interferon gamma (IFNγ), Interleukin-10 (IL10), IL12p70, IL13, IL1β, IL2, IL4, IL6, IL8, and tumor necrosis factor alpha (TNFα), before and after a 16-week intervention with physical exercise, and we studied whether changes were modulated by the patients' APOE genotype. RESULTS Most inflammatory markers remained unchanged after exercise. We found an increasing effect of 16 weeks of physical exercise on sTREM2 measured in CSF. Further, IL6 in plasma increased in the exercise group after physical exercise (mean relative change 41.03, SD 76.7), compared to controls (-0.97, SD 49.4). In a sub-analysis according to APOE genotype, we found that in ε4 carriers, exercise had a stabilizing effect on IFNγ concentration with a mean relative change of 7.84 (SD 42.6), as compared to controls (114.7 (SD 188.3), p = 0.038. CONCLUSION Our findings indicate an effect of physical exercise on markers of neuroinflammation in CSF measured by an increase in sTREM2 in patients with AD. Further, there may be a small inflammatory systemic effect related to physical exercise in patients with AD.
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Affiliation(s)
- Camilla Steen Jensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | | | - Lærke Borg Østergaard
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, DK-2100 Copenhagen, Denmark.
| | - Peter Høgh
- Department of Clinical Medicine, University of Copenhagen, Denmark; Regional Dementia Research Centre, Department of Neurology, Zealand University Hospital, DK-4000 Roskilde, Denmark.
| | - Lene Wermuth
- Dementia Clinic, Department of Neurology, Odense University Hospital, DK-5000 Odense, Denmark.
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, WC1N London, UK; UK Dementia Research Institute at UCL, London WC1E 6BT, UK.
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, WC1N London, UK; UK Dementia Research Institute at UCL, London WC1E 6BT, UK; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, S-431 80 Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, S-431 80 Mölndal, Sweden.
| | - Niels H H Heegaard
- Department of Clinical Biochemistry, Immunology and Genetics, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Biochemistry, University of Southern Denmark, Odense, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Anja Hviid Simonsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, DK-2100 Copenhagen, Denmark.
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9
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Malling ASB, Morberg BM, Wermuth L, Gredal O, Bech P, Jensen BR. The effect of 8 weeks of treatment with transcranial pulsed electromagnetic fields on hand tremor and inter-hand coherence in persons with Parkinson's disease. J Neuroeng Rehabil 2019; 16:19. [PMID: 30704504 PMCID: PMC6357382 DOI: 10.1186/s12984-019-0491-2] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Parkinson’s disease (PD) tremor comprises asymmetric rest and postural tremor with unilateral onset. Tremor intensity can be amplified by stress and reduced by attention, and the medical treatment is complex. Mirror movements and unintentional synchronization of bimanual movements, possibly caused by insufficient inhibition of inter-hemispheric crosstalk, have been reported in PD, indicating a lag of lateralization. Potential neuroprotective effects of pulsed electromagnetic fields (PEMF) have been reported in-vitro and in rodents, as have influences of PEMF on human tremor. The aim was to investigate the effect of 8 weeks daily transcranial PEMF treatment (T-PEMF) of persons with PD on rest and postural hand tremor characteristics and on inter-hand coherence. Methods Hand accelerations of 50 PD participants with uni- or bilateral tremor participating in a clinical trial were analysed. A rest and postural tremor task performed during serial subtraction was assessed before and after 8 weeks of T-PEMF (30 min/day, 50 Hz, ±50 V, 3 ms squared pulses) or placebo treatment (sham stimulation 30 min/day). Forty matched healthy persons (no treatment) were included as reference. Intensity and inter-hand coherence related measures were extracted. Results The T-PEMF treatment decreased the inter-hand coherence in the PD group with unilateral postural tremor. The PD group with unilateral postural tremor was less clinically affected by the disease than the PD group with bilateral postural tremor. However, no differences between T-PEMF and placebo treatment on either intensity related or coherence related measures were found when all persons with PD were included in the analyses. The peak power decreased and the tremor intensity tended to decrease in both treatment groups. Conclusions Eight weeks of T-PEMF treatment decreased inter-hand coherence in the PD group with unilateral postural tremor, while no effects of T-PEMF treatment were found for the entire PD group. The unilateral postural tremor group was less clinically affected than the bilateral postural tremor group, suggesting that early treatment initiation may be beneficial. In theory, a reduced inter-hand coherence could result from a neuronal treatment response increasing inter-hemispheric inhibition. However, this requires further studies to determine. Studies of even longer treatment periods would be of interest. Trial registration ClinicalTrials.gov, NCT02125032. Registered 29 April 2014, https://clinicaltrials.gov/ct2/show/NCT02125032?term=NCT02125032&rank=1 Electronic supplementary material The online version of this article (10.1186/s12984-019-0491-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Sofie Bøgh Malling
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Bo Mohr Morberg
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases, Taastrup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Bente Rona Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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10
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Segtnan EA, Majdi A, Constantinescu C, Grupe P, Gerke O, Dali HÍ, Strøm OE, Holm J, Alavi A, Sadigh-Eteghad S, Wermuth L, Hildebrandt MG, Gjedde A, Høilund-Carlsen PF. Diagnostic manifestations of total hemispheric glucose metabolism ratio in neuronal network diaschisis: diagnostic implications in Alzheimer's disease and mild cognitive impairment. Eur J Nucl Med Mol Imaging 2019; 46:1164-1174. [PMID: 30637500 DOI: 10.1007/s00259-018-4248-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/29/2018] [Accepted: 12/26/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE We tested the hypothesis that lateralized hemispheric glucose metabolism may have diagnostic implications in Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS We performed FDG-PET/CT in 23 patients (mean age 63.7 years, range 50-78, 17 females) diagnosed with AD (n = 15) or MCI (n = 8) during a six-month period in 2014. Ten neurologically healthy individuals (HIs) (mean age 62.5 years, range 43-75, 5 females) served as controls. A neuroimaging expert provided visual assessment of diaschisis. The total hemispheric glucose metabolism ratio (THGr) was calculated, and with area-under the curve of receiver operating characteristics (AUC-ROC) we generated a "Network Diaschisis Test (NDT)". RESULTS The qualitative detection of cerebral (Ce) and cerebellar (Cb) diaschisis was 7/15 (47%), 0/8 (0%), and 0/10 (0%) in AD, MCI, and HI groups, respectively. Median cerebral THGr was 0.68 (range 0.43-0.99), 0.86 (range 0.64-0.98), and 0.95 (range 0.65-1.00) for AD, MCI, and HI groups, respectively (p = 0.04). Median cerebellar THGr was, respectively, 0.70 (range 0.18-0.98), 0.70 (range 0.48-0.81), and 0.84 (range 0.75-0.96) (p = 0.0138). A positive NDT yielded a positive predictive value of 100% for the presence of AD or MCI and a 86% negative predictive value for healthy brain. Moreover, the diagnostic manifestation of THGr between MCI and AD led to a positive predictive value of 100% for AD, but a negative predictive value of 42.9% for MCI. CONCLUSION Patients with AD or MCI had more pronounced diaschisis, lateralized hemispheric glucose metabolism and lower THGr compared to healthy controls. The NDT distinguished AD and MCI patients from HIs, and AD from MCI patients with a high positive predictive value and moderate and low negative predictive values. THGr can be a straightforward source of investigating neuronal network diaschisis in AD and MCI and in other cerebral diseases, across institutions.
