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Bu S, Pang H, Li X, Zhao M, Wang J, Liu Y, Yu H. Multi-parametric radiomics of conventional T1 weighted and susceptibility-weighted imaging for differential diagnosis of idiopathic Parkinson's disease and multiple system atrophy. BMC Med Imaging 2023; 23:204. [PMID: 38066432 PMCID: PMC10709839 DOI: 10.1186/s12880-023-01169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aims to investigate the potential of radiomics with multiple parameters from conventional T1 weighted imaging (T1WI) and susceptibility weighted imaging (SWI) in distinguishing between idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). METHODS A total of 201 participants, including 57 patients with PD, 74 with MSA, and 70 healthy control (HCs) individuals, underwent T1WI and SWI scans. From the 12 subcortical nuclei (e.g. red nucleus, substantia nigra, subthalamic nucleus, putamen, globus pallidus, and caudate nucleus), 2640 radiomic features were extracted from both T1WI and SWI scans. Three classification models - logistic regression (LR), support vector machine (SVM), and light gradient boosting machine (LGBM) - were used to distinguish between MSA and PD, as well as among MSA, PD, and HC. These classifications were based on features extracted from T1WI, SWI, and a combination of T1WI and SWI. Five-fold cross-validation was used to evaluate the performance of the models with metrics such as sensitivity, specificity, accuracy, and area under the receiver operating curve (AUC). During each fold, the ANOVA and least absolute shrinkage and selection operator (LASSO) methods were used to identify the most relevant subset of features for the model training process. RESULTS The LGBM model trained by the features combination of T1WI and SWI exhibited the most outstanding differential performance in both the three-class classification task of MSA vs. PD vs. HC and the binary classification task of MSA vs. PD, with an accuracy of 0.814 and 0.854, and an AUC of 0.904 and 0.881, respectively. The texture-based differences (GLCM) of the SN and the shape-based differences of the GP were highly effective in discriminating between the three classes and two classes, respectively. CONCLUSIONS Radiomic features combining T1WI and SWI can achieve a satisfactory differential diagnosis for PD, MSA, and HC groups, as well as for PD and MSA groups, thus providing a useful tool for clinical decision-making based on routine MRI sequences.
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Affiliation(s)
- Shuting Bu
- Department of Radiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Huize Pang
- Department of Radiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Xiaolu Li
- Department of Radiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Mengwan Zhao
- Department of Radiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Juzhou Wang
- Department of Radiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Yu Liu
- Department of Radiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Hongmei Yu
- Department of Neurology, the First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning, 110001, PR China.
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An EJ, Sim WS, Kim SM, Kim JY. Suitability of visual cues for freezing of gait in patients with idiopathic Parkinson's disease: a case-control pilot study. J Neuroeng Rehabil 2023; 20:91. [PMID: 37464390 PMCID: PMC10354967 DOI: 10.1186/s12984-023-01214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is one of the most debilitating symptoms in patients with idiopathic Parkinson's disease (IPD). Visual cues can relieve FOG symptoms. However, there is no consensus on patient characteristics that can benefit from visual cues. Therefore, we examined the differences in IPD patient characteristics according to the effectiveness of visual cueing. METHODS Through gait experiments, we investigated the number of FOG occurrences, average FOG period per episode, proportion of FOG duration in the total gait cycles, and FOG-free period gait spatiotemporal parameters in ten participants diagnosed with FOG due to IPD. Subsequently, the differences between their clinical characteristics and striatal dopamine active transporter availability from six subregions of the striatum were compared by dividing them into two groups based on the three reduction rates: occurrence numbers, mean durations per episode, and proportion of FOG duration in the total gait cycles improved by visual cueing using laser shoes. The relationships among these three reduction rates and other FOG-related parameters were also investigated using Spearman correlation analyses. RESULTS According to the three FOG-related reduction rates, the group assignments were the same, which was also related to the baseline self-reported FOG severity score (New Freezing of Gait Questionnaire): the more severe the FOG, the poorer the response to the visual cueing. By visual cueing, the better response group demonstrated the characteristics of lower new FOG questionnaire total scores, higher dopamine active transporter availability of the anterior and posterior putamen, and shorter mean duration of FOG per episode in the absence of cueing. These results were replicated using Spearman correlation analyses. CONCLUSIONS For FOG symptoms following IPD, gait assistance by visual cueing may be more effective when the total NFOGQ score is lower and the DAT of putamen is higher. Through this study, we demonstrated clinical and striatal dopaminergic conditions to select patients who may be more likely to benefit from visual cueing with laser shoes, and these findings lead to the need for early diagnosis of FOG in patients with IPD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05080413. Registered on September 14, 2021.
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Affiliation(s)
- Eui Jin An
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Woo-Sob Sim
- Department of Prosthetics and Orthotics Center, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Seung Min Kim
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jun Yup Kim
- Department of Physical Medicine and Rehabilitation, Hanyang University Medical Center, Seoul, Republic of Korea.
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea.
- Mailing address:, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Su HC, Sun YT, Yang MY, Wu CY, Hsu CM. Dihydroisotanshinone I and BMAL-SIRT1 Pathway in an In Vitro 6-OHDA-Induced Model of Parkinson's Disease. Int J Mol Sci 2023; 24:11088. [PMID: 37446264 DOI: 10.3390/ijms241311088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Danshen has been widely used for the treatment of central nervous system diseases. We investigated the effect of dihydroisotanshinone I (DT), a compound extracted from Danshen, as well as the corresponding mechanisms in an in vitro-based 6-OHDA-induced Parkinson's disease (PD) model. SH-SY5Y human neuroblastoma cell lines were pretreated with 6-hydroxydopamine (6-OHDA) and challenged with DT. Subsequently, the cell viability and levels of reactive oxygen species (ROS) and caspase-3 were analyzed. The effect of DT on the 6-OHDA-treated SH-SY5Y cells and the expression of the core circadian clock genes were measured using a real-time quantitative polymerase chain reaction. Our results indicated that DT attenuated the 6-OHDA-induced cell death in the SH-SY5Y cells and suppressed ROS and caspase-3. Moreover, DT reversed both the RNA and protein levels of BMAL1 and SIRT1 in the 6-OHDA-treated SH-SY5Y cells. Additionally, the SIRT1 inhibitor attenuated the effect of DT on BMAL1 and reduced the cell viability. The DT and SIRT1 activators activated SIRT1 and BMAL1, and then reduced the death of the SH-SY5Y cells damaged by 6-OHDA. SIRT1 silencing was enhanced by DT and resulted in a BMAL1 downregulation and a reduction in cell viability. In conclusion, our investigation suggested that DT reduces cell apoptosis, including an antioxidative effect due to a reduction in ROS, and regulates the circadian genes by enhancing SIRT1 and suppressing BMAL1. DT may possess novel therapeutic potential for PD in the future, but further in vivo studies are still needed.
