Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism

Orthostatic hypotension (OH) is one of the commonly occurring nonmotor symptoms in patients with idiopathic Parkinson’s disease (IPD) and atypical parkinsonism (AP). We aimed to review current evidences on epidemiology, diagnosis, treatment, and prognosis of OH in patients with IPD and AP. Major electronic medical databases were assessed including PubMed/MEDLINE and Embase up to February 2013. English-written original or review articles with keywords such as “Parkinson’s disease,” “atypical parkinsonism,” and “orthostatic hypotension” were searched for relevant evidences. We addressed different issues such as OH definition, epidemiologic characteristics, pathophysiology, testing and diagnosis, risk factors for symptomatic OH, OH as an early sign of IPD, prognosis, and treatment options of OH in parkinsonian syndromes. Symptomatic OH is present in up to 30% of IPD, 80% of multiple system atrophy (MSA), and 27% of other AP patients. OH may herald the onset of PD before cardinal motor symptoms and our review emphasises the importance of its timely diagnosis (even as one preclinical marker) and multifactorial treatment, starting with patient education and lifestyle approach. Advancing age, male sex, disease severity, and duration and subtype of motor symptoms are predisposing factors. OH increases the risk of falls, which affects the quality of life in PD patients.

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Towards optimising experimental quantification of persistent pain in Parkinson’s disease using psychophysical testing

npj Parkinson s Disease ◽

10.1038/s41531-021-00173-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kirsty Bannister ◽

Rory V. Smith ◽

Patrick Wilkins ◽

Tatum M. Cummins

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Treatment Options ◽

Persistent Pain ◽

Research Literature ◽

Pain Processing ◽

Motor Symptoms ◽

Healthcare Provision ◽

Psychophysical Testing

AbstractPeople with Parkinson’s disease (PD) may live for multiple decades after diagnosis. Ensuring that effective healthcare provision is received across the range of symptoms experienced is vital to the individual’s wellbeing and quality of life. As well as the hallmark motor symptoms, PD patients may also suffer from non-motor symptoms including persistent pain. This type of pain (lasting more than 3 months) is inconsistently described and poorly understood, resulting in limited treatment options. Evidence-based pain remedies are coming to the fore but therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Since the ability to establish a link between the neurodegenerative changes that underlie PD and those that underlie maladaptive pain processing leading to persistent pain could illuminate mechanisms or risk factors of disease initiation, progression and maintenance, we evaluated the latest research literature seeking to identify causal factors underlying persistent pain in PD through experimental quantification. The majority of previous studies aimed to identify neurobiological alterations that could provide a biomarker for pain/pain phenotype, in PD cohorts. However heterogeneity of patient cohorts, result outcomes and methodology between human psychophysics studies overwhelmingly leads to inconclusive and equivocal evidence. Here we discuss refinement of pain-PD paradigms in order that future studies may enhance confidence in the validity of observed effect sizes while also aiding comparability through standardisation. Encouragingly, as the field moves towards cross-study comparison of data in order to more reliably reveal mechanisms underlying dysfunctional pain processing, the potential for better-targeted treatment and management is high.

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Evidence Supports PA Prescription for Parkinson’s Disease: Motor Symptoms and Non-Motor Features: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082894 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2894

Author(s):

Yi-Chen Cheng ◽

Chun-Hsien Su

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Complex Disease ◽

Progressive Disease ◽

Exercise Intervention ◽

Neurodegenerative Disorder ◽

Motor Symptoms ◽

Pharmacological Interventions ◽

Risk Of Falls

Parkinson’s disease (PD) is a prevalent neurodegenerative disorder, which relates to not only motor symptoms, but also cognitive, autonomic, and mood impairments. The literature suggests that pharmacological or surgical treatment has a limited effect on providing relief of the symptoms and also restricting its progression. Recently, research on non-pharmacological interventions for people living with PD (pwPD) that alleviate their motor and non-motor features has shown a new aspect in treating this complex disease. Numerous studies are supporting exercise intervention as being effective in both motor and non-motor facets of PD, such as physical functioning, strength, balance, gait speed, and cognitive impairment. Via the lens of the physical profession, this paper strives to provide another perspective for PD treatment by presenting exercise modes categorized by motor and non-motor PD symptoms, along with its effects and mechanisms. Acknowledging that there is no “one size fits all” exercise prescription for such a variable and progressive disease, this review is to outline tailored physical activities as a credible approach in treating pwPD, conceivably enhancing overall physical capacity, ameliorating the symptoms, reducing the risk of falls and injuries, and, eventually, elevating the quality of life. It also provides references and practical prescription applications for the clinician.

