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Li X, Chen C, Pan T, Zhou X, Sun X, Zhang Z, Wu D, Chen X. Trends and hotspots in non-motor symptoms of Parkinson's disease: a 10-year bibliometric analysis. Front Aging Neurosci 2024; 16:1335550. [PMID: 38298610 PMCID: PMC10827952 DOI: 10.3389/fnagi.2024.1335550] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Non-motor symptoms are prevalent among individuals with Parkinson's disease (PD) and seriously affect patient quality of life, even more so than motor symptoms. In the past decade, an increasing number of studies have investigated non-motor symptoms in PD. The present study aimed to comprehensively analyze the global literature, trends, and hotspots of research investigating non-motor symptoms in PD through bibliometric methods. Studies addressing non-motor symptoms in the Web of Science Core Collection (WoSCC), published between January 2013 and December 2022, were retrieved. Bibliometric methods, including the R package "Bibliometrix," VOS viewer, and CiteSpace software, were used to investigate and visualize parameters, including yearly publications, country/region, institution, and authors, to collate and quantify information. Analysis of keywords and co-cited references explored trends and hotspots. There was a significant increase in the number of publications addressing the non-motor symptoms of PD, with a total of 3,521 articles retrieved. The United States was ranked first in terms of publications (n = 763) and citations (n = 11,269), maintaining its leadership position among all countries. King's College London (United Kingdom) was the most active institution among all publications (n = 133) and K Ray Chaudhuri was the author with the most publications (n = 131). Parkinsonism & Related Disorders published the most articles, while Movement Disorders was the most cited journal. Reference explosions have shown that early diagnosis, biomarkers, novel magnetic resonance imaging techniques, and deep brain stimulation have become research "hotspots" in recent years. Keyword clustering revealed that alpha-synuclein is the largest cluster for PD. The keyword heatmap revealed that non-motor symptoms appeared most frequently (n = 1,104), followed by quality of life (n = 502), dementia (n = 403), and depression (n = 397). Results of the present study provide an objective, comprehensive, and systematic analysis of these publications, and identifies trends and "hot" developments in this field of research. This work will inform investigators worldwide to help them conduct further research and develop new therapies.
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Affiliation(s)
- Xuefeng Li
- Changchun University of Chinese Medicine, Changchun, China
| | - Chunhai Chen
- The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Ting Pan
- The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Xue Zhou
- Changchun University of Chinese Medicine, Changchun, China
| | - Xiaozhou Sun
- Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Ziyang Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Dalong Wu
- The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Xinhua Chen
- The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
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Chen Y, Huang H, Zhang P, Xu Y, Chen Y. Constipation in multiple system atrophy: a pilot study in Chinese patients. Front Neurol 2023; 14:1202279. [PMID: 37360344 PMCID: PMC10289683 DOI: 10.3389/fneur.2023.1202279] [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: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Objective This study aimed to investigate the prevalence and clinical characteristics of subjective constipation in Chinese patients with multiple system atrophy (MSA), as well as the timing of constipation onset relative to the occurrence of motor symptoms. Methods A total of 200 patients who were consecutively admitted to two large Chinese hospitals from February 2016 to June 2021 and subsequently diagnosed with probable MSA were enrolled in this cross-sectional study. Demographic and constipation-related clinical data were collected, and motor and non-motor symptoms were assessed using various scales and questionnaires. Subjective constipation was defined using ROME III criteria. Results The frequency of constipation was 53.5, 59.7, and 39.3% in MSA, MSA with predominately parkinsonism (MSA-P), and MSA with predominately cerebellar ataxia (MSA-C), respectively. MSA-P subtype and high total UMSARS scores were associated with constipation in MSA. Similarly, the high total UMSARS scores were associated with constipation in MSA-P and MSA-C patients. Among the 107 patients with constipation, 59.8% began experiencing it before the onset of motor symptoms, and the interval between constipation and occurrence of motor symptoms was significantly longer in these patients than in those who experienced constipation after onset of motor symptoms. Conclusion Constipation is a highly prevalent non-motor symptom in MSA and more often occurs before the onset of motor symptoms. The results of this study may help guide future research into MSA pathogenesis in its earliest stages.
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Affiliation(s)
- Yalan Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Li YJ, Leong II, Fan JQ, Yan MY, Liu X, Lu WJ, Chen YY, Tan WQ, Wang YT, Zhuang LX. Efficacy of acupuncture for the treatment of Parkinson's disease-related constipation (PDC): A randomized controlled trial. Front Neurosci 2023; 17:1126080. [PMID: 36866329 PMCID: PMC9972583 DOI: 10.3389/fnins.2023.1126080] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To evaluate the efficacy of acupuncture in treating Parkinson's disease-related constipation (PDC). Materials and methods This was a randomized, controlled trial in which patients, outcome assessors, and statisticians were all blinded. Seventy-eight eligible patients were randomly assigned to either the manual acupuncture (MA) or sham acupuncture (SA) groups and received 12 sessions of treatment over a 4-week period. Following treatment, patients were monitored until the eighth week. The primary outcome was the change in weekly complete spontaneous bowel movements (CSBMs) from baseline after treatment and follow-up. The Constipation Symptom and Efficacy Assessment Scale (CSEAS), the Patient-Assessment of Constipation Quality of Life questionnaire (PAC-QOL), and the Unified Parkinson's Disease Rating Scale (UPDRS) were used as secondary outcomes. Results In the intention-to-treat analysis, 78 patients with PDC were included, with 71 completing the 4-week intervention and 4-week follow-up. When compared to the SA group, weekly CSBMs were significantly increased after treatment with the MA group (P < 0.001). Weekly CSBMs in the MA group were 3.36 [standard deviation (SD) 1.44] at baseline and increased to 4.62 (SD, 1.84) after treatment (week 4). The SA group's weekly CSBMs were 3.10 (SD, 1.45) at baseline and 3.03 (SD, 1.25) after treatment, with no significant change from baseline. The effect on weekly CSBMs improvement in the MA group lasted through the follow-up period (P < 0.001). Conclusion Acupuncture was found to be effective and safe in treating PDC in this study, and the treatment effect lasted up to 4 weeks. Clinical trial registration http://www.chictr.org.cn/index.aspx, identifier ChiCTR2200059979.