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Affiliation(s)
- Hui-Chen Su
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ming-Yu Yang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Ching-Yuan Wu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Cancer Center, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Seong M, Park S, Sung YH, Kim EY. Diagnostic performance of a high-spatial-resolution voxelwise analysis of neuromelanin-sensitive imaging in early-stage idiopathic Parkinson's disease. BMC Med Imaging 2023; 23:64. [PMID: 37202720 DOI: 10.1186/s12880-023-01018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Quantitative assessments of neuromelanin (NM) of the substantia nigra pars compacta (SNpc) in neuromelanin-sensitive MRI (NM-MRI) to determine its abnormality have been conducted by measuring either the volume or contrast ratio (CR) of the SNpc. A recent study determined the regions in the SNpc that are significantly different between early-stage idiopathic Parkinson's disease (IPD) patients and healthy controls (HCs) using a high spatial-resolution NM-MRI template, which enables a template-based voxelwise analysis to overcome the susceptibility of CR measurement to inter-rater discrepancy. We aimed to assess the diagnostic performance, which has not been reported, of the CRs between early-stage IPD patients and HCs using a NM-MRI template. METHODS We retrospectively enrolled early-stage IPD patients (n = 50) and HCs (n = 50) who underwent 0.8-mm isovoxel NM-MRI and dopamine-transporter PET as the standard of reference. A template-based voxelwise analysis revealed two regions in nigrosomes 1 and 2 (N1 and N2, respectively), with significant differences in each substantia nigra (SNpc) between IPD and HCs. The mean CR values of N1, N2, volume-weighted mean of N1 and N2 (N1 + N2), and whole SNpc on each side were compared between IPD and HC using the independent t-test or the Mann-Whitney U test. The diagnostic performance was compared in each region using receiver operating characteristic curves. RESULTS The mean CR values in the right N1 (0.149459 vs. 0.194505), left N1 (0.133328 vs. 0.169160), right N2 (0.230245 vs. 0.278181), left N2 (0.235784 vs. 0.314169), right N1 + N2 (0.155322 vs. 0.278143), left N1 + N2 (0.140991 vs. 0.276755), right whole SNpc (0.131397 vs. 0.141422), and left whole SNpc (0.127099 vs. 0.137873) significantly differed between IPD patients and HCs (all p < 0.001). The areas under the curve of the left N1 + N2, right N1 + N2, left N1, right N1, left N2, right N2, left whole SNpc, and right whole SNpc were 0.994 (sensitivity, 98.0%; specificity, 94.0%), 0.985, 0.804, 0.802, 0.777, 0.766, 0.632, and 0.606, respectively. CONCLUSION Our NM-MRI template-based CR measurements revealed significant differences between early-stage IPD patients and HCs. The CR values of the left N1 + N2 demonstrated the highest diagnostic performance.
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Affiliation(s)
- Minjung Seong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | | | - Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Pavelka L, Rauschenberger A, Landoulsi Z, Pachchek S, Marques T, Gomes CP, Glaab E, May P, Krüger R. Body-First Subtype of Parkinson's Disease with Probable REM-Sleep Behavior Disorder Is Associated with Non-Motor Dominant Phenotype. J Parkinsons Dis 2022; 12:2561-2573. [PMID: 36245388 PMCID: PMC9837682 DOI: 10.3233/jpd-223511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The hypothesis of body-first vs. brain-first subtype of PD has been proposed with REM-Sleep behavior disorder (RBD) defining the former. The body-first PD presumes an involvement of the brainstem in the pathogenic process with higher burden of autonomic dysfunction. OBJECTIVE To identify distinctive clinical subtypes of idiopathic Parkinson's disease (iPD) in line with the formerly proposed concept of body-first vs. brain-first subtypes in PD, we analyzed the presence of probable RBD (pRBD), sex, and the APOEɛ4 carrier status as potential sub-group stratifiers. METHODS A total of 400 iPD patients were included in the cross-sectional analysis from the baseline dataset with a completed RBD Screening Questionnaire (RBDSQ) for classifying as pRBD by using the cut-off RBDSQ≥6. Multiple regression models were applied to explore (i) the effect of pRBD on clinical outcomes adjusted for disease duration and age, (ii) the effect of sex on pRBD, and (iii) the association of APOEɛ4 and pRBD. RESULTS iPD-pRBD was significantly associated with autonomic dysfunction (SCOPA-AUT), level of depressive symptoms (BDI-I), MDS-UPDRS I, hallucinations, and constipation, whereas significantly negatively associated with quality of life (PDQ-39) and sleep (PDSS). No significant association between sex and pRBD or APOE ɛ4 and pRBD in iPD was found nor did we determine a significant effect of APOE ɛ4 on the PD phenotype. CONCLUSION We identified an RBD-specific PD endophenotype, characterized by predominant autonomic dysfunction, hallucinations, and depression, corroborating the concept of a distinctive body-first subtype of PD. We did not observe a significant association between APOE ɛ4 and pRBD suggesting both factors having an independent effect on cognitive decline in iPD.
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Affiliation(s)
- Lukas Pavelka
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg,Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg,Correspondence to: Lukas Pavelka, MD, Physician scientist, National Centre for Excellence in Research in Parkinson’s disease. Tel.: +352 621621578; E-mail: and Prof. Rejko Krüger, MD, Coordinator of Luxembourg National Centre for Excellence in Research in Parkinson’s disease. Tel.: +352 26 970 458; E-mail:
| | - Armin Rauschenberger
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Zied Landoulsi
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
| | - Sinthuja Pachchek
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg,Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Taina Marques
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Clarissa P.C. Gomes
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Enrico Glaab
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Patrick May
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
| | - Rejko Krüger
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg,Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg,Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg,Correspondence to: Lukas Pavelka, MD, Physician scientist, National Centre for Excellence in Research in Parkinson’s disease. Tel.: +352 621621578; E-mail: and Prof. Rejko Krüger, MD, Coordinator of Luxembourg National Centre for Excellence in Research in Parkinson’s disease. Tel.: +352 26 970 458; E-mail:
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Batum M, Ak AK, Arı MS, Mayali H, Kurt E, Selçuki D. Evaluation of the visual system with visual evoked potential and optical coherence tomography in patients with idiopathic Parkinson's disease and with multiple system atrophy. Doc Ophthalmol 2022; 145:99-112. [PMID: 35881261 DOI: 10.1007/s10633-022-09887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In addition to motor findings, non-motor findings including alterations in visual acuity, decrease in blink reflex, and pupil reactivity cause the impaired quality of life in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). Our study aimed to examine possible latency and amplitude changes in pattern visual evoked potentials (pVEP) along with retinal and macular changes in optical coherence tomography (OCT) in PD and MSA groups. We also intended to investigate whether any OCT parameters could be a biomarker for Parkinson's or MSA. METHODS Our study included 50 patients with PD, 15 with MSA, and 50 healthy control subjects. All patients in the study underwent neurological and ophthalmological examination and investigations of OCT to measure the retinal and macular thickness and pVEP to assess visual pathways. RESULTS When PD, MSA, and control groups were compared, a significant difference was found in all retinal thickness values in average, nasal, and superior retinal nerve fiber thickness (pRNFL), and in all macular thickness values except nasal outer and inferior outer quadrants and in ganglion cell complex (GCC) thicknesses (p < 0.05). Moreover, a significant difference was found in N75, P100, and N145 latencies and N75-P100 amplitude (p < 0.05). The thickness of both pRNFL, inner and outer macular quadrants, was thinner in the MSA group than in PD but GCC thickness was thinner in PD group. CONCLUSIONS The present study compared pVEP and OCT parameters in PD and MSA groups. It was concluded that pVEP and OCT examinations were of importance in that they were easily accessible, affordable, noninvasive biomarkers that might be used in early periods and progression of the disease and in follow-up.