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The Parkinson’s Real-World Impact Assessment (PRISM) Study: A European Survey of the Burden of Parkinson’s Disease in Patients and their Carers

Journal of Parkinson s Disease ◽

10.3233/jpd-212611 ◽

2021 ◽

pp. 1-15

Author(s):

Eduardo Tolosa ◽

Georg Ebersbach ◽

Joaquim J. Ferreira ◽

Olivier Rascol ◽

Angelo Antonini ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Impact Assessment ◽

Real World ◽

European Countries ◽

Life Questionnaire ◽

Motor Symptoms ◽

Non Motor Symptoms

Background: A greater understanding of the everyday experiences of people with Parkinson’s disease (PD) and their carers may help improve clinical practice. Objective: The Parkinson’s Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD and their carers. Methods: PRISM is an observational cross-sectional study, in which people with PD and their carers completed an online survey using structured questionnaires, including the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQuest) and Zarit Burden Interview (ZBI). Results: Data were collected from 861 people with PD (mean age, 65.0 years; mean disease duration, 7.7 years) and 256 carers from six European countries. People with PD reported a large number of different co-morbidities, non-motor symptoms (mean NMSQuest score, 12.8), and impaired HRQoL (median PDQ-39 summary score, 29.1). Forty-five percent of people with PD reported at least one impulse control behaviour. Treatment patterns varied considerably between different European countries. Levodopa was taken in the last 12 months by 85.9% of participants, and as monotherapy by 21.8% . Carers, who were mostly female (64.8%) and the partner/spouse of the person with PD (82.1%), reported mild to moderate burden (mean ZBI total score, 26.6). Conclusions: The PRISM study sheds light on the lives of people with PD and those who care for them, re-emphasising the many challenges they face in everyday life. The study also provides insights into the current treatment of PD in Europe.

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A mobile app for tracking non-motor symptoms of people with Parkinson’s disease: A usability study

Innovation in Aging ◽

10.1093/geroni/igaa057.3284 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 890-890

Author(s):

JuHee Lee ◽

Yujin Suh ◽

Yielin Kim

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Tracking System ◽

Smart Phone ◽

Telephone Counseling ◽

Mobile App ◽

Motor Symptoms ◽

Hand Tremor ◽

Non Motor Symptoms

Abstract Smart phone-based technology for people with Parkinson’s disease has been developed worldwide. Unmonitored non-motor symptoms decrease quality of life of people with Parkinson’s disease, so the needs for technology to manage non-motor symptoms are increasing. The technology is needed to detect subtle changes in non-motor symptoms by healthcare professional. There is no mobile app which manage comprehensive symptoms of Parkinson’s disease including non-motor symptoms. It is necessary to develop a new tracking system that can effectively manage non-motor symptoms as well as motor symptoms of Parkinson’s disease. We developed a prototype of mobile app for Android smartphones, with cooperation with Mazelone company. we also have shaped functions for monitoring of motor symptoms and medication adherence. It also provided a section for caregivers to use on behalf of people with Parkinson’s disease who have difficulty to use app due to hand tremor. Through Delphi technique, we obtained content validity from eight medical and nursing experts on the contents of the application. We provided regular telephone counseling to improve and encourage their app usage. Fifteen participants used the app for 6 weeks. To evaluate usability of mobile app, we provided constructed questionnaire and conducted individual telephone interview. A mobile app for tracking non-motor symptoms demonstrated high usability and satisfaction. We learned lessons about facilitators and barriers when implementing an app such as perception and acceptance of mobile technology. The mobile app will improve continuum of care. Future studies need to improve the contents and refine technical approach for people with Parkinson’s disease.

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1.032 NON-MOTOR SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH PARKINSON'S DISEASE

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(11)70146-8 ◽

2012 ◽

Vol 18 ◽

pp. S18

Author(s):

D. Joshi ◽

P. Chatterjee ◽

B. Kumar ◽

A.Z. Ansari ◽

V.N. Mishra ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Symptoms ◽

Non Motor Symptoms

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Motor Symptom Asymmetry Predicts Non-motor Outcome and Quality of Life Following STN DBS in Parkinson's Disease

10.21203/rs.3.rs-871480/v1 ◽

2021 ◽

Author(s):