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Affiliation(s)
- Eivind A Segtnan
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Alireza Majdi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Caius Constantinescu
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Grupe
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Heini Í Dali
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Olaf Emil Strøm
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jorun Holm
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lene Wermuth
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Dementia Clinic, Department of Neurology, Odense University Hospital, Odense C, Denmark
| | - Malene G Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Albert Gjedde
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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11
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Frederiksen KS, Larsen CT, Hasselbalch SG, Christensen AN, Høgh P, Wermuth L, Andersen BB, Siebner HR, Garde E. A 16-Week Aerobic Exercise Intervention Does Not Affect Hippocampal Volume and Cortical Thickness in Mild to Moderate Alzheimer's Disease. Front Aging Neurosci 2018; 10:293. [PMID: 30319397 PMCID: PMC6167961 DOI: 10.3389/fnagi.2018.00293] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 06/20/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Brain imaging studies in healthy elderly subjects suggest a positive effect of aerobic exercise on both brain structure and function, while the effects of aerobic exercise in Alzheimer’s Disease (AD) has been scarcely investigated. Methods: In a single-blinded randomized MRI study, we assessed the effects of an aerobic exercise intervention on brain volume as measured by magnetic resonance imaging (MRI) and its correlation to cognitive functioning in patients with AD. The study was a sub-study of a larger randomized controlled trial (ADEX study). Forty-one patients were assigned to a control or exercise group. The exercise group performed 60-min of aerobic exercise three times per week for 16 weeks. All participants underwent whole-brain MRI at 3 Tesla and cognitive assessment at baseline and after 16 weeks. Attendance and intensity were monitored providing a total exercise load. Changes in regional brain volumes and cortical thickness were analyzed using Freesurfer software. Results: There was no effect of the type of intervention on MRI-derived brain volumes. In the entire group with and without training, Exercise load showed a positive correlation with changes in volume in the hippocampus, as well as frontal cortical thickness. Volume changes in frontal cortical thickness correlated with changes in measures of mental speed and attention and exercise load in the exercise group. Conclusion: We did not find evidence to support an effect of 16 weeks of aerobic exercise on brain volume changes in patients with AD. Longer intervention periods may be needed to affect brain structure as measured with volumetric MRI. Clinical Trial registration:ClinicalTrials.gov Identifier: NCT01681602, registered September 10th, 2012 (Retrospectively registered).
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Affiliation(s)
- Kristian Steen Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Thode Larsen
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Nymark Christensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Peter Høgh
- Regional Dementia Research Center, Department of Neurology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Wermuth
- Dementia Clinic, Odense University Hospital, Odense, Denmark
| | - Birgitte Bo Andersen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen Garde
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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12
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Malling ASB, Morberg BM, Wermuth L, Gredal O, Bech P, Jensen BR. Effect of transcranial pulsed electromagnetic fields (T-PEMF) on functional rate of force development and movement speed in persons with Parkinson's disease: A randomized clinical trial. PLoS One 2018; 13:e0204478. [PMID: 30252895 PMCID: PMC6155540 DOI: 10.1371/journal.pone.0204478] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022] Open
Abstract
Background Parkinson’s disease is caused by dopaminergic neurodegeneration resulting in motor impairments as slow movement speed and impaired balance and coordination. Pulsed electromagnetic fields are suggested to have neuroprotective effects, and could alleviate symptoms. Objective To study 1) effects of 8-week daily transcranial pulsed electromagnetic field treatment on functional rate of force development and movement speed during two motor tasks with different levels of complexity, 2) if treatment effects depend on motor performance at baseline. Methods Ninety-seven persons with Parkinson’s disease were randomized to active transcranial pulsed electromagnetic field (squared bipolar 3 ms pulses, 50 Hz) or placebo treatment with homebased treatment 30 min/day for 8 weeks. Functional rate of force development and completion time of a sit-to-stand and a dynamic postural balance task were assessed pre and post intervention. Participants were sub-grouped in high- and low-performers according to their baseline motor performance level. Repeated measure ANOVAs were used. Results Active treatment tended to improve rate of force development during chair rise more than placebo (P = 0.064). High-performers receiving active treatment improved rate of force development during chair rise more than high-performers receiving placebo treatment (P = 0.049, active/placebo: 11.9±1.1 to 12.5±1.9 BW/s ≈ 5% / 12.4±1.3 to 12.2±1.3 BW/s, no change). No other between-treatment-group or between-treatment-subgroup differences were found. Data on rate of force development of the dynamic balance task and completion times of both motor tasks improved but did not allow for between-treatment differentiation. Conclusion Treatment with transcranial pulsed electromagnetic fields was superior to placebo regarding functional rate of force development during chair rise among high-performers. Active treatment tended to increase functional rate of force development while placebo did not. Our results suggest that mildly affected persons with Parkinson’s disease have a larger potential for neural rehabilitation than more severely affected persons and indicate that early treatment initiation may be beneficial.
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Affiliation(s)
- Anne Sofie Bøgh Malling
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- * E-mail: (ASBM); (BRJ)
| | - Bo Mohr Morberg
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases, Taastrup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Bente Rona Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- * E-mail: (ASBM); (BRJ)
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13
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Jensen BR, Malling ASB, Morberg BM, Gredal O, Bech P, Wermuth L. Effects of Long-Term Treatment with T-PEMF on Forearm Muscle Activation and Motor Function in Parkinson's Disease. Case Rep Neurol 2018; 10:242-251. [PMID: 30283322 PMCID: PMC6167712 DOI: 10.1159/000492486] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/24/2018] [Indexed: 11/27/2022] Open
Abstract
Bipolar pulsed electromagnetic stimulation applied to the brain (T-PEMF) is a non-pharmacological treatment which has been shown to stimulate nerve growth, attenuate nerve abnormalities, and improve microcirculation. We report on a 62-year-old, medically well-treated man with idiopathic Parkinson's disease. He was treated with T-PEMF, 30 min per day for three 8-week periods separated by two 1-week breaks. The disease made his handwriting impossible to read mainly due to small letters and lack of fluency. Forearm EMG measured during standardized conditions showed an involuntary spiky EMG pattern with regular burst activity (on his left side) at baseline. The intervention normalized the handwriting and forearm EMG. The UPDRS-motor score decreased from 25 to 17, and UPDRS-II-handwriting decreased from a pre-intervention value of 3 to 0 after the intervention. Finally, the patient reported improved fine motor function, less muscle stiffness, less muscle cramps and tingling, and less fatigue during the day in response to the T-PEMF treatment. The improved handwriting lasted for approximately 3 months after the treatment. Our results should be considered as preliminary, and large-scale, controlled studies are recommended to elucidate the therapeutic potential of long-term treatment with T-PEMF.