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Affiliation(s)
- Melike Batum
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey.
| | - Ayşın Kısabay Ak
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Mehmet Semih Arı
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Hüseyin Mayali
- Department of Eye Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Emin Kurt
- Department of Eye Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Deniz Selçuki
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
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Zhao H, Tsai CC, Zhou M, Liu Y, Chen YL, Huang F, Lin YC, Wang JJ. Deep learning based diagnosis of Parkinson's Disease using diffusion magnetic resonance imaging. Brain Imaging Behav 2022; 16:1749-1760. [PMID: 35285004 DOI: 10.1007/s11682-022-00631-y] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/31/2022]
Abstract
The diagnostic performance of a combined architecture on Parkinson's disease using diffusion tensor imaging was evaluated. A convolutional neural network was trained from multiple parcellated brain regions. A greedy algorithm was proposed to combine the models from individual regions into a complex one. Total 305 Parkinson's disease patients (aged 59.9±9.7 years old) and 227 healthy control subjects (aged 61.0±7.4 years old) were enrolled from 3 retrospective studies. The participants were divided into training with ten-fold cross-validation (N = 432) and an independent blind dataset (N = 100). Diffusion-weighted images were acquired from a 3T scanner. Fractional anisotropy and mean diffusivity were calculated and was subsequently parcellated into 90 cerebral regions of interest based on the Automatic Anatomic Labeling template. A convolutional neural network was implemented which contained three convolutional blocks and a fully connected layer. Each convolutional block consisted of a convolutional layer, activation layer, and pooling layer. This model was trained for each individual region. A greedy algorithm was implemented to combine multiple regions as the final prediction. The greedy algorithm predicted the area under curve of 94.1±3.2% from the combination of fractional anisotropy from 22 regions. The model performance analysis showed that the combination of 9 regions is equivalent. The best area under curve was 74.7±5.4% from the right postcentral gyrus. The current study proposed an architecture of convolutional neural network and a greedy algorithm to combine from multiple regions. With diffusion tensor imaging, the algorithm showed the potential to distinguish patients with Parkinson's disease from normal control with satisfactory performance.
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Affiliation(s)
- Hengling Zhao
- School of Information and Communication Engineering, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Chih-Chien Tsai
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Mingyi Zhou
- School of Information and Communication Engineering, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Yipeng Liu
- School of Information and Communication Engineering, University of Electronic Science and Technology of China (UESTC), Chengdu, China.
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Fan Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Yu-Chun Lin
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. .,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan. .,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. .,Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan.
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Wagner L, Deck R. [Implementation of an individualized tablet-based training program in the domestic setting following complex treatment of Parkinson's disease-Success factors and barriers]. Nervenarzt 2021; 93:583-591. [PMID: 34622319 PMCID: PMC9200696 DOI: 10.1007/s00115-021-01202-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Regular physical activity is of great relevance in Parkinson's disease. As part of the project "Individualized training program for Parkinson's disease patients" (ParkProTrain), a tablet-based program was developed to support individual self-training. It has been tested over a period of 9 months in domestic settings. Patients were asked about the feasibility of use and satisfaction. METHODS Patients who used the program at home following inpatient Parkinson's complex treatment (PCT) were interviewed twice (9 and 36 weeks after PCT). RESULTS The program helped patients to stay motivated throughout the interventional period. It provided them with both structure and flexibility to develop their own training routine. The following were named as positive aspects (success factors), including: the introductory seminars in the clinic, the close supervision during the interventional period, the soundness and Parkinson's specificity, the feasibility and manageability of the program and the individualized training plans; however, patients also provided information on how the program could still be optimized (barriers). DISCUSSION The program has already successfully implemented a number of aspects that promote activity. Further recommendations were derived for future use, to which more attention should be paid: Parkinson's specificity and individualization of the program, flexible training in terms of location and time, close and personal support throughout the study period and the technique should be designed to be easy to learn and manage.
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Affiliation(s)
- Lynn Wagner
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
| | - Ruth Deck
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
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Carricarte Naranjo C, Marras C, Visanji NP, Cornforth DJ, Sanchez-Rodriguez L, Schüle B, Goldman SM, Estévez M, Stein PK, Lang AE, Jelinek HF, Machado A. Short-term deceleration capacity of heart rate: a sensitive marker of cardiac autonomic dysfunction in idiopathic Parkinson's disease. Clin Auton Res 2021. [PMID: 34251546 DOI: 10.1007/s10286-021-00815-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cardiac autonomic dysfunction in idiopathic Parkinson's disease (PD) manifests as reduced heart rate variability (HRV). In the present study, we explored the deceleration capacity of heart rate (DC) in patients with idiopathic PD, an advanced HRV marker that has proven clinical utility. METHODS Standard and advanced HRV measures derived from 7-min electrocardiograms in 20 idiopathic PD patients and 27 healthy controls were analyzed. HRV measures were compared using regression analysis, controlling for age, sex, and mean heart rate. RESULTS Significantly reduced HRV was found only in the subcohort of PD patients older than 60 years. Low- frequency power and global HRV measures were lower in patients than in controls, but standard beat-to-beat HRV markers (i.e., rMSSD and high-frequency power) were not significantly different between groups. DC was significantly reduced in the subcohort of PD patients older than 60 years compared to controls. CONCLUSIONS Deceleration-related oscillations of HRV were significantly reduced in the older PD patients compared to healthy controls, suggesting that short-term DC may be a sensitive marker of cardiac autonomic dysfunction in PD. DC may be complementary to traditional markers of short-term HRV for the evaluation of autonomic modulation in PD. Further study to examine the association between DC and cardiac adverse events in PD is needed to clarify the clinical relevance of DC in this population.
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GÜLER S, CAYLAN A, TURAN FN, DAĞDEVİREN N. Prevalence and Clinical Features of Idiopathic Parkinson's Disease in Western Turkey. Noro Psikiyatr Ars 2021; 59:98-104. [PMID: 35685054 PMCID: PMC9142027 DOI: 10.29399/npa.27486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/08/2021] [Indexed: 06/15/2023] Open
Abstract
Introduction We aimed to determine the prevalence and risk factors of idiopathic Parkinson's disease (IPD) in Western Turkey, which encompasses Edirne and its surrounding districts. Methods In this study, 9887 individuals, able to communicate and agreed to participate in the study, were evaluated. The data was obtained by answering a face-to-face questionnaire consisting of 53 questions from volunteers living at 30 randomly selected family health centers in Edirne and its counties. The questionnaire included demographic information, questions to evaluate potential concomitant conditions, and questions regarding the symptomatology used in IPD diagnosis. Following the questionnaire, it was planned to determine the degree of IPD with the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale (HY) clinical rating scale in patients diagnosed with IPD to assess disease severity in patients diagnosed with IPD. Results Of the 9887 individuals, 118 were diagnosed with IPD according to the questionnaire results from Edirne and its districts, and the prevalence of IPD was 1.2%. Approximately, 58.4% of the patients with IPD were male and 41.6% were female, which was not significantly different (p=0.214). Non-motor symptoms such as difficulty urinating, anxiety, depression, fatigue, REM sleep behavior disorder, and difficulty falling asleep or staying asleep were also examined in patients diagnosed with IPD. Depression was identified in 45.7% of the cases, while the control group was 4.3% (p=0.001). Fatigue was identified in 46.8% of the cases and control group was 3.5% (p=0.002). Conclusions IPD prevalence studies will increase the awareness in the community and provide early diagnosis and treatment as well as serve as a basis to increased life expectancy, reduce morbidity, and improve life quality.
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Affiliation(s)
- Sibel GÜLER
- Department of Neurology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Ayşe CAYLAN
- Department of Family Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
| | - F. Nesrin TURAN
- Department of, Biostatistics Trakya University Faculty of Medicine, Edirne, Turkey
| | - Nezih DAĞDEVİREN
- Department of Family Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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11
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Fernandes C, Ferreira F, Lopes RL, Bicho E, Erlhagen W, Sousa N, Gago MF. Discrimination of idiopathic Parkinson's disease and vascular parkinsonism based on gait time series and the levodopa effect. J Biomech 2021; 125:110214. [PMID: 34171610 DOI: 10.1016/j.jbiomech.2020.110214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 11/16/2022]
Abstract
Idiopathic Parkinson's disease (IPD) and vascular parkinsonism (VaP) present highly overlapping phenotypes, making it challenging to distinguish between these two parkinsonian syndromes. Recent evidence suggests that gait assessment and response to levodopa medication may assist in the objective evaluation of clinical differences. In this paper, we propose a new approach for gait pattern differentiation that uses convolutional neural networks (CNNs) based on gait time series with and without the influence of levodopa medication. Wearable sensors positioned on both feet were used to acquire gait data from 14 VaP patients, 15 IPD patients, and 34 healthy subjects. An individual's gait features are affected by physical characteristics, including age, height, weight, sex, and walking speed or stride length. Therefore, to reduce bias due to intersubject variations, a multiple regression normalization approach was used to obtain gait data. Recursive feature elimination using the linear support vector machine, lasso, and random forest were applied to infer the optimal feature subset that led to the best results. CNNs were implemented by means of various hyperparameters and feature subsets. The best CNN classifiers achieved accuracies of 79.33%±6.46, 82.33%±10.62, and 86.00%±7.12 without (off state), with (on state), and with the simultaneous consideration of the effect of levodopa medication (off/on state), respectively. The response to levodopa medication improved classification performance. Based on gait time series and response to medication, the proposed approach differentiates between IPD and VaP gait patterns and reveals a high accuracy rate, which might prove useful when distinguishing other diseases related to movement disorders.
