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Maher S, Donlon E, Mullane G, Walsh R, Lynch T, Fearon C. Treatment of Apathy in Parkinson's Disease and Implications for Underlying Pathophysiology. J Clin Med 2024; 13:2216. [PMID: 38673489 PMCID: PMC11051068 DOI: 10.3390/jcm13082216] [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: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Apathy is a prevalent and highly debilitating non-motor symptom of Parkinson's disease (PD) that is often overlooked in clinical practice due to its subtle nature. This review aims to provide a comprehensive overview of the current evidence for the treatment of apathy in PD, highlighting recent advancements and emerging therapeutic avenues. In this review, we analyse a diverse array of treatment strategies for apathy in PD, including pharmacological interventions, non-pharmacological approaches, and emerging neuromodulation techniques. We evaluate the efficacy, safety, and limitations of established pharmacotherapies, such as dopaminergic agents, antidepressants, and cognitive enhancers. Additionally, we examine the promising role of non-pharmacological interventions, encompassing psychotherapies and behavioural interventions, in ameliorating apathetic symptoms. Furthermore, this review explores the effects of neuromodulation techniques on apathy, including the modulation of apathy via deep brain stimulation and emerging data on the potential influence of transcranial magnetic stimulation (TMS) on apathy in PD. Ultimately, a deeper understanding of effective treatment strategies for apathy has the potential to significantly improve the quality of life and overall well-being of individuals living with PD.
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Affiliation(s)
- Senan Maher
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Eoghan Donlon
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Gerard Mullane
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Richard Walsh
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Tim Lynch
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Fearon
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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Lin J, Li C, Ou R, Hou Y, Zhang L, Wei Q, Liu K, Jiang Q, Yang T, Xiao Y, Pang D, Yu Y, Song W, Zhao B, Chen X, Yang J, Wu Y, Shang H. Longitudinal evolution and plasma biomarkers for excessive daytime sleepiness in Parkinson's disease. J Gerontol A Biol Sci Med Sci 2024:glae086. [PMID: 38526870 DOI: 10.1093/gerona/glae086] [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: 08/05/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is one of the most frequent non-motor symptoms in Parkinson's disease (PD); however, the pathogenesis of EDS is unclear, and there is a lack of information on plasma biomarkers for EDS in PD. We aimed to investigate the plasma biomarkers of EDS in a large PD cohort. METHODS A total of 159 PD patients were included in the prospective cohort study and followed up annually for three years. Plasma biomarkers including glial fibrillary acidic protein, amyloid-beta, p-tau181, and neurofilament light chain (NfL), were measured using an ultrasensitive single-molecule array (SimoaTM) technology at each visit. EDS was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS The frequency of EDS in PD increased from 15.1% at baseline to 25.0% after three years. The mean ESS scores increased from 5.1 [Standard Deviation (SD): 4.8] at baseline to 6.1 [SD: 5.5] at the third year of follow-up. At baseline, compared with patients with PD without EDS, those with EDS were more likely to be male, had poorer cognitive performance, and more severe motor and non-motor symptoms. The adjusted generalized estimating equations models showed that higher plasma NfL levels (OR 1.047 [1.002-1.094], p = 0.042) were associated with EDS during follow-ups. The adjusted linear mixed-effects model showed that higher plasma NfL levels (β 0.097 [0.012-0.183], p = 0.026) were associated with ESS scores during follow-ups. CONCLUSIONS Higher plasma NfL levels were associated with EDS in PD, indicating an association between neuro-axonal degeneration and EDS in PD.