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Affiliation(s)
- Bente Rona Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Sofie Bøgh Malling
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bo Mohr Morberg
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases, Taastrup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Morberg BM, Malling AS, Jensen BR, Gredal O, Wermuth L, Bech P. The Hawthorne effect as a pre-placebo expectation in Parkinsons disease patients participating in a randomized placebo-controlled clinical study. Nord J Psychiatry 2018; 72:442-446. [PMID: 30744517 DOI: 10.1080/08039488.2018.1468480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Hawthorne effect on clinical studies in Parkinson's disease has not been thoroughly investigated. Evidently the Hawthorne effect may have impact on study outcomes acting as a 'pre-placebo' effect in the recruitment phase, hence before inclusion. AIM The aim of this study was to discuss the Hawthorne effect in relation to clinical and self-reported outcome measures in a randomized clinical study in the recruitment phase and during the study. METHODS Data from 97 participants with Parkinson's disease treated with Transcranial Pulsed Electromagnetic Fields were applied, randomized to an active (n = 49) or a placebo treated group (n = 48). The participants received one home treatment session, for eight consecutive weeks. Outcome measures were the Unified Parkinson's Disease Rating Scale, The 39-item Parkinson's Disease Questionnaire and the WHO-5. RESULTS No difference in treatment effect between the two groups was found pertaining the Unified Parkinson's Disease Rating Scale. No difference in treatment effect between the two groups was found pertaining the 39-item Parkinson's Disease Questionnaire, apart from the dimension mobility. No difference in treatment effect between the two groups was found pertaining the WHO-5 scale. CONCLUSIONS The Hawthorne effect may have caused a 'pre-placebo' effect on the outcome measures even before obtaining baseline outcomes measures. This study may have been particularly prone to a Hawthorne effect due to the intense contact with the participants before and during the study. Moreover, the Hawthorne effect should not be viewed upon as a single entity but rather as entities affecting outcome measures throughout the full study period.
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Affiliation(s)
- Bo Mohr Morberg
- a Department of Neurology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Anne Sofie Malling
- a Department of Neurology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Bente Rona Jensen
- a Department of Neurology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Ole Gredal
- a Department of Neurology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Lene Wermuth
- a Department of Neurology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Per Bech
- b Psychiatric Research Unit , Psychiatric Centre North Zealand, University of Copenhagen , Hillerød , Denmark
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15
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Morberg BM, Malling AS, Jensen BR, Gredal O, Bech P, Wermuth L. Effects of transcranial pulsed electromagnetic field stimulation on quality of life in Parkinson's disease. Eur J Neurol 2018; 25:963-e74. [PMID: 29573167 DOI: 10.1111/ene.13637] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Pulsed electromagnetic fields induce a protective and anti-inflammatory effect in the nervous system primarily due to growth factor upregulation that possibly abates neurodegeneration in Parkinson's disease (PD). This study investigated treatment effects of transcranial pulsed electromagnetic fields (T-PEMFs) on quality of life in PD and the feasibility and safety of this treatment. METHODS In this double-blinded clinical study, 97 participants with idiopathic PD (Hoehn & Yahr stage I-IV), on optimal medical anti-parkinsonian treatment, were block randomized (3:3) to either active (n = 49) or placebo treatment (n = 48). Treatment with T-PEMFs entailed one daily 30-min home treatment for eight consecutive weeks. The 39-item Parkinson's Disease Questionnaire (PDQ-39) was assessed at baseline and endpoint. A special questionnaire was used to profile adverse events by interviewing the participants over the full treatment period. Treatment compliance was accounted for by daily treatment registration. RESULTS The active group improved with respect to clinical effect size for the two dimensions, i.e. mobility and activities of daily living, compared with the placebo group. No between-group differences were found for the remaining PDQ-39 dimensions. There were no between-group difference in adverse events. Treatment compliance was 97.9%. CONCLUSION Treatment with T-PEMFs improved mobility and activities of daily living scores for clinical effect size only in the active group, indicating a positive treatment response for motor symptoms. No difference was found between the two groups for the remaining PDQ-39 dimensions. The treatment had no or only mild adverse events and was performed with high compliance.
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Affiliation(s)
- B M Morberg
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense
| | - A S Malling
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense
| | - B R Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense
| | - O Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases, Taastrup
| | - P Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - L Wermuth
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense
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16
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Pehrson C, Hertz JM, Wirenfeldt M, Stenager E, Wermuth L, Winther Kristensen B. Hereditary spastic paraplegia type 8: Neuropathological findings. Brain Pathol 2018; 28:292-294. [PMID: 28181327 DOI: 10.1111/bpa.12494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Caroline Pehrson
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Jens Michael Hertz
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Martin Wirenfeldt
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Egon Stenager
- MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Department of Neurology, Sygehus Sønderjylland, Denmark and Institute of Regional Research, University of Southern Denmark, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Bjarne Winther Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Steen Jensen C, Portelius E, Siersma V, Høgh P, Wermuth L, Blennow K, Zetterberg H, Waldemar G, Gregers Hasselbalch S, Hviid Simonsen A. Cerebrospinal Fluid Amyloid Beta and Tau Concentrations Are Not Modulated by 16 Weeks of Moderate- to High-Intensity Physical Exercise in Patients with Alzheimer Disease. Dement Geriatr Cogn Disord 2018; 42:146-158. [PMID: 27643858 DOI: 10.1159/000449408] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical exercise may have some effect on cognition in patients with Alzheimer disease (AD). However, the underlying biochemical effects are unclear. Animal studies have shown that amyloid beta (Aβ), one of the pathological hallmarks of AD, can be altered with high levels of physical activity. AIM The objective of this study was to elucidate the effect of 16 weeks of moderate- to high-intensity physical exercise on the biomarkers of AD, with special emphasis on the amyloidogenic pathway. METHODS From a total of 53 patients with AD participating in the Preserving Cognition, Quality of Life, Physical Health and Functional Ability in Alzheimer's Disease: The Effect of Physical Exercise (ADEX) study we analyzed cerebrospinal fluid samples for Aβ species, total tau (t-tau), phosphorylated tau (p-tau) and soluble amyloid precursor protein (sAPP) species. We also assessed the patients for apolipoprotein E ε4 (ApoE ε4) genotype. RESULTS We found no effect of 16 weeks of physical exercise on the selected biomarkers, and no effect of ApoE ε4 genotype. CONCLUSION Our findings suggest that the possible effect of physical exercise on cognition in patients with AD is not due to modulation of Aβ, t-tau, p-tau and sAPP species.