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Affiliation(s)
| | | | | | - Estela Bicho
- Algoritmi Center, University of Minho, Portugal.
| | | | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal; ICVS-3Bs PT Government Associate Laboratory, Portugal.
| | - Miguel F Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal; ICVS-3Bs PT Government Associate Laboratory, Portugal; Neurology Department, Hospital da Senhora da Oliveira, Guimarães, EPE, Portugal
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12
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D'Iorio A, Esposito M, Maggi G, Amboni M, Vitale C, Santangelo G. Neuropsychological correlates of prospective memory: A comparison between tremor-dominant Parkinson's disease and cervical dystonia. J Clin Neurosci 2021; 87:156-161. [PMID: 33863525 DOI: 10.1016/j.jocn.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 11/19/2022]
Abstract
Cervical Dystonia (CD) and Parkinson's disease, particularly tremor-dominant motor phenotype (TD-PD), showed a selective deficit of time-based prospective memory (TBPM). The two movement disorders are mainly characterized by dysfunctions of basal-ganglia and prefrontal cortex but it is reported that cerebellum also plays a key role in their pathogenesis. These cerebral structures are specifically involved in TBPM rather than in event-based PM (EBPM), but until now no study directly compared these two components of PM between CD and TD-PD patients. Therefore, the present study aimed at investigating if differences in PM functioning between CD and TD-PD patients might exist and if the type of movement disorder moderated the relationship between deficit of PM and deficit of executive functions and retrospective memory. Thirty TD-PD, 27CD patients and 29 healthy subjects (HCs), matched for demographic features, underwent neuropsychological tests for PM, executive functions, retrospective memory and self-rated questionnaires. The three groups did not differ on neuropsychological variables except for TBPM where TD-PD and CD patients performed worse than HCs; moreover, TD-PD performed worse than CD patients. Moderation analysis indicated that the type of movement disorder moderated the relationship between executive dysfunction and TBPM, but not EBPM. In conclusion, selective deficit of TBPM characterizes both CD and TD-PD but it is associated with executive dysfunction only in TD-PD. It might be possible to speculate that the involvement of the cerebellum, responsible for internal timing processes, could explain the impairment of TBPM in both movement disorders. This issue deserves to be explored in future neuroimaging studies.
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Affiliation(s)
- Alfonsina D'Iorio
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Marcello Esposito
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy; Clinical Neurophysiology Unit, Cardarelli Hospital, Naples, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Marianna Amboni
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Carmine Vitale
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy; Department of Motor Sciences and Wellness, University "Parthenope", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy.
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13
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Kannenberg S, Caspers J, Dinkelbach L, Moldovan AS, Ferrea S, Südmeyer M, Butz M, Schnitzler A, Hartmann CJ. Investigating the 1-year decline in midbrain-to-pons ratio in the differential diagnosis of PSP and IPD. J Neurol 2020; 268:1526-1532. [PMID: 33277666 PMCID: PMC7990839 DOI: 10.1007/s00415-020-10327-2] [Citation(s) in RCA: 1] [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: 06/18/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/03/2022]
Abstract
Background A reliable measure of PSP-specific midbrain atrophy, the midbrain-to-pons ratio (MTPR) has been reported to support the differential diagnosis of progressive supranuclear palsy (PSP) from idiopathic Parkinson’s disease (IPD). Since longitudinal analyses are lacking so far, the present study aimed to evaluate the diagnostic value of the relative change of MTPR (relΔt_MTPR) over a 1-year period in patients with PSP, IPD, and healthy controls (HC). Methods Midsagittal individual MRIs of patients with PSP (n = 15), IPD (n = 15), and healthy controls (HC; n = 15) were assessed and the MTPR at baseline and after 1 year were defined. The diagnostic accuracy of the MTPR and its relative change were evaluated using ROC curve analyses. Results PSP-patients had a significantly lower MTPR at baseline (M = 0.45 ± 0.06), compared to both non-PSP groups (F (2, 41) = 62.82, p < 0.001), with an overall predictive accuracy of 95.6% for an MTPR ≤ 0.54. PSP-patients also presented a significantly stronger 1-year decline in MTPR compared to IPD (p < 0.001). Though predictive accuracy of relΔt_MTPR for PSP (M = − 4.74% ± 4.48) from IPD (M = + 1.29 ± 3.77) was good (76.6%), ROC analysis did not reveal a significant improvement of diagnostic accuracy by combining the MTPR and relΔt_MTPR (p = 0.670). Still, specificity for PSP increased, though not significantly (p = 0.500). Conclusion The present results indicate that the relΔt_MTPR is a potentially useful tool to support the differential diagnosis of PSP from IPD. For its relative 1-year change, still, more evaluation is needed.
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Affiliation(s)
- Silja Kannenberg
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Lars Dinkelbach
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Alexia-S Moldovan
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.,Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Stefano Ferrea
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.,Department of Neurology, Ernst Von Bergmann Hospital, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Christian J Hartmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.,Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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14
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Unger MM, Becker A, Keller A, Schäfer KH, Schwiertz A, Oertel WH. [The role of the gut microbiome in idiopathic Parkinson's disease]. Nervenarzt 2020; 91:1085-95. [PMID: 33025073 DOI: 10.1007/s00115-020-01011-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In recent years studies have provided increasing evidence suggesting an association between the (gut) microbiome and idiopathic Parkinson's disease (IPD). OBJECTIVE The aim of this article is to summarize and evaluate existing evidence with respect to the relevance of the (gut) microbiome for IPD. MATERIAL AND METHODS An analysis and critical review of studies in the field of IPD and (gut) microbiome were carried out. The resulting potential perspectives and therapeutic strategies are discussed. RESULTS Despite partially divergent results between different studies (potentially due to the applied methods and variance in the composition of the investigated cohorts), there is an overlap between studies indicating an association between IPD, the microbiome and microbial metabolites. Nevertheless, the cause-effect relationship between IPD and the microbiome has still not been clarified. Taken together, existing evidence supports a potentially relevant role for the microbiome with respect to typical disease symptoms and pathogenesis of the disease. CONCLUSION Over the past 5 years there has been an enormous increase in the evidence with respect to the relevance of the microbiome for IPD. While early work in this field was mainly descriptive, new diagnostic methods provide evidence for the underlying mechanisms and the complex interactions between man as the host, the human immune system, the enteric nervous system, gut microbiota and microbial metabolites. A relatively novel and clinically relevant field of research is how the gut microbiome can influence the success of oral pharmacotherapy and whether substitution of specific microbiome components might be used either for future therapeutic or prophylactic strategies.
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15
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Sackley CM, Rick C, Au P, Brady MC, Beaton G, Burton C, Caulfield M, Dickson S, Dowling F, Hughes M, Ives N, Jowett S, Masterson-Algar P, Nicoll A, Patel S, Smith CH, Woolley R, Clarke CE. A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial. Trials 2020; 21:436. [PMID: 32460885 PMCID: PMC7251680 DOI: 10.1186/s13063-020-04354-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. METHODS/DESIGN PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. PRIMARY OUTCOME Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. DISCUSSION The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.