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Affiliation(s)
- Junyu Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Chunyu Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Lingyu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Kuncheng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qirui Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Tianmi Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yi Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Dejiang Pang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yujiao Yu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ying Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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Tall P, Qamar MA, Batzu L, Leta V, Falup-Pecurariu C, Ray Chaudhuri K. Non-oral continuous drug delivery based therapies and sleep dysfunction in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1443-1449. [PMID: 37126118 PMCID: PMC10645607 DOI: 10.1007/s00702-023-02640-7] [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: 03/16/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
Continuous drug delivery (CDD) has emerged as a feasible and pragmatic therapeutic option for dopamine replacement therapy in advanced Parkinson's disease (PD). CDD aims to mimic the physiological tonic dopamine release from striatal dopaminergic neurons and thus reduces the severity and duration of motor and non-motor fluctuations partly related to pulsatile levodopa stimulation. Non-motor symptoms and fluctuations are ubiquitous in PD and include sleep dysfunction, a problem that occurs in over 90% of PD patients across all stages, from prodromal to palliative. In this review, we discuss the currently available and in development non-oral dopaminergic CDD strategies with a focus on their efficacy in the treatment of the burdensome sleep dysfunction in PD.
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Affiliation(s)
- P Tall
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
| | - M A Qamar
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
| | - L Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - V Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - C Falup-Pecurariu
- Faculty of Medicine, Transilvania University, Brasov, Romania
- Department of Neurology, County Clinic Hospital, Brasov, Romania
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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Alberts JL, Kaya RD, Penko AL, Streicher M, Zimmerman EM, Davidson S, Walter BL, Rosenfeldt AB. A Randomized Clinical Trial to Evaluate a Digital Therapeutic to Enhance Gait Function in Individuals With Parkinson's Disease. Neurorehabil Neural Repair 2023; 37:603-616. [PMID: 37465959 DOI: 10.1177/15459683231184190] [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] [Indexed: 07/20/2023]
Abstract
BACKGROUND Postural instability and gait dysfunction (PIGD) is a cardinal symptom of Parkinson's disease (PD) and is exacerbated under dual-task conditions. Dual-task training (DTT), enhances gait performance, however it is time and cost intensive. Digitizing DTT via the Dual-task Augmented Reality Treatment (DART) platform can expand the availability of an effective intervention to address PIGD. OBJECTIVE The aim of this project was to evaluate DART in the treatment of PIGD in people with PD compared to a Traditional DTT intervention. It was hypothesized that both groups would exhibit significant improvements in gait, and the improvements for the DART group would be non-inferior to Traditional DTT. METHODS A single-blind randomized controlled trial was conducted with 47 PD participants with PIGD. Both groups completed 16 therapeutic sessions over 8 weeks; the DART platform delivered DTT via the Microsoft HoloLens2. Primary outcomes included clinical ratings and single- and dual-task gait biomechanical outcomes. RESULTS Clinical measures of PD symptoms remained stable for DART and Traditional DTT groups. However, both groups exhibited a significant increase in gait velocity, cadence, and step length during single- and multiple dual-task conditions following the interventions. Improvements in gait velocity in the DART group were non-inferior to Traditional DTT under the majority of conditions. CONCLUSION Non-inferior improvements in gait parameters across groups provides evidence of the DART platform being an effective digital therapeutic capable of improving PIGD. Effective digital delivery of DTT has the potential to increase use and accessibility to a promising, yet underutilized and difficult to administer, intervention for PIGD. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Dual-task Augmented Reality Treatment for Parkinson's Disease (DART) NCT04634331; posted November 18, 2020.