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Affiliation(s)
- Ying-Jia Li
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ian-I Leong
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing-Qi Fan
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Yue Yan
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Liu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Jing Lu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuan-Yuan Chen
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Qiang Tan
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu-Ting Wang
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Xing Zhuang
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Li-Xing Zhuang,
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Hu WZ, Cao LX, Yin JH, Zhao XS, Piao YS, Gu WH, Ma JH, Wan ZR, Huang Y. Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson's disease and progressive supranuclear palsy. Front Neurol 2023; 13:1081219. [PMID: 36756345 PMCID: PMC9901543 DOI: 10.3389/fneur.2022.1081219] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Background Non-motor symptoms (NMS) are compulsory clinical features for the clinical diagnosis of multiple system atrophy (MSA), some of which precede motor symptoms onset. To date, few studies have systematically investigated NMS in MSA and the timing of presenting NMS as the disease progresses. Clinically, MSA is difficult to be differentiated from Parkinson's disease (PD) and progressive supranuclear palsy (PSP), and the differences in NMS between MSA and PD/PSP remain unclear. The aim of this study was to compare the burden of NMS between MSA and PD/PSP and to delineate the timing of NMS presentation relative to the onset of motor symptoms in MSA. Methods A total of 61, 87, and 30 patients with MSA, PD, and PSP, respectively, were enrolled in this study. NMS was systematically assessed in all patients using the NMS scale (NMSS), and the onset of NMS relative to the onset of motor symptoms in MSA was investigated. Results MSA group had higher total NMSS scores (82.15 ± 46.10) than the PD (36.14 ± 30.78) and PSP (50.30 ± 55.05) groups (p < 0.001 overall). The number distribution pattern of the NMS was significantly different among the three parkinsonian disorders (p < 0.001 overall). In total, 85.2% of patients with MSA had more than 10 NMS, which was significantly higher than PD (28.7%) and PSP (33.3%). The frequency and scores of many NMSS subdomains and symptoms were higher in MSA than in PD and PSP (all p < 0.05). Multivariate logistic regression analysis revealed that patients with fainting, lack of motivation, swallowing, and loss of sexual interest could be attributed to MSA rather than PD or PSP, while patients with loss of concentration and forgetfulness were characteristic features of PD or PSP rather than MSA. REM-sleep behavior disorder (RBD), constipation, problems having sex, and loss of sexual interest preceded the motor symptoms onset of MSA by 2.81 ± 4.51, 1.54 ± 6.32, 1.35 ± 4.70, and 0.45 ± 3.61 years, respectively. Conclusion The NMS spectrum in MSA differs from that of PD and PSP. Patients with MSA have a higher NMS burden than patients with PD or PSP. RBD, constipation, problems having sex, and loss of sexual interest may become early diagnostic clinical markers of MSA.
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Affiliation(s)
- Wen-Zheng Hu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling-Xiao Cao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jin-Hui Yin
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue-Song Zhao
- Traditional Chinese Medical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Shan Piao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei-Hong Gu
- Neurology Department, China-Japan Friendship Hospital, Beijing, China
| | - Jing-Hong Ma
- Neurology Department, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Zhi-Rong Wan
- Department of Neurology, Aerospace Central Hospital, Beijing, China
| | - Yue Huang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Pharmacology, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia,*Correspondence: Yue Huang ✉
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Yoshida K. Effects of Botulinum Toxin Therapy on Health-Related Quality of Life Evaluated by the Oromandibular Dystonia Rating Scale. Toxins (Basel) 2022; 14:656. [PMID: 36287925 PMCID: PMC9609031 DOI: 10.3390/toxins14100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Oromandibular dystonia (OMD) refers to a focal dystonia in the stomatognathic system. Health-related quality of life (HRQoL) in isolated dystonia is associated with non-motor symptoms such as depression, anxiety, and pain, as well as motor symptoms. To evaluate HRQoL in patients with OMD, the therapeutic effects of botulinum neurotoxin (BoNT) therapy were assessed using a recently developed and validated comprehensive measurement tool called the Oromandibular Dystonia Rating Scale (OMDRS). Altogether, 408 patients (jaw closing dystonia, n = 223; tongue (lingual) dystonia, n = 86; jaw opening dystonia, n = 50; jaw deviation dystonia, n = 23; jaw protrusion dystonia, n = 13; and lip (labial) dystonia, n = 13) were evaluated at baseline and after the end of BoNT therapy or in a stable status. The total OMDRS score reduced significantly from 149.1 to 57.6 (p < 0.001). Mean improvement was 63.1%. All examiner-rated subscales (severity, disability, and pain) and patient-rated questionnaire scores (general, eating, speech, cosmetic, social/family life, sleep, annoyance, mood, and psychosocial function) were significantly lower at the endpoint than at baseline (p < 0.001). The BoNT injection had a highly positive impact on patient HRQoL, and the OMDRS could evaluate both motor phenomena and non-motor symptoms.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Xu Q, Zhou M, Jiang C, Wu L, He Q, Zhao L, Dong Y, Liu J, Chen W. Application of the Chinese Version of the Montreal Cognitive Assessment-Basic for Assessing Mild Cognitive Impairment in Parkinson's Disease. Brain Sci 2021; 11:1575. [PMID: 34942877 DOI: 10.3390/brainsci11121575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
Mild cognitive impairment (MCI) is a common and pivotal non-motor symptom in Parkinson’s disease (PD). It is necessary to use the appropriate tools to characterize the cognitive profiles and identify the subjects at risk of MCI in clinical practice. A cohort of 207 non-demented patients with PD and 52 age- and gender-matched cognitively normal controls (NCs) underwent the Chinese Version of Montreal Cognitive Assessment-Basic (MoCA-BC) evaluation. Patients with PD also received detailed motor and non-motor evaluation by serial scales. Cognitive profiles were investigated in patients with PD-MCI, relative to patients with normal cognition (PD-NC) and cognitively NCs. In addition, differences in demography, major motor and non-motor symptoms were compared between patients with PD-MCI and PD-NC. There were 70 patients with PD-MCI, occupying 33.8% of the total patients. Patients with PD-MCI had impairment in multiple cognitive domains, especially in executive function, memory and visuospatial function on MoCA-BC, relative to cognitively NCs or PD-NC. Compared with PD-NC patients, PD-MCI patients were older (p = 0.002) and had a later onset age (p = 0.007) and higher score of the Unified Parkinson’s Disease Rating Scale (UPDRS) part III (p = 0.001). The positive rate of clinical possible rapid eye movement sleep behavior disorder (cpRBD) in the PD-MCI group was significantly increased relative to the PD-NC group (p = 0.003). Multivariate logistic analysis showed that older age (OR = 1.06; p = 0.012), higher score of UPDRS-III (OR = 1.03; p = 0.018) and the presence of cpRBD (OR = 2.10; p = 0.037) were independently associated factors of MCI in patients with PD. In conclusion, executive function, memory and visuospatial function are the main impaired cognitive profiles in PD-MCI via MoCA-BC. Aging, motor severity and RBD may be independently related factors of MCI in PD.