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Affiliation(s)
- C. M. Sackley
- Population Health Sciences, Addison House, King’s College London, Guy’s Campus, London, SE1 1UL UK
- School of Health Science, University of Nottingham, QMC, Nottingham, NG7 2HA UK
| | - C. Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - P. Au
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - M. C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - G. Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C. Burton
- School of Allied and Public Health Professions, Canterbury Christ church University, Canterbury, CT1 1QU UK
| | - M. Caulfield
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - S. Dickson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - F. Dowling
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - M. Hughes
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - N. Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - S. Jowett
- Health Economics, University of Birmingham, Birmingham,, B15 2TT UK
| | - P. Masterson-Algar
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - A. Nicoll
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - S. Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - R. Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham,, B18 7QH UK
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16
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Giehl K, Ophey A, Reker P, Rehberg S, Hammes J, Barbe MT, Zokaei N, Eggers C, Husain M, Kalbe E, van Eimeren T. Effects of Home-Based Working Memory Training on Visuo-Spatial Working Memory in Parkinson's Disease: A Randomized Controlled Trial. J Cent Nerv Syst Dis 2020; 12:1179573519899469. [PMID: 32002011 PMCID: PMC6966247 DOI: 10.1177/1179573519899469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive impairment is a very frequent and severe nonmotor symptom of Parkinson's disease (PD). Early intervention in this at-risk group for cognitive decline may be crucial for long-term preservation of cognitive functions. Computerized working memory training (WMT) has been proven beneficial in non-PD patient populations, but such evidence is still needed for patients with PD. OBJECTIVE This study aimed to evaluate the effect of WMT on visuo-spatial working memory (WM) in cognitively unimpaired patients with PD. METHODS A single-blind randomized controlled trial encompassing 76 patients with PD but no cognitive impairment according to level II diagnostic criteria was conducted. Thirty-seven patients engaged in home-based adaptive WMT 5 times per week for a period of 5 weeks, whereas the remaining patients were in the waiting list arm of the study (control group [CG]). Working memory performance was evaluated using a computerized task before and after intervention and at 14-week follow-up, allowing to quantify the precision of WM on a continuous scale, ie, to test not only if an item was remembered but also how well the location of this item was retained. RESULTS Coincidently, the WMT group showed slightly worse WM performance compared with the CG at baseline, which was ameliorated after WMT. This training-induced effect remained stable until follow-up. CONCLUSION Patients showing relatively low WM performance, despite not formally diagnosable as Parkinson's disease with mild cognitive impairment (PD-MCI), seem to benefit from home-based WMT. Thus, WMT could potentially be implemented in future trials as a time- and cost-efficient route to counteract subtle cognitive changes in early disease stages. TRIAL REGISTRATION German Clinical Trial Register (drks.de, DRKS00009379).
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Affiliation(s)
- Kathrin Giehl
- Multimodal Neuroimaging Group,
Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Anja Ophey
- Department of Medical Psychology,
Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and
Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Paul Reker
- Department of Neurology, University
Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne,
Germany
| | - Sarah Rehberg
- Department of Medical Psychology,
Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and
Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group,
Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, University
Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne,
Germany
| | - Nahid Zokaei
- Oxford Centre for Human Brain Activity,
Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University
of Oxford, Oxford, UK
| | - Carsten Eggers
- Department of Neurology, University
Hospital of Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg,
Germany
- Center for Mind, Brain and Behavior,
Philipps-University of Marburg and Justus Liebig University Giessen, Marburg,
Germany
| | - Masud Husain
- Nuffield Department of Clinical
Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology,
University of Oxford, Oxford, UK
| | - Elke Kalbe
- Department of Medical Psychology,
Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and
Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Thilo van Eimeren
- Multimodal Neuroimaging Group,
Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
- Department of Neurology, University
Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne,
Germany
- German Center for Neurodegenerative
Diseases (DZNE), Bonn, Germany
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17
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Galazky I, Kaufmann J, Voges J, Hinrichs H, Heinze HJ, Sweeney-Reed CM. Neuronal spiking in the pedunculopontine nucleus in progressive supranuclear palsy and in idiopathic Parkinson's disease. J Neurol 2019; 266:2244-2251. [PMID: 31155683 DOI: 10.1007/s00415-019-09396-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022]
Abstract
The pedunculopontine nucleus (PPN) is engaged in posture and gait control, and neuronal degeneration in the PPN has been associated with Parkinsonian disorders. Clinical outcomes of deep brain stimulation of the PPN in idiopathic Parkinson's disease (IPD) and progressive supranuclear palsy (PSP) differ, and we investigated whether the PPN is differentially affected in these conditions. We had the rare opportunity to record continuous electrophysiological data intraoperatively in 30 s blocks from single microelectrode contacts implanted in the PPN in six PSP patients and three IPD patients during rest, passive movement, and active movement. Neuronal spikes were sorted according to shape using a wavelet-based clustering approach to enable comparisons between individual neuronal firing rates in the two disease states. The action potential widths showed a bimodal distribution consistent with previous findings, suggesting spikes from noncholinergic (likely glutamatergic) and cholinergic neurons. A higher PPN spiking rate of narrow action potentials was observed in the PSP than in the IPD patients when pooled across all three conditions (Wilcoxon rank sum test: p = 0.0141). No correlation was found between firing rate and disease severity or duration. The firing rates were higher during passive movement than rest and active movement in both groups, but the differences between conditions were not significant. PSP and IPD are believed to represent distinct disease processes, and our findings that the neuronal firing rates differ according to disease state support the proposal that pathological processes directly involving the PPN may be more pronounced in PSP than IPD.
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Affiliation(s)
- I Galazky
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - J Kaufmann
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Departments of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - J Voges
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - H Hinrichs
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Center for Neurodegenerative Disease (DZNE), Magdeburg, Germany
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - H-J Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Center for Neurodegenerative Disease (DZNE), Magdeburg, Germany
| | - C M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Departments of Neurology and Stereotactic Neurosurgery, Otto-Von-Guericke University, Magdeburg, Germany.
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18
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Fahmy E, Rabah A, Sharaf S, Helmy H, Kamal A. Interleukin-18 promoter polymorphisms and idiopathic Parkinson disease: an Egyptian study. Acta Neurol Belg 2019; 119:219-24. [PMID: 29700781 DOI: 10.1007/s13760-018-0927-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
Etiology of sporadic Parkinson's disease (PD) is largely unknown. The contribution of genetic factors to the pathogenesis of PD is supported by the demonstration of high concordance in twins, increased risk among relatives of PD patients and existence of familial cases. This study aimed to examine the relation between interleukin 18 (IL-18) gene promoter polymorphisms and idiopathic PD, and its impact on clinical presentation and disease severity. 30 idiopathic PD patients and 15 age- and sex-matched healthy subjects were included. Disease severity was assessed using Unified Parkinson's Disease Rating Scale (UPDRS). Genetic testing for IL-18 gene promoter -607C/A single nucleotide polymorphisms (SNP) was done using real-time polymerase chain reaction (PCR) technique. A raised risk of PD development was found in patients with A/C and C/C genotypes of the site -607C/A (odds ratios = 1.83 and 1.98, respectively). The distribution of the genotypes showed no significant relation to gender or predominant clinical presentation. The age at onset of disease was significantly lower in C/C and A/A genotypes compared to A/C genotype (p = 0.001 and 0.04, respectively). Patients with A/A genotype showed significantly higher mentation score of UPDRS compared to patients with A/C and C/C genotypes (p = 0.003 and p = 0.002, respectively). Polymorphisms of IL-18 gene promoter increase the risk of developing idiopathic PD. The polymorphisms may affect phenotypic expression rather than being a direct cause of idiopathic PD.