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Affiliation(s)
- Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Ryan D Kaya
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Matthew Streicher
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Eric M Zimmerman
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Sara Davidson
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Benjamin L Walter
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
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Talebi S, Asoudeh F, Naeini F, Sadeghi E, Travica N, Mohammadi H. Association between animal protein sources and risk of neurodegenerative diseases: a systematic review and dose-response meta-analysis. Nutr Rev 2023; 81:1131-1143. [PMID: 36647769 DOI: 10.1093/nutrit/nuac114] [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] [Indexed: 01/18/2023] Open
Abstract
CONTEXT Current findings about the differential effects of various sources of dietary animal protein on the risk of neurodegenerative diseases are contradictory. OBJECTIVE The current meta-analysis was conducted to investigate the associations between intake of dietary animal protein sources and the risk of neurodegenerative diseases. DATA SOURCES PubMed, Scopus, Web of Science, and Google Scholar databases were searched systematically until October 2021. DATA EXTRACTION Prospective cohort studies exploring the association between consumption of animal protein sources and risk of neurodegenerative diseases in the general population were included. Among 10 571 identified studies, 33 prospective cohort studies met the eligibility criteria. DATA ANALYSIS Dietary fish consumption was associated with a reduced risk of Alzheimer's disease (RR = 0.75; 95%CI, 0.57-0.97), dementia (RR = 0.84; 95%CI, 0.75-0.93), and cognitive impairment (RR = 0.85; 95%CI, 0.81-0.95). The risk of developing Parkinson's disease was significantly higher among those in the highest vs the lowest intake categories of total dairy (RR = 1.49; 95%CI, 1.06-2.10) and milk (RR = 1.40; 95%CI, 1.13-1.73). Moreover, dietary intake of total dairy (RR = 0.89; 95%CI, 0.80-0.99), total meat (RR = 0.72; 95%CI, 0.57-0.90), and poultry (RR = 0.82; 95%CI, 0.68-0.99) was significantly associated with a lower risk of cognitive impairment. A linear dose-response meta-analysis revealed that each 200-g increase in total daily dairy intake was associated with an 11% higher risk of Parkinson's disease and a 12% lower risk of cognitive impairment. Furthermore, there was a strong linear association between fish consumption and reduced risk of dementia. CONCLUSION Dairy consumption is associated with an increased risk of Parkinson's disease, but a higher intake of fish may be associated with lower risk of neurodegenerative disease. Future well-controlled, randomized clinical trials are essential to validate the present findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021281887.
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Affiliation(s)
- Sepide Talebi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Asoudeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Naeini
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sadeghi
- Research Consultation Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nikolaj Travica
- IMPACT-Institute for Mental and Physical Health and Clinical Translation; the Food & Mood Centre; and Barwon Health; Deakin University School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Kim M, Bezprozvanny I. Potential direct role of synuclein in dopamine transport and its implications for Parkinson's disease pathogenesis. Biochem Biophys Res Commun 2023; 671:18-25. [PMID: 37290280 DOI: 10.1016/j.bbrc.2023.05.110] [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: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
Parkinson Disease (PD) is a progressive neurodegenerative disorder that is caused by dysfunction and death of dopaminergic neurons. Mutations in the gene encoding α-synuclein (ASYN) have been linked with familial PD (FPD). Despite important role of ASYN in PD pathology, its normal biological function has not been clarified, although direct action of ASYN in synaptic transmission and dopamine (DA+) release have been proposed. In the present report we propose a novel hypothesis that ASYN functions as DA+/H+ exchanger that can facilitate transport of dopamine across synaptic vesicle (SV) membrane by taking advantage of proton gradient between SV lumen and cytoplasm. According to this hypothesis, normal physiological role of ASYN consists of fine-tuning levels of dopamine in the SVs based on cytosolic concentration of dopamine and intraluminal pH. This hypothesis is based on similarity in domain structure of ASYN and pHILP, a designed peptide developed to mediate loading of lipid nanoparticles with the cargo molecules. We reason that carboxy-terminal acidic loop D2b domain in both ASYN and pHILP binds cargo molecules. By mimicking DA+ association with E/D residues in D2b domain of ASYN using Tyrosine replacement approach (TR) we have been able to estimate that ASYN is able to transfer 8-12 molecules of dopamine across SV membrane on each DA+/H+ exchange cycle. Our results suggest that familial PD mutations (A30P, E46K, H50Q, G51D, A53T and A53E) will interfere with different steps of the exchange cycle, resulting in partial loss of dopamine transport function phenotype. We also predict that similar impairment in ASYN DA+/H+ exchange function also occurs as a result on neuronal aging due to changes in SV lipid composition and size and also dissipation of pH gradient across SV membrane. Proposed novel functional role of ASYN provides novel insights into its biological role and its role in PD pathogenesis.