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Affiliation(s)
- Camilla Steen Jensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Jensen CS, Portelius E, Høgh P, Wermuth L, Blennow K, Zetterberg H, Hasselbalch SG, Simonsen AH. Effect of physical exercise on markers of neuronal dysfunction in cerebrospinal fluid in patients with Alzheimer's disease. Alzheimers Dement (N Y) 2017; 3:284-290. [PMID: 29067334 PMCID: PMC5651430 DOI: 10.1016/j.trci.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Physical exercise has gained increasing focus as a potential mean to maintain cognitive function in patients with Alzheimer's disease (AD). Alongside the markers of specific AD pathology (amyloid β and tau), other pathologies such as neuronal damage and synaptic loss have been proposed as markers of the disease. Here, we study the effect of physical exercise on biomarkers of neuronal and synaptic integrity. METHODS Cerebrospinal fluid (CSF) from 51 AD subjects who participated in the randomized controlled trial Preserving Cognition, Quality of Life, Physical Health and Functional Ability in Alzheimer's Disease: The Effect of Physical Exercise (ADEX) was analyzed for the concentration of neurofilament light (NFL), neurogranin (Ng), visinin-like protein-1 (VILIP-1), and chitinase-3-like protein 1 (YKL-40). Participants were subjected to either 16 weeks of moderate- to high-intensity exercise (n = 25) or treatment as usual (control group, n = 26), and CSF was collected before and after intervention. RESULTS No significant differences in CSF concentrations of VILIP-1, YKL-40, NFL, and Ng were observed when comparing mean change from baseline between the exercise and control groups. Similarly, when classifying subjects based on their exercise levels, no significant changes were observed for the biomarkers in the control group compared with the high-exercise group (attending 80% of the exercise sessions with an intensity of 70% of maximum heart rate or above). DISCUSSION These results are not supportive of a modulatory effect of physical exercise on the selected biomarkers of neuronal and synaptic integrity in patients with AD.
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Affiliation(s)
- Camilla Steen Jensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Erik Portelius
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Peter Høgh
- Regional Dementia Research Centre, Department of Neurology, Zealand University Hospital and Copenhagen University Hospital, Roskilde, Denmark
| | - Lene Wermuth
- Dementia Clinic, Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Anja Hviid Simonsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
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Malling A, Morberg B, Wermuth L, Gredal O, Bech P, Jensen B. Treatment with transcranial pulsed electromagnetic field enhances functional rate-of-force development during chair rise in persons with Parkinson's disease. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Morberg B, Malling A, Jensen B, Gredal O, Bech P, Wermuth L. The effects of transcranial pulsed electromagnetic fields in the treatment of Parkinson’s disease. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Morberg BM, Malling AS, Jensen BR, Gredal O, Bech P, Wermuth L. Parkinson's disease and transcranial pulsed electromagnetic fields: A randomized clinical trial. Mov Disord 2017; 32:625-626. [DOI: 10.1002/mds.26927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Bo Mohr Morberg
- Department of Neurology; Odense University Hospital, The University of Southern Denmark; Odense Denmark
| | - Anne Sofie Malling
- Department of Neurology; Odense University Hospital, The University of Southern Denmark; Odense Denmark
| | - Bente Rona Jensen
- Department of Neurology; Odense University Hospital, The University of Southern Denmark; Odense Denmark
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases; Taastrup Denmark
| | - Per Bech
- Psychiatric Research Unit; Psychiatric Centre North Zealand, University of Copenhagen; Hillerød Denmark
| | - Lene Wermuth
- Department of Neurology; Odense University Hospital, The University of Southern Denmark; Odense Denmark
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22
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Abstract
OBJECTIVES In the present study we investigate organochlorines as possible risk factors for Parkinson's disease (PD) in an arctic population. This has never been done before. STUDY DESIGN Case-control study of Inuit in Greenland. MATERIALS AND METHODS Plasma from 31 PD (20 males and 11 females) (mean age 69 yr) and 122 controls (57 males and 65 females) (mean age 61 yr) was analysed for 31 PCBs and pesticides by dual-column GC-ECD and GC-NCI/MS. RESULTS Plasma concentrations of PCBs and pesticides were markedly increased in both PD and controls. The concentrations did not differ between the PD cases and controls. However, the mean DDE concentration was higher in PD than in controls (42.1 and 15.0 microg/l, respectively, and with a wide range among the PD cases). The difference was significant for log transformed DDE values after control for age and sex (p=0.005). CONCLUSION A few epidemiological studies indicate a possible connection between exposure to pesticides and PD. The idea that exposure to organochlorines may be an important risk factor for PD among the Inuit in Greenland requires more investigations.
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Affiliation(s)
- O G Koldkjaer
- Department of Clinical Biochemistry, Sønderborg Hospital, University of Southern Denmark.