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Fan TS, Liu SC, Wu RM. Alpha-Synuclein and Cognitive Decline in Parkinson Disease. Life (Basel) 2021; 11:1239. [PMID: 34833115 DOI: 10.3390/life11111239] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder in elderly people. It is characterized by the aggregation of misfolded alpha-synuclein throughout the nervous system. Aside from cardinal motor symptoms, cognitive impairment is one of the most disabling non-motor symptoms that occurs during the progression of the disease. The accumulation and spreading of alpha-synuclein pathology from the brainstem to limbic and neocortical structures is correlated with emerging cognitive decline in PD. This review summarizes the genetic and pathophysiologic relationship between alpha-synuclein and cognitive impairment in PD, together with potential areas of biomarker advancement.
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Zhang L, Hou Y, Cao B, Wei QQ, Ou R, Liu K, Lin J, Yang T, Xiao Y, Zhao B, Shang H. Vascular Risk Factors and Cognition in Multiple System Atrophy. Front Neurosci 2021; 15:749949. [PMID: 34764851 PMCID: PMC8576549 DOI: 10.3389/fnins.2021.749949] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: Vascular risk factors have been reported to be associated with cognitive impairment (CI) in the general population, but their role on CI in multiple system atrophy (MSA) is unclear. This study aimed to explore the relationship between vascular risk factors and CI in patients with MSA. Methods: The clinical data and vascular risk factors were collected. The Montreal Cognitive Assessment tool was used to test the cognitive function of patients with MSA. Binary logistic regression was used to analyze the correlation between vascular risk factors and CI. Results: A total of 658 patients with MSA with a mean disease duration of 2.55 ± 1.47 years were enrolled. In MSA patients, hypertension was recorded in 20.2%, diabetes mellitus in 10.3%, hyperlipidemia in 10.2%, smoking in 41.2%, drinking in 34.8%, and obesity in 9.6%. The prevalence of CI in patients with MSA, MSA with predominant parkinsonism (MSA-P), and MSA with predominant cerebellar ataxia (MSA-C) was 45.0, 45.1, and 44.9%, respectively. In the binary logistic regression model, patients with more than one vascular risk factors were significantly more likely to have CI in MSA (OR = 4.298, 95% CI 1.456-12.691, P = 0.008) and MSA-P (OR = 6.952, 95% CI 1.390-34.774, P = 0.018), after adjusting for age, sex, educational years, disease duration, and total Unified multiple system atrophy rating scale scores. Conclusion: Multiple vascular risk factors had a cumulative impact on CI in MSA. Therefore, the comprehensive management of vascular risk factors in MSA should not be neglected.
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Affiliation(s)
- Lingyu Zhang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qian-Qian Wei
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Kuncheng Liu
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Junyu Lin
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Tianmi Yang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Xiao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - HuiFang Shang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Abstract
INTRODUCTION In patients with cervical dystonia (CD), pain is a major contributor to disability and social isolation and is often the main reason patients seek treatment. Surveys evaluating patient perceptions of their CD symptoms consistently highlight pain as a troublesome and disabling feature of their condition with significant impact on daily life and work. AREAS COVERED In this article, the authors review the epidemiology, assessment, possible mechanisms and treatment of pain in CD, including a meta-analysis of randomized controlled trial data with abobotulinumtoxinA. EXPERT OPINION Mechanisms of pain in CD may be muscle-based and non-muscle based. Accumulating evidence suggests that non-muscle-based mechanisms (such as abnormal transmission and processing of nociceptive stimuli, dysfunction of descending pain inhibitory pathways as well as structural and network changes in the basal ganglia, cortex and other areas) may also contribute to pain in CD alongside prolonged muscle contraction. Chemodenervation with botulinum toxin is considered the first-line treatment for CD. Treatment with botulinum toxin is usually effective, but optimization of the injection parameters should include consideration of pain as a core symptom in addition to the motor problems.