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Affiliation(s)
- Meewhi Kim
- Dept of Physiology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Ilya Bezprozvanny
- Dept of Physiology, UT Southwestern Medical Center, Dallas, TX, 75390, USA; Laboratory of Molecular Neurodegeneration, St Petersburg State Polytechnical Universty, St Petersburg, 195251, Russian Federation.
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7
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Alghamdi AM, Al-Abbasi FA, AlGhamdi SA, Fatima F, Alzarea SI, Kazmi I. Rosinidin inhibits NF-κB/ Nrf2/caspase-3 expression and restores neurotransmitter levels in rotenone-activated Parkinson's disease. Saudi J Biol Sci 2023; 30:103656. [PMID: 37187936 PMCID: PMC10176079 DOI: 10.1016/j.sjbs.2023.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Objectives The examination was sighted to study the preventive effects of rosinidin against rotenone-activated Parkinson's disease in rats. Methods Animals were randamoized into five groups: I-saline, II-rotenone (0.5 mg/kg/b.wt.), III- IV-10 and 20 mg/kg rosinidin after rotenone and V-20 mg/kg rosinidin per se for 28 days and were assigned for behavioral analysis., Biochemical parameters i.e. lipid peroxidation, endogenous antioxidants, nitrite level, neurotransmitter levels, proinflammatory biomarkers such as interleukin- 6 (IL-6), tumor necrosis factor-α, IL-1β, nuclear factor kappa B, nuclear factor erythroid 2-related factor 2, and caspase-3 were assessed on the 29th day of the research. Results Rosinidin augmented the effectiveness of rotenone on akinesia, catalepsy, forced-swim test, rotarod, and open-field test. Biochemical findings indicated that treatment of rosinidin showed restoring neuroinflammatory cytokines, antioxidants, and neurotransmitter levels in rotenone-injected rats. Conclusion As a result of rosinidin treatment, the brain was protected from oxidative stress-induced neuronal damage and inhibited neuroinflammatory cytokines.
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Affiliation(s)
- Amira M. Alghamdi
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Fahad A. Al-Abbasi
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Shareefa A. AlGhamdi
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Farhat Fatima
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Sami I. Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka 72341, Aljouf, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Corresponding author.
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Del Din S, Galna B, Lord S, Nieuwboer A, Bekkers EMJ, Pelosin E, Avanzino L, Bloem BR, Olde Rikkert MGM, Nieuwhof F, Cereatti A, Della Croce U, Mirelman A, Hausdorff JM, Rochester L. Falls Risk in Relation to Activity Exposure in High-Risk Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:1198-1205. [PMID: 31942969 PMCID: PMC7243591 DOI: 10.1093/gerona/glaa007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 11/27/2022] Open
Abstract
Background Physical activity is linked to many positive health outcomes, stimulating the development of exercise programs. However, many falls occur while walking and so promoting activity might paradoxically increase fall rates, causing injuries, and worse quality of life. The relationship between activity exposure and fall rates remains unclear. We investigated the relationship between walking activity (exposure to risk) and fall rates before and after an exercise program (V-TIME). Methods One hundred and nine older fallers, 38 fallers with mild cognitive impairment (MCI), and 128 fallers with Parkinson’s disease (PD) were randomly assigned to one of two active interventions: treadmill training only or treadmill training combined with a virtual reality component. Participants were tested before and after the interventions. Free-living walking activity was characterized by volume, pattern, and variability of ambulatory bouts using an accelerometer positioned on the lower back for 1 week. To evaluate that relationship between fall risk and activity, a normalized index was determined expressing fall rates relative to activity exposure (FRA index), with higher scores indicating a higher risk of falls per steps taken. Results At baseline, the FRA index was higher for fallers with PD compared to those with MCI and older fallers. Walking activity did not change after the intervention for the groups but the FRA index decreased significantly for all groups (p ≤ .035). Conclusions This work showed that V-TIME interventions reduced falls risk without concurrent change in walking activity. We recommend using the FRA index in future fall prevention studies to better understand the nature of intervention programs.