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23
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Hoffmann K, Sobol NA, Frederiksen KS, Beyer N, Vogel A, Vestergaard K, Brændgaard H, Gottrup H, Lolk A, Wermuth L, Jacobsen S, Laugesen LP, Gergelyffy RG, Høgh P, Bjerregaard E, Andersen BB, Siersma V, Johannsen P, Cotman CW, Waldemar G, Hasselbalch SG. Moderate-to-High Intensity Physical Exercise in Patients with Alzheimer’s Disease: A Randomized Controlled Trial. J Alzheimers Dis 2015; 50:443-53. [DOI: 10.3233/jad-150817] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kristine Hoffmann
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nanna A. Sobol
- Musculoskeletal Rehabilitation Research Unit, University of Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Kristian S. Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Beyer
- Musculoskeletal Rehabilitation Research Unit, University of Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Hanne Gottrup
- Dementia Clinic, Aarhus University Hospital, Denmark
| | - Annette Lolk
- Dementia Clinic, Odense University Hospital, Denmark
| | - Lene Wermuth
- Dementia Clinic, Odense University Hospital, Denmark
| | - Søren Jacobsen
- Department of Geriatrics, Odense University Hospital, Svendborg Hospital, Denmark
| | | | | | - Peter Høgh
- Regional Dementia Research Center, Region Zealand, Roskilde Hospital, University of Copenhagen, Denmark
| | - Eva Bjerregaard
- Memory Clinic, Glostrup Hospital, University of Copenhagen, Denmark
| | - Birgitte B. Andersen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Peter Johannsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carl W. Cotman
- Institute for Memory Impairments and Neurological Disorders, University of California-Irvine, CA, USA
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steen G. Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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24
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Jensen CS, Høgh P, Wermuth L, Portelius E, Zetterberg H, Blennow K, Hasselbalch SG, Simonsen AH. P1‐069: Moderate‐to‐high intensity physical training does not alter cerebrospinal amyloid‐β
1‐42
levels in patients with Alzheimer's disease. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Camilla Steen Jensen
- Danish Dementia Research CentreCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Peter Høgh
- Regional Dementia Research CentreCopenhagen University Hospital RoskildeRoskildeDenmark
| | - Lene Wermuth
- Department of NeurologyOdense University HospitalOdensenDenmark
| | - Erik Portelius
- The Sahlgrenska Academy, Institute of Neuroscience and PhysiologyUniversity of GothenburgGothenburgSweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska AcademyUniversity of GothenburgMölndalSweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska AcademyUniversity of GothenburgMölndalSweden
| | | | - Anja Hviid Simonsen
- Danish Dementia Research CentreCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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25
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Wermuth L. [Dementia – now and in the future]. Ugeskr Laeger 2015; 177:V67001. [PMID: 26027663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Lene Wermuth
- Neurologisk Afdeling/Demensklinikken, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C.
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26
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Kenborg L, Lassen CF, Ritz B, Andersen KK, Christensen J, Schernhammer ES, Hansen J, Wermuth L, Rod NH, Olsen JH. Lifestyle, family history, and risk of idiopathic Parkinson disease: a large Danish case-control study. Am J Epidemiol 2015; 181:808-16. [PMID: 25925389 DOI: 10.1093/aje/kwu332] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/27/2014] [Indexed: 11/12/2022] Open
Abstract
The relationship between Parkinson disease (PD) and smoking has been examined in several studies, but little is known about smoking in conjunction with other behaviors and a family history of PD. Using unconditional logistic regression analysis, we studied individual and joint associations of these factors with idiopathic PD among 1,808 Danish patients who were diagnosed in 1996-2009 and matched to 1,876 randomly selected population controls. Although there was a downward trend in duration of smoking, this was not observed for daily tobacco consumption. A moderate intake of caffeine (3.1-5 cups/day) was associated with a lower odds ratio for PD (0.45, 95% confidence interval: 0.34, 0.62), as was a moderate intake of alcohol (3.1-7 units/week) (odds ratio = 0.60, 95% confidence interval: 0.58, 0.84); a higher daily intake did not reduce the odds further. When these behaviors were studied in combination with smoking, the odds ratios were lower than those for each one alone. Compared with never smokers with no family history of PD, never smokers who did have a family history had an odds ratio of 2.81 (95% confidence interval: 1.91, 4.13); for smokers with a family history, the odds ratio was 1.60 (95% confidence interval: 1.15, 2.23). In conclusion, duration of smoking seems to be more important than intensity in the relationship between smoking and idiopathic PD. The finding of lower risk estimates for smoking in combination with caffeine or alcohol requires further confirmation.
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Morberg BM, Jensen J, Bode M, Wermuth L. The impact of high intensity physical training on motor and non-motor symptoms in patients with Parkinson's disease (PIP): A preliminary study. NeuroRehabilitation 2014; 35:291-8. [DOI: 10.3233/nre-141119] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Krøigård T, Christensen J, Wermuth L, Ritz B, Lassen CF. The Use of Antidepressant Medication in Parkinson's Disease Patients is not Affected by the Type of Antiparkinson Medication. Journal of Parkinson's Disease 2014; 4:327-30. [DOI: 10.3233/jpd-140386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas Krøigård
- Department of Neurology, Odense University Hospital & Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jane Christensen
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital & Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Beate Ritz
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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Abstract
BACKGROUND AND PURPOSE It has been speculated that gastrointestinal infection with Helicobacter pylori (HP) contributes to the development of Parkinson's disease (PD). We used nationwide Danish registers to investigate this hypothesis. METHODS We identified 4484 patients with a first time PD diagnosis between 2001 and 2008 from the Danish National Patient Register (DNPR) and 22, 416 population controls from the Danish Civil Registration System (CRS). Information on drug use was obtained from the National Prescription Registry (NPR). We used logistic regression to compute odds ratios (OR) for the association between treatment for HP and risk of PD. RESULTS Prescriptions for HP-eradication drugs and proton pump inhibitors (PPI) 5 or more years prior to the diagnosis of PD were associated with a 45% and 23% increase in PD risk, respectively. Hospitalizations and outpatient visits for gastritis and peptic/duodenal ulcers, however, were not associated with PD. CONCLUSIONS Our population-based study suggests that chronic HP infections and/or gastritis contribute to PD or that these are PD-related pathologies that precede motor symptoms.
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Affiliation(s)
- H H Nielsen
- Department of Neurology, Odense University Hospital, Odense, Denmark.
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30
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Wermuth L, Lassen CF, Himmerslev L, Olsen J, Ritz B. Validation of hospital register-based diagnosis of Parkinson's disease. Dan Med J 2012; 59:A4391. [PMID: 22381086 PMCID: PMC3643969] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Denmark has a long-standing tradition of maintaining one of the world's largest health science specialized register data bases as the National Hospital Register (NHR). To estimate the prevalence and incidence of diseases, the correctness of the diagnoses recorded is critical. Parkinson's disease (PD) is a neurodegenerative disorder and only 75-80% of patients with parkinsonism will have idiopathic PD (iPD). It is necessary to follow patients in order to determine if some of them will develop other neurodegenerative diseases and a one-time-only diagnostic code for iPD reported in the register may be incorrect. MATERIAL AND METHODS This was a large nationwide population-based study of risk factors for iPD, called Parkinson's disease in Denmark (PASIDA). We evaluated the iPD diagnosis reported in the NHR. Medical records with primary diagnoses of iPD from six neurological departments were collected and abstracted using a standardized system to review the diagnostic accuracy of the ICD codes. RESULTS Among the 1,040 medical records abstracted, 857 (82.4%) patients met our criteria for iPD. 183(17.6%) of the patients suffered from other diagnoses such as atypical PD (66 patients), secondary PD (60 patients) and other diagnoses (46 patients). CONCLUSION Possibly only about 82% of the patients with the primary diagnosis of iPD in the Danish NHR actually suffered from iPD. To improve diagnostic validity, we appeal to update the ICD code and to identify the correct parkinsonian phenotype to reduce biased case sampling in register-based studies and appropriate treatment for these rare diseases. FUNDING This study was supported by a grant from the National Institutes of Environmental Health Sciences, USA (grant No R01 ES013717). The funding source had no role in the design or analysis of the study or in the decision to submit the manuscript for publication. TRIAL REGISTRATION Ethical approval: The study protocol was approved by the Danish Data Protection Agency (No 2006-41-7323) and by UCLA-IRB.