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Affiliation(s)
- Raymond L Rosales
- Dept. of Neurology and Psychiatry, the Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines.,The Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | | | | | - Richard M Trosch
- The Parkinson's and Movement Disorders Center, Farmington Hills, MI, USA
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Aubry-Lafontaine E, Tremblay C, Durand-Martel P, Dupré N, Frasnelli J. Orthonasal, but not Retronasal Olfaction Is Specifically Impaired in Parkinson's Disease. Chem Senses 2021; 45:401-406. [PMID: 32249295 DOI: 10.1093/chemse/bjaa024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Olfactory dysfunction (OD) in Parkinson's disease (PD) appears several years before the presence of motor disturbance. Olfactory testing has the potential to serve as a tool for early detection of PD, but OD is not specific to PD as it affects up to 20% of the general population. Olfaction includes an orthonasal and a retronasal components; in some forms of OD, retronasal olfactory function is preserved. We aimed to evaluate whether combined testing components allows for discriminating between PD-related OD and non-Parkinsonian OD (NPOD). The objective of this study is to orthonasal and retronasal olfactory function in PD patients and compare them to a NPOD group and to healthy controls. We hypothesized that this combined testing allows to distinguish PD patients from both other groups. We included 32 PD patients, 25 NPOD patients, and 15 healthy controls. Both olfactory components were impaired in PD and NPOD patients, compared with controls; however, NPOD patients had significantly better orthonasal scores than PD patients. Furthermore, the ratio of retronasal/orthonasal score was higher in PD than in both other groups. In the NPOD group, orthonasal and retronasal scores were significantly correlated; no such correlation could be observed in PD patients. In summary, PD patients seem to rely on compensatory mechanisms for flavor perception. Combined orthonasal and retronasal olfactory testing may contribute to differentiate PD patients from patients with NPOD.
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Affiliation(s)
| | - Cécilia Tremblay
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Pascali Durand-Martel
- Department of Neurology, Centre intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Québec City, QC, Canada
| | - Nicolas Dupré
- Division of Neurosciences, Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Research Center, Hôpital du Sacré-Cœur, Montreal, QC, Canada
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Kwon KY, Lee EJ, Lee M, Ju H, Im K. Impact of motor subtype on non-motor symptoms and fall-related features in patients with early Parkinson's disease. Geriatr Gerontol Int 2021; 21:416-420. [PMID: 33780137 DOI: 10.1111/ggi.14156] [Citation(s) in RCA: 9] [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] [Received: 09/15/2020] [Revised: 01/27/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
AIM Clinical implications for motor phenotypes of Parkinson's disease (PD) remain to be further elucidated, particularly at the early stages of the disease. We aimed to compare the non-motor and fall-related features between tremor-dominant (TD) and postural instability-gait difficulty (PIGD) subtypes in patients with early PD. METHODS PD was categorized into TD, intermediate and PIGD types, according to the literature. Not only motor symptoms, but also non-motor symptoms for global cognition, depression, anxiety, fatigue and dysautonomia, were measured in detail. In addition, fall-related features, including a previous history of falls, fear of fall measurement and gait freezing were assessed. RESULTS In patients with early PD (disease duration no more than 5 years), 35 patients with TD-type PD and 31 patients with PIGD-type PD were finally evaluated for the study. Compared with the TD group, the PIGD group showed higher fatigue, gastrointestinal dysfunction and fall-related parameter scores. Moreover, the PIGD scores were significantly correlated with all of those symptoms. CONCLUSIONS Our findings suggest that PIGD is significantly linked to fatigue, gastrointestinal dysfunction and fall-related features during the early stages of PD. Geriatr Gerontol Int 2021; 21: 416-420.
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Affiliation(s)
- Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Taiwan
| | - Eun Ji Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Taiwan
| | - Mina Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Taiwan
| | - Hyunjin Ju
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Taiwan
| | - Kayeong Im
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Taiwan
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12
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Xing F, Mo Y, Chen X, Liu T, Wang K, Hu P. Using the Chinese Smell Identification Test to explore olfactory function in Parkinson's disease. J Clin Exp Neuropsychol 2021; 43:156-162. [PMID: 33657978 DOI: 10.1080/13803395.2021.1891207] [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] [Indexed: 10/22/2022]
Abstract
Introduction: The Chinese Smell Identification Test (CSIT) was developed specifically for Chinese populations. This work investigated the utility of this test in detecting Parkinson's disease (PD). Olfactory dysfunction is a common non-motor symptom of PD. There are different opinions on the efficacy of drugs for anosmia in PD.Objective: To investigate the olfactory function of Chinese PD patients, verify the effectiveness of the CSIT, and further detect the effects of dopaminergic drugs on anosmia.Methods: In total, 149 PD patients were recruited from the First Affiliated Hospital of Anhui Medical University and 149 healthy comparison participants (HCP) were recruited from the Institute of Psychology of the Chinese Academy of Sciences. The CSIT was used for olfactory function testing in all participants.Results: CSIT scores were significantly lower in the PD group than in the HCP group (t(296) = -12.797, P < 0.001, d = 1.48). Receiver operating characteristic curve analysis showed that the optimal threshold value for the olfactory recognition test was 22.5, which had a sensitivity and specificity of 71.1% and 89.3%, respectively, for the detection of Parkinson's disease. Sex showed a significant influence on CSIT score (t = -3.552, P = 0.001), with males being more likely to develop olfactory dysfunction. We found CSIT scores of the non-medication group and the group with medication were lower than those of the HCP group, and the difference was statistically significant (t(82) = -7.116, P < 0.0167, d = 1.59; t(82) = -4.907, P < 0.0167, d = 1.10). CSIT scores of the group with medication were significantly higher than those of the non-medication group (t(41) = -3.067, P < 0.0167, d = 0.41).Conclusions: In China, the CSIT is recommended to improve the sensitivity of PD detection. The olfactory function of PD patients was improved after treatment with dopaminergic drugs.
