Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson's Disease

INTRODUCTION

The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients.

METHODS

PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems.

RESULTS

The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments.

CONCLUSION

Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Quality of life and non-motor symptoms in Parkinson's disease patients with subthreshold depression

BACKGROUND

The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified.

MATERIAL AND METHODS

PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL.

RESULTS

The frequency of depressive symptoms was higher in PD patients (n = 694) than in controls (n = 207) (p < 0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1 ± 12.8 vs 11.6 ± 10; p < 0.0001) and global QoL (EUROHIS-QOL8; 3.7 ± 0.5 vs 4 ± 0.5; p < 0.0001) were significantly worse in subD (n = 120) than nonD (n = 348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9 ± 32 vs 29.1 ± 25.8;p < 0.0001). Non-motor symptoms burden (NMSS;OR = 1.019;95%CI 1.011-1.028; p < 0.0001), neuropsychiatric symptoms (NPI; OR = 1.091; 95%CI 1.045-1.139; p < 0.0001), impulse control behaviors (QUIP-RS; OR = 1.035; 95%CI 1.007-1063; p = 0.013), quality of sleep (PDSS; OR = 0.991; 95%CI 0.983-0.999; p = 0.042), and fatigue (VAFS-physical; OR = 1.185; 95%CI 1.086-1.293; p < 0.0001; VAFS-mental; OR = 1.164; 95%CI 1.058-1.280; p = 0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone.

CONCLUSIONS

SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.

Effect of vitamin D nutritional status on muscle function and strength in healthy women aged over sixty-five years

BACKGROUND

Vitamin D insufficiency is common in elderly adults, and leads to secondary hyperparathyroidism, bone loss, muscle weakness, and osteoporotic fractures.

OBJECTIVE

To evaluate the relation between vitamin D nutritional status and muscle function and muscle strength in women aged over 65 years.

METHODS

Fifty-four postmenopausal women from Buenos Aires (latitude 34° S), average age (X±DS) 71±4, were included in the study. Determinations of serum calcium, phosphate, 25 hydroxyvitamin D (25OHD), intact parathormone (iPTH) and calciuria / creatininuria ratio in 24-hour urine samples were performed. Muscle function was assessed by means of walking-speed test, standing balance, and sit-to-stand tests. Lower extremity muscle strength was determined using a manual dynamometer.

RESULTS

25OHD levels ≥20 ng/ml were found to be associated with better lower extremity muscle function and strength. Forty- six % of participants had 25OHD levels ≥20 ng/ml. Women with 25OHD levels ≥20 ng/ml scored higher on the muscle function tests (11.2±0.9 vs.10.0±2.1; p<0.003) and had stronger knee extensor (13.4±2.7 vs.11.6±2.5 Kg.; p<0.03) and hip abductor (8.3±2.7 vs. 7.3±3.1 Kg; p<0.04) muscles; strength of their hip flexors tended to be higher but did not reach significantly different values (17.0±3.3 vs. 15.4±2.8 Kg.; 0.1>p>0.05). Negative correlation was observed between iPTH and muscle function (r= -0.436; p<0.02).

CONCLUSION

25OHD levels ≥20 ng/ml are needed for a better muscle function and strength. Assessing vitamin D nutritional status in adults aged ≥ 65 years would allow correcting hypovitaminosis D and improve muscle function and strength.

Ehlers-Danlos syndrome and periventricular nodular heterotopia in a Spanish family with a single FLNA mutation

BACKGROUND

The Ehlers-Danlos syndrome (EDS) comprises a group of hereditary connective tissue disorders. Periventricular nodular heterotopia (PNH) is a human neuronal migration disorder characterised by seizures and conglomerates of neural cells around the lateral ventricles of the brain, caused by FLNA mutations. FLNA encodes filamin A, an actin binding protein involved in cytoskeletal organisation. The amino-terminal actin binding domain (ABD) of filamins contains two tandem calponin homology domains, CHD1 and CHD2.

OBJECTIVE

To report clinical and genetic analyses in a Spanish family affected by a connective tissue disorder suggestive of EDS type III and PNH.

METHODS

A clinical and molecular study was undertaken in the three affected women. Clinical histories, physical and neurological examinations, brain magnetic resonance imaging studies, and skin biopsies were done. Genetic analysis of the FLNA gene was undertaken by direct sequencing and restriction fragment length polymorphism analysis.

RESULTS

Mutation analysis of the FLNA gene resulted in the identification of a novel mutation in exon 3 (c.383C-->T) segregating with the combination of both syndromes. This mutation results in a substitution of an alanine residue (A128V) in CHD1.

CONCLUSIONS

The findings suggest that the Ala128Val mutation causes the dual EDS-PNH phenotype. This association constitutes a new variant within the EDS spectrum. This is the first description of a familial EDS-PNH association with a mutation in FLNA.

Serum levels of coenzyme Q in patients with Lewy body disease

The purpose of the present study was to compare serum levels of coenzyme Q(10) (CoQ(10)) and the coenzyme Q(10) cholesterol (CoQ(10)/cholesterol) ratio in 18 patients with Lewy body disease (LBD) with 20 matched controls. The mean serum coenzyme Q10 levels in patients with LBD were significantly reduced with respect to control group, however, no differences were found in CoQ(10)/cholesterol ratio between LBD patients and control group. There was no correlation among CoQ(10) and CoQ(10)/cholesterol ratio with age, age of onset, body mass index, duration of the disease or scores of the Mini Mental State Examination, UPDRS and Hoehn and Yahr stage. These results suggest the involvement of this enzimatic system in the pathogenic mechanism of LBD.

[Multiple cerebral hematomas: review of 7 cases]

We present seven patients with multiple spontaneous cerebral haemorrhages, diagnosed by CT scan, in a 10-year period in the Hospital 12 de Octubre. The clinical presentation, radiologic features, and prognosis of this entity are analyzed, and the diverse etiologic factors are discussed. All of the patients in this series were over 50 years of age, the majority not hypertensive (57%, n = 4), and in almost half the cases (43%, n = 3) the brain haemorrhages were associated with diverse coagulation disorders. The localization of the haemorrhages was exclusively supratentorial. Four patients presented with a moderate global confusional state, and one patient with deep coma. All the patients had focal signs. The mortality was elevated, with three patients dying, but the clinical evolution and outcome of those who survived was favourable.

[Congenital fiber-type disproportion: analysis of a series of 11 cases]

We present 11 patients with congenital fiber type disproportion suggesting the existence of two different clinical groups. The first group not associated with other diseases, presents a uniform clinical picture and a generally good prognosis, although the patients with severe respiratory involvement can die. The second group includes the cases in which CFTD is associated with other congenital diseases such as Lowe's Syndrome, Möbius' Syndrome, hypothyroidism and hydrocephalus. In this group the clinical presentation and prognosis is that of the associated disease added to that of CFTD. The frequent association of CFTD with other congenital diseases suggests that CFTD may not be a specific myopathy but a histological abnormality due to different pathogenic insults which interfere with the normal growth and maturation of the muscle fibres.