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Affiliation(s)
- Lene Wermuth
- Department of Neurology, Odense University Hospital, Denmark.
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31
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Abstract
OBJECTIVE Insulin contributes to normal brain function. Previous studies have suggested associations between midlife diabetes and neurodegenerative diseases, including Parkinson's disease. Using Danish population registers, we investigated whether a history of diabetes or the use of antidiabetes drugs was associated with Parkinson's disease. RESEARCH DESIGN AND METHODS From the nationwide Danish Hospital Register hospital records, we identified 1,931 patients with a first-time diagnosis of Parkinson's disease between 2001 and 2006. We randomly selected 9,651 population control subjects from the Central Population Registry and density matched them by birth year and sex. Pharmacy records comprising all antidiabetes and anti-Parkinson drug prescriptions in Denmark were available. Odds ratios (ORs) were estimated by logistic regression models. RESULTS Having diabetes, as defined by one or more hospitalizations and/or outpatient visits for the condition, was associated with a 36% increased risk of developing Parkinson's disease (OR 1.36 [95% CI 1.08-1.71]). Similarly, diabetes defined by the use of any antidiabetes medications was associated with a 35% increased Parkinson's disease risk (1.35 [1.10-1.65]). When diabetes was defined as the use of oral antidiabetes medications, effect estimates were stronger in women (2.92 [1.34-6.36]), whereas when diabetes was defined as any antidiabetes drug prescription, patients with early-onset Parkinson's disease were at highest risk (i.e., Parkinson's disease diagnosed before the age of 60 years; 3.07 [1.65-5.70]). CONCLUSIONS We found that a diagnosis of, or treatment received for, diabetes was significantly associated with an increased risk of developing Parkinson's disease, especially younger-onset Parkinson's disease. Our results suggest a common pathophysiologic pathway between the two diseases. Future studies should take age at Parkinson's disease onset into account.
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Affiliation(s)
- Eva Schernhammer
- Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
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32
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Manthripragada AD, Schernhammer ES, Qiu J, Friis S, Wermuth L, Olsen JH, Ritz B. Non-steroidal anti-inflammatory drug use and the risk of Parkinson's disease. Neuroepidemiology 2011; 36:155-61. [PMID: 21508649 DOI: 10.1159/000325653] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 02/09/2011] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Experimental evidence supports a preventative role for non-steroidal anti-inflammatory drugs (NSAIDs) in Parkinson's disease (PD). METHODS We investigated associations between use of aspirin, nonaspirin NSAIDs, and acetaminophen and PD in a large population-based case-control study using Danish health and pharmacy registries. We identified 1,931 PD cases reported in hospital or outpatient clinic records who had received a primary diagnosis of PD between 2001 and 2006, and 9,651 age- and sex-matched controls from the Danish population register. Prescription medication use was documented in a pharmacy database covering all residents of Denmark since 1995. RESULTS Adjusting for age, sex, use of cardiovascular disease drugs, diagnosis of chronic pulmonary obstructive disorder, and Charlson comorbidity scores, and excluding prescriptions filled within 5 years before diagnosis, we found no evidence for an association between PD and either aspirin use (OR = 0.97; 95% CI 0.82, 1.14) or nonaspirin NSAID use (OR = 0.97; 95% CI 0.86, 1.09), regardless of intensity of use; further, there was no association between use of ibuprofen or acetaminophen and PD. CONCLUSION Our findings provide no evidence for a protective effect of nonaspirin and aspirin NSAID prescription drug use shortly before PD onset.
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Boas J, Worm-Petersen J, Dupont E, Mikkelsen B, Wermuth L. The levodopa dose-sparing capacity of pergolide compared with that of bromocriptine in an open-label, crossover study. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00188.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The objective of this study was to investigate whether statin (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor) use is associated with risk of Parkinson's disease (PD) in Denmark. We identified 1,931 patients with a first time diagnosis of PD reported in hospital or outpatient clinic records between 2001 and 2006. We density matched to these patients 9,651 population controls by birth year and sex relying on the Danish population register. For every participant, we identified pharmacy records of statin and anti-Parkinson drug prescriptions since 1995 and before index date from a prescription medication use database for all Danish residents. Whenever applicable, the index dates for cases and their corresponding controls were advanced to the date of first recorded prescription for anti-Parkinson drugs. In our primary analyses, we excluded all statin prescriptions 2-years before PD diagnosis. Employing logistic regression adjusting for age, sex, diagnosis of chronic obstructive pulmonary disease, and Charlson comorbidity, we observed none to slightly inverse associations between PD diagnosis and statin prescription drug use. Inverse associations with statin use were only observed for short-term (<or=1 yrs) statin users (2-year lag OR 0.57; 95% CI 0.36 to 0.89); and suggested at higher intensity statin use (2-year lag OR 0.69; 95% CI 0.45-1.04). No associations were seen among long-term users and no difference by sex, age, or type of statins used (lipophilic/hydrophilic). We found little evidence for a neuroprotective role of statins in PD except for short-term or high intensity users. Yet, further investigations into the contributions of intensity, duration, and lag periods of statin use may still be warranted.
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Affiliation(s)
- Beate Ritz
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, California 90095-1772, USA.
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36
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Wermuth L, Sørensen B, Fog I, Hertel T, Bonnesen T, Ejlersen E. [Educational specialists' function in Southern Denmark]. Ugeskr Laeger 2008; 170:3533-3536. [PMID: 18976617] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A new educational training concept was introduced with the latest Danish national reform of specialist training of doctors in 2004. We performed a questionnaire survey, the aim of which was to explore the result of the implementation so far and to get ideas facilitating a sharper focus of our efforts to further develop the educational reform. The results showed high commitment within the system and also pointed to management support as an essential prerequisite for job satisfaction. The development and assessment of the specialist training, however, need further observation.
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Affiliation(s)
- Lene Wermuth
- Neurologisk Afdeling, Odense Universitetshospital, DK-5000 Odense C.