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Affiliation(s)
- Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sue Lord
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Esther M J Bekkers
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genova, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Freek Nieuwhof
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Radboud University Medical Center, Department of Geriatric Medicine, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Andrea Cereatti
- Department of Biomedical Sciences, Bioengineering Unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- Department of Biomedical Sciences, Bioengineering Unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration, Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel.,Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Singh A, Tripathi P, Singh S. Neuroinflammatory responses in Parkinson's disease: relevance of Ibuprofen in therapeutics. Inflammopharmacology 2021; 29:5-14. [PMID: 33052479 DOI: 10.1007/s10787-020-00764-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) pathogenesis inevitably involves neuroinflammatory responses attained through contribution of both neuron and glial cells. Investigation done in both experimental models of PD and in samples of PD patients suggested the involvement of both central and peripheral inflammatory responses during PD pathogenesis. Such neuroinflammatory responses could be regulated by neuron-glia interaction which is one of the recently focused areas in the field of disease diagnosis, pathogenesis and therapeutics. Such aggravated neuroinflammatory responses during PD are very well associated with augmented levels of cyclooxygenase (COX). An increased expression of cyclooxygenase (COX) with a concomitant increase in the prostaglandin E2 (PGE2) levels has been observed during PD pathology. Ibuprofen is one of the non-steroidal anti-inflammatory drugs (NSAID) and clinically being used for PD patients. This review focuses on the neuroinflammatory responses during PD pathology as well as the effect of ibuprofen on various disease related signaling factors and mechanisms involving nitrosative stress, neurotransmission, neuronal communication and peroxisome proliferator-activated receptor-γ. Such mechanistic effect of ibuprofen has been mostly reported in experimental models of PD and clinical investigations are still required. Since oxidative neuronal death is one of the major neurodegenerative mechanisms in PD, the antioxidant capacity of ibuprofen along with its antidepressant effects have also been discussed. This review will direct the readers towards fulfilling the existing gaps in the mechanistic aspect of ibuprofen and enhance its clinical relevance in PD therapeutics and probably in other age-related neurodegenerative diseases.
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Roycroft M, Abdelhafiz AH, Rose J. Patient-controlled variable dosing of levodopa for Parkinson's disease. Age Ageing 2020; 49:305-306. [PMID: 31985772 DOI: 10.1093/ageing/afz167] [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: 07/03/2019] [Revised: 08/27/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022] Open
Abstract
Medication for idiopathic Parkinson's disease (PD) is for symptomatic relief, and typically, patients are advised to take their medication at agreed regular times. Here, we present a lady with moderate PD and superimposed anxiety for whom this management strategy did not work well as it increased her anxiety significantly around dosing times. She was switched to an PRN regime and although taking the same total dose of levodopa with similar symptom control was overall much happier. Although there are sound reasons behind regular dosing of levodopa (its short duration of action and relationship of clinical response to plasma concentration), a holistic co-created management plan against classical advice but taking into account the psychological burden of disease and medication may in many cases be more appropriate.
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Affiliation(s)
| | | | - Joanne Rose
- The Rotherham NHS Foundation Trust, Rotherham, UK
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Del Din S, Galna B, Godfrey A, Bekkers EMJ, Pelosin E, Nieuwhof F, Mirelman A, Hausdorff JM, Rochester L. Analysis of Free-Living Gait in Older Adults With and Without Parkinson's Disease and With and Without a History of Falls: Identifying Generic and Disease-Specific Characteristics. J Gerontol A Biol Sci Med Sci 2019; 74:500-506. [PMID: 29300849 PMCID: PMC6417445 DOI: 10.1093/gerona/glx254] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Falls are associated with gait impairments in older adults (OA) and Parkinson's disease (PD). Current approaches for evaluating falls risk are based on self-report or one-time assessment and may be suboptimal. Wearable technology allows gait to be measured continuously in free-living conditions. The aim of this study was to explore generic and specific associations in free-living gait in fallers and nonfallers with and without PD. METHODS Two hundred and seventy-seven fallers (155 PD, 122 OA) who fell twice or more in the previous 6 months and 65 nonfallers (15 PD, 50 OA) were tested. Free-living gait was characterized as the volume, pattern, and variability of ambulatory bouts (Macro), and 14 discrete gait characteristics (Micro). Macro and Micro variables were quantified from free-living data collected using an accelerometer positioned on the low back for one week. RESULTS Macro variables showed that fallers walked with shorter and less variable ambulatory bouts than nonfallers, independent of pathology. Micro variables within ambulatory bouts showed fallers walked with slower, shorter and less variable steps than nonfallers. Significant interactions showed disease specific differences in variability with PD fallers demonstrating greater variability (step length) and OA fallers less variability (step velocity) than their nonfaller counterparts (p < 0.004). CONCLUSIONS Common and disease-specific changes in free-living Macro and Micro gait highlight generic and selective targets for intervention depending on type of faller (OA-PD). Our findings support free-living monitoring to enhance assessment. Future work is needed to confirm the optimal battery of measures, sensitivity to change and value for fall prediction.