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Affiliation(s)
- Fengbo Xing
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yuting Mo
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Xing Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Tingting Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China.,Department of Medical Psychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
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13
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Maycas-Cepeda T, López-Ruiz P, Feliz-Feliz C, Gómez-Vicente L, García-Cobos R, Arroyo R, García-Ruiz PJ. Hypomimia in Parkinson's Disease: What Is It Telling Us? Front Neurol 2021; 11:603582. [PMID: 33569034 PMCID: PMC7868377 DOI: 10.3389/fneur.2020.603582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Amimia is one of the most typical features of Parkinson's disease (PD). However, its significance and correlation with motor and nonmotor symptoms is unknown. The aim of this study is to evaluate the association between amimia and motor and nonmotor symptoms, including cognitive status, depression, and quality of life in PD patients. We also tested the blink rate as a potential tool for objectively measuring upper facial bradykinesia. Methods: We prospectively studied amimia in PD patients. Clinical evaluation was performed using the Unified Parkinson's Disease Rating Scale (UPDRS) and timed tests. Cognitive status, depression, and quality of life were assessed using the Parkinson's Disease Cognitive Rating Scale (PD-CRS), the 16-Item Quick Inventory of Depressive Symptomatology (QIDS-SR16), and the PDQ-39, respectively. Amimia was clinically evaluated according to item 19 of UPDRS III. Finally, we studied upper facial amimia by measuring resting blink frequency and blink rate during spontaneous conversation. Results: We included 75 patients. Amimia (item 19 UPDRS III) correlated with motor and total UPDRS (r: 0.529 and 0.551 Spearman), and its rigidity, distal bradykinesia, and motor axial subscores (r: 0.472; r: 0.252, and r: 0.508, respectively); Hoehn and Yahr scale (r: 0.392), timed tests, gait freezing, cognitive status (r: 0.29), and quality of life (r: 0.268) correlated with amimia. Blinking frequency correlated with amimia (measured with item 19 UPDRS), motor and total UPDRS. Conclusion: Amimia correlates with motor (especially axial symptoms) and cognitive situations in PD. Amimia could be a useful global marker of overall disease severity, including cognitive decline.
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Affiliation(s)
- Teresa Maycas-Cepeda
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Department of Clinical Medicine, Universidad Europea Madrid, Madrid, Spain
| | - Pedro López-Ruiz
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Department of Clinical Medicine, Universidad Europea Madrid, Madrid, Spain
| | | | - Lidia Gómez-Vicente
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Department of Clinical Medicine, Universidad Europea Madrid, Madrid, Spain
| | - Rocío García-Cobos
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Department of Clinical Medicine, Universidad Europea Madrid, Madrid, Spain
| | - Rafael Arroyo
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Department of Clinical Medicine, Universidad Europea Madrid, Madrid, Spain
| | - Pedro J García-Ruiz
- Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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14
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Zhou Y, He R, Zhao Y, He Y, Hu Y, Sun Q, Xu Q, Tan J, Yan X, Tang B, Guo J. Olfactory Dysfunction and Its Relationship With Clinical Features of Parkinson's Disease. Front Neurol 2020; 11:526615. [PMID: 33178098 PMCID: PMC7596377 DOI: 10.3389/fneur.2020.526615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023] Open
Abstract
Objective: To conduct an investigation into the reliability of assessing the olfactory function of patients with Parkinson's disease (PD) in a clinical setting of crowding patients in populated countries, such as China, by the hyposmia rating scale (HRS) and compare other non-motor features between patients with PD with olfactory dysfunction (PD-OD) and patients with PD without olfactory dysfunction (PD-NOD), according to the result of olfactory function assessed by the Sniffin' Sticks test. Methods: A total of 320 patients with clinically confirmed or clinically possible PD were recruited. Olfactory function of all participants was assessed with the HRS and the Sniffin' Sticks test. Demographic data and clinical information were collected, and patients were evaluated using standardized assessment protocols. With reference to the Sniffin' Sticks test, the specificity, sensitivity, coincidence rate, and kappa value of the HRS was computed, and then its reliability was evaluated. We divided patients into PD-OD and PD-NOD groups based on the results of olfactory function assessed by the Sniffin' Sticks test. Clinical manifestations were compared between PD-OD and PD-NOD. Results: The percentage of patients with OD determined by the Sniffin' Sticks test was 65.6%, and the percentage of those with OD was 55.6% when using the HRS measured olfactory function. With reference to the Sniffin' Sticks test, the specificity, sensitivity, coincidence rate, and kappa value of the HRS were 82.73, 75.71, 78.13%, and 0.55, respectively. The area under the receiver operating characteristic curve for the HRS was 0.793. There were no differences in demographic characteristics between the PD-OD and PD-NOD groups. The patients with hyposmia had more severe non-motor symptoms. Conclusion: The HRS is of great value as a self-assessment scale for evaluating olfactory function, especially in PD patients over 55 years old. Moreover, PD patients with hyposmia have more severe non-motor features than PD patients without hyposmia, mainly in terms of mood and constipation.
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Affiliation(s)
- Yangjie Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Runcheng He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yan He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yacen Hu
- Department of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qiying Sun
- Department of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jieqiong Tan
- Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Medical Genetics, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Medical Genetics, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
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15
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Mendorf S, Witte OW, Zipprich H, Prell T. Association Between Nonmotor Symptoms and Nonadherence to Medication in Parkinson's Disease. Front Neurol 2020; 11:551696. [PMID: 33192983 PMCID: PMC7604271 DOI: 10.3389/fneur.2020.551696] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Nonadherence to medication is a common and serious issue in the treatment of patients with Parkinson's disease (PD). Among others, distinct nonmotor symptoms (NMS) were found to be associated with nonadherence in PD. Here, we aimed to confirm the association between NMS and adherence. Methods: In this observational study, the following data were collected: sociodemographic data, the German versions of the Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Becks depression inventory II (BDI-II), nonmotor symptoms questionnaire (NMSQ), and the Stendal adherence to medication score (SAMS). Results: The final sample included 137 people with PD [54 (39.4%) females] with a mean age of 71.3 ± 8.2 years. According to SAMS, 10.9% of the patients were fully adherent, 73% were moderately nonadherent, and 16.1% showed clinically significant nonadherence. Nonadherence was associated with LEDD, BDI-II, education level, MDS-UPDRS III, and the NMSQ. The number of NMS was higher in nonadherent patients than in adherent patients. In the multiple stepwise regression analysis, the items 5 (constipation), 17 (anxiety), and 21 (falls) predicted nonadherence to medication. These NMSQ items also remained significant predictors for SAMS after correction for LEDD, MDS-UPDRS III, BDI-II, age, education level, gender, and disease duration. Conclusion: Our study, in principle, confirms the association between NMS burden and nonadherence in PD. However, in contrast to other clinical factors, the relevance of NMSQ in terms of nonadherence is low. More studies with larger sample sizes are necessary to explore the impact of distinct NMS on adherence.