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Abstract
OBJECTIVE A study in The Faroe Islands in 1995 suggested a high prevalence of idiopathic Parkinson's disease (IPD) and total parkinsonism of 187.6 and 233.4 per 100,000 inhabitants respectively. METHODS Detailed case-finding methods 10 years later were used and a neurologist has verified the diagnosis. RESULTS The crude prevalence of IPD and total parkinsonism was 206.7 per 100,000 and 227.4 per 100,000 respectively. The age-adjusted prevalence is twice as high as data from Norway and Denmark. Age at initiation of treatment and the fatality rate did not explain the increased prevalence. During 1995-2005, the average annual incidence was 21.1 per 100,000 persons for Parkinson's disease, and 22.9 per 100,000 persons, if including atypical parkinsonism. CONCLUSION The high prevalence was verified and linked to a high incidence. The cause of the high prevalence is unknown, but neurotoxic contaminants in traditional food may play a role in the pathogenesis in this population, perhaps jointly with genetic predisposition.
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Affiliation(s)
- L Wermuth
- Department of Neurology, Odense University Hospital, Odense, Denmark.
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Petersen MS, Halling J, Bech S, Wermuth L, Weihe P, Nielsen F, Jørgensen PJ, Budtz-Jørgensen E, Grandjean P. Impact of dietary exposure to food contaminants on the risk of Parkinson's disease. Neurotoxicology 2008; 29:584-90. [DOI: 10.1016/j.neuro.2008.03.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 02/29/2008] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
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Abstract
A large follow-up study in Denmark of 14,088 patients in whom Parkinson's disease was diagnosed at hospital showed a twofold higher incidence of malignant melanoma in these patients than in the general population. In a nested case-control study of 45 patients with malignant melanoma, 97 patients with nonmelanoma skin cancer, and 172 control subjects, we investigated the hypothesis that treatment with levodopa increases the risk for skin cancer. Information on diagnoses and treatment was retrieved from medical records. We observed a significant fourfold to fivefold increase in the risk for malignant melanoma in a subgroup of patients with a probable diagnosis of idiopathic Parkinson's disease as compared with other patients. There was apparently no effect of levodopa on the risk for malignant melanoma as indicated by an odds ratio of 1.0 (95% confidence interval, 0.8-1.3) per 1,000 g cumulative intake of the drug. We conclude that the increased rate of malignant melanoma observed in patients treated at hospital for Parkinson's disease is restricted to those with idiopathic Parkinson's disease, however, unrelated to the treatment with levodopa.
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Affiliation(s)
- Jørgen H Olsen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
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Aspegren K, Bastholt L, Bested KM, Bonnesen T, Ejlersen E, Fog I, Hertel T, Kodal T, Lund J, Madsen JS, Malchow-Møller A, Petersen M, Sørensen B, Wermuth L. Validation of the PHEEM instrument in a Danish hospital setting. Med Teach 2007; 29:498-500. [PMID: 17885982 DOI: 10.1080/01421590701477357] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.
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Affiliation(s)
- K Aspegren
- The Postgraduate Deanery and Office of Medical Education, Faculty of Medicine, Odense, Denmark.
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Wermuth L, Bünger N, Von Weitzel-Mudersback P, Pakkenberg H, Jeune B. Clinical characteristics of Parkinson's disease among Inuit in Greenland and inhabitants of the Faroe Islands and Als (Denmark). Mov Disord 2004; 19:821-824. [PMID: 15254942 DOI: 10.1002/mds.20058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In earlier studies, we found high age-adjusted prevalences of Parkinson's disease (PD) in the Faroe Islands (209 per 100,000 inhabitants) and in Greenland (187.5 per 100,000 inhabitants) compared to the age-adjusted prevalence on the island of Als in the southern part of Denmark (98.3 per 100,000 inhabitants). We thoroughly examined patients with suspected parkinsonism using internationally accepted diagnostic criteria. In the present study, we found no significant clinical differences between patients with PD in the three areas, despite this high difference in prevalence. However, comparing the age at examination and age at treatment, the patients were younger in Greenland, a higher proportion of patients had cognitive decline, and they had a higher mean Hoehn and Yahr rating score, although they received a lower levodopa dose. A higher proportion of the patients in Greenland were newly diagnosed than in the other two areas.
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Affiliation(s)
- Lene Wermuth
- Department of Neurology, Sonderborg Hospital, Denmark
| | - Nick Bünger
- Department of Psychiatry, Odense University Hospital, Denmark
| | | | - Henning Pakkenberg
- Research Laboratory for Stereology and Neuroscience, Bispebjerg Hospital, Denmark
| | - Bernard Jeune
- Epidemiology, Institute of Public Health Ageing Research Centre, University of Southern Denmark, Odense, Denmark
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Wermuth L, Pakkenberg H, Jeune B. High age-adjusted prevalence of Parkinson’s disease among Inuit in Greenland. Int J Circumpolar Health 2004; 63 Suppl 2:369-70. [PMID: 15736687 DOI: 10.3402/ijch.v63i0.17938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lene Wermuth
- Department of Neurology, Soenderborg Hospital, Denmark.
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Abstract
The prevalence of PD among Inuits in Greenland has not been determined. The authors found 40 patients with PD at the prevalence date January 1, 2000. The crude prevalence of PD was estimated to be 81.0 per 100.000 inhabitants born in Greenland. However, owing to the low proportion of 50+ year old Inuits (16.5 vs 33.5% in Denmark) the age-adjusted prevalence was much higher-187.5 per 100,000 persons.
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Affiliation(s)
- Lene Wermuth
- Department of Neurology, Soenderborg Hospital, Denmark.
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Wermuth L, von Weitzel-Mudersbach P, Jeune B. A two-fold difference in the age-adjusted prevalences of Parkinson's disease between the island of Als and the Faroe Islands. Eur J Neurol 2000; 7:655-60. [PMID: 11136351 DOI: 10.1046/j.1468-1331.2000.00131.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With the aim of comparing the previously found high prevalence of idiopathic Parkinson's disease (PD) in the Faroe Islands with the prevalence of PD in an area of Denmark, we used the same case-finding methods for case ascertainment and the same strict criteria to diagnose PD on the island of Als. During the last year before the prevalence date (1 January 1998), we found in various registries from pharmacies, hospital, private neurologist and general practitioners 121 patients with suspected Parkinsonism out of 56,839 inhabitants on the island of Als. After exclusion of those who had other diseases, a total of 79 patients were left for further examinations. Among these we found 58 with PD. The overall prevalence of PD was estimated to be 102.0 and the age-adjusted prevalence to be 98.3 per 100,000 persons compared with 187.6 and 209.0 in the Faroe Islands. Compared with the previous results from the Faroe Islands (prevalence date 1 July 1995) we found an even lower mean age at onset of PD symptoms and at onset of treatment, a lower proportion of definite PD and a lower average dose of levodopa. We therefore conclude that the two-fold higher prevalence in the Faroe Islands than on the island of Als was not due to an early diagnosis and a higher ascertainment of cases with mild PD, which was suggested as being one possible explanation for our previous finding of a high prevalence of PD in the Faroe Islands.