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Donadio V. Skin nerve α-synuclein deposits in Parkinson's disease and other synucleinopathies: a review. Clin Auton Res 2018; 29:577-585. [PMID: 30506233 DOI: 10.1007/s10286-018-0581-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE The in vivo diagnosis of synucleinopathies is an important research aim since clinical diagnostic criteria show low accuracy. The skin innervation, especially the autonomic subdivision, is a useful region to search for abnormal α-syn aggregates in synucleinopathies since the peripheral sympathetic nerves can be the earliest-affected neural region and autonomic symptoms may precede the classical symptoms of these disorders. METHODS The major advantages of skin biopsy as an in vivo diagnostic tool for synucleinopathies are that it is an inexpensive and easy-to-perform technique requiring only limited facilities, and that it is repeatable in long-term studies as it causes only minor discomfort to the patient. RESULTS This review analyzes current progress in this area of research that may facilitate the standardization of this method, potentially eliminating differences among laboratories in the implementation of the method. CONCLUSIONS The most suitable and commonly used technique for identifying in vivo α-syn aggregates in skin nerves is indirect immunofluorescence, although several aspects of this approach need to be standardized, particularly when synucleinopathies without autonomic failure present a patchy distribution of abnormal α-syn aggregates in skin nerves. By contrast, synucleinopathies with autonomic failure may present widespread diffusion of abnormal aggregates in autonomic skin nerves.
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Affiliation(s)
- Vincenzo Donadio
- IRCCS Istituto Delle Scienze Neurologiche di Bologna (Italy), UOC Clinica Neurologica, Via Altura 3, 40139, Bologna, Italy.
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Reed X, Bandrés-Ciga S, Blauwendraat C, Cookson MR. The role of monogenic genes in idiopathic Parkinson's disease. Neurobiol Dis 2019; 124:230-9. [PMID: 30448284 DOI: 10.1016/j.nbd.2018.11.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/01/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022] Open
Abstract
In the past two decades, mutations in multiple genes have been linked to autosomal dominant or recessive forms of monogenic Parkinson's disease (PD). Collectively, these monogenic (often familial) cases account for less than 5% of all PD, the majority being apparently sporadic cases. More recently, large-scale genome-wide association studies have identified over 40 loci that increase risk of PD. Importantly, there is overlap between monogenic and sporadic PD genes, particularly for the loci that contain the genes SNCA and LRRK2, which are mutated in monogenic dominant PD. There have also been reports of idiopathic PD cases with heterozygous variants in autosomal recessive genes suggesting that these mutations may increase risk of PD. These observations suggest that monogenic and idiopathic PD may have shared pathogenic mechanisms. Here, we focus mainly on the role of monogenic PD genes that represent pleomorphic risk loci for idiopathic PD. We also discuss the functional mechanisms that may play a role in increasing risk of disease in both monogenic and idiopathic forms.
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Adewusi JK, Hadjivassiliou M, Vinagre-Aragón A, O'Connor KR, Khan A, Grünewald RA, Zis P. Sensory neuropathic symptoms in idiopathic Parkinson's disease: prevalence and impact on quality of life. Acta Neurol Belg 2018; 118:445-450. [PMID: 29796943 DOI: 10.1007/s13760-018-0947-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/16/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Neuropathic symptoms are commonly reported in Parkinson's disease (PD), but robust data on the epidemiology of such symptoms are lacking. The present study sought to investigate the prevalence and determinants of peripheral sensory neuropathic symptoms (PSNS) in idiopathic PD (IPD) and ascertain the effects of such symptoms on the patients' quality of life (QoL). METHODS Patients with IPD and age-matched and gender-matched controls were screened for neuropathic symptoms using the Michigan Neuropathy Screening Instrument. The impact of neuropathic symptoms on QoL was investigated using the 36-Item Short Form Survey. RESULTS Fifty-two patients and 52 age-matched and gender-matched controls were recruited. PSNS were reported more frequently in patients with IPD than in the control subjects (57.7 versus 28.8%, p = 0.003). No significant relationships were found between PD-related clinical characteristics (i.e. disease severity and duration, duration of exposure to levodopa) and the presence of PSNS. Significant correlations were found between the number of PSNS and physical functioning (Spearman's Rho - 0.351), even after adjusting for age, gender and Hoehn and Yahr score. CONCLUSION Our results support the notion of a greater prevalence of PSNS in IPD patients as compared to the general population, which, at least in part, may be secondary to large and/or small fibre peripheral neuropathy. This warrants further investigation in larger studies that include detailed neurophysiological assessments.
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Affiliation(s)
- Joy K Adewusi
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - Ana Vinagre-Aragón
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - Karen Ruth O'Connor
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Aijaz Khan
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - Richard Adam Grünewald
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK.
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Yazar T, Yazar HO, Zayimoğlu E, Çankaya S. Incidence of sarcopenia and dynapenia according to stage in patients with idiopathic Parkinson's disease. Neurol Sci 2018; 39:1415-21. [PMID: 29752635 DOI: 10.1007/s10072-018-3439-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
Abstract
AIM In this study, the aim was to identify the incidence of sarcopenia and dynapenia according to disease stage among idiopathic Parkinson's disease (IPD) patients and collect data to illuminate precautions related to reducing the disease load. METHOD The study was completed with 166 patients divided by stage according to modified Hoehn and Yahr (HYR) criteria and 249 healthy volunteers aged from 18 to 39 and 68 to 75 years met the inclusion criteria. In our prospective and cross-sectional study, patients with IPD according to "UK Brain Bank" diagnostic criteria had the Unified Parkinson's Disease Rating Scale (UPDRS) and HYR scales applied. The patient and control groups had skeletal muscle mass index (SMMI), muscle power, and physical performance assessed. Diagnosis of sarcopenia used the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. RESULTS In our study, in parallel with the increase in disease stage among IPD patients, the incidence of sarcopenia (led by severe sarcopenia) and dynapenia was high compared to that among the control group of the same age. CONCLUSION In the early stages of chronic progressive diseases like IPD, identification of sarcopenia and dynapenia is important considering the limitations of disease-preventive effects in treatments applied after diagnosis.
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Kammermeier S, Maierbeck K, Dietrich L, Plate A, Lorenzl S, Singh A, Bötzel K, Maurer C. Qualitative postural control differences in Idiopathic Parkinson's Disease vs. Progressive Supranuclear Palsy with dynamic-on-static platform tilt. Clin Neurophysiol 2018; 129:1137-1147. [PMID: 29631169 DOI: 10.1016/j.clinph.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES We aimed to assess whether postural abnormalities in Progressive Supranuclear Palsy (PSP) and Idiopathic Parkinson's Disease (IPD) are qualitatively different by analysing spontaneous and reactive postural control. METHODS We assessed postural control upon platform tilts in 17 PSP, 11 IPD patients and 18 healthy control subjects using a systems analysis approach. RESULTS Spontaneous sway abnormalities in PSP resembled those of IPD patients. Spontaneous sway was smaller, slower and contained lower frequencies in both PSP and IPD as compared to healthy subjects. The amount of angular body excursions as a function of platform angular excursions (GAIN) in PSP was qualitatively different from both IPD and healthy subjects (GAIN cut-off value: 2.9, sensitivity of 94%, specificity of 72%). This effect was pronounced at the upper body level and at low as well as high frequencies. In contrast, IPD patients' stimulus-related body excursions were smaller compared to healthy subjects. Using a systems analysis approach, we were able to allocate these different postural strategies to differences in the use of sensory information as well as to different error correction efforts. CONCLUSIONS While both PSP and IPD patients show abnormal postural control, the underlying pathology seems to be different. SIGNIFICANCE The identification of disease-specific postural abnormalities shown here may be helpful for diagnostic as well as therapeutic discriminations of PSP vs. IPD.