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Affiliation(s)
- Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Hannah Zipprich
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
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16
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Kitta T, Ouchi M, Chiba H, Higuchi M, Togo M, Abe-Takahashi Y, Kusakabe N, Shinohara N. Animal Model for Lower Urinary Tract Dysfunction in Parkinson's Disease. Int J Mol Sci 2020; 21:E6520. [PMID: 32906613 DOI: 10.3390/ijms21186520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022] Open
Abstract
Although Parkinson's disease (PD) is characterized by the loss of dopaminergic neurons in the substantia nigra and subsequent motor symptoms, various non-motor symptoms often precede these other symptoms. While motor symptoms are certainly burdensome, a wide range of non-motor symptoms have emerged as the key determinant of the quality of life in PD patients. The prevalence of lower urinary tract symptoms differs according to the study, with ranges between 27% and 63.9%. These can be influenced by the stage of disease, the presence of lower urinary tract-related comorbidities, and parallels with other manifestations of autonomic dysfunction. Animal models can provide a platform for investigating the mechanisms of PD-related dysfunction and for the assessment of novel treatment strategies. Animal research efforts have been primarily focused on PD motor signs and symptoms. However, the etiology of lower urinary tract dysfunction in PD has yet to be definitively clarified. Several animal PD models are available, each of which has a different effect on the autonomic nervous system. In this article, we review the various lower urinary tract dysfunction animal PD models. We additionally discuss techniques for determining the appropriate model for evaluating the development of lower urinary tract dysfunction treatments.
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17
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Sengul Y, Temur HO, Corakcı Z, Sengul HS, Dowd H, Ustun I, Alkan A, Louis ED. Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study. Int J Neurosci 2020; 132:154-164. [PMID: 32730718 DOI: 10.1080/00207454.2020.1803859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. OBJECTIVE To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. METHOD Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. RESULTS Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. CONCLUSION These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.
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Affiliation(s)
- Y Sengul
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey.,Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - H O Temur
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Z Corakcı
- Department of Occupational Therapy, Bezmialem Foundation University School of Medical Sciences, Istanbul, Turkey
| | - H S Sengul
- Laboratory of Neuropsychology, Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey
| | - H Dowd
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - I Ustun
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - A Alkan
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - E D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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Wu L, Wang Q, Zhao L, Jiang CY, Xu Q, Wu SC, Dong YR, He Q, Chen W, Liu JR. Clinical and Oculomotor Correlates With Freezing of Gait in a Chinese Cohort of Parkinson's Disease Patients. Front Aging Neurosci 2020; 12:237. [PMID: 32903684 PMCID: PMC7438737 DOI: 10.3389/fnagi.2020.00237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
Accumulating evidence suggests that freezing of gait (FOG) is a unique gait disturbance in Parkinson’s disease (PD), and its pathophysiology is not fully elucidated. The present study aims to investigate the clinical and oculomotor associations with FOG in Chinese PD patients. From Jan 2017 to Dec 2019, a total of 210 PD patients were consecutively registered for FOG evaluation based on item-3 of the Freezing of Gait Questionnaire (FOGQ). We explored the demographic, motor, and non-motor symptom differences in FOG positive (PD+FOG, n = 45) vs. negative (PD-FOG, n = 165) group. In addition, 40 PD patients and 37 healthy controls (HC) also underwent oculomotor test via videonystagmography (VNG). Visually guided saccade (VGS) latency, saccade accuracy and gain in smooth pursuit eye movement (SPEM) at three frequencies of horizontal axis were compared among PD+FOG (n = 20), PD-FOG (n = 20), and HC (n = 37). Compared with PD-FOG, PD+FOG had longer disease duration, more severe motor symptoms, lower cognitive scores, more severe depressive and autonomic impairments, as well as higher daily levodopa equivalent dosage. FOG occurred more frequently in patients with wearing-off. VNG subgroup analysis demonstrated that PD+FOG had prolonged saccade latency and decreased saccade accuracy relative to PD-FOG or HC. SPEM gain at 0.1 and 0.2 Hz was also decreased in PD+FOG compared with HC. Furthermore, prolonged saccade latency was correlated with higher FOGQ scores in PD patients. Our results verify that PD with FOG patients suffer from more severe motor and non-motor symptoms, indicating more extensive neurodegeneration. Prolonged saccade latency could be a practical oculomotor parameter both for identification and progression of FOG in PD.
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Affiliation(s)
- Li Wu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Wang
- Department of Neurology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lei Zhao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Yan Jiang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Xu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Cheng Wu
- Biostatistics Office of Clinical Research Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - You-Rong Dong
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing He
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Baille G, Perez T, Devos D, Machuron F, Dujardin K, Chenivesse C, Defebvre L, Moreau C. Dyspnea Is a Specific Symptom in Parkinson's Disease. J Parkinsons Dis 2020; 9:785-791. [PMID: 31476170 DOI: 10.3233/jpd-191713] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dyspnea is a multidimensional sensation that is reported in Parkinson's disease (PD). The multidimensional dyspnea profile (MDP) questionnaire can help to distinguish the perceptive dimension and the emotion response. OBJECTIVE The aim was to assess the clinical features associated with dyspnea using the MDP questionnaire in order to determine which aspects of the symptom was linked with anxiety, depression or motor severity of the disease. METHODS Non-demented patients were asked whether they experienced shortness of breath in the last month. In case of positive answer, dyspnea was assessed by the MDP. MDS-UPDRS, global cognitive performance, non-motor symptoms and quality of life were assessed. RESULTS 60/163 patients were dyspneic since 4.6±2.4 years. The most frequent best sensory quality (SQ) described were: hyperpnoea (35%), physical breathing effort (25%) and air hunger (20%). Hyperpnoea and air hunger had the highest SQ intensity. Anxiety had the highest intensity in the emotional domain. CONCLUSION Dyspnea is a frequent symptom in PD, with specific presentations and two main aspects: one related with anxiety and another with ventilation control impairment.