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Affiliation(s)
- L Wermuth
- Department of Neurology, Sonderborg Hospital, Denmark.
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Abstract
Use of methamphetamine, a potent central nervous system stimulant, increased in the early- to mid-1990s in the United States, concentrated in the west, midwest, and south. The use and trade of methamphetamine was facilitated by a fairly simple production process and the involvement of numerous small entrepreneurs as well as drug-trafficking syndicates. National data from the 1994 Drug Abuse Warning network revealed that for the period from 1991 to 1994 methamphetamine use among short-stay hospital patients more than tripled, and methamphetamine-related deaths reported by medical examiner offices nearly tripled. In addition, the Treatment Episode Data Set revealed a 43 percent increase in treatment-program admissions in which clients identified methamphetamine as the primary drug of abuse. Nonetheless, methamphetamine use did not become widespread in the U.S. population. Low-income and unemployed young white men continue to be the group most likely to use methamphetamine, but by the mid-1990s the drug had increased in popularity in more diverse populations and regions. Economic and social pressures experienced by a broad array of Americans may partially explain expanded methamphetamine use; for example, depressed economic conditions in rural and semi-rural areas have contributed to methamphetamine's appeal as a source of income. A "war against drugs" approach has characterized the policy response, with increased criminal justice penalties. A public health approach is recommended, including prevention campaigns, harm-reduction outreach and treatment approaches, and pharmacologic and abstinence-based drug treatment approaches.
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Affiliation(s)
- L Wermuth
- California State University, Chico, USA
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Biernat H, Ellias SA, Wermuth L, Cleary D, de Oliveira Santos EC, Jørgensen PJ, Feldman RG, Grandjean P. Tremor frequency patterns in mercury vapor exposure, compared with early Parkinson's disease and essential tremor. Neurotoxicology 1999; 20:945-52. [PMID: 10693975] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
A new portable tremometer allows determination of tremor intensities at different tremor frequencies. Based on past studies, two tremor frequency windows of similar size were chosen at 3.0-6.5 Hz and 6.6-10.0 Hz to reflect major tremor intensities in Parkinson's disease and mercury vapor poisoning, respectively. In 81 healthy controls, total tremor intensity was higher for the preferred hand and depended on age. Ten patients treated for Parkinson's disease showed substantially increased tremor intensity, especially within the low-frequency window. This pattern was also apparent in 14 patients with de novo Parkinson's disease whose overall tremor intensity was only mildly elevated. In contrast, ten patients with essential tremor had peak frequencies in both windows, and some patients had increased tremor on one side only. Sixty-three Brazilian gold traders exposed to mercury vapor showed increased tremor predominantly in the high-frequency window. Three of the gold traders had a narrower tremor peak at frequencies of 7-8 Hz. While the urine-mercury concentration was significantly associated with the current number of burning sessions per week, it did not correlate with tremor intensities. However, eight traders had a urinary mercury excretion level above 50 microg and at the same time a greatly increased average tremor intensity within the high-frequency window. These patterns were statistically significant for relative tremor intensities, but were less clear when total intensities were used. These observations suggest that the relative distribution of tremor intensities in specific frequency bands may be a valuable supplement to current diagnostic methods for subjects with mercury vapor exposure.
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Affiliation(s)
- H Biernat
- Department of Environmental Medicine, Odense University, Denmark
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Abstract
Pramipexole (SND 919), a potent non-ergot dopamine agonist, or placebo, was administered to 69 patients with advanced Parkinson's disease (33 received placebo, 36 received pramipexole) in a double-blind, randomized, multi-center study in which individually optimized doses of L-dopa plus a dopa decarboxylase inhibitor were associated with dyskinesia, "on-off" fluctuation, dystonia, akinesia, or end-of-dose deterioration. Study medication was titrated over 7 weeks to the maximal tolerated dose or to the maximal dose allowed by the study (5 mg/day in four divided doses). Dosing was maintained for 4 weeks and then tapered during the final week. Total score on the Unified Parkinson's Disease Rating Scale (UPDRS) for the intent-to-treat population was significantly improved in the pramipexole-treated group compared with the placebo-treated group (16.9 +/- 14.9 vs 9.0 +/- 16.1; p = 0.0184). By the end of maintenance, the mean reduction in L-dopa requirement was -150.7 mg for pramipexole-treated patients compared to -10.6 for placebo-treated patients. The most common adverse events (< 10%) were dizziness, insomnia, nausea, and postural hypotension. Aggravated parkinsonism occurred only after withdrawal of the study medication. Treatment with pramipexole in doses up to 5 mg/day was safe and well tolerated by patients with advanced Parkinson's disease.Copyright Lippincott-Raven Publishers
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Affiliation(s)
- L Wermuth
- Department of Neurology, Odense University Hospital, 5000, Odense C, Denmark
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Abstract
We used several case-findings methods and strict criteria for case ascertainment to diagnose parkinsonism and idiopathic Parkinson's disease (PD) in the Faroe Islands. In the last few years before the prevalence date of July 1, 1995, we searched various registries from pharmacies, hospitals, and general practices, and found 195 patients with suspected parkinsonism out of 43,709 inhabitants. After excluding those who died before the prevalence date or were treated with levodopa (LD) for other diseases, a total of 124 patients remained for study, of whom 122 participated. We found 102 patients with parkinsonism and 82 with PD versus the expected 53 (p < 0.001, age-specific prevalences in the county of Rogaland, Norway). The overall prevalence of PD was estimated to be 187.6 and the age-adjusted prevalence to be 183.3 versus 110.9 per 100,000 inhabitants in the county of Rogaland. Compared to the study from Rogaland, the mean age at onset of PD symptoms, the mean age at the prevalence date, and the duration of PD indicated that the higher prevalence was not due to either an early onset nor to a longer duration of PD. A lower proportion of definite PD, a lower mean score on the Hoehn-Yahr scale, and a lower average dose of LD suggest that the high prevalence may be due to early diagnosis and a higher ascertainment of cases with mild disease. However, a high incidence cannot be excluded.
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Affiliation(s)
- L Wermuth
- Department of Neurology, Odense University Hospital, Denmark
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Affiliation(s)
- L Wermuth
- California State University, Chico 95929-0445, USA
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