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Affiliation(s)
- Stefan Kammermeier
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany.
| | - Kathrin Maierbeck
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany; Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Klinik für Anästhesiologie, Marchioninistraße 15, 81377 München, Germany
| | - Lucia Dietrich
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany; Abteilung für Allgemeinchirurgie, Kliniken Ostallgäu-Kaufbeuren, Dr.-Gutermann-Straße 2, 87600 Kaufbeuren, Germany
| | - Annika Plate
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany
| | - Stefan Lorenzl
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany; Abteilung für Neurologie, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734 Hausham, Germany
| | - Arun Singh
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany; Department of Neurology, University of Iowa, Iowa, IA, United States
| | - Kai Bötzel
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Marchioninistraße 15, 81377 München, Germany
| | - Christoph Maurer
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany
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Shepherd TA, Edelstyn NMJ, Longshaw L, Sim J, Watts K, Mayes AR, Murray M, Ellis SJ. Feasibility of a randomized single-blind crossover trial to assess the effects of the second-generation slow-release dopamine agonists pramipexole and ropinirole on cued recall memory in idiopathic mild or moderate Parkinson's disease without cognitive impairment. Pilot Feasibility Stud 2017; 4:11. [PMID: 28694990 PMCID: PMC5501424 DOI: 10.1186/s40814-017-0154-7] [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: 09/06/2016] [Accepted: 06/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background The aim was to assess the feasibility of a single-centre, single-blind, randomized, crossover design to explore the effects of two slow-release dopamine agonists, ropinirole and pramipexole, on cued recall in Parkinson’s disease. As the design required a switch from the prescribed agonist (pramipexole-to-ropinirole, or ropinirole-to-pramipexole), the primary objectives were to (a) examine the efficacy of processes and procedures used to manage symptoms during the washout period and (b) to use cued recall estimates to inform a power calculation for a definitive trial. Secondary objectives were to assess consent and missing data rates, acceptability of clinical support for the OFF sessions, experience of the OFF sessions and of agonist switching, barriers-to-participation for patients and informal caregivers. Methods Patients were randomized in a 1:1 ratio to two treatment arms and stabilized on each agonist for 6 weeks. The arms differed only in the sequence in which the agonists were administered. Cued recall was assessed ON medication and, following a washout period resulting in 93.75% agonist elimination, OFF medication. Results A total of 220 patients were screened: 145 were excluded and 75 invitations to participate were sent to eligible patients. Fifty-three patients declined, 22 consented and 16 completed the study. There were no serious adverse events, and rates of non-serious adverse events were equivalent between the agonists. Using the largest standard deviation (SD) of the ON–OFF difference cued recall score (inflated by ~25% to give a conservative estimate of the SD in a definitive trial) and assuming an effect of at least 10% of the observed range of OFF medication cued recall scores for either agonist to be clinically important, a main trial requires a sample size of just under 150 patients. The consent and missing data rates were 29 and 27% respectively. The washout period and the preparation for the OFF sessions were acceptable, and the sessions were manageable. The experience of switching was also manageable. Barriers to participation included concerns about disease stability, side effects, research process, carer workload and accessibility of the information sheet. Conclusions This study presented challenges to recruitment both in design and execution, and while it was a major aim of the study to assess this, evaluation of these challenges provided the opportunity to explore how they could be overcome for future studies. Trial registration EudraCT 2012-000801-64
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Affiliation(s)
- Thomas A Shepherd
- Research Institute for Primary Care and Health Sciences, Keele University, ST5 5BG Keele, Staffordshire UK
| | | | - Laura Longshaw
- University Hospital of North Midlands, Stoke on Trent, Staffordshire UK.,Keele University, Keele, Staffordshire UK
| | - Julius Sim
- Research Institute for Primary Care and Health Sciences, Keele University, ST5 5BG Keele, Staffordshire UK
| | - Keira Watts
- University Hospital of North Midlands, Stoke on Trent, Staffordshire UK.,Keele University, Keele, Staffordshire UK
| | - Andrew R Mayes
- Psychological Sciences, University of Manchester, Manchester, UK
| | - Michael Murray
- School of Psychology, Keele University, Keele, Staffordshire UK
| | - Simon J Ellis
- University Hospital of North Midlands, Stoke on Trent, Staffordshire UK.,Keele University, Keele, Staffordshire UK
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Ataç Uçar C, Gökçe Çokal B, Ünal Artık HA, İnan LE, Yoldaş TK. Comparison of neutrophil-lymphocyte ratio (NLR) in Parkinson's disease subtypes. Neurol Sci 2016; 38:287-293. [PMID: 27837368 DOI: 10.1007/s10072-016-2758-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 09/10/2016] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Abstract
It has been hypothesized that chronic inflammation may play an important role in the development and progression of the neurodegeneration of Idiopathic Parkinson's disease (IPD). Neutrophil-lymphocyte ratio (NLR) is a marker that indicates the peripheral inflammation. There is only one study regarding NLR and IPD. In this study, we assessed to investigate NLR in patients with IPD, comparing the results with controls and to determine whether there is a difference in NLR levels in subgroups of IPD (akinetic-rigid and tremor-dominant) differ in their levels of NLR. Medical records of 200 IPD patients and 60 controls reviewed retrospectively. Forty-six IPD patients met the inclusion criteria. NLR was calculated by dividing neutrophil count to lymphocyte count. Thirteen akinetic-rigid (AR-IPD) and thirty-three tremor-dominant (TD-IPD) patients' and controls results were compared. There was not a statistically difference between the NLR levels of IPD patients, controls, and AR-IPD and TD-IPD patients. This result suggests that cerebral inflammation is in the forefront in the development of neurodegeneration in IPD, and that more evidence is needed for the role of peripheral inflammation in the development progression of disease.
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Affiliation(s)
- Ceyla Ataç Uçar
- Department of Neurology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Burcu Gökçe Çokal
- Department of Neurology, Ankara Training and Research Hospital, Ankara, Turkey
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Hong JH, Kim YK, Park JS, Lee JE, Oh MS, Chung EJ, Kim JY, Sung YH, Lyoo CH, Lee JH, Kwon DY, Kim HS, Shin HW, Park SA, Park IS, Kim JS, Lee PH, Koh SB, Baik JS, Kim SJ, Ma HI, Kim JW, Kim YJ. Lack of association between LRRK2 G2385R and cognitive dysfunction in Korean patients with Parkinson's disease. J Clin Neurosci 2016; 36:108-113. [PMID: 27839916 DOI: 10.1016/j.jocn.2016.10.013] [Citation(s) in RCA: 8] [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: 05/31/2016] [Accepted: 10/15/2016] [Indexed: 01/22/2023]
Abstract
Aside from the glucocerebrosidase gene, the genetic risk factors for cognitive decline in Parkinson's disease (PD) are controversial. We investigated whether the G2385R polymorphism in leucine-rich repeat kinase 2 gene (LRRK2), a risk variant for the development of PD in East Asians, is associated with cognitive dysfunction in PD. We recruited 299 PD patients, consisting of 23 carriers and 276 non-carriers of LRRK2 G2385R, from 14 centers. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). PD with cognitive dysfunction was defined as an MMSE Z score that, adjusting for age at study entry and years of education, was below -1.0 standard deviations. In multivariate analysis, PD duration, age at study entry and depression were significant risk factors for cognitive dysfunction as assessed by MMSE performance or the MoCA. In linear regression analysis of the association between MMSE Z scores and PD duration, there was no significant difference associated with the LRRK2 G2385R genotype. The interaction terms between PD duration and the LRRK2 G2385R genotype were not significant for the MMSE Z score but were significant for the MoCA. In conclusion, the LRRK2 G2385R genotype may not be associated with cognitive dysfunction in PD.