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Affiliation(s)
- Guillaume Baille
- Department of Neurology, Expert Center for Parkinson's Disease, INSERM UMRS_1171, Lille University Medical Center, LICEND COEN center, Lille, France
| | - Thierry Perez
- CHU Lille, Lung Function Department, Univ Lille, INSERM 1019, CNRS UMR 8204, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - David Devos
- CHU Lille, Department of Allergy and Respiratory Medicine, Competence Center for rare lung diseases, Univ. Lille, CNRS, INSERM, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - François Machuron
- Univ. Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Department of Biostatistics, Lille, France
| | - Kathy Dujardin
- Department of Neurology, Expert Center for Parkinson's Disease, INSERM UMRS_1171, Lille University Medical Center, LICEND COEN center, Lille, France
| | - Cécile Chenivesse
- CHU Lille, Lung Function Department, Univ Lille, INSERM 1019, CNRS UMR 8204, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Luc Defebvre
- Department of Neurology, Expert Center for Parkinson's Disease, INSERM UMRS_1171, Lille University Medical Center, LICEND COEN center, Lille, France
| | - Caroline Moreau
- Department of Neurology, Expert Center for Parkinson's Disease, INSERM UMRS_1171, Lille University Medical Center, LICEND COEN center, Lille, France
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Abstract
INTRODUCTION Dyspnea is a complex and debilitating non-motor symptom experienced by a significant proportion of PD patients which results in limitations to physical ability and a reduction in quality of life. AREAS COVERED The authors highlight the underlying pathophysiological mechanisms that can contribute to dyspnea in PD patients, and provide the clinician with a practical working algorithm for the management of such patients. The authors further highlight important clinical red flags that should be heeded in dyspneic PD patients and discuss therapeutic strategies for managing dyspnea. EXPERT OPINION Although awareness of dyspnea in PD is increasing, further studies of its prevalence and natural history at different stages of the disease are needed. In particular, it is important to determine whether dyspnea could be an early or prodromal disease manifestation. Although peripheral mechanisms are likely to play a major role in the pathophysiology of dyspnea, the possibility that central changes in brainstem ventilatory control may also play a part warrants further investigation.
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Affiliation(s)
- Srimathy Vijayan
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia.,Faculty of Health and Medical Sciences, University of Western Australia , Nedlands, Perth, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital , Nedlands, Perth, Australia.,School of Human Sciences, University of Western Australia , Crawley, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands , Perth, Australia
| | - Soumya Ghosh
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| | - Rick Stell
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| | - Frank L Mastaglia
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
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21
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Huang H, Yang X, Zhao Q, Ning P, Shen Q, Wang H, Xie D, Lu H, Xu Y. Clinical characteristics of patients with essential tremor or essential tremor plus. Acta Neurol Scand 2020; 141:335-341. [PMID: 31863462 DOI: 10.1111/ane.13209] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The International Parkinson and Movement Disorder Society introduced the category of essential tremor (ET)-plus in its new ET classification scheme, but how the clinical correlates of ET-plus differ from those of "pure" ET is unclear. By comparing the clinical characteristics of ET and ET-plus patients, we expect to better understand the impact and invoked questions of the new classification on clinical practice. METHODS We reviewed the medical records of 280 ET syndrome patients in an ongoing cross-sectional study in a Chinese population and reclassified them according to the new criteria. Clinico-demographic characteristics were compared between ET and ET-plus patients. Risk factors of diagnosis of ET-plus were explored using logistic regression. RESULTS A total of 121 patients (50.8%) were reclassified as having ET and 117 as having ET-plus. ET-plus group was significantly older at tremor onset, less educated, and more likely to have cranial tremor, depression symptom, anxiety symptom, and probable REM sleep behavior disorder. ET-plus group also showed more severe upper limb tremor and cognition impairment. Regression analysis identified four independent risk factors associated with ET-plus: late tremor onset (OR 3.04, 95%CI 1.60-5.79), less educated (OR 0.91, 95%CI 0.85-0.97), severe upper limb tremor (OR 2.46, 95%CI 1.30-4.62), and presence of cranial tremor (OR 2.30, 95%CI 1.20-4.41). CONCLUSIONS The new classification scheme emphasized that ET syndrome is heterogeneous. ET-plus cannot be seen as a subtype or a diagnosis of ET syndrome, but rather as a placeholder, representing an area of current scientific uncertainty.
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Affiliation(s)
- Hongyan Huang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Xinglong Yang
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Quanzhen Zhao
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Pingping Ning
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Qiuyan Shen
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Hui Wang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Dan Xie
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Haitao Lu
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Yanming Xu
- Department of Neurology West China Hospital Sichuan University Chengdu China
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22
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Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M. Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson's Disease. Neurol Med Chir (Tokyo) 2019; 59:331-336. [PMID: 31231086 PMCID: PMC6753254 DOI: 10.2176/nmc.oa.2019-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms in individuals with advanced Parkinson’s disease (PD) and enables physicians to reduce doses of antiparkinsonian drugs. We investigated possible predictive factors for the successful reduction of antiparkinsonian drug dosage after STN-DBS. We evaluated 33 PD patients who underwent bilateral STN-DBS. We assessed rates of reduction of the levodopa-equivalent daily dose (LEDD) and levodopa daily dose (LDD) by comparing drug doses before vs. 6-months post-surgery. We used correlation coefficients to measure the strength of the relationships between LEDD and LDD reduction rates and preoperative factors including age, disease duration, preoperative LEDD and LDD, unified Parkinson’s Disease Rating Scale part-II and -III, levodopa response rate, Mini-Mental State Examination score, dyskinesia score, Hamilton Rating Scale for depression, and the number of non-motor symptoms. The average LEDD and LDD reduction rates were 61.0% and 70.4%, respectively. Of the variables assessed, only the number of psychiatric/cognitive symptoms was significantly correlated with the LEDD reduction rate. No other preoperative factors were correlated with the LEDD or LDD reduction rate. A wide range of preoperative psychiatric and cognitive symptoms may predict the successful reduction of antiparkinsonian drugs after STN-DBS.