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Affiliation(s)
- Silvia Del Din
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality
- School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alan Godfrey
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality
- Department of Computer and Information Science, Northumbria University, Newcastle upon Tyne, UK
| | - Esther M J Bekkers
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genova, Italy
| | - Freek Nieuwhof
- Departments of Geriatric Medicine and Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anat Mirelman
- Center for the study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel
| | - Jeffrey M Hausdorff
- Center for the study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel
- Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Rochester L, Galna B, Lord S, Burn D. The nature of dual-task interference during gait in incident Parkinson's disease. Neuroscience 2014; 265:83-94. [PMID: 24508154 DOI: 10.1016/j.neuroscience.2014.01.041] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [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: 10/16/2013] [Revised: 12/19/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
Dual-task interference during gait is a common phenomenon in older adults and people with Parkinson's disease (PD). Dual-task performance is driven by cognitive processes involving executive function, attention and working memory which underpin resource capacity and allocation. The underlying processes that contribute to dual-task interference are poorly understood, and confounded by methodological differences. The aim of this study was to explore the nature of dual-task interference in PD with respect to age-matched controls. We examined 121 people with early PD and 189 controls and controlled for baseline task demand on both tasks allowing between-group differences to be attributed to dual-task interference rather than differences in baseline performance. We also compared a wide range of gait characteristics to evaluate the pattern of interference. Participants walked for two minutes at a preferred pace under single- and dual-task (test of working memory capacity-digit span recall) conditions. In a subgroup task demand was increased (digit span+1) (n=55 control, n=44 PD) to assess the influence of resource capacity. Finally the association between dual-task interference with motor and cognitive characteristics was examined to evaluate resource capacity and allocation. PD and controls responded similarly to the dual-task for all gait characteristics except for step width and step width variability and this was the same when task demand increased (dual+1). Control participants took wider steps (p=0.006) and step width variability increased significantly for controls (p=0.001) but not PD. Interference was specific to the gait characteristic rather than a global pattern of impairment. Digit span error rates were not significantly different between groups during dual-task performance. There were no significant correlations with dual-task interference and global cognition, motor deficit, and executive function for either group. Effects of dual-tasks on gait performance are twofold and specific to the gait characteristic. They reflect an age-related reduction in gait performance (especially forward progression) in PD and controls possibly due to reduced resource capacity; and secondly, show postural stability during walking in early PD is disproportionately affected highlighting a PD-specific dual-task co-ordination deficit. Further work is required to identify the cognitive, executive and motor correlates of dual-task interference from which inferences about underlying cognitive processes can be made. These findings inform an understanding of dual-task impairment in early PD and suggest that management should target postural control under dual-task conditions from the early stages.
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Affiliation(s)
- L Rochester
- Institute for Ageing and Health, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, United Kingdom.
| | - B Galna
- Institute for Ageing and Health, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, United Kingdom
| | - S Lord
- Institute for Ageing and Health, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, United Kingdom
| | - D Burn
- Institute for Ageing and Health, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, United Kingdom
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