Julie Péron ◽

Philippe Voruz ◽

Jordan Pierce ◽

Kévin Ahrweiller ◽

Claire Haegelen ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Symptom ◽

Control Group ◽

Motor Symptoms ◽

Healthy Control ◽

The Impact ◽

Stn Dbs

Abstract Risk factors for long-term non-motor disorders and quality of life following subthalamic nucleus deep-brain stimulation (STN DBS) have not yet been fully identified. In the present study, we investigated the impact of motor symptom asymmetry in Parkinson’s disease.Data were extracted for 52 patients with Parkinson’s disease (half with left-sided motor symptoms and half with right-sided ones) who underwent bilateral STN and a matched healthy control group. Performances for cognitive tests and neuropsychiatric and quality-of-life questionnaires at 12 months post-DBS were compared with a pre-DBS baseline. Results indicated a deterioration in cognitive performance post-DBS in patients with left-sided motor symptoms. Performances of patients with right-sided motor symptoms were maintained, except for a verbal executive task. These differential effects had an impact on patients’ quality of life. The results highlight the existence of two distinct cognitive profiles of Parkinson’s disease, depending on motor symptom asymmetry. This asymmetry is a potential risk factor for non-motor adverse effects following STN DBS.

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Short-term quality of life after subthalamic stimulation depends on non-motor symptoms in Parkinson's disease

Brain Stimulation ◽

10.1016/j.brs.2018.02.015 ◽

2018 ◽

Vol 11 (4) ◽

pp. 867-874 ◽

Cited By ~ 18

Author(s):

Haidar Salimi Dafsari ◽

Luisa Weiß ◽

Monty Silverdale ◽

Alexandra Rizos ◽

Prashanth Reddy ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Symptoms ◽

Short Term ◽

Subthalamic Stimulation ◽

Non Motor Symptoms

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Parkinsonism, Parkinson’s disease, and related conditions

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0116 ◽

2017 ◽

pp. 897-906

Author(s):

John V. Hindle ◽

Sion Jones ◽

Glesni Davies

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Older People ◽

Lewy Bodies ◽

Cell Loss ◽

Brain Regions ◽

Motor Symptoms ◽

Advanced Care Planning ◽

Non Motor Symptoms

Parkinson’s disease (PD) is a progressive neurodegenerative condition characterized clinically by fatiguable bradykinesia, rigidity and tremor and pathologically by deposition of Lewy bodies and cell loss in the substantia nigra and other brain regions. Parkinsonism is the term used to describe the clinical features of conditions resembling PD. Their management requires specialist assessment and a multidisciplinary approach. Levodopa remains the mainstay of treatment for PD. Although other treatments are used, older people are more sensitive to their side effects. Non-motor symptoms, particularly neuropsychiatric problems, significantly impact quality of life and need special consideration in older people. Towards the later stage of the disease, management can be complex, and should involve advanced care planning.

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Effects of Qigong Exercise on Non-Motor Symptoms and Inflammatory Status in Parkinson’s Disease: A Protocol for a Randomized Controlled Trial

Medicines ◽

10.3390/medicines6010013 ◽

2019 ◽

Vol 6 (1) ◽

pp. 13 ◽

Cited By ~ 3

Author(s):

Sanghee Moon ◽

Caio Sarmento ◽

Irina Smirnova ◽

Yvonne Colgrove ◽

Kelly Lyons ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Controlled Trial ◽

Cost Effective ◽

Motor Symptoms ◽

Mixed Design ◽

Inflammatory Status ◽

Non Motor Symptoms ◽

Pro Inflammatory Cytokines

Background: Non-motor symptoms such as sleep disturbance, cognitive decline, fatigue, anxiety, and depression in Parkinson’s disease (PD) impact quality of life. Increased levels of pro-inflammatory cytokines in individuals with PD have been reported, which may contribute to non-motor symptoms. A mind-body exercise, Qigong, has demonstrated benefits across different medical conditions. However, a lack of evidence causes clinicians and patients to be uncertain about the effects of Qigong in individuals with PD. This study will examine the effects of Qigong on non-motor symptoms and inflammatory status in individuals with PD. Methods: Sixty individuals with PD will be recruited. Qigong and sham Qigong group (n = 30 for each) will receive a 12-week intervention. Participants will practice their assigned exercise at home (2×/day) and attend routinely group exercise meetings. Results: Clinical questionnaires and neuropsychological tests will measure non-motor symptoms including sleep quality (primary outcome). Biomarker assays will measure inflammatory status. A two-way mixed-design analysis of variance (ANOVA) will be utilized. Conclusions: This study may generate evidence for the benefits of Qigong on non-motor symptoms of PD and the effect on inflammatory status. Findings may lead to the development of a novel, safe, and cost-effective rehabilitation approach for individuals with PD.

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