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Affiliation(s)
- Jeong Hoon Hong
- ILSONG Institute of Life Science, Hallym University, Anyang, South Korea
| | - Yue Kyung Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jae Seol Park
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Eun Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Eun Joo Chung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jeong-Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Young-Hee Sung
- Department of Neurology, Gachon University College of Medicine, Incheon, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University College of Medicine, Ansan Hospital, Ansan, South Korea
| | - Hyun Sook Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun Ah Park
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - In-Seok Park
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University College of Medicine at Guro Hospital, Seoul, South Korea
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Sang Jin Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University School of Medicine, Busan, South Korea
| | - Yun Joong Kim
- ILSONG Institute of Life Science, Hallym University, Anyang, South Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea; Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang, South Korea.
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Lopez WOC, Higuera CAE, Fonoff ET, Souza CDO, Albicker U, Martinez JAE. Listenmee and Listenmee smartphone application: synchronizing walking to rhythmic auditory cues to improve gait in Parkinson's disease. Hum Mov Sci 2014; 37:147-56. [PMID: 25215623 DOI: 10.1016/j.humov.2014.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/03/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022]
Abstract
Evidence supports the use of rhythmic external auditory signals to improve gait in PD patients (Arias & Cudeiro, 2008; Kenyon & Thaut, 2000; McIntosh, Rice & Thaut, 1994; McIntosh et al., 1997; Morris, Iansek, & Matyas, 1994; Thaut, McIntosh, & Rice, 1997; Suteerawattananon, Morris, Etnyre, Jankovic, & Protas , 2004; Willems, Nieuwboer, Chavert, & Desloovere, 2006). However, few prototypes are available for daily use, and to our knowledge, none utilize a smartphone application allowing individualized sounds and cadence. Therefore, we analyzed the effects on gait of Listenmee®, an intelligent glasses system with a portable auditory device, and present its smartphone application, the Listenmee app®, offering over 100 different sounds and an adjustable metronome to individualize the cueing rate as well as its smartwatch with accelerometer to detect magnitude and direction of the proper acceleration, track calorie count, sleep patterns, steps count and daily distances. The present study included patients with idiopathic PD presented gait disturbances including freezing. Auditory rhythmic cues were delivered through Listenmee®. Performance was analyzed in a motion and gait analysis laboratory. The results revealed significant improvements in gait performance over three major dependent variables: walking speed in 38.1%, cadence in 28.1% and stride length in 44.5%. Our findings suggest that auditory cueing through Listenmee® may significantly enhance gait performance. Further studies are needed to elucidate the potential role and maximize the benefits of these portable devices.
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Affiliation(s)
- William Omar Contreras Lopez
- Division of Stereotactic and Functional Neurosurgery, Department of General Neurosurgery, University Medical Center Freiburg, Freiburg im Breisgau, Germany; Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo, Medical School, São Paulo, Brazil.
| | | | - Erich Talamoni Fonoff
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo, Medical School, São Paulo, Brazil
| | - Carolina de Oliveira Souza
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo, Medical School, São Paulo, Brazil
| | - Ulrich Albicker
- Inomed Medizintechnik GmbH, Im Hausgruen 29 79312, Emmendingen, Germany
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Pan-Montojo F, Reichmann H. Considerations on the role of environmental toxins in idiopathic Parkinson's disease pathophysiology. Transl Neurodegener 2014; 3:10. [PMID: 24826210 PMCID: PMC4019355 DOI: 10.1186/2047-9158-3-10] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/29/2014] [Indexed: 12/21/2022] Open
Abstract
Neurodegenerative diseases are characterized by a progressive dysfunction of the nervous system. Often associated with atrophy of the affected central or peripheral nervous structures, they include diseases such as Parkinson’s Disease (PD), Alzheimer’s Disease and other dementias, Genetic Brain Disorders, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease), Huntington’s Disease, Prion Diseases, and others. The prevalence of neurodegenerative diseases has increased over the last years. This has had a major impact both on patients and their families and has exponentially increased the medical bill by hundreds of billions of Euros. Therefore, understanding the role of environmental and genetic factors in the pathogenesis of PD is crucial to develop preventive strategies. While some authors believe that PD is mainly genetic and that the aging of the society is the principal cause for this increase, different studies suggest that PD may be due to an increased exposure to environmental toxins. In this article we review epidemiological, sociological and experimental studies to determine which hypothesis is more plausible. Our conclusion is that, at least in idiopathic PD (iPD), the exposure to toxic environmental substances could play an important role in its aetiology.
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Affiliation(s)
- Francisco Pan-Montojo
- Neurologische Klinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany ; Munich Cluster for Systems Neurology (SyNergy), Adolf-Butenandt-Institut Ludwig-Maximilians-Universität München, Schillerstr. 44, 80336 Munich, Germany
| | - Heinz Reichmann
- Klinik und Poliklinik für Neurologie, Carl Gustav Carus University Hospital, TU-Dresden, Fetscherstr. 74, 01307 Dresden, Germany
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Phu AL, Xu Z, Brakoulias V, Mahant N, Fung VS, Moore GD, Martin A, Starcevic V, Krause M. Effect of impulse control disorders on disability and quality of life in Parkinson's disease patients. J Clin Neurosci 2014; 21:63-6. [PMID: 24035421 DOI: 10.1016/j.jocn.2013.02.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 02/17/2013] [Indexed: 11/22/2022]
Abstract
Impulse control and related disorders (ICRD) are not uncommon in patients with idiopathic Parkinson's disease (PD). The present study aimed to investigate the effects of ICRD on quality of life (QoL) and disability in PD. From two movement disorder clinics in Sydney, Australia, 100 consecutive patients with PD were included in the trial. The Unified Parkinson's Disease Rating Scale (UPDRS), Mini Mental State Examination and the Parkinson's Disease Questionnaire-39 were used to measure disease severity, cognition and disease-specific QoL. The diagnosis of ICRD was based on face-to-face structured clinical interviews by three psychiatrists with experience in ICRD using the Expanded Structured Clinical Interview for the Diagnostic and Statistical Manual IV for Obsessive-Compulsive Disorder Related/Spectrum Disorders. ICRD were present in 15% of our patient population, and had a negative impact on QoL and Activity of Daily Living (ADL) scores. After adjusting for the presence of major depressive disorders and PD duration, the effect on emotional wellbeing remained statistically significant (p<0.004). Disease duration also correlated with worse QoL and ADL scores. Major depression disorders reduced QoL but not ADL. Patients with ICRD tended to suffer more from depression than those without ICRD. There were no statistically significant differences in age, sex, major depressive disorders, PD duration, total levodopa equivalent daily dose, use of dopamine agonists, or UPDRS motor score between patients with and without ICDR.
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Hakyemez HA, Veyseller B, Ozer F, Ozben S, Bayraktar GI, Gurbuz D, Cetin S, Yildirim YS. Relationship of olfactory function with olfactory bulbus volume, disease duration and Unified Parkinson's disease rating scale scores in patients with early stage of idiopathic Parkinson's disease. J Clin Neurosci 2013; 20:1469-70. [PMID: 23870619 DOI: 10.1016/j.jocn.2012.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 10/26/2022]
Abstract
We aimed to investigate the relationship between olfactory function and olfactory bulbus (OB) volume, disease duration and Unified Parkinson's disease rating scale (UPDRS) scores in early stage idiopathic Parkinson's disease patients. The University of Pennsylvania Smell Identification Test (UPSIT) was used for the evaluation of olfactory function. UPSIT scores for patients with Parkinson's disease were significantly lower than controls. There was no significant difference between stage 1 and stage 2 patients. OB volumes were higher in stage 1 and 2 patients than controls, but there was no statistical difference between the three groups. No significant correlation was found between UPSIT and UPDRS total scores, nor between UPSIT scores and disease duration in stage 1 and 2 patients. According to our results, we propose UPSIT be used as a screening test to diagnose presymptomatic patients, but not OB volumes.
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