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Affiliation(s)
- Kazuhiro Samura
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine
| | - Yasushi Miyagi
- Department of Stereotactic and Functional Neurosurgery, Fukuoka Mirai Hospital
| | - Minako Kawaguchi
- Department of Neurosurgery, Faculty of Medicine, Kyushu University
| | - Fumiaki Yoshida
- Department of Neurosurgery, Faculty of Medicine, Kyushu University.,Department of Anatomy and Physiology, Faculty of Medicine, Saga University
| | | | - Masatou Kawashima
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine
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23
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Knudsen K, Haase AM, Fedorova TD, Bekker AC, Østergaard K, Krogh K, Borghammer P. Gastrointestinal Transit Time in Parkinson's Disease Using a Magnetic Tracking System. J Parkinsons Dis 2018; 7:471-479. [PMID: 28759975 DOI: 10.3233/jpd-171131] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Symptoms from the gastrointestinal tract are highly prevalent in Parkinson's disease (PD), but knowledge of the underlying pathology is incomplete and valid objective markers on regional gastrointestinal function are limited. OBJECTIVE The aims were to evaluate gastrointestinal transit time and motility in PD patients and controls. METHODS Twenty-two PD patients and 15 controls were included. Gastric-, small intestinal-, and caecum-ascending colonic transit times as well as colonic motility, defined as mass- and fast movements, were performed using the ambulatory 3D-Transit system. Gastrointestinal transit time with radio opaque markers, gastric emptying scintigraphy, and subjective non-motor symptoms were also evaluated. RESULTS Using the 3D-Transit system, the patient group displayed significantly longer small intestinal- and caecum-ascending transit times (p = 0.030 and p = 0.0063). No between-group difference was seen in gastric transit time (p = 0.91). Time to first mass- and fast colonic movement were significantly increased in PD (p = 0.023 and p = 0.006). Radio opaque marker gastrointestinal transit time was significantly increased in the patient group (p < 0.0001), whereas no difference was seen in scintigraphic gastric emptying time (p = 0.68). Prevalence of constipation symptoms on the NMSQuest was 41% in PD and 7% in controls. CONCLUSIONS Significantly increased small intestinal- and caecum-ascending 3D-Transit times were detected in PD patients. Also, time to first propagating colonic movement was increased. Radio opaque marker gastrointestinal transit time was significantly delayed, but no difference was seen in gastric transit time and gastric emptying time. The present findings highlight widespread intestinal involvement in PD increasing throughout the gastrointestinal tract.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Anne-Mette Haase
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | | | | | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
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24
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Knudsen K, Fedorova TD, Bekker AC, Iversen P, Østergaard K, Krogh K, Borghammer P. Objective Colonic Dysfunction is Far more Prevalent than Subjective Constipation in Parkinson's Disease: A Colon Transit and Volume Study. J Parkinsons Dis 2018; 7:359-367. [PMID: 28157109 DOI: 10.3233/jpd-161050] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal function has received increased interest in the context of Parkinson's disease (PD). Constipation is among the most frequent non-motor symptoms, but our understanding of the underlying pathology is limited. Subjective constipation correlates poorly with objective markers. OBJECTIVE The aims were to evaluate colonic transit time and volume in PD and to correlate these measures with subjective symptoms and gastric emptying. METHODS Thirty-two PD patients and 26 controls were included. Colonic transit time, computed tomography-based volume estimation, and gastric emptying were performed as objective markers of gastrointestinal function. Subjective gastrointestinal symptoms were evaluated by three different questionnaires. RESULTS Seventy-nine percent of PD patients displayed prolonged colonic transit time (p < 0.0001) and 66% of patients had significantly increased colonic volume (p = 0.0002). Particularly the transverse and rectosigmoid segments were affected. There was no difference in gastric emptying time between groups. The prevalence of subjective constipation in PD patients was significantly lower and ranged from 3% to 38% depending on the type of questionnaire. CONCLUSIONS Significantly delayed colonic transit time and increased volume were frequent findings in PD patients, and objective dysfunction was considerably more prevalent than subjective constipation symptoms. Also, the prevalence of subjective constipation varied widely depending upon which questionnaire was employed. These findings highlight the need for more research on how to define constipation in PD and also the need for improved understanding of the relationship between subjective symptoms and objective dysfunction.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Anne C Bekker
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | | | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
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25
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Mahlknecht P, Seppi K, Frauscher B, Kiechl S, Willeit J, Stockner H, Djamshidian A, Nocker M, Rastner V, Defrancesco M, Rungger G, Gasperi A, Poewe W, Högl B. Probable RBD and association with neurodegenerative disease markers: A population-based study. Mov Disord 2015. [PMID: 26208108 DOI: 10.1002/mds.26350] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The prevalence of rapid eye movement sleep behavior disorder (RBD) and its association with markers of neurodegeneration in the general population are poorly defined. METHODS We assessed the prevalence of probable RBD defined by two validated questionnaires, the RBD Screening Questionnaire (RBDSQ) and the Innsbruck RBD-Inventory (RBD-I), and studied its associations with clinical and imaging markers for neurodegeneration in the Bruneck Study cohort aged 60 y or older. RESULTS Of the 456 participants without Parkinson's disease, 4.6% (RBDSQ; 95%CI, 3.0%-7.0%) and 7.7% (RBD-I; 95%CI, 5.6%-10.5%) had probable RBD. Probable RBD diagnosed with either of the questionnaires was associated with hyposmia (trend; P < 0.1), anxiety (P < 0.05), depression (P < 0.05), antidepressant use (P < 0.05), and self-reported non-motor symptoms (P < 0.01), specifically, dribbling saliva, memory problems, apathy, concentration problems, and anxiety. CONCLUSIONS Our findings may provide a basis for future studies intending to identify cohorts at risk for Lewy body diseases through screening of the general elderly population for RBD.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Austria.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Austria.,Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, UK
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Verena Rastner
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | | | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Italy
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